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Background: The combination of prediabetes and depressive or anxiety symptoms is known to increase the risk of progression to diabetes. We aimed to assess the effects of vitamin D supplementation on anxiety and depression status among elderly people with prediabetes. Methods: Participants were randomly assigned to a weekly dose of vitamin D3 of 25,000 IU (n=45) or nothing (n = 45) , in addition to lifestyle measures. The State Trait Anxiety Inventory and the Patient Health Questionnaire-9 (PHQ-9) tools were used to evaluate anxiety and depression levels, respectively, at baseline, 6 and 12 months. Results: Participants in the intervention and control group presented comparable baseline characteristics in terms of age (73.± 7.16 vs. 74.03 ± 7.64 years, respectively) , fasting glucose (103.4 ± 12.vs. 102.29 ± 12.82 mg/dl, respectively) and HbA1c values (5.87 ± 0.21 vs. 5.87 ± 0.22 %, respectively) . In the supplemented group, 25-hydroxyvitamin D concentrations increased significantly at 6 (26.56 ± 8.64 ng/ml) and 12 months (28.71 ± 9.03 ng/ml) compared to baseline (19.98 ± 6.73 ng/ml, p Conclusion: In a high-risk population, a weekly vitamin D supplementation scheme was effective in reducing anxiety and depression levels. Further studies are needed to elucidate the relevant mechanisms. Disclosure E.Zaromytidou: None. M.Grammatiki: Research Support; Lilly. E.Manthou: None. I.S.Psarrakou: None. I.Iakovou: None. A.Gotzamani: None. K.Kotsa: Advisory Panel; Abbott, Novo Nordisk, Research Support; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Speaker's Bureau; AstraZeneca, Merck Sharp & Dohme Corp., Novartis AG, Sanofi. T.Koufakis: Advisory Panel; Novo Nordisk, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly, Novo Nordisk. G.Dimakopoulos: None. D.Drivakou: None. G.Meristoudis: None. S.Konstantinidou: None. G.Karaliolios: None. E.Melidou: None. P.Rakitzi: None.

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia; patients are usually asymptomatic and the cause in 80-85% of cases is a single parathyroid adenoma (PA). Parathyroid adenomas arise from clonal expansion of tumor cells and may be located either posteriorly to the thyroid lobes or in ectopic sites. The incidence of intrathyroidal PAs varies from 1% to 6% and although uncommon, they pose certain diagnostic difficulties which may complicate treatment. The identification of the adenoma requires a combination of clinical evidence, imaging information and cytological findings due to the challenging distinction between thyroid and parathyroid lesions. We present the case of a patient with a large, partially cystic intrathyroidal parathyroid adenoma which was initially identified as a malignant thyroid nodule. We discuss the caveats that present in these rare cases and the important clinical and histological features that aid in the final diagnosis. In the case of our patient the cytological similarities between thyroid malignant cells and parathyroid cells, in combination with the negative sestamibi scan, resulted in a more invasive surgery than that a single parathyroid adenoma would require. Clinicians need to be vigilant in terms of the similarities between parathyroid and thyroid cytology in order to provide optimal patient care in these rare cases.

Aim: The renin–angiotensin–aldosterone system has been implicated in the pathogenesis of insulin resistance and nonalcoholic fatty liver disease (NAFLD). The beneficial effect of spironolactone in a mouse model with diabetes and NAFLD has recently been reported. The main aim was assessment of the effect of spironolactone on serum metabolic parameters and insulin resistance in patients with NAFLD. Methods: This study includes preliminary results of a single-centre randomised controlled trial of treatment with vitamin E (group 1, 10 patients) versus spironolactone plus vitamin E (group 2, 10 patients) in biopsy-proven NAFLD. Serum transaminases, lipids, potassium, sodium, glucose and insulin were measured, and homeostatic model assessment-insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI) were calculated before and 8 weeks after baseline assessment. Results: Insulin was decreased within group 2 (15.3 ± 2.7 at baseline vs. 10.3 ± 5.0 at week 8, p = 0.013). Although no difference in glucose was observed, HOMA-IR significantly decreased (4.4 ± 0.9 vs. 2.8 ± 0.5, respectively, p = 0.047). QUICKI was increased, but not statistically significantly. Conclusions: Spironolactone and vitamin E combined therapy seems to exhibit a favourable effect on serum insulin and HOMA-IR in patients with NAFLD. If validated in a large-scale clinical trial, it may prove an inexpensive therapeutic approach for the management of NAFLD patients.