Search

PubMed: 27941175, A 46 year-old female patient presented to the hospital with ongoing and progressively increasing fatigue, severe nausea and vomiting, loss of appetite, constipation, palpitations and somnolence. Laboratory evaluation revealed a severe hypercalcaemia and overt hyperthyroidism. She was diagnosed with primary hyperparathyroidism accompanied by Graves’ disease. The patient underwent total thyroidectomy and right inferior parathyroid gland adenoma excision on the 24th day of her admission to the hospital aft er calcium levels and free thyroid hormone levels were brought to normal ranges. We suggest that a possibility of simultaneous thyrotoxicosis and primary hyperparathyroidism in cases presenting with a hypercalcaemic crisis should be considered © 2016, De Gruyter Open Ltd. All Rights Reserved.

WOS: 000397981700073, PubMed: 27891368, Introduction: Gestational diabetes is defined as various degrees of glucose intolerance diagnosed or detected for the first time during pregnancy and is the most common metabolic complication of pregnancy. Early diagnosis and adequate treatment are important to prevent complications. Preeclampsia, polyhydramnios, fetalmacrosomia, and operative delivery are some of the complications seen in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM). Aim: The present study was designed to determine whether there was an association between Mean Platelet Volume (MPV) in predicting poor fetal outcome, insulin resistance, neonatal Apgar scores and gestational age for women with GDM. Materials and Methods: In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of 138 healthy controls. MPV, insulin and homeostatic model assessment (HOMA-IR) values were measured at 24-28 weeks of the pregnancy. An independent samples t-test was used to compare MPV values. Multivariate linear regression models were used to establish relations between MPV values, HOMAIR, insulin levels and Apgar score. Results: There was a significant positive correlation between MPV values, HOMA-IR and Insulin levels and a negative correlation with Apgar score at 1 min and 5 min in the GDM group (r=0.227, p=0.02; r=0.206, p=0.03; r=-0.485, p8.0 fL had a sensitivity of 82% and a specificity of 75% for the prediction of GDM. Conclusion: We investigated the potential of MPV values in predicting low Apgar scores and insulin resistance in women with GDM.

PubMed: 27560634, Objective. Roux-en-Y gastric bypass (RYGB) is an independent risk factor for moderate hypocalcaemia and may lead to the development of resistant hypocalcaemia following thyroid surgery. Subject and Results. A 35-year old female patient was referred to our hospital by her family physician for treatment of resistant hypocalcaemia. The patient underwent RYGB three years ago and a total thyroidectomy for a benign thyroid nodule one year ago. Calcitriol, calcium carbonate, magnesium oxide, and ergocalciferol therapeutic dosages were incremented. Despite dosage increments, the desired calcium levels were not achieved. In the sixth month after admission to our hospital, pancrelipase was added to patient’s treatment scheme. On the following visit, a good calcium increase had been achieved. Conclusion. This report presents a case history of RYGB and resistant hypocalcaemia, which developed after thyroid surgery and positively responded to pancrelipase treatment. © 2016, Institute of Experimental Endocrinology. All rights reserved.

Objective: Hypothalamo-pituitary-adrenal (HPA) axis is affected by thyroid hormones. The present study was designed to compare the level of salivary cortisol, serum cortisol, plasma adrenocorticotropic hormone (ACTH) and urinary free cortisol (UFC) levels in patients with subclinical and overt thyrotoxicosis and hypothyroidism. Material and Methods: We analyzed the salivary cortisol, serum cortisol, plasma ACTH and UFC levels in 123 patients with thyroid dysfunction. The patients were classified into four groups; overt thyrotoxicosis (n= 32), subclinical thyrotoxicosis (n= 29), overt hypothyroidism (n= 28) and subclinical hypothyroidism (n= 34). Results: There were no significant differences in terms of salivary cortisol, serum cortisol, plasma ACTH and UFC levels in patients with subclinical and overt thyrotoxicosi s (p> 0.05). Similarly, no significant differences could be detected in terms of salivary cortisol, serum cortisol, plasma ACTH and UFC levels in patients with subclinical and overt hypothyroidism (p> 0.05). The comparison of patients with hypothyroidism and thyrotoxicosis also did not yield any significant difference in terms of salivary cortisol, serum cortisol, plasma ACTH and UFC levels (p> 0.05). Conclusion: Similar salivary cortisol, serum cortisol, plasma ACTH and UFC levels were detected in patients with hypothyroidism and thyrotoxicosis. Thus, we may suggest that thyroid hormone status does not play a role in the HPA axis. The major limitation of this study was the absence of a healthy control group. Further studies with large numbers of patients are required to clarify the association between thyroid hormone dysfunction and glucocorticoid levels.

A 35-year-old male patient was admitted with fatigue and muscle weakness. He had been on methimazole due to thyrotoxicosis for 2 weeks. Laboratory tests showed overt hyperthyroidism and hypokalemia. Potassium replacement was started with an initial diagnosis of thyrotoxic hypokalemic periodic paralysis. Later on, despite the euthyroid condition and potassium chloride treatment, hypokalemia persisted. Further investigations revealed hyperreninemic hyperaldosteronism. The patient was considered to have Gitelman's syndrome (GS) and all genetic analysis was done. A c. 1145C>T, p. Thr382Met homozygote missense mutation located on solute carrier family 12, member gene 3, exon 9 was detected and GS was confirmed.

Because the adrenal glands are common locations for metastases, pheochromocytoma is frequently misdiagnosed as adrenal metastasis in patients with a history of cancer. An incidental adrenal mass was detected during an abdominal computed tomography (CT) scan performed to stage the nasopharyngeal carcinoma in a 35-year-old male patient. The features of an adrenal mass on the CT, magnetic resonance imaging (MRI), and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) were thought to show adrenal metastasis. However, the patient did not complain about flushing, palpitation, headache or excessive sweating. His blood pressure was 132/74 mmHg, and his pulse rate was 82 bpm. A pheochromocytoma was found during a biochemical diagnosis that evaluated the catecholamine in urine collected over a 24-hour period. The urine had elevated urinary adrenaline, metanephrine, and vanillylmandelic. An I123 MIBG scan showed avid tracer uptake in the right adrenal mass with no evidence of abnormal uptake elsewhere. A right adrenalectomy operation was performed and a diagnosis of pheochromocytoma was confirmed histopathologically. Incidental adrenal masses detected in the presence history of cancer should always be subjected to hormonal evaluation. Although patients may be asymptomatic, the probability of incidental pheochromocytoma should not be ignored.

WOS: 000362601400003, Purpose: This study aimed to investigate the influence of aerobic exercise on the quality of life and leptin and adiponectin levels in patients with type 2 diabetes mellitus. Material and Method: Patients were randomized into two groups: aerobic exercise-training and control group. Parameters were assessed at baseline and end of the twelve-week follow-up for 60 type 2 diabetic patients who completed the program. The 36-item Short Form Health Survey was administered to the patients. Results: The exercise-training group results showed a decrease in adiponectin and leptin levels, a reduction of waist circumference and percentage of body fat (p=0.007, 0.023, 0.012 and 0.048, respectively). The leptin levels in the aerobic exercise group were positively correlated with body mass index (r=0.303, p=0.021) and percentage of body fat (r=0.371, p=0.005); they were negatively correlated with physical problems (r=-0.482; p=0.009) and pain (r=-0.540; p=0.003). Exercise led to statistically significant improvements in the SF-36 physical functioning and mental health subscales (p=0.020 and 0.023, respectively). Discussion: The association of better HbA1c, waist circumference, and percentage of body fat with improved mental and physical scores may be related to a decrease in leptin levels, despite a significant reduction in serum adiponectin levels.

We describe herein a case of hypokalemia due to proximal renal tubular acidosis (RTA) and Fanconi's syndrome (FS) and nephrogenic diabetes insipidus with DIC – a rare complication of Sjogren's syndrome (SS) and brucellosis. The interesting feature of this case was the presentation with severe hypokalemia, causing acute flaccid quadriparesis with cardiac arrest which is extremely rare. The patient was a 48-year-old woman who suffered cardiopulmonary arrest an hour after hospitalization. Analysis of a blood sample obtained before her cardiopulmonary arrest yielded surprising results: laboratory investigations showed profound hypokalemia (1.1 mEq/L) with renal K wasting, hyperchloremic metabolic acidosis with normal anion gap, hypophosphatemia with hypouricemia, glucosuria, and proteinuria. A diagnosis of RTA and FS were made. On the seventh day, she looked acutely ill, temperature 38.8 °C and pale, and her physical examination revealed purpuric skin lesions on both legs. The serum antibrucella titration agglutination test was found to be 1 of 160 positive with a nosocomial infection. The clinical and laboratory findings were consistent with disseminated intravascular coagulation (DIC). She was unable to concentrate her urine and so a diagnosis of nephrogenic diabetes insipidus (NDI) was reached. A thorough survey for the cause of FS, RTA and NDI revealed that she had xerophthalmia and xerostomia accompanied by high anti-Ro antibody, positive Schirmer test, confirming the diagnosis of SS.

Objective.Diabetes mellitus (DM) is associated with low-grade inflammation. The benefits of regular exercise for the DM are well established, whereas less is known about the impact of aerobic exercise on malondialdehyde (MDA) and tumor necrosis factor-alpha (TNF-α) in the DM.Methods.We randomised 64 participants, who do not exercise regularly, without any diabetic chronic complications in parallel to 12 weeks of aerobic exercise (three times per week,n=31) and no exercise (control;n=33). Plasma levels of soluble TNF-αand MDA levels were measured before-after physical training programme and control group.Results.Sixty-four patients with type 2 diabetes mellitus were analysed. When comparing the two groups of patients with age, gender, hemoglobin A1c (HbA1c) levels, lipid profile, waist circumference, body mass index (BMI) and class of treatment for diabetes were not different between groups. While soluble TNF-αremained essentially unaffected by physical training, plasma concentrations of MDA markedly decreased(P<0.05); physical training also decreased body weight, waist circumference, and blood pressure(P<0.05).Conclusion.Exercise training favorably affected body weight, waist circumference, and blood pressure. A three-weekly, 12-week, aerobic-training programme, without a concomitant weight loss diet, was associated with significant decrease in MDA levels in type 2 diabetic individuals.

ATP-sensitive potassium (K(ATP)) channels of pancreatic β-cells play a key role in glucose-stimulated insulin secretion mechanism. The Kir6.2 protein, forming the K(ATP) channel pore inwardly, and the SUR1 protein that surrounds it forming the outside part of the channel were encoded by ABCC8 and KCNJ11 genes, respectively. Recent studies reported that the single nucleotide polymorphisms (SNPs) established in these genes are associated with defects in insulin secretion and type 2 diabetes mellitus (T2DM). We aimed to investigate the allele profiles and the risk alleles of the ABCC8 and KCNJ11 genes and to highlight the associations with the disease in patients in Konya region of Turkey where T2DM is common.In this study, 169 patients with T2DM and 119 healthy controls were included. A total of 29 SNPs in ABCC8 and KCNJ11 genes were screened by PCR-SSCP technique and sequenced. Biochemical parameters and genotype-phenotype relationships were analyzed using variance analysis.R1273R silent substitution in exon 31 and 16/-3t→c substitution in noncoding region of exon 16 of ABCC8 gene showed a significant association (OR 4.8 [95% CI 2.41-9.77], p0.001 and OR 3.5 [95% CI 1.64-7.40], p0.001 under dominant and recessive models, respectively). We detected a significant association between E/K heterozygote genotype and reduced plasma insulin level in patients with T2DM (p0.05).ABCC8 exons 16 and 31 variants increase susceptibility to T2DM and KCNJ11 E23K decreases insulin secretion in a Turkish population.

A 71-year-old female patient followed primary immune thrombocytopenia (ITP) was admitted to endocrinology unit with excessive sweating. We started methimazole for Graves' disease. Without any additional immunosuppressive treatment, at week 12 of methimazole therapy, thyroid stimulating hormone (TSH) levels returned to normal, and platelet counts rose to tolerable levels. When her hospital records were analyzed, they revealed that a year ago, when she had been diagnosed with ITP, her TSH values had been suppressed. After immunosuppressive therapy, her platelet values were maintained at normal levels, and during her control visits, her TSH levels were measured twice and were within normal limits. We think that immunosuppressive therapy for ITP without considering thyroid function tests may result in a transient euthyroid state, which potentially masks Graves' disease accompanying immunosuppressive therapy and associated recurrent ITP attacks.

Dispeptik yakınmaların sık görülmesi nedeniyle diyabet hastaları reçeteli ya da reçetesiz olarak proton pompa inhibitörleri (PPİ) grubu ilaçları sık olarak kullanırlar. Farklı hastalıklar nedeniyle çeşitli ilaç gruplarının bir arada kullanılması, azalan sitokrom p450 enzim aktivitesi nedeniyle özellikle yaşlı hastalarda, ilaç-ilaç etkileşimi ve ilaç etkisinin değişmesi riskini artırmaktadır. Bu vaka sunumunda 82 yaşında diyabetik hastada omeprazol ve gliklazid ilaç etkileşimine bağlı gelişen hipoglisemi olgusu sunuldu., Patients with diabetes mellitus frequently use prescription or nonprescription proton pump inhibitors (PPI) since they commonly have dyspeptic complaints. Simultaneous use of various drug groups due to presence of different diseases in the same patient increases the risk of drug-to-drug interaction and change of drug effect secondary to decreased cytochrome p450 enzyme activity, especially in elderly patients. A case of an 82-year-old diabetic patient who developed hypoglycemia secondary to a drug interaction of omeprazole and gliclazide.