Vascular endothelial growth factor and endocan expression in adrenal cortical tumors and their relationship with histopathological prognostic parameters.

The aim of this study was to determine the tissue expressions of vascular endothelial growth factor (VEGF) and endocan in adrenal cortical tumors and the factors associated with them. The study included 6 subjects with adrenocortical adenoma (ACA), 7 subjects with adrenocortical carcinoma (ACC), and 13 control subjects with a normal adrenal cortex. The status of VEGF and endocan expression was determined by the proportions of cells staining on a scale ranging from negative (not staining at all) to strongly positive. VEGF expression was detected in 1 (16.7%) of 6 subjects in the ACA group and in 6 (85.7%) of 7 subjects in the ACC group. VEGF expression was not detected in any of the subjects in the control group. Endocan expression was detected in 6 (100%) of 6 subjects in the ACA group and in 7 (100%) of 7 subjects in the ACC group, while it was detected in only 4 (30.7%) of 13 subjects in the control group. VEGF was expressed with a high frequency in subjects with ACC and with a low frequency in subjects with ACA, but it was not expressed in subjects with normal adrenal cortex tissue. Although endocan was expressed with a higher frequency in subjects with ACC and ACA, it was also expressed in subjects with normal adrenal cortex tissue. The percentage of cells expressed endocan in subjects with ACC was also significantly higher than in subjects with both ACA and normal adrenal cortex.

Arterial Stiffness, Carotid Intima-Media Thickness, Endocan, and A Disintegrin and Metalloproteinase With Thrombospondin Type I Motif 9 Levels and Their Relationship With Disease Activity in Patients With Acromegaly With and Without Cardiovascular Risk Factors.

OBJECTIVE: Cardiovascular complications such as cardiomyopathy and endothelial dysfunction, which are frequently seen in patients with acromegaly, are among the most important causes of morbidity and mortality. In this study, we aimed to investigate arterial stiffness, carotid intima-media thickness, endocan level, and A disintegrin and metalloproteinase with thrombospondin type I motif 9 level and their relationship with disease activity in patients with acromegaly with and without cardiovascular risk factors. METHODS: A total of 60 patients with acromegaly-25 with active disease, 26 with well-controlled disease, and 9 with newly diagnosed disease-and 60 age-, sex-, and body mass index (BMI)-matched healthy control subjects were enrolled in this study. All the subjects' height, weight, BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG) level, insulin, hemoglobin A1C (HbA1C), C-reactive protein , lipid, endocan, A disintegrin and metalloproteinase with thrombospondin type I motif 9 levels, pulse wave velocity (PWV), and carotid intima-media thickness were measured. RESULTS: The SBP, DBP, FPG level, HbA1C level, and PWV of the acromegaly group were higher than those of the control group. In patients with acromegaly with cardiovascular disease (CVD) risk factors, the PWV was higher than that in the control group, and in patients with acromegaly without CVD risk factors, the PWV was similar to that in the control group. In a correlation analysis, a positive correlation was found between PWV and age, BMI, SBP, DBP, FPG level, and HbA1C level in the acromegaly group. CONCLUSION: In our study, we found that arterial stiffness increased in patients with acromegaly with CVD risk factors and that increased arterial stiffness was associated with hemodynamic (SBP and DBP) and metabolic (BMI, FPG level, and HbA1C level) parameters.

Evaluation of subclinical cardiovascular disease by carotid intima media thickness, epicardial adipose tissue thickness, serum endocan, and nesfatin-1 levels in patients with primary hyperparathyroidism.

BACKGROUND: Data on the presence and extent of cardiovascular disease (CVD) risk in primary hyperparathyroidism (PHPT) are conflicting. In our study, we aimed to investigate the increased CVD risk in patients with PHPT by carotid intima-media thickness (CIMT), epicardial adipose tissue (EAT) thickness, and serum levels of endocan and nesfatin-1. METHODS: Patients with PHPT (n = 44) and age- and sex-matched healthy control subjects (n = 40) were enrolled in this study. Demographic data of the participants were questioned. Serum endocan and nesfatin-1 concentrations were assessed using commercially available ELISA kits. Noninvasive measurements of CIMT and EAT thickness were made with high-resolution ultrasonography and B-mode echocardiography. RESULTS: There was no statistically significant difference in serum endocan and nesfatin-1 levels and EAT thickness in the PHPT group compared to controls. CIMT was statistically significantly higher in the PHPT group compared to controls (p = 0.001). A negative correlation was found between PTH and low-density lipoprotein cholesterol level (p = 0.001) but no significant relationship was found between other parameters. DISCUSSION: We found that CIMT is increased in patients with PHPT and consequently, CVD risk is high in these patients. More comprehensive studies are needed to identify other markers that predict increased CVD risk in patients with PHPT.

Prevalence of comorbidities and associated factors in acromegaly patients in the Turkish population

Background/aim: The presence of comorbidities in patients with acromegaly causes an increase in morbidity and/or mortality and a decrease in quality of life. In this study, we aimed to investigate the demographic, clinical and laboratory features, prevalence of acro- megaly-related comorbidities, and factors associated with these comorbidities in patients with acromegaly. Materials and methods: In the study, 96 patients who were followed up with the diagnosis of acromegaly were included. Clinical, labo- ratory and imaging features, and accompanying comorbidities of the patients were recorded from the patient files. Results: Of the patients included in the study, 63 (65.6%) were female and 33 (34.4%) were male. The mean age of diagnosis was 42.61± 12.08, and the mean follow-up period was 9.97 ± 7.26 years. Median insulin-like growth factor 1 level was 238.16 ng/mL (30.5­820), median growth hormone level was 2.05 ug/L (0.1­29.4). A total of 60 (62.5%) of the patients were in the well-controlled group, and 36 (37.5%) had active disease at the time of inclusion. Diabetes mellitus (DM) was detected in 30 (31.3%) patients, prediabetes in 19 (28.8%) patients, hypertriglyceridemia in 38 (42.2%) patients, hypertension (HT) in 41 (42.7%) patients, cardiovascular disease in 5 (5.2%) patients, malignancy in 9 (9.4%) patients, obstructive sleep apnea syndrome in 8 (8.3%) patients, carpal tunnel syndrome in 11 (11.5%) patients, arthropathy in 5 (5.2%) patients, hearing loss in 7 (7.3%) patients, thyroid nodule in 56 (67.5%) patients, thyroid cancer in 4 (4.2%) patients, colonic polyp in 19 (38.8%) patients. Conclusion: In this study, we revealed that the most common comorbidities in acromegaly patients in the Turkish population are thyroid nodules, low high-density lipoprotein (HDL cholesterol (HDL-C) level, hypertriglyceridemia, HT, colonic polyps, DM, and prediabetes, and female sex and age at diagnosis are the most important factors associated with comorbidities.

Increased incidence of malignancy in patients with primary hyperparathyroidism

Background/aim: Primary hyperparathyroidism (PHPT) is a disease that is diagnosed more frequently and generally in the asymptomatic period, with widely available biochemical tests. Evidence suggesting an association between PHPT and malignancy risk is increasing. Clarification of this association will be useful in PHPT for malignancy screening and management of patients with PHPT. In this study, we aimed to investigate the frequency of cancer in PHPT patients. Materials and methods: A total of 775 PHPT patients were included in the retrospective study. Demographic, clinical and laboratory data of the patients were evaluated retrospectively. Results: Malignancy was detected in 128 (16.50%) of 775 PHPT patients (female/male: 625/150). The mean age at diagnosis of PHPT was 57.99 ± 10.86 years, and the mean age at diagnosis of malignancy was 57.46 ± 11.17 years. Of the 128 patients with malignancy, 53 (41.40%) were diagnosed in the same year as PHPT. In terms of malignancy types, 51 (6.50%) of 775 PHPT patients had thyroid cancer. Thyroid cancer was followed by breast cancer (2.30%) and stomach cancer (1%) in order of frequency. Conclusion: We think that PHPT patients should be examined more carefully in terms of cancer risk, especially thyroid cancer. More comprehensive studies are needed to clarify the relationship between PHPT and cancer.

Incidence of second primary malignancies in patients with thyroid cancer in the Turkish population

Background/aim: Thyroid cancer is the most common endocrine malignancy. Recently the incidence has been increasing faster compared to other malignancies. Different studies have shown that the incidence of breast cancer in patients followed due to thyroid cancer has increased, and vice versa. The aim of this study was to evaluate the frequency of second primary cancers in the follow-up of patients with thyroid cancer. Materials and methods: In this study, 1196 patients with thyroid cancer were evaluated in the Necmettin Erbakan University Meram Medical School's Department of Endocrinology between 2004 and 2018. Demographic characteristics and radiological and pathological results of the patients were recorded. The presence of accompanying second malignancies in patients with thyroid cancer was investigated. Results: In our study, 985 (82.4%) women (mean age: 46.1 ± 13.3 years) and 211 (17.6%) men (mean age: 49.9 ± 14.2 years) were evaluated. The median follow-up was 63 months (2­164 months). Of the 1196 patients, 1126 (94.1%) had no additional cancer and 70 (5.9%) patients had a second malignancy. The accompanying second malignancies were breast cancer in 24 (2%) patients, skin cancer in 8 (0.7%) patients, renal cell cancer in 5 (0.4%) patients, lung cancer in 5 (0.4%) patients, colon cancer in 5 (0.4%) patients, lymphoma in 5 (0.4%) patients, endometrial cancer in 4 (0.3%) patients, and 14 cases of other rare types of cancer. Conclusion: In our study, it was found that the most common second primary malignancy in patients with thyroid cancer was breast cancer. However, other cancers (skin cancer, renal cell cancer, lymphoma, and colon, lung, or endometrial cancer) may occur in patients with thyroid cancer.

Plasma nesfatin-1 levels are increased in patients with polycystic ovary syndrome.

BACKGROUND: Nesfatin-1 is a recently discovered neuropeptide derived from its precursor nucleobindin-2 (NUCB2) and has been implicated in the regulation of feeding and energy metabolism. It is located in the brain and also produced at the periphery and present in the plasma. However, its pathophysiological role in humans remains unknown. Polycystic ovary syndrome (PCOS) is commonly presented with obesity, insulin resistance, hyperandrogenemia and hirsutism. AIM: To characterize serum nesfatin-1 levels in PCOS women and determine association of nesfatin-1 with metabolic parameters. MATERIALS AND METHODS: It is a cross-sectional study of 55 PCOS and 28 healthy women matched in age, in a university hospital setting. Anthropometric, hormonal, metabolic parameters and nesfatin-1 blood levels were determined. RESULTS: Nesfatin-1 levels were significantly higher in PCOS group compared with the controls 371.43 ± 2.50 versus 275.55 ± 1.74 pg/mL. Multivariate logistic regression analysis that contains: nesfatin-1, body mass index and homeostasis model assessment index revealed significant correlation of nesfatin-1 with the existence of PCOS (p < 0.05). CONCLUSIONS: Higher nesfatin-1 levels in PCOS women compared to control group may suggest a possibility that nesfatin-1 may play some role in the PCOS.

Effect of ethinyl estradiol-cyproterone acetate treatment on asymmetric dimethyl-arginine levels in women with polycystic ovary syndrome.

PURPOSE: Our study was undertaken to evaluate the levels of asymmetric dimethyl-arginine (ADMA) in a group of patients affected with polycystic ovary syndrome (PCOS)--under ethinyl estradiol-cyproterone acetate treatment or not--as compared with a group of healthy controls. METHODS: Fifty-eight women with PCOS and 45 patients as control group were included in the study. The 58 women with PCOS were separated into two groups: Group A (n = 29) were treated with an oral contraceptive pill containing 0.035 mg of ethinyl estradiol (EE) and 2 mg of cyproterone acetate (CA) (Diane-35) for 6 months. Group B (n = 29) did not take any drug. Group C (n = 45) was healthy women as control group. Serum levels of ADMA, lipid and glucose metabolism parameters, hormone profile were measured on the sixth month of treatment. RESULTS: ADMA levels were similar in women with PCOS and controls, whereas ADMA levels significantly decreased after a period of 6 months treatment with EE + CA in women with PCOS. ADMA levels and insulin resistance were decreased with treatment. However, patients with PCOS had significantly higher total cholesterol and Low-density lipoprotein cholesterol (LDL-C) compared to controls, treatment with EE + CA did not provide any improvement on lipid parameters. CONCLUSION: Serum ADMA levels and insulin resistance were lower in PCOS group treated with EE + CA than control group.

The platelet activating factor acetyl hydrolase, oxidized low-density lipoprotein, paraoxonase 1 and arylesterase levels in treated and untreated patients with polycystic ovary syndrome.

PURPOSE: To evaluate the platelet activating factor acetyl hydrolyze (PAF-AH), oxidized low-density lipoprotein (ox-LDL), paraoxonase 1 (PON1), arylesterase (ARE) levels and the effects of metformin and Diane-35 (ethinyl oestradiol + cyproterone acetate) therapies on these parameters and to determine the PON1 polymorphisms among PCOS patients. METHODS: Ninety patients with PCOS, age 30, and body mass index-matched healthy controls were included in the study. Patients were divided into three groups: metformin treatment, Diane-35 treatment and no medication groups. The treatment with metformin or Diane-35 was continued for 6 months and all subjects were evaluated with clinical and biochemical parameters 6 months later. One-way Anova test, t test and non-parametric Mann-Whitney U tests were used for statistical analysis. RESULTS: PAF-AH and ox-LDL levels were statistically significantly higher in untreated PCOS patients than controls, and they were statistically significantly lower in patients treated with metformin or Diane-35 than untreated PCOS patients. In contrast, there were lower PON1 (not statistically significant) and ARE (statistically significant) levels in untreated PCOS patients than the control group and they significantly increased after metformin and Diane-35 treatments. In PCOS patients serum PON1 levels for QQ, QR and RR phenotypes were statistically significantly lower than the control group. CONCLUSION: In patients with PCOS, proatherogenic markers increase. The treatment of PCOS with metformin or Diane-35 had positive effects on lipid profile, increased PON1 level, which is a protector from atherosclerosis and decreased the proatherogenic PAF-AH and ox-LDL levels.

Levels of thrombin activatable fibrinolysis inhibitor in gestational diabetes mellitus.

Thrombin-activatable fibrinolysis inhibitor (TAFI) is a procarboxypeptidase, which is synthesised in liver and activated by thrombin and the thrombin-thrombomodulin complex. TAFI suppresses fibrinolysis by removing carboxy-terminal lysine residues from partially degraded fibrin. In this study we aimed to assess the circulating levels of TAFI antigen, 'a fibrinolytic parameter' in women with gestational diabetes (GDM). Thirty-four pregnant women with GDM and 50 pregnant women with normal glucose tolerance were included in the study. Plasma TAFI antigen levels were significantly higher in pregnant women with GDM when compared with controls. Increased TAFI levels may contribute to the decreased fibrinolytic potency, causing a thrombophilic state. GDM is regarded as a specific form of diabetes, and it could in addition be a predictor of type 2 diabetes mellitus in the future and the risk of complications due to hypercoagulability increases in this disease. Increased TAFI levels may also have a role in increased risk of hypercoagulability.

Expression of endocan and vascular endothelial growth factor and their correlation with histopathological prognostic parameters in pheochromocytoma.

OBJECTIVE: Endocan and vascular endothelial growth factor (VEGF) are markers expressed in various cancer types that are highly vascular, and they have prognostic significance for these cancers. In this study, we aimed to show the expression of endocan and VEGF in pheochromocytoma tumor tissues and to evaluate their correlations with histopathological parameters. MATERIAL AND METHODS: Thirty-eight patients who had been operated for pheochromocytoma were included in the study. As the control group, 28 subjects whose specimens contained normal adrenal medulla tissue were included. The formalin-fixed paraffin-embedded specimens of pheochromocytoma patients were evaluated for Pheochromocytoma of the Adrenal gland Scaled Score (PASS). Sections were then stained for immunohistochemical analysis. The degree of endocan and VEGF positivity was determined by the proportion of stained cells on a negative to strong scale. RESULTS: Endocan (p < 0.001) and VEGF (p = 0.004) expressions were found to be significantly higher in the pheochromocytoma group than in the control group. In the pheochromocytoma group, total PASS score (r = 0.714; p < 0.001) and most of the PASS score components were positively correlated with the level of endocan expression. Median Ki-67 index (p = 0.010), total PASS score (p < 0.001), tumor cell spindling (p = 0.048), and nuclear pleomorphism (p = 0.030) were higher in pheochromocytoma with VEGF expression than in those without. CONCLUSION: If our findings are supported by studies with a larger sample size, we think that endocan has the potential to be used both as a tumor marker and in predicting malignancy potential in patients with pheochromocytoma, and that the detection of VEGF expression in these tumors is also associated with an increase in malignancy potential.

Expression of the angiogenesis markers endocan in Cushing's syndrome due to cortisol producing adenoma.

PURPOSE: In this study, we aimed to investigate the endocan expression in tissue samples of patients diagnosed with Cushing's syndrome (CS) due to Cortisol-Producing-Adenoma (CPA) and compare it with normal adrenal cortex tissue, and also to evaluate the correlations of endocan expression with clinical and histopathological features. METHODS: 11 patients who were operated for CS due to CPA between 2009-2021 and 14 control subjects with normal adrenal cortex were included in the study. Demographic, laboratory and clinicopathological data of the patients were recorded. Sections of 4-5 µm thickness were taken from paraffin blocks of patients diagnosed with CS due to CPA and control subjects with normal adrenal cortex tissue. The sections were then stained in a closed system automatic immunohistochemical staining device to perform immunohistochemical analysis. The endocan positive grade were determined based on the proportion of stained cells on a scale of negative to strong. RESULTS: The number of subjects with positive endocan expression and the mean endocan expression level in the CS group were significantly higher than the control group (p = 0.005, p < 0.001, respectively). No correlation was found between endocan expression and clinical and histopathological features. CONCLUSION: According to the results of our study, endocan overexpression in CPA tissues may be related to the hormonal functionality of CPA.

Evaluation of subclinical atherosclerosis in obese patients with three noninvasive methods: Arterial stiffness, carotid intima-media thickness, and biomarkers of endothelial dysfunction.

Objective: In this study, we aimed to evaluate subclinical atherosclerosis in patients with obesity who had cardiovascular disease risk indicators such as arterial stiffness, which is evaluated using pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and biomarkers of endothelial dysfunction such as endocan, ADAMTS97, and ADAMTS9. Subjects and methods: Sixty obese subjects, including 23 subjects with body mass index (BMI) ≥ 40, 37 subjects with BMI ≥ 30 but < 40, and 60 age-and sex-matched control subjects, were included in our study. Serum endocan, ADAMTS97, and ADAMTS9 levels as well as PWV and CIMT measurements of the subjects in the obese and control groups were performed. Results: In the obesity group, PWV levels were significantly higher than they were in the control group and endocan levels were significantly lower than they were in the control group. When we compared the obese group with BMI ≥ 40 and the control group, the BMI ≥ 40 group had significantly higher PWV and CIMT levels than the control group had, whereas endocan, ADAMTS7, and ADAMTS9 levels were similar to those of the control group. When we compared the obese group with BMI ≥ 30 < 40 to the control group, endocan levels were lower in the group with BMI ≥30 < 40, and PWV and CIMT levels were similar to the control group. Conclusion: We found that arterial stiffness and CIMT increased in obese patients with BMI ≥ 40 and that increased arterial stiffness was associated with age, systolic blood pressure, and HBA1C. In addition, we found that the endocan levels were lower in obese patients than they were in nonobese control individuals.

Influence of snoring on microalbuminuria in diabetic patients.

OBJECTIVE: Obstructive sleep apnea (OSA) and snoring are known independent risk factors for insulin resistance. Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. The aim of our study was to search the prevalence of self-reported snoring and high-risk pre-test OSA diagnosis in diabetic patients and search the influence of snoring on microalbuminuria. METHODS: A total of 237 diabetic patients (mean age, 58.6 ± 12.4 years; 126 males), were asked to complete the Berlin Questionnaire that includes questions about snoring, witnessed apnea, tiredness, history of high blood pressure and/or BMI < 30 kg/m(2). Also, their past and current medical records were reviewed for their medications, diabetic control, and complications like neuropathy, retinopathy, and microalbuminuria. RESULTS: According to the Berlin Questionnaire, a high pre-test probability for the diagnosis of OSA was found in 47.3% of the patients. Snoring was detected in 60.3% of the patients. The mean Epworth Sleepiness Scale score was 7.8 ± 4.6 and 31.6% of the patients reported excessive daytime sleepiness. We found that the both BMI and waist circumferences were significantly associated with snoring and high-risk pre-test OSA. There were no differences for age, gender, fasting glucose, HbA1c, and lipid panels between snorers and non-snorers, and between high-risk pre-test OSA and low-risk pre-test OSA patients. Microalbuminuria was significantly more common in patients who snore. Although snoring was independently associated with microalbuminuria, there were no differences between groups for other microvascular diabetic complications. CONCLUSION: Prevalence of OSA-related symptoms was very common in diabetic patients and further prospective studies are needed to elucidate the role of OSA's effect on diabetic control and complications.

Serum platelet-activating factor acetylhydrolase activity: relationship with metabolic syndrome in women with history of gestational diabetes mellitus.

OBJECTIVE: The aim of this study was to evaluate plasma platelet-activating factor acetylhydrolase (PAF-AH) activity in euglycaemic women with history of gestational diabetes (GDM), and to explore whether this activity is associated with metabolic syndrome (MS) in this group of women. METHODS: The cross-sectional study included 36 women with history of GDM and 40 women with history of normal glucose tolerance in pregnancy (control group). RESULTS: Compared to the controls, the GDM group had significantly higher mean values for serum glucose, insulin, HOMA-IR, triglyceride, GGT and plasma PAF-AH activity, and a statistically higher prevalence of MS. Within the GDM group, women diagnosed with MS had significantly higher PAF-AH activity than those without MS (p=0.002). CONCLUSION: This is the first study to have shown that plasma PAF-AH activity and GGT levels may be significant for evaluating atherosclerosis risk and metabolic hepatic damage in women with history of GDM.

Thyroid Nodules in Patients with Acromegaly: Frequency According to the ACR TI-RADS Classification and its Relationship with Disease Activity.

PURPOSE: In our study, we aimed to determine the frequency of thyroid nodules in patients with acromegaly according to the American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) classification and its relationship with acromegaly disease activity. METHODS: A total of 56 patients with acromegaly and age, sex, and body mass index matched with 56 healthy control subjects were included in our study. Thyroid-stimulating hormone, free thyroxine, and anti-thyroperoxidase antibody levels of patients and control subjects were measured. In addition, patients and healthy controls were evaluated by ultrasonography to determine thyroid structure, thyroid volume, and thyroid nodules and to make ACR TI-RADS classification. RESULTS: Thyroid nodules were present in 31 (55.4%) of 56 patients in the acromegaly group and 20 (35.7%) of 56 subjects in the control group, and the frequency of thyroid nodules was significantly higher in the acromegaly group (p=0.038). The mean number of nodules in the acromegaly group and control group was 1.27±1.43 and 0.48±0.73, respectively, and the mean number of nodules was significantly higher in the acromegaly group (p=0.003). The number of patients with TI-RADS 1, TI-RADS 2, and TI-RADS 4 nodules in the acromegaly group was higher than the control group (p=0.026, p=0.049, p=0.007, respectively). No difference was found in terms of cytological findings between those who have undergone FNAB in the acromegaly group and control group. CONCLUSION: In our study, we found that the frequency of thyroid nodules, the number of thyroid nodules, and the number of TI-RADS 1, TI-RADS 2, and TI-RADS 4 nodules increased in patients with acromegaly. There was no significant difference between acromegaly disease activity and thyroid nodule frequency, number of thyroid nodules, and TI-RADS classifications.

Cardiac flow parameters with conventional and pulsed tissue Doppler echocardiography imaging in patients with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is independently associated with the major cardiovascular risk factors. The aim of this study was to examine the echocardiographic profiles of patients with PCOS using conventional echocardiographic methods and tissue Doppler imaging. METHODS: For this study, we have registered 48 women with PCOS and 21 healthy control subjects who were matched with respect to age and body mass index. Standard two-dimensional and M-mode measurement, transmitral valve flows and tissue Doppler imaging of mitral and tricuspid anulus were recorded. RESULTS: In PCOS and control groups, left ventricular and atrium diameters, ejection fraction, mitral E/A ratio, deceleration time and isovolumic relaxation time were similar. There were no significant differences between patients with PCOS and control subjects with respect to tissue Doppler profiles. CONCLUSION: Patients with PCOS execute echocardiographic measures of cardiac function that are similar to those of healthy women.

HDR Syndrome Accompanying Type 1 Diabetes Mellitus and Hypopituitarism.

HDR (Hypoparathyroidism, Deafness, and Renal Dysplasia) syndrome is an autosomal dominant disorder characterized by the triad of hypoparathyroidism, sensorineural deafness, and renal disease. Approximately 65% of patients with HDR syndrome have all three of these features, while others have different combinations of these features. We aimed to present a case with primary hypoparathyroidism, hearing loss, and nondiabetic chronic kidney disease and diagnosed as HDR syndrome while being followed up for type 1 diabetes mellitus and hypopituitarism.

Association of obesity with inflammation in occult chronic kidney disease.

BACKGROUND: There are few studies concerning the development of chronic kidney disease (CKD) in obese patients independent of its relation with other risk factors. Also, the role of inflammation in this relationship is unclear. In this study we aimed to test the hypothesis that obesity is associated with risk for CKD and whether this risk is associated with serum C-reactive protein (CRP) levels in an apparently healthy obese population. METHODS: Biochemical parameters and urinary protein excretion were determined in 110 patients with body mass index (BMI) >30.0 (calculated as kg/m2) and 50 age-matched healthy controls. Glomerular filtration rate was estimated by calculation of creatinine clearance. RESULTS: Of the patients, 17.3% had CKD. They had higher CRP levels than controls (6.52 +/- 0.58 mg/L and 4.48 +/- 1.26 mg/L, respectively, p=0.001). Furthermore, CRP levels were positively correlated with BMI, waist circumference, waist to hip ratio and proteinuria, and negatively correlated with glomerular filtration rate (GFR). When GFR was considered as the dependent variable in a multiple regression analysis, CRP maintained its significant correlation with GFR. CONCLUSION: Our study of apparently healthy obese individuals, has shown a significant association between BMI and CKD independent of other potential mediators. Furthermore, our findings suggest that inflammation may be the pathogenic mechanism of obesity-related CKD.

Increased thrombin-activatable fibrinolysis inhibitor antigen levels as a clue for prothrombotic state in polycystic ovary syndrome.

OBJECTIVES: Our study was undertaken to evaluate the levels of thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and also its relationship with other hemostasis markers in a group of patients affected with polycystic ovary syndrome (PCOS)-under Diane-35 (ethinyl estradiol 0.035 mg/cyproterone acetate 2 mg) treatment or not-as compared with a group of healthy controls. METHODS: Forty-two women with PCOS and 30 age-matched healthy controls were involved in the study. Group A were on Diane-35 for at least 6 months; group B did not take any drug; group C served as a control group. RESULTS: TAFI antigen levels of groups A and B were significantly higher than in controls, but no difference was observed between them. All of the other coagulation and fibrinolysis parameters (including prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer) were comparable between the three groups. CONCLUSION: The evidence presented herein suggests that women with PCOS have impaired fibrinolysis, as reflected by increased TAFI. This impairment can contribute to the risk of cardiovascular disease in PCOS. Elucidation of the modifiable mechanisms in PCOS can represent an opportunity for preventive therapy of the cardiovascular risks associated with PCOS.