Evaluation of routine basal serum calcitonin measurement for early diagnosis of medullary thyroid carcinoma in seven hundred seventy-three patients with nodular goiter.

The aims of the study were to identify medullary thyroid cancer (MTC) in its earliest stages by screening patients with basal calcitonin measurements and to determine whether basal serum calcitonin measurements should be a part of the routine evaluation of a nodular goiter. Basal serum calcitonin levels were obtained from 75 patients (female:male 57:18, mean age 42.8 years, range with 18-76 years) with nonnodular thyroid disease as controls. Their mean basal calcitonin level was 7.8+/-0.4 pg/mL with a range of 5-27 pg/mL. Seven hundred seventy-three patients with nodular goiter were included in the study (female:male 586:187) with the mean age of 46.1 years (range 17-78). Four patients had elevated basal serum calcitonin levels ranging between 150-1000 pg/mL. These 4 patients underwent surgery. MTC was confirmed by histopathology in all 4. One patient's mother and brother were also diagnosed as MTC as a result of family screening. Basal serum calcitonin levels were higher than 150 pg/mL in these patients. Fine needle aspiration biopsy (FNAB) of 2 of 4 MTC patients were incorrectly diagnosed as papillary carcinoma; another had malignant cytology and the fourth had benign cytology. None were diagnosed as MTC on the basis of FNAB. In conclusion, calcitonin measurement is an effective method for the diagnosis of MTC. Measurement of basal calcitonin levels in patients with malignant or suspicious FNAB may be a cost-effective approach to screen for MTC. High basal serum calcitonin levels increase the chance of curative therapy by diagnosing MTC in the early stages. It is superior to FNAB for diagnosis of MTC.

Triiodothyronine antibodies in patients with goiter.

OBJECTIVE: To investigate the prevalence of triiodothyronine (T(3)) antibodies in patients with goiter, the influence of these antibodies on the results of thyroid hormone measurements, and the potential relationship between T(3) antibodies and thyroid autoantibodies. METHODS: We undertook a study of 100 healthy control subjects (80 female and 20 male subjects) who had no clinical or biochemical evidence of thyroid disease and 100 patients (81 female and 19 male patients) with goiter. Serum concentrations of total T(3), total thyroxine, free T(3), and free thyroxine were measured by radioimmunoassay kits with a coated tube method. An immunoprecipitation method was used to detect anti-triiodothyronine auto-antibodies. RESULTS: Patients with a T(3) antibody binding ratio +3 standard deviations (SD) above the mean for the normal control group were considered to have T(3) antibodies. Normal control group binding was 2.4 +/- 1.3%. On the basis of +3 SD, seven patients had T(3) antibodies. The mean serum total T(3) level was 1.61 +/- 0.1 nmol/L in patients with binding ratios above +3 SD, whereas the mean serum total T(3) level was 2.23 +/- 0.3 nmol/L in patients without T(3) antibodies. Thus, patients with a binding ratio above +3 SD had a significant decrement in total T(3) levels. No correlation was found between the presence of T(3) antibody and antimicrosomal and antithyroglobulin antibodies. CONCLUSION: When serum thyroid hormone concentrations are measured with a coated tube-radioimmunoassay method, antibodies can result in low T(3) concentrations. T(3) antibodies should be suspected whenever a discordance is noted between the measured thyroid hormone concentrations and the clinical status.

Small cell neuroendocrine carcinoma of the thymus complicated by Cushing's syndrome. Report of a 58-year-old woman with a 3-year history of hypertension.

A 58-year-old woman with a history of Cushing's syndrome for three years presented with a mediastinal mass and received the diagnosis of small cell neuroendocrine carcinoma of the thymus invading the pericardium. On immunohistochemical study, the neoplastic cells reacted with antibodies against cytokeratin, epithelial membrane antigen, neuron-specific enolase, chromogranin, synaptophysin, and ACTH. Clinicopathologic findings of this rare case of ectopic adrenocorticotropic hormone (ACTH) syndrome are discussed with a literature review.

Acarbose treatment in obesity: a controlled study.

UNLABELLED: Acarbose is an alpha-glucosidase inhibitor which reversibly inhibits oligosaccharidase and disaccharidase at the brush border of the small intestine. The aim of this study was to observe its effectiveness in the treatment of obesity. METHODS: Two groups of 25 obese women were put on a 15 kcal/kg/day low-calorie diet for 12 weeks. One group (the study group) received 150 mg/day acarbose for the first 2 weeks and 300 mg/day acarbose for the remaining 10 weeks. The second group (controls) received no additional treatment. Body weight, BMI, skinfold thickness, serum lipids, OGTT, and insulin and C-peptide responses to OGTT were assessed before and after the study. RESULTS: Body weight, BMI and skinfold thickness decreased significantly in both groups. Basal insulin and triglyceride levels in the study group, total and LDL cholesterol and triglyceride levels in the control group decreased significantly. No difference was found between the two groups when these decrements were compared, but the triglyceride level fell more in the control group. CONCLUSION: Additional acarbose therapy is not more beneficial than low-calorie diet therapy alone.

The 4A syndrome association with osteoporosis.

4A syndrome is characterised by adrenocortical insufficiency, achalasia, alacrima, autonomic and other neurological abnormalities. We report an 18-year-old boy with 4 A syndrome and having all classical features of the disease including sensorimotor neuropathy. In addition, the patient had low aldosterone levels and signs of osteoporosis, which apparently developed without glucocorticoid replacement therapy. Although it is speculated that the lack of local growth factors, nutritional deficiency secondary to achalasia or receptor abnormalities regarding bone metabolism contribute to osteoporosis, its etiopathogenesis still needs to be clarified.

Glycaemic index of different kinds of carbohydrates in type 2 diabetes.

An adequate diet provides good metabolic control in diabetics. Since 1981 when Jenkins showed that complex carbohydrates are digested more slowly and raise blood glucose less than simple sugars, many studies have been performed in this field. In this study, seven kinds of carbohydrate-rich food were compared with glucose in 52 Type 2 diabetic patients and 31 normal volunteers. The subject consumed either macaroni, white rice, potatoes, tarhana soup (tarhana includes wheat flour, yoghurt, tomato and green pepper), noodle soup, white or whole wheat bread, or glucose at one-week intervals after an overnight fast. The glycaemic index (GI) of each food was calculated from the area under its glycaemic response curve (AUC) expressed as a percentage of the mean response to glucose. The results showed that the foods ranked from the highest to the lowest GI as follows: white bread; whole wheat bread; macaroni; tarhana soup; white rice; potatoes; noodle soup.

Glucose metabolism and catecholamine responses during physical exercise in non-insulin-dependent diabetes.

Blood glucose, lactate, insulin, C-peptide, norepinephrine and epinephrine concentrations were determined in non-insulin-dependent diabetic patients and in healthy controls before, during and after moderate exercise, to evaluate the effects of physical exercise on glucoregulation. Ten diabetic and ten healthy control females bicycled 14 minutes at 60% of their maximal heart rates. In the diabetic patients, there were no significant changes in blood glucose levels post-exercise, while in controls the 60 minute post-exercise levels were higher than those measured in mid-exercise (p < 0.05). Lactate concentrations increased with exercise in both groups in a similar manner, with highest values at the end of exercise. No significant changes in insulin and C-peptide levels were induced with exercise in either group. Norepinephrine and epinephrine concentrations increased 2.5-3 fold with exercise in both groups (p < 0.05 for all values) but in the diabetics an earlier and prolonged catecholamine response was observed. We propose that catecholamines prevent hypoglycaemia during exercise when changes in insulin and C-peptide do not occur. In diabetic patients with good metabolic control, the glucoregulatory response to exercise is not worse than in anthropometrically similar controls with similar levels of fitness.

Long-term treatment with acarbose for the treatment of reactive hypoglycemia.

OBJECTIVE: Acarbose, a potent alpha-glucosidase inhibitor, provides a new concept for the treatment of metabolic disorders, and particularly diabetes mellitus. It reduces the postprandial blood glucose increment and insulin response. For this reason the drug has been successfully used not only in the treatment of type 1 and type 2 diabetes, but also in the management of reactive hypoglycemia and dumping syndrome. The primary aim of the present study is to evaluate the long-term effect of acarbose in reducing hypoglycemic symptoms and influencing laboratory measurements in patients with the diagnosis of reactive hypoglycemia. DESIGN AND METHODS: 21 non-obese (BMI < 27 kg/m2) patients (6 males, 15 females) complaining of postprandial symptoms suggesting hypoglycemia and who showed blood glucose values of < 54 mg/dl on one or more occasions during a 5 h oral glucose tolerance test (OGTT) were selected. RESULTS: Before treatment, ingestion of glucose decreased plasma glucose levels at the 3rd and 4th hours, the lowest levels being 39 mg/dl and 45 mg/dl respectively. Eighteen patients had hypoglycemic symptoms during OGTT. Following 3 months of acarbose treatment, the lowest plasma glucose levels at the 3rd and 4th hours increased to 67 mg/dI and 75 mg/dI respectively. Plasma insulin and c-peptide levels were reduced between the 1st and 5th hours, but only the 1st and 2nd hour decrements were statistically significant. The area under the curve (AUC) between 0-300 minutes for insulin was not significant. Plasma glucose levels were significantly increased during the last 3 hours. The AUC for glucose was not significantly changed. Frequency of hypoglycemic attacks was reduced from 4 times a week to 1. C-peptide levels in 24-hour urine collection did not change significantly: 45 micrograms/I and 56 micrograms/I respectively before and after treatment. CONCLUSIONS: These results confirm that acarbose may be of value in preventing reactive hypoglycemia by reducing the early hyperglycemic stimulus to insulin secretion, and in the treatment of reactive hypoglycemia.