Evaluation of placenta and fetal lung using shear wave elastography in gestational diabetes mellitus: An innovative approach.

PURPOSE: This study aims to investigate placental and fetal lung stiffness in pregnant women with and without gestational diabetes, considering the well-established delay in fetal lung maturation associated with gestational diabetes. MATERIALS AND METHODS: This prospective cohort study was conducted at a tertiary center and included pregnant women who underwent a 75-gram oral glucose tolerance test between 24-28 weeks of gestation. Elastography measurements were performed using point shear wave elastography (pSWE). RESULTS: The study included 60 pregnant women diagnosed with gestational diabetes and 60 pregnant women in the control group. SWE velocity of peripheral placenta, central placenta, and lung were higher in the gestational diabetes group compared to the control group. Furthermore, SWE velocity of peripheral placenta, central placenta, and lung were higher in newborns with neonatal respiratory morbidity. Based on the ROC analysis of gestational diabetes patients the AUC for lung SWE velocity was 0.88 (cut-off 12.4 kPa, 95% CI: 0.77-0.99, p<0.001) with a sensitivity of 71.4% and specificity of 95.6% in predicting neonatal respiratory morbidity. CONCLUSION: Fetal placental and lung stiffness increase in fetuses of pregnant women with diabetes. Moreover, higher fetal lung stiffness during the fetal period is associated with increased neonatal respiratory morbidity. Zweck: Diese Studie zielt darauf ab, die Lungensteifheit der Plazenta und des Fötus bei schwangeren Frauen mit und ohne Schwangerschaftsdiabetes zu untersuchen, wobei die bekannte Verzögerung der fetalen Lungenreifung im Zusammenhang mit Schwangerschaftsdiabetes berücksichtigt wird. Materialien und Methoden: Diese prospektive Kohortenstudie wurde an einem tertiären Zentrum durchgeführt und umfasste schwangere Frauen, die sich zwischen der 24. und 28. Schwangerschaftswoche einem oralen 75-Gramm-Glukosetoleranztest unterzogen. Elastographiemessungen wurden mittels Punktscherwellenelastographie (pSWE) durchgeführt. Ergebnisse: Die Studie umfasste 60 schwangere Frauen mit diagnostiziertem Schwangerschaftsdiabetes und 60 schwangere Frauen in der Kontrollgruppe. Die SWE-Geschwindigkeit der peripheren Plazenta, der zentralen Plazenta und der Lunge war in der Gruppe mit Schwangerschaftsdiabetes höher als in der Kontrollgruppe. Darüber hinaus war die SWE-Geschwindigkeit der peripheren Plazenta, der zentralen Plazenta und der Lunge bei Neugeborenen mit neonataler respiratorischer Morbidität höher. Basierend auf der ROC-Analyse von Patienten mit Schwangerschaftsdiabetes betrug die AUC für die Lungen-SWE-Geschwindigkeit 0,88 (Grenzwert 12,4 kPa, 95 %-KI: 0,77-0,99, p < 0,001) mit einer Sensitivität von 71,4 % und einer Spezifität von 95,6 % bei der Vorhersage neonataler Erkrankungen Atemwegsmorbidität. Schlussfolgerung: Die Steifheit der fetalen Plazenta und der Lunge nimmt bei Feten schwangerer Frauen mit Diabetes zu. Darüber hinaus ist eine höhere fetale Lungensteifheit während der Fetalperiode mit einer erhöhten Atemwegsmorbidität bei Neugeborenen verbunden.

Effect of post-transplant diabetes mellitus on cardiovascular events and mortality: a single-center retrospective cohort study.

PURPOSE: This study aims to investigate the impact of post-transplant diabetes mellitus (PTDM) on cardiovascular events, graft survival, and mortality and to determine the risk factors involved in developing PTDM. METHODS: A total of 703 patients who underwent kidney transplantation were included in the study. The total sample was subdivided into three groups: (i) patients with PTDM; (ii) patients who had diabetes before the transplantation (DM); and (iii) patients without diabetes (NoDM). The data on graft failure, cardiovascular events, all-cause mortality, and the potential risk factors that play a role in developing PTDM were recorded and analyzed. RESULTS: The patients were followed for a median of 80 (6-300) months after transplantation. Out of all patients, 41 (5.8%) had DM before transplantation, and 101 (14.4%) developed PTDM. Recipient BMI, post-transplant fasting plasma glucose, and hepatitis C seropositivity were independent risk factors for PTDM development. The incidence of cardiovascular events was 6.1% in the NoDM group, 14.9% in the PTDM group, and 29.3% in the DM group (p < 0.001). In PTDM patients, hepatitis C seropositivity and the recipient's age at transplant were independent predictors of a cardiovascular event. There were no significant differences between the groups regarding the risk of graft loss. PTDM had no significant effect on all-cause mortality. However, the survival rates of DM patients were significantly reduced compared to those with NoDM or PTDM. CONCLUSIONS: PTDM had no impact on patient survival. Hepatitis C seropositivity and recipient age at transplant predicted cardiovascular events in PTDM patients.

Anthropometric measurements and serum TNF-α, IL-6 and adiponectin in type 2 diabetes.

Objective: To investigate the effect of anthropometric measurements on serum adiponectin and inflammatory markers in Type 2 diabetes mellitus (T2DM). Methods: This study was conducted with 46 subjects newly diagnosed with T2DM and 30 healthy volunteers free from pre-existing inflammatory disease, cancer, Type 1 diabetes and using any medications. Demographic, clinical and anthropometric data were collected. The anthropometric measurements and insulin resistance components (fasting plasma glucose (FPG), HbA1c, fasting insulin, HOMA-IR) were analyzed. HOMA-ß values were calculated to measure pancreatic beta cell functions. Serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured to determine the presence of inflammation and serum adiponectin levels were assessed. Results: Individuals with T2DM showed higher body mass index (BMI), body fat percentage, waist circumference (WC), waist-to-hip ratio and waist-to-height ratio values. Serum cytokine levels were higher but adiponectin levels were lower in diabetic patients. Serum concentrations of CRP were found to be significantly correlated with WC and body fat mass (kg and %); TNF-α was significantly associated with WC and waist-to-hip ratio in individuals with T2DM. Adiponectin was negatively correlated with WC and waist-to-hip ratio in healthy subjects. Conclusions: Prevention of obesity and central adiposity is an important factor to prevent elevations in inflammatory cytokine levels in diabetic patients.

The Effects of Hyperemesis Gravidarum on the Oral Glucose Tolerance Test Values and Gestational Diabetes.

This study is aimed at determination whether pregnant women who develop hyperemesis gravidarum in the first trimester have a tendency to develop gestational diabetes mellitus (GDM). It is also aimed at identification of effects of hyperemesis gravidarum and GDM on prenatal and neonatal status in case they were detected together. Hyperemesis gravidarum diagnose was based on the following signs and symptoms. To diagnose GDM, first trimester fasting blood glucose measurement and subsequent blood glucose monitoring and 75-g oral glucose tolerance test (OGTT) were performed in the second trimester. A total of 949 singleton pregnant women (95 with and 852 without hyperemesis gravidarum) who met our criteria were included in the study. In the first trimester, plasma blood glucose and positive GDM screening were found to be significantly higher in the hyperemesis gravidarum group compared to the control group (p=0.042 and p<0.001, respectively). However, actual GDM cases were similar between both groups. The positive predictive value was significantly lower in the hyperemesis gravidarum group (28.5% vs. 72.7%, p=0.003). In the second trimester, the prevalence of GDM was 6.6% in the hyperemesis gravidarum group and 7.3% in the control group, with no significant difference (p=0.218) between-groups. In this study, hyperemesis gravidarum was found to cause changes in maternal metabolism in the first trimester of pregnancy due to limited calorie intake and fasting; in the presence of hyperemesis gravidarum, it should be known that the positive predictive value of first trimester gestational diabetes screening may decrease and the diagnosis of pseudo-GDM may increase.

Effect of Co-twin Fetal Sex on Fetal Anthropometry and Birth Time in Twin Pregnancies.

OBJECTIVE: This study of twin deliveries aimed to examine the effect of fetal sex and fetal sex of the co-twin on fetal anthropometry and length of gestation. METHODS: Pregnancies were grouped as male/male, male/female, and female/female. Birth weight, head circumference, body length and delivery time of newborns were compared between unlike-sex and like-sex twin pregnancies. RESULTS: A total of 1028 pregnant women who met the inclusion criteria were enrolled in the study. Of these pregnancies, 32.6% (n = 335) were male/male, 33.4% (n = 343) were male/female, and 34.0% (n = 350) were female/female. The discordant (male/female) newborns had a higher total birth weight than concordant twins (P = 0.015). Compared with male newborns from male/female twin pregnancies, male newborns from male/male pregnancies were found to be 129 grams heavier, 0.7 cm longer, and had a 0.4 cm larger head circumference (P<0.001, P=0.023, and P = 0.039, respectively). Pregnancies with male/female fetuses had statistically significantly longer gestations than pregnancies with male/male and female/female fetuses (P = 0.003 and P = 0.004, respectively). The shortest mean gestation was observed in the male/male group. Male/male pregnancies had a 1.53 times higher risk of preterm delivery than male/female pregnancies and a 1.51 times higher risk than female/female pregnancies (OR 1.53; 95% CI 1.07-2.19 and OR 1.51; 95% CI 1.06-2.16, respectively). CONCLUSIONS: This study suggests that, in twin pregnancies, birth weight, head circumference, and body length are affected by the sex of the co-twin. Male sex is associated with shorter gestation and male/male twin pregnancies are at higher risk for preterm labour.

Prediction of central lymph node metastasis in patientswith thyroid papillary microcarcinoma

Background/aim: The purpose of this study was to analyze the clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) and predictive factors for central lymph node metastasis (CLNM).Materials and methods: Patients diagnosed as having PTC and PTMC were evaluated. Clinical and laboratory parameters were recorded.Results: The mean age at diagnosis was 47.3 +- 11.9 years. Of all 223 patients, 91 (40.8%) had lymph nodes removed, 29 of whom had lymph node metastasis and 24 of whom had only CLNM. Univariate analysis revealed that central lymph node metastasis was associated with male sex, presence of bilaterality, presence of extrathyroidal extension, and tumor size (P = 0.033, P = 0.027, P < 0.001, P < 0.001, respectively). However, multivariate logistic regression analysis showed that sex, age, tumor size, multifocality, bilaterality, extrathyroidal extension, clinical suspicion, and chronic lymphocytic thyroiditis were not significantly correlated with an increased risk for CLNM.Conclusion: Lymph node metastasis is known to be a significant predictor of locoregional recurrence in patients with PTC and PTMC. Further prospective studies are needed to identify the extent of surgery such as central lymph node dissection in patients with PTC or PTMC.

Autoimmune estrogen dermatitis in an infertile female.

Autoimmune estrogen dermatitis is a cyclical cutaneous eruption that occurs premenstrually and goes to the rapid resolution within a few days of menstrual cycles. The disorder has variable clinical manifestations consisting of macules, papules, vesicles, urticarial lesions, bullae, eczematous plaques, and erythema multiforme-like lesions. Herein, we present a case of a 30-year-old woman with attacks of edema and erosions involving the oral and genital mucosal sites on every first day of her menstruation period. She had also multiple endocrinological problems such as hypotroidism and infertility. To determine the sex hormon sensitivity, intradermal skin tests were performed. Based on her personal history and skin test findings, a diagnosis of autoimmune estrogen dermatitis was made. After the oophorectomy, she was free from the skin and mucosal symptoms. We propose that it is important to suspect the diagnosis of autoimmune estrogen dermatitis in patients who present with recurrent cylic eruptions and it must be kept in mind that these patients might have a concomitant infertility.

Vitamin D status and seasonal changes in plasma concentrations of 25-hydroxyvitamin D in office workers in Ankara, Turkey.

BACKGROUND: Lack of sun exposure is one of the primary causes of epidemic vitamin D deficiency worldwide. The aim of this study was to investigate vitamin D status and seasonal changes in summer and winter in office workers. METHODS: This study was conducted in Ankara located at 39° 52' 30" N, 32° 52' E. The study consisted of 118 premenopausal women and men aged between 21 and 52 years-old. Seasonal changes were evaluated in August and February. Fasting serum was obtained for intact parathyroid hormone (iPTH) and 25-hydroxyvitamin D (25OHD). Additional data were collected by a questionnaire that enquired about age, weight, height, wearing style, dietary calcium intake and sunlight exposure. Serum 25OHD concentration was measured using a precise HPLC assay. Low vitamin D status was defined as a 25OHD concentration less than 30 ng/mL. RESULTS: Mean serum 25OHD concentration in summer was 28.4±10.4 ng/mL and 13.8±6.6 ng/mL in winter (p<0.001). 35.6% of the subjects were vitamin D insufficient in summer and 12.7% in winter (p<0.001) while 31.5% were vitamin D deficient in summer and 83.9% in winter (p<0.001). A significant increase in iPTH levels (33.1±15.9 pg/mL vs 49.6±24.3 pg/mL, p<0.001) was observed throughout the seasonal change. No significant association was found between 25OHD levels and iPTH, body mass index, age and sun exposure index (p>0.05 for all) in both seasons. CONCLUSION: Vitamin D deficiency is very prevalent in office workers even in summer time and this should be accepted as a public health problem.

Early promising results for the endoscopic surgical treatment of Cushing's disease.

High levels of endogenous cortisol due to Cushing's disease cause significant mortality and morbidity. Treatment of Cushing's disease is challenging. For many years, transsphenoidal microsurgical resection of the adenoma has been the treatment of choice. However, recently, neuroendoscope has taken its place in the neurosurgeon's armamentarium, and the endoscopic transsphenoidal resection of pituitary tumors has become a familiar approach. Our aim was to present the results of pure endoscopic surgery in the treatment of corticotropinomas for comparison with the results of previous endoscopic and microsurgical series. We present a retrospective analysis of 90 patients with diagnosis of Cushing's disease who were operated between 2006 and 2012. Among 90 patients, a total of 81 (90.0 %) had a remission (28 out of 29 macroadenomas (96.6 %) and 53 out of 61 microadenoma patients (86.9 %)). Of note is that 66 out of 69 (95.7 %) primary patients (i.e., those who were operated in our center) and 15 out of 21 (71.4 %) patients previously operated in other centers reached a hypo/eucortisolemic state. A remission rate comparable with previous endoscopic series was achieved. In nine patients, it was not possible to achieve remission at all. On the other hand, only four of our cases (5.6 %) had a recurrence, and with reoperation, all of these patients entered a re-remission. To our knowledge, our series is the largest series studying endoscopically operated adrenocorticotropic hormone-secreting adenomas. Our results suggest that the endoscopic approach has opened a new avenue in the treatment of Cushing's disease, previously a therapeutic challenge for both the clinician and the neurosurgeon. Endoscopic approach in the treatment of Cushing's disease is clearly better for patients because of its low morbidity rates and short duration of hospital stay. On the other hand, long-term follow-up of our patients will show whether these favorable observations will persist.

Effects of L-thyroxine therapy on circulating leptin and adiponectin levels in subclinical hypothyroidism: a prospective study.

Subclinical hypothyroidism (SCH) is defined by increased thyrotropin (TSH) and normal free thyroxine (fT4) levels. Controversial data are available regarding the effects of SCH on adipose tissue. Adiponectin and leptin are two major adipokines secreted from adipose tissue. We aimed to determine the levels of adiponectin and leptin in women with SCH and potential effects of L-thyroxine therapy on those levels. Forty three women with SCH and 53 age- and BMI-matched healthy euthyroid control women were included. Adiponectin and leptin levels, total cholesterol (TC), triglycerides (TG), HDL-, and LDL cholesterol, fat mass (FM) and fat-free mass (FFM) were determined in all participants. Patients received L-thyroxine treatment for 6 months after which all measurements were repeated. Patients with SCH and controls had similar baseline values for adiponectin, leptin, lipids, FM and FFM. All patients reached euthyroid status after 6 months of replacement therapy. Treatment resulted in an increase in adiponectin (p <0.01) and a decrease in leptin levels (p <0.05). Lipid levels, FM and FFM did not show a significant change. Achievement of euthyroid status by replacement therapy increases adiponectin and decreases leptin levels in women with SCH in this prospective study independent of a change in body fat mass.

Serum resistin and high sensitive CRP levels in patients with subclinical hypothyroidism before and after L-thyroxine therapy.

BACKGROUND: Subclinical hypothyroidism (SH) is defined by increased thyrotropin (TSH) and normal free thyroxine (fT4) and free triiodothyronine (fT3) levels. Resistin is secreted from adipose tissue and is reported to be associated with insulin resistance and/or inflammation. High sensitive CRP (hs-CRP) is a reliable marker of inflammation. Data related to levels of resistin and hs-CRP in SH and the effect of L-thyroxine treatment on those is limited. We aimed to determine the levels of resistin and hs-CRP in women with SH, and potential effects of L-thyroxine therapy on those levels. MATERIAL AND METHODS: Thirty-six patients with SH and 27 age- and BMI-matched healthy control women were included. Waist circumference (Wc), waist-to-hip ratio (WHR), resting energy expenditure (REE), fat mass (FM) and lean mass (LM), TSH, free T4 (fT4), free T3 (fT3), total cholesterol (TC), triglycerides (TG), and HDL- and LDL-cholesterol were determined in all participants. Patients received L-thyroxine treatment for 6 months, after which all measurements were repeated. Resistin and hs-CRP levels were studied from frozen samples after the completion of the study. RESULTS: The 2 groups had similar values for Wc, WHR, FM, LM, TC, TG, HDL-C, LDL-C, resistin, and hs-CRP at the beginning. fT4 were higher, whereas TSH was lower in the control group. Resistin and hs-CRP levels did not change after treatment. hs-CRP correlated with BMI and FM before and after treatment. CONCLUSIONS: Our results suggest that achievement of euthyroid status by replacement therapy did not change resistin or hs-CRP levels in women with SH. hs-CRP correlated with parameters of obesity, which emphasizes the role of body weight in inflammation.

Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome.

OBJECTIVE: Oral contraceptives alone or in combination with antiandrogens are commonly used in the treatment for polycystic ovary syndrome (PCOS). We aimed to determine the effects of ethinyl estradiol/drospirenone (EE-DRSP) plus spironolactone therapy on inflammation and cardiometabolic risk in PCOS. DESIGN: Prospective cohort study. PATIENTS: Twenty-three lean, normal glucose-tolerant patients with PCOS and 23 age- and body mass index (BMI)-matched healthy control women. MEASUREMENTS: Androgens, high-sensitivity C-reactive protein (hsCRP), homocysteine, lipids, fasting insulin, and glucose levels during a standard 75-g, 2-h oral glucose tolerance test were measured. Patients with PCOS were evaluated before and after receiving EE-DRSP (3 mg/30 µg) plus spironolactone (100 mg/day) for 6 months. Healthy controls were evaluated at baseline only. RESULTS: hsCRP, homocysteine, lipids, insulin and glucose levels were similar between patient and control groups at baseline. EE-DRSP plus spironolactone increased hsCRP and homocysteine levels in patients with PCOS (0.50 ± 0.28 vs 1.5 ± 1.3 mg/l, P < 0.05 and 13.1 ± 5.2 vs 17.6 ± 5.3 µm, P < 0.05, respectively). BMI, waist-to-hip ratio, LDL, HDL cholesterol and triglycerides, and glucose tolerance did not change. Modified Ferriman-Gallwey hirsutism scores, testosterone levels and free androgen index improved (9.1 ± 4.2 vs 6.2 ± 3.4, P = 0.001; 80.6 ± 31.1 47.8 ± 20.3 ng/dl, P < 0.05; and 10.5 ± 7.4 vs 1.1 ± 0.8, P < 0.001, respectively). CONCLUSIONS: EE-DRSP plus spironolactone therapy in 6 months improves androgen excess in lean PCOS women without any adverse effects on adiposity, glucose tolerance status or lipid profile. However, this combination increases hsCRP and homocysteine levels.

Ethinyl estradiol-drospirenone vs ethinyl estradiol-drospirenone plus metformin in the treatment of lean women with polycystic ovary syndrome.

OBJECTIVE: Oral contraceptive use might be associated with cardiometabolic risk in PCOS. We aimed to compare the effects of ethinyl estradiol-drospirenone (EE/DRSP) alone vs EE/DRSP plus metformin on clinical and cardiometabolic parameters in PCOS. DESIGN: Prospective observational study. PATIENTS: Forty-five lean patients with PCOS who received EE/DRSP (30 µg/3 mg) (n = 25) or EE/DRSP plus metformin (1700 mg/day) (n = 20) and 45 BMI-matched healthy controls. MEASUREMENT: BMI, waist-to-hip ratio (WHR), hirsutism scores, androgens, lipids, glucose and insulin levels during an OGTT were measured before and after 6 months of treatment in patients and compared to controls. RESULTS: At baseline, patients with PCOS showed similar glucose, insulin and lipids but increased 2 h glucose values compared to controls. Hirsutism scores and free androgen index decreased in both treatment groups. BMI and WHR did not show any change in the EE/DRSP group, while metformin addition resulted in a decrease in BMI. Lipid levels increased in both groups. Glucose and insulin parameters did not change in any group, but metformin addition compared to EE/DRSP alone significantly decreased waist circumference, fasting insulin and HOMA-IR. After-treatment values for both EE/DRSP alone and in combination with metformin compared to the control group showed increased 2 h glucose and increased lipids in patients with PCOS. CONCLUSION: EE/DRSP alone or in combination with metformin improves clinical and biochemical hyperandrogenism in lean PCOS. Both treatments similarly alter lipid profile. EE/DRSP alone does not affect insulin sensitivity, whereas combining EE/DRSP with metformin might improve it.

Comparison of 800 and 3700 MBq iodine-131 for the postoperative ablation of thyroid remnant in patients with low-risk differentiated thyroid cancer.

INTRODUCTION: The initial treatment of differentiated thyroid cancer is thyroidectomy, followed by remnant ablation with iodine-131 (I-131) in some patients. However, controversy exists concerning the appropriate radioiodine dose. The aim of the study is to compare the success rate of low and high activities of I-131 for postoperative remnant ablation. PATIENTS AND METHODS: A total of 108 nonmetastatic low-risk patients (mean age: 46, 85% women) with papillary and follicular carcinoma had I-131 ablation for the postoperative thyroid remnant. Fifty-three patients received a low dose (L) (800 MBq) and 55 patients received a high dose (H) (3700 MBq) of I-131. After total thyroidectomy, thyroid bed I-131 uptake (RAIU) and neck ultrasonography (USG) were performed to determine the remnant volume and the iodine avidity, which were used to calculate the dose delivered to the remnant tissue. The success rate of I-131 ablation was assessed with four different criteria based on serum thyroglobulin (Tg) and USG with and without the utilization of I-131 diagnostic whole-body scintigraphy (DxWBS). Ablation was considered to be successful if patients fulfilled all of the following criteria. (a) Strict criteria based on three tests: (i) USG negative, (ii) no tracer uptake or less than twice the background activity in the thyroid bed on DxWBS and/or up to 0.2% RAIU, and (iii) Tg < 0.2 ng/ml; (b) lax criteria based on three tests: (i) USG negative, (ii) no tracer uptake or less than twice the background activity in the thyroid bed on DxWBS and/or ≤ 0.2% RAIU, and (iii) Tg < 2 ng/ml; (c) strict criteria based on two tests: (i) USG negative and (ii) Tg < 0.2 ng/ml; (d) lax criteria based on two test: (i) USG negative and (ii) Tg < 2 ng/ml. RESULTS: When three tests were used to define successful ablation, in group L, 32 out of 53 (60%) and 43 out of 53 (81%) patients were successfully treated versus 35 out of 55 (64%) and 42 out of 55 (76%) for group H on the basis of strict and lax criteria, respectively (P=NS). The differences were not statistically significant between the two groups when only two tests were used to define ablation success (62 vs. 69% with strict and 89 vs. 87% with lax criteria, respectively). CONCLUSION: Our findings suggest that remnant thyroid tissue in patients with low-risk, well-differentiated thyroid cancer after total thyroidectomy can be ablated with 800 MBq of I-131. The success rate is not different from that obtained with 3700 MBq I-131.

Dynamics of Nampt/visfatin and high molecular weight adiponectin in response to oral glucose load in obese and lean women.

BACKGROUND: High molecular weight adiponectin (HMWA) is the active circulating form of adiponectin. Nampt/visfatin is the enzyme secreted from adipocytes in an active form and is one of the putative regulators of insulin secretion. OBJECTIVE: To investigate the dynamics of total adiponectin (TA), HMWA and Nampt/visfatin in obese and lean women during oral glucose tolerance test (OGTT). METHODS: We studied normal glucose-tolerant (NGT), age-matched, 30 obese and 30 lean women. All subjects underwent a standard 75 g, 2-h OGTT, and area under the curve (AUC) during OGTT for glucose, insulin, Nampt/visfatin, TA and HMWA was calculated. Body fat mass was assessed by bioimpedance analysis. Results Obese women had significantly higher basal and AUC values for insulin and Nampt/visfatin, whereas basal and AUC-HMWA were significantly lower in this group. Alternatively, obese and lean groups had similar basal and AUC values for glucose and TA. Basal insulin levels were negatively correlated with HMWA levels, but not with basal Nampt/visfatin. AUC-insulin was correlated positively with AUC-visfatin, and negatively with AUC-HMWA. Total and truncal body fat mass showed positive correlation with basal and AUC-visfatin, and negative correlation with basal and AUC-HMWA. CONCLUSION: In the NGT state, obese women have higher Nampt/visfatin and lower HMWA levels, both basally and in response to oral glucose challenge. The dynamics of Nampt/visfatin and HMWA during OGTT appear to be linked with insulin and adiposity. Counter-regulatory adaptations in HMWA and Nampt/visfatin might have an impact on suggested adipoinsular axis, contributing to maintenance of normal glucose tolerance.

Late relapse of a light-chain myeloma as extramedullary plasmacytoma of the thyroid gland after second allogeneic stem-cell transplantation.

We present a rare experience with a myeloma patient who had a late relapse as isolated extramedullary plasmacytoma of the thyroid gland after a second allogeneic transplantation. We give PET/CT scan findings at diagnosis and during follow up of the disease after subsequent management. The possible pathogenesis of the late extramedullary relapse of myeloma after allogeneic stem-cell transplantation and management options are discussed.

Hypothyroid Graves' disease complicated with elephantiasis nostras verrucosa (ENV): a case report and review of the literature.

Thyroid dermopathy is not a frequent feature of hyperthyroid Graves' disease, being present in less than 5% of the patients. Graves' disease has been shown to exist in euthyroid or hypothyroid forms in untreated patients. Here, we describe a case of hypothyroid Graves' disease with elephantiasis nostras verrucosa (ENV), which is an extreme form of thyroid dermopathy (TD). A 58-year-old female patient was admitted to the emergency department with somnolence, hypothermia, and bradycardia. Her mental status gradually worsened, resulting in a deep coma. She was intubated and followed in the intensive care unit, as she needed mechanical ventilatory assistance due to respiratory failure. She also had bilateral non-pitting edema, a cobblestone-like appearance, and hyperkeratotic greenish-brown-colored lesions in the pretibial and dorsal regions of the feet that were compatible with ENV. Hypothyroid Graves' disease is a very rare condition among autoimmune thyroid disorders, and ENV is an extremely rare form of TD. Here, we present a patient with hypothyroid Graves' disease and ENV.

Circulating adiponectin represents a biomarker of the association between adiposity and bone mineral density.

An association exists between adiposity, insulin resistance, and osteoporosis; however, the mechanism of this relationship remains enigmatic. We aimed to determine whether the insulin resistance index (HOMA-IR), serum adiponectin, or leptin levels are associated with bone mineral density (BMD). A cross-sectional, observational study was designed. Eighty-four postmenopausal ambulant women [52.5 (50.0-58.0) years; body mass index (BMI): 29.4 (25.9-33.8) kg/m(2)] referred for osteoporosis screening were enrolled. Anthropometric measures, fasting serum adiponectin and leptin levels, and the HOMA-IR were determined. The relationships between these variables and lumbar, hip, and forearm BMD measured by dual-energy X-ray absorptiometry (DXA) were analyzed. Considering all 84 participants, the HOMA-IR index was 1.82 (1.17-2.86), serum adiponectin was 13.25 (10.49-16.88) microg/ml, and serum leptin was 19.26 (14.94-24.90) ng/ml. BMI, waist circumference, and leptin positively correlated with hip and lumbar BMD, whereas adiponectin negatively correlated. Multivariate analysis confirmed an inverse relation between serum adiponectin level and femoral neck and lumbar BMD measurements. In total hip and forearm areas, there was no independent association of adipocytokines with BMD measurements. Instead, waist circumference was independently associated with BMD measurements. In conclusion, adiponectin may represent a biomarker in the relationship between visceral fat mass and BMD. However, this association is probably confounded by the specific body composition parameters (i.e., waist circumference, BMI) in postmenopausal women.

Molecular diagnosis and clinical characterization of pseudohypoparathyroidism type-Ib in a patient with mild Albright's hereditary osteodystrophy-like features, epileptic seizures, and defective renal handling of uric acid.

We describe a patient who presented with epileptic seizures unresponsive to anticonvulsive treatment. Laboratory investigations demonstrated epileptiform seizure activity in the brain but also revealed severe hypocalcemia, hyperphosphatemia, and elevated serum parathyroid hormone. In addition, the patient showed a reduced serum level of 25-[OH]-vitamin D. The diagnosis of pseudohypoparathyroidism type-Ib (PHP-Ib) was made based on these clinical findings and upon identification of a 3-kb deletion within the STX16 locus, a genetic defect frequently associated with autosomal dominant PHP-Ib. This mutation was also present in the patient's unaffected mother and her affected sister. Despite the molecular diagnosis of PHP-Ib, which is characterized by parathyroid hormone resistance in the absence of Albright's hereditary osteodystrophy (AHO), the patient had a round face, slightly short stature, and short fourth metacarpals, which were consistent with mild AHO. The patient and her affected sister, who lacked AHO-like features, showed reduced serum levels of uric acid and increased fractional excretion of uric acid, a finding that was reported only once previously for PHP-Ib. Unlike the previous report, the fractional uric acid excretion and serum uric acid levels returned to normal in our patient and her sister after 3 months of treatment period. These findings underscore several important points with respect to the pathogenesis and clinical presentation of PHP-Ib. Furthermore, the findings in the index case present interesting novel aspects, including a previously undescribed coexistence of the 3-kb STX16 deletion and AHO-like features and a clinical course complicated by concomitant 25-[OH]-vitamin D deficiency, which may have resulted, at least partly, from long-term use of antiepileptic drugs.

Rosiglitazone-induced anasarca without heart failure: capillary leakage?

Severity of thiazolidinedione (Rosiglitazone)-induced fluid retention is linked almost exclusively to cardiac decompensation. We here report a 68-year old female with type 2 diabetes mellitus, in whom a life-threatening (anasarca type) acute pulmonary edema, induced by rosiglitazone plus insulin therapy, occurred without any evidence of left ventricular systolic or diastolic dysfunction. It seems that thiazolidinedione-induced severe edema does not have to be the result of acute congestive heart failure. These agents have been shown to increase vascular permeability in experimental models. Thus, the recommendation of only cardiac monitoring in pulmonary edema, associated with thiazolidinediones, should be reconsidered.