Are irisin levels associated with inflammation and insulin resistance in patients with moderate-to-severe psoriasis?

BACKGROUND: A wide variety of effects of irisin, as a myokine and adipokine, have been reported. Although there are some clues about its role in the modulation of immune response in the pathogenesis of immune-mediated diseases such as psoriasis, it has not yet been clearly elucidated. The aim of the present study is to investigate the relationship of irisin levels with inflammation and insulin resistance in patients with psoriasis. METHODS: This study was conducted in patients with moderate-to-severe psoriasis and healthy subjects who were admitted to Haseki Training and Research Hospital. In addition to routine laboratory analyses, hs-CRP, insulin, irisin, adiponectin, and leptin levels were measured. The association between irisin levels and study variables was assessed using univariate and multivariate analyses. RESULTS: A total of 42 non-diabetic patients with moderate-to-severe psoriasis and 43 healthy subjects were enrolled. The mean irisin, waist circumference, insulin, insulin resistance, and hs-CRP, and frequency of metabolic syndrome were significantly higher in psoriasis patients than healthy controls. Psoriasis and control groups were similar in terms of adiponectin, leptin, and Body Mass Index levels. Also, hs-CRP levels were positively and strongly correlated with irisin, adiponectin, and leptin levels. The median irisin level was 2.15 µg/mL. In the binary logistic regression analysis, CRP level (OR=1.14, 95% CI 1.005-1.29, P=0.042) and a BMI>30 kg/m2 (OR=5.9, 95% CI 1.02-34.4, P=0.048) were independent predictors of a higher irisin level. CONCLUSIONS: This study demonstrates that serum irisin levels are higher in patients with moderate-to-severe psoriasis than in healthy subjects. Irisin seems to be associated with inflammation, as measured by hs-CRP. More comprehensive studies are needed to clarify the effect of irisin, on immune-modulate response in patients with psoriasis.

Evaluation of the relationship between Behcet's disease and cardiovascular disorders through metabolic function and copeptin.

INTRODUCTION: Behcet's disease (BD) is a chronic inflammatory and multisystem vasculitis. Cardiac involvement is one of the major complications of BD. Cardiac involvement is sporadic in terms of its specific relationship to mortality. How to identify and follow up on cardiac-related complications in BD patients has yet to be determined. AIM: The aim of our study is to assess cardiovascular diseases in BD patients by measuring metabolic function and copeptin levels and comparing these to a healthy control group. Knowing the specific metabolic functions that are negatively affected by BD will help doctors determine which functions need to be more closely monitored in BD patients. Our study is the first study in the available literature that evaluates copeptin in BD patients. MATERIAL AND METHODS: A control group of 58 healthy volunteers, including 32 females and 26 males (average age: 39.8 ±10.3 years, range: 18-50 years), was formed to compare with 84 BD patients (average age: 40.5 ±11 years, range: 21-63 years), including 39 females and 45 males. Diastolic and systolic blood pressure, height, weight, body mass index (BMI), and waistline were measured for both groups. All study patients were also given hemograms, and fasting blood sugar (FBS), uric acid, lipid profile, insulin, C-reactive protein (CRP), and copeptin levels were measured. An ELISA Kit was used to measure copeptin. RESULTS: FBS, CRP, and insulin levels were significantly higher in the patient group (p < 0.001, p = 0.004, and p = 0.038, respectively). Patients who had had the disease for more than 10 years had higher BMIs, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels (p = 0.034, p = 0.004, p = 0.016, and p = 0.045, respectively). Additionally, CRP levels were found to be higher in long-term patients and patients with active lesions. Diastolic blood pressure and waist circumference were also higher in the BD group. Patients who had active lesions had significantly higher diastolic blood pressure (p = 0.047). There were no statistically significant differences in copeptin levels between BD and control groups. CONCLUSIONS: Cardiovascular involvement rarely contributes to the high mortality rate of BD patients. There were meaningful elevations in metabolic markers identified when BD and cardiovascular disease risk was assessed with metabolic parameters. The cardiac disease risk should be closely followed using metabolic functions, particularly in long-term BD patients with vascular involvement.

Visfatin levels in hormonally inactive adrenal adenoma and their association with metabolic parameters

Background/aim: In parallel with increased frequency and higher quality of imaging techniques, the prevalence of adrenal adenoma has gradually increased. However, despite the growing incidence, the metabolic and tumorigenesis processes involved in its etiology are still unclear. Although visfatin has been reported to be associated with inflammation and tumorigenesis, its role in adrenal adenoma has not yet been investigated. Therefore, the present study was performed with an aim to evaluate visfatin levels and cardiometabolic risk factors in patients with adrenal adenoma. Materials and methods: Thirty patients recently diagnosed with adrenal adenoma along with 30 healthy participants were studied in a tertiary healthcare center. Twenty-four-hour ambulatory blood pressure monitoring and carotid artery intima-media thickness (CIMT) measurements were performed. Results: The frequencies of diabetes mellitus and hypertension were found to be statistically higher in the adrenal adenoma group. Although the values of mean fasting glucose, insulin, HOMA-IR levels, and the mean, maximum, minimum, delta systolic, and diastolic blood pressures were established to be higher in the adrenal adenoma group, the differences were not found to be statistically significant. Mean high-sensitive C-reactive protein, visfatin levels, and CIMT were seen to be significantly higher in the adenoma group. Conclusion: Cardiometabolic risk factors as well as the visfatin levels were established to be higher in patients with adrenal adenoma. Elevated visfatin levels might play a role in the development and metabolic process of adrenal adenoma.

A rare case of ectopic ACTH syndrome originating from malignant renal paraganglioma.

Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of a non-pituitary ACTH-secreting tumor leading to Cushing's syndrome. Only a few cases have been reported previously as causing ectopic ACTH related to paraganglioma. Herein, we present a case of Cushing's syndrome, in who was proved to be attributable to an ACTH-secreting renal malignant paraganglioma. A 40-year-old woman presented with a five-month history of newly diagnosed hypertension and diabetes, weakness, hyperpigmentation, oligomenorrhea, hirsutism, and acneiform lesions. She showed cushingoid features, including moon face, facial hirsutism, facial and truncal acne, hyperpigmentation, and severe muscle weakness of the limbs. She did not have other findings such as striae, supraclavicular fat accumulation, and buffalo hump. Laboratory examination showed the presence of hypopotasemia, hyperglycemia, hyperthyroidism, and leukocytosis. The serum levels of ACTH, cortisol, and urine-free cortisol were markedly elevated. Results of an overnight 2-mg dexamethasone suppression test included a basal serum cortisol of 61.1 mcg/dL (normal range: 4.6-22.8 mcg/dL) and a cortisol value of 46.1 mcg/dL after dexamethasone administration. There was no suppression found after 2-day 8-mg dexamethasone administration. Magnetic resonance imaging (MRI) of the pituitary gland indicated two microadenomas. An abdominal MRI scan revealed horseshoe kidney, bilateral adrenal hyperplasia, and masses with dimensions of 35 x 31 mm in the left kidney. Inferior petrosal sinus sampling showed no evidence of a central-to-peripheral gradient of ACTH. A positron emission tomography/computed tomography scan showed intense increased activity in the lower pole of the left kidney. Left adrenalectomy and left partial nephrectomy were performed. The resected tumor was diagnosed as the ACTH-secreting paraganglioma in the pathological examination, which was confirmed by immunohistochemical studies with chromogranin A, synaptophysin, and ACTH. Only a few cases of paragangliomas as a cause of ectopic ACTH syndrome have been reported. To our knowledge, this is the first case of renal paraganglioma resulting in Cushing's syndrome due to ectopic ACTH hypersecretion.

Visceral Obesity Mediates the Association Between Metabolic Syndrome and Obstructive Sleep Apnea Syndrome.

BACKGROUND: Metabolic syndrome (MetS) and visceral obesity are more prevalent in obstructive sleep apnea syndrome (OSAS). We investigated the association of visceral fat (VF) measures with the components of MetS in OSAS patients with different severity levels, according to World Health Organization (WHO, 1999), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III, 2001), and International Diabetes Federation (IDF, 2005) definitions. PATIENTS AND METHODS: Study population was grouped according to polysomnography results as non-OSAS [who had apnea-hypopnea index (AHI) <5, n = 51], mild OSAS (5 < AHI <15, n = 52), moderate OSAS (15 < AHI <30, n = 53), and severe OSAS (AHI >30, n = 53). VF ratio was measured by abdominal bioimpedance analysis. Waist-to-hip ratio (WHR), homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profiles were assessed in all subjects. RESULTS: The prevelance of MetS in OSAS patients was 30.0%, 35.6%, and 44.4% according to WHO, NCEP-ATP III, and IDF definitions, respectively. MetS was found in 27.5% non-OSAS and 72.8% OSAS according to at least one definition (P = 0.012). Within OSAS group, 27.2% subjects had average, 38.0% had slightly excessive, and 34.8% had an excessive VF ratio. The prevelance of MetS was similar in various VF ratios (P > 0.05). However HOMA-IR increased progressively with VF ratio after adjusting for age, gender, and body mass index (BMI; P = 0.02). AHI increased progressively with BMI (P = 0.02), WHR (P = 0.03), VF ratio (P = 0.01), HOMA-IR (P = 0.02), and MetS (P = 0.016). CONCLUSION: Since severity of OSAS, in terms of AHI and insulin resistance, is both associated with VF rather than BMI, VF should be suggested to link OSAS and MetS. The IDF definition is more sensitive in OSAS patients to diagnose MetS, as central obesity and insulin resistance are obligatory components. This would allow clinicians to intervent earlier to adverse metabolic outcomes of OSAS.

Circulating E-selectin levels and insulin resistance are associated with early stages of atherosclerosis in nonfunctional adrenal incidentaloma.

OBJECTIVE: To evaluate circulating E-selectin levels in patients with nonfunctional adrenal incidentaloma (NFA) in relation to insulin resistance and early atherosclerosis. SUBJECTS AND METHODS: A total of 40 patients with NFA (mean [SD] age: 55.6 [10.7] years; 70% were females) and 35 controls (mean [SD] age: 51.5 [8.1] years; 71.4% were females) selected from age-, gender- and body mass index (BMI)- matched healthy subjects were enrolled. Serum hsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated. High-resolution B-mode ultrasonography was performed. Serum levels of E-selectin were evaluated by enzyme-linked immunosorbent assay. RESULTS: Patients with NFA had significantly higher values for E-selectin (14.9 (4.8) vs. 12.2 (4.1) ng/mL, p < 0.01) and CIMT (0.6 (0.1) vs. 0.5 (0.1) mm, p < 0.05) than controls. Serum E-selectin levels showed a statistically significant association with hsCRP (r = 0.751, p < 0.001), HOMA-IR (r = 0.575, p < 0.001) and CIMT (r = 0.762, p < 0.001). CIMT (Carotid intima media thickness) was increased in patients with NFA patients with NFA were more insulin resistant than controls and statistically significant relationship was found between size of tumor and HOMA-IR (r = 0.361, p < 0.001). CONCLUSION: In conclusion, based on significantly higher values for E-selectin, CIMT and HOMA-IR in patients with NFA than controls along with significant correlation of E-selectin levels to CIMT, HOMA-IR and hs-CRP, our findings seems to indicate an increased risk of early atherosclerosis and impaired endothelial function in NFA patients, particularly in case of insulin resistance.

Circulating E-selectin levels and insulin resistance are associated with early stages of atherosclerosis in nonfunctional adrenal incidentaloma

Objective To evaluate circulating E-selectin levels in patients with nonfunctional adrenal incidentaloma (NFA) in relation to insulin resistance and early atherosclerosis.Subjects and methods A total of 40 patients with NFA (mean [SD] age: 55.6 [10.7] years; 70% were females) and 35 controls (mean [SD] age: 51.5 [8.1] years; 71.4% were females) selected from age-, gender- and body mass index (BMI)- matched healthy subjects were enrolled. Serum hsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated. High-resolution B-mode ultrasonography was performed. Serum levels of E-selectin were evaluated by enzyme-linked immunosorbent assay.Results Patients with NFA had significantly higher values for E-selectin (14.9 (4.8) vs. 12.2 (4.1) ng/mL, p < 0.01) and CIMT (0.6 (0.1) vs. 0.5 (0.1) mm, p < 0.05) than controls. Serum E-selectin levels showed a statistically significant association with hsCRP (r = 0.751, p < 0.001), HOMA-IR (r = 0.575, p < 0.001) and CIMT (r = 0.762, p < 0.001). CIMT (Carotid intima media thickness) was increased in patients with NFA patients with NFA were more insulin resistant than controls and statistically significant relationship was found between size of tumor and HOMA-IR (r = 0.361, p < 0.001).Conclusion In conclusion, based on significantly higher values for E-selectin, CIMT and HOMA-IR in patients with NFA than controls along with significant correlation of E-selectin levels to CIMT, HOMA-IR and hs-CRP, our findings seems to indicate an increased risk of early atherosclerosis and impaired endothelial function in NFA patients, particularly in case of insulin resistance.

Is there any association between thrombosis and tissue factor pathway inhibitor levels in patients with vitamin D deficiency?

OBJECTIVE: The aim of this study was to evaluate the relationship between vitamin D levels and hemostatic factors like tissue factor pathway inhibitor (TFPI). METHODS: Patients who had 25-hydroxyvitamin D3 (25(OH)D3) levels measured were included. Coagulation and hemostatic parameters were evaluated. Patients were divided into 3 groups based on 25(OH)D3 levels as group 1 (25(OH)D3 < 10 ng/mL, n = 25), group 2 (25(OH)D3 = 10-19.9 ng/mL, n = 22), and group 3 (25(OH)D3 ≥ 20 ng/mL, n = 28). RESULTS: A total of 75 patients with a mean age of 39 (range 18-57) years were included in the study. Prothrombin time was longer in group 3 than in group 2 (P = .043). The TFPI levels were higher in group 3 than in the other groups (P < .001). There was a strong positive correlation between 25(OH)D3 and TFPI levels (r = .47, P < .001). CONCLUSION: Further studies are needed for evaluation of the role of TFPI in hemostasis and thrombotic process in patients with vitamin D deficiency.

Insulin-like growth factor 1, liver enzymes, and insulin resistance in patients with PCOS and hirsutism.

AIM: Hyperinsulinemia and insulin resistance are commonly seen in patients with hirsutism and polycystic ovary syndrome (PCOS), and are associated with cardiovascular disease risk. However, it is not yet known whether insulin-like growth factor I (IGF-I) and alanine transaminase (ALT) produced by the liver play roles in hyperinsulinemia and subclinical atherosclerotic process in patients with PCOS and idiopathic hirsutism (IH). MATERIALS AND METHODS: This was a prospective case-controlled study. The study population consisted of 25 reproductive-age PCOS women, 33 women with IH, and 25 control subjects. RESULTS: Mean IGF-I levels and median ALT levels were higher in patients with IH and PCOS than controls, but these differences were not statistically significant. The participants who had a homeostasis model assessment insulin resistance index (HOMA-IR) greater than 2.7 had significantly higher IGF-1 and ALT levels. ALT levels were positively correlated with body mass index, FG, insulin and HOMA-IR. CONCLUSION: The study illustrated that IGF-1 and ALT levels were significantly higher in patients with increased insulin resistance. Due to short disease duration in younger participants, we did not observe any correlation between IGF-1 and hyperinsulinemia. These findings suggest that increased hepatic production of IGF-I and ALT might be an early indicator of insulin resistance in hirsutism.

Cushing's syndrome in type 2 diabetes patients with poor glycemic control.

Cushing's syndrome may be more frequent in some specific patient groups such as type 2 diabetes and obesity. The aim of this study was to investigate the prevalence of Cushing's syndrome in outpatients with type 2 diabetes with poor glycemic control despite at least 3-months insulin therapy. Outpatients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite receiving at least 3-months long insulin treatment (insulin alone or insulin with oral antidiabetics) were included. Patients with classic features of Cushing's syndrome were excluded. Overnight 1 mg dexamethasone suppression test (DST) was performed as a screening test. A total of 277 patients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite insulin therapy were included. Two of the 277 patients with type 2 diabetes were diagnosed with Cushing's syndrome (0.72 %). Hypertension was statistically more frequent in the patients with cortisol levels ≥1.8 µg/dL than the patients with cortisol levels <1.8 µg/dL after overnight 1 mg DST (p = 0.041). Statistically significant correlation was determined between cortisol levels after 1 mg DST and age, daily insulin dose (r = 0.266 and p < 0.001, r = 0.163 and p = 0.008, respectively). According to our findings, the prevalence of Cushing's syndrome among patients with type 2 diabetes with poor glycemic control despite insulin therapy is much higher than in the general population. The patients with type 2 diabetes with poor glycemic control despite at least three months of insulin therapy should be additionally tested for Cushing's syndrome if they have high dose insülin requirements.

Is refined carbohydrate consumption related to allergic diseases?

Exposure to refined carbohydrates has been found to be associated with disorders such as increased blood pressure, retinopathy, adipose tissue inflammation, glucose intolerance, type 2 diabetes mellitus, poor metabolic profile, esophageal adenocarcinoma, and small intestine, prostate, pleural, and pancreatic cancers. Additionally, recent studies have demonstrated that ingestion of refined carbohydrates is related to secretion of cytokines and chemokines. However, to our knowledge, there is still no data on the relationship between refined carbohydrate consumption and allergic disorders ranging from bronchopulmonary to skin diseases. Therefore, the purpose of this review was to evaluate whether consumption of refined carbohydrates plays a role in allergic diseases.

Copeptin, a surrogate marker for arginine vasopressin, is associated with cardiovascular risk in patients with polycystic ovary syndrome.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) have higher risk for cardiovascular disease (CVD). Copeptin has been found to be predictive for myocardial ischemia. We tested whether copeptin is the predictor for CVD in PCOS patients, who have an increased risk of cardiovascular disease. METHODS: This was a cross sectional controlled study conducted in a training and research hospital. The study population consisted of 40 reproductive-age PCOS women and 43 control subjects. We evaluated anthropometric and metabolic parameters, carotid intima media thickness and copeptin levels in both PCOS patients and control group. RESULTS: Mean fasting insulin, homeostasis model assessment insulin resistance index (HOMA-IR), triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), free testosterone, 17-OH progesterone, Dehydroepiandrosterone sulfate (DHEAS), carotid intima media thickness (CIMT) levels were significantly higher in PCOS patients. Mean copeptin level was in 12.61 ± 3.05 pmol/L in PCOS patients while mean copeptin level was 9.60 ± 2.80 pmol/L in healthy control women (p < 0.001). After adjustment for age and BMI, copeptin level was positive correlated with fasting insulin, free testosterone levels, CIMT, and HOM A-IR. CONCLUSIONS: Copeptin appeared to have an important role in metabolic response and subsequent development of atherosclerosis in insulin resistant, hyperandrogenemic PCOS patients.

Three noninvasive methods in the evaluation of subclinical cardiovascular disease in patients with acromegaly: epicardial fat thickness, aortic stiffness and serum cell adhesion molecules.

CONTEXT: Several studies have reported increased risk of cardiovascular disease due to early development of endothelial dysfunction and structural vascular changes in patients with acromegaly. OBJECTIVE: The aim of this study was to evaluate subclinical cardiovascular disease with epicardial fat thickness (EFT), aortic stiffness and serum levels of cell adhesion molecules (CAMs) in patients with acromegaly. DESIGN: Cross-sectional study. PATIENTS: Twenty-seven patients with active acromegaly (AA), 13 patients with remission acromegaly (RA) and 37 age- and sex-matched healthy controls were studied. MEASUREMENTS: Epicardial fat thickness was evaluated by transthoracic echocardiography (TTE). Aortic stiffness (ß) index, aortic strain (AoS) and aortic distensibility (AoD) were calculated from the aortic diameters measured by TTE. Serum levels of CAMs such as intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and E-selectin were measured. RESULTS: Epicardial fat thickness was significantly increased in patients with RA and AA as compared to controls 9·71 ± 1·54 and 10·08 ± 1·95 mm vs 5·74 ± 0·92 mm, P < 0·001, respectively). A significant positive correlation was found between the EFT and growth hormone (GH) levels (r = 0·365, P = 0·024). ß-index was similarly higher in patients with RA and AA than controls (15·68 ± 7·27 and 11·90 ± 8·24 vs 6·85 ± 2·87, P < 0·001, respectively). AoS and AoD were significantly decreased in patients with RA and AA as compared to the control group (3·81 ± 1·94 and 3·68 ± 1·99 vs 8·19 ± 4·19%, P < 0·001, respectively; and 1·21 ± 0·66 and 1·18 ± 0·63 vs 2·58 ± 1·50, 10(-6) cm(2) /dyn, P < 0·001, respectively). Serum ICAM-1 and VCAM-1 levels were significantly higher in patients as compared to the control group (P < 0·001 vs P = 0·032, respectively). There were no significant differences in EFT, AoD, AoS, ß-index and serum CAMs between two patients groups (AA vs RA, P > 0·05). There was a significant negative correlation between E-selectin and AoD (r = -0·45, P = 0·008). In multiple linear regression analysis, EFT was found to be associated with GH levels (ß-coefficient = 0·575, P = 0·008). CONCLUSION: This study suggests that EFT and risk of subclinical cardiovascular disease are increased in patients with acromegaly. Serum GH level is an independent risk factor for EFT.

Preclinical atherosclerosis in patients with prolactinoma.

OBJECTIVE: The aim of this study was to evaluate the effect of hyperprolactinemia on body fat, insulin sensitivity, inflammatory markers, and cardiovascular risk in patients with prolactinoma. METHODS: The study included 35 untreated hyperprolactinemic patients with pituitary adenomas, and 36 age-, gender-, and body mass index (BMI)-matched healthy controls without any known disease. Serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and heart-type fatty acid binding protein (H-FABP) levels were measured. Waist and hip circumference (WC and HC) were measured in all the participants. The body fat percentage was measured, and the visceral fat and abdominal fat percentages were measured via bioelectrical impedance (BIA). In addition, carotid intima media thickness (CIMT) was measured using high-resolution B-mode ultrasound. RESULTS: The serum glucose level, HOMA-IR, triglyceride level, and SC were significantly higher in the patient group than in the control group. The hs-CRP level and CIMT were significantly higher in the hyperprolactinemic patients. Visceral and truncal fat percentages were significantly higher in the patients with prolactinoma. H-FABP levels were similar in the 2 groups, and there was a positive correlation between the prolactin (PRL) and H-FABP protein levels. CONCLUSIONS: Based on the present findings, hyperprolactinemia is associated with preclinical atherosclerosis and metabolic abnormalities. Patients with hyperprolactinemia might experience cardiovascular disease in the long term. Metabolic control should be achieved in addition to the control of hyperprolactinemia in the clinical management of patients diagnosed with prolactinoma.

Is there any relationship between recurrent oral aphthous stomatitis and prediabetes?

Periodontal disease has been associated with glycaemia. Recurrent aphthous stomatitis (RAS) is one of the most common oral lesions and is characterized by painful recurrent oral ulcers. However, the exact cause and treatment of RAS is not yet well-known. Furthermore, there is still unknown the relationship between RAS and glycaemia. Prediabetes has shown to have role on worse metabolic profile. However, there is still no data on the relationship between prediabetes and clinical RAS. Therefore, the purpose of this hypothesis is to assess whether the prediabetes aggravate RAS.

Subclinical atherosclerosis and hyperandrogenemia are independent risk factors for increased epicardial fat thickness in patients with PCOS and idiopathic hirsutism.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting reproductive-age women and is reported to be associated with an increased risk of cardiovascular disease and early atherosclerosis. Epicardial fat thickness (EF) is clinically related to subclinical atherosclerosis and visceral fat changes. Therefore, the objective of this study is to compare the carotid artery intima-media thickness (CIMT), EF and cardiometabolic risk factors in patients with PCOS, patients with idiopathic hirsutism (IH) and healthy controls. METHODS: This cross-sectional controlled study was conducted in a training and research hospital. The study population consisted of 50 reproductive-age PCOS women, 34 women with IH and 39 control subjects. We evaluated anthropometric, hormonal and metabolic parameters as well as CIMT and EF measurements in PCOS patients, IH patients and controls. RESULTS: The mean fasting insulin, HOMA-IR, hsCRP, GGT, CIMT, and EF levels were significantly higher in patients with PCOS and IH (p < 0.05). A significant positive correlation was found between EF and age, BMI, WHR, Ferriman Gallwey score (FG), fasting insulin, HOMA-IR, triglyceride, total cholesterol, LDL-C, 17 OH progesterone, free testosterone, CIMT, hsCRP, and GGT, whereas a significant negative correlation was observed between EF and HDL-C (p < 0.05). In the multiple linear regression analyses, EF was found to be associated with the FG (ß coefficient: 0.389, p < 0.001), CIMT (ß coefficient: 0.376, p < 0.001) and free testosterone levels (ß coefficient: 0.173, p < 0.038). CONCLUSION: EF appears to be a marker that will enable the detection of the cardiometabolic response in patients with PCOS and IH, even at an early stage.

Heart type fatty acid binding protein response and subsequent development of atherosclerosis in insulin resistant polycystic ovary syndrome patients.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) have higher risk for cardiovascular disease (CVD). Heart type fatty acid binding protein (HFABP) has been found to be predictive for myocardial ischemia.Wet ested whether HFABP is the predictor for CVD in PCOS patients, who have an increased risk of cardiovascular disease. METHODS: This was a prospective, cross sectional controlled study conducted in a training and research hospital.The study population consisted of 46 reproductive-age PCOS women and 28 control subjects. We evaluated anthropometric and metabolic parameters, carotid intima media thickness and HFABP levels in both PCOS patients and control group. RESULTS: Mean fasting insulin, homeostasis model assessment insulin resistance index (HOMA-IR), triglyceride, total cholesterol, low density lipoprotein cholesterol, free testosterone, total testosterone, carotid intima media thickness (CIMT) levels were significantly higher in PCOS patients. Although HFABP levels were higher in PCOS patients, the difference did not reach statistically significant in early age groups. After adjustment for age and body mass index, HFABP level was positive correlated with hsCRP, free testosterone levels, CIMT and HOMA-IR. CONCLUSIONS: Heart type free fatty acid binding protein appeared to have an important role in metabolic response and subsequent development of atherosclerosis in insulin resistant, hyperandrogenemic PCOS patients.

The relationship between LH and thyroid volume in patients with PCOS.

BACKGROUND: Thyroid volume (TV) has been found to be associated with age, anthropometry, smoking, iodine status and hyperinsulinemia. Hyperinsulinemia is frequent finding in patients with PCOS and has associations with TV. However, the TV has been evaluated only a few studies in patients with PCOS. Therefore, the aim of this study was to evaluate the biochemical and hormonal variables in patients with PCOS comparing with the controls and their relationships between TV. METHODS: This was a case-control study conducted in a training and research hospital. The study population consisted of 47 reproductive-age PCOS women and 30 control subjects. We evaluated anthropometric, biochemical and hormonal parameters as well as thyroid volume in PCOS patients and controls. Insulin resistance was calculated using the homeostasis model assessment insulin resistance index (HOMA-IR). RESULTS: Mean age, BMI, thyroid stimulant hormone (TSH) levels and TV were similar between groups (p<0.05). The HOMA-IR and free T4 levels were higher in patients with PCOS. However, hyperinsulinemia and insulin resistance were not found to be associated with TV. Thyroid volume was positively correlated with the LH and anti TPO levels. The participants were divided into 2 groups according to HOMA-IR levels. The mean TV measurement was higher in group with higher HOMA-IR levels, but the difference was not significant in young age PCOS patients. CONCLUSION: In early age PCOS patients it was observed that insulin resistance had no effect on TV. In this case, anti TPO and LH have dominant effect on TV. Chronic stimulation with LH and insulin may lead to increase in TV in later stages of the PCOS diseases.

Medical hypothesis: can gonadotropins influence thyroid volume in women with PCOS?

It has been reported that luteinizing hormone (LH) had thyropropic effect on rat and human thyroid membrane. It has been known that patients with PCOS have elevated LH levels in comparison to healthy controls.The goiter prevalence is more common in women than in men regardless of population. The higher incidence of thyroid diseases in women has been previously attributed to higher estradiol levels. Estradiol has been shown to enhance proliferative and mitogenic activities of thyroid cells. However, in recent years chronic estradiol treatment has been shown to reduce volume densities of thyroid follicles, follicular epithelium and thyroid gland volume. It is thought to be due to LH suppression.Therefore we suggested that increased LH levels might provide a stimulus for growth on thyroid and alter thyroid function. Therefore patients with PCOS who had elevated LH levels should be treated by combined estradiol pills such as estrogen-progestin contraceptives for suppression of LH secretion. Further studies are needed to evaluate the association between LH, LH suppression and thyroid volume in patients with PCOS.

Parathyroid adenoma screening efficacies of different imaging tools and factors affecting the success rates.

PURPOSE: We aimed to compare the efficacy of three different parathyroid adenoma screening tools--high-resolution ultrasonography (USG), technetium Tc 99m-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy, and magnetic resonance imaging (MRI)--and we evaluated the factors affecting the detection success rates. METHODS: Parathyroid imaging was evaluated by USG, double-phase 99mTc-MIBI parathyroid scintigraphy, and cervical MRI in patients with hyperparathyroidism (n=39). RESULTS: Among the 39 patients, USG, parathyroid scintigraphy, and MRI correctly identified 35 adenomas (89.7%), 28 adenomas (71.8%), and 26 adenomas (66.7%), respectively. Positive predictive values for USG (34/35), scintigraphy (27/28), and cervical MR (26/26) imaging were 97.1%, 96%, and 100%, respectively. Parathyroid adenomas were detected with 92.3% (36/39) certainty when both USG and scintigraphy modalities were applied together. Minimally invasive parathyroidectomy under local anesthesia with unilateral incision was successfully performed in 24 (61.5%) patients. CONCLUSIONS: Minimally invasive surgery for parathyroid adenomas has been developed and has equal success with traditional surgery. However, accurate localization of adenomas should be obtained prior to surgery. In this study, ultrasound was found to be effective in localizing adenomas for successful surgery. Adding other imaging modalities does not improve localizing the parathyroid adenomas.