Metabolic effects of dopamine-agonists treatment among patients with prolactinomas.

PURPOSE: To evaluate the effect of cabergoline treatment on metabolic parameters including the Triglyceride-glucose (TyG) index in newly diagnosed patients with prolactinoma. METHODS: 71 consecutive nondiabetic patients with prolactinoma were enrolled. Anthropometric and laboratory tests including TyG index were measured at baseline, 3 and 6 months visits. Treatment with cabergoline at the dose of 0.25 mg twice weekly was started and increased according to prolactin levels and continued for 6 months. RESULTS: At the baseline examination, the mean (SD) age, body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of patients were 36.2 (10.5) years, 29.2 (5.0) kg/m2, 98.2 (13.7) cm, 115.3 (13.3) mmHg, and 71.4 (8.1) mmHg, respectively. Forty-one (57.7%) of patients were women and 46 (64.8%) had microadenoma. Cabergoline treatment significantly improved anthropometric and metabolic measures including BMI, WC, fasting plasma glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid (only among women), TyG index, and hypogonadism. Blood pressure (both systolic and diastolic) levels remained steady except for a significant decrease in DBP after 6 months of treatment only among women. A declining trend in MetS prevalence was found from baseline to a 3-month evaluation in both genders which was statistically significant among men. CONCLUSION: Short-term treatment with cabergoline can significantly improve cardiovascular risk factors except for blood pressure. Moreover, the TyG index as a surrogate marker of insulin resistance decreased significantly after the reduction of prolactin by treatment. Generally, results were similar among both genders.

Randomized Study of the Effects of Zinc, Vitamin A, and Magnesium Co-supplementation on Thyroid Function, Oxidative Stress, and hs-CRP in Patients with Hypothyroidism.

Hypothyroidism can occur due to deficiencies in micronutrients such as zinc, magnesium, and vitamin A. The aim of this study was to determine the effects of supplementation with these micronutrients on thyroid function, oxidative stress, and hs-CRP levels in patients with hypothyroidism. In a randomized double-blind, placebo-controlled trial with two parallel groups, 86 hypothyroid patients aged 20-65 were allocated to receive daily supplementation with either: (intervention group, n = 43) one 30 mg zinc gluconate capsule per day, one 250 mg magnesium oxide tablet per day, and one 25,000 IU vitamin A capsule twice/week for 10 weeks or (placebo group, n = 43) placebo capsules and tablets as above for 10 weeks. Neither of the groups changed their diet or physical activity. Thyroid hormones (free and total thyroxine (FT4 and TT4), free tri-iodothyronine (FT3), and thyroid-stimulating hormone (TSH)), oxidative markers (malondialdehyde (MDA) and total antioxidant capacity (TAC)), serum hs-CRP, and anthropometric indices (height and weight) were assessed at the baseline and at the end of the study. In the intervention group, we found a significant increase in serum FT4, decreased anthropometric indices, and lower levels of serum hs-CRP by the end of the 10 week protocol (P < 0.05). In the placebo group, serum TAC was decreased and hs-CRP increased (P < 0.05), with no significant changes in serum TSH, FT3, TT4, and MDA after the intervention. Zinc, vitamin A, and magnesium supplementation may have beneficial effects in patients with hypothyroidism and in diseases associated with hyperthyroidism.

Adrenal Insufficiency in Septic Patients Admitted to Intensive Care Unit: Prevalence and Associated Factors.

Background: Adrenal insufficiency (AI) is associated with an increase in the risk of mortality in ICU-admitted septic patients. It should be suspected not only in patients with septic shock but also in those with sepsis. The aim of this study was to investigate the prevalence of AI in the spectrum of septic patients and determine the main predictors of this condition. Methods: This study included 99 patients with the diagnosis of sepsis, severe sepsis, or septic shock. Patients with basal cortisol < 10 µg/dl or those with ∆ cortisol < 9 µg/dl after the cosyntropin test were considered as having AI. Appropriate statistical tests were used for comparing the variables between the two groups. A logistic regression model was applied to determine the predictors of AI. The P-value <0.05 was considered as a significant level. Results: AI was found in 25 (25.3%) of these patients. There was no significant difference in the occurrence of AI in patients with sepsis, severe sepsis, or septic shock. Patients with positive blood culture (OR (95% CI); 7.8 (3.5-9.1); p=0.021) or those with CRP≥ 3+ (OR (95% CI); 14.1 8 (5.7-16.2); p<0.001) were more likely to develop AI. Conclusion AI is prevalent among ICU admitted septic patients even in the absence of septic shock. The main predictors of AI are high levels of CRP and positive blood culture.

Restless Legs Syndrome in Iranian People With Type 2 Diabetes Mellitus: The Role in Quality of Life and Quality of Sleep.

STUDY OBJECTIVES: To investigate the prevalence of restless legs syndrome (RLS) in patients with type 2 diabetes mellitus (T2DM) and explore its role in quality of life (QoL) and quality of sleep of these patients. METHODS: This is a cross-sectional study performed on 210 Iranian people with T2DM. The diagnosis of RLS was established based on the essential diagnostic criteria for RLS recommended by the National Institutes of Health. Sleep quality and QoL were assessed in all participants using Pittsburgh Sleep Quality Index and EuroQol five-dimension questionnaire, respectively. Regression models were used for final analysis of data. RESULTS: The prevalence of RLS was 19.5%; of whom 38.1% had poor quality of sleep. Male sex, being single, body mass index (BMI), and RLS were associated with poor quality of sleep. Patients with RLS were almost three times as likely as the patients without RLS to have poor sleep quality. Moreover, being female, BMI value, level of glycosylated hemoglobine (HbA1C), and RLS were associated with lower QoL. RLS lowers the score of QoL even more than BMI and HbA1C. In addition, the QoL and sleep quality of this population of patients with diabetes have not been affected by the severity of RLS as well as presence or absence of neuropathy. CONCLUSIONS: RLS has an independent and significant role in sleep quality and QoL in the patients with diabetes. Neuropathy with RLS does not confer any additive burden on QoL and sleep quality of this population of patients with diabetes.

Changes in the size of the thyroid in patients with benign non-toxic multinodular goiter after radioactive iodine therapy.

Background: Multinodular goiter (MNG) is regarded as one of the most common causes of hyperthyroidism, particularly in areas of mild-to-moderate iodine deficiency. The present study aims to explore the effects of the radioactive iodine (RAI) therapy on benign non-toxic MNG and evaluate its side effects. Methods: Patients with benign non-toxic MNG entered the study. Ultrasonography was applied to calculate the percentage of the decrease in the size of the thyroid before and six months minimum after the treatment. Chi-square, Mann-Whiteny-U and T-test were done using SPSS v.18.0 (p<0.05). Results: The volumes of the thyroid lobes and nodules decreased significantly due to RAI therapy (p<0.001). The total volume of the thyroid, volume of the right nodule, and volume of the left nodule decreased by 77.8%, 40.7%, and 34.6% respectively. Conclusion: According to the results of the current study, RAI therapy is an effective treatment method although it has short-term side effects. This treatment option is recommended for patients with benign non-toxic MNG, notably those who cannot be a candidate for surgery. This treatment affects the size of the thyroid and its nodules significantly and decreases almost all of the complications.

Relationship Between Obesity and Liver Enzymes Levels in Turner's Syndrome.

BACKGROUND: Liver enzyme abnormalities have been reported in Turner's syndrome (TS). There are some studies about possible causes of abnormal levels of liver enzymes. One of the main suggestions is obesity. The study aimed to determine the relationship between obesity and liver enzymes levels in patients with TS. METHODS: Forty-one karyotype-proven TS patients referred to Endocrinology and Metabolism Research Center were included in this cross-sectional study. Height and weight of patients were measured and their body mass index (BMI) was calculated. The patients were divided into two groups as the control group including 27 cases (65.8%) with normal BMI (defined as < 85th percentile for age and gender), and the overweight group including 14 cases (34.2%) (defined as BMI > 85th percentile for age and gender). Serum levels of aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (AlkPh) were measured. RESULTS: There were no statistically significant differences regarding AST (27 ± 2.7 vs. 29.6 ± 5.85 U/L; P = 0.3), ALT (20.1 ± 2.45 vs. 22.2 ± 5.85 U/L; P = 0.5), and AlkPh (583.4 ± 2.45 vs. 472.8 ± 161.5 U/L; P = 0.28) between overweight TS patients and those with normal BMI. CONCLUSION: There was no significant difference in liver enzyme levels between TS patients with normal BMI and those who were overweight.

Effects of Zinc and Selenium Supplementation on Thyroid Function in Overweight and Obese Hypothyroid Female Patients: A Randomized Double-Blind Controlled Trial.

OBJECTIVE: Zinc (Zn) and selenium (Se) are essential trace elements involved in thyroid hormone metabolism. This study was conducted to investigate the effects of Zn and Se supplementation on thyroid function of overweight or obese female hypothyroid patients in a double-blind, randomized controlled trial. METHODS: Sixty-eight female hypothyroid patients were randomly allocated to one of the 4 supplementation groups receiving Zn + Se (ZS; 30 mg Zn as zinc-gluconate and 200 µg Se as high-selenium yeast), Zn + placebo (ZP), Se + placebo (SP), or placebo + placebo (PP) for 12 weeks. Serum Zn, Se, free and total triiodothyronine (FT3 and FT4), free and total thyroxine (FT4 and TT4), thyroid-stimulating hormone (TSH), and anthropometric parameters were measured. Dietary intake was recorded using 24-hour food recall. Physical activity questionnaire was completed. RESULTS: No significant alterations were found in serum Zn or Se concentrations. Mean serum FT3 increased significantly in the ZS and ZP groups (p < 0.05) but this effect was significant in the ZP group compared to those in SP or PP groups (p < 0.05). Mean serum FT4 increased and TSH decreased significantly (p < 0.05) in the ZS group. TT3 and TT4 decreased significantly in the SP group (p < 0.05). Mean FT3:FT4 ratio was augmented significantly in the ZP group (p < 0.05). No significant treatment effects were found for TT3, FT4, TT4, or TSH between groups. CONCLUSION: This study showed some evidence of an effect of Zn alone or in combination with Se on thyroid function of overweight or obese female hypothyroid patients.