Serum TSH, 25(OH) D and phosphorus levels predict weight loss in individuals with diabetes/prediabetes and morbid obesity: a single-center retrospective cohort analysis.

BACKGROUND: To evaluate the association of vitamin D and thyroid-stimulating hormone (TSH) with weight loss (WL) percentage (%) in patients with diabetes/prediabetes and Class II/III obesity. METHODS: A retrospective cohort study was designed. Data were collected from a database of a referral endocrinology clinic that is prospectively and systematically generated. After exclusion of unavailable cases, the study enrolled 285 patients (51 ± 11 years old, female/male = 208/77; diabetes/prediabetes = 159/126; no/on levothyroxine replacement = 176/109; Class II/III obesity = 184/101, respectively) who maintained euthyroidism and were followed up for ≥6 months. The data were analyzed to determine the predictors of WL%. RESULTS: Compared with baseline, in the median 22 months of follow-up, the whole study group lost 5.1% of their baseline body weight. As most obesity management trials define success as 'at least 10% of WL compared to baseline', we stratified the patients based on WL% extents. The distribution was as follow: Group 1 (n = 61) lost ≥10% body weight, Group 2 (n = 162) lost < 10% body weight, while Group 3 (n = 62) gained weight by the final visit. In groups 1 and 2 (weight losers), the serum thyroid stimulatig hormone (TSH) and parathyroid hormone (PTH) levels decreased and the free thyroxine (fT4), calcium, phosphorus, and 25-hydroxyvitamin D (25(OH)D) levels increased. In Group 3 (weight gainers), these changes were not observed (except for an increase in calcium levels). Regression analysis revealed that the final visit TSH (ß = - 0.14, p < 0.05), 25(OH) D (ß = 0.15, p < 0.05), and phosphorus (ß = 0.20, p < 0.05) levels predicted WL%. However, if patients with autoimmune thyroiditis were excluded from the analysis, the decrease in TSH levels was not statistically significant. CONCLUSIONS: Serum TSH, phosphorus, and 25(OH) D levels predict WL% in euthyroid patients with diabetes/prediabetes and morbid obesity. TSH predictivity seems to be a function of thyroid autoimmunity present with increased frequency in this cohort. Greater levels of phosphorus within the reference range and a sufficient vitamin D status are associated with a greater WL%.

Occult Adrenal Insufficiency in Renal Amyloidosis Patients.

OBJECTIVE: Systemic amyloidosis may affect many organs, and may cause endocrinologic problems which may result in adrenal insufficiency. However, assessment of adrenocortical reserve is challenging in amyloidosis patients with renal involvement. We aimed to evaluate adrenocortical reserve with various methods of cortisol measurement to determine any occult clinical condition. METHODS: Patients with renal amyloidosis and healthy subjects were evaluated in this cross-sectional study. Basal cortisol, corticosteroid-binding globulin (CBG), and albumin levels were measured. Serum free cortisol (cFC) level was calculated. Cortisol response tests performed after ACTH stimulation test (250 µg, intravenously) were evaluated, and free cortisol index (FCI) was calculated. RESULTS: Twenty renal amyloidosis patients, and 25 healthy control subjects were included in the study. Patients and control subjects had similar median serum baseline cortisol levels [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)] whereas patients' stimulated cortisol levels at the 60th minute were lower [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. The 60th-minute total cortisol levels of 8 of the 20 (40%) amyloidosis patients were <500 nmol/L, but only three of these 8 patients had stimulated FCI <12 nmol/mg suggesting an adrenal insufficiency (15%). CONCLUSION: ACTH stimulation test and cortisol measurements should be considered in renal amyloidosis patients with severe proteinuria to avoid false positive results if only ACTH stimulation test is used. It will be appropriate to evaluate this group of patients together with estimated measurements as FCI.

Urinay neutrophil gelatinase-associated lipocalin as a biomarker in different renal problems

Background/aim: Neutrophil gelatinase-associated lipocalin (NGAL) is used previously to estimate the etiology, severity, and clinical outcomes of acute kidney injury (AKI). However, the role of urinary NGAL (uNGAL) in the postrenal setting is not clear. In our study, we aimed to discover the cut-off value of uNGAL that can be used in the differential diagnosis of underlying AKI etiologies. Materials and methods: In this prospective cross-sectional study, we examined 82 subjects in four groups: patients that had (1) postrenal AKI; (2) AKI other than postrenal etiologies; (3) stable chronic kidney disease; and (4) healthy subjects. A renal function assessment was carried out by measuring serum creatinine (sCr) and uNGAL at the time of diagnosis [0th min (T0)]. We followed the study group for three months. Results: At the time of diagnosis, sCr (T0) was highest in the postrenal AKI and AKI groups in contrast to stable chronic kidney disease patients and healthy subjects (P < 0.001), as expected. T0 median uNGAL was highest in the postrenal group (P < 0.001). Area under curve (AUC) of uNGAL to estimate postrenal AKI presence was 0.957 (95% CI, 0.897­1.000; P < 0.001). The cut-off point of uNGAL was 42.625 ng/mL for this estimation. Conclusion: Patients with AKI must be classified according to the underlying etiologies as soon as possible. uNGAL may be useful to estimate the etiologies, and whether the problem is acute or chronic in the course. In postrenal kidney problems, to plan the urgency of the urologic procedures, it is crucial.

The relation between serum cathepsin D level and carotid intima-media thickness in nondiabetic hypertensive patients.

BACKGROUND/AIM: We aimed to investigate the relation between carotid intima-media thickness (CIMT) and serum cathepsin D level in hypertensive patients. MATERIALS AND METHODS: This was a cross-sectional study of 74 hypertensive patients (22 males and 52 females, with a mean age of 51.86 ± 11.75 years). Serum levels of cathepsin D were measured with an enzyme-linked immunosorbent assay. CIMT measurements were taken from 3 different points: right and left common carotid arteries, bifurcation, and the first 2 cm of the internal carotid artery. Mean CIMT was calculated by averaging the measurements taken 3 times from each carotid artery. RESULTS: Mean CIMT value was 0.76 ± 0.15 mm, and median cathepsin D level was 190.3 (12.8-2681.3) ng/mL. A marked positive correlation was found between cathepsin D levels and CIMT (r = 0.331, P = 0.04). In multivariate linear regression analysis, cathepsin D, albumin levels, and the duration of hypertension were significant predictors of CIMT (P = 0.017, P = 0.008, and P = 0.043, respectively). CONCLUSIONS: Increased serum cathepsin D level was found to be associated with CIMT in nondiabetic hypertensive patients.

Prognostic factors in crescentic glomerulonephritis: a single-center experience.

INTRODUCTION: Crescentic glomerulonephritis (CGN) is a fatal disease, rapidly leading to end-stage renal disease. Diagnosis should be accurate and treatment should be started immediately. We investigated the factors associated with the renal prognosis in CGN patients. MATERIALS AND METHODS: Forty-one patients with CGN who were followed up at the Nephrology Clinic of Ankara Numune Education and Research Hospital were divided into 2 arms of the dialysis-dependent group after treatment and the group that was followed up without dialysis. Demographic and clinical features along with biopsy findings during time of diagnosis were evaluated for both groups. RESULTS: The mean age was 41.3 ± 17.2 years old and 26 were men. Twenty patients developed end-stage renal disease, requiring long-term dialysis. The dialysis-dependent group had higher serum creatinine levels (8.2 ± 3.6 mg/dL versus 2.6 ± 2.5 mg/dL) and percentages of glomeruli with crescent (83.1 ± 19.1% versus 56.4 ± 11.9%), were more likely to have oligoruia-anuria (90.5% versus 9.5%) and be dialysis-dependent at admission (86.4% versus 13.6%), and had longer elapsed time until the beginning of treatment (18.9 ± 10.4 days versus 10.6 ± 3.0 days) after treatment. At admission, their serum creatinine was greater than 4.2 mg/dL and the rate of crescentic glomeruli was greater than 63%. CONCLUSIONS: In patients with CGN, renal prognosis is poor and the time of admission to the hospital, degree of renal insufficiency, presence of oligo-anuria, dialysis requirement, and the percentage of crescentic glomeruli on biopsy are closely related to progression to end-stage renal disease.

Coexistence of autosomal dominant polycystic kidney disease and amyloidosis in a patient with nephrotic-range proteinuria.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the development and growth of cysts in the kidneys. Non-nephritic-range proteinuria is a common presentation in ADPKD patients; however, nephrotic syndrome is a rare coincidence. A 52-year-old man is described who was diagnosed with secondary amyloidosis with ADPKD. To our knowledge, this is the first case of amyloidosis associated with frequently infected renal cysts. Patients with ADPKD who show massive proteinuria should be investigated in terms of concomitant glomerular disease.

Endobronchial metastasis of thyroid follicular carcinoma.

Well-differentiated forms of thyroid cancer, including follicular carcinoma, usually have good prognoses. But they are also known to metastasize to the bones, lungs and central nervous system. Endobronchial metastasis is exceptionally rare. In this paper, we report on a patient with endobronchial metastasis of follicular thyroid carcinoma. A 77-year-old male patient presented to our hospital with hemoptysis and a growing mass over the right clavicula. Computerized tomography (CT) of the chest revealed multiple lung metastases. Flexible bronchoscopy revealed a fragile polypoid mass of 1.5 cm, 6 cm distal to the vocal cords. Biopsy from the supraclavicular mass was consistent with follicular thyroid carcinoma. Taking into account the advanced nature of the disease as well as the general condition and age of the patient, aggressive treatment modalities were not considered in the management. Palliation for hemoptysis was attained by external radiotherapy. After radiotherapy, hemoptysis did not recur, and the patient was discharged. Although endobronchial metastasis of thyroid follicular carcinoma is very rare, the presence of endobronchial metastasis may be life threatening due to massive hemoptysis, and such a lesion must be suspected in any cancer patients presenting with hemoptysis.