Treatment of hypothyroidism improves glomerular filtration rate (GFR) in geriatric patients

Background/aim: Renal function of patients with hypothyroidism increases after reaching euthyroid state. There is no data regarding geriatric age group. The aim of the study was determined to investigate whether renal function of geriatric patients with hypothyroidism increases after they become euthyroid. Materials and methods: Patients who were sixty-five years or older were retrospectively screened in two centers. TSH, T3, T4, creatinine, and eGFR calculated by CKD-EPI formula were recorded under the presence of accompanying hypothyroidism. The same variables were recorded after the patients became euthyroid. Results: 285 patients were included in the study, the median age was 73(65­84), and 234 patients were female. Patients were examined in four groups according to TSH values. There were 160 (56.1%) patients with TSH 5­9.9 uIU/mL, 60(21.1%) patients with TSH between 10­19.9 uIU/mL, 41(14.4 %) patients with TSH between 20­49.9 uIU/mL and 24(8.4%) patients with TSH> 50uIU/mL. There was a significant and negative correlation between the initial TSH values and the first calculated eGFR values (p: 0.001; r: ­0.191). The median eGFR of the patients in hypothyroid cases was 66.59 (14.62­116.07), while the median eGFR value of patients was 69.6 (12.91­109.31) in the euthyroid state. This value obtained after thyroid replacement was significantly improved when compared to the first eGFR (p: 0.001). In logistic regression analysis, pretreatment TSH value was found to independently affect eGFR (p: 0.009; Exb: 1.017). Conclusion: It has been observed that hypothyroidism treatment increases eGFR in geriatric patients. Similar results were obtained after studies with younger patients in the literature. This study is a study in which only geriatric age group patients were examined. It should be kept in mind that hypothyroidism which is not corrected in geriatric patients may also contribute to a decrease in eGFR.

Trimester-specific reference intervals of thyroid function tests in Turkish pregnants.

Physiological changes in hormone levels occur in thyroid gland during pregnancy. Screening of the thyroid hormone levels and determining trimester-specific reference intervals in pregnancy are important. Guidelines recommend the use of trimester-specific reference ranges for each country. The aim of this study is to determine trimester-specific thyroid function reference intervals for pregnancy in Turkish population. In total, 5000 patients were screened out of which 1258 patients have all of fT3, fT4 and TSH levels measured, were included in the study. Patients were grouped as follows: 482 women were in first trimester, 361 women were in second trimester, and 415 women were in third trimester. All analyses were performed by means of chemiluminescence methods (Liaison®; DiaSorin S.p.A., Saluggia, Italy). The TSH reference intervals were 0.005-3.65, 0.01-3.63, and 0.2-3.46 mIU/L at the first, the second, and the third trimesters of pregnancy, respectively. The fT4 reference intervals were 0.72-1.79, 0.71-1.26, and 0.65-1.12 ng/dL at the first, the second, and the third trimesters, respectively. The fT3 reference intervals were 2.45-4.03, 2.37-3.85, and 2.31-3.77 ng/dL at the first, the second, and the third trimesters, respectively. It is crucial to determine population- and gestational-specific reference intervals for trustworthy treatment of pregnants.

Renal function improves with the treatment of hypothyroidism.

BACKGROUND: It has been known that thyroid hormones may affect renal function. In this study, we aimed to investigate the effect of levothyroxine replacement on renal function in hypothyroid patients before and after treatment. METHODS: We retrospectively investigated free T3 (fT3), free T4 (fT4), TSH, creatinine, and eGFR measurements during both hypothyroid and euthyroid states of hypothyroid patients. The eGFR was calculated using the simplified Modification of Diet in Renal Disease formula. RESULTS: fT3, fT4, and eGFR measurements increased, meanwhile creatinine and TSH levels decreased significantly after euthyroidism was achieved with levothyroxine treatment (p < 0.0001 for all). The correlation analyses revealed that ∆creatinine and ∆TSH levels were significantly correlated before and after levothyroxine treatment (r: 0.288, p < 0.0001). ∆eGFR and ∆TSH levels were significantly correlated before and after LT4 treatment (r: -0.272, p < 0.0001). CONCLUSION: In this study, we evaluated creatinine and eGFR levels in patients with hypothyroidism and found out that renal function improved in most patients after euthyroidism was achieved. In some patients, above-normal creatinine levels completely returned to normal once the patients became euthyroid.

The effect of isotretinoin on retinol-binding protein 4, leptin, adiponectin and insulin resistance in acne vulgaris patients.

BACKGROUND: The effect of isotretinoin (ISO) on adipokines and insulin resistance has been investigated in a few studies, and the results are conflicting. OBJECTIVE: The aim of this study was to investigate the effect of ISO treatment on insulin resistance and adipokines. METHODS: Thirty-three patients with acne vulgaris and a control group of 30 healthy volunteers were included in our study. Screening for the biochemical parameters was performed just before the initiation and after 3 months of ISO treatment. RESULTS: In the acne group, basal leptin levels were significantly lower (p = 0.003) and basal adiponectin levels significantly higher (p = 0.008) compared with the control group. After ISO treatment, leptin levels (p = 0.0005) decreased and adiponectin levels (p = 0.003) increased significantly. However, measurements of fasting blood glucose, insulin, C peptide, retinol-binding protein 4 (RBP4), homeostasis model assessment insulin resistance and BMI did not differ after ISO treatment. CONCLUSION: ISO may affect leptin and adiponectin levels. It does not, however, affect insulin resistance and RBP4 levels.

The effect of different doses of isotretinoin on pituitary hormones.

BACKGROUND: There are a limited number of studies investigating the side effects and effectiveness of various doses of isotretinoin (ISO). We have previously shown that high-dose ISO affects pituitary hormones. OBJECTIVES: To our knowledge, there is no study in the literature looking into the effects of various doses of ISO on pituitary hormones. We searched pituitary hormones in three groups of different doses in acne patients. METHODS: We included 105 acne vulgaris patients from two different centers. We divided the patients into three groups; the first group received 0.5-1 mg/kg/day, the second 0.2-0.5 mg/kg/day and the third intermittent 0.5-1 mg/kg/day (only 1 week in 1 month) ISO treatment. Blood samples were collected for biochemistry and hormone analysis, before the treatment and after 3 months. RESULTS: After 3 months of treatment with ISO, luteinizing hormone (LH) (p < 0.001), prolactin (p < 0.001), total testosterone (p < 0.001), adrenocorticotropic hormone (ACTH) (p < 0.001), cortisol (p < 0.001), insulin-like growth factor-binding protein 3 (p < 0.001), insulin-like growth factor 1 (IGF-1) (p = 0.002), growth hormone (GH) (p = 0.002) and free T3 (fT3) (p < 0.001) levels had decreased significantly. Furthermore, we split data into three different groups. Among the patients receiving intermittent-dose ISO, LH, ACTH, IGF-1, GH and fT3 measurements lost significance. Most of the significant measurements observed in the whole group were also significant among the patients receiving high-dose ISO. Additionally, dehydroepiandrosterone sulfate (p = 0.003) levels increased, and free T4 levels decreased significantly. CONCLUSIONS: ISO affects pituitary hormones at all of these three doses. The differences in pituitary hormones are more pronounced in high-dose treatment. The weakest effect was observed in the intermittent-dose group. Choosing lower doses of ISO may decrease side effects, however the effectiveness of the treatment may also be diminished. ISO, by affecting the PPARγ/RXR system, may affecting hormone systems. These changes in various hormone systems may be related to the effectiveness of ISO.

High-sensitivity C-reactive protein is a strong predictor of non-alcoholic fatty liver disease.

BACKGROUND/AIMS: Non-alcoholic fatty liver disease (NAFLD) is a clinical term that covers simple fatty liver (SFL) and non-alcoholic steatohepatitis (NASH), and high-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation. The aim of the present study was to investigate the relationship between steatosis and hs-CRP in patients with ultrasonographically verified NAFLD. METHODOLOGY: We examined 296 consecutive patients. NAFLD was detected by ultrasound (US). Patients with NAFLD who had an alanine aminotransferase (ALT) level of > 40 IU/mL were considered to have NASH and those with normal liver function test results were considered to have SFL. Patients who did not have NAFLD constituted the control group. The SFL, NASH and control groups were compared in terms of hs-CRP levels. RESULTS: Of 296 patients, 86 had normal hepatic US findings and 210 had hepatosteatosis. Hs-CRP levels were higher in patients with NAFLD as compared to the control group (0.68 mg/ dL vs. 0.34 mg/dL, respectively; P < 0.05). There was no significant difference between patients with SFL and NASH in terms of hs-CRP levels (P > 0.05). Logistic regression analysis revealed that hs-CRP was a strong predictor of NAFLD (odds ratio: 6.04; 95% confidence interval: 2.08-17.74). CONCLUSIONS: hs-CRP can be used as a non-invasive marker of NAFLD as it was found to be a strong predictor of NAFLD in this study.

Re-emergence of a forgotten diabetes complication: Euglycemic diabetic ketoacidosis.

Diabetic ketoacidosis (DKA) is the most common emergency complication of diabetes. Euglycemic DKA (EDKA), on the other hand, has been known for many years but is a rare and under-recognized condition and constitutes a very small proportion of DKA cases. However, in recent years, an increase in the incidence of EDKA has been observed with the widespread use of sodium-glucose co-transporter 2 inhibitors, which have proven benefits in the treatment of diabetes mellitus and its cardiorenal complications, heart failure, and chronic kidney disease. Unlike classical DKA, these patients without significant hyperglycemia can easily be missed in emergency departments. EDKA should be kept in mind in patients with diabetes presenting with DKA but with a blood glucose level <250 mg/dL. The diagnostic and therapeutic approach after clinical suspicion in these patients is similar to classical DKA and is briefly summarized in this review. The most important point in treatment is that these patients are normoglycemic but have a significant insulin deficiency (relative or absolute). Therefore, insulin is the mainstay of the treatment and should be given together with dextrose solutions to avoid hypoglycemia.

The effect of acitretin treatment on insulin resistance, retinol-binding protein-4, leptin, and adiponectin in psoriasis vulgaris: a noncontrolled study.

BACKGROUND/AIM: To investigate the effects of acitretin treatment on insulin resistance (IR) and adipokines, particularly retinol-binding protein (RBP)-4. METHODS: Thirty-four patients with chronic plaque psoriasis and a control group of 34 healthy volunteers were recruited in the study. Screening for the parameters was performed before starting and after 3 months of acitretin treatment in the psoriasis group. The control group was only evaluated at the beginning of the study and did not receive placebo. We could not compare our results with a placebo control group because of ethical reasons. RESULTS: Basal adiponectin (p = 0.01), insulin (p < 0.0001) levels and homeostasis model assessment (HOMA) IR (p < 0.0001) were significantly higher in psoriasis patients. After the treatment, insulin (p = 0.014), C peptide (p = 0.011), RBP-4 (p < 0.0001) levels and HOMA-IR (p = 0.008) decreased significantly. Posttreatment leptin (p = 0.036) levels were significantly lower than those of the controls. Posttreatment adiponectin (p = 0.005) and insulin (p = 0.048) levels were higher than those of the controls. CONCLUSIONS: This study showed for the first time that RBP-4 levels and IR are decreased significantly with acitretin treatment. This finding is very important in psoriasis patients because psoriasis may cause insulin resistance and diabetes. Further experimental and clinical studies are needed to clarify the effect of acitretin on adipocyte structure and behavior.

Insulin resistance is increased in alopecia areata patients.

Increased insulin resistance (IR) has been found in androgenetic alopecia in several studies. However, IR has not been investigated in alopecia areata (AA). We aimed to investigate IR in AA patients and the controls. Anthropometric and demographic data were obtained from 51 AA patients and 36 controls. We measured insulin, c-peptide and blood glucose and HOMA-IR. Demographic characteristics of the two groups were similar. AA group had higher insulin [12.5 ± 7.01 vs. 8.3 ± 3.9 µIU/mL, p = 0.001], c-peptide [2.7 ± 1.07 vs. 2. ± 0.6 ng/mL, p = 0.007] and HOMA-IR levels [2.8 ± 1.6 vs. 1.9 ± 0.9, p = .004] than the controls. Patient and control groups were also similar regarding lipid profiles. In this study, we found increased IR in AA patients for the first time in literature. Increased inflammatory cytokines and hypothalamic-pituitary-adrenal axis activation may be responsible for this finding. Further studies with larger sample sizes may give additional information for IR in AA.

Serum holotranscobalamine, vitamin B12, folic acid and homocysteine levels in alopecia areata patients.

Alopecia areata has been associated with many autoimmune diseases. There is a common belief that the prevalence of pernicious anemia is increased in patients with alopecia areata. In this study, we sought to investigate vitamin B12, folate and homocysteine metabolism in alopecia areata. We measured holotranscobalamine (holoTC), vitamin B12, folate and homocysteine levels in 75 patients with alopecia areata and 54 controls. We did not find any significant differences in these parameters between these groups. We think that alopecia areata may not be associated with vitamin B12 deficiency. The co-occurrence of pernicious anemia and alopecia areata in rare autoimmune syndromes, may not justify routine measurements of these parameters in alopecia areata patients.

The effect of vitamin D status on non-alcoholic fatty liver disease: a population-based observational study.

INTRODUCTION: The effect of vitamin D status on steatosis has not been fully elucidated. In this study, we planned to investigate this interaction using a large-scale population-based cohort. MATERIAL AND METHODS: Patients diagnosed with simple steatosis (K76.0) and non-alcoholic steatohepatitis (NASH) (K75.8) by using the International Classification of Diseases 10th Revision (ICD-10) coding system, and who had 25-hydroxyvitamin D (25OHD) measurements at the diagnosis, were included in the study. Control group comprised subjects without liver diseases. Age, gender, alanine aminotransferase (ALT) and 25OHD levels, and the date of the measurements were recorded. RESULTS: We compared ALT and 25OHD measurements between the patient and control groups, and between the simple steatosis and NASH subgroups. 25OHD levels were lower and ALT levels were higher in the patient group (p < 0.001, effect size = 0.028, and p < 0.001, effect size = 0.442, respectively). Logistic regression analysis showed that when 25OHD levels decrease by 1 ng/dL, it increases the risk of being in the patient group by 3.7%. CONCLUSION: Our results suggest that vitamin D status may be related to the development of non-alcoholic fatty liver disease (NAFLD). Although this relationship is weak, it may be important in the pathogenesis of steatosis.

Serum 25-hydroxyvitamin D levels are correlated with mitral valve calcification score in patients with rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Rheumatic mitral stenosis (RMS) is a chronic disease related to autoimmune heart valve damage after streptococcal infection. Epidemiological evidence supports an association between vitamin D and the susceptibility and severity of autoimmune disorders. The study aim was to assess the serum levels of 25-hydroxyvitamin D and their correlation with Wilkins calcification score in patients with RMS. METHODS: Thirty-four patients with RMS and 29 healthy age- and gender-matched controls were enrolled in the study. All subjects underwent transthoracic echocardiography after a complete medical evaluation and laboratory examination. The planimetric mitral valve area and Wilkins score were evaluated for all patients, and biochemical parameters and serum levels of 25-hydroxyvitamin D and calcitriol were determined. RESULTS: The mean patient age was similar in the RMS and control groups (50 +/- 10 versus 52 +/- 10 years; p = NS). The serum level of 25-hydroxyvitamin D was significantly lower in RMS patients than in controls (8.6 ng/ml; range: 4.9-26.3 ng/ml versus 12.3 ng/ml; range: 4-158 ng/ml; p = 0.031). A significantly moderate inverse correlation was identified between the serum 25-hydroxyvitamin D level and the Wilkins score (r = -0.567, p < 0.001), but no correlation was identified between 25-hydroxyvitamin D levels and other echocardiographic parameters of mitral stenosis. The serum level of calcitriol was also significantly lower in RMS patients than in controls (19.8 pg/ml; range: 16.0-54.6 pg/ml versus 26.1 pg/ml; range: 13.2-47.0 pg/ml; p = 0.013). CONCLUSION: The study results showed that serum levels of 25-hydroxyvitamin D were significantly lower in RMS patients than in controls, and also correlated with the Wilkins calcification score. Thus, a link may exist between 25-hydroxyvitamin D and the calcification process in RMS.

Elevation of B-type natriuretic peptide level in asymptomatic hepatitis B virus-positive patients is not associated with abnormalities of cardiac function.

OBJECTIVES: To compare B-type natriuretic peptide (BNP) and echocardiographic parameters in patients with hepatitis B virus (HBV) and healthy control subjects. SUBJECTS AND METHODS: 52 consecutive patients with HBV and 47 healthy controls were examined. All subjects underwent transthoracic echocardiography after a complete medical history and laboratory examination including BNP, C-reactive protein (CRP) and high-sensitivity CRP (hsCRP). RESULTS: Demographic characteristics were similar in patients with HBV and the control group. No significant difference was found in conventional Doppler and tissue Doppler parameters between the two groups. BNP levels were significantly higher in patients with HBV [6.5 ng/l (range 0.5-85.2)] than controls [4.3 ng/l (range 0.5-18.3)], p = 0.039. hsCRP [3.25 mg/l (0.02-40.2) vs. 0.5 mg/l (0.02-8.0)] levels were significantly higher in patients with HBV than control subjects (p < 0.001). CONCLUSION: Patients with HBV had higher BNP, CRP, and hsCRP levels than controls. Echocardiographic findings were similar in both groups. This slight BNP elevation in HBV patients may be related to chronic inflammation due to HBV.

Therapeutic hotline. Does isotretinoin have effect on vitamin D physiology and bone metabolism in acne patients?

Isotretinoin is an effective therapy for severe nodulocystic acne. Several experimental studies suggest that it may have an effect on vitamin D physiology. In the present study, the authors aimed to investigate the effect of isotretinoin treatment on the metabolism of vitamin D in acne patients. A prospective analysis of 50 consecutive acne patients who were treated with isotretinoin for 3 months was done. Before and after 3 months of treatment, 25 hydroxy vitamin D, 1,25 dihydroxy vitamin D, and bone alkaline phosphatase, calcium, phosphate, and parathormone levels were measured. The 25 hydroxy vitamin D and serum calcium levels decreased significantly (p < 0.0001, p < 0.05, respectively), whereas 1,25 dihydroxy vitamin D, parathormone, and bone alkaline phosphatase levels increased significantly after 3 months of isotretinoin treatment (p < 0.005, p < 0.005, p < 0.0001, respectively). Aspartate aminotransferase, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels also increased significantly after isotretinoin treatment. This prospective clinical study showed that isotretinoin has an effect on vitamin D metabolism. Further clinical studies with longer periods of follow-up are needed to understand the effect of isotretinoin on vitamin D and bone metabolism.

Insulin resistance is increased in patients with vitiligo.

The aim of this study was to evaluate the relationship between vitiligo and insulin resistance (IR). A total of 96 subjects were included in the study; 57 patients with vitiligo and 39 subjects in an age and a body mass index-matched control group. In fasting blood samples, insulin, C-peptide, glucose, total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) were measured. IR was calculated with the homeostasis model assessment-IR (HOMA-IR) method. Comparison of the vitiligo and the control groups revealed that patients with vitiligo had higher IR (2.3 vs. 2.0, p < 0.01), higher insulin and C-peptide levels (p < 0.001, p < 0.001, respectively), higher LDL/HDL ratio and lower HDL-C levels (p < 0.01, p < 0.0001, respectively). Systolic blood pressures of patients with vitiligo were also higher compared with control subjects (p < 0.01). Further experimental and clinical studies are needed to elucidate the molecular mechanisms underlying this association.

Isotretinoin influences pituitary hormone levels in acne patients.

Besides suppressing sebum production, the exact mechanism of action of isotretinoin in acne vulgaris is not known. Several hormones have been linked to the pathogenesis of acne. In this study, we investigated the effects of isotretinoin on the pituitary-adrenal axis, whose activity may be increased in acne. Various hormone systems were evaluated before and after 3 months of isotretinoin treatment in 47 acne patients. Free triiodothyronine (T3), thyroid-stimulating hormone and thyroid-stimulating hormone receptor antibody levels decreased significantly during isotretinoin treatment (p < 0.001, p < 0.02 and p < 0.02, respectively), as did those of luteinising hormone, prolactin and total testosterone (p < 0.005), as well as morning cortisol and adrenocorticotropic hormone (p < 0.005 and p < 0.05, respectively). We conclude that isotretinoin causes mild suppression of pituitary hormone levels, which may be beneficial for tackling the pathogenesis of acne.

The metabolic syndrome is associated with complicated gallstone disease.

BACKGROUND: Gallstone disease (GD) is a common condition worldwide. Several studies demonstrated that the presence of gallstones is strongly associated with cardiovascular disease. The metabolic syndrome is a highly prevalent cardiovascular condition. OBJECTIVE: To examine the relationship between complicated GD (CGD) and the metabolic syndrome or its components. METHODS: Two hundred seventeen patients with gallstones were examined. All patients underwent biliary ultrasonography after a complete medical history and laboratory examination. Data collection for the diagnosis of metabolic syndrome included measurements of waist circumference, blood pressure and lipids, and biochemical tests. RESULTS: Of the 217 patients examined, 115 patients (53%) had CGD and 102 patients (47%) had uncomplicated GD (UCGD). There was a significant difference between the number of patients with large gallstones in the CGD and UCGD groups (n=14 [12%] versus n=2 [2%], respectively; P=0.004). Metabolic syndrome, diabetes mellitus and large waist circumference were more prevalent in the CGD group than in the UCGD group. Homeostatic model assessment of insulin resistance scores were higher in the CGD group than in UCGD group (2.51 [95% CI 0.57 to 23.90] versus 2.20 [95% CI 0.09 to 8.87], respectively; P=0.032). Logistic regression analysis revealed that the presence of metabolic syndrome (OR 1.434; 95% CI 1.222 to 1.846, P=0.014), diabetes mellitus (OR 1.493; 95% CI 1.255 to 1.953; P=0.035) and large gallstones (OR 1.153; 95% CI 1.033 to 1.714; P=0.017) were independent predictors of CGD. CONCLUSION: Results of the present study demonstrated that metabolic syndrome, diabetes and gallstone size were associated with CGD. Further prospective studies are needed to understand the clinical importance of this association.

Effects of sleeve gastrectomy on neutrophil-lymphocyte ratio.

OBJECTIVES: Obesity and related diseases have become one of the most important health problems in the modern age. In addition to its clinical use in the treatment of obesity, bariatric surgery reduces obesity-induced inflammation. Neutrophil-lymphocyte ratio (NLR) is a cheap and easily attainable inflammatory marker. The purpose of this study is to show the effect of bariatric surgery on NLR at preoperative and postoperative 3rd, 6th, and 12th months after SG. METHODS: 298 patients, who underwent sleeve gastrectomy (SG) in general surgery clinic between 2015 and 2017, were included in the study. We excluded the patients younger than 18 years old, and did not have any inflammatory, infectious, hematological, and comorbide diseases such as diabetes mellitus, cardiovascular diseases, ischemic heart disease, hypertension, renal insufficiency, cancer, and respiratory problems like asthma, obstructive sleep apnea syndrome. We evaluated the levels of NLR at preoperative and postoperative 3rd, 6th, and 12th months visits. RESULTS: There were a total of 298 adult patients (age: mean 38.6, minimum 18, maximum 69 years old). Of whom 247 were female (82.9%) and 51 were male (17.1%). We found that NLR levels decreased significantly at 3rd, 6th, and 12th month visits after SG (p<0.001). CONCLUSIONS: We concluded that NLR levels decrease after surgery in a proportional reduction in adipose tissue. The decrease in NLR levels may also be associated with the protective effects of sleeve gastrectomy against low-grade inflammation-related diseases.

Central and peripheral blood pressures and arterial stiffness increase in hypoparathyroidism.

Objective The aim of the present study was to evaluate whether arterial stiffness is affected in the patients with hypoparathyroidism through pulse wave analysis (PWA). Subjects and methods Sixty-three patients diagnosed with hypoparathyroidism and sixty volunteers were evaluated for the study. When 21 patients were excluded in the hypoparathyroidism group due to exclusion criteria, the research continued with 42 patients and 60 volunteers who are similar to the patients in terms of age, gender and body mass index (BMI). Fasting plasma glucose after 10 hours of fasting, creatinine, thyroid stimulating hormone (TSH), free thyroxine (fT4), albumin, calcium, phosphorus, magnesium, 25-OH vitamin D, parathormone (PTH) and urine calcium results in 24-hour urine for the patients in the hypoparathyroidism group were recorded. Evaluation of arterial stiffness was performed by Mobil-O-Graph 24h PWA device. Results Systolic blood pressure (SBP) (p = 0.01), diastolic blood pressure (DBP) (p = 0.005), mean blood pressure (p = 0.009), central SBP (p = 0.004), central DBP (p = 0.01) and pulse wave velocity (PWV) (p = 0.02) were found higher in the hypoparathyroidism group. A positive correlation was detected between phosphorus level and SBP [(p = 0.03. r = 0.327)], central SBP [(p = 0.04, r = 0.324)] and PWV [(p = 0.003, r = 0.449)]. We detected that age and serum phosphorus levels were independent predictor variables for PWV (B = 0.014, p < 0.001 and B = 0.035, p < 0.001, respectively). Conclusion We detected that hypoparathyroidism causes an increase in blood pressure and arterial stiffness. The most significant determinant factors were detected as advanced age and hyperphosphatemia. The patients diagnosed with hypoparathyroidism should be closely monitored and treatment planning should include to prevent the patients from hyperphosphatemia.

Increased levels of 25 hydroxyvitamin D and 1,25-dihydroxyvitamin D after rosuvastatin treatment: a novel pleiotropic effect of statins?

OBJECTIVES: Low levels of 25-hydroxyvitamin D are associated with higher risk of cardiovascular morbidity and mortality. Large trials demonstrated that statins significantly decrease cardiovascular morbidity and mortality. 7-dehydrocholesterol is the precursor of both cholesterol and vitamin D. The aim of this study was to investigate the possible effect of rosuvastatin on vitamin D metabolism. METHODS: The study was performed in a prospective cohort design. The study group consisted of 91 hyperlipidemic patients who had not been treated with lipid lowering medications. Lipid parameters, 25 hydroxyvitamin-D, 1,25-dihydroxyvitamin D, and bone alkaline phosphatase were obtained at baseline and after 8 weeks of rosuvastatin treatment. RESULTS: None of the subjects withdrew from the study because of the adverse effects. The mean age was 59.9 +/- 12.5 years. The majority of the patients were male (55, 60%). Seventeen patients were diabetic, and 43 patients had systemic hypertension. There was a significant increase in 25-hydroxyvitamin D, from mean 14.0 (range 3.7- 67) to mean 36.3 (range 3.8 -117) ng/ml (p < 0.001), and also an increase of 1,25-dihydroxyvitamin D from mean 22.9 +/- 11.2 to 26.6 +/- 9.3 pg/dl (p = 0.023). Bone alkaline phosphatase decreased after 8 weeks of rosuvastatin treatment, mean 17.7 (range 2.6-214) to mean 9.5 (range 2.3-19.1) u/l (p < 0.001) rosuvastatin treatment. CONCLUSION: This study has shown an effect of rosuvastatin on vitamin D metabolism, with an increase in both 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D. This may be an important pleiotropic effect whereby rosuvastatin reduces mortality in patients with coronary artery disease. Further studies are needed to clarify the relationship between statins and vitamin D metabolism.