International Journal of Endocrinology and Metabolism
Volume:5 Issue: 4, dec 2007

Obesity is a rapidly increasing concern among women and men particularly in the Middle East countries. This study was aimed to determine the relation between reproductive factors and the risk of obesity, particularly abdominal obe-sity in women. We conducted a popula-tion based cross-sectional study on a sample of 1800 women, aged between 20 to 70 years, using cluster sampling techniques in an urban area, in the north of Iran. The height, weight and waist circumference were measured with standard methods and information on the number of pari-ties, live births, pregnancy, social and demo-graphic status, and data on life style was col-lected during interviews. The mean (±SD) age of women was 37.5±13.0 years; 22.6% of women were nullipa-rous, 31.7% had 1-2, and 19.9% ≥5 pregnancies respectively. About 22.9% of women had no his-tory of parity, and33.8%, and 17.4% had 1-2 and ≥5 parities respectively. The overall prevalence rate of obesity and abdominal obesity was 27.7% and 46.2% respectively. In multiple logistic re-gression analysis, after adjustment for age, edu-cation level, marital status, parental obesity, marriage age, occupational activity, leisure time physical activity, duration of exercise per week, the risk of obesity increased significantly by 9% (adjusted OR=1.09, 95%CI: 1.01-1.18) and 10% (adjusted OR=1.10, 95% CI: 1.01-1.21) with each additional parity and live birth respectively. The results of this study indicate that the risk of obesity escalates with increase in the number of parities and live births. Hence, reproductive factors should be considered as in-dependent risk factors of obesity in women.

Hypoglycemia is a medical emergency with non-specific symptoms and severe side effects. We determined causes and symptoms of hypogly-cemia in patients with low blood glucose admit-ted to the emergency ward; approaches for the prevention in hypoglycemia and side effects are also proposed. All patients with symp-toms of hypoglycemia and blood glucose levels below 45 mg/dL admitted to the emergency ward, between 2002-2003, were included in this survey. Initially a questionnaire on demographic information, coexisting disorders and drug his-tory was completed; physical exam was done and then 10 ml of venous sample were obtained for CBC, liver and renal function tests; if indicated, hormonal assay and 72 hour fasting test were done. Eighty-nine patients with mean age of 66.73 ± 14.91 years were included; 53% female and 47% male (P= NS). 86.5% were diabetic and 13.5% nondiabetic (P< 0.001). Common causes of hypoglycemia were: drugs (36.3%), renal failure (23%), sepsis (14.3%) and medical mismanage-ment (11%). The most common symptoms in diabetic and nondiabetic patients were adrener-gic + neurglycopenic 50.6% and 58.3%, neurgly-copenic 46.8% and 41.7%, and adrenergic 2.6% and 0% respectively (P=NS). Drugs were the most common cause of hypoglycemia, although medical misman-agement was observed in 11% of patients. Educa-tion not only for patients but also for medical groups is the basis of prevention. High percent-age of patients had neurglycopenic symptoms due to long duration of diabetes and also old age as an independent risk factor; drugs should hence be used cautiously in old patients, and training physicians especially for geriatric groups is also recommended.

HBV and HCV infections play an important role in the pathogenesis of patients with diabetes. The aim of this study was to determine changes in blood glucose, insulin resistance and cell function in IGT patients with chronic hepatitis B and C. A group of 560 patients with IGT, chosen from among participants of the Tehran Glucose and Lipid Study, were enrolled in this survey; their sera were examined in stage I for hepatitis B and C. FBS, HOMA-IR,  cell function in the three groups (hepatitis B, C and seronegative) were studied, and these evalua-tions were repeated after 3 years. The changes over three years were quantitatively calculated by means of T tests paired T test. X2 and the MC Nemar test ANOVA variance analysis were used for qualitative variables (for determination of variable effects). Spearman and Pearson correla-tion coefficients were used to find relationship between variables. Of participants, 64.9% were female and 35.1% male; their average age was 50.8±12.7 years at the beginning of the study. There was no sig-nificant difference for FBS, HOMA-IR,  cell function between the 3 groups. After three years, six of them were HCV positive and six were HBV positive. There was no significant differ-ence between their FBS, HOMA-IR and CF af-ter 3 years. Blood glucose changes and  cell function in persons that were positive for HBV or HCV in the first and second stages of the study showed no significant statistical change after three years, whereas HOMA-IR showed significant reduction compared to the beginning of study (from 4±2 to 3.1±2.2, p<0.05). In general, in persons that were seronegative for HBV or HCV in both stages of this study, significant changes were observed in different degrees of insulin resistance after three years; 22.5% of per-sons sensitive to insulin became resistant, while 49.6% of them became sensitive (p<0.001), changes that were not observed in seropositive patients. There was no significant statistical difference between the seropositive group for changes in blood glucose, HOMA IR, and  cell function after 3 years whereas in the seronega-tive patients, blood glucose increased and  cell function and HOMA-IR decreased.

Although the relationship between calcium in-take during lactation and breast milk calcium concentration has been studied by many inves-tigators, evidence available on the effects of calcium supplementation during pregnancy on the calcium content of breast-milk is limited. The aim of this double-blind placebo-controlled trial was to determine the effect of calcium supplementation during the 3rd tri-mester of pregnancy on the calcium concentra-tion of mature breast-milk. Sixty-eight pregnant women in Ahwaz city, southwest Iran were randomly assigned to the “Calcium” (1 gr/d) or “Placebo” groups from the 28th-30th week of gestation until delivery. Breast-milk samples were taken 1.5 to 3 months after delivery. Cal-cium concentrations were measured using atomic absorption spectrometry. There were no significant differences between the two groups with respect to the demographic characteristics, anthropometric indices, and dietary energy and calcium intakes, at baseline. No differences were found in calcium concentrations in mature breast-milk between the two groups [mean±SD were 228±38 and 235±42 mg/L in the calcium and placebo groups, respectively, (P=0.49)]. Our study did not support the hy-pothesis that calcium supplementation during pregnancy affects the calcium concentration later in mature breast-milk.

Determination of thyrotropin (TSH), total and free thyroxine (T4) and triiodothyronine (T3) are widely used for thyroid function evaluation. There have been numerous reports of interfer-ence in thyroid hormone immunoassays. Herein, the possible occurrence of interference is inves-tigated for a radioimmunoassay kit of total T3. A total of 3471 patients were examined through the serum level meas-urement of TSH, total T4 and T3. T3 analysis was made through a competitive solid-phase radio labeled (125I) immunoassay by T3 Izotop kit (Izotop Co. Budapest, Hungary). The presence of T3 assay interference was considered probable if the endocrine profile was inconsistent with the clinical picture and/or the obtained value for T3 showed extreme deviaton from normal levels, i.e. above 780 ng/dL. For such patients, the exis-tence of interference was verified by re-measuring T3 level by another RIA kit (Immu-notech kit, Marseille, France). Among 3471 patients studied, 40 cases (1.2 %) had spuriously high T3 serum levels with T3-Izotop kit while normal T3 levels (132.1±31.0 ng/dL) were observed with T3-Immunotech kit; the positive interference was more prevalent among women (1.4% vs. 0.5% in men), especially post-menopausal women. Mean serum levels of total T4 and TSH in the positive interference group were 9.0±2.0 μg/dL and 1.79±1.47 μU/mL, respectively. In accordance with numerous re-ports of interferences in thyroid hormone im-munoassays, the results of our study indicates that both laboratory professionals and clinicians must be vigilant to the possibility of antibody interference in thyroid function assays.

Acromegaly is a rare disease with increased mor-tality rate. Present literature documents the treatment of choice for acromegaly is surgery, curative in 91% of pituitary microadenomas and up to 73% of macroadenomas. The aim of this study was to present our experience in the diag-nosis and treatment of a series of patients suffer-ing from acromegaly, and to compare the results concerning control of disease with other series using modern criteria for therapy. Of fifty patients (31 men, 19 women) referring to the Mashhad Endo-crine Out-patient Clinic between 2001 and 2005, diagnosed with acrimegaly. 40 underwent sur-gery as initial therapy. We used a combination of modern, evidence-based remission criteria in-cluding basal GH below 2.5 µg/L (5 mU/L), a na-dir GH below than 1.0 µg/L (2 mU/L) after an oral glucose tolerance test, and normal age-related IGF-I levels 6 months after surgery for the definition of cure in our patients. Fifteen of the 40 patients operated (37.5%) remained in remission after just transsphenoidal surgery; 80% of patients with microadenomas but only 31.4% of patients with macroadenomas achieved remission; 50% intrasellar macroade-nomas showed remission, compared with only 21.7% extrasellar extended macroadenomas. The rate of biochemical ‘cure’ correlated with the magnitude of the initial GH levels, the tumor size and invasion. In conclusion, using stringent crite-ria of remission, our results compared well with similar series of microadenomas and intrasellar macroadenomas, whereas outcomes for extrasel-lar macroadenomas were less than satisfactory.

Insulinoma is a rare neuroendocrine tumor with an incidence of approximately 4 per 5 million population. They are typically sporadic, solitary and less than 2 cm in diameter. Despite the in-troduction of sophisticated cross-imaging tech-niques such as CT scan, MRI and ultrasound, lo-calization of insulinomas, especially those smaller than 2 cm remains a problem; for this, one can localize insulinoma by stimulating re-lease of insulin using selective intra-arterial in-jection of calcium and subsequent measurement of insulin levels in the hepatic veins. We report here a case of multiple pancreatic insulinomas measuring 3.0 x 2.1 x 2.0 cm (head) and 1.0 x 0.8 x 0.3 cm (body) not seen by imaging techniques but localized by intra-arterial calcium stimula-tion with hepatic venous sampling and intraop-erative ultrasound imaging. This is the first se-lective intra-arterial calcium stimulation with hepatic venous sampling for localization of pan-creatic insulinoma in the Philippines.

Allgrove syndrome (triple A syndrome) is an autosomal recessive disorder characterized by achalasia, alacrima and adrenocorticotropic hor-mone (ACTH) resistant adrenal insufficiency. It is a multisystem disease and in addition to cardinal manifestations, associated features es-pecially neurologic problems, must be detected and treated. In this case report, we report a 17 year-old boy diagnosed as having Allgrove syndrome with predominant symptoms of achalasia and additional features consisting of short neck, long eye lashes, unexplained fever and chills, reduced visual acuity because of amblyopia, thenar and hypothenar atrophy and abnormal opposition of fingers. If necessary screening with stimulatory tests in patients with unexplained features such as long eye lashes, short neck, muscle atrophy, na-sal speech, skin and neurologic abnormalities and hyperkeratosis, should be recommended.

Lipoprotein (a) is a major and independent risk factor for cardiovascular disease. The pathogenicity of Lp(a) as a risk factor may depend upon its Lysine binding site(LBS) activity. It is suggested that non enzymatic glycation of Lp(a) resulting from high plasma glucose level found in diabetic patients may be one of the factors contributing to the severity of this disease. The purpose of this research was to study the effect of glycation on Lysine binding site activity of lipoprotein(a). Lp(a) was glycated by incubation of 100 ml serum in vitro with 0.25 to 350 mmol of glucose for 10 days at 37oC. Glycated Lp(a) was separated by using m–aminobronate affinity column chromatography and Lysine binding site properties of the glycated Lp(a) were compared with native Lp(a) by using lysine sepharose affinity chromatography. Glucose uptake by Lp(a) was linear as a function of concentration and time up to 7 days for all given concentrations. Glycation increased the negative charge of Lp(a) as monitored by electrophoresis and increased the affinity of Lp(a) for Lysine sepharose affinity column chromatography. Chemical modification induced by glycation of lp(a) affected its lysine binding site activity and increased LP(a) lysine positive subspecies.Therefore it is suggested that nonenzymatic glycation of Lp(a) may contribute to premature atherogenesis of patients with diabetes mellitus by increasing its LBS activity. and diverting lipoprotein catabolism from non-athero genic to atherogenic pathways.