EndoBridge 2023: highlights and pearls

EndoBridge 2023 took place on October 20-22, 2023, in Antalya, Turkey. Accredited by the European Council, the 3-day scientific program of the 11th Annual Meeting of EndoBridge included state-of-the-art lectures and interactive small group discussion sessions incorporating interesting and challenging clinical cases led by globally recognized leaders in the field and was well attended by a highly diverse audience. Following its established format over the years, the program provided a comprehensive update across all aspects of endocrinology and metabolism, including topics in pituitary, thyroid, bone, and adrenal disorders, neuroendocrine tumors, diabetes mellitus, obesity, nutrition, and lipid disorders. As usual, the meeting was held in English with simultaneous translation into Russian, Arabic, and Turkish. The abstracts of clinical cases presented by the delegates during oral and poster sessions have been published in JCEM Case Reports. Herein, we provide a paper on highlights and pearls of the meeting sessions covering a wide range of subjects, from thyroid nodule stratification to secondary osteoporosis and from glycemic challenges in post-bariatric surgery to male hypogonadism. This report emphasizes the latest developments in the field, along with clinical approaches to common endocrine issues. The 12th annual meeting of EndoBridge will be held on October 17-20, 2024 in Antalya, Turkey.

Heterogeneity of sensitization profiles and clinical phenotypes among patients with seasonal allergic rhinitis in Southern European countries-The @IT.2020 multicenter study

BACKGROUND

Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach.

OBJECTIVE

To describe sensitization profiles and clinical phenotypes of pollen allergic patients in nine Southern European cities with a uniform methodological approach.

METHODS

Within the @IT.2020 multicenter observational study, pediatric and adult patients suffering from SAR were recruited in nine urban study centers located in seven countries. Clinical questionnaires, skin prick tests (SPT) and specific IgE (sIgE) tests with a customized multiplex assay (Euroimmun Labordiagnostika, Lübeck, Germany) were performed.

RESULTS

Three hundred forty-eight children (mean age 13.1 years, SD: 2.4 years) and 467 adults (mean age 35.7 years SD: 10.0 years) with a predominantly moderate to severe, persistent phenotype of SAR were recruited. Grass pollen major allergenic molecules (Phl p 1 and/or Phl p 5) ranged among the top three sensitizers in all study centers. Sensitization profiles were very heterogeneous, considering that patients in Rome were highly poly-sensitized (sIgE to 3.8 major allergenic molecules per patient), while mono-sensitization was prominent and heterogeneous in other cities, such as Marseille (sIgE to Cup a 1: n = 55/80, 68.8%) and Messina (sIgE to Par j 2: n = 47/82, 57.3%). Co-sensitization to perennial allergens, as well as allergic comorbidities also broadly varied between study centers.

CONCLUSIONS

In Southern European countries, pollen allergy is heterogeneous in terms of sensitization profiles and clinical manifestations. Despite the complexity, a unique molecular, multiplex, and customized in-vitro IgE test detected relevant sensitization in all study centers. Nevertheless, this geographical diversity in pollen allergic patients imposes localized clinical guidelines and study protocols for clinical trials of SAR in this climatically complex region.

Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm

PURPOSE OF REVIEW

The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine.

RECENT FINDINGS

The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.

Dynapenic Abdominal Obesity and Metabolic Health in Non-Geriatric Patients with Obesity

Background: Dynapenic abdominal obesity (DAO) is the combination of low muscle strength and high central adiposity, which can lead to functional and cardiometabolic impairments. Objective: The aim of this study was to examine the relationship between DAO and metabolic parameters in non-geriatric patients with obesity. Methods: All patients seen in the obesity outpatient clinic during a random month, along with 30 healthy individuals, were included in the study. Body mass index (BMI), waist circumference (WC), hip circumference (HC), serum fasting blood glucose, triglyceride, high-density lipoprotein, low-density lipoprotein (LDL), insulin, and glycated hemoglobin (HbA1c) levels were measured. Muscle function tests were conducted. Hypertension and diabetes mellitus diagnoses were recorded. DAO was determined using handgrip strength and WC. Metabolic syndrome was defined based on International Diabetes Federation (IDF) criteria. Data were analyzed using SPSS. Results: A total of 106 individuals participated in the study, including 76 individuals with obesity as the case group and 30 healthy individuals as the control group. In the case group, BMI, WC, HC, and chair stand test results were higher compared to the control group. There was no significant difference between the case and control groups in terms of gait speed or handgrip test results. In the case group, 30 people (39.5%) had dynapenic obesity (DO), and in the control group, 8 people (26.7%) had DO. There was no significant difference in DO rates between the case and control groups. In the case group, the HbA1c level was higher in DO (+) group than DO (-) group. In the control group, DO (+) group had higher LDL and HbA1c level than DO (-) group. No significant difference was observed in other search parameters between the DO (+) and DO (-) groups in both the case and control groups. Conclusion: DAO is common among people with obesity and contributes to a poor prognosis, increased morbidity, and mortality. Therefore, including its treatment in the management of obesity is crucial for individuals of all age ranges.

SERUM CARBOXYMETHYL-LYSINE AND SOLUBLE RECEPTOR FOR ADVANCED GLYCATION END PRODUCTS IN HYPERTHYROID AND HYPOTHYROID PATIENTS

Purpose

The formation and accumulation of advanced glycation end products (AGEs) are enhanced with increased oxidative stress and inflammatory conditions. A hyperthyroid and hypothyroid state is associated with oxidative stress. This study aimed to evaluate skin AGE deposition, serum carboxymethyl-lysine (CML), and serum soluble receptor for AGEs (sRAGE) levels in hypothyroid and hyperthyroid patients.

Methods

A total of 203 subjects were included in this cross-sectional study. After excluding diabetes mellitus, 103 newly diagnosed hypothyroid patients, 50 newly diagnosed hyperthyroid patients, and 50 control (euthyroid) subjects were enrolled. All tests were done before beginning the appropriate treatment. Accumulated AGEs in the skin collagen were measured by skin autofluorescence (SAF) using an AGE Reader.

Results

SAF measurements were 1.82 ± 0.04, 1.80 ± 0.40, and 1.63 ± 0.30 arbitrary units for the hypothyroid, hyperthyroid, and euthyroid groups, respectively (p = 0.04). Serum CML levels were 8.2 ± 2.8, 10.2 ± 2.0, and 8.0 ± 3.3 ng/mL for the hypothyroid, hyperthyroid, and euthyroid groups, respectively (p = 0.01). sRAGE levels were similar between the groups. Serum thyroid-stimulating hormone and SAF measurements were positively correlated (r = 0.25, p = 0.02) in the hypothyroid group and negatively correlated in the hyperthyroid group (r = -0.36, p = 0.04). There was no correlation between CML and sRAGE levels.

Conclusion

SAF measurements are increased in both hypo- and hyperthyroid normoglycemic patients. Serum CML levels are increased in hyperthyroid patients. Hypo and hyperthyroid states might be associated with acceleration of AGE accumulation and may have a long term effect on metabolic memory.

Is there an increased cardiovascular risk in patients with prolactinoma? A challenging question

PURPOSE

Epicardial adipose tissue thickness (EATT) is considered to be a surrogate for visceral fat and a novel cardiovascular risk indicator. Hyperprolactinemia has been shown to be associated with increased cardiovascular risk. The aim was to evaluate the association between EATT, carotid intima media thickness (CIMT), and cardiac functions in patients with prolactinoma.

METHODS

Patients with the diagnosis of prolactinoma were included. The control group consisted of healthy age matched individuals with normal prolactin levels. Prolactin, fasting blood glucose (FBG), insulin, hemoglobin A1c (HbA1c), alanine aminotransferase (ALT), total cholesterol, triglycerides, and high (HDL) and low density lipoprotein (LDL) cholesterol were measured. EATT, CIMT, cardiac systolic, and diastolic functions were determined using echocardiography.

RESULTS

We evaluated 67 patients with prolactinoma (aged 40.7 ± 11.9 years, F/M: 51/16) and 57 controls (aged 42.5 ± 7.4 years, F/M: 36/21). Of the 67 patients, 24 had normal prolactin levels. FBG level was higher in prolactinoma patients than in controls. Patients and controls had similar HbA1c, HOMA-IR, ALT, total, HDL, LDL cholesterol, and triglycerides levels, and similar cardiac systolic and diastolic functions. Prolactinoma patients had greater EATT (3.0 ± 0.5 mm vs. 2.6 ± 0.4 mm, p < 0.001) and CIMT (0.57 ± 0.08 mm vs. 0.52 ± 0.04 mm, p = 0.03) than controls. EATT was correlated with body mass index, FBG, HbA1c, and triglyceride levels.

CONCLUSIONS

EATT and CIMT were greater in patients with prolactinoma, although they had normal cardiac systolic and diastolic functions.

Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options

Purpose

The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic.

Methods

We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire.

Results

Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves’ disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3–4 cytological results and papillary microcarcinoma.

Conclusion

This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.

The Role of Obesity in Predicting the Clinical Outcomes of COVID-19

INTRODUCTION

The aim of this was to describe the predictors of mortality related to COVID-19 infection and to evaluate the association between overweight, obesity, and clinical outcomes of COVID-19.

METHODS

We included the patients >18 years of age, with at least one positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction. Patients were grouped according to body mass index values as normal weight <25 kg/m2 (Group A), overweight from 25 to <30 kg/m2 (Group B), Class I obesity 30 to <35 kg/m2 (Group C), and ≥35 kg/m2 (Group D). Mortality, clinical outcomes, laboratory parameters, and comorbidities were compared among 4 groups.

RESULTS

There was no significant difference among study groups in terms of mortality. Noninvasive mechanical ventilation requirement was higher in group B and D than group A, while it was higher in Group D than Group C (Group B vs. Group A [p = 0.017], Group D vs. Group A [p = 0.001], and Group D vs. Group C [p = 0.016]). Lung involvement was less common in Group A, and presence of hypoxia was more common in Group D (Group B vs. Group A [p = 0.025], Group D vs. Group A [p < 0.001], Group D vs. Group B [p = 0.006], and Group D vs. Group C [p = 0.014]). The hospitalization rate was lower in Group A than in the other groups; in addition, patients in Group D have the highest rate of hospitalization (Group B vs. Group A [p < 0.001], Group C vs. Group A [p < 0.001], Group D vs. Group A [p < 0.001], Group D vs. Group B [p < 0.001], and Group D vs. Group C [p = 0.010]).

CONCLUSION

COVID-19 patients with overweight and obesity presented with more severe clinical findings. Health-care providers should take into account that people living with overweight and obesity are at higher risk for COVID-19 and its complications.

Skin Autofluorescence and Carotid Intima-Media Thickness Evaluation Following Bariatric Surgery in Patients with Severe Obesity

PURPOSE

Advanced glycation end product (AGE) is a marker of metabolic memory. Accumulated AGEs in skin collagen measured with skin autofluorescence (SAF) was found to be associated with subclinical atherosclerosis. We aimed to evaluate SAF and carotid intima-media thickness (CIMT) and its association with clinical and biochemical parameters in severely obese patients before and after bariatric surgery.

MATERIALS AND METHODS

In this observational study, 432 morbid obese patients evaluated before and after 6 and 12 months of bariatric surgery for metabolic and anthropometric parameters, CIMT and SAF. SAF was assessed in the forearm with an AGE Reader.

RESULTS

SAF measurements were higher in diabetic (2.04 ± 0.52 AU) obese patients compared to non-diabetic (1.78 ± 0.40 AU) obese patients (p < 0.0001). Although bariatric surgery-induced weight loss resulted in a decrease in CIMT in the 6th and 12th months compared to baseline, weight loss and metabolic improvements were not associated with a parallel decrease in SAF measurements. SAF measurements were positively correlated with body mass index (r 0.527, p < 0.0001), HbA1c (r 0.362, p < 0.0001), and CIMT (r 0.319, p < 0.0001). Multivariate analysis showed the presence of diabetes (but not BMI, age, and sex) was independently associated with SAF (R² = 7.62%), and the presence of diabetes, low-density cholesterol, and systolic blood pressure were independently associated with CIMT measurements (R² = 21.7%).

CONCLUSION

Bariatric surgery-induced weight loss and metabolic improvement were found to be associated with improvement in CIMT, while skin AGE accumulation was not regressed in the first year of surgery.

The clinicopathologic characteristics of familial and sporadic papillary thyroid carcinoma in Turkish patients

Background/aim

The aim of this study is to investigate clinicopathologic features of familial papillary thyroid carcinoma (fPTC) and compare them with sporadic papillary thyroid carcinoma (sPTC) in Turkish patients. A retrospective analysis of the papillary thyroid carcinoma (PTC) cases, with or without family history with a follow-up around 10 years was performed.

Materials and methods

A series of patients with fPTC (82 fPTC families with 146 affected individuals) were compared with patients with sPTC (n = 112). The clinicopathologic features [(age, gender, histologic subtype, tumour size, bilaterality, multifocality, extrathyroidal extension (ETE), lymph node metastasis (LNM)] and treatment procedures (lymph node dissection, radioactive iodine ablation), and the outcomes like recurrences in the neck region, distant metastasis, and the need for reoperation were compared between the groups.

Results

When the groups were compared, there was no significant difference in age (P = 0.449), and tumour size (P = 0.898) between familial and sporadic PTC patients. fPTC group had a significantly higher risk of male gender (P=0.001), bilaterality (P = 0.004), multifocality (P = 0.011), LNM (P = 0.013), ETE (P = 0.040), and distant metastasis (P ≤ 0.0001) than the sPTC group. However, recurrence rate was similar between the 2 groups (P = 0.436).

Conclusion

The results of this study confirms a more aggressive nature in fPTC patients, in terms of bilaterality, multifocality, ETE, LNM, and distant metastasis, compared to sPTC patients in Turkish population.

Should we perform routine prophylactic central neck dissection in patients with thyroid papillary microcarcinoma?

PURPOSE

Cervical lymph node (LN) metastases in papillary thyroid cancer (PTC) are common in tumors especially that are larger than 1cm. Ipsilateral central neck dissection (CND) is usually preferred even in the absence of a palpable LN. This study aims to clarify the incidence and predictive factors for occult ipsilateral central LN metastasis in these patients, and the management of patients without clinical evidence of metastasis.

METHODS

204 PTC patients were studied. The patients were divided into two according to the tumor size of ≤5mm or larger. Patient demographics, tumor properties, LN metastasis, preoperative neck ultrasonography findings and surgical outcomes were analyzed.

RESULTS

There were 152 patients in study group-1 (nodule > 5 mm) and 52 patients in group-2 (nodule ≤ 5 mm). The mean tumor size was 11.9 mm. Overall, preoperative neck ultrasonography showed central neck LN in 25 (12.3%) patients, however, final pathology revealed metastatic LN at central compartment in 59 (28.9%) patients. There were 56 (27.5%) patients with metastasis in group-1 compared to 3 (1.4%) patients in group-2.

CONCLUSIONS

Prophylactic CND is advised in PTC for the reduction of recurrence in central compartment. According to our results, in patients with tumors smaller than 5 mm and without evidence of nodal metastasis in preoperative neck ultrasonography, we do not recommend prophylactic CND.

Effects of MC4R, FTO, and NMB gene variants to obesity, physical activity, and eating behavior phenotypes

Obesity is a major contributory factor of morbidity and mortality. It has been suggested that biological systems may be involved in the tendency to be and to remain physically inactive also behaviors such as food and beverage preferences and nutrient intake may at least partially genetically determined. Consequently, besides environment, genetic factors may also contribute to the level of physical activity and eating behaviors thus effect obesity. Therefore the aim of this study is to investigate the effect of various gene mutations on obesity, physical activity levels and eating behavior phenotypes. One hundred patients and 100 controls were enrolled to the study. Physical activity levels were measured with an actical acceloremeter device. Eating behaviors were evaluated using Three-Factor Eating questionnaire (TFEQ). Associations between eating behavior scores and physical characteristics were also evaluated. The information about other obesity risk factors were also collected. Mutations were investigated with PCR, direct sequencing and Real-Time PCR. rs1051168, rs8050146 -2778C > T mutations were found statistically significant in patients, rs1121980 was found statistically significant in controls. 21 mutations were found in MC4R and near MC4R of which 18 of them are novel and 8 of them cause amino acid change. In addition, it was found that, some obesity related factors and questions of TFEQ are associated with various investigated gene mutations. Any relation between gene mutations and physical activity levels were not detected. It is thought that, due to the genotype data and eating behaviors, it may be possible to recommend patients for proper eating patterns to prevent obesity. © 2016 IUBMB Life, 68(10):806-816, 2016.

Weak hybridization and isolated localized magnetic moments in the compounds CeT₂Cd₂₀ (T = Ni, Pd)

We report the physical properties of single crystals of the compounds CeT2Cd20 (T = Ni, Pd) that were grown in a molten Cd flux. Large separations of  ∼6.7-6.8 Å between Ce ions favor the localized magnetic moments that are observed in measurements of the magnetization. The strength of the Ruderman-Kittel-Kasuya-Yosida magnetic exchange interaction between the localized moments is severely limited by the large Ce-Ce separations and by weak hybridization between localized Ce 4 f and itinerant electron states. Measurements of electrical resistivity performed down to 0.138 K were unable to observe evidence for the emergence of magnetic order; however, magnetically-ordered ground states with very low transition temperatures are still expected in these compounds despite the isolated nature of the localized magnetic moments. Such a fragile magnetic order could be highly susceptible to tuning via applied pressure, but evidence for the emergence of magnetic order has not been observed so far in our measurements up to 2.5 GPa.

Enhancement of superconductivity near the pressure-induced semiconductor-metal transition in the BiS₂-based superconductors LnO₀.₅F₀.₅BiS₂ (Ln = La, Ce, Pr, Nd)

Measurements of electrical resistivity were performed between 3 and 300 K at various pressures up to 2.8 GPa on the BiS2-based superconductors LnO0.5F0.5BiS2 (Ln=Pr, Nd). At lower pressures, PrO0.5F0.5BiS2 and NdO0.5F0.5BiS2 exhibit superconductivity with critical temperatures Tc of 3.5 and 3.9 K, respectively. As pressure is increased, both compounds undergo a transition at a pressure Pt from a low Tc superconducting phase to a high Tc superconducting phase in which Tc reaches maximum values of 7.6 and 6.4 K for PrO0.5F0.5BiS2 and NdO0.5F0.5BiS2, respectively. The pressure-induced transition is characterized by a rapid increase in Tc within a small range in pressure of ∼0.3 GPa for both compounds. In the normal state of PrO0.5F0.5BiS2, the transition pressure Pt correlates with the pressure where the suppression of semiconducting behaviour saturates. In the normal state of NdO0.5F0.5BiS2, Pt is coincident with a semiconductor-metal transition. This behaviour is similar to the results recently reported for the LnO0.5F0.5BiS2 (Ln=La, Ce) compounds. We observe that Pt and the size of the jump in Tc between the two superconducting phases both scale with the lanthanide element in LnO0.5F0.5BiS2 (Ln=La, Ce, Pr, Nd).

Vitamin D receptor gene ApaI, TaqI, FokI and BsmI polymorphisms in a group of Turkish patients with Hashimoto's thyroiditis

AIM

Previous studies have suggested an influence of vitamin D receptor polymorphisms on the development of autoimmune thyroid disease in different ethnic populations. We aimed to investigate the distribution of vitamin D receptor (VDR) alleles in a group of Turkish patients with Hashimoto's thyroiditis (HT).

METHODS

One hundred and eleven patients (male/female: 5/106, 47.9±12.8 years) and 159 healthy controls (male/female: 21/138, 30.5±6.3 yrs) were included in the study. VDR gene FokI, BsmI, ApaI TaqI polymorphisms were examined using a polymerase chain reaction (PCR) -based restriction analysis. Serum levels of (thyroid-stimulating hormone) TSH, anti-thyroid peroxidase and anti-thyroglobulin levels were determined.

RESULTS

The VDR TaqI "TT" (59.5% in patients vs. 27.6% in controls; 95% confidence interval [CI]: 0.14-0.46) and FokI 'FF' genotypes (67.6% in patients vs. 44.6% in controls; 95% CI: 0.46-0.81) occurred more frequently in patients, while VDR "Tt" (56.6% in patients vs. 32.4% in controls 95% CI: 1.22-2.14) and "Ff" genotypes (25.2% in patients vs. 49.1% in controls 95% CI: 1.27-2.18) were more common in controls. There were no differences in the genotype frequencies of the ApaI and BsmI polymorphisms in cases and controls. The most common genotypes were "bbAaTTFF" in the thyroiditis group (12.6% patients vs. 5.6% in controls, P>0.05) and "BbAaTtFf" in the control group (6.3% patients vs. 22.2% in controls, P=0.002).

CONCLUSION

VDR gene TaqI TT and FokI FF genotypes are associated with increased risk of HT disease in our group of Turkish patients. BbAaTtFf genotype seems to be protective for HT disease in our population.

Impaired diastolic function and elevated Nt-proBNP levels in type 1 diabetic patients without overt cardiovascular disease

Diabetic cardiomyopathy is an important complication of type 1 diabetes mellitus. Diastolic heart failure is an early manifestation of diabetic cardiac disease. Nt-proBNP is a valuable marker of ventricular dysfunction. The aim of this study was to determine Nt-proBNP concentrations in type 1 diabetic patients and determine their relationship with ventricular diastolic dysfunction (DD) and carotid artery intima media thickness (CIMT) measurements. Sixty-seven type 1 diabetic patients (30.2 ± 8.0 years; W/M: 24/43) without known cardiovascular disease and 48 healthy controls (30.5 ± 6.4 years; W/M: 19/29) were recruited. Nt-proBNP levels were measured. Conventional and tissue Doppler echocardiography were used to evaluate left ventricular diastolic function and CIMT. Nt-proBNP in diabetic patients was significantly higher than in controls (38 ± 34.8 vs. 15.1 ± 12.7 pg/ml) (P = 0.004). Ea level was higher (12.3 ± 3 vs. 10.3 ± 4 cm/s, P = 0.003) and E/Ea ratio was lower in patients (6.6 ± 2.5 vs. 9.7 ± 5.9, P = 0.001) compared with controls. Ratio of DD was higher in patients than controls (11.1 vs. 2.1%, P = 0.01). CIMT measurements in diabetic patients were higher than controls (0.54 ± 0.11 vs. 0.48 ± 0.05 mm, P = 0.02). Logistic regression revealed age and HbA1c to be independently associated with the presence of DD. Nt-proBNP levels are elevated in type 1 diabetic patients without overt cardiovascular disease and the presence of DD is increased in diabetic patients in comparison with controls. Nt-proBNP levels do not seem to be related to the presence of DD and subclinical atherosclerosis in this group of patients.

Association of metabolic syndrome parameters with TT3 and FT3/FT4 ratio in obese Turkish population

BACKGROUND

Obesity and metabolic syndrome are major health problems worldwide, including Turkey. Recent studies have shown an association between thyroid function tests and metabolic syndrome parameters. In this study, we aimed to determine the frequency of metabolic syndrome in an obese Turkish population and the relationship between metabolic syndrome and thyroid functions.

MATERIALS AND METHOD

We recruited 211 patients (187 females/24 males; mean age, 39.7±11.7 years) with body mass index (BMI) >30 kg/m(2) and no other hormonal pathology that could cause obesity. Anthropometric evaluation was followed by measurement of fasting blood glucose (FBG), insulin, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), total thyroxine (TT4), free T3 (FT3), and free T4 (FT4). Metabolic syndrome was defined according to the 2005 revision of the National Cholesterol Education Program Adult Panel III (NCEP ATP III) criteria. Insulin resistance was calculated from homeostasis model assessment of insulin resistance (HOMA-IR) formula. The TSH cutoff value was set at 2.5 mU/L.

RESULTS

Metabolic syndrome was diagnosed in 122 patients (58%). Metabolic syndrome positive patients had significantly higher FBG, triglycerides, FT4, systolic (SBP) and diastolic blood pressure (DBP), and statistically lower HDL-C and FT3/FT4 ratio than metabolic syndrome negative patients. TSH decreased with age and was not related with any metabolic syndrome parameters. The FT3/FT4 ratio negatively correlated with FBG, triglycerides, SBP, and DBP (P=0.003, r=-38; P=0.02, r=-0.28; P=0.005, r=-0.35; and P=0.007, r=-0.34, respectively); TT3 positively correlated with HOMA-IR (P=0.006, r=0.40), FBG (P=0.009, r=0.38), and waist circumference (P=0.02, r=0.34).

CONCLUSION

Metabolic syndrome frequency was increased in our study population compared to the general population. Metabolic syndrome parameters (except HDL) correlated with TT3, FT4, and the FT3/FT4 ratio. FT4 levels were associated with obesity and metabolic syndrome independently of insulin resistance, whereas TT3 levels were associated with both insulin resistance and metabolic syndrome. This relationship can be explained by compensatory effects of TT3, and probably FT4, on energy expenditure and thermogenesis in obese people.

Bulky gastrinoma of the common bile duct: unusual localization of extrapancreatic gastrinoma--case report

Zollinger-Ellison syndrome is characterized by elevated levels of serum gastrin associated with increased gastric acid secretion, gastrointestinal ulcerations and diarrhea. Most gastrinomas (75%) occur sporadically and are located within the gastrinoma triangle. Extraduodenal, extrapancreatic and extranodal gastrinomas have been shown in 5.6% of the patients with Zollinger-Ellison syndrome who underwent surgery. We report a 44-year-old female who had been complaining of nausea and diarrhea for 12 years. Abdominal computed tomography and magnetic resonance imaging detected a homogeneous, regular-shaped 6 x 7 cm solid mass, located between the liver, right kidney and inferior vena cava. Somatostatin receptor positive scanning led us to investigate a neuroendocrine tumor. Serum gastrin level was found very high and the patient underwent surgery. Local excision of the tumor was performed, and an 8x6x5 cm, well-capsulated, solitary mass, originating from the common bile duct was removed. The unique feature of our case is the unusual localization, and although the tumor was very large in size, only capsule invasion was observed with no evidence of distant metastasis.

Effect of oxidative stress on aorta and tibia osteoprotegerin gene expression in ovariectomized rats

AIM

Atherosclerosis and osteoporosis share some common pathophysiological pathways. Increase in oxidative stress and activation of cytokines that increase osteoclastogenesis were reported in postmenopausal period. The aim of this study was to determine the link between these two states.

METHODS

A total of 32 female adult Wistar albino rats were included in the study. Rats in control group were sham operated, vehicle group were ovariectomized and given 17.5%hydroxypropyl-β-cyclodextrin. Rats in group III and IV were ovariectomized and given 17β-estradiol or raloxifene for 12 weeks, respectively. Aorta and tibia bone samples were collected. Tissue oxidative stress was determined via measurement of malondialdehyde levels and osteoprotegerin gene expression with RT-PCR.

RESULTS

Ovariectomy increased MDA levels both in bone and aorta compared to sham operated rats. Use of 17β-estradiol or raloxifene did not create a significant difference compared to ovariectomized rats. Ovariectomy caused a significant decrease in OPG gene expression in the tibia and aorta compared to sham operated rats. Although 17β-estradiol and raloxifene preserved gene expression in aorta they did not have any effect on bone tissue. OPG mRNA expression was negatively correlated with tissue MDA levels only in ovariectomized rats.

CONCLUSION

This study confirms the increase in ovariectomy-induced oxidative stress and association of it to bone and vascular tissue OPG mRNA expression.

Circulating endothelial cells are elevated in patients with type 1 diabetes mellitus

OBJECTIVE

Circulating endothelial cells (CECs) have emerged as vascular damage markers and are increased in type 2 diabetic patients. Since type 1 diabetes is associated with vascular damage, we hypothesized high CEC numbers in this patient population.

METHODS

Thirty-nine patients with type 1 diabetes and 39 controls were included. CECs were isolated using anti-CD146-coated Dynabeads, stained with Ulex lectin-1, and counted by fluorescence microscopy. Endothelial function was measured as flow-mediated dilation (FMD). Thiobarbituric acid reactive substances (TBARS), total glutathione levels (GSH), and paraoxonase (PON) activity levels were measured as oxidative stress markers.

RESULTS

Patients with type 1 diabetes mellitus had higher number of CECs (7.46+/-5.37 vs 2.13+/-1.13 cells/ml, P<0.001), lower FMD (7.87+/-2.19 vs 12.06+/-2.34%, P<0.001), higher TBARS (4.94+/-1.20 vs 3.07+/-0.75 nmol/MDA, P<0.001), lower GSH (206.12+/-98.06 vs 353.61+/-68.45 microM, P<0.001), and lower PON activity levels (89.10+/-17.82 vs 127.65+/-29.01 U/l, P<0.001) as compared to controls. There was positive correlation between CEC numbers and HbAlc levels (r=0.49, P=0.002). CECs and fasting glucose levels were not correlated. There was no correlation between the number of CECs and FMD. Furthermore, there were no correlations between the number of CECs and TBARS, GSH and PON activity levels. Multiple regression analysis showed that HbAlc levels (r(2)=0.40, P<0.009) were associated with CEC numbers.

CONCLUSION

CECs are elevated in patients with type 1 diabetes mellitus reflecting endothelial damage. This increase is dependent on long-term glucose control.

Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects

CONTEXT

Vitamin D receptors are present in many tissues. Hypovitaminosis D is considered to be a risk factor for atherosclerosis.

OBJECTIVE

This study explores the effects of vitamin D replacement on insulin sensitivity, endothelial function, inflammation, oxidative stress, and leptin in vitamin D-deficient subjects.

DESIGN, SETTING, AND PATIENTS

Twenty-three asymptomatic vitamin D-deficient subjects with 25-hydroxyvitamin D [25(OH)D] levels below 25 nmol/liter were compared with a control group that had a mean 25(OH)D level of 75 nmol/liter. The vitamin D-deficient group received 300,000 IU im monthly for 3 months. The following parameters were evaluated before and after treatment: vitamin D metabolites, leptin, endothelial function by brachial artery flow mediated dilatation (FMD), insulin sensitivity index based on oral glucose tolerance test, and lipid peroxidation as measures of thiobarbituric acid reactive substances (TBARS).

RESULTS

FMD measurements were significantly lower in 25(OH)D-deficient subjects than controls (P = 0.001) and improved after replacement therapy (P = 0.002). Posttreatment values of TBARS were significantly lower than pretreatment levels (P < 0.001). A positive correlation between FMD and 25(OH)D (r = 0.45; P = 0.001) and a negative correlation between FMD and TBARS (r = -0.28; P < 0.05) were observed. There was a significant increase in leptin levels after therapy, and the leptin levels were positively correlated with 25(OH)D levels (r = 0.45; P < 0.05).

CONCLUSIONS

This study shows that 25(OH)D deficiency is associated with endothelial dysfunction and increased lipid peroxidation. Replacement of vitamin D has favorable effects on endothelial function. Vitamin D deficiency can be seen as an independent risk factor of atherosclerosis. Hypovitaminosis D-associated endothelial dysfunction may predispose to higher rates of cardiovascular disease in the winter.

Exogenous subclinical hyperthyroidism impairs endothelial function in nodular goiter patients

BACKGROUND

Exogenous subclinical hyperthyroidism is associated with cardiovascular and metabolic changes. The aim of this study was to evaluate the effect of levothyroxine (LT4) suppression on endothelial function and insulin sensitivity in euthyroid nodular goiter patients.

METHODS

Twenty-two euthyroid patients with multinodular goiter (MNG) and 22 matched healthy controls were studied. LT4 was administered in doses ranging from 50 to 150 microg/day to reach target serum thyroid-stimulating hormone (TSH) levels <0.5 mIU/L. Patients were studied before and after 8 weeks after the target TSH level <0.5 mIU/L. The control group was studied twice, 16 weeks apart. Flow mediated vasodilatation (FMD), insulin sensitivity index (ISI), lipid peroxidation, and high-sensitivity C-reactive protein (hsCRP) were the outcome measures.

RESULTS

LT4 treatment significantly suppressed TSH levels to 0.2 +/- 0.1 mIU/L (minimum and maximum range was 0.05-0.3 mIU/L). FMD decreased from 10.7 +/- 2.7% to 5.4 +/- 1.7% (p < 0.001) and mean ISI decreased from 2.56 +/- 1.10 to 1.41 +/- 0.50 (p < 0.001) with LT4 treatment in the MNG group. Lipid peroxidation measured as thiobarbituric acid reactive substances (Tbars) (p < 0.05), and hsCRP (p < 0.001) levels significantly increased compared to the baseline in the MNG group. FMD measurement inversely correlated with free T4 (p = 0.008) and Tbars (p = 0.004), and positively correlated with ISI (p = 0.004). Serum Tbars and hsCRP were independent predictors of FMD (p = 0.004) in multivariate analysis. All results expressed as mean +/- SD.

CONCLUSIONS

TSH suppression therapy with LT4 leading to subclinical hyperthyroidism may cause impaired endothelial function, increased oxidative stress, and decreased insulin sensitivity in euthyroid nodular goiter patients.

Impact of body mass index on cancer development

PURPOSE

To determine the impact of body mass index (BMI) on cancer in a hospital-based Turkish population.

PATIENTS AND METHODS

The study group consisted of 2015 (1172 females: 423 pre- and 749 postmenopausal; and 843 males) patients with histologically proven cancer who applied to Marmara University Medical School, Medical Oncology Clinic. The control group included 305 healthy caregivers (192 females: 110 pre- and 82 postmenopausal; and 113 males).

RESULTS

Mean BMI of the patients with breast, ovarian and cervical carcinoma was significantly higher than that of the healthy female controls (p<0.001, 0.003, <0.001, respectively). Postmenopausal breast cancer patients had significantly higher BMI than postmenopausal female controls (odds ratio [OR] 1.3; 95% confidence interval [CI], 1.06-1.6; p=0.012), while this was not seen in premenopausal patients. When compared with controls obese postmenopausal female patients had 3.26-fold (95% CI 1.54-6.90) increased risk for breast cancer (p=0.002). Mean BMI of lung, stomach, esophagus, pancreas and head and neck carcinoma patients was significantly lower than that of the healthy controls. Female patients with lung and colorectal carcinoma had higher BMI than female controls.

CONCLUSION

Elevated BMI might be a risk factor for breast cancer in postmenopausal women. Case-control studies may not show the actual association between BMI and cancers that present with pre-diagnosis weight loss and advanced stage.

Temporal effects of low-dose ACE inhibition on endothelial function in Type 1 diabetic patients

AIM

Increased asymmetrical dimethylarginine (ADMA) is known to disturb endothelial function. ACE inhibitors decrease plasma ADMA levels in diseases associated with endothelial dysfunction. The effects of ACE inhibition on endothelial function and plasma ADMA levels in Type 1 diabetic patients was evaluated in the study.

METHODS

Thirty Type 1 diabetic patients [29+/-6 yr; females (F)/males (M): 18/12] and 29 controls (30+/-6 yr; F/M: 16/13) were recruited. Flow-mediated dilatation (FMD), plasma ADMAand thiobarbituric acid reactive substances (TBARs) were determined at baseline, on day 15 and 90 of 0.5 mg qd trandolapril therapy.

RESULTS

Compared to controls, baseline FMD levels were lower (4.7+/-2.0% vs 11.2+/-3.9%) (p<0.001), plasma ADMA (271.1+/-48.1 nmol/l vs 237.5+/-25.1 nmol/l) (p<0.05) and TBARs levels [4517.1+/-2366.9 nmol/malondialdehyde (MDA) vs 1775.9+/-598.7 nmol/MDA] (p<0.001) were higher in diabetic patients. On day 90 of trandolapril treatment, FMD (8.6+/-4.1%) (p<0.01) increased, ADMA levels (229.6+/-42.9 nmol/l) (p<0.001) decreased and TBARs levels (1531.8+/-1036.0 nmol/MDA) (p<0.001) decreased significantly. FMD was negatively correlated with plasma ADMA (r=-0.228, p<0.01), and TBARs levels (r=-0.244, p=0.02), whereas ADMA and TBARs levels were correlated positively (r=0.399, p<0.0001).

CONCLUSIONS

In conclusion, endothelial dysfunction is associated with elevated plasma ADMA levels in Type 1 diabetic patients. Low-dose ACE inhibition improves endothelial dysfunction and reduces ADMA levels. The antioxidant action of ACE inhibitors may play role in this process.