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Milionis C, Ilias I, Lekkou A, Venaki E, Koukkou E. Future clinical prospects of C-peptide testing in the early diagnosis of gestational diabetes. World J Exp Med 2024; 14:89320. [PMID: 38590302 PMCID: PMC10999065 DOI: 10.5493/wjem.v14.i1.89320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/11/2023] [Accepted: 12/28/2023] [Indexed: 03/19/2024] Open
Abstract
Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy. It is one of the most common metabolic disorders among expectant mothers, with potential serious short- and long-term complications for both maternal and offspring health. C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin. It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin. Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis. Inadequate compensation by islet beta-cells results in hyperglycemia. The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis. Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes. Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes, and Metabolism, ‘Elena Venizelou’ General Hospital, Athens 11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes, and Metabolism, ‘Elena Venizelou’ General Hospital, Athens 11521, Greece
| | - Anastasia Lekkou
- Department of Endocrinology, Diabetes, and Metabolism, ‘Elena Venizelou’ General Hospital, Athens 11521, Greece
| | - Evangelia Venaki
- Department of Endocrinology, Diabetes, and Metabolism, ‘Elena Venizelou’ General Hospital, Athens 11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes, and Metabolism, ‘Elena Venizelou’ General Hospital, Athens 11521, Greece
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Tselebis A, Koukkou E, Milionis C, Zabuliene L, Pachi A, Ilias I. Artificial night light and thyroid cancer. World J Methodol 2024; 14:89853. [PMID: 38577208 PMCID: PMC10989407 DOI: 10.5662/wjm.v14.i1.89853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/06/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The occurrence of thyroid cancer (TC) has increased in recent decades. Exposure to outdoor artificial light at night (ALN) is associated with an increased risk of cancer. AIM To investigated the impact of ALN, as a significant environmental pollutant, on TC incidence worldwide. METHODS The assessment involved analyzing satellite ALN data in conjunction with TC incidence data [adjusted standardized rate (ASR)], while considering the quality of cancer registries (QCR), gross domestic product (GDP) per person, and health expenditure per person (HEP) for each country. RESULTS Results indicated a correlation between higher ASR and ALN exposure percentages, particularly in countries with higher GDP or HEP quartiles (all P< 0.05). Significant differences in ASR were observed across QCR levels, both high and low quality (all P < 0.05), but not in countries without registry activity. However, when evaluating ASR against ALN exposure percentages while considering GDP/HEP quartiles or QCR levels, no significant associations were found (all P > 0.10). CONCLUSION The findings suggest a potential link between higher GDP and adverse health conditions, serving as possible risk factors for TC, rather than a direct association with ALN. Limitations include the use of cross-sectional data, temporal misalignment, and reliance on ALN as a socioeconomic proxy. It is proposed that light pollution might be connected to a lifestyle conducive to carcinogenesis. Additionally, the presence of higher GDP/HEP could enhance access to diagnostic resources, potentially facilitating TC diagnosis and inclusion in cancer registries.
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Affiliation(s)
- Athanasios Tselebis
- Department of Psychiatry, “Sotiria” General Chest Diseases Hospital, Athens GR-11527, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General Hospital, Athens GR-11521, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General Hospital, Athens GR-11521, Greece
| | - Lina Zabuliene
- Faculty of Medicine, Vilnius University, Vilnius LT-03101, Lithuania
| | - Argyro Pachi
- Department of Psychiatry, “Sotiria” General Chest Diseases Hospital, Athens GR-11527, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General Hospital, Athens GR-11521, Greece
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Milionis C, Ilias I, Milioni SO, Venaki E, Koukkou E. Caring for the Older Transgender Adults: Social, Nursing, and Medical Challenges. Clin Nurs Res 2024:10547738241231054. [PMID: 38339880 DOI: 10.1177/10547738241231054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Aging is a challenging process for people with gender nonconformity. Indeed, the older transgender population faces several disparities in accessing and using health care and social support services. Furthermore, the clinical management of gender transition in later life is empirical since clear research evidence is lacking. This paper aimed to present the problems encountered by older transgender adults in their access to social support and health care and to propose insightful solutions to address them both from a social and medical/nursing perspective. Trans elders face profound disparities in health and social care due to factors associated with limited accessibility to health services, social restrictions, administrative failures, and physical vulnerabilities. The medical treatment of older transgender adults also needs a careful approach to achieve satisfying gender affirmation without clinically significant risks. The potential induction of hormone-sensitive malignancies and the provocation of major adverse vascular events are the main concerns. Gender transition in older adults without a prior history of following gender-affirming therapy is challenging due to biological factors related to advanced age. Caring for elderly trans people unfolds at multiple levels. International organizations and governmental bodies should address the underprivileged status of elderly transgender people by creating and implementing inclusive policies. Safe and respectful clinical and residential environments and the formation of clearer medical guidelines could meet the unique needs of older trans adults. Care providers must advocate for their patients and be equipped to provide safe and effective services.
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Ilias I, Milionis C, Venaki E, Koukkou E. Is erectile dysfunction more prevalent from COVID-19's beginning and onwards? What do relevant Google searches show? Aging Male 2023; 26:2256401. [PMID: 37747067 DOI: 10.1080/13685538.2023.2256401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Evangelia Venaki
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
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Venaki E, Koukkou E, Ilias I. Melatonin’s actions are not limited to sleep. World J Exp Med 2023; 13:4-6. [PMID: 36970311 PMCID: PMC10037225 DOI: 10.5493/wjem.v13.i2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
Melatonin is widely available as a supplement, usually for sleep disorders. The consumption of melatonin supplements has increased considerably in recent years. An overlooked aspect of melatonin’s administration is the resulting increase in prolactin secretion, via its action on hypothalamic dopaminergic neurons. We believe that since the effect of melatonin on prolactin is tangible, the laboratory finding of hyperprolactinemia could be encountered more often, given the increase in melatonin’s use. This is an issue that merits further study.
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Affiliation(s)
- Evangelia Venaki
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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Milionis C, Ilias I, Venaki E, Koukkou E. Glucose Homeostasis, Diabetes Mellitus, and Gender-Affirming Treatment. Biomedicines 2023; 11:biomedicines11030670. [PMID: 36979649 PMCID: PMC10045127 DOI: 10.3390/biomedicines11030670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
The transgender (trans) population includes individuals with gender identities more fittingly aligned with the opposite sex or with an alternative that transcends the classical dipole of male/female. Hormonal treatment in transgender individuals aims to suppress the secretion of endogenous sex steroids and replace them with the steroids of the desired gender. The mainstay of gender-affirming treatment in transgender males is testosterone, whereas for transgender females it is estrogen, usually combined with an anti-androgen or a gonadotropin-releasing hormone agonist if testes are present. Testosterone and estrogen are involved in carbohydrate metabolism via direct effects on skeletal muscle, liver, adipose tissue, and immune cells and indirectly through changes in body fat mass and distribution. The effect of transgender treatment on glucose tolerance is not clear. The provided conflicting results demonstrate a positive, neutral, or even negative association between exogenous testosterone and insulin sensitivity in trans men. Studies show that feminizing hormonal therapy of trans women has mainly an aggravating effect on insulin sensitivity. The existing evidence is not robust and further research is needed to investigate the relationships between body fat distributions, muscle mass, and glycemia/insulin resistance in transgender people under hormonal therapy.
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Milionis C, Ilias I, Venaki E, Koukkou E. The metabolic effects of hormonal treatment in transgender males: Safety of the testosterone gender-affirming therapy. Int J Risk Saf Med 2023; 34:21-28. [PMID: 35964205 DOI: 10.3233/jrs-200087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Gender dysphoria is characterised by a sense of distress because of discordance between the self-perception of gender identity and the assigned sex. Hormonal treatment of transgender males uses testosterone to induce and preserve masculinisation. OBJECTIVE The study investigated the safety of testosterone therapy in transgender males. METHODS The present study used a retrospective file review of transgender male subjects who were treated with testosterone (initially transdermal testosterone gel and subsequently parenteral testosterone undecanoate) for at least 18 months and had subsequently achieved a serum testosterone level within the normal range of cisgender male counterparts. Changes in somatometric data and blood biomarkers were investigated. RESULTS The mean testosterone serum levels after approximately 18 months of treatment were about 545 ng/dL (SD ± 94 ng/dL). There was a statistically significant rise in body mass index (𝜒d = +1.23 kg/m2) with a reduction in blood glucose (𝜒d = -5.33 mg/dL) as well as statistically significant increases in aspartate transaminase (𝜒d = +4.3 U/L), haemoglobin (𝜒d = +1.72 g/dL), and haematocrit (𝜒d = +4.76%). In contrast, there were no significant changes in the lipidaemic profile of the subjects. CONCLUSIONS Treatment with testosterone is routinely used for the promotion of virilising physical changes in transgender males. However, the likelihood of adverse effects of continuous treatment is still unclear. This study contributed to the notion that achieving testosterone levels within the target range is a prerequisite for the safety of the gender-affirming treatment.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, General Hospital "Elena Venizelou", Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, General Hospital "Elena Venizelou", Athens, Greece
| | - Evaggelia Venaki
- Department of Endocrinology, Diabetes and Metabolism, General Hospital "Elena Venizelou", Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, General Hospital "Elena Venizelou", Athens, Greece
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Milionis C, Ilias I, Koukkou E. Liver function in transgender persons: Challenges in the COVID-19 era. World J Clin Cases 2023; 11:299-307. [PMID: 36686345 PMCID: PMC9850971 DOI: 10.12998/wjcc.v11.i2.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/23/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Transgender persons constitute a non-negligible percentage of the general population. Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries that aim to align bodily appearance with gender identity. Hormonal treatment acts via suppressing the secretion of the endogenous sex hormones and replacing them with the hormones of the desired sex. The administration of testosterone is the typical masculinizing treatment in trans men, whilst trans women are routinely treated with estradiol agents in combination with anti-androgens or gonadotrophin-releasing hormone agonists if testes are present. Exogenous androgenic steroids, estradiol agents, and anti-androgens have been implicated in a series of hepatotoxic effects. Thus, liver integrity is a major concern with the long-term administration of cross-sex therapy. Hepatic tissue is susceptible to coronavirus disease 19 (COVID-19) through various pathophysiological mechanisms. Special consideration should be paid to minimize the risk of hepatic damage from the potential cumulative effect of COVID-19 and gender-affirming treatment in transgender patients. Appropriate care is significant, with continuous laboratory monitoring, clinical observation and, if needed, specific treatment, especially in severe cases of infection and in persons with additional liver pathologies. The pandemic can be an opportunity to provide equal access to care for all and increase the resilience of the transgender population.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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Spanoudaki S, Maridaki M, Chryssanthopoulos C, Koukkou E, Philippou A. Glycemic Responses During And After Exercise At Constant Or Alternating Intensity Above The Lactate Threshold. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000881320.45120.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ilias I, Milionis C, Koukkou E. Further understanding of thyroid function in pregnant women. Expert Rev Endocrinol Metab 2022; 17:365-374. [PMID: 35831988 DOI: 10.1080/17446651.2022.2099372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Normal thyroid status throughout pregnancy is important for both maternal and fetal health. Despite the bulk of contemporary research honing on thyroid function in gestation and the relevant disorders, there are still gaps in our current knowledge about the etiology and treatment of thyroid diseases in pregnant women. AREAS COVERED This article analyzes the adaptation of the thyroid gland to gestational physiological changes and attempts to explain the effect of several factors on thyroid function in pregnancy. It also stresses proper utilization and interpretation of thyroid tests during pregnancy and underlines the significance of proper screening and treatment of pregnant women aiming at favorable health outcomes. EXPERT OPINION Appropriate strategies for diagnosing and treating thyroid disease in pregnancy are important. Laboratory thyroid testing plays a leading role, but test results should be interpreted with caution. Given the possible serious maternal and fetal/neonatal complications of thyroid disease in pregnancy, we recommend universal screening with TSH measurements of all pregnant women. Additional assessment with determination of the levels of free thyroid hormones and thyroid antibodies may be necessary under certain conditions. The economic burden of such interventions should be considered.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
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Kakoulidis I, Ilias I, Linardi A, Stergiotis S, Togias S, Michou A, Koukkou E. Glycemic profile assessment during betamethasone administration in women with twin pregnancies after IVF with or without gestational diabetes. Diabetes Metab Syndr 2022; 16:102534. [PMID: 35691203 DOI: 10.1016/j.dsx.2022.102534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Betamethasone's effect on glycemia in twin pregnancies, with or without gestational diabetes mellitus, has not been adequately investigated. METHODS We assessed the glycemic profile of 30 women with twin pregnancies after in-vitro-fertilization who were given betamethasone. RESULTS The majority of women were treated eventually with insulin to maintain glycemia. In insulin-treated women the increase in insulin dosage was of 61.1%. Insulin use/dosage was not associated with betamethasone dose, age, gestational age, weight gain in pregnancy, or duration of hyperglycemia. CONCLUSION Post-betamethasone, twin pregnancies seem to follow the same glycemia pattern as singleton pregnancies.
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Affiliation(s)
- Ioannis Kakoulidis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece.
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Anastasia Linardi
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Stefanos Stergiotis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Stefanos Togias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Aikaterini Michou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
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Milionis C, Ilias I, Koukkou E. Progesterone in gender-affirming therapy of trans women. World J Biol Chem 2022; 13:66-71. [PMID: 35721880 PMCID: PMC10558402 DOI: 10.4331/wjbc.v13.i3.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
Progesterone is an endogenous steroid hormone with an important role for the physiology of the female reproductive system and the mammary gland. It has additional significant actions in other tissues, such as the cardiovascular system, the central nervous system, and bones. The present article explores potential clinical implications from the addition of bioidentical progesterone to gender-affirming treatment of trans women. For this purpose, it provides an overview of the physiological action of progesterone in target tissues and speculates on possible benefits for gender transitioning. Progesterone is expected to exert moderate anti-androgen action through suppression of the hypothalamic-pituitary-gonadal axis and inhibition of the conversion of testosterone to dihydrotestosterone. It may also contribute to breast maturation. In the long-term, progesterone could prevent bone loss and protect cardiovascular health. The potential benefits are mainly inferred by extrapolating evidence from biological actions in cisgender women and medical assumptions and hence, clinicians need to be cautious when applying these data into practice. Further research is needed to ascertain the efficacy and safety of progesterone in current hormonal regimens.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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Ilias I, Milionis C, Koukkou E. COVID-19 and thyroid disease: An infodemiological pilot study. World J Methodol 2022; 12:99-106. [PMID: 35721248 PMCID: PMC9157630 DOI: 10.5662/wjm.v12.i3.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/11/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Google Trends searches for symptoms and/or diseases may reflect actual disease epidemiology. Recently, Google Trends searches for coronavirus disease 2019 (COVID-19)-associated terms have been linked to the epidemiology of COVID-19. Some studies have linked COVID-19 with thyroid disease.
AIM To assess COVID-19 cases per se vs COVID-19-associated Google Trends searches and thyroid-associated Google Trends searches.
METHODS We collected data on worldwide weekly Google Trends searches regarding “COVID-19”, “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, “coronavirus”, “smell”, “taste”, “cough”, “thyroid”, “thyroiditis”, and “subacute thyroiditis” for 92 wk and worldwide weekly COVID-19 cases' statistics in the same time period. The study period was split in half (approximately corresponding to the preponderance of different SARS-COV-2 virus variants) and in each time period we performed cross-correlation analysis and mediation analysis.
RESULTS Significant positive cross-correlation function values were noted in both time periods. More in detail, COVID-19 cases per se were found to be associated with no lag with Google Trends searches for COVID-19 symptoms in the first time period and in the second time period to lead searches for symptoms, COVID-19 terms, and thyroid terms. COVID-19 cases per se were associated with thyroid-related searches in both time periods. In the second time period, the effect of “COVID-19” searches on “thyroid’ searches was significantly mediated by COVID-19 cases (P = 0.048).
CONCLUSION Searches for a non-specific symptom or COVID-19 search terms mostly lead Google Trends thyroid-related searches, in the second time period. This time frame/sequence particularly in the second time period (noted by the preponderance of the SARS-COV-2 delta variant) lends some credence to associations of COVID-19 cases per se with (apparent) thyroid disease (via searches for them).
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes & Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes & Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes & Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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Ilias I, Katsantonis J, Kakoulidis I, Koukkou E. Generalized Lipomatosis in a Patient with Type 1 Diabetes. Skinmed 2022; 20:131. [PMID: 35532766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece;
| | - John Katsantonis
- Department of Dermatology, Tzaneio General Hospital, Piraeus, Greece
| | - Ioannis Kakoulidis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
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Kakoulidis I, Ilias I, Stergiotis S, Togias S, Michou A, Lekkou A, Mastrodimou V, Pappa A, Milionis C, Venaki E, Koukkou E. Study on the Interaction between Serum Thyrotropin and Semen Parameters in Men. Med Sci (Basel) 2022; 10:medsci10020022. [PMID: 35466230 PMCID: PMC9036276 DOI: 10.3390/medsci10020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 11/22/2022] Open
Abstract
The effect of thyroid function on semen parameters has been studied in pathological conditions in small studies. With this research work, we aimed to study thyroid hormone effects on semen parameters in 130 men who were evaluated for couple subfertility. Our study was cross-sectional. We noted semen volume, sperm concentration, total sperm count, testosterone levels and thyrotropin (TSH) levels. The analysis included ordinary least squares regression (OLS-R), quantile regression (QR) and segmented line regression (SR). Using OLS-R, a weak negative correlation was found between the logTSH levels and semen volume (r = −0.16, r2 = 0.03, p = 0.05). In Q-R, each incremental unit increase in logTSH decreased the mean semen volume between −0.78 ± 0.44 and −1.33 ± 0.34 mL (40–60th response quantile) and between −1.19 ± 0.71 and −0.61 ± 0.31 mL (70–90th response quantile) (p = 0.049). With SR, a biphasic relationship of sperm concentration with TSH was noted (positive turning to negative, peaking at TSH = 1.22 μIU/mL). Thus, a weak negative association between the TSH levels and semen volume was noted, showing a trough within the usual normal range for TSH. Moreover, a biphasic relationship between the sperm concentration and TSH was also noted, peaking at approximately mid-normal TSH levels. Based on our results, TSH explained slightly less than 3% of the variation in semen volume and 7% of the sperm concentration (thus, other factors, which were not studied here, have a more important effect on it).
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Milionis C, Koukkou E, Ilias I. Conundrums in the medical treatment of transgender persons. Endocr Metab Immune Disord Drug Targets 2022; 22:795-797. [PMID: 35209825 DOI: 10.2174/1871530322666220223161227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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Triantafyllou AS, Ilias I, Economou NT, Pappa A, Koukkou E, Steiropoulos P. Dream Recall/Affect and Cortisol: An Exploratory Study. Clocks Sleep 2022; 4:9-15. [PMID: 35225949 PMCID: PMC8883916 DOI: 10.3390/clockssleep4010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
The effect of cortisol on dreams has been scarcely studied. The aim of this exploratory study was to assess the possible effect of cortisol levels on dream recall/affect, considering, in female subjects, their menstrual cycle phase. Fifteen men and fifteen women were recruited. Saliva samples were used for the detection of cortisol levels. Participants were instructed to provide four saliva samples, during three consecutive days. After awakening, on the second and third day, they were asked whether they could recall the previous night’s dreams and whether these were pleasant or unpleasant. Female subjects followed this procedure twice: firstly, during the luteal phase and, secondly, during the follicular phase of the menstrual cycle. Subjects with higher evening or higher morning cortisol levels tended to show increased dream recall; a non-statistically significant association between morning cortisol levels and positive dream affect was also found. This association acquired statistical significance for salivary morning cortisol levels exceeding the upper normal level of 19.1 nmol/L (OR: 4.444, 95% CI: 1.108–17.830, p-value: 0.039). No connection between menstrual cycle stages and dream recall/affect was detected. In conclusion, cortisol may be a crucial neuromodulator, affecting dream recall and content. Therefore, its effects on sleep and dreams should be further studied.
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Affiliation(s)
- Alexandros S. Triantafyllou
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.T.); (N.-T.E.); (P.S.)
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, 11521 Athens, Greece; (A.P.); (E.K.)
- Correspondence: ; Tel.: +30-213-205-1389
| | - Nicholas-Tiberio Economou
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.T.); (N.-T.E.); (P.S.)
- Sleep Study Unit, Eginition Hospital, University of Athens & Enypnion Sleep Disorders—Epilepsy Center, 11521 Athens, Greece
| | - Athina Pappa
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, 11521 Athens, Greece; (A.P.); (E.K.)
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, 11521 Athens, Greece; (A.P.); (E.K.)
| | - Paschalis Steiropoulos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.S.T.); (N.-T.E.); (P.S.)
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Kakoulidis I, Thomopoulos C, Ilias I, Stergiotis S, Togias S, Michou A, Milionis C, Venaki E, Koukkou E. Alpha-Methyldopa May Attenuate Insulin Demand in Women with Gestational Diabetes Treated with Betamethasone. Healthcare (Basel) 2022; 10:healthcare10010135. [PMID: 35052298 PMCID: PMC8775714 DOI: 10.3390/healthcare10010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/02/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is associated with hypertensive disorders in pregnancy. Alpha-methyl-DOPA (αMD) is a commonly used medication for hypertension in pregnant women. This medication may be associated with alteration in insulin resistance and glucose homeostasis. The aim of the present study was to investigate in 152 pregnant women whether the demands of exogenous insulin in glucocorticoid-treated women during pregnancy are different between those with GDM and hypertension treated with αMD and those without hypertension. In the group of women with GDM under insulin treatment, who received αMD for hypertension, the increase in insulin needs was relatively lower by at least 30% of the pre-admission insulin dose compared to all of the remaining women not receiving αMD in the same group (9 women vs. 50 women, p = 0.035). Our work raises the hypothesis that αMD can favorably modulate insulin sensitivity in the third trimester of pregnancy in previously insulin-treated women with gestational diabetes who receive glucocorticoids.
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Affiliation(s)
- Ioannis Kakoulidis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
| | - Costas Thomopoulos
- Department of Cardiology, Elena Venizelou General and Maternity Hospital, GR-11522 Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
| | - Stefanos Stergiotis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
| | - Stefanos Togias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
| | - Aikaterini Michou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
| | - Evangelia Venaki
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, GR-11521 Athens, Greece
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Kakoulidis I, Ilias I, Linardi A, Michou A, Milionis C, Lekkou A, Venaki E, Koukkou E. Insulin requirements during lactation in women with diabetes mellitus type 1 in comparison with pre-pregnancy levels: A 10-year retrospective study. Health Care Women Int 2021; 43:309-312. [PMID: 34586960 DOI: 10.1080/07399332.2021.1959588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The metabolic profile variability of women with diabetes mellitus type 1 (DM1) during breastfeeding, leads to a reassessment in managing glycemia, mainly to prevent hypoglycemia. In this retrospective study we assessed insulin needs, vis-à-vis breastfeeding in DM1. A 10.7% reduction of daily insulin dosage, compared to pre-pregnancy insulin needs, was noted in women who breastfed exclusively versus 10.8% in those who supplemented breastfeeding (p = NS). Women who experienced hypoglycemic episodes, tended (but not significantly) to be younger (p = 0.10), with longer duration of DM1 and more weight gain in pregnancy. Exclusive breastfeeding was associated with younger age (p = 0.04), regardless of hypoglycemia (p = 0.25).
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Affiliation(s)
- Ioannis Kakoulidis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Anastasia Linardi
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Aikaterini Michou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Anastasia Lekkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Evangelia Venaki
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
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Schaffner M, Mühlberger N, Conrads-Frank A, Qerimi Rushaj V, Sroczynski G, Koukkou E, Heinsbaek Thuesen B, Völzke H, Oberaigner W, Siebert U, Rochau U. Benefits and Harms of a Prevention Program for Iodine Deficiency Disorders: Predictions of the Decision-Analytic EUthyroid Model. Thyroid 2021; 31:494-508. [PMID: 32847437 DOI: 10.1089/thy.2020.0062] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Iodine deficiency is one of the most prevalent causes of intellectual disability and can lead to impaired thyroid function and other iodine deficiency disorders (IDDs). Despite progress made on eradicating iodine deficiency in the last decades in Europe, IDDs are still prevalent. Currently, evidence-based information on the benefit/harm balance of IDD prevention in Europe is lacking. We developed a decision-analytic model and conducted a public health decision analysis for the long-term net benefit of a mandatory IDD prevention program for the German population with moderate iodine deficiency, as a case example for a European country. Methods: We developed a decision-analytic Markov model simulating the incidence and consequences of IDDs in the absence or presence of a mandatory IDD prevention program (iodine fortification of salt) in an open population with current demographic characteristics in Germany and with moderate ID. We collected data on the prevalence, incidence, mortality, and quality of life from European studies for all health states of the model. Our primary net-benefit outcome was quality-adjusted life years (QALYs) predicted over a period of 120 years. In addition, we calculated incremental life years and disease events over time. We performed a systematic and comprehensive uncertainty assessment using multiple deterministic one-way sensitivity analyses. Results: In the base-case analysis, the IDD prevention program is more beneficial than no prevention, both in terms of QALYs and life years. Health gains predicted for the open cohort over a time horizon of 120 years for the German population (82.2 million inhabitants) were 33 million QALYs and 5 million life years. Nevertheless, prevention is not beneficial for all individuals since it causes additional hyperthyroidism (2.7 million additional cases). Results for QALY gains were stable in sensitivity analyses. Conclusions: IDD prevention via mandatory iodine fortification of salt increases quality-adjusted life expectancy in a European population with moderate ID, and is therefore beneficial on a population level. However, further ethical aspects should be considered before implementing a mandatory IDD prevention program. Costs for IDD prevention and treatment should be determined to evaluate the cost effectiveness of IDD prevention.
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Affiliation(s)
- Monika Schaffner
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Annette Conrads-Frank
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Vjollca Qerimi Rushaj
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Faculty of Pharmacy, School of PhD Studies, Ss. Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Eftychia Koukkou
- Department of Endocrinology, University of Patras, Patras, Greece
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wilhelm Oberaigner
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard Chan School of Public Health, Boston, Massachusetts, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ursula Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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21
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Schaffner M, Rochau U, Mühlberger N, Conrads-Frank A, Qerimi Rushaj V, Sroczynski G, Koukkou E, Thuesen BH, Völzke H, Oberaigner W, Siebert U. The economic impact of prevention, monitoring and treatment strategies for iodine deficiency disorders in Germany. Endocr Connect 2021; 10:1-12. [PMID: 33263563 PMCID: PMC7849460 DOI: 10.1530/ec-20-0384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE More than 30% of the German population suffers from mild to moderate iodine deficiency causing goiter and other iodine deficiency disorders (IDDs). The economic burden of iodine deficiency is still unclear. We aimed to assess costs for prevention, monitoring and treatment of IDDs in Germany. DESIGN We performed a comprehensive cost analysis. METHODS We assessed direct medical costs and direct non-medical costs for inpatient and outpatient care of IDDs and costs for productivity loss due to the absence of work in 2018. Additionally, we calculated total costs for an IDD prevention program comprising universal salt iodization (USI). We performed threshold analyses projecting how many cases of IDDs or related treatments would need to be avoided for USI to be cost-saving. RESULTS Annual average costs per case in the year of diagnosis were € 211 for goiter/thyroid nodules; € 308 for hyperthyroidism; and € 274 for hypothyroidism. Average one-time costs for thyroidectomy were € 4184 and € 3118 for radioiodine therapy. Average costs for one case of spontaneous abortion were € 916. Annual costs of intellectual disability were € 14,202. In the German population, total annual costs for USI would amount to 8 million Euro. To be cost-saving, USI would need to prevent, for example, 37,900 cases of goiter/thyroid nodules. CONCLUSION USI potentially saves costs, if a minimum amount of IDDs per year could be avoided. In order to recommend the implementation of USI, a full health-economic evaluation including a comprehensive benefit-harm assessment is needed.
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Affiliation(s)
- Monika Schaffner
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Correspondence should be addressed to S Monika:
| | - Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Nikolai Mühlberger
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Vjollca Qerimi Rushaj
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Faculty of Pharmacy, School of PhD Studies, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | | | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wilhelm Oberaigner
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard Chan School of Public Health, Boston, Massachusetts, USA
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Anastasiou E, Farmakidis G, Gerede A, Goulis DG, Koukkou E, Kourtis A, Mamopoulos A, Papadimitriou K, Papadopoulos V, Stefos T. Clinical practice guidelines on diabetes mellitus and pregnancy: Ι. Pre-existing type 1 and type 2 diabetes mellitus. Hormones (Athens) 2020; 19:593-600. [PMID: 32415647 DOI: 10.1007/s42000-020-00192-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 11/27/2022]
Abstract
Women with type 1 (T1DM) or type 2 diabetes (T2DM) diagnosed prior to pregnancy are classified as having pre-existing diabetes mellitus (DM). The prevalence of hyperglycemia in pregnancy has been estimated at 17% globally and 5.4% in Europe, differences existing among racial and ethnic groups, following the prevalence of type 2 diabetes. Only a minority (approximately 15%) of the cases of diabetes during pregnancy represent women with pre-existing diabetes. Because of the rising prevalence of obesity and limited screening for diabetes in young women, there has been, globally, an increase in the diagnosis of previously unknown overt diabetes early in pregnancy; these women should be treated as women with pre-existing diabetes, as they may already have unrecognized complications (e.g., nephropathy and retinopathy). The Hellenic Endocrine Society and the Hellenic Society of Maternal-Fetal Medicine commissioned an expert group to construct national guidelines on "Diabetes mellitus and pregnancy: Pre-existing type 1 and 2 diabetes mellitus". Following a search for the best available evidence and critical appraisal of the search results, the writing group generated a series of consensus recommendations regarding preconception counseling and care, care during pregnancy, and care after the pregnancy in cases of pre-existing T1DM and T2DM.
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Affiliation(s)
| | | | - Angeliki Gerede
- Hellenic Society of Maternal-Fetal Medicine, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Hellenic Endocrine Society, Athens, Greece.
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece.
| | | | | | | | | | | | - Theodoros Stefos
- Hellenic Society of Maternal-Fetal Medicine, Thessaloniki, Greece
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Anastasiou E, Farmakidis G, Gerede A, Goulis DG, Koukkou E, Kourtis A, Mamopoulos A, Papadimitriou K, Papadopoulos V, Stefos T. Clinical practice guidelines on diabetes mellitus and pregnancy: ΙI. Gestational diabetes mellitus. Hormones (Athens) 2020; 19:601-607. [PMID: 32451981 DOI: 10.1007/s42000-020-00193-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy and is associated with several perinatal complications. GDM is defined as diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation. In Europe, in 2016, the prevalence of GDM was estimated to be 5.4% (3.8-7.8). It varied depending on maternal age, year of data collection, country, area of Europe, week of gestation at testing, and diagnostic criteria. The Hellenic Endocrine Society and the Hellenic Society of Maternal-Fetal Medicine commissioned an expert group to construct national guidelines on "Diabetes mellitus and pregnancy: Gestational diabetes mellitus." Following a search for the best available evidence and critical appraisal of the results, the writing group generated a series of consensus recommendations regarding screening tests for the general population, monitoring and management, fetal monitoring, management of preterm labor, planning of labor and delivery, puerperium and breastfeeding, and long-term follow-up of GDM.
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Affiliation(s)
- Eleni Anastasiou
- Hellenic Endocrine Society - Greek Society of Endocrinologists, Athens, Greece
| | | | | | - Dimitrios G Goulis
- Hellenic Endocrine Society - Greek Society of Endocrinologists, Athens, Greece.
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece.
| | - Eftychia Koukkou
- Hellenic Endocrine Society - Greek Society of Endocrinologists, Athens, Greece
| | - Anargyros Kourtis
- Hellenic Endocrine Society - Greek Society of Endocrinologists, Athens, Greece
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Kakoulidis I, Ilias I, Koukkou E. SARS-CoV-2 infection and glucose homeostasis in pregnancy. What about antenatal corticosteroids? Diabetes Metab Syndr 2020; 14:519-520. [PMID: 32388332 PMCID: PMC7202835 DOI: 10.1016/j.dsx.2020.04.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Administration of corticosteroids is common in obstetric practice. In this concise review we queried on the effects of corticosteroids in pregnancies complicated by SARS-CoV-2. METHODS We performed a literature search on PubMed, regarding the use of corticosteroids in patients with SARS-CoV-2 infection, in pregnancies complicated by SARS-CoV-2, as well as their impact on glycemia in pregnant women with or without diabetes. Furthermore, we searched for effects of SARS-CoV-2 and of other coronaviridae on insulin secretion and glycemia. RESULTS SARS-CoV-2 infection appears to be a risk factor for complications in pregnancy. Corticosteroids may not be recommended for treating SARS-CoV-2 pneumonia but they may be needed for at-risk pregnancies. Corticosteroids in pregnancy have a diabetogenic potential. SARS-CoV-2 and other coronaviridae may have effects on glycemia. CONCLUSIONS Caution should be exercised while using corticosteroids in pregnant women with COVID-19 requiring preterm delivery.
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Affiliation(s)
- Ioannis Kakoulidis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, GR11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, GR11521, Greece.
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, GR11521, Greece
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Kakoulidis I, Ilias I, Linardi A, Venaki E, Koukkou E. Cystic Fibrosis-Related Diabetes and Subclinical Hypothyroidism in Pregnancy. Cureus 2020; 12:e8895. [PMID: 32742862 PMCID: PMC7389253 DOI: 10.7759/cureus.8895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pregnancy in women with cystic fibrosis-related diabetes (CFRD) is rare and requires intensive monitoring and individualized treatment due to the pathophysiologic parameters of the disease in relation to insulin therapy and special nutritional needs. We present the case of a 33-year-old primigravida woman with CFRD (ΔF508 homozygote, with mild pulmonary involvement) on insulin therapy and treatment for exocrine pancreatic insufficiency, who developed subclinical hypothyroidism during gestation. Due to the complexity of the disease, major clinical challenges were glycemic variance, hypoglycemic episodes, and difficulty in weight gaining. In addition, the presence of malabsorption in the intestinal mucosa was an important aspect of difficulty in the treatment of subclinical hypothyroidism. Thus, the flexible approach in the timing of basal insulin administration, combined with the individualized medical nutrition therapy, and along with the progressive increase in levothyroxine dosage, all were proven to be key components in the effective management of our patient.
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Kakoulidis I, Ilias I, Linardi A, Michou A, Milionis C, Petychaki F, Venaki E, Koukkou E. Glycemia after Betamethasone in Pregnant Women without Diabetes-Impact of Marginal Values in the 75-g OGTT. Healthcare (Basel) 2020; 8:healthcare8010040. [PMID: 32079162 PMCID: PMC7151230 DOI: 10.3390/healthcare8010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 11/21/2022] Open
Abstract
Betamethasone (BM) administration in pregnancy has been shown to reduce the incidence and severity of neonatal respiratory distress syndrome. Its known diabetogenic impact, combined with placental insulin resistance, leads to a transient increase in glycemia. However, its effect on glucose homeostasis in pregnancy has not been adequately investigated. We closely monitored and assessed the glycemic profile of 83 pregnant women, with normal glucose metabolism, who were given BM during their hospitalization due to threatened premature labor. A significant change in the glycemic profile in most patients was noted, lasting 1.34 ± 1.05 days. Sixty-six of eighty-three women were eventually treated with insulin to maintain glycemia within acceptable limits. The mean ± SD insulin dosage was 12.25 ± 11.28 units/day. The need for insulin therapy was associated with higher BM doses and the presence of marginal values in the 75-g oral glucose tolerance test (OGTT) at 60 min. Our study demonstrates, following BM administration, the need for increased awareness and individualized monitoring/treatment of pregnant women with normal—yet marginal—values in the 75-g OGTT.
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Kakoulidis I, Ilias I, Linardi A, Milionis C, Michou A, Koukkou E. Glycemic profile assessment during betamethasone administration in women with gestational diabetes mellitus. Diabetes Metab Syndr 2019; 13:214-215. [PMID: 30641699 DOI: 10.1016/j.dsx.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022]
Abstract
AIM Betamethasone's effect on glucose homeostasis in the presence of gestational diabetes has not been adequately investigated. MATERIALS-METHODS We assessed the glycemic profile of 99 women with gestational diabetes (52 on insulin, 47 on medical nutrition therapy) who were given betamethasone during hospitalization for at risk pregnancies. RESULTS In insulin-treated women the increase in total daily insulin dose significantly linked to betamethasone dose (p = 0.014). In women on diet, the need for insulin was positively related to betamethasone dose, age and gestational age >34th week (all p < 0.05). CONCLUSION Parsimonious betamethasone use might still be beneficial with a milder effect on glycemia.
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Affiliation(s)
- Ioannis Kakoulidis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece.
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Anastasia Linardi
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Aikaterini Michou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou General and Maternity Hospital, Athens, Greece
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Sakkas EG, Paltoglou G, Linardi A, Gryparis A, Nteka E, Chalarakis N, Mantzou A, Vrachnis N, Iliodromiti Z, Koukkou E, Deligeoroglou E, Sakkas GE, Mastorakos G. Associations of maternal oestradiol, cortisol, and TGF-β1 plasma concentrations with thyroid autoantibodies during pregnancy and postpartum. Clin Endocrinol (Oxf) 2018; 89:789-797. [PMID: 30151971 DOI: 10.1111/cen.13843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyroid physiology and autoimmunity are altered in pregnancy. While oestradiol, cortisol, and TGF-β1 are implicated in these phenomena outside pregnancy, their associations with thyroid autoantibodies during pregnancy and postpartum are not thoroughly examined. This study aimed to unravel their eventual associations during pregnancy and postpartum in the same cohort of 93 pregnant women studied prospectively from 2015 to 2017. METHODS Blood samples were drawn at the 24th and the 36th gestational week and at the 1st postpartum week for measurements of thyroid hormones, TSH, anti-TPO, anti-Tg, oestradiol, cortisol, and TGF-β1. RESULTS Serum anti-TPO was greater (P < 0.05) at the 1st postpartum than at the 24th and 36th gestational weeks. At the 36th gestational week, cortisol was greater (P < 0.05) and TGF-β1 lower (P < 0.05) than at the 24th gestational and the 1st postpartum weeks. At the 1st postpartum week, cortisol correlated negatively with anti-Tg (r = -0.419) (P < 0.05). ΔTGF-β1 was the best negative and Δoestradiol the best positive predictor of the 1st postpartum week anti-TPO (P < 0.05, b = -0.509; P < 0.05, b = 0.459 respectively). CONCLUSIONS At postpartum, increased TGF-β1 is related to a less pronounced anti-TPO increase as compared to the 3rd trimester, suggesting an immunosuppressive role for TGF-β1. During pregnancy and postpartum, oestradiol, cortisol, and TGF-β1 are associated with suppression of thyroid autoantibodies.
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Affiliation(s)
- Evangelos G Sakkas
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Paltoglou
- Department of Endocrinology and Diabetes, Great Ormond Street Hospital, London, UK
| | | | - Alexandros Gryparis
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Nteka
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Chalarakis
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aimilia Mantzou
- Department of Endocrinology, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Iliodromiti
- Department of Neonatology, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftychia Koukkou
- Endocrine Unit, Elena Venizelou Maternity Hospital, Athens, Greece
| | - Efthymios Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - George Mastorakos
- Unit of Endocrinology, Diabetes mellitus and Metabolism, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Linardi A, Michou E, Ilias I, Petychaki F, Kakoulidis I, Pappa A, Koukkou E. Resistant Thyrotoxicosis due to Graves' Disease in Pregnancy: Case Report and Review of the Literature. Cureus 2018; 10:e3232. [PMID: 30410838 PMCID: PMC6207494 DOI: 10.7759/cureus.3232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The effective management of Graves' disease (GD) during pregnancy is crucial for maternal and neonatal well-being. Conventional treatment of GD during pregnancy includes antithyroid drugs (ATDs) and surgery, ideally during the second trimester. We report a 27-year-old woman with GD and we present the course of GD during her three consecutive pregnancies. During the first pregnancy, thyrotoxicosis was successfully treated with low doses of antithyroid drugs; in the second pregnancy, thyrotoxicosis was only controlled at the third trimester; while in the third pregnancy, our patient presented with treatment-resistant thyrotoxicosis, which was finally managed with corticosteroids in adjunction with ATDs. Although hyperthyroid, the patient maintained her fertility. Resistance to ATD is a rare condition and in our case was adequately controlled with corticosteroids.
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Affiliation(s)
- Anastasia Linardi
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, GRC
| | - Ekaterini Michou
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, GRC
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, GRC
| | - Foteini Petychaki
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens , GRC
| | - Ioannis Kakoulidis
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, GRC
| | - Athina Pappa
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, GRC
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, GRC
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Dessinioti C, Tzanetakou V, Zisimou C, Platsidaki E, Koukkou E, Katsambas A, Antoniou C. A study of androgenic signs and disorders in Greek female patients with acne. J Eur Acad Dermatol Venereol 2018; 32:e279-e282. [PMID: 29377293 DOI: 10.1111/jdv.14817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- C Dessinioti
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, 5, I.Dragoumi street, 16121, Athens, Greece
| | - V Tzanetakou
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, 5, I.Dragoumi street, 16121, Athens, Greece
| | - C Zisimou
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, 5, I.Dragoumi street, 16121, Athens, Greece
| | - E Platsidaki
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, 5, I.Dragoumi street, 16121, Athens, Greece
| | - E Koukkou
- Department of Endocrinology, "Elena Venizelou" Maternity Hospital, 2, Elenas Venizelou square, 11521, Athens, Greece
| | - A Katsambas
- University of Athens, 18, Tetrapoleos street, 11527, Athens, Greece
| | - C Antoniou
- Department of Dermatology, Andreas Syggros Hospital, University of Athens, 5, I.Dragoumi street, 16121, Athens, Greece
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Ilias I, Linardi A, Milionis C, Tselebis A, Koukkou E. [Procrastination in the self-management of gestational diabetes]. Presse Med 2018; 47:180-181. [PMID: 29373275 DOI: 10.1016/j.lpm.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/11/2017] [Accepted: 11/27/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ioannis Ilias
- Hôpital El Venizelou, département d'endocrinologie, Athènes, Grèce.
| | | | | | | | - Eftychia Koukkou
- Hôpital El Venizelou, département d'endocrinologie, Athènes, Grèce
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Diamanti-Kandarakis E, Dattilo M, Macut D, Duntas L, Gonos ES, Goulis DG, Gantenbein CK, Kapetanou M, Koukkou E, Lambrinoudaki I, Michalaki M, Eftekhari-Nader S, Pasquali R, Peppa M, Tzanela M, Vassilatou E, Vryonidou A. MECHANISMS IN ENDOCRINOLOGY: Aging and anti-aging: a Combo-Endocrinology overview. Eur J Endocrinol 2017; 176:R283-R308. [PMID: 28264815 DOI: 10.1530/eje-16-1061] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 12/14/2022]
Abstract
Aging and its underlying pathophysiological background has always attracted the attention of the scientific society. Defined as the gradual, time-dependent, heterogeneous decline of physiological functions, aging is orchestrated by a plethora of molecular mechanisms, which vividly interact to alter body homeostasis. The ability of an organism to adjust to these alterations, in conjunction with the dynamic effect of various environmental stimuli across lifespan, promotes longevity, frailty or disease. Endocrine function undergoes major changes during aging, as well. Specifically, alterations in hormonal networks and concomitant hormonal deficits/excess, augmented by poor sensitivity of tissues to their action, take place. As hypothalamic-pituitary unit is the central regulator of crucial body functions, these alterations can be translated in significant clinical sequelae that can impair the quality of life and promote frailty and disease. Delineating the hormonal signaling alterations that occur across lifespan and exploring possible remedial interventions could possibly help us improve the quality of life of the elderly and promote longevity.
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Affiliation(s)
| | | | - Djuro Macut
- Clinic for EndocrinologyDiabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Leonidas Duntas
- Medical SchoolUniversity of Ulm, Ulm, Germany
- Endocrine ClinicEvgenidion Hospital, University of Athens, Athens, Greece
| | - Efstathios S Gonos
- National Hellenic Research FoundationInstitute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | - Dimitrios G Goulis
- First Department of Obstetrics & GynecologyMedical School, Aristotle University of Thessaloniki, Unit of Reproductive Endocrinology, Thessaloniki, Greece
| | - Christina Kanaka Gantenbein
- First Department of Pediatrics Medical SchoolAghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Kapetanou
- National Hellenic Research FoundationInstitute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | | | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and GynecologyUniversity of Athens, Aretaieio Hospital, Athens, Greece
| | - Marina Michalaki
- Endocrine DivisionInternal Medicine Department, University Hospital of Patras, Patras, Greece
| | - Shahla Eftekhari-Nader
- Department of Internal MedicineMc Goven Medical School, The University of Texas, Houston, Texas, USA
| | | | - Melpomeni Peppa
- Second Department of Internal Medicine PropaedeuticResearch Institute and Diabetes Center, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Evangeline Vassilatou
- Endocrine Unit2nd Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Andromachi Vryonidou
- Department of EndocrinologyDiabetes and Metabolism, 'Red Cross Hospital', Athens, Greece
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Koukkou E, Ilias I, Mamalis I, Adonakis GG, Markou KB. Serum Thyroglobulin Concentration Is a Weak Marker of Iodine Status in a Pregnant Population with Iodine Deficiency. Eur Thyroid J 2016; 5:120-4. [PMID: 27493886 PMCID: PMC4949369 DOI: 10.1159/000446070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the reliability of thyroglobulin (Tg) as a marker of iodine status during pregnancy. DESIGN 299 women aged 30.5 ± 4.8 years (mean ± SD) were studied. METHODS In every subject, we measured urinary iodine concentration (UIC), serum thyrotropin (TSH), Tg, free thyroxine (fT4), Tg autoantibodies (TgAbs) and human chorionic gonadotropin (hCG) levels. We excluded samples with increased TgAbs from the analysis. RESULTS According to WHO criteria, the study population was iodine deficient in every trimester. Serum Tg levels did not differ during the three trimesters of pregnancy. Serum hCG levels fell significantly as pregnancies advanced. A weak, significantly negative correlation (limited to the 3rd trimester) was found between Tg and UIC (ρ = -0.187, p = 0.039). Serum fT4 decreased as pregnancies advanced and TSH increased. Serum fT4 was negatively correlated with TSH (ρ = -0.161, p = 0.006) and positively with hCG (ρ = +0.165, p = 0.005). The multiple regression equation of Tg based on hCG, TSH, UIC and trimester of pregnancy was significant but weak (F = 4.057, p = 0.003; R(2) = 0.055), with hCG as a significant predictor Tg (p for log hCG = 0.041). CONCLUSIONS Tg cannot be considered as a valid marker of iodine deficiency in pregnancy, at least in a mildly iodine-deficient environment. Further studies in a larger patient cohort with differences in iodine status, as well as studies on Tg changes after improving iodine status in pregnant women, are needed in order to corroborate these results.
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Affiliation(s)
- Eftychia Koukkou
- Department of Endocrinology, E Venizelou Maternity Hospital, Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, E Venizelou Maternity Hospital, Athens, Greece
| | - Irene Mamalis
- Departments of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Georgios G. Adonakis
- Departments of Obstetrics and Gynecology, University of Patras Medical School, Patras, Greece
| | - Kostas B. Markou
- Departments of Endocrinology, University of Patras Medical School, Patras, Greece
- *Kostas B. Markou, MD, Thisseos Street 6, GR–26500 Ovria Patras (Greece), E-Mail
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Koukkou E, Kravaritis S, Mamali I, Markantes GG, Michalaki M, Adonakis GG, Georgopoulos NA, Markou KB. No increase in renal iodine excretion during pregnancy: a telling comparison between pregnant women and their spouses. Hormones (Athens) 2014; 13:375-81. [PMID: 25079462 DOI: 10.14310/horm.2002.1487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Adequate dietary iodine intake is necessary for normal thyroid gland function at all times, and most particularly during pregnancy. Increased iodine loss is cited, among other factors, as responsible for the increased iodine demand in this period. Our aim was to compare renal iodine excretion between women during all three pregnancy trimesters with that of their spouses and thereby to estimate the iodine intake in an a large sample of pregnant women in urban areas in Greece. DESIGN Four hundred twenty-four healthy pregnant women were included prospectively (residents of Athens n=218, residents of Patras n=206). The spouses of 177 of these women following the same diet were also studied. Determinations included serum FT4, TSH and aTPO and urinary iodine excretion (UIE). RESULTS No difference was found either in median UIE throughout pregnancy or between the UIE of the pregnant women and their spouses during the trimesters. Throughout pregnancy, mild iodine deficiency was noted and was classified as mild in 60%, moderate in 30% and severe in 10% of the women studied. Users of iodized salt had significantly higher median UIE compared with non-users. Serum FT4 levels decreased and TSH increased as pregnancy progressed. CONCLUSIONS Our study indicates that renal iodine excretion is not increased during pregnancy. This finding needs to be confirmed by further investigation in other populations with different iodine intakes. Thus, increased iodine requirements in pregnancy are possibly due to extra-renal causes. The population of pregnant women in Greek urban areas is mildly-and often moderately and severely-iodopenic and needs to be treated accordingly.
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Affiliation(s)
- Eftychia Koukkou
- Department of Endocrinology, "Elena Venizelou" Hospital, Athens, Greece
| | | | - Irene Mamali
- Department of Endocrinology, University of Patras; Greece
| | | | | | | | - Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Department of Endocrinology, University of Patras; Greece
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Koukkou E, Ilias I, Alexiou M, Mamali I, Nicopoulou S, Alevizaki M, Markou K. Urine selenium changes during pregnancy do not correlate with thyroid autoantibodies in a mildly iodine deficient population. Biol Trace Elem Res 2014; 157:9-13. [PMID: 24249585 DOI: 10.1007/s12011-013-9860-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/04/2013] [Indexed: 01/24/2023]
Abstract
Selenium (Se) is a key component of iodinases; higher Se levels are associated with lower titers of antithyroid peroxidase antibodies (anti-TPO). Pregnancy exerts profound effects on thyroid function and autoimmunity. To assess the relationship of urine Se levels with thyroid function and autoimmunity in pregnant women residing in Athens, Greece, we studied prospectively 47 euthyroid women in uncomplicated singleton pregnancies (mean age + SD: 30 + 5 years) in each trimester, measuring urine Se levels, urine iodine, plasma thyrotropin (TSH), free thyroxine and triiodothyronine (FT4 and FT3), as well as levels of anti-TPO antibodies. Changes of the measured parameters were assessed over each trimester; thyroid parameters were assessed with relation to Se levels. Urine Se dropped by the third trimester, whereas urine iodine did not change appreciably during pregnancy. TSH and anti-TPO did not show appreciable changes; FT4 and FT3 gradually decreased as the pregnancy advanced. No relationship between urine Se levels and anti-TPO was found. During pregnancy, changes in urine Se levels accompany mild changes in thyroid function. However, we did not find some association between these changes and thyroid autoimmune activity over this period, probably because the effect of Se on thyroid autoimmunity may only become apparent in case of excess Se fortification.
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Affiliation(s)
- E Koukkou
- Department of Endocrinology, Diabetes and Metabolism, E. Venizelou Hospital, Athens, Greece,
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Ilias I, Spanoudi F, Koukkou E, Adamopoulos DA, Nikopoulou SC. Do lunar phases influence menstruation? A year-long retrospective study. Endocr Regul 2013; 47:121-2. [DOI: 10.4149/endo_2013_03_121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Pearce EN, Alexiou M, Koukkou E, Braverman LE, He X, Ilias I, Alevizaki M, Markou KB. Perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant women from Greece. Clin Endocrinol (Oxf) 2012; 77:471-4. [PMID: 22486757 DOI: 10.1111/j.1365-2265.2012.04407.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Thyroid hormone, requiring adequate maternal iodine intake, is critical for neurodevelopment in utero. Perchlorate and, less so, thiocyanate decrease uptake of iodine into the thyroid gland by competitively inhibiting the sodium/iodide symporter (NIS). It remains unclear whether environmental perchlorate exposure adversely affects thyroid function in first-trimester pregnant women. DESIGN Cross-sectional. PATIENTS 134 pregnant women from Athens, Greece, at mean ± SD 10·9 ± 2·3 weeks' gestation. MEASUREMENTS Urinary iodide, perchlorate, and thiocyanate and thyroid function tests were measured. RESULTS The median urinary iodide was 120 μg/l. Urinary perchlorate levels were detectable in all women: median (range) 4·1 (0·2-118·5) μg/l. Serum thyroperoxidase antibodies (TPO Ab) were detectable in 16% of women. Using Spearman's rank correlation analyses, there was no correlation between urinary perchlorate concentrations and serum TSH, although inverse correlations were seen between urine perchlorate and free T3 and free T4 values. In univariate analyses, urine thiocyanate was positively correlated with serum TSH, but was not associated with serum free T3 or free T4. Urine perchlorate was positively correlated with gestational age. In multivariate analyses adjusting for urinary iodide concentrations, urine thiocyanate, gestational age, maternal age and TPO Ab titres, urine perchlorate was not a significant predictor of thyroid function. CONCLUSIONS Low-level perchlorate and thiocyanate exposure is ubiquitous, but, in adjusted analyses, is not associated with alterations in thyroid function tests among mildly iodine-deficient Greek women in the first trimester of pregnancy.
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Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, MA, USA.
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Koukkou E, Billa E, Kapolla N, Pappa A, Venaki E, Andreou L, Nicopoulou SC, Adamopoulos DA. An empiric treatment for idiopathic oligozoospermia revisited: a 20-year investigative saga. Andrologia 2012; 44:337-42. [PMID: 22946848 DOI: 10.1111/j.1439-0272.2012.01286.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2012] [Indexed: 11/29/2022] Open
Abstract
A series of studies aiming at introducing an effective treatment for idiopathic oligozoospermia was conducted in a step-wise fashion spanning over a 20-year period. The concept was that co-administration of an accessory gland-stimulating androgen, testosterone undecanoate (40 mg t.i.d.) and the FSH raising anti-oestrogen tamoxifen citrate (10 mg b.i.d.) may improve sperm parameters. A prerequisite for such an effect was the demonstration that testosterone undecanoate had no suppressing action on pituitary-testicular axis. In this context, initial studies demonstrated no change in basal or stimulated gonadotrophin and testosterone secretion in short- or long-term protocols. Two subsequent trials with this combination showed a marked improvement of sperm parameters and pregnancy incidence, with a seasonal variation noted in response to treatment, this being higher during the cold seasons of autumn and winter. Regarding the mechanism of testosterone undecanoate's action, a recent study from our unit showed that its administration resulted in a marked rise of serum DHT levels. Because this steroid is an epididymal function promoter, it appears that its contribution in the combination is mediated mainly through its DHT raising effect. By and large, this empiric approach for the treatment of idiopathic oligozoospermia was satisfactorily documented after a 20-year investigative saga.
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Affiliation(s)
- E Koukkou
- Department of Endocrinology, Andrology Clinic, Diabetes and Metabolism, "Elena Venizelou" Hospital, Athens, Greece.
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Georgopoulos NA, Theodoropoulou A, Roupas NA, Rottstein L, Tsekouras A, Mylonas P, Vagenakis GA, Koukkou E, Armeni AK, Sakellaropoulos G, Leglise M, Vagenakis AG, Markou KB. Growth velocity and final height in elite female rhythmic and artistic gymnasts. Hormones (Athens) 2012; 11:61-9. [PMID: 22450345 DOI: 10.1007/bf03401538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to determine the impact of intensive training on adult final height in elite female rhythmic and artistic gymnasts. METHODS The study included 215 rhythmic gymnasts (RG) and 113 artistic gymnasts (AG). RESULTS AG were below the 50th percentile, while RG were taller than average. Final adult height was lower than target height in AG, while in RG, it exceeded target height. AG started training earlier than RG (p<0.001) and reported lower intensity of training (p<0.001). RG were taller than AG, with higher target height, greater Δ final height-target height and lower body fat and BMI (p<0.001). Using multiple regression analysis, the main factors influencing final height were weight SDS (p<0.001), target height SDS (p<0.001) and age of menarche (p<0.001) for RG, and weight SDS (p<0.001) and target height SDS (p<0.001) for AG. CONCLUSION In both elite female RG and AG, genetic predisposition to final height was not disrupted and remained the main force of growth. Although in elite RG genetic predisposition for growth was fully preserved, in elite female AG final adult height falls shorter than genetically determined target height, though within the standard error of prediction.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Patras, Greece.
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Abstract
OBJECTIVE Elite male artistic gymnasts (AG) are exposed to high levels of physical and psychological stress during adolescence and experience a significant late maturation in both linear growth and pubertal development. The aim of the present study was to determine the impact of intensive physical training on the adult final height in elite male AG. METHODS This study is unique in character, as all variables were measured on the field of competition. The study was prospective and longitudinal; however, the current analysis of data is cross-sectional. Data from 86 elite male AG were obtained during the gymnastics competitions of European and World Championships. Clinical evaluation included height and weight measurements, as well as assessment of pubic hair and genital development according to Tanner's stages of pubertal development. The laboratory investigation included determination of skeletal maturation. All athletes completed a questionnaire that included questions on personal (onset and intensity of training, number of competitions per year) and family data (paternal and maternal heights). RESULTS Male AG were below the 50th percentile for both final height and weight. Elite male AG had final height standard deviation score (SDS) lower than their genetic predisposition. Final height SDS was correlated positively with target height SDS (r = 0.430, p < 0.001) and weight SDS (r = 0.477, p < 0.001) and negatively to the intensity of training (r = -0.252, p = 0.022). The main factors influencing final height, by multiple regression analysis were weight SDS (p < 0.001) and target height SDS (p = 0.003). CONCLUSION In elite maleAG, final height falls short of genetic predisposition, still well within normal limits. Considering medical and psychological risks in general, and based on the results of this research project, the International Federation of Gymnastics has increased the age limit for participants in international gymnastics competitions by 1 year.
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Affiliation(s)
- Neoklis A Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, Patras, Greece.
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Georgopoulos NA, Rottstein L, Tsekouras A, Theodoropoulou A, Koukkou E, Mylonas P, Polykarpou G, Lampropoulou E, Iconomou G, Leglise M, Vagenakis AG, Markou KB. Abolished circadian rhythm of salivary cortisol in elite artistic gymnasts. Steroids 2011; 76:353-7. [PMID: 21073886 DOI: 10.1016/j.steroids.2010.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 10/24/2010] [Accepted: 10/29/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of intensive physical exercise and acute psychological stress during high level athletic competition as reflected on the levels of salivary cortisol in elite artistic gymnasts (AGs). DESIGN The study included 239 AGs (142 females-97 males) who participated in the European Championship of Gymnastics in 2006 and 81 adolescents (40 females-41 males), matched for age, as controls. All athletes participated voluntarily in all or parts of the study, providing samples or data for each of the variables measured. Height, weight, body fat, lean body mass (LBM), bone age and Tanner stage of puberty were assessed and data concerning the time of thelarche, adrenarche and menarche as well as, the onset and the intensity (hours per week) of training were obtained. METHODS Saliva samples were collected, the morning before training and in the afternoon shortly after the competition. From controls, the saliva samples were collected in the morning. Cortisol concentrations were measured using a chemiluminescence method. Acute stress was assessed using a questionnaire designed for the study. RESULTS No difference was found between morning and afternoon salivary cortisol levels in both male and female AGs (females: AM: 15.45±7.45nmol/l vs PM: 15.73±9.38nmol/l; males: AM: 10.21±5.52nmol/l vs PM: 9.93±13.8nmol/l, p>0.05). Female AGs presented higher levels of morning salivary cortisol than female controls (p<0.05). Both male and female AGs had higher degree of psychological stress in comparison with controls (p<0.001, p<0.013, respectively). Female AGs had higher morning and afternoon salivary cortisol levels (p<0.01, p<0.01, respectively) and higher degree of stress (p<0.003) than males. CONCLUSIONS In elite AGs the diurnal rhythm of salivary cortisol has been abolished, probably due to the strenuous training and competition conditions. Female AGs presented higher levels of morning salivary cortisol and psychological stress compared to both male AGs and female controls. The long term consequences of these modifications of the HPA axis remain to be elucidated.
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Affiliation(s)
- Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital of Patras, Rio 26500, Patras, Achaia, Greece
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Koukkou E, Mitios G, Kapolla N, Spiropoulos E, Lass H, Bourounis M, Pappa A, Nicopoulou S, Adamopoulos DA. Testosterone undecanoate in the functional compartments of the male reproductive tract. Basic Clin Androl 2009. [DOI: 10.1007/s12610-009-0035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background
Assessment of testosterone undecanoate’s (TU) presence in the functional compartments of the male reproductive tract has never been performed despite the evidence that its documented beneficial effect in male infertility might be mediated through an epididymal action and this study was set to examine this possibility.
Materials and methods
In 18 normozoospermic volunteers TU has been administered (40 mg t.i.d.) for 6 days with serum measurements of TU, total testosterone (T), DHT, E2, SHBG, FSH, LH, and PRL before and at the end of medication. Steroid hormones (T, E2, and TU) were also assayed in seminal plasma. In a selected group of 7 men with previously diagnosed non-obstructive azoospermia TU, T, and E2 were assayed in the extracts of testicular biopsy material taken before ICSI and at the end of the same medication.
Results
A marked rise of serum DHT (average 148%, P < 0.001) has been found after treatment, whereas T, E2, FSH, LH, SHBG, and PRL did not significantly change. Measurable amounts of TU were found in the serum of all men but only in 6 cases in seminal plasma (11.1 ± 8.0 ng/mL) and all of them in semen delivered 7–8 h after the last TU capsule was taken. In dilution fluid from testicular tissue extracts, no detectable amounts of TU were found whereas mean values of 92.5 ± 54.3 pg/mL and 43.8 ± 16.3 ng/mL for E2 and T were observed. Positive correlations among TU and E2, T or DHT concentrations were found in serum samples (P < 0.01, 0.02, and 0.002) as well as between E2 and T (P < 0.01), E2 and DHT (P < 0.001), or T and DHT (P < 0.001).
Conclusion
It is concluded that TU was identified and measured for the first time in seminal plasma of a fair percentage (33%) of men on this medication and was associated in all men with a marked rise of DHT concentration, a known epididymal function promoter, in the absence of an effect on pituitary and gonadal activity. On this evidence, it appears that a beneficial effect of TU on epididymal function may be a distinct possibility.
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Billa E, Kapolla N, Nicopoulou SC, Koukkou E, Venaki E, Milingos S, Antsaklis A, Adamopoulos DA. Metformin administration was associated with a modification of LH, prolactin and insulin secretion dynamics in women with polycystic ovarian syndrome. Gynecol Endocrinol 2009; 25:427-34. [PMID: 19533481 DOI: 10.1080/09513590902770172] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
UNLABELLED AIM. To elucidate the dynamics of FSH, LH, prolactin (PRL), TSH and insulin secretion in women with polycystic ovarian syndrome (PCOS) treated with metformin (MET). PATIENTS AND METHODS In a prospective, controlled and randomised trial, 32 women with PCOS and 32 with normal cycle were recruited to receive MET (850 mg b.i.d.) or placebo (n: 16 for each subgroup) for an average of 40 days. Pituitary function and insulin secretion were assessed before and after intervention by GnRH-TRH tests and oral glucose tolerance test induced insulin response. RESULTS Basal and area under the response curve (AURC) LH values were higher in PCOS than in normal controls before MET and declined following treatment in the former group (P < 0.05). Ovulatory PCOS responders had lower basal LH, AURC(LH) and AURC(PRL) values during MET than anovulatory cases (P < 0.05 for all) and AURCins was lower in ovulatory than anovulatory PCOS before and on MET (P < 0.02-P < 0.05), with a rise of QUICKY index in the former group during MET treatment (P < 0.05). FSH and TSH were similar. CONCLUSIONS MET administration lowered LH activity in all PCOS women and in ovulatory responders and also compromised PRL stimulated secretion in the latter cases. These findings were indicative of an effect of MET on pituitary activity.
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Affiliation(s)
- Evangelia Billa
- Endocrine Department, Elena Venizelou Hospital, Athens GR-115 21, Greece
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Adamopoulos DA, Pappa A, Billa E, Nicopoulou SC, Koukkou E, Venaki E. Seasonality in sperm parameters in normal men and dyspermic patients on medical intervention. Andrologia 2009; 41:118-24. [PMID: 19260849 DOI: 10.1111/j.1439-0272.2008.00899.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study attempted to investigate the presence of seasonal variations in sperm parameters and to evaluate the season's impact on the response to treatment in men with idiopathic oligozoospermia (IO). To this end, a retrospective analysis of the records of 294 men, who participated in a controlled study, was performed. This sample included IO men (n = 106) treated with tamoxifen citrate (10 mg b.i.d.) and testosterone undecanoate (40 mg t.i.d.) or placebo (n = 106) and normozoospermic men (n = 82) serving as controls. Outcome measures included sperm parameters, functional sperm fraction (FSF) and incidence of pregnancy. Analysis showed a raised frequency of high FSF values and increased area under the response curve (AURC) for FSF mean during autumn-winter seasons in patients on active treatment compared with those in placebo (P < 0.05-P < 0.04). Moreover, receiver operation characteristics (ROC) curves for a >100% FSF rise significantly discriminated autumn-winter from other seasons (P < 0.001, all), whereas active treatment showed higher than placebo FSF values particularly during autumn and winter (P < 0.001, all). The pregnancy incidence was higher in the autumn in all groups. It is concluded that FSF values showed a better response to active treatment during autumn and winter, indicating that commencement of empirical treatment at this time in IO men may stand a better chance to succeed.
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Affiliation(s)
- D A Adamopoulos
- Department of Endocrinology, Diabetes and Metabolism, "Elena Venizelou" Hospital, Athens, Greece.
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Nicopoulou SC, Alexiou M, Michalakis K, Ilias I, Venaki E, Koukkou E, Mitios G, Billa E, Adamopoulos DA. Body mass index vis-à-vis total sperm count in attendees of a single andrology clinic. Fertil Steril 2009; 92:1016-1017. [PMID: 19243747 DOI: 10.1016/j.fertnstert.2008.12.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 12/08/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
In this large series of 349 unselected men, no significant relationship between body mass index and total sperm count was found. Thus, the association of body mass index and sperm count reported in some studies was not confirmed.
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Affiliation(s)
- Stamatina C Nicopoulou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Maria Alexiou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Konstantinos Michalakis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece.
| | - Evangelia Venaki
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Georgios Mitios
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Evagelia Billa
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
| | - Dimitrios A Adamopoulos
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece
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Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Koukkou E, Panagiotakos D, Tountas N, Economopoulos T, Raptis SA. Insulin-stimulated rates of glucose uptake in muscle in hyperthyroidism: the importance of blood flow. J Clin Endocrinol Metab 2008; 93:2413-5. [PMID: 18349060 DOI: 10.1210/jc.2007-2832] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND In hyperthyroidism, although hepatic insulin resistance is well established, information on the effects of insulin on glucose uptake in skeletal muscle is variable. METHODS To investigate this, a meal was given to nine hyperthyroid (HR) and seven euthyroid (EU) subjects. Blood was withdrawn for 360 min from a forearm deep vein and the radial artery for measurements of insulin and glucose. Forearm blood flow (BF) was measured with strain-gauge plethysmography. Glucose flux was calculated as arteriovenous difference multiplied by BF and fractional glucose extraction as arteriovenous difference divided by arterial glucose concentrations. RESULTS Both groups displayed comparable postprandial glucose levels, with the HR having higher insulin levels than the EU. In the forearm of HR vs. EU: 1) glucose flux was similar [area under the curve (AUC)(0-360) 673 +/- 143 vs. 826 +/- 157 micromol per 100 ml tissue]; 2) BF was increased (AUC(0-360) 3076 +/- 338 vs. 1745 +/- 145 ml per 100 ml tissue, P = 0.005); and 3) fractional glucose extraction was decreased (AUC(0-360) 14.5 +/- 3 vs. 32 +/- 5%min, P = 0.03). CONCLUSIONS These results suggest that, in hyperthyroidism, insulin-stimulated glucose uptake in muscle is impaired; this defect is corrected, at least in part, by the increases in BF.
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Affiliation(s)
- George Dimitriadis
- Second Department of Internal Medicine, Research Institute and Diabetes Center, Athens University, Attikon University Hospital, 1 Rimini Street, Haidari, Greece.
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Markou KB, Tsekouras A, Anastasiou E, Vlassopoulou B, Koukkou E, Vagenakis GA, Mylonas P, Vasilopoulos C, Theodoropoulou A, Rottstein L, Lampropoulou E, Apostolopoulos D, Jabarov R, Vagenakis AG, Georgopoulos NA. Treating iodine deficiency: long-term effects of iodine repletion on growth and pubertal development in school-age children. Thyroid 2008; 18:449-54. [PMID: 18399768 DOI: 10.1089/thy.2007.0277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Iodine deficiency (ID) is still a major universal health problem. Iodine deficiency disorders (IDDs) affect people of all ages, among whom the most vulnerable are children and adolescents. The aim of the present study was to assess the long-term effects on growth and pubertal development of correcting severe ID in areas of Azerbaijan between 1999 and 2000. METHODS Iodized oil was administered orally to 293,000 children, aged 6-16 years. Among those, 364 children were randomly selected and were examined 1 year before the administration of iodized oil (Group I-neg, iodine negative) and 295 children (Group I-Rx, iodine treated) were examined 4 years (Group I-R x 4, iodine treated 4 years later; n = 173) or 5 years (Group I-R x 5, iodine treated 5 years later; n = 122) after the last dose of iodide. RESULTS In Group I-neg the median urine iodine concentration (UIC) (mcg/L) was 36 (mean: 36.272 +/- 11.036) and increased significantly (p < 0.001) in Group I-R x 4: 188 (mean: 230.969 +/- 155.818) and in Group I-R x 5: 175 (mean: 201.176 +/- 130.369). The prevalence of goiter was 99% in Group I-neg and 2% in Group I-R x 4. Children in Group I-Rx had a greater standard deviation score (SDS) for height (-0.1364 +/- 1.279, n = 294) than children in Group I-neg (-0.5019 +/- 1.17, n = 363) (p < 0.001, t = -3.817), which was more significant for boys. SDS for weight was similar in both groups (Group I-neg: -0.17 +/- 0.78, n = 363; Group I-Rx: -0.115 +/- 0.917, n = 294). The rate of puberty development as judged by the development of breast and pubic hair was normalized in both sexes after the correction of ID. CONCLUSIONS Our results demonstrate that long-term correction of severe ID leads to sustained improvement of linear growth accompanied by a normalization of the time of onset of pubertal development for both sexes.
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Affiliation(s)
- Kostas B Markou
- Division of Endocrinology, Department of Internal Medicine, University of Patras Medical School, University Hospital, Patras, Greece
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Abstract
AIM To report on a unique case of hypogonadism associated with excessive carotene intake in a young male athlete. CASE REPORT A 20-year-old patient presented with a gradual decline in muscular and physical activity, sexual interest and erectile ability associated with a high in carotene and low in animal fat diet of his own design a year prior to the clinical manifestations. Clinically, he presented with very overt signs of carotene excess: his palms and soles were yellow. Moreover, 2 weeks after normalization of his diet, carotene B levels were at the upper end of the normal range. METHODS Repeated stimulation tests of hypothalamic, pituitary and testicular function were performed before and at 3, 6 and 12 months after the introduction of a balanced diet. RESULTS Very low basal and stimulated values for gonadotropins and gonadal steroids were found at the initial evaluation with a progressive recovery shown after months of a balanced diet and carotene B restoration. Complete androgen secretion and sexual response recovery were observed only after 9-12 months from diagnosis. CONCLUSION This is the first report associating excessive carotene intake with a hypothalamic form of hypogonadism in a young man.
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Affiliation(s)
- Dimitrios Adamopoulos
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens, Greece.
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Adamopoulos DA, Nicopoulou S, Koukkou E, Pappa A, Billa E. Responsiveness to Tamoxifen Citrate and Testosterone Undecanoate Is Independent of the Severity of Idiopathic Oligozoospermia. ACTA ACUST UNITED AC 2005; 26:565-6; author reply 566-7. [PMID: 16187481 DOI: 10.2164/jandrol.05091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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