Cristina Preda

Serum Uric Acid Concentration in Overweight and Obese Women with Polycystic Ovary Syndrome / Nivelul acidului uric la femeile supraponderale și obeze cu sindromul ovarelor polichistice

Abstract Background: Women with polycystic ovary syndrome (PCOS) are at high risk for the development of diabetes mellitus, hypertension and coronary heart disease. Due to the inverse correlation between serum uric acid and insulin sensitivity, the measurement of uric acid may provide a marker of insulin resistance. Objective: To establish the relationship between uric acid and markers of insulin resistance in obese and overweight women with PCOS. Methods: Serum uric acid levels were measured in 38 PCOS obese and overweight patients and 30 controls matched for age and body mass index (BMI). Anthropometric variables, plasma glucose and insulin levels were measured. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Results: No statistically significant differences in uric acid levels between PCOS and non-PCOS women were found. Serum uric acid levels were positively correlated with BMI, waist circumference, insulin and HOMA. Following the use of stepwise linear regression analysis, BMI was the only parameter retained by the regression model, responsible for 42.1% of the variability of serum uric acid levels. Conclusions: In PCOS women obesity seems to be the main determinant of plasma uric acid levels. Insulin and HOMA are also involved to a lesser extent, but their role remains to be clarified by further studies. Rezumat Femeile cu sindromul ovarelor polichistice (PCOS) au un risc crescut de a dezvolta diabet zaharat, hipertensiune arterială și afectare coronariană. Datorită corelației negative dintre nivelul seric al acidului uric și sensibilitatea la insulină, determinarea acidului uric ar putea reprezenta un marker al rezistenței la insulină. Obiectiv: Stabilirea relației dintre acidul uric și markeri ai rezistenței la insulină la femeile supraponderale și obeze cu PCOS. Metodă: Nivelul seric al acidului uric a fost măsurat la un lot de 38 de paciente supraponderale și obeze cu PCOS comparativ cu un lot control alcătuit din 30 de femei cu aceeași vârstă și indice de masă corporală (BMI). Au fost evaluați parametri antropometrici, nivelul glicemiei și insulinemiei. Rezistența la insulină a fost apreciată prin calcularea indicelui HOMA (HOmeostasis Model Assessment). Rezultate: Nu au existat diferențe statistic semnificative între nivelurile de acid uric la femeile cu PCOS comparativ cu femeile fără PCOS. Nivelul acidului uric s-a corelat pozitiv cu BMI, circumferința taliei, insulină și HOMA. Aplicând analiza regresiei liniare, am observat că BMI a fost singurul parametru responsabil de 42,1% din variabilitatea nivelului acidului uric. Concluzii: La femeile cu PCOS obezitatea pare principalul determinat al nivelului de acid uric. Insulina și HOMA sunt implicate de asemenea în mai mică măsură, rolul lor urmând a fi clarificat în studii viitoare.

Concomitant autoimmune thyroiditis and primary hyperparathyroidism – random association? Two cases report

Autoimmune thyroiditis and primary hyperparathyroidism are frequent diseases, mainly affecting postmenopausal women. The association between the two pathologies has been described in the literature but the underlying mechanism is not yet elucidated. We present two female patients with autoimmune thyroiditis who developed primary hyperparathyroidism. Both had normal thyroid function, high antithyroid antibodies, and high PTH and calcium values. Thyroid ultrasonography and 99mTc-MIBI scintigraphy localized the lesion but only one patient underwent surgery. Vitamin D and selenium values were normal or slightly reduced. Both patients had osteoporosis, treated with bisphosphonates. Their evolution is, till now, satisfactory. More theories are trying to explain the correlation between autoimmune thyroiditis and primary hyperparathyroidism: the inflammatory process, the high TSH or PTH values, high calcium, low vitamin D. The possible selenium intervention would correlate environmental and genetic factors. However, all these theories are controversial and not yet proved by experimental or randomized clinical studies.