Melia Karakose

Vitamin D3 levels and insulin resistance in papillary thyroid cancer patients

Both insulin resistance (IR) and vitamin D deficiency (VDD) are found to be associated with many cancer types. In this study, we evaluated the presence of IR and VDD in thyroid cancer patients based on controls. Total 344 papillary thyroid cancer and 116 controls were part of the study. Glucose, insulin, homeostasis model analysis-insulin resistance (HOMA-IR) (control group 2.12xa0±xa00.9 and patient group 3.6xa0±xa01.1; pxa0<xa00.0001), LDL were significantly high; HOMA-S and vitamin D3 levels (control group 19.11xa0±xa08 and patient group 17xa0±xa016; pxa0=xa00.004) were significantly low in the patient group. Vitamin D deficiency (64/108 in controls vs 166/235; pxa0=xa00.026) and insulin resistance (24/108; 115/235; pxa0<xa00.0001) were more frequent in papillary thyroid cancer patients. After regression analysis, tumor diameter showed significant association with log-HOMA-IR (Bxa0=xa00.315; pxa0=xa00.017) and log-vitamin D3 (Bxa0=xa00.207; pxa0=xa00.04). Vitamin D deficiency and insulin resistance frequencies show no difference between micro- and macropapillary thyroid cancers. Receiver operating characteristic curve shows the best cutoff point for tumor diameter showing that the presence of lymph node metastasis was 0.65xa0cm with 81.2xa0% sensitivity and 52xa0% specificity. Best cutoff point for the capsular invasion tumor diameter was 0.75xa0cm with 83.3xa0% sensitivity and 60.4xa0% specificity. No difference between follicular and classical type papillary thyroid carcinomas has been yet discovered. As a result, thyroid cancer patients are more insulin resistant and vitamin D3 deficient. Vitamin D3 levels and HOMA-IR index may affect tumor diameter. Tumor size that is lower than 1xa0cm (0.65–0.75xa0cm) may be related with capsular invasion and lymph node involvement.

Hyperprolactinaemia associated with increased thyroid volume and autoimmune thyroiditis in patients with prolactinoma.

The aim of this investigation was to evaluate the effects of hyperprolactinaemia on thyroid function, volume and nodularity in patients with prolactinoma.

Copeptin, a surrogate marker for arginine vasopressin, is associated with cardiovascular risk in patients with polycystic ovary syndrome.

BackgroundWomen with polycystic ovary syndrome (PCOS) have higher risk for cardiovascular disease (CVD). Copeptin has been found to be predictive for myocardial ischemia. We tested whether copeptin is the predictor for CVD in PCOS patients, who have an increased risk of cardiovascular disease.MethodsThis was a cross sectional controlled study conducted in a training and research hospital. The study population consisted of 40 reproductive-age PCOS women and 43 control subjects. We evaluated anthropometric and metabolic parameters, carotid intima media thickness and copeptin levels in both PCOS patients and control group.ResultsMean fasting insulin, homeostasis model assessment insulin resistance index (HOMA-IR), triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), free testosterone, 17-OH progesterone, Dehydroepiandrosterone sulfate (DHEAS), carotid intima media thickness (CIMT) levels were significantly higher in PCOS patients. Mean copeptin level was in 12.61u2009±u20093.05 pmol/L in PCOS patients while mean copeptin level was 9.60u2009±u20092.80 pmol/L in healthy control women (pu2009<u20090.001). After adjustment for age and BMI, copeptin level was positive correlated with fasting insulin, free testosterone levels, CIMT, and HOM A-IR.ConclusionsCopeptin appeared to have an important role in metabolic response and subsequent development of atherosclerosis in insulin resistant, hyperandrogenemic PCOS patients.

Is There Any Association Between Thrombosis and Tissue Factor Pathway Inhibitor Levels in Patients With Vitamin D Deficiency

Objective: The aim of this study was to evaluate the relationship between vitamin D levels and hemostatic factors like tissue factor pathway inhibitor (TFPI). Methods: Patients who had 25-hydroxyvitamin D3 (25(OH)D3) levels measured were included. Coagulation and hemostatic parameters were evaluated. Patients were divided into 3 groups based on 25(OH)D3 levels as group 1 (25(OH)D3 < 10 ng/mL, n = 25), group 2 (25(OH)D3 = 10-19.9 ng/mL, n = 22), and group 3 (25(OH)D3 ≥ 20 ng/mL, n = 28). Results: A total of 75 patients with a mean age of 39 (range 18-57) years were included in the study. Prothrombin time was longer in group 3 than in group 2 (P = .043). The TFPI levels were higher in group 3 than in the other groups (P < .001). There was a strong positive correlation between 25(OH)D3 and TFPI levels (r = .47, P < .001). Conclusion: Further studies are needed for evaluation of the role of TFPI in hemostasis and thrombotic process in patients with vitamin D deficiency.

Effect of lifestyle interventions with or without metformin therapy on serum levels of osteoprotegerin and receptor activator of nuclear factor kappa B ligand in patients with prediabetes

Osteoprotegerin has been shown to be increased in cardiovascular disorders and type 2 diabetes mellitus. Prediabetes represents a high risk condition for diabetes and diabetic complications. Therefore, we aimed to find the relationship between prediabetes and osteoprotegerin with nuclear factor–B ligand, carotid intima media thickness, and metabolic markers. A total of 54 participants with prediabetes including impaired fasting glucose (nu2009=u200921), impaired glucose tolerance (nu2009=u20098), impaired fasting glucose and impaired glucose tolerance (nu2009=u200925), and 60 healthy individuals as a control were admitted to the study. Metabolic and anthropometric parameters, insulin resistance variables, osteoprotegerin, and nuclear factor–B ligand markers, carotid intima media thickness were examined at baseline for all participants. To evaluate the effect of therapy we determined the same parameters after the end of the study. Measurements of waist circumference, body mass index, body fat percentage and levels of fasting blood glucose, fasting insulin, homeostatic model assessment of insulin resistance, triglyceride levels and hsCRP and carotid intima media thickness were significantly higher in patients with prediabetes (pu2009<u20090.05). We also found higher osteoprotegerin and lower nuclear factor–B ligand levels in patients than in controls however, the value was non-significant (pu2009>u20090.05). Patients with prediabetes were under lifestyle interventions with (group 1, nu2009=u200933) or without metformin (group 2, nu2009=u200921) therapy. Baseline anthropometric and metabolic characteristics were not found statistically different in group 1 and group 2. Mean follow up period of the patients were 7.9u2009±u20092.2 month (min-max: 6–12 months). After the follow up period we evaluated the same parameters and found significant differences between waist circumference, body mass index, body fat percentage, fasting insulin, homeostatic model assessment of insulin resistance, and osteoprotegerin levels (pu2009<u20090.05). However, carotid intima media thickness, and nuclear factor–B ligand levels significantly different only in the group treated with metformin (pu2009<u20090.05). We also compared the variables after the treatment period with the control group and found significantly lower levels in terms of fasting insulin, homeostatic model assessment of insulin resistance, waist circumference, body mass index, body fat percentage, carotid intima media thickness, osteoprotegerin, and nuclear factor–B ligand values (pu2009<u20090.05). Correlation analysis revealed a negative relationship between nuclear factor–B ligand and body mass index, and body fat percentage in group 1 (pu2009=u20090.05, ru2009=u2009−0.646, pu2009=u20090.01, ru2009=u2009−0.585). Therapy of prediabetes was associated with a significant decrease in osteoprotegerin and certain metabolic variables together with an increase in nuclear factor–B ligand levels particularly in patients with under metformin therapy.

Hyperprolactinemia has no effect on plasma ghrelin levels in patients with prolactinoma.

OBJECTIVEnAccumulating evidence suggests that prolactin is a modulator of body weight and composition and that it regulates some transporters in adipose tissue. It was demonstrated that hyperprolactinemia is associated with weight gain and obesity. Ghrelin is a novel hormone secreted from many organs including the pituitary gland. Ghrelin acts by regulating energy homeostasis and stimulating appetite. The aim of this study is to investigate whether ghrelin has a role in the case of weight gain in patients with prolactinoma.nnnMATERIAL AND METHODSnForty-four patients with prolactinoma, both newly diagnosed and undergoing cabergoline treatment, were included in this study. Age- and sex-matched healthy subjects were included in the control group. Serum fasting glucose, insulin, lipid profile, and ghrelin levels were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) was also calculated. Body mass index (BMI) and total fat ratio (%) of all the participants were assessed by bioelectrical impedance analysis using TBF-310GS™ (Tanita Corporation, Tokyo, Japan).nnnRESULTSnPatients with prolactinoma demonstrated significantly higher serum levels of fasting insulin, triglyceride, and waist and hip circumference measurement. No significant difference was found between the fasting glucose, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and HOMA-IR levels. BMI was significantly higher in the patients with prolactinoma than that in the control group (p<0.05). Additionally, the total body fat percentage was higher in the patients with prolactinoma than that in the control group; however, the difference was not significant (p>0.05). Furthermore, there was no significant difference in terms of the ghrelin levels between these groups. There was a correlation with serum ghrelin and growth hormone levels (p<0.02, rho=0.489). However, no significant correlation was obtained between serum prolactin or ghrelin levels and body fat percentage.nnnCONCLUSIONnAccording to the results of our study, ghrelin has no effect on weight gain in patients with prolactinoma. Further studies are needed to evaluate whether ghrelin affects the prevalence of obesity in patients with prolactinoma.

Thyroid hormone resistance in two patients with papillary thyroid microcarcinoma and their BRAFV600E mutation status

Resistance to thyroid hormone (RTH) is a rare autosomal dominant hereditary disorder. Here in, we report two patients with RTH in whom differentiated thyroid cancer was diagnosed. Two patients were admitted to our clinic and their laboratory results were elevated thyroid hormone levels with unsuppressed TSH. We considered this situation thyroid hormone resistance in the light of laboratory and clinical datas. Thyroid nodule was palpated on physical examination. Thyroid ultrasonography showed multiple nodules in both lobes. Total thyroidectomy was performed. The pathological findings were consistent with papillary thyroid microcarcinoma. BRAFV600E mutation analysis results were negative. RTH is very rare and might be overlooked. There is no consensus on how to overcome the persistently high TSH in patients with RTH and differentiated thyroid cancer (DTC). Further studies are needed to explain the relationship between RTH and DTC which might be helpful for the treatment of these patients.

Transformation of nonfunctioning pancreatic tumor into malignant insulinoma after 3 years: an uncommon clinical course of insulinoma.

A 62-year-old man admitted to our outpatient clinic with two months of recurrent life threatening hypoglycemia episodes. He was diagnosed as malignant insulinoma with multiple metastases of liver and peripancreatic lymph nodes. Liver biopsy specimen was demonstrated grade 2 neuroendocrine tumor compatible with clinical and radiological results. He was followed under the treatment of continuous intravenous glucose infusion during the diagnostic procedures. He had a pancreatic lesion history measured 20 x 12 mm in diameter via the abdominal tomography examination approximately two years before the diagnosis. Unusual course of this case suggests the transformation of nonfunctioning pancreatic neuroendocrine tumor into functional insulin secreting tumor with metastases. The patient was found inoperable and started on chemotherapy.

The metabolic effects of drugs used for the treatment of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. It is characterized by menstrual disorders, hyperandrogenism (clinical and/or biochemical) and ultrasonographic features. It is well known that PCOS has unfavourable effects on carbohydrate metabolism, the parameters of cardiovascular disease and lipid profile. Mode of treatment is mainly guided by the main complaint of the patient. A lot of medicines have been used for many years to treat these women. For that reason the recognition the effects of these drugs on the metabolic risk profile is important. The aim of this review was to evaluate the effects of these drugs on metabolic parameters in women with PCOS.

A rare coexistence of non-functional adrenocortical carcinoma and multicentric papillary thyroid microcarcinoma: a case report

IntroductionIn this report, we describe a rare case of papillary thyroid carcinoma with adrenocortical carcinoma without excess hormone production.Case presentationA 40-year-old Turkish man was admitted to our institution with a large left adrenal mass that was identified during the work-up for shortness of breath. The patient did not have specific signs and symptoms of hormone excess. The mass was removed surgically. The pathological findings were consistent with adrenocortical carcinoma. The patient was also found to have a multicentric papillary thyroid microcarcinoma.ConclusionMost adrenocortical carcinomas and papillary thyroid carcinomas are sporadic; however, the occurrence of two different endocrine neoplasms during the same period of time is a rare situation, but it is possible, as in our patient. When an endocrine tumor is diagnosed, endocrinologists must be consider the possibility of the existence of another endocrine tumor.