Ramis Colak

Ghrelin, paraoxonase and arylesterase levels in depressive patients before and after citalopram treatment

OBJECTIVES The purpose of this study was to examine alterations in lipid profiles and in the serum concentrations of acylated and desacylated ghrelin, paraoxonase and arylesterase in psychiatric patients before and after treatment with 40 mg citalopram daily for 3 months. DESIGN AND METHODS Samples were collected from 22 healthy controls and 24 psychiatric patients before and after citalopram treatment. Blood levels of acylated and desacylated ghrelin were measured by radioimmunoassay. Paraoxonase and arylesterase activities were determined spectrophotometrically. Lipid parameters were measured on the OLYMPUS-AU400. RESULTS It was found that the levels of acylated, desacylated ghrelin, paraoxonase arylesterase, total cholesterol and triglyceride were lower in depressive patients before citalopram treatment than in the control group. Those parameters were not restored after citalopram treatment except for the arylesterase level. CONCLUSION Decreased PON1 and ghrelin levels as well as fluctuations in lipid profiles may be involved in the etiology of depressive disorders.

Presence of obestatin in breast milk : Relationship among obestatin, ghrelin, and leptin in lactating women

OBJECTIVE The peptide hormones ghrelin and leptin have been found in blood and breast milk. This study was undertaken to investigate whether breast milk also contains obestatin, which is derived from the same gene as ghrelin but has opposite actions, and to characterize the relations among serum and milk ghrelin, obestatin, and leptin levels in lactating mothers. METHODS Venous blood, colostrum, and mature milk were obtained from healthy lactating women (n = 31) just before suckling. The ghrelin and obestatin concentrations were determined by radioimmunoassay. Leptin levels were measured by enzyme-amplified sensitivity immunoassay. RESULTS Obestatin levels in colostrum (538.9 pg/mL) and mature milk (528.5 pg/mL) were more than twice the corresponding blood levels (270.3 and 289.4 pg/mL, respectively). In contrast, leptin levels in colostrum (2.01 ng/mL) and mature milk (2.04 ng/mL) were more than five-fold lower than the corresponding blood levels (11.54 ng/mL). There was no correlation between breast milk ghrelin levels and leptin (r = -0.18, P > 0.05). However, there was a positive correlation between leptin levels in breast milk and blood (r = 0.369, P < 0.05). CONCLUSION The origin of milk obestatin is not currently known, but it comes from the blood or breast and may drain through the mammary glands into the milk. Ghrelin, obestatin, and leptin in the milk may directly affect appetite and their levels may be related to the regulation of energy balance and the pathogenesis of obesity.

The prevalence of non-classic adrenal hyperplasia among Turkish women with hyperandrogenism

The prevalence of non-classic adrenal hyperplasia (NCAH) among Turkish women with hirsutism has not been established so far. Thus, we aimed to evaluate the prevalence of 21-hydroxylase (21-OH) deficiency by ACTH stimulation test among hirsute women. The study population consisted of 285 premenopousal women, aged 16–46 years (mean: 23.2 ± 0.3). All were hirsute and hyperandrogenic. Androgen secreting tumors of the ovaries and the adrenal glands were excluded as well as thyroid dysfunction and hyperprolactinemia. All the patients were evaluated by 0.25 mg (i.v.) ACTH stimulation test and 17-OHP responses were obtained at 30 and 60 min. The diagnosis of NCAH due to 21-OH deficiency was considered in patients with the poststimulation 17-OHP level exceed 10 ng/ml. Six (2.1%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. The rest of the patients were polycystic ovary syndrome (n = 166, 58.2%) and idiopathic hyperandrogenemia (n = 113, 39.7%). There were no patients with idiopathic hirsutism because patients with normal serum androgen levels were excluded. This first and most extensive national study investigating NCAH prevalence among Turkish population showed that NCAH is not prevalent in this population.

Presence of thyroid-associated ophthalmopathy in Hashimoto's thyroiditis

AIM To determine the prevalence of ophthalmopathy in Hashimotos patients and to make a comparison in subgroups of patients. METHODS The study involved 110 Hashimotos thyroiditis patients and 50 control subjects attending to the endocrinology department of the hospital. Subgroup classification of patients was made as euthyroid, subclinic and clinic in Hashimatos thyroiditis. All patients were evaluated by a single experienced ophthalmologist for the prevalence and characteristics of eye signs. RESULTS The overall prevalences of eye changes were 22.7% (25 patients) in patients and 4% (2 persons) in control subjects respectively (P=0.002). In patients the most common symptom was retrobulbar eye pain with or without any eye movement. Thirteen patients had significant upper eyelid retraction (11.8%). Six patients had eye muscle dysfunction as reduced eye movements in up gaze. In control patients one person had proptosis and another had lid retraction. The clinical activity score and classification of the ophthalmopathy did not show any significant differences among subgroups. CONCLUSION The eye signs were mostly mild (22.7%) and the most common eye sign was the presence of upper eyelid retraction (11.8%). Additionally six patients had eye muscle dysfunction as reduced eye movements in up gaze. Therefore we recommend to make a routine ophthalmic examination in Hashimotos thyroiditis patients in order not to omit the associated ophthalmopathy.

Acromegaly is associated with decreased skin transepidermal water loss and temperature, and increased skin pH and sebum secretion partially reversible after treatment.

BACKGROUND Acromegaly is characterized by an acquired progressive somatic disfigurement, mainly involving the face and extremities, besides many other organ involvement. Wet and oily skin was described in acromegaly patients and it was attributed to hyperhidrosis and increased sebum production but this suggestion has not been evaluated with reliable methods. OBJECTIVE The aim of this study was to examine the skin parameters of patients with acromegaly using measurements of skin hydration, sebum content, transepidermal water loss, pH and temperature and particularly the effects of 12 months of treatment on these parameters. METHODS 52 patients with acromegaly and 24 healthy control subjects were included in this two blinded prospective study. Skin properties were measured on forehead and forearm by Corneometer CM825, Sebumeter SM810, Tewameter TM210 and Phmeter PH900 as non-invasive reliable measuring methods. Serum GH, IGF-1 and all measurements of skin properties on forehead and forearm were repeated at the end of the 3, and 6 months of therapy in 20 cases. Patients were treated with appropriate replacement therapy for deficient pituitary hormones. RESULTS The sebum content and pH of the skin of acromegalic patients were significantly higher and transepidermal water loss and skin temperature were found to be significantly lower in acromegalic patients when compared to the control group both on forehead and forearm. GH and IGF-1 levels were positively correlated with sebum levels and negatively correlated with skin temperature on both forehead and forearm. The sebum levels of the patients were significantly decreased both on forehead and forearm at 3rd and 6th months of treatment. CONCLUSION The present study demonstrated increased sebum secretion, decreased transepidermal water loss, alkali and hypothermic skin surface in patients with acromegaly by reliable methods for the first time. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics which can be at least partially reversible with treatment.

A comparison between the effects of low (1 µg) and standard dose (250 µg) ACTH stimulation tests on adrenal cortex functions with Behçet's disease

Introduction  Behçets disease is a rare, chronic disorder. The cause of Behçets disease is unknown. It is believed to be caused by an autoimmune reaction. As in other chronic autoimmune diseases, Behçets disease may show a subclinical adrenal failure and some changes in cortisol levels. We aimed to evaluate adrenal gland function in Behçets disease patients.

The effects of zoledronic acid treatment on depression and quality of life in women with postmenopausal osteoporosis: A clinical trial study

Background: Osteoporosis affects quality of life (QoL) and may lead to depression in women. The purpose of this study was to evaluate the effects of zoledronic acid (ZA) treatment on depression and QoL in women with postmenopausal osteoporosis (PO). Materials and Methods: A total of 88 newly diagnosed women with PO were included in this study. All patients were treated with once-yearly ZA (5 mg). A QoL questionnaire from the European Foundation for Osteoporosis and Beck Depression Inventory were given to patients at baseline and at 12 months. The results for baseline and post - 12th month were compared, and bone mineral density (BMD) levels were compared. Results: The consumption of once-yearly ZA (5 mg) treatment increases BMD at levels of lumbers 1–4 (P = 0.026), total Hip T scores P value is same as femoral neck (P: 0,033). ZA 5 mg treatment also improved QoL (P = 0.001) and reduced depression (P = 0.001). Conclusion: ZA treatment increases BMD levels and QoL while reducing depression. Once-yearly ZA (5 mg) may be considered for postmenopausal women as a first-line treatment.

L-Thyroxine Treatment of Patients with Subclinical Hypothyroidism Reduce Inflammation

Background: Subclinical hypothyroidism (SCH) has been found to be associated with cardiovascular disease including atherosclerosis which is also called inflammatory disorder. The objective of this study was, to investigate the efficacy of L-thyroxine therapy on inflammation in patients with SCH and to determine whether treatment of SCH would reduce inflammation. Methods: Twenty patients with thyroid stimulating hormone levels between 5 and 10 mU/L and twenty healthy persons (control) were enrolled to the study. 0.025-0.075 mg/d L-thyroxine therapy was given to the patients. Patients were followed till they became euthyroid. C-reactive protein (CRP), lipid profile and thyroid function tests were evaluated. CRP was determined by a high sensitivity immunoassay. Results: CRP, total cholesterol and low-density lipoprotein (LDL) were significantly elevated in patients with subclinical hypothyroidism compared to the control group at baseline (p<0.01, p<0.05, p<0.001, respectively). L-thyroxine therapy significantly decreased CRP (p<0.01) and low-density lipoprotein in treatment group (p<0.05). Nevertheless, no significant change was found in other lipid parameters. Conclusion: These findings demonstrate that patients with SCH are characterized by inflammatory disorders and higher lipid profile.

A Comparison Between the Effects of Low (1 μg) and Standard Dose (250 μg) ACTH Stimulation Tests on Adrenal Cortex Functions with Leprosy Patients

Leprosy is a chronic granulomatous disease that either remains localized or widespread depending on the immunological status of the affected patient. It can lead to clinical or subclinical adrenal failure by influencing adrenal steroidogenesis. In the present study, 26 patients (21 males and 5 females) who were diagnosed with lepromatous leprosy and 15 healthy individuals who were compatible with the patients in terms of age and sex were subjected to an adrenocorticotrophic hormone (ACTH) stimulation test. The leprosy and control groups were subjected to 1 μg low dose (LDT) and 250 μg intravenous standard dose (SDT) ACTH stimulation tests after 12-hour nocturnal fasting with an interval of three days. Cortisol responses in 0, 30, and 60 minutes were examined. There was no difference between leprosy and control groups in terms of mean baseline cortisol values. Mean value of the peak cortisol response to both LDT and SDT was found to be significantly lower in the leprosy group than in the control group (p < 0.001 and p < 0.01, respectively). Peak cortisol response to LDT in the leprosy group was found below 20 μg/dL in 9 patients (34.6%). As for the peak cortisol response to SDT, it was lower than 20 μg/dL in 5 patients (19.23%). It was found that LDT response was abnormally low in 4 patients (15.38%) who responded normally to SDT. It was observed that there could be a decrease in adrenocortical reserve capacity although baseline adrenocortical functions were normal in patients with leprosy. It was seen that LDT was more sensitive than SDT in identifying this decrease.

Beneficial effects of training at the anaerobic threshold in addition to pharmacotherapy on weight loss, body composition, and exercise performance in women with obesity

Objective The aim of this study was to determine and compare the effects of weight loss achieved through orlistat therapy alone or a combination of orlistat and an aerobic exercise training program on aerobic fitness and body composition in obese females. Methods Twenty-eight obese patients were randomly assigned to receive 12-week treatment with hypocaloric diet–orlistat or diet–orlistat–exercise. Each participant performed an incremental ramp exercise test every 4 weeks to measure aerobic fitness. Fourteen participants performed continuous exercise (approximately 45 minutes per session) at a work rate corresponding to the anaerobic threshold three times per week. Results A decrease in the fat mass to body weight ratio of 3.8% (P=0.006) was observed at the end of the 12 weeks in the orlistat group, while a decrease of 9.5% (P=0.001) was seen in the orlistat–exercise group. Maximal exercise capacity increased by 46.5% in the orlistat–exercise group and by 19.5% in the orlistat group. Conclusion While orlistat therapy resulted in an improvement in body composition and aerobic fitness at the end of the 12-week period, its combination with exercise training provided improvements in the same parameters within the first 4 weeks of the study. These additional beneficial effects of combining aerobic exercise with orlistat therapy are important with regards to obesity-associated risk factors.