Rocco Valeriano

Serum concentrations of adiponectin and leptin in patients with thyroid dysfunctions.

Thyroid dysfunction is associated with metabolic changes that affect mass and adipocyte function, as well as lipid and carbohydrate metabolism. Adipose tissue performs complex metabolic and endocrine functions. Leptin and adiponectin are two of the most important adipocytokines, both involved in the regulation of intermediate metabolism. The aim of this study was to evaluate the relationships between thyroid status and circulating levels of the two adipose tissue hormones. We studied 15 patients with hyperthyroidism, 15 patients with hypothyroidism and 15 euthyroid subjects, all matched by sex, age and body mass index (BMI). Serum concentrations of free thyroxine, free triiodothyronine, thyrotropin, leptin and adiponectin and anthropometric parameters (weight, height, BMI) were assessed. No significant difference was found among the 3 groups, as assessed by Student’s t-test, both for adiponectin and leptin. We conclude that metabolic changes associated with thyroid dysfunction are not related to variations in serum levels of adiponectin or leptin.

Effects of Bariatric Surgery on Early Myocardial Alterations in Adult Severely Obese Subjects

Objective: Aim of this study was to investigate the effect of weight loss on structural and functional myocardial alterations in severely obese subjects treated with bariatric surgery. Patients and Methods: Thirteen severely obese patients (2 males and 11 females) were enrolled in the study. All subjects underwent conventional 2D color Doppler echocardiography. The new ultrasonic techniques used were: (a) integrated backscatter for the analysis of myocardial reflectivity, referred to pericardial interface as expression of myocardial structure (increase in collagen content) and of cyclic variation index as expression of intrinsic myocardial contractility and (b) color Doppler myocardial imaging (CDMI) for the analysis of strain and strain rate (myocardial deformability). All subjects underwent bariatric surgery and were resubmitted to echocardiographic and biochemical examination 6–24 months after surgery. Results: The main finding of the present study was a quite complete normalization of myocardial functional and structural alterations after weight loss. In particular, the cyclic variation index at septum level improved from 14.6 ± 7.0 before to 25.7 ± 11.2 (means ± SD) after surgery (controls: 36.2 ± 9.1). Mean reflectivity at septum level significantly decreased from 55.8 ± 9.5 to 46.5 ± 8.8 (controls: 43.0 ± 8.0). Also, the strain at septum level significantly improved after surgery (from –11.9 ± 3.2 to –20.4 ± 5.3; controls: –23.4 ± 9). Conclusion: This study establishes: (a) the utility of new ultrasonic techniques to detect very early structural and functional myocardial alterations in severely obese patients, and (b) the regression of these subclinical abnormalities after weight loss achieved by bariatric surgery.

Ultrasonographic evaluation of liver volume and the metabolic syndrome in obese women

Non-alcoholic fatty liver disease is a common finding in obese subjects, and increasing evidence has been provided suggesting that it represents the hepatic component of the metabolic syndrome. The aim of this study was to evaluate whether the extent of liver enlargement is related to the severity of the metabolic syndrome in obese women. The relationship between ultrasound-measured hepatic left lobe volume (HLLV) and various features of the metabolic syndrome was evaluated in 85 obese women. The mean±SD value of HLLV in obese women was 431±214 ml (range 46–1019 ml) while it was 187±31 ml (range 143–258 ml) in lean subjects. In a multiple logistic regression analysis, ultrasound-measured intra-abdominal fat was the only anthropometric measure independently associated with HLLV. A strong positive association was found between HLLV and serum liver enzymes, triglycerides, glucose, insulin, uric acid, C reactive protein, systolic and diastolic blood pressure, while a negative correlation was observed between HLLV and HDL cholesterol. The values of HLLV corresponding to the cut-off values of various risk factors for the diagnosis of the metabolic syndrome were calculated, yielding a mean value of 465 ml. In conclusion, ultrasound measurement of HLLV represents a simple, reliable and low-cost tool for the evaluation of liver involvement in the metabolic syndrome. The strong association between liver enlargement and various cardiovascular risk factors associated with insulin resistance supports the role of liver steatosis as an important link among the many facets of the metabolic syndrome in human obesity.

Non-autoimmune hyperthyroidism associated with isolated bilateral ocular lymphoma mimicking Graves’ disease with ophthalmopathy: A cause of misdiagnosis

A very rare association of non-autoimmune hyperthyroidism due to nodular goiter with isolated bilateral non-Hodgkin’s ocular lymphoma is described. A 66-year-old woman presented with bilateral proptosis, marked periocular swelling, conjunctival hyperemia and chemosis, severe extraocular muscle impairment with diplopia. Thyroid function tests showed normal free thyroid hormone concentrations with undetectable serum thyrotropin levels. Patient was placed on antithyroid drug treatment, ocular conditions deteriorated. More than two years later, when first seen in our Institution, orbital CT scan showed the presence of a retro-ocular mass that, at biopsy, proved to be B-cell non-Hodgkin’s lymphoma, apparently with no localization in other sites. Thyroid evaluation revealed subclinical hyperthyroidism due to an autonomous thyroid nodule in the left lobe of the gland. Radiotherapy of the orbit was followed by a dramatic regression of lymphoma, but further staging some months later showed involvement of several abdominal lymph node structures. This case underscores the need of a thorough diagnostic work-up of ocular disease resembling Graves’ ophthalmopathy, even when it is bilateral and associated with overt or subclinical hyperthyroidism.

Contents Vol. 109, 2008

E. Abadie, Saint Denis C.W. Akins, Boston, Mass. J.S. Alpert, Tucson, Ariz. E.A. Amsterdam, Sacramento, Calif. J.J. Badimon, New York, N.Y. A. Battler, Petah Tikva R. Becker, Durham, N.C. G.A. Beller, Charlottesville, Va. P.C. Block, Atlanta, Ga. R.O. Bonow, Chicago, Ill. J. Camm, London B. Carabello, Houston, Tex. K. Chatterjee, San Francisco, Calif. P.F. Cohn, Stony Brook, N.Y. M.H. Crawford, San Francisco, Calif. H. Cuénoud, Worcester, Mass. J.E. Dalen, Tucson, Ariz. S. Dalla Volta, Padova P.C. Deedwania, Fresno, Calif. A.N. De Maria, San Diego, Calif. P.S. Douglas, Durham, N.C. J.A. Eleft eriades, New Haven, Conn. U. Elkayam, Los Angeles, Calif. G. Ewy, Tucson, Ariz. M. Ezekowitz, Wynnewood, Pa. R. Ferrari, Milan G. Filippatos, Athens G.I. Fishman, New York, N.Y. K. Fox, London G.S. Francis, Cleveland, Ohio V. Fuster, New York, N.Y. B.J. Gersh, Rochester, Minn. W. Gersony, New York, N.Y. J. Gold, Toledo, Ohio R. Goldberg, Worcester, Mass. S. Goldberg, Philadelphia, Pa. M. Goldman, New York, N.Y. P.J. Goldschmidt, Miami, Fla. J. Gore, Worcester, Mass. T.H. Haghfelt, Odense J.L. Halperin, New York, N.Y. C.L. Hanis, Houston, Tex. S. Haunsø, Copenhagen Z.-X. He, Beijing