Sayid Shafi Zuhur

The relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus according to the severity of 25-hydroxyvitamin D deficiency

OBJECTIVE: To assess the relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus in Turkish pregnant women according to the severity of 25-hydroxyvitamin D deficiency and assess intact parathyroid hormone levels in women with gestational diabetes mellitus and controls with low and sufficient 25-hydroxyvitamin D levels. METHODS: We analyzed serum 25-hydroxyvitamin D and intact parathyroid hormone levels in 234 women with gestational diabetes mellitus and 168 controls. To define the deficiency status, 25-hydroxyvitamin D levels were further classified into severely deficient, deficient, insufficient and sufficient groups. RESULTS: Women with gestational diabetes mellitus had significantly lower 25-hydroxyvitamin D levels compared to controls (30.8±16.3 vs. 36.0±16.2 nmol/L). However, when subgroups of 25-hydroxyvitamin D were analyzed, gestational diabetes mellitus was significantly more common only in women with severely deficient 25-hydroxyvitamin D levels. After adjusting for covariates, only severely deficient 25-hydroxyvitamin D levels were independently associated with an increased relative risk of gestational diabetes mellitus. The relative risk of gestational diabetes mellitus in women with insufficient and deficient 25-hydroxyvitamin D levels was not statistically significant. Intact parathyroid hormone concentrations were also significantly higher in women with gestational diabetes mellitus compared to the controls (45.3±26.2 vs. 38.7±27.6 pg/ml). CONCLUSIONS: The results obtained from this study provide novel data indicating that only severely deficient maternal serum 25-hydroxyvitamin D levels are significantly associated with an elevated relative risk of gestational diabetes mellitus, even after adjusting for established risk factors of gestational diabetes mellitus.

The Role of Helicobacter pylori in Patients with Hypothyroidism in Whom Could Not be Achieved Normal Thyrotropin Levels Despite Treatment with High Doses of Thyroxine

Background:  Helicobacter pylori infection is a most frequent cause of chronic gastritis. H. pylori may decrease absorption of oral thyroxine by decreasing gastric acid secretion in the stomach. In this study, we aimed to investigate the change in thyroid function tests of the cases after H. pylori eradication who were not responding to high doses of thyroxine treatment before H. pylori eradication.

Anterior pituitary hormone deficiency in subjects with total and partial primary empty sella: do all cases need endocrinological evaluation?

AIM To compare anterior pituitary functions between subjects with total and partial primary empty sella (PES) and to assess whether all cases with PES need endocrinological evaluation. MATERIAL AND METHODS Eighty-one subjects with PES (34 total and 47 partial) were included in the study. Basal anterior pituitary and its target hormones were assessed and those with low insulin like growth factor-1 and/or low basal cortisol levels underwent insulin tolerance test (ITT). RESULTS 67.4% of the subjects with total and 14.9% of those with partial PES had different degrees of hypopituitarism. However, the frequency of hypopituitarism was significantly higher in cases with total PES. The odds ratio (OR) and 95% confidence interval (CI) of secondary hypothyroidism, secondary adrenal, growth hormone and gonadotropin deficiency in subjects with total compared to those with partial PES were as follows: OR = 20.0, 95% CI 4.16 - 95.9, OR = 2.4, 95% CI 1.34 - 5.7, OR = 15.3, 95% CI 4.48 - 52.6 and OR = 10.6, 95% CI 3.37 - 33.5, respectively. CONCLUSION A substantial number of subjects with PES, particularly those with total PES, have pituitary hormone deficiency, so regardless of the type of PES, all subjects must be promptly and carefully evaluated for anterior pituitary hormone deficiency.

The Diagnostic Utility of Color Doppler Ultrasonography, Tc-99m Pertechnetate Uptake, and TSH-Receptor Antibody for Differential Diagnosis of Graves' Disease and Silent Thyroiditis: A Comparative Study.

OBJECTIVE The differential diagnosis of Graves disease (GD) and silent thyroiditis (ST) is important for the selection of appropriate treatment. To date, no study has compared the diagnostic utility of color Doppler ultrasonography (CDUSG), Tc-99m (technetium-99m) pertechnetate uptake, and thyroid-stimulating hormone (TSH)-receptor antibody (TRAb) for the differential diagnosis of these two conditions. In the present study, we compared the diagnostic utility of inferior thyroid artery (ITA) peak systolic and end diastolic velocities (PSV and EDV) measured by CDUSG, Tc-99m pertechnetate uptake, and TRAb for differential diagnosis of GD and ST. METHODS A total of 150 subjects with GD, 79 with ST, and 71 healthy euthyroid controls were included in the study. Diagnoses of GD and ST were made according to patient signs and symptoms, physical examination findings, the results of TRAb and Tc-99m pertechnetate uptake, and follow-up findings. All subjects underwent CDUSG for the quantitative measurement of ITA blood-flow velocities. RESULTS The mean ITA-PSV and EDV in patients with GD were significantly higher than in ST patients. In receiver operating characteristic analysis, the sensitivity/specificity of the 30 and 13.2 cm/s cutoff values of the mean ITA-PSV and EDV for discrimination of GD from ST were 95.3/94.9% and 89.3/88.6%, respectively. The sensitivity/specificity of the 1.0 international unit (IU)/L and 3% cutoff values of the TRAb and Tc-99m pertechnetate uptake analyses were 93.0/91.0% and 90.7/89.9%, respectively. CONCLUSION The measurement of ITA-PSV by CDUSG is a useful diagnostic tool and is a complementary method to the TRAb and Tc-99m pertechnetate uptake methods for differential diagnosis of GD and ST.

Immunohistochemical expression of ErbB2 in adamantinomatous craniopharyngiomas: a possible target for immunotherapy.

AIM To determine the immunohistochemical expression of ErbB2 in adamantinomatous craniopharyngiomas (ACP) and to assess its relationship with nuclear expression of β-catenin in surgically resected human ACP tissue sections and to estimate whether these tumors could be candidates for anti-ErbB2 therapy. MATERIAL AND METHODS The ErbB2 and β-catenin immunostaining was performed on paraffin embedded tissue sections of 20 ACP using avidin-biotin-peroxidase complex method. ErbB2 immunoreactivity was interpreted according to the American Society of Clinical Oncology/ College of American Pathologists criterions for breast carcinoma. RESULTS Foci of nuclear reactivity for β-catenin was observed in all ACP tissue specimens mainly concentrated in whorl like arrays of the epithelial cells. Two (10%) of the cases were score 3+ for ErbB2 as demonstrated by strong complete membrane staining. However, the localization of 3+ ErbB2 cells was different from those with nuclear β-catenin immunoreactivity. CONCLUSION Our preliminary data demonstrate score 3+ staining for ErbB2 in 10% of ACP and different localization of 3+ ErbB2 cells and cells with nuclear β-catenin immunoreactivity. However, because of the small number of cases, further studies with larger samples should be conducted to verify and validate our preliminary data and to determine the effect of ErbB2 protein in ACP cell growth, survival and differentiation.

IS BIOCHEMICAL ASSESSMENT OF PHEOCHROMOCYTOMA NECESSARY IN ADRENAL INCIDENTALOMAS WITH MAGNETIC RESONANCE IMAGING FEATURES NOT SUGGESTIVE OF PHEOCHROMOCYTOMA

OBJECTIVE Currently, it is unclear whether pheochromocytomas can be ruled out based on low intensity on T2-weighted sequences and signal loss on out-of-phase magnetic resonance imaging (MRI) sequences. Hence, in this study, we investigated whether biochemical screening for pheochromocytoma in patients with adrenal incidentalomas (AIs) showing MRI features not suggesting pheochromocytoma would prove beneficial. METHODS We performed MRI for 300 AIs in 278 consecutive patients. All patients were screened for pheochromocytoma with plasma metanephrine and normetanephrine. Patients with high plasma levels of metanephrine and/or normetanephrine were also assessed for pheochromocytoma by urinary metanephrines. RESULTS Hyperintensity was detected on T2-weighted MRI sequences in 28 (9.3%) of the 300 AIs. Among these 28 incidentalomas, pheochromocytoma was diagnosed in 13 (46.4%) of the cases by histopathologic analysis. Hyperintensity on T2-weighted MRI was significantly higher in pheochromocytomas compared to the remaining AIs (P<.001). All 13 pheochromocytomas were characterized by hyperintensity on T2-weighted sequences and the absence of signal loss on out-of-phase MRI sequences. Pheochromocytoma was not detected in any of the 272 AIs that appeared hypointense or isointense on T2-weighted MRI sequences or in the 250 cases with signal loss on out-of-phase sequences. CONCLUSION The results of this study suggest that AIs that appear hypointense or isointense on T2-weighted MRI sequences and those with signal loss on out-of-phase sequences may not require routine biochemical screening for pheochromocytoma. Further studies including a higher number of pheochromocytomas are required to confirm our results.

Primary hyperparathyroidism detected in a patient undergoing two prior thyroidectomies for follicular thyroid carcinoma: a case report

Conclusion: PHPT in the presence of thyroid follicular carcinoma is a rare occurrence. Non-visualization of parathyroid tissue by imaging studies in a patient with two prior thyroidectomy operations and RAI therapy makes our case quite an interesting one. Cinacalcet therapy is a good therapeutic option to control calcium levels in cases where excessive secretion of PTH cannot be achieved by surgical intervention. A 57-year-old female patient underwent left total and right subtotal thyroidectomy operations on 18.05.2009 for multinodular goiter. Pathological examination revealed a 5.5 cm follicular carcinoma in the left lobe. Lymphovascular invasion of the tumor was present. On 30.06.2009, she underwent completion thyroidectomy, and central compartment and ipsilateral lateral cervical lymph nodes dissection. Subsequently received ablative therapy with radioactive iodine (RAI) at a dose of 150 mCi. Elevated calcium and reduced phosphorus levels were found during her follow-up visits (Table). While the findings of several tests were consistent with primary hyperparathyroidism, only a slightly echoic, wellcircumscribed lesion (5x5x11 mm) located close to the former place of the inferior pole of the right thyroid gland was detected by neck ultrasound images and its vascularization was shown by Doppler ultrasound (Figure-1). However, no increase in activity or uptake was observed during parathyroid scintigraphy (Figure-2) and neck CT did not show a tumor mass formation. Her serum calcitonin level was normal (Table). The possibility of a thyroid medullary carcinoma was excluded by reexamining of her paraffin-embedded thyroid blocks. The patient who already had undergone two major surgeries and one course of RAI treatment refused another neck operation. Thus, treatment with Cinacalcet was initiated. Calcium values returned to normal after the treatment (Table).