Tsuneyoshi Ka

Increased frequency of metabolic syndrome and its individual metabolic abnormalities in Japanese patients with primary gout.

Background:Gout patients are frequently complicated with hypertension, obesity, dyslipidemia, and/or impaired glucose tolerance, which are components of the metabolic syndrome and risks for atherosclerotic diseases. Objectives:To determine the relationship between metabolic syndrome and gout, as well as plasma concentrations of adipocytokines in gout patients. Subjects and Methods:The frequency of metabolic syndrome as well as its constituents were investigated in 258 male gout patients and 111 males who attended an annual check-up examination. In addition, plasma concentrations of adipocytokines were measured in 107 of the patients. Results:Gout patients had a higher prevalence of metabolic syndrome as compared with the controls (36.4% vs. 15.3%, P < 0.0001). In addition, frequencies of individual metabolic abnormalities, such as waist circumference >85 cm, hypertension, and hypertriglyceridemia, were significantly increased in the gout patients as compared with the controls. Furthermore, uric acid over-production gout had a significantly higher prevalence of metabolic syndrome as compared with uric acid under-excretion gout (48.6% vs. 32.4%, P < 0.001). The plasma concentrations of leptin and plasminogen activator inhibitor-1 were significantly higher in the patients (P < 0.05, respectively), while that of adiponectin and the adiponectin/leptin ratio were significantly decreased in the gout patients as compared with the controls (P < 0.05, respectively). Conclusion:A higher prevalence of metabolic syndrome in gout patients may in part contribute to susceptibility to atherosclerotic diseases. Therefore, more attention should be paid to the presence of metabolic syndrome in gout patients to reduce their risk for cardiovascular disease complications.

Insulin autoimmune syndrome in a patient with ANCA-associated glomerulonephritis.

The patient, a 66-year-old woman, who has been under hemodialysis due to antineutrophil cytoplasm autoantibody (ANCA)-associated glomerulonephritis since 2003, was hospitalized because of cold sweating, general fatigue, and somnolence. Hypoglycemia (43 mg/dL) with markedly elevated insulin level (1410 μU/mL) and insulin antibody was found in her serum. She was diagnosed as having insulin autoimmune syndrome. She has not taken any medication that might cause insulin autoimmune syndrome. The possible association of ANCA-associated glomerulonephritis with insulin autoimmune syndrome is discussed.