Xian-ling Wang

A comparison of urinary albumin excretion rate and microalbuminuria in various glucose tolerance subjects

Aims  To investigate the difference of urinary albumin excretion rate (UAER) and microalbuminuria (MAU) in various glucose tolerance subjects, especially between isolated‐impaired glucose tolerance subjects and isolated‐impaired fasting glycaemia subjects.

Pituitary stalk interruption syndrome in Chinese people: clinical characteristic analysis of 55 cases.

Objective Pituitary stalk interruption syndrome (PSIS) is characterized by the absence of pituitary stalk, pituitary hypoplasia, and ectopic posterior pituitary. Due to the rarity of PSIS, clinical data are limited, especially in Chinese people. Herein, we analyzed the clinical characteristics of patients diagnosed with PSIS from our center over 10 years. Patients and Methods We retrospectively analyzed the clinical manifestations and laboratory and MRI findings in 55 patients with PSIS. Results Of the 55 patients with PSIS, 48 (87.3%) were male. The average age was 19.7±6.7 years and there was no familial case. A history of breech delivery was documented in 40 of 45 patients (88.9%) and 19 of 55 patients (34.5%) had a history of dystocia. Short stature was found in 47 of 55 patients (85.5%) and bone age delayed 7.26±5.37 years. Secondary sex characteristics were poor or undeveloped in most patients. The prevalence of deficiencies in growth hormone, gonadotropins, corticotropin, and thyrotropin were 100%, 95.8%, 81.8%, 76.3%, respectively. Hyperprolactinemia was found in 36.4% of patients. Three or more pituitary hormone deficiencies were found in 92.7% of the patients. All patients had normal posterior pituitary function and absent pituitary stalk on imaging. The average height of anterior pituitary was 28 mm, documented anterior pituitary hypoplasia. Midline abnormalities were presented in 9.1% of patients. Conclusions The clinical features of our Chinese PSIS patients seem to be different from other reported patients in regarding to the higher degree of hypopituitarism and lower prevalence of midline defects. In addition, our patients were older at the time of case detection and the bone age was markedly delayed. We also had no cases of familial PSIS.

Accurate combined preoperative localization of insulinomas aid the choice for enucleation: a single institution experience over 25 years.

BACKGROUND/AIMS To assess the accuracy of combined preoperative localizations and analyze the change in management strategy of operation of insulinoma. METHODOLOGY One hundred and seventy-two patients with a diagnosis of insulinoma at a tertiary hospital between 1985 and 2010 were reviewed, where accurate combined preoperative localization before surgical exploration was the primary management policy of insulinoma. Operation details for 147 patients were checked. RESULTS An average of 2.89 preoperative localization studies including 1.61 non-invasive studies and 1.28 invasive studies were utilized per patient. Contrast-enhanced ultrasonography (CEUS) was the most sensitive invasive modality (88.1%) whereas magnetic resonance imaging (MRI) was the most sensitive non-invasive modality (64.0%). All 147 patients underwent complete surgical resection which included 126 enucleations and 18 distal pancreatectomies with a cure rate of 95.2% (140/147) at a median follow-up of 45 months (range 1-248). The postoperative morbidity and long-term outcome of enucleation was similar to distal pancreatectomy despite a higher rate of microscopic margin involvement. CONCLUSIONS Accurate combined preoperative localization of insulinomas is useful of the choice of enucleation, eliminates the need for blind distal pancreatectomy and avoids re-operation. Whenever possible, a pancreas-sparing approach such as enucleation should be adopted.

Cognitive function with glucose tolerance status and obesity in Chinese middle-aged and aged adults

Objectives: To evaluate the relationship of cognitive function with glucose tolerance status and obesity in Chinese middle-aged or aged adults. Methods: A sample of 1722 subjects aged 40 years or order was investigated from four communities in Shijingshan District, Beijing, China. People with any emotional disorder, substance abuse, known diabetes or stroke were excluded. Global cognitive function was measured by the Mini-Mental State Examination (MMSE). Results: People with normal glucose tolerance showed higher mean MMSE scores compared to those with pre-diabetes or diabetes (p > 0.05 in males, p < 0.05 in females). People with ideal BMI (18.5–23.9) showed higher mean MMSE scores compared to those with BMI < 18.5 or BMI ≥ 24, but there was no statistical significance (p < 0.05) The significantly lower MMSE scores was shown in the groups with waist circumferences ≥ 85 cm in males, or ≥ 80 cm in females (p < 0.05). The multivariate linear regression analysis showed significant association of MMSE with waist circumferences, SBP, HDL-c and FPG (p = 0.000, B = −0.179; p = 0.000, B = −0.073; p = 0.016, B = 0.165; p = 0.028, B = −0.124, respectively), except the association with age, education, economic income, smoking and alcohol intake. Conclusions: In middle aged or aged residents, glucose tolerance status, obesity, and especially central obesity may be the important contributors to cognitive impairment.

Characterization of Papillary Thyroid Microcarcinomas Using Sonographic Features in Malignant Papillary Thyroid Cancer: A Retrospective Analysis

AbstractThe diagnosis of malignant thyroid nodules is still a clinical challenge. This study aimed to determine the ultrasonographic characteristics of papillary thyroid carcinoma.The ultrasonographic and pathological data of 2453 thyroid nodules in a cohort of 1895 Chinese patients who underwent thyroidectomy from January 2010 to December 2012 were retrospectively reviewed.Anteroposterior and transversal (AP/TR) diameters ≥1, solid structure, infiltrative margins, hypoechoic appearance, and microcalcifications were more common in malignant nodules than in benign nodules (P < 0.01). These ultrasonographic features were independent risk factors of malignancy (P < 0.01) as determined by logistic regression analysis. Based on multivariate analysis, these characteristics were also present in large nodules (diameter >10 mm). However, in small nodules (diameter ⩽10 mm), only AP/TR ≥1 and infiltrative margins were independent risk factors of malignancy (P < 0.01).Ultrasonography is of high diagnostic value for malignant thyroid nodules and may help to improve the differential diagnosis. Small and large nodules have distinct ultrasonographic features.

Mutation analyses in pedigrees and sporadic cases of ethnic Han Chinese Kallmann syndrome patients

Kallmann syndrome, a form of idiopathic hypogonadotropic hypogonadism, is characterized by developmental abnormalities of the reproductive system and abnormal olfaction. Despite association of certain genes with idiopathic hypogonadotropic hypogonadism, the genetic inheritance and expression are complex and incompletely known. In the present study, seven Kallmann syndrome pedigrees in an ethnic Han Chinese population were screened for genetic mutations. The exons and intron–exon boundaries of 19 idiopathic hypogonadotropic hypogonadism (idiopathic hypogonadotropic hypogonadism)-related genes in seven Chinese Kallmann syndrome pedigrees were sequenced. Detected mutations were also tested in 70 sporadic Kallmann syndrome cases and 200 Chinese healthy controls. In pedigrees 1, 2, and 7, the secondary sex characteristics were poorly developed and the patients’ sense of smell was severely or completely lost. We detected a genetic mutation in five of the seven pedigrees: homozygous KAL1 p.R191ter (pedigree 1); homozygous KAL1 p.C13ter (pedigree 2; a novel mutation); heterozygous FGFR1 p.R250W (pedigree 3); and homozygous PROKR2 p.Y113H (pedigrees 4 and 5). No genetic change of the assayed genes was detected in pedigrees 6 and 7. Among the 70 sporadic cases, we detected one homozygous and one heterozygous PROKR2 p.Y113H mutation. This mutation was also detected heterozygously in 2/200 normal controls and its pathogenicity is likely questionable. The genetics and genotype–phenotype relationships in Kallmann syndrome are complicated. Classical monogenic inheritance does not explain the full range of genetic inheritance of Kallmann syndrome patients. Because of stochastic nature of genetic mutations, exome analyses of Kallmann syndrome patients may provide novel insights.

Thyrotrophic status in patients with pituitary stalk interruption syndrome.

Abstract Pituitary stalk interruption syndrome (PSIS) is associated with simultaneous or subsequent pituitary hormone deficiencies (PHDs). Although the clinical features of multiple PHDs are well known, the status of the thyrotrophic axis in PSIS has not been thoroughly investigated. The clinical data of 89 PSIS patients and 34 Sheehan syndrome (SS) patients were retrospectively analyzed. The prevalence of central hypothyroidism in the PSIS patients and the SS patients was 79.8% and 70.6%, respectively. The thyroid-stimulating hormone (TSH) levels in the PSIS patients were significantly higher in comparison with the SS patients (5.13 ± 3.40 vs 1.67 ± 1.20 mU/L, P < .05). TSH elevation (8.79 ± 3.17 mU/L) was noticed in 29 of 71 (40.85%) hypothyroid PSIS patients but not in the 24 hypothyroid SS patients. The TSH levels in the hypothyroid PSIS patients were significantly higher in comparison with the euthyroid PSIS patients (5.42 ± 3.67 vs 3.66 ± 1.50 mU/L). Thyroid hormone replacement significantly reduced the TSH levels in the PSIS patients with elevated TSH levels from 7.24 ± 0.98 to 1.67 ± 1.51 mU/L (P < .05). The logistic regression analysis suggested that TSH level was not significantly associated with pituitary stalk status and height of the anterior pituitary gland. PSIS is a newly recognized cause of central hypothyroidism. The proportion and amplitude of TSH elevations are higher in PSIS than in other causes of central hypothyroidism.

Rare and curable renin-mediated hypertension: a series of six cases and a literature review.

Abstract Background: Reninoma is an extremely rare renal tumor characterized by excessive renin secretion causing secondary hypertension and hypokalemia. Reninoma is a benign and highly manageable lesion if it is discovered early and removed surgically. Methods: We report six cases of reninoma and provide a literature review on this rare disease, highlighting the diagnostic evaluation and follow-up of each patient. Results and conclusions: Reninoma should be considered in young adults with elevated renin activity and refractory hypertension. Imaging studies and selective venous catheterization are often helpful in identifying the lesion. In most cases of reninoma presenting with renin-mediated hypertension, conservative surgical treatment should be considered to remove the small, superficial lesion.

Chronic inflammatory demyelinating polyneuropathy mimicking diabetic neuropathy in a young female with type 2 diabetes mellitus

The presentations of chronic inflammatory demyelinating polyneuropathy (CIDP) overlap with those of diabetic peripheral neuropathy (DPN). We described a young girl with CIDP underlying type 2 diabetes mellitus, presenting with progressive numbness and limb weakness, who was initially misdiagnosed to have DPN. Finally immunosuppressive therapy got good response.

Type 1 Diabetes Caused by Interferon α-2α in Polycythemia Vera Therapy

One of the main problems with long-term interferon α-2α (IFNα-2α) therapy for chronic viral hepatitis and malignant tumors is the development of autoimmune abnormalities. Up until now, there have been few reports about type 1 diabetes caused by IFNα-2α therapy in patients with polycythemia vera (PV) (1). A 59-year-old male patient without history of diabetes, whose fasting blood glucose (FBG) and A1C were 70.6 mg/dl and 4.8%, respectively, was diagnosed with PV in October 1999. He had been initially treated with Hydrea for 6 months, but the response had been unfavorable. Therefore, he switched to IFNα-2α (recombinant interferon α-2α; Shanghai Roche Pharmaceuticals, Shanghai, China) therapy, …