Immune rebound: multiple sclerosis after treatment of Cushing's disease

High cortisol level in endogenous Cushing's syndrome suppresses the immune system and after treatment there may be an over activity of immune reaction leading to autoimmune diseases mostly thyroid and rheumatologic disorders. This is the second reported case of multiple sclerosis developing after treatment of Cushing's syndrome. A 42-year old man is reported who presented with bone fracture and osteoporosis and diagnosed with Cushing's disease. Six months after surgical treatment of his pituitary adenoma, he developed progressive multiple sclerosis. We conclude that after treatment of endogenous Cushing's syndrome, the patients should be watched for development of autoimmune disorders including those affecting the central nervous system

Diabetic ketoalkalosis after steroid pulse therapy in a patient with pancreas transplant rejection

Diabetic ketoacidosis [DKA] is characterized by excessive production of organic acids leading to a low blood pH. Rarely, because of other complicating factors blood pH may be in the alkalemic range and the term diabetic ketoalkalosis has been coined to describe this condition. So far, less than 30 such cases have been reported in the literature. We report a 34-year-old woman who received methylprednisolone pulse therapy for the treatment of pancreas transplant rejection. Thereafter, she developed vomiting and abdominal pain. Her laboratory data showed high blood sugar, hypokalemia, alkalemic pH, elevated plasma anion gap, and significant ketonemia. She responded well to the treatment of DKA. It was concluded that an alkalemic pH does not rule out the presence of ongoing DKA. In suspected cases, changes in plasma anion gap and bicarbonate and the presence of ketonemia should be noted

Infection by Cag A positive strains of Helicobacter pylori is associated with autoimmune thyroid disease in Iranian patients

Infectious agents have been suspected as a triggering factor for development of autoimmune thyroid disease [ATD]. Some reports from Western countries have suggested association between Helicobacter pylori [HP] infection and ATD. To investigate the association of ATD with Cag A seropositivity in a population with high rate and early age of onset of HP infection. IgG anti HP and anti Cag A antibodies were measured in 88 patients with ATD and compared with results of 112 healthy individuals. The rate of infection with HP was not significantly different in patient and control groups, but there was significant association between ATD and infection with Cag A strains [p<0.005]. This association was significant for both hypothyroidism [p<0.005] and Graves' disease [p<0.02]. Cag A antibody level correlated with titers of thyroid auto antibodies [p<0.001]. In a population with high rate and early age of onset of HP infection, only infection with Cag A positive strains is associated with ATD, and this may be due to immune cross reactivity

[Comparison of serum leptin and thyroid hormones levels in obese and non-obese women]

Many factors are known to be involved in a number of human pathologies of obesity including serum leptin and thyroid hormones levels. The purpose of this study was to compare the serum levels of leptin and thyroid hormones in obese and non-obese women, in Shiraz-Iran during 2006. In this case- control study, 35 women with BMI?30 Kg/m2 recruited as an obese group [Case group] and 35 women with healthy BMI [BMI<25 Kg/m2] were selected as a control group. General information data were gathered from each sample using questionnaires and face-to-face interviews. Body weight, height, waist and hip circumferences were measured and BMI, WHR and percent of body fat [%TBF] were calculated for each subject. Venous blood samples were drawn from subjects and serum was separated to determine the concentrations of serum leptin and thyroid hormones [T4, T3 and TSH] levels. Mean serum concentration of leptin was significantly higher in obese group than control group [p<0.001]. Serum leptin levels positively correlated to anthropometric indices [BMI, WHR,%TBF]. No significant difference was observed between obese and non-obese groups in serum thyroid hormones concentration. Serum leptin levels positively related to serum T3 levels [P<0.05]. This study indicated that obese women had higher leptin levels compared to non-obese. The interaction between thyroid hormone in particular T3 and leptin can be one of the reason for increasing the serum leptin level among obse women

[Plasma zinc concentration in type 2 diabetic patients and control group in Shiraz city, 2007]

The relationship between diabetes and serum insulin and Zinc [Zn] levels is complex with no clear cause and effect relationships. Since Zn plays a clear role in the synthesis, storage and secretion of insulin as well as conformational integrity of insulin in the hexametric form, the decreased Zn, which affects the ability of the islet cell to produce and secrete insulin, might then compound the problem, particularly in type 2 diabetes. The aim of this study was to determine the changes of plasma Zn in patients with type 2 diabetes mellitus and healthy control in Shiraz city. As a case-control study, we determined the serum Zn levels by atomic absorption spectrophotometer, blood HbA1c levels with columnar chromatographic method and Glucose, by enzymatic colorimetric method in auto analyzer. Data are reported as the Mean +/- SD and P<0.05 was considered as statistically significant. Results of this study revealed that levels of Zn in serum of diabetic patients is lower than in the healthy control in Shiraz city [P<0.05]. With respect to the result of this study, dietary educations about consuming enriched Zn foods such as sea foods and corn in diabetic patients is necessitated

Ketoacidosis as the primary manifestation of acromegaly

Although diabetes mellitus is common in acromegaly, diabetic ketoacidosis [DKA] is rarely reported in this disease. Herein, we reported on a 41-year-old man with acromegaly whose first presentation was DKA. After treatment of acromegaly, his diabetes subsided. We concluded that, even in nondiabetic individuals, a high level of growth hormone can rarely cause DKA

[ incidence of chronic diabetic complications during a 12 years period in patients referring to clinics of Shiraz University of Medical Sciences]

Background: chronic complications of diabetes causes substantial mortality and morbidity. The incidence and rate of progression of these complications depends on ethnic factors. The aim of this study was to investigate the incidence of late complications of diabetes and its relation to blood glucose control in a group of diabetic patients from South of Iran

Methods: in this retrospective study, medical records of all diabetic patients who were followed regularly during a 12 year period at outpatient clinics of Shiraz University of Medical Sciences were investigated. Information regarding age, sex, type of diabetes, duration of disease, mean fasting and postprandial blood sugar, complications [eye, kidneys, peripheral nerves, foot, cardiovascular, cerebrovascular], and timing of complications with regard to duration of disease were collected

Results: the study population included 392 patients [205 males and 186 females], 300 patients had type 2 and 92 had type 1 diabetes. The mean age at diagnosis was 20.4+/-12.8 years for type 1 and 47.5+/-10.4 years for type 2 patients. 95% of patients developed at least one chronic complication during the follow-up period. The incidence rates of eye, renal and peripheral nerve complications were 51.5, 44.7, and 68.8 percent respectively. Diabetic foot problems occurred in 16.8 percent of cases and it led to amputation in 8.4 percent [33 cases] of patients. The incidence rates of cardiovascular and cerebrovascular complications were 49.7 and 15.3 percent respectively. The development of eye, renal, and peripheral nerve complications was related to blood sugar control

Conclusion: our diabetic patients developed chronic complications early and at a higher than expected rates. Future studies and more emphasis on prevention methods are recommended

[Investigation of relation between basal and stimulated levels of growth hormone and proteinuria in type 2 diabetic patients]

Background: previous in vitro and animal studies have supported a role for growth hormone in development of diabetic nephropathy. The purpose of this study was to investigate the relation between basal and stimulated growth hormone and proteinuria in type 2 diabetic patients

Methods: 21 type 2 diabetic patients with macroalbuminuria were selected. Fasting insulin, basal and levodopa stimulated growth hormone levels were measured. The control group consisted of 21 type 2 diabetic patients with 24 hr urine protein of less than 50 mg. The two groups were matched according to sex, age, duration of diabetes, body mass index, creatinine clearance, fasting blood sugar, glycosylated hemoglobin, and blood pressure

Results: the patients with macroalbuminuria had higher basal growth hormone [3.1+/-2.6 vs 1.25 +/- 0.7 ng/ml, P = 0.024]. Stimulated growth hormone and fasting insulin levels were not significantly different

Conclusion: there is direct relation between basal growth hormone and development of diabetic nephropathy and this relation suggests a role for growth hormone in human diabetic nephropathy