Parathyroid adenoma and hypercalcemic crisis a rare cause of acute pancreatitis

The relationship between primary hyperparathyroidism and pancreatitis has yet to be established firmly. We present a patient with acute pancreatitis and a hypercalcemic crisis induced by a parathyroid adenoma. A 72-year-old woman presented with lethargy and a constant pain in the epigastric region. She had a medical history of diabetes mellitus, hypertension, nephrolithiasis, and ischemic heart disease. Blood examination revealed leukocytosis and high serum amylase and lipase levels. Ultrasound exam confirmed the diagnosis of acute pancreatitis with a normal biliary tract and no gallstones. On further evaluation severe hypercalcemia [24 mg/dL] was detected, which was treated with 0.9% sodium chloride solution and calcitonin. The acute pancreatitis and its symptoms resolved after 3 days. Ultrasound exam and technetium 99m sestamibi scan showed a parathyroid lesion. Ultimately the patient underwent right thyroid lobectomy because of refractory hypercalcemia. The pathology report was indicative of a parathyroid adenoma. Subsequently, the parathyroid gland was resected with normalization of calcium, parathyroid hormone, and amylase levels and the patient was discharged in good condition 7 days after surgery. Apart from the acute supportive management, common to all cases of acute pancreatitis, definite management must be tailored to the specific cause. Hypercalcemia during the course of pancreatitis must prompt an investigation for primary hyperparathyroidism with early surgical intervention if a parathyroid source is detected

Insulin resistance and endocrine-metabolic abnormalities in polycystic ovarian syndrome: comparison between obese and non-obese PCOS patients

Background: Insulin resistance has an important role in pathophysiology of polycystic ovarian syndrome [PCOS]. Yet there are certain controversies regarding the presence of insulin resistance in non-obese patients

Objective: The aim was to compare the insulin resistance and various endocrine and metabolic abnormalities in obese and non-obese PCOS women

Materials and Methods: In this cross-sectional study which was performed from 2007-2010, 115 PCOS patients, aged 16-45 years were enrolled. Seventy patients were obese [BMI >/=25] and 45 patients were non-obese [BMI <25]. Presence of insulin resistance and endocrine-metabolic abnormalities were compared between two groups. Collected data were analyzed with SPSS version 16.0 and p<0.05 was considered as statistically significant

Results: There was no significant difference in presence of insulin resistance [HOMA-IR >2.3] between two groups [p=0.357]. Waist circumference [p<0.001], waist/hip ratio [p<0.001], systolic [p<0.001] and diastolic [p<0.001] blood pressures, fasting blood sugar [p=0.003] and insulin [p=0.011], HOMA-IR [p=0.004], total cholesterol [p=0.001] and triglyceride [p<0.001] were all significantly higher in obese PCOS patients. There was no significant difference in total testosterone [p=0.634] and androstenedione [p=0.736] between groups whereas Dehydroepiandrotendione sulfate [DHEAS] was significantly higher in non-obese PCOS women [p=0.018]. There was no case of fatty liver and metabolic syndrome in non-obese patients, whereas they were seen in 31.3% and 39.4% of obese PCOS women, respectively

Conclusion: Our study showed that metabolic abnormalities are more prevalent in obese PCOS women, but adrenal axis activity that is reflected in higher levels of DHEAS was more commonly pronounced in our non-obese PCOS patients

Serum triiodothyronine level as an indicator of inflammation in patients undergoing dialysis

It has been shown that inflammation affects thyroid function. In patients with end-stage renal disease, low plasma triiodothyronine [T3] may be an unsuspected expression of the inflammatory state of these patients. This study evaluated the correlation between T3 and high-sensitivity C-reactive protein [HSCRP] levels in patients on peritoneal dialysis [PD] and hemodialysis. This is a cross-sectional study aiming at the correlation between T3 and HSCRP levels among 30 patients on PD, 30 patients on hemodialysis, and 20 healthy individuals. Serum levels of HSCRP, T3, thyroxine [T4], thyroid stimulating hormone, T3 resin uptake, and free T3 index [FT3I] and free T4 index [FT4I] were compared between the three groups. There were no significant differences between hemodialysis and PD patients in respect to T3, T4, FT3I, and FT4I. In PD and hemodialysis patients, T3 and FT3I were lower than in controls [P < .001], but there was no significant difference between PD and hemodialysis patients. T3 resin uptake and thyroid stimulating hormone differed significantly between PD and hemodialysis patients. There was a significant inverse correlation between HSCRP and T3 and FT3I among hemodialysis patients [P = .04]; however, there was no such correlations in PD patients. The relationship between T3 and HSCRP suggests that inflammation might be involved in the low T3 syndrome in hemodialysis patients, but we did not find a significant correlation between T3 and HSCRP levels in patients on peritoneal dialysis

[Evaluation of an ultrasonic insulin delivery system in hyperglycemic rabbits]

Sonophoresis has been assessed as a novel approach to crate skin permeability and drug delivery using low frequencies of ultrasound waves in the range of 20 kHz to 3 MHz. In this study, a system including seven 40 kHZ piezoelectric transducers and an insulin chamber designed by the Medical Physics Research Center has been evaluated on hyperglycemic rabbits. Thirty five rabbits became hyperglycemic through Alloxan monophydrate injection and were divided into five groups. The rabbits were treated in two main groups [with insulin and ultrasound radiation in two radiation periods], one main control group and two further control groups [one group with ultrasound radiation with longer radiation period in absence of insulin and presence of normal saline; and the other group without ultrasound radiation in presence of insulin]. By filling the system chamber with insulin and placing in on the skin of the abdomen and activating the piezoelectric transducers, blood samples were drawn from the animals before ultrasound irradiation and after it is specified intervals. The glucose level was measured using a glucometer and the serum insulin level was determined using a radioimmunoassay method. Maximum decrease in glucose level was recorded for a 20 minute irradiation in a 180 minute period, and the highest increase in insulin level was recorded for the 10 minute radiation group in a 60 minute period. Because rapid uptake and reaching a peak in a short time and its swift decrease make a good scheme for controlling glucose level after meals, the 10 minute radiation seems to be more suitable. Also, it is predicted that irradiation time in the interval between food consumption and use of the instrument is critical