effect of bisphosphonate on prevention of glucocorticoid-induced osteoporosis

Glucocorticoid therapy can induce osteoporosis. Bone mineral density [BMD] measurement has been used to assess the risk of fracture in these patients. The most important mechanism is diminished bone formation mainly at the sites with trabecular bone. The objective of this study is to evaluate the effect of alendronate on prevention of glucocorticoid-induced osteoporosis. During 18 months, in a prospective clinical trial, 72 patients with autoimmune disease were randomly divided into 2 equal groups. Group 1 [n=36] was treated with oral vitamin-D, 50000 IU twice weekly and calcium, 500 mg twice daily. Group 2 [n=36] was treated with oral vitamin-D, 50000 IU twice weekly, calcium, 500 mg twice daily, and alendronate, 10 mg per day. The patients were followed clinically, undergoing densitometry and X-ray of the spine and hip area for 18 months. Change of BMD in the lumbar spine after 18 months of therapy was -1/67% and +2.4% in groups 1 and 2, respectively. Change in femoral neck BMD was -2.1% in group 1 and +1.8% in group 2. The administration of alendronate plus vitamin D and calcium was more effective in preventing bone loss due to glucocorticoid-induced osteoporosis than vitamin-D and calcium alone

Determination of association of macroprolactinemia with macroprolactinoma using poly ethylene glycol precipitation test

Prolactin in human serum exists in 3 different molecular forms, i. e, monomeric, big and at times big big [Macroprolactin]. Macroprolactin is a complex of prolactin and IgG and may account for a significant proportion of idiopathic hyperprolactinemia. Its biological activity is considered low or absent, usually idiopathic and poorly symptomatic. Since its association with a prolactin producing macroadenoma is poorly documented, we performed this study on the patients with Macroprolactinoma for the presence of macroprolactinaemia through its identification with Poly Ethylene Glycol. The study aims is to comparing the clinical [galactorrhea and oligomenorrhea] findings in patients with macroprolactinaemia and those without it. In this study 10 patients with Macroprolactinoma [macroadenoma in MRI of hypophysis, prolactin level more than l00gIL and clinical and radiological response of tumor to dopamionergic agents after treatment] were evaluated for the presence of Macroprolactinemia, using Poly Ethylene Glycol precipitation test. Doing so, one patient infected by Macroprolactinemia was detected. At the time of reception, the clinical findings in all 10 patients were classic and similar and in the follow ups, both clinical and radiological changes were the same. Our Results suggest that Macroprolactinoma may be associated with Macroprolactinemia

[ study of 450 cases of thyroid nodules and evaluation of diagnostic accuracy of fine needle aspiration]

Thyroid nodule is a common disease and although usually benign, malignancy should always be ruled out. Fine needle aspiration [FNA] is the diagnostic modality of choice in approach to thyroid nodules. The main aim of this study is assessment of characteristics of thyroid nodules, risk of malignancy and accuracy rate of FNA in patients in Mashhad. We studied 450 patients with thyroid nodules during 2003 through 2007 with physical examination, radioisotope scan and FNA. Thyroid surgery performed in 64 patients and histopathology results compared with FNA cytological results. The patients were 383 women [85.1%] and 67women [14.9%] with mean age of 39.8 +/- 12.7 years. The mean length of largest diameter of nodules was 3.97 +/- 1.8 and the smallest one was 3.26 +/- 1.7 [cm]. 59% of nodules were located on right lobe, 36% of them on left lobe and 5% on isthmus of thyroid. 24.4% of nodules were cystic. 30.3% of thyroid nodules were functional or hot and 69.7% of them were cold in thyroid radioisotope scan. In evaluation of cytological findings of nodules aspirate, 288 [68.6%] were benign, 22[5.2%] were malignant, 92 [21.9%] were follicular lesions, 13[3%] were suspicious and 5[%1.2] were non diagnostic. Comparison of cytopathologic results before and after surgery showed that FNA in operated patients yielded a sensitivity of 82. 3%, specificity of 78. 9%, a positive predictive value of 77.7%, negative predictive value of 83. 3% and accuracy of 80.5%

[Diabetic ketoacidosis in a patient with acromegaly, a case report]

Although impaired glucose tolerance affects 36% and overt diabetes mellitus can be seen in 30% of cases with acromegaly, diabetic ketoacidosis is rarely reported in patients with this disease. We present an unusual complication of acromegaly: a 22 year old woman with amenorrhea [6 month age] and blurred vision of left eye [4 month ago] referred to Ghaem neurology clinic in Mashhad. With a growth hormone [GH] level of = 100 ng/ml, Insulin like growth Factor-1 [IGF-1] =1560 ng/ ml and pituitary macro adenoma in magnetic resonance imaging [MRI], she was candidated for surgery. A few hours before surgery she had dyspnea, loss of consciousness, fever and with blood sugar [BS] =500 mg/ml, Hco3 = 2.4, PH=7.06 and keton in urine. Diabetic ketoacidosis was diagnosed. The patient was treated with high dose of insulin [500 IU/day] and hydration. After octerotide administration the need for insulin decreased and after pituitary adenectomy, there was no need for insulin therapy and the patient was discharged on metformin [one tablet per day]

[Effect of hyperthyroidism on bone mineral density in premenopausal women]

Hyperthyroidism is a state of high bone turnover, but there is controversy about its effects on bone mineral density. It is more common in females [F: M ratio 10:1]. Since post-menopausal women are potentially at risk for osteoporosis because of aging and estrogen deficiency and because hyperthyroidism is more common in females, this study was done to determine the effects of hyperthyroidism on bone mineral density [BMD] in premenopausal thyrotoxic women. In this case- control study 50 women with untreated hyperthyroidism [age- range 20-50 yr] from outpatient endocrine clinics in the years 2004 - 2005 were selected. Patients who used drugs or had diseases that affect bone mineral density were excluded. After history taking and physical examination, thyroid function tests, PTH, phosphorus, calcium, alkalin phosphatase, fasting plasma glucose and creatinine were measured and then bone densitometry by LUNAR [DPX-IQ] device was performed. One hundred and ten age- and weight - matched healthy women from participants in Iranian Multicenter Osteoporosis Study [IMOS] were selected as controls. SPSS version 11.5 was used for data analysis and P value less than 0.05 cosidered as significant. Mean of age, height and weight was similar in patients and controls. Forty seven cases [94%] had Graves' disease and 3 cases [6%] had toxic solitary adenoma. Mean duration of disease before diagnosis was 6.02 +/- 4.38 months. There was no significant difference in mean of bone mineral density in vertebral column [p=0.83] and also in femural neck [p=0.74] between patients and controls. There was no correlation between bone mineral density in vertebral column and also in femural neck with serum levels of T4, T3, TSH and FT4I. There was no correlation between bone mineral density and duration of disease before diagnosis and also between bone mineral density and age. Hyperthyroidism is a known state of high bone turnover, but in hyperthyroid premenopausal women with disease of short duration and without other risk factors of low bone mass, bone densitometry could not be recommended as a required routine measurement

[Thyroid autoantibodies in chronic urticaria]

Osteoporosis is the most common metabolic bone disease with significant morbidity and mortality. This study is a part of national study of osteoporosis in Iran. We studied the prevalence of osteoporosis and osteopenia in Mashhad and correlation of bone mineral density with age, height, weight and BMI. Also, we studied correlation between bone mineral densities in different skeletal regions. We also determine prevalence of low bone mass in Mashhadian women based on Mashhadian women reference population. 1003 persons from Mashhad citizens [631 women and 372 men], aged between 20-79 years were selected by random cluster sampling from 2000 through 2003. Those who had known diseases or used medications affecting bone mineral density were excluded based on history and physical examination. We used LUNAR [DPX-IQ] device for densitometry and WHO criteria for interpretation. SPSS [11.5] used for analysis of data and P value less than 0.05 considered as significant. Mean of age, height, weight and BMI was 42.02 +/- 12.77 years, 157.66 +/- 7.16 centimeter, and 69.11 +/- 12.24 kilogram and 27.83 +/- 4.8 kg/m[2], respectively. Mean of age in men and women was similar but mean of height, weight and BMI was higher in men and difference between men and women in height, weight and BMI was significant. There was a positive, significant correlation between bone mineral density in vertebral column and femoral neck regions and correlation coefficient [r] between them was 0.7. There was a positive significant correlation between bone mineral density and following parameters: height, weight and BMI. Correlation between BMD and age was negative and significant. In women prevalence of low bone mass with US/European reference population was higher than with Mashhadian reference population. These findings support the importance of regional reference population for better interpretation of BMD results. Finally, prevalence of osteopenia and osteoporosis in Mashhad was 46.8% and 12.6%, respectively. Osteoporosis is a health problem in Mashhad. So we encourage preventive measures such as modification of nutrition, adequate Calcium and Vitamin D intake and life style modification. We emphasize on using of regional reference population for interpretation of densitometry results. Because of correlation coefficient [r] of bone mineral density in different sites of skeleton is 0.7; we recommend that bone densitometry should be done both in vertebral column and femoral regions

[Study of 52 cases of osteomalacia]

Osteomalacia is a disorder of bone mineralization secondary to Vitamin D deficiency. Clinical presentation and related parameters in 52 cases and their treatment discussed. This is a discriptive study of patients with osteomalacia which is performed at the departments of rheumatology and endocrines, Mashhad Medical Sciences University. Patients were diagnosed according to clinical presentation, radiological findings, blood tests, and bone biopsy if necessary. Patients were treated either orally with 0/25 micro g Calcitriol or as IM injection of vitamin-D [300000 units]. For the prevention of recurrence, injection was repeated every 6-12 months. Older patients were also recommended to expose themselves to ultraviolet radiation 2-3 times every week. All findings were recorded and later processed using statistical tests. From the 52 patients, 47 were women [90%] and 5 were men [10%]. Clinical presentations were back pain, fatigue and bone tenderness especially in lumbar area, osteopenic symptoms, and gait disorder. 44 patients had Looser's zone which is diagnostic of osteomalacia Based on calculated statistics, a significant reduction in serum Calcium [P< 0.005], phosphorus [P< 0.002], and increased Alkaline phosphatase [P< 0.002] and parathyroid hormone [P< 0.004] was observed. Most of our patients were admitted during winter and early sprin. The disease was more common in young women [age 10-19] than women older than 30 years of age [P< 0.004]. Patients with Vitamin D deficiency were alleviated by Vitamin D treatment. Osteomalacia exists as a silent disease in north east of Iran. The main cause of this is considered to be vitamin D deficiency. Therefore, preventive measures are to be taken

[Evaluation of hypogonadism with Major Thalassemia]

Although new treatments have prolonged survival and improved quality of life in the patients with major Thalassemia, endocrine complications especially hypogonadotropic hypogonaidsm still occur. The objective of this study is to determine prevalence and risk factors of hypogonaidsm in 47 patients with major Thalassemia. 47 patients with Thalassemia major aged 14 years and older were studied. Those who had any other problems were omitted from this study. Serum level of LH, FSH, Testestrone, Estradiol were measured and correlation with parameters including duration of transfusion, duration and dose of Desferal treatment, Ferretin level and pertinent clinical findings was evaluated and compared in groups of patients with and without hypogonaidsm. Short stature and underweight was seen in 68/1% of patients. Mean hight was 151 +/- 10.2 and mean of weight was 43.5 +/- 8.4. Hypogonadotropic hypogonaidsm was seen in 63/8 %. The prevalence of hypogonaidsm was more in males than females [p= 0.025]. No significant correlation was found between duration of transfusion, duration and dose of Desferal treatment and Ferretin level with hypogonaidsm. Endocrin complications of Major Thalassemia is frequent and factors other than iron overload including zinc deficiency or genetic differences may influence susceptibility to hypogonaidsm

[Anemia in patients with hypothyroidism]

In hypothyroidism reduction of oxygen demand and supply can reduce the synthesis of erythropoietin and cause anemia. Autoimmune mechanisms causing hypothyroidism can also cause vitamin B12 deficiency and related anemias. Furthermore absorption of iron and other elements are disturbed and further accelerates anemia. Menorrhagia, is another cause of iron loss. Changes in WBC are not significant and platelet function may change which is not clinically important. We studied 30 new cases of hypothyroidism. Control group [32 person] was chosen among individuals having simple goiter and normal thyroid function tests. We compared hematological parameters in patients and control group. Comparison was made between patients with severe [TSH>70] and mild [TSH<70] hypothyroidism and relationship between severity and duration of hypothyroidism with these parameters. 1-anemia was found in 56.7% of patients [10% macrocytic, 16.7% normochrome normocytic and 30% hypochromic microcytic]. In control group 40.625% were anemic [6.25% macrocytic, 3.125% normochromic normocytic and 31.25% hypochromic microcytic].2- Hemoglobin, hematocrit and number of RBCs had statistically significant difference between patients and control group. 3- MCH, MCHC and MCV had no statistically significant difference between patients and control group. 4- There was no significant difference in the number of WBC and platelets between patients and control group. 5- No relationship was found between blood parameters and duration of the disease. 6- There was no correlation between severity of disease and hemoglobin and hematocrit values but MCHC was significantly lower in patients with severe hypothyroidism. Erythroid lineage showed the most important changes in hypothyroidism. All 3 types of anemia were found. Hemoglobin, hematocrit, and number of RBC showed marked decrease in patients compared with controls. White blood cells and platelets had no changes in hypothyroid patients

Relation of hyperthyroidism with urine volume and specific gravity

Introduction: Polyuria and nocturia may be the first clinical manifestation of hyperthyroidism. Most of the reported studies about renal function in Hyperthyroidism are performed in animals

Material and Methods: In this study we have evaluated 12-hour urine volume and specific gravity of morning urine in 50 new hyperthyroid patients and we have compared the results with similar study in 34 normal persons from their families in the same age group [control]

Results: We found significant increase in urine volume [p<0.001] and decrease in specific gravity in patients with hyperthyroidism [p<0.001]. There was no significant correlation between urine volume and specific gravity with plasma concentration of thyroid hormones

Conclusion: There is increased urine volume and decreased specific gravity. This should be considered in differential diagnosis of diabetes insidious

Report of two cases of idiopathic precocious puberty in family

Precocious Puberty is the result of premature activation of LHRH neuronal function due to structural damage of the neuroendocrine brain systems, or generalized activation of the neuronal glial mechanisms. In this article we present two sisters with idiopathic precocious puberty, one of them recived medication and the other under follow up

[Osteoporosis; diagnosis and treatment]

Osteoporosis is the most common metabolic disorder which is increasing all over the world. It is associated with age and sex, therefore the highest prevalence of the disease is seen in post menopausal women. Increase in life expectancy and number of old people will cause significant rise in the prevalence of osteoporosis in future. In our country according to Tehran survey, prevalence of osteoporosis in 60-69 yr. women in spine and hip region is 52.4% and 5.9% and in the same age range in men is 9.4% and 3.1%, respectively. Osteoporosis is thus a problem of the world in second half of the present century specially in Asia, so prevention, diagnosis and treatment of disease is imperative for health improvement. One of the most important complications of osteoporosis is fracture of spine and femur neck which increases mortality and morbidity. More than 90% of hip and femur neck fractures occur in 50 yr old or above, and 80% of them are women. Osteoporotic fractures incur high cost for the patient and community. Major risk factors of osteoporosis are: age, low bone density, history of fragility fracture and history of familial osteoporosis. Today the diagnosis of osteoporosis is based on bone density measurement. Osteoporosis is a mulitfactorial disorder and its prevention and treatment are difficult. Most of the treatments available for treatment of osteoporosis recent have antiresorptive effects which reduce bone distruction. Some of these drugs also decrease pathologic fractures. New drugs increasing bone formation are coming up. However in all kinds of treatments existance of sufficient calcium and vitamin D reserve is necessary for efficacy of medications that could be provided by nutrition or supplements

role of radionuclide scanning, songraphy and fine needle aspiration cytology in palpable throid nodule diagnosis

One hundred consecutive patients with palpable thyroid nodules were enrolled in this study at Mashhad University of Medical Sciences. There were 19 males and 81 females. Age range was between 7-66 years. Most of the lesions were located in the right lobe of thyroid. 93 thyroids had a single nodule on physical examination. 99 patients had sonography. 74 of them had single and 18 had multiple nodules and one showed no nodule. In 80 cases thyroid scan was performed. In 6 patients despite a palpable thyroid nodule, scan was considered normal. 69 patients had cold nodule which was cystic in 24 cases. Fine needle aspiration [FNA] and cytology were done in all of the patients. In 4 patients FNA was considered malignant and in 10 patients it was suspicious to malignancy. 9 patients had surgery and 5 had cancer. According to the present study, FNA is the most accurate tool to select the malignant nodules and to decide on the most suitable surgical intervention

Psoriasis and hypoparathyroidism

A 50- year-old white woman was admitted because of extensive eruptive skin and mucosal lesions and nail involvement associated with fatigue and pallor of two weeks duration. She had a history of thyroidectomy and hypocalcemic crisis. Generalized pustular psoriasis [GPP] was confirmed by biopsy. She also had nail hyperkeratosis associated with paronychia, palpable axillary lymphadenopathy, positive Chvostek's sign, bilateral cataracts and fever. 48 hours after calcium infusion her fever and other symptoms improved. Skin, mucosal and nail lesions also gradually subsided. We concluded that serum calcium should be evaluated in all cases of GPP

Papillary thyroid carcinoma in Mashhad

Thyroid cancer is the most common endocrine malignancy. This study surveys the pathologic characteristics of thyroid cancer in Mashhad and study of papillary carcinoma in more detail. In this retrospective study, 108 out of 197 cases of thyroid cancer were papillary in type [55%], with female to male ratio of 1.91 which is lower than current reports. The age at the time of diagnosis ranged from five to 78. Mean age for females was 36 and for males was 38.45 years. We hope that this study will stimulate physicians to reevaluate their thoughts about thyroid cancer and try to recognize such patients at an earlier stage in the course of their disease

Hydatid Cyst of the thyroid

Thyroid is a rare localization for hydatid cyst. Although the incidence of hydatid cyst is high in this geographic area, we have had only two cases of thyroid involvement in the last 10 years in Ghaem medical center in Mashhad

Iodine deficiency disorders in Neishabour

Iodine deficiency has been considered in Iran since 20 years ago and has been acknowledged recently. We studied iodine deficiency disorders in 1618 Neishabourian students. 60% of children had palpable and 2.5% had visible goiters. Height and weight of these children were lower than International and Tehranian children but higher than Isfahanian children. Hormone studies showed increased T4, decreased T3RU, increased T3 and T3/T4 ratio which are indicators of iodine deficiency