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The typical manifestations of primary aldosteronism (PA) are hypertension with or without hypokalemia, high aldosterone, and low renal level. However, PA with normal blood pressure is rare in clinical practice. This article reported the diagnosis and treatment of a patient with subclinical PA, admitted for "adrenal accidental tumor" with normal blood pressure and serum potassium. We summarized and analyzed the clinical characteristics and treatment strategies, in order to provide some reference for clinicians.
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To investigate the renal venous and spermatic venous sampling in assisting the diagnosis of reninoma. The case of reninoma was retrospectively reviewed together with the literature review of reninoma diagnosed with renal venous and spermatic venous sampling. A young patient with hypertension and headache was admitted to our hospital. Laboratory test showed high plasma renin concentration (>500 mIU/L), and enhanced computed tomography(CT) in the upper abdomen showed a mass in left inferior renal pole. The concentration of renin in the left spermatic vein was significantly higher than that in renal veins and branches, and peripheral vein, which was considered the left reninoma possibility. The left renal mass was resected surgically and pathologic exam revealed reninoma. The renin level and the blood pressure recoveried normal after operation.The literature reported that the positive rate of renal vein segmental blood collection for locating renin tumor was only 8.3%-64%. The possible reason was that reninoma usually located in the renal cortex, and the tumor blood might be collected by renal capsule vein instead of renal vein. In fact, the renal capsule vein intersects with the lateral division of the spermatic vein, but there have been no reports about the localization of reninoma by spermatic vein sampling. Since renin secreted by reninoma may go into the spermatic vein through renal capsule vein, it should be noted that spermatic venous blood should be collected simultaneously in renal vein sampling when locating reninoma.
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Objective:To explore the proportion of obstructive sleep apnea (OSA) in primary aldosteronism (PA) in Chinese population and compare the clinical characteristics between PA patients with OSA and those without.Methods:A total of 96 patients diagnosed with PA from September 2015 to November 2018 were recruited in this study. OSA was screened by cardio-respiratory polygraphy. According to the apnea hypopnea index (AHI), the patients were divided into PA with OSA group (AHI ≥5 times) and PA without OSA group (AHI<5 times).Results:Among all patients (96), 69 (71.9%) were with OSA, among them 22 patients (22.9%) were with mild OSA, 17 patients (17.7%) were with moderate OSA and 30 patients (31.3%) were with severe OSA. Compared with the patients without OSA, the patients with OSA were elder, and had higher levels of body mass index (BMI), waist circumference (WC), hip circumference (HC), creatinine (CR) and glycosylated haemoglobin (HbA1c) ( P<0.05), but lower concentrations of plasma aldosterone (PAC), supine aldosterone renin concentration ratio(ARR) and the PAC after the diagnosis test ( P<0.05). Spearman correlation analyses showed that BMI, WC, HC, CR and HbA1c were positively correlated with AHI ( P<0.05), while high-density lipoproteincholesterol (HDL-C), supine-PAC and saline infusion test(SIT)-post PAC were negatively correlated with AHI ( P<0.05). Conclusions:The proportion of OSA in PA patients is relatively high (71.9%). Metabolic abnormalities are more common in PA patients with OSA, indicating that screening for OSA should be carried out routinely in PA patients.
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A total of 108 subjects were enrolled in this study, including 21 healthy subjects(control group), 34 non-obese patients with polycystic ovary syndrome [PCOS1 group, body mass index(BMI)<25 kg/m2], 32 obese patients with PCOS(PCOS2 group, BMI≥25 kg/m2), and 21 simple obese patients whose age and BMI matched with PCOS2(OB group). BMI, waist-hip ratio(WHR), fasting plasma glucose(FPG), postprandial 2h plasma glucose(2hPG), HbA1C, fasting insulin(FINS), postprandial 2h insulin(2hINS), sex hormones, and lipid parameters were determined. The status of insulin resistance was assessed by homeostasis model assessment for insulin resistant index(HOMA-IR)and insulin sensitivity index(ISI). Levels of plasma galectin-3 and interleukin-6(IL-6)were detected by ELISA. The results showed that the plasma level of galectin-3 was significantly higher in PCOS group than those in control and OB groups(all P<0.05). Moreover, the level of galectin-3 was also higher in OB group compared with control group, while galectin-3 level in PCOS2 group was higher than that in PCOS1 group(all P<0.05). After adjusted by age, BMI, and WHR, correlation analysis showed that the level of galectin-3 was positively correlated with FPG, 2hPG, FINS, HOMA-IR, highly-sensitive C-reactive protein, and IL-6, while negatively correlated with ISI. A multiple linear regression analysis revealed that the plasma galectin-3 concentration was independently associated with IL-6, HOMA-IR, and BMI(all P<0.05). These data suggest that plasma galectin-3 is closely associated with glucose metabolism, chronic inflammation, and insulin resistance, which may be involved in the pathogenesis of PCOS. (Chin J Endocrinol Metab, 2018, 34: 578-582)
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Objective To investigate the effects of high glucose and glucose fluctuation on the apoptosis of MC3T3-E1 osteoblasts. Methods MC3T3-E1 osteoblasts cultured in vitro were divided into control, N-acetyl-L-cysteine ( NAC) group, high glucose ( HG), HG + NAC, glucose fluctuation ( GF), and GF + NAC groups. Cell proliferation was examined by CCK-8 analysis. The apoptosis rates of cells in different groups were measured by flow cytometry, which was stained with Annexin V-FITC/ PI. The protein expressions of Bax and Bcl-2 were detected by Western blot. DCFH-DA probe was used to measure reactive oxygen species (ROS) level. Results Compared with control group, the proliferation rates of cells in HG and GF groups were significantly declined(P<0. 01), especially more obviously in GF group(P<0. 05). The apoptosis rates in HG and GF groups were higher than that in control group(P<0. 05 or P<0. 01), being higher in GF group than in HG group(P<0. 01). The protein expressions of Bcl-2 were decreased in HG and GF groups compared with control group (P<0. 01) while Bax expression was raised (P<0. 05 or P<0. 01). Compared with HG group, Bcl-2 expression was lower and Bax expression was higher in GF group (P<0. 05). HG and GF promoted the production of ROS, especially the latter. NAC suppressed the production of ROS, increased Bcl-2 expression, while decreased Bax expression, and ameliorated the elevated cell apoptosis rate. Conclusion Glucose fluctuation aggravates high glucose-induced oxidative stress, which contributes to the declined proliferation and increased apoptosis of MC3T3-E1 osteoblasts.
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Objective To investigate the effects of miR-335-5p on the proliferation and apoptosis of osteoblasts which were exposed to high glucose condition, and explore its possible molecular mechanisms. Methods MC3T3-E1 osteoblasts were divided into four groups:control group(5. 5 mmol/L glucose), high glucose group(HG group, 22. 0 mmol/L glucose), agomir-335-5p group(transfected with agomir-335-5p and exposed to 22. 0 mmol/L glucose) , and agomir negative control group( agomir NC group, transfected with agomir negative control and exposed to 22. 0 mmol/L glucose), cultured for 7 days. Cell proliferaton, cell apoptosis, expressions of miR-335-5p and dickkopfhomolog1(DKK1)mRNA,proteinlevelsofDKK1andcysteinylaspartate-specificproteinase-3(caspase-3) were detected using MTT, flow cytometry, quantitative realtime PCR and western blot, respectively. Results Compared with control group, the expression of miR-335-5p mRNA and cell proliferation in HG group were significantly decreased(P0. 05). The miR-335-5p mRNA expression and cell proliferation in agomir-335-5p group were higher than those in HG group and agomir NC group(P<0. 05). However, Cell apoptosis and the protein levels of DKK1 and caspase-3 in agomir-335-5p group were lower than those in HG group(P<0. 05). Conclusion High glucose inhibits the proliferation and induce the apoptosis of MC3T3-E1 osteoblast through decreasing the expression of miR-335-5p and subsequently increasing the DKK1 expression.
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Objective To test the RET-proto-oncogene in a multiple endocrine neoplasia type 2( MEN2) family for confirming the diagnosis and classification , guiding treatment and prevention , and improving the prog-nosis.Methods There were 2 patients of MEN2 with clinical diagnosis and 1 asymptomatic first-degree relative in the pedigree .PCR and direct gene sequencing of PCR produces were used to scan the entire 21 exons of RET-proto-oncogene in the 3 members of the pedigree and 3 normal controls .Results The 2 patients and 1 asympto-matic first-degree relative in the pedigree all had a mutation of the codon 634 in exon 11.It was a heterozygous missense mutation C634R(TGC → CGC).The 3 normal controls showed no abnormalities .Conclusion The gene test of RET proto-oncogene helps to confirm the diagnosis of the pedigree as MEN 2, which can guide the treatment and help identify one asymptomatic mutation carrier .
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Objective To explore the relationship between the women menopausal period and metabolic syndrome (MS) .Meth-ods The female residents of Chongqing urban areas above 40 years were selected as the investigation group ,all the subjects were performed the questionnaire survey and the physical examination ,at the same time the biochemical indexes were detected .Finally , 1402 women of natural menopause were included in this study .The study subjects were divided into different groups according to the menopausal period of <5 years ,5- <10 years ,10- <15 years and ≥15 years .The Logistic regression analysis was adopted to analyze the relationship between the menopausal period with MS and its components .Results The MS prevalence in this group was 40 .87% ,and the menopausal period of the women with MS was significantly higher than that without MS (P<0 .05) .The MS prevalences of postmenopausal women in the menopause period of <5 years ,5 - <10 years ,10 - <15 years and ≥15 years were 29 .37% ,34 .29% ,45 .30% and 49 .13% respectively (P<0 .05) .After adjustment for age and BMI (except central obesity ) ,the MS risk in the menopausal period of 10- <15 years and was 1 .54 times of that in the menopausal period of <5 years .The Logis-tic regression analysis showed that BMI and menopausal period were the influence factors of MS .Conclusion Post-menopausal women are the high-risk group of MS and the menopausal period is correlated to MS .
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Objective To examine the role of p38MAPK in high glucose-induced apoptosis of osteoblast MC3T3-E1 cell line, and to investigate its effect on the expressions of apoptosis-related molecules including caspase3, bax, and bcl-2. Methods The lentiviral vector containing short hairpin RNA targeting p38MAPK was constructed. The cultured osteoblast MC3T3-E1 cell were divided into 5 groups:normal control group(A group), high glucose group(B group), p38MAPK-shRNA transfection group(C group), signal transduction inhibitor group(D group), and transfection with negative control siRNA group(E group). RT-PCR was used to determine the p38MAPK mRNA expression levels in MC3T3-E1 cells. Flow cytometry(FCM)was employed to detect the cell apoptotic percentage. The protein levels of apoptosis-related molecules p38MAPK, p-p38MAPK, caspase-3, bax, and bcl-2 were assayed by Western blot. Ultrastructural alternation of MC3T3-E1 cell was observed under transmission electron microscopy(TEM). Results The lentiviral vector containing short hairp in RNA targeting p38MAPK was successfully constructed and transfected into MC3T3-E1 cells. RT-PCR result suggested that the siRNA targeting p38MAPK could effectively reduce the p38MAPK mRNA expression level induced by high glucose in MC3T3-E1 cell line. FCM showed siRNA significantly decreased high glucose-induced apoptosis percentage of MC3T3-E1 cells(P＜0.01). Meanwhile, we also found the siRNA significantly attenuated the proteins levels of p38MAPK, p-p38MAPK, caspase-3, and gene bax induced by high glucose in MC3T3-E1 cells, whereas the protein level of gene bcl-2 was enhanced remarkably when compared with high glucose group and negative control siRNA group(P＜0.01, P＜0.05).Conclusion The iRNA targeting p38MAPK suppressed high glucose-induced MC3T3-E1 cell apoptosis via inhibiting the activation of p38MAPK signaling pathway, thereby reducing the expressions levels of p-p38MAPK, caspase-3 and gene bax, and up-regulating the level of gene bcl-2.
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The relationship between oxidative stress and the first-phase of pancreatic β cell insulin secretion in subjects with different statuses of glucose tolerance was explored. Fasting adiponectin, 8-hydroxydeoxyguanosin ( 8-OHdG), malondialdehyde ( MDA ), superoxide dismutase ( SOD ), insulin area under the curve ( AUC ) from 0 to 10 min, and AIR3-5 were measured. The levels of oxidative stress-related markers were elevated, the activities of superoxide dismutase,adiponectin, and first-phase of insulin secretion were reduced with the disease progression. MDA and 8-OHdG were negatively correlated with adiponectin, homeostasis model assessment β cell function index ( HOMA-β ),AUC ,and AIR3-5. SOD was positively correlated with adiponectin, HOMA-β, AUC, AIR3-5. The plasma 8-OHdG and SOD were independently associated with AIR3-5. Oxidative stress exerts a significant effect on the first phase of pancreatic β cell insulin secretion, which may contribute to the pathogenesis of type 2 diabetes.
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Objective To investigate the relationship between angiotensin Ⅱ and pancreatic islet β cell secretion function under different glucose tolerance statuses. Method Forty-two patients with newly diagnosed type 2diabetes mellitus ( DM group), 38 subjects with impaired fasting glucose/impaired glucose tolerance ( IFG/IGTgroup) ,and 40 normal control subjects (NGT group) underwent intravenous glucose tolerance test. Fasting plasma angiotensin Ⅱ ( Ang Ⅱ ) and adiponectin were assayed by ELISA. Acute insulin response from 3 to 10 min( AIR3-10 ),the area under the curve( AUCⅠ ) and the peak concentration of the first-phase ( 0-10 min) insulin secretion, the area under the curve of the second-phase( 10-120 min) insulin secretion( AUCⅡ), homeostasis model assessment for β cell function index(HOMA-β) and homeostasis model assessment for insulin resistance index(HOMA-IR) were calculated to explore the relationship with Ang Ⅱ. Result ( 1 ) The levels of Ang Ⅱ in DM group and IFG/IGT group were significantly higher than that in NGT group( P＜0.05 ). The AIR3-10, AUCⅠ and peak concentration, AUCⅡ ,adiponectin in DM group and IFG/IGT group were significantly lower than those in the NGT group ( P＜0. 05), and these results were more significantly reduced in DM group compared with those in IFG/IGT group. (2) Ang Ⅱ was negatively correlated with AIR3-10, AUCⅠ and the peak concentration, AUCⅡ, adiponectin, HOMA-β ( P＜0. 01 ), and positively correlated with fasting blood glucose,2 h blood glucose after glucose loading, fasting insulin, HOMA-IR (P＜0. 05 ). (3)Multiple stepwise regression analysis showed that Ang Ⅱ was independently associated with AUCⅠ and AUCⅡ.Conclusion Ang Ⅱ was an independent factor that affected the insulin secretion function of pancreatic islet βcells. Ruling out the effect of blood pressure, body position, drugs, and other factors, high levels of Ang Ⅱ could predict the dysfunction of pancreatic islet β cell as well as insulin resistance in patients with type 2 diabetes.
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SD rats were injected with streptozotocin and fed with high fat diet,used as type 2 diabetic model. Transcription factor Fox01 [in nucleus (15.00±1. 15 vs 6.45±0. 62) %, P<0.05], Caspase-3 [(23.73 ±1.48 vs 6.30±2.20)% ,P<0.01] expressions in pancreatic istet β cells and the positive rate of islet β cells apoptosis[(22.29±1.84 vs 6.25±2.42) %, P<0.01] in diabetic rats were higher than those of control rats. The islet cells which highly expresed Fox01 (in nucleus)and caspase-3 were just the apoptotic islet cells. Therefore,Fox01 may be involved in regulating apoptosis of islet β cells in type 2 diabetes.
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Objective To investigate the changes of bone mineral density (BMD) and its causing factors in menopausal female patients with type Ⅱ diabetes mellitus (DM2). Methods Dual energy X ray absorptimetry was used to measure the BMD of lumbar spines (L 2-4 ) and proximal femur in 82 female patients with type Ⅱ diabetes and 46 normal controls. According to BMD, DM2 patients were divided into two groups (DM A and DM B). Fasting plasma glucose (FPG), fasting plasma insulin (FINS), fasting plasma C peptide (FCP), glycated hemoglobin (HbAc1), urine albumin excretion rate (UAER), and urine ? 2 microglobin (? 2 MG) were measured and compared between the two groups. Results BMD of lumbar spines (L 2-4 ), femoral neck and Ward's triangle in diabetic patients were significantly lower than that of the controls ( P
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0.05). The inducing action of glucose to the apoptsis of MC3T3-E1 osteoblast was in concentration and time dependent manner(P