Pharmacokinetic and the effect of capsaicin in Capsicum frutescens on decreasing plasma glucose level.

BACKGROUND: The active substance found in Capsicum frutescens (capsicum) that gives hot and spicy flavor is capsaicin, and it seems to have many pharmacological effects. OBJECTIVE: The present research was conducted to study the effect of capsicum on plasma glucose level and to correlate its action with the pharmacokinetic properties of capsaicin in capsicum. MATERIAL AND METHOD: The crossover study was performed in 12 healthy volunteers by performing the OGTT while receiving placebo or 5 grams of capsicum. The insulin secretion and capsaicin level in plasma were measured using the HPLC method. RESULTS: The results of the OGTT showed that plasma glucose levels in volunteers who received capsicum were significantly lower than those in the placebo group at 30 and 45 minutes (p < 0.05). Furthermore, plasma insulin levels were significantly higher at 60, 75, 105, and 120 minutes (p < 0.05). When comparing before and after capsicum intake, the results showed the insulin levels were maintained The pharmacokinetic parameters of capsaicin shown as C(max), T(max), AUC(0-t), T1/2 are 2.47 +/- 0.13 ng/ml, 47.08 +/- 1.99 min, 103.6 +/- 11.3 ng x min/ml, and 24.87 +/- 4.97 min, respectively. CONCLUSION: In conclusion, the present study found that 5 grams of capsicum presented capsaicin levels that were associated with a decrease in plasma glucose levels and the maintenance of insulin levels. The present result might have clinical implications in the management of type 2 diabetes.

Normal reference range of serum insulin-like growth factor (IGF)-I in healthy Thai adults.

BACKGROUND: Serum insulin-like growth factor (IGF)-I level is growth hormone (GH) dependent and reflects GH secretion. Analysis of IGF-I is a component in the diagnosis of GH-related disorders and is going to be of interest in determining the risk of many disorders such as cancer or atherosclerosis. The diagnosis value of IGF-I is dependent on the establishment of an accurate reference ranges, which can be affected by parameters such as age, gender, ethnicity, medications, chronic illness, or assay methodologies. OBJECTIVE: To determine reference ranges of IGF-I for healthy Thai adults. MATERIAL AND METHOD: Eight hundred sixteen healthy Thai adults aged between 21-70 years were recruited in the present study. Serum IGF-I was measured by using immunochemiluminescent (ICMA; Roche, USA). Subjects were recorded by their age and gender groups. Data were presented in mean and +/- 2 standard deviation (SD). Correlation analysis between serum IGF-I and physical parameters including sex, age, weight, height, and body mass index (BMI) was also made. RESULTS: The present study demonstrated normal reference range of serum IGF-I by using mean +/- 2 SD value. The well-known age dependency of serum IGF-I levels was also revealed. Levels decreased with increasing age in both genders. The mean value of serum IGF-I was slightly higher in women at the age of 30-40 years compared with men in the same age group, but not statistically insignificant. In addition, serum IGF-I was found to correlate directly with the height and negatively with BMI. However, age-adjusted IGF-I level did not show correlation with these physical parameters. CONCLUSION: This reference range will be beneficial for using IGF-I assay as a tool in the diagnosis of GH function abnormalities in Thai subjects.

Functioning adrenocortical carcinoma with superior vena cava and upper airway obstructions.

BACKGROUND: Adrenocortical carcinoma (ACC) is one of the most aggressive endocrine malignancies with a dismal prognosis. Typically, the tumor is large and has regional invasion or distant metastasis at initial presentation. OBJECTIVE: To describe an unusual case of functioning ACC presenting with superior vena cava (SVC) and upper airway obstruction. MATERIAL AND METHOD: A 23-year-old man with cushingoid appearance was evaluated for a neck mass and SVC syndrome. Hormonal assessment and neck mass biopsy including immunohistochemistry study were performed RESULTS: Cushing's syndrome was confirmed by elevated 24-hr urinary free cortisol and no suppressible cortisol level after standard low dose (2 mg/day) of dexamethasone suppression test. Computerized tomography (CT) study revealed a huge left suprarenal mass and multiple mediastinal lymph nodes compressing SVC and trachea. Histopathological findings of the neck mass were compatible with metastatic ACC. CONCLUSION: The present report describes a functioning ACC patient with an unusual metastatic site causing SVC and upper airway obstruction. His hospital course was progressively worsened due to peptic perforation and decompensated respiratory failure, which led him to expire.

A SPINK1 gene mutation in a Thai patient with fibrocalculous pancreatic diabetes.

Fibrocalculous pancreatitis diabetes (FCPD), a late stage of tropical chronic pancreatitis (TCP), is classified as a secondary cause of diabetes mellitus resulting from pancreatic exocrine dysfunction. The distinctive features of FCPD and TCP are young age at onset, presence of large intraductal pancreatic calculi, and reported mainly in tropical developing countries. Their etiology is still obscure, but the autodigestion due to aberrant intraductal activation of zymogens by trypsin is thought to be a primary common event. Recently, mutations in SPINKI gene encoding a pancreatic secretory trypsin inhibitor have been reported in association with an increased risk of pancreatitis. We describe a heterozygous mutation, IVS3+2 T>C, of SPINK1 gene in a young Thai female patient with typical presentation of FCPD. To our knowledge, this is the first report of the SPINK1 gene mutation in a FCPD patient in Southeast Asia.

Adrenal crisis due to bilateral adrenal hemorrhage in primary antiphospholipid syndrome.

The authors report a case of a 56-year-old Thai woman with a history of recurrent venous thrombosis, spontaneous abortion and Graves' disease who presented with bilateral flank pain, nausea, vomiting and low-grade fever followed by hypotension. Adrenal crisis from bilateral adrenal hemorrhage was diagnosed by a low serum cortisol level during hypotension and bilateral hyperdense oval masses in each of the adrenal glands in a computerized tomographic study. Her hemostatic and serologic profile was compatible with primary antiphospholipid syndrome. Rapid improvement was observed after the administration of intravenous hydrocortisone. She was discharged on long-term glucocorticoid replacement for her primary adrenal insufficiency as well as an anticoagulant for prevention of thrombosis. The antiphospholipid syndrome should be suspected in a patient presenting with adrenal crisis without a distinct etiology.