Breast inflammation in type 1 diabetes.

BACKGROUND: Lymphocytic mastitis is an uncommon fibroinflammatory disease of the breast which occurs in patients with longstanding diabetes. Various imaging patterns in mammography, ultrasound and magnetic resonance imaging (MRI) have been widely described. This communication wishes to provide some explanation to the variation of imaging findings by a study of follow-up cases and present young nonlactating women who had abscess as the first clinical manifestation of type 1 diabetes. METHODS: Five women with pathologically confirmed lymphocytic mastopathy and 8 women with type 1 diabetes who presented with breast abscess at National Guard Hospital, Riyadh were studied. The ultrasound, mammographic and MRI features were analyzed. Follow-up of 2 to 4 years was done. The clinical findings were analyzed in a descriptive way. RESULTS: A total of 13 women were studied. Age ranged from 22-54 years. The clinical presentation was a painless hard breast mass in the 5 cases with lymphocytic mastitis and painful mass in 8 women with breast abscess, 3 of which were non-lactating young women. The common imaging finding at mammography was diffuse or focal stromal distortion unilaterally or bilaterally in 4 cases (80%). Complete clinical and mammographic resolution occurred in 2 (40%) of the cases while it was only partial in the rest with lymphocytic mastopathy. Initial ultrasound showed stromal changes in 3 (60%), mass-like lesion in 1 (20%) and normal in 1 (20%). At follow-up ultrasound examination, all had interval development of dense acoustic shadowing representing the previous lesions between 1-2 years. CONCLUSION: Lymphocytic mastitis can have various patterns at the initial presentation at ultrasound. However, the chronic change at follow-up in this study was intense acoustic shadowing without any mass in all. Type 1 diabetes is suggested in young non-lactating females presenting with breast abscess.

Ovarian steroids modulate neuroendocrine dysfunction in polycystic ovary syndrome.

OBJECTIVE: Neuroendocrine dysfunction in polycystic ovary syndrome (PCOS) was addressed by studying the steroid hormone changes in women with PCOS with either high or normal LH levels leading to inferences regarding the primacy of elevated LH in the pathophysiology of PCOS. METHODS: A cross-sectional study was designed in an academic clinical facility involving 234 women with PCOS. Patients were divided into two groups based on an LH/FSH ratio < or >1 and hormonal and metabolic studies were performed in both groups. Factors were determined by binomial logistic regression that predicted group membership of these women. RESULTS: Higher follicular phase estradiol (E2) and androstenedione (A4) levels as well as greater insulin sensitivity were the only factors that predicted the presence of neuroendocrine dysfunction with elevated A4 being necessary for neuroendocrine dysfunction. CONCLUSIONS: It was concluded that uncoupling of hypothalamic E2 inhibition by elevated ovarian A4 associated with E2 related sensitization of pituitary LH leads to neuroendocrine dysfunction in PCOS.

Leptin levels in Arabs with primary hyperthyroidism.

BACKGROUND: The aim of this report was to study leptin status in hyperthyroid men and women (prior to and after medical treatment) and in matched controls in Arabs. SUBJECTS AND METHODS: Twenty-nine hyperthyroid patients (19 women and 10 men) and 32 controls (20 women and 12 men) matched for age, ethnic status and body mass index (BMI) were studied. The patients were studied at the time of diagnosis and six months after antithyroid treatment with carbimazole-titrating dose, which rendered them euthyroid. On each study occasion, the subjects fasting blood was collected for the measurement of leptin, glucose, insulin and C-peptide. RESULTS: Fasting leptin level was significantly lower in women with hyperthyroidism at baseline (mean+/-SEM, 15.8+/-2.9 microg/L, P=0.01), and after six months of antithyroid treatment (13.4+/-1.7 microg/L, P=0.004) than in control women (25.6+/-2.7 microg/L), but the difference was not significant in the men. Women in each group had significantly higher leptin concentrations than men (patients: 15.8+/-2.9 vs. 4.9+/-0.9 microg/L, P=0.009; controls: 25.67+/-2.7 vs. 7.9+/-1.4 microg/L, P=0.0005). The differences in women leptin remained significant even when expressed in relation to BMI. Baseline fasting glucose (P=0.01), insulin (P=0.007), and C-peptide (P=0.02) were significantly higher in the patients than controls. After six months of antithyroid therapy, fasting glucose, insulin and C-peptide levels were similar in the patients and controls. Within the patients, baseline leptin concentrations correlated positively with BMI (rho=0.65, P=0.02) and negatively with free T3 (rho=0.62, P=0.03). It neither demonstrated an association with baseline nor with six-month values of fasting glucose, insulin and C-peptide. CONCLUSION: Leptin concentration is decreased in Arab women with hyperthyroidism. Six months of antithyroid therapy is not associated with alterations in leptin levels.

Consideration on some hormone binding proteins patterns during pregnancy.

Serum concentrations of sex hormone binding globulin, transcortin, thyroxine binding globulin, transthyretin together with retinol binding protein, ceruloplasmin, transferrin and albumin were measured sequentially in pregnant women in order to derive more definite suppositions relating to the prime function of hormone binding proteins. Thus, the fact that except for transthyretin all other specific hormone binding proteins exhibited appreciable but significantly variable increases would suggest: a) the apparent existence of more complex mechanisms regulating protein metabolism during pregnancy than hitherto postulated (i.e. the general notion of an integrated estrogen influence); b) a major and distinctive role for each of the hormone binding proteins is plausible since alterations in hormonal requirements by the fetus as pregnancy progresses can not be provided by the almost constant transplacental transfer rate of the "free" hormone moiety.