The effect of 25-hydroxyvitamin D levels on QT interval duration and dispersion in type 2 diabetic patients.

AIM: To assess the relationship between corrected QT (QTc) interval and vitamin 25-hydroxyvitamin D levels (25-OHD) deficiency in type 2 diabetic patients. METHODS: The study included 253 patients with type 2 diabetes and 170 age-matched controls treated between October and December 2013. QTc duration and QTc dispersion were measured on ECG recordings and 25-OHD, calcium, phosphorus, and blood glucose levels were determined. RESULTS: Patients with diabetes had significantly longer QTc duration and QTc dispersion than controls (P<0.001 and P<0.001 respectively). Diabetic patients with prolonged QTc duration were older and had longer diabetes duration and higher HbA1c levels than patients with normal QTc interval. They significantly more frequently had 25-OHD deficiency (P<0.001), but had similar calcium and phosphorus levels. Diabetic patients with prolonged QTc dispersion were of similar age and had similar diabetes duration and HbA1c levels as patients with normal QTc dispersion. They significantly more frequently had 25-OHD deficiency (P=0.010), but had similar calcium and phosphorus levels. CONCLUSION: This study showed prolonged QTc duration and QTc dispersion in patients with type 2 diabetes, especially those with 25-OHD deficiency.

Increased prevalence of metabolic syndrome in patients with psoriatic arthritis.

OBJECTIVE: The increased incidence of cardiovascular disease (CVD) in patients with psoriatic arthritis (PsA) has been reported previously. We aimed to evaluate the presence of metabolic syndrome and to assess the insulin resistance associated with chronic inflammation in patients with PsA. METHODS: Fifty-nine (34 females, 25 males) consecutive PsA patients were enrolled in this study. The control group consisted of 82 (46 females, 36 males) healthy volunteers. All subjects were questioned about criteria of National Cholesterol Education Program Adult Panel III (NCEP ATP III) and also the modified World Health Organization (WHO) definition. Disease activity, damage, and functional activity were assessed by using functional indices [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), Disease Activity Score in 28 joints (DAS28), The Multi-Dimensional Health Assessment Questionnaire-function (MDHAQ-function), The Multi-Dimensional Health Assessment Questionnaire-Routine Assessment of Patient Index Data scores (MDHAQ-RAPID-3)]. Fasting blood samples were collected for complete biochemical analysis. RESULTS: According to the NCEP criteria, 21 (35.5%) of PsA patients and 12 (14.6%) of healthy controls were classified as having metabolic syndrome (P=0.004). According to the NCEP criteria, hypertension and hyperglycemia were more common in the PsA group than the healthy controls (P=0.000 and P=0.043, respectively). According to the WHO criteria, 14 (23.7%) of the patients and 14 (17%) of the healthy controls had metabolic syndrome (P=0.328). No correlation was observed between functional indices and cardiovascular risks factors that were among the metabolic syndrome components. CONCLUSIONS: This study demonstrated an increase in the frequency of metabolic syndrome, which is a major risk factor for atherosclerosis in patients with PsA. Patients with PsA should be closely followed in terms of cardiovascular events, and aggressive treatment should be performed for both cardiovascular risk factors and the disease itself.

Secondary metabolic syndrome: the frequency of factors which may underlie the parameters of metabolic syndrome.

BACKGROUND AND OBJECTIVES: Each of the metabolic syndrome (MetS) components (central obesity, hypertriglyceridemia, hypertension, low high-density lipoprotein cholesterol, and insulin resistance) may arise from an underlying disease or factors such as hormonal or pharmacological factors. These components arising secondary to a reason other than life style disturbances cause secondary MetS. The present study aimed to present, for the first time, the factors affecting secondary MetS. DESIGN AND SETTINGS: An observational study at Medeniyet University Goztepe Training and Research Hospital, Istanbul, from June 2010 to February 2011. PATIENTS AND METHODS: The underlying causes in 902 MetS patients with a mean age of 53.5 (12.9) years, of whom 79% were female, were investigated. A detailed evaluation was made, which comprised a history for drugs, diseases and habits that may manifest MetS parameters, physical examination, and laboratory analysis. RESULTS: In 10.6% of the patients, hypothyroidism was determined as the main factor affecting secondary MetS, and in 4.1% the use of corticosteroid was determined as the main factor. Other factors underlie affecting secondary MetS are as follows: the use of thiazide diuretics (22.8%), beta-blockers (12.5%), antiphysichotics (2.1%), insulins (12.8%), insulin secretagog oral hypoglycemics (13.8%), thiazolidinediones (4.9%), oral contraceptives (0.8%), and alcohol intake (2.2%). CONCLUSION: Hypothyroidism and corticosteroid treatment are the leading causes of secondary MetS. While evaluating the patients, it is a prerequisite to determine the high frequency of other factors that may affect the presence and the degree of MetS parameters.

Is there a real adrenal axis dysfunction in patients with amyloidosis associated with familial Mediterranean fever?

Systemic amyloidosis with AA-type amyloid deposition is the major complication of FMF, leading to end stage renal disease. There is no clear data on the prevalence of adrenal involvement in patients with FMF amyloidosis. The aim of this study is to determine the adrenal axis function in patients FMF with amyloidosis. Twenty patients with FMF with amyloidosis (F/M: 10/10, mean age; 38 ± 11 SD years), twenty without amyloidosis (F/M: 14/6, mean age 32 ± 10 years), and healthy controls (F/M: 12/8, mean age: 30 ± 7.6 SD years) were recruited. A dose of 250 mg tetracosactide (Synacthen) was then administered intravenously and further blood samples collected 30 and 60 min later. Blood samples were separated and collected at 4°C, and serum cortisol levels were measured. A normal cortisol response to Synacthen was defined as a post-stimulation peak cortisol value of >18 mg/d either at 30 or 60 min. sample. The mean disease duration was 8.8 ± 6 SD years, (range, 2-21) in FMF patients without amyloidosis compared to 16 ± 9.5 years (range, 0-30) in FMF with amyloidosis (P = 0.001). The cortisol concentrations increased significantly at 30 and 60 min compared to baseline after injection of synacthen in all groups. There were no statistically significant differences found among three groups, for basal, 30 and 60 min for cortisol levels (P = 0.154). FMF patients with amyloidosis do not exhibit overt adrenal insufficiency even though their basal cortisol levels were mildly lower.

Pure leydig cell tumour of the ovary in a post-menopausal patient with severe hyperandrogenism and erythrocytosis.

A 60-year-old woman, presented with hirsutism, male pattern baldness, deepening voice and plethora over the past 5 years. Hormonal evaluation showed markedly elevated serum testosterone level (> 1600 ng/dl) and oestradiol level (220 pg/ml) normal DHEA-SO4 level with suppressed LH and FSH levels. She had markedly erythrocytosis with normal hematological indices. The diagnosis of probable secondary erythrocytosis was made. Trans abdominal ultrasound and CT scan revealed a 14 cm × 11 cm × 9 cm solid pelvic mass. An ovarian androgen secreting tumour was suspected and surgery was performed. Histological examination showed a leydig cell tumour. After the operation testosterone and haematocrit levels returned to normal with regression of clinical symptoms. This is the first case of a leydig cell tumour with an erythropoietic effect of excess testosterone.

Obesity might not be a risk factor for female sexual dysfunction.

OBJECTIVE: To evaluate female sexual dysfunction (FSD) in obese women in comparison with age-matched control group, emphasising their hormonal and psychological status. PATIENTS, SUBJECTS AND METHODS: Sixty-four sexually active obese premenauposal women were compared with a control group of 27 age-matched healthy volunteers with a normal body mass index (BMI). The obese group was evaluated in three categories according to BMI (kg/m(2)), as group 1 (30-34.9), group 2 (35-39.9) and group 3 (> 40). All women were evaluated with Female Sexual Function Index (FSFI) questionnaire and Beck Depression Inventory (BDI). In addition, serum levels of follicle-stimulating hormone, luteinizing hormone, prolactin, dehydroepiandrosterone-SO(4) , free testosterone, 17α-hydroxyprogestrone, androstenedione, oestradiol, free thyroxine and thyrotropin were determined. RESULTS: The mean FSFI scores were not statistically significant between control and obese patients (P = 0.29). FSD was diagnosed in 50% (32/64) and 41% (11/27) of the patients in the obese and control groups, respectively (P = 0.34). There were no differences between total FSFI and FSFI domain scores among BMI categories. BDI scores were significantly higher in the obese groups than in healthy controls, and negatively correlated with total FSFI and all FSFI domain scores. Among hormonal analyses, only free testosterone levels were negatively correlated with total FSFI scores. CONCLUSION: This study showed that obesity has no significant relationship with FSD, but obese patients were found to be in a more depressive mood than age-matched normal counterparts.

Screening for Cushing's syndrome in obese patients.

OBJECTIVES: The aim of this study was to examine the frequency of Cushing's syndrome (CS) in obese patients devoid of specific clinical symptoms of Cushing's syndrome. METHODS: A total of 150 obese patients (129 female, 21 male; mean age 44.41 +/- 13.34 yr; mean BMI 35.76 +/- 7.13) were included in the study. As a first screening step, we measured 24-h urinary free cortisol (UFC). An overnight 1-mg dexamethasone suppression test was also performed on all patients. Urinary free cortisol levels above 100 microg/24 h were considered to be abnormal. Suppression of serum cortisol <1.8 microg/dL after administration of 1 mg dexamethasone was the cut-off point for normal suppression. The suppression of the serum cortisol levels failed in all of the patients. RESULTS: MEASURED LABORATORY VALUES WERE AS FOLLOWS: ACTH, median level 28 pg/ml, interquartile range (IQR) 14-59 pg/ml; fasting glucose, 100 (91-113) mg/dL; insulin, 15.7 (7.57-24.45) mU/ml; fT(4), 1.17 (1.05-1.4) ng/dL; TSH, 1.70 (0.91-2.90) mIU/L; total cholesterol, 209 (170.5-250) mg/dL; LDL-c, 136 (97.7-163) mg/dL; HDL-c, 44 (37.25-50.75) mg/dL; VLDL-c, 24 (17-36) mg/dL; triglycerides, 120.5 (86-165) mg/dL. The median UFC level of the patients was 30 microg/24 h (IQR 16-103). High levels of UFC (>100 microg/24 h) were recorded in 37 patients (24%). Cushing's syndrome was diagnosed in 14 of the 150 patients (9.33%). Etiologic reasons for Cushing's syndrome were pituitary microadenoma (9 patients), adrenocortical adenoma (3 patients), and adrenocortical carcinoma (1 patient). CONCLUSION: A significant proportion (9.33%) of patients with simple obesity were found to have Cushing's syndrome. These findings argue that obese patients should be routinely screened for Cushing's syndrome.

Screening for Cushing's syndrome in obese patients

Objectives: The aim of this study was to examine the frequency of Cushing's syndrome (CS) in obese patients devoid of specific clinical symptoms of Cushing's syndrome. Methods: A total of 150 obese patients (129 female, 21 male; mean age 44.41 ± 13.34 yr; mean BMI 35.76 ± 7.13) were included in the study. As a first screening step, we measured 24-h urinary free cortisol (UFC). An overnight 1-mg dexamethasone suppression test was also performed on all patients. Urinary free cortisol levels above 100 ìg/24 h were considered to be abnormal. Suppression of serum cortisol <1.8 ìg/dL after administration of 1 mg dexamethasone was the cut-off point for normal suppression. The suppression of the serum cortisol levels failed in all of the patients. Results: Measured laboratory values were as follows: ACTH, median level 28 pg/ml, interquartile range (IQR) 14-59 pg/ml; fasting glucose, 100 (91-113) mg/dL; insulin, 15.7 (7.57-24.45) mU/ml; fT4, 1.17 (1.05-1.4) ng/dL; TSH, 1.70 (0.91-2.90) mIU/L; total cholesterol, 209 (170.5-250) mg/dL; LDL-c, 136 (97.7-163) mg/dL; HDL-c, 44 (37.25-50.75) mg/dL; VLDL-c, 24 (17-36) mg/dL; triglycerides, 120.5 (86-165) mg/dL. The median UFC level of the patients was 30 ìg/24 h (IQR 16-103). High levels of UFC (>100 ìg/24 h) were recorded in 37 patients (24 percent). Cushing's syndrome was diagnosed in 14 of the 150 patients (9.33 percent). Etiologic reasons for Cushing's syndrome were pituitary microadenoma (9 patients), adrenocortical adenoma (3 patients), and adrenocortical carcinoma (1 patient). Conclusion: A significant proportion (9.33 percent) of patients with simple obesity were found to have Cushing's syndrome. These findings argue that obese patients should be routinely screened for Cushing's syndrome.

Management of Cushing's disease using cavernous sinus sampling: effectiveness in tumor lateralization.

OBJECTIVE: The aim of this study was to determine the accuracy of bilateral cavernous sinus sampling (CSS) in preoperative tumor lateralization (right/left) within the pituitary in patients with Cushing's disease (CD). PATIENTS AND METHODS: The study consisted of 26 consecutive patients who had undergone CSS followed by transsphenoidal surgery (TS) for CD between 2000 and 2006 at our institution. The magnetic resonance imaging (MRI) of the selected patients either revealed a normal pituitary or a lesion

Forty month follow-up of persistent and difficultly controlled acromegalic patients treated with depot long acting somatostatin analog octreotide.

The objective of the present study was to investigate the effects of octreotide long acting release (S-LAR) preparation on GH and IGF-1 serum concentrations and pituitary tumor size in patients with persistent and difficultly controlled acromegaly even after adjuvant irradiation and/or dopamine agonists. Thirty-three patients with active acromegaly (26 female and 7 male, mean age; 43.94 +/- 14.01 SD years) were included in this study. Patients were evaluated at baseline and at 6, 12, 30 and 40 months for GH, IGF-1, and GH response to OGTT and biliary ultrasonography. Sella MRI was performed at initial and at 40 months. All patients received 20 mg S-LAR. Afterwards, the dosage was titrated to improve individual GH response and reduction of IGF-1 into normal ranges. Basal serum IGF-1 levels decreased from median: 530 microg/l [IQR: 420-600] to 340 microg/l [IQR: 230-460] at 6 months (p = 0.01), to 400 microg/l [IQR: 222.4-600] at 12 months (p = 0.48), to 396 microg/l [IQR: 318-468] at 30 months (p = 0.49), to 482 microg/l [308-580] at 40 months (p = 0.47). Nadir GH levels in OGTT fell from 2.70 ng/ml [IQR: 1.35-6.90] to 1.60 ng/ml [IQR: 0.36-4.10] at 6 months (p = 0.03), to 0.31 ng/ml [IQR: 0.18-0.65] at 12 months (p<0.0001), to 1.50 ng/ml [IQR: 0.83-4.00] at 30 months (p = 0.398) and to 0.89 ng/ml [IQR: 0.58-1.35] at 40 months (p<0.0001). Initially, pituitary adenoma volume was median: 1.18 ml [IQR: 0.08-3.50] and it shrank to 0.21 ml [IQR: 0-2.1] at 40 months (p = 0.08). Gallstones were detected in 12 patients and six of them underwent cholecystectomy. S-LAR is an effective treatment regimen in reducing GH and IGF-1 concentrations and as well as in shrinking tumor volume in persistent and difficultly controlled acromegalic patients.