Is idiopathic mild hyperprolactinemia a cardiovascular risk factor?

BACKGROUND: There is a strong relationship between arterial stiffness and endothelial dysfunction and hypertension. How arterial stiffness is affected in elevated PRL conditions is uncertain. Biological action of prolactin contributing to the atherosclerotic process is a new research area. AIMS: We aimed at investigating cardiovascular risk predictability by conducting arterial stiffness measurement in patients with idiopathic hyperprolactinemia. SUBJECTS AND METHODS: The biochemical parameters and arterial stiffness analyses of 54 patients with idiopathic hyperprolactinemia, who had applied to our polyclinic in 2017 and 2018, and 55 healthy volunteers having similar characteristics with regard to age, sex and body mass index. RESULTS: The median prolactin level of the idiopathic hyperprolactinemia patients with a median age of 31 was found to be 45 ng/mL. The peripheral and central blood pressures and pulse wave velocities (PWV) of both the patient group and the control group were found to be similar. Any relations between prolactin levels and blood pressure and arterial stiffness could not be found. DISCUSSION: Our study showed that arterial stiffness did not increase in young patients with idiopathic mild hyperprolactinemia. However, the long-term effects of mildly elevated prolactin levels are unknown. Prospective randomized studies are required, that could reveal more clearly the prolactin-cardiovascular risk relation, and the clinical effects of extra-pituitary hyperprolactinemia.

The easy way of evaluating exocrine pancreatic insufficiency in type 2 diabetes : listen to the patients' complaints and look in their eyes!

BACKGROUND AND STUDY AIMS: The objective of this study is to determine the prevalence of exocrine pancreatic insufficiency (EPI) in diabetic patients, and to investigate whether there is a relationship between EPI and diabetes period, gastrointestinal complaints and other diabetic microvascular complications. PATIENTS AND METHODS: A total of 93 participants, consisting of 57 type 2 diabetes patients and 36 healthy volunteers have been included in our cross-sectional study. Participants were questioned for abdominal complaints and weight loss. Fecal elastase-1 (FE-1) was determined in fecal spot samples received from participants. The relationship between EPI and blood glucose, HbA1c, and duration and complications of diabetes were investigated. RESULTS: FE-1 levels were significantly lower in diabetic group compared to control group (p=0.007). The number of patients with FE-1 levels of <200µg/g were significantly higher in diabetic group (p=0.002). A statistically significant negative correlation was determined between FE-1 levels and the duration of diabetes (r= -0.453 p<0.001). FE-1 levels were significantly lower in patients with retinopathy (p= 0.014). In the post-hoc analysis, this difference was due to patients in the proliferative retinopathy group. A significant negative correlation was determined between the presence of retinopathy and FE-1 levels (r=-0.32, p=0.02). Abdominal pain and distension complaints were independent predictive factors that estimate EPI. CONCLUSIONS: An important part of type 2 diabetes patients has EPI and it should be considered in diabetes patients upon abdominal pain and distension. Determination of proliferative retinopathy in the eye examination may also suggest an idea on the possible presence of EPI.

Alternate-day calcium dosing may be an effective treatment option for chronic hypoparathyroidism.

PURPOSE: Conventional treatment of chronic hypoparathyroidism consists of oral calcium supplements and active vitamin D analogs; however, some patients are unable to meet treatment goals despite the high dosage of oral calcium supplementation. We aimed to investigate the effectiveness of alternate-day oral calcium intake in patients with uncontrolled chronic hypoparathyroidism. METHODS: In this retrospective cohort study, we evaluated 66 patients with chronic hypoparathyroidism who were admitted to our hospital between January 2017 and January 2019. Fourteen patients receiving ≥ 2000 mg/day oral elemental calcium and who were admitted to emergency department or our outpatient clinic at least once in the last 3 months for hypocalcemia requiring intravenous calcium replacement were switched to the alternate-day dosing regimen in which patients took calcium orally every other day. We collected and analyzed patients' medical history information, serum and urinary parameters over a 3-month period prior to and following the treatment. RESULTS: Before alternate-day dosing regimen, median oral calcium intake was 3750 mg/day, oral calcitriol intake was 0.88 mcg/day, serum calcium levels were 7.71 mg/dL, serum phosphate levels were 5.35 mg/dL, and 24-h urine calcium levels were 165 mg/day. Following alternate-day dosing regimen, median oral calcium intake was 1500 mg/day, oral calcitriol intake was 0.88 mcg/day, serum calcium levels were 8.25 mg/dL, serum phosphate levels were 5 mg/dL, and 24-h urine calcium levels were 210.5 mg/day. After alternate-day dosing regimen, oral calcium intake decreased and serum calcium levels increased. The number of emergency visits dropped from 21 to 3 after alternate-day dosing regimen. CONCLUSION: Patients with uncontrolled chronic hypoparathyroidism could be controlled more effectively with alternate-day dosing regimen.