Is There a Tendency for Thrombosis in Gestational Diabetes Mellitus?

CONTEXT: Impact of gestational diabetes mellitus (GDM) on the coagulation system, dynamics involved at a pathophysiological level and the exact mechanism remain unclear. AIMS: To evaluate the association between diabetes-related parameters and hemostatic factors to search for a tendency of thrombosis in GDM. SETTINGS AND DESIGN: Nineteen pregnant women who had GDM, 16 healthy pregnant and 13 healthy nonpregnant controls admitted to the Endocrinology outpatient clinics were enrolled in the study. SUBJECTS AND METHODS: Fasting and postprandial glucose, hemoglobin A1c and insulin levels, and insulin resistance; fructosamine, thrombin activatable fibrinolysis inhibitor (TAFI), tissue factor pathway inhibitor (TFPI), plasminogen activator inhibitor Type-1 (PAI-1), tissue-type plasminogen activator (t-PA), fibrinogen, plasminogen and hemoglobin levels, platelet counts, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were studied. STATISTICAL ANALYSIS USED: One-way analysis of variance, Kruskal-Wallis, and post hoc Tukey honestly significant difference or Conover's nonparametric multiple comparison tests for comparison of the study groups. RESULTS: PT and aPTT were significantly lower in GDM patients compared to controls (P < 0.05), whereas fibrinogen and plasminogen levels were significantly higher in this group compared to both nonpregnant and healthy pregnant controls (P < 0.05 for each). TAFI, TFPI, PAI-1, and tissue t-PA levels were not significantly different among groups. CONCLUSIONS: Our findings indicate tendency to develop thrombosis in GDM similar to diabetes mellitus; but more comprehensive studies with larger sample size are needed to determine the relationship between GDM and hemostasis.

The effect of disease control on mean platelet volume and red blood cell distribution in patients with acromegaly.

OBJECTIVES: Several studies have shown increased atherogenic risk factors and biomarkers of inflammation and atherosclerosis in association with growth hormone excess. Mean platelet volume (MPV) and red blood cell distribution (RDW) are currently gaining interest as new independent cardiovascular risk factors. The aim of this study was to evaluate the effect of disease control on MPV and RDW in acromegaly patients. MATERIALS AND METHODS: We retrospectively enrolled 36 acromegaly patients (23 males, 13 females; mean age 41.94 ± 11.55). Patients were divided into two groups: disease controlled by surgical treatment alone (group A) or by somatostatin analog (SSA) therapy (group B). MPV and RDW measurements were evaluated during active and inactive disease periods in the two groups. RESULTS: There were statistically significant increases in MPV and RDW in patients receiving SSA therapy (P = 0.012 and P = 0.020, respectively). The differences in MPV and RDW changes in patients receiving surgical treatment alone were not statistically significant (P=0.364 and P=0.339, respectively). CONCLUSIONS: This is the first report on the evaluated the effect of disease control on MPV and RDW in acromegaly patients. Our study results showed that MPV and RDW measurements are significantly increased in acromegaly patients with disease controlled by SSA therapy. Therefore, acromegalic patients treated with SSAs may have increased cardiovascular risk based on an increase in MPV and RDW.

Serum survivin increases in prolactinoma.

BACKGROUND: Prolactinoma is the most common adult pituitary adenoma. Survivin is a member of the family of inhibitors of apoptosis proteins. Its expression is observed in many tumors. Survivin expression has shown in prolactinoma tissue before but no study exists showing serum survivin level. The aim of the present study was to investigate serum survivin levels in patients with prolactinoma and demonstrate its value in diagnosis of the disease. METHODS: The group of patients consisted of 25 women, aged from 17 to 51 years. As a control group, 21 healthy women, aged from 22 to 45 years were included. Twenty patients had microprolactinoma, while five patients had macroprolactinoma. All patients had received dopamine agonist treatment. Serum survivin levels were measured in all of the groups. RESULTS: Survivin levels were significantly higher in prolactinoma patients compared to controls (19.04 (10 - 38) pg/mL; 15.05 (8 - 22) pg/mL; P = 0.042). There was no difference between microadenoma and macroadenoma patients in survivin levels (19.22 (10 - 38) pg/mL; 18.40 (16 - 22) pg/mL; P = 0.914). In correlation analysis, survivin was not correlated with other parameters. CONCLUSIONS: We consider that higher survivin levels might be a molecular marker predicting the presence of prolactinoma and may be useful for the diagnosis. But large-scale research is needed to clarify its role in diagnosis of prolactinoma patients.

Ocular findings in Sheehan's syndrome.

BACKGROUND: Sheehan's syndrome (SS) is one of the most common causes of hypopituitarism. The primary effect of SS is a deficiency in production of growth hormone (GH). A number of studies have supported the association between congenital GH deficiency and ocular anomalies. However, ocular findings such as central corneal thickness (CCT), intraocular pressure (IOP), and retinal nerve fiber layer thickness (RNFLT) have not been evaluated in patients with adult GH deficiency. The objective of this study was to evaluate ocular anomalies in SS with GH deficiency under a cross-sectional design. METHODS: Thirty three SS patients with GH deficiency and 28 controls with no history of thyroid, adrenal, or pituitary gland diseases or surgery underwent complete hormonal and ophthalmological evaluation, including an assessment of CCTs, IOPs, and RNFLT. RESULTS: The mean CCTs were significantly lower in the SS group compared with the control group (p < 0.001). There was no significant difference between patients and controls in terms of mean IOP, mean corrected IOP, and mean RNFLT (p = 0.517, p = 0.186, p = 0.965, respectively). The mean CCT was positively correlated with insulin-like growth factor 1 (IGF-1; p < 0.01) and adrenocorticotropic hormone (ACTH; p < 0.01) and negatively correlated with the corrected mean IOP (p < 0.05). In covariance analysis, IGF-1 was found to be a potential predictor of the mean CCT (p = 0.023). CONCLUSIONS: This study is the first investigation of ocular findings in SS and adult GH deficiency. Adult GH deficiency is characterized by lower CCT values.

Serum lipid changes and insulin resistance in familial Mediterranean fever.

OBJECTIVE: Inflammation is known to alter lipid profiles and to induce insulin resistance. This study was planned to test the hypothesis that familial Mediterranean ferver (FMF) patients and their first-degree asymptomatic relatives may have lipid profile changes and/or insulin resistance, similar to other inflammatory diseases. MATERIAL AND METHODS: We studied 72 FMF patients, 30 asymptomatic first-degree relatives, and 75 healthy controls. Fasting and 2-hour postprandial glucose, insulin, apolipoprotein (Apo) A1, Apo B, acute phase reactants, and lipid profiles of all subjects were studied. Insulin resistance was determined by the HOMA (Homeostasis Model Assessment) index. RESULTS: There was no difference between the groups with regard to sex, mean systolic and diastolic blood pressure, body mass index, smoking status, fasting and postprandial 2-hour glucose, insulin, acute phase reactants, and HOMA index levels. High-density lipoprotein cholesterol (HDL-C) levels were similar between FMF patients and FMF relatives (48.9±12.4 mg/dL vs 49.3±13.8 mg/dL; p=NS), and both were lower than controls (48.9±12.4 mg/dL vs 59.6±15.1 mg/dL; p<0.001 and 49.3±13.8 mg/dL vs 59.8±15.1 mg/dL; p=0.001, respectively). Apo A1 levels in FMF patients and asymptomatic first-degree FMF relatives were both lower than in controls, similar to the HDL-C levels (126.1±25.7 mg/dL vs 151.2±31.4 mg/dL; p<0.001 and 129.5±29.0 mg/dL vs 151.2±31.4 mg/dL; p=0.002, respectively). TG levels were significantly higher in FMF relatives as compared to controls (113.4±53.6 mg/dL vs 97.1± 54.9 mg/dL; p=0.025). CONCLUSION: Low HDL-C and low Apo A1 levels are found in FMF patients and their first-degree asymptomatic relatives. Low-grade inflammation caused by MEFV mutations may be responsible for these lipid profile changes.

Increased total Renin levels but not Angiotensin-converting enzyme activity in obese patients with polycystic ovary syndrome.

OBJECTIVE: To investigate the renin-angiotensin-aldosterone system and angiotensin-converting enzyme (ACE) activity in patients with polycystic ovarian syndrome (PCOS). SUBJECTS AND METHODS: In this case-control study, 41 obese (PCOS) women and 29 healthy controls, matched for age and body mass index, were enrolled. Anthropometric, metabolic, and hormonal patterns, including plasma aldosterone, plasma renin, and ACE activity, were measured in each subject. RESULTS: Plasma renin levels were significantly higher in PCOS patients (19.7 ± 14.5 µg/ml) compared with controls (12.9 ± 9.0 µg/ml, p < 0.05). ACE activity and aldosterone levels did not significantly differ between both groups (p = 0.15 and p = 0.18, respectively). Analysis of PCOS patients showed a significant correlation of fasting insulin levels with levels of renin (r = 0.305, p < 0.01) and free testosterone (r = 0.384, p = 0.001). Similarly, homeostasis model assessment index was positively correlated with total renin concentrations (r = 0.366, p < 0.01) and free testosterone (r = 0.352, p < 0.01). CONCLUSION: Obese PCOS women had higher total renin levels, but not ACE activity and aldosterone levels, related to insulin resistance compared with controls.