Predictors of Survival in Adrenocortical Carcinoma: An Analysis From the National Cancer Database.

Context: Adrenocortical carcinoma (ACC) is rare; knowledge about prognostic factors and survival outcomes is limited. Objective: To describe predictors of survival and overall survival (OS) outcomes. Design and Patients: Retrospective analysis of data from the National Cancer Database (NCDB) from 2004 to 2015 on 3185 patients with pathologically confirmed ACC. Main Outcome Measures: Baseline description, survival outcomes, and predictors of survival were evaluated in patients with ACC. Results: Median age at ACC diagnosis was 55 (range: 18 to 90) years; did not differ significantly by sex or stage of the disease at diagnosis. On multivariate analysis, increasing age, higher Charlson-Deyo comorbidity index score, high tumor grade, and no surgical therapy (all P < 0.0001); and stage IV disease (P = 0.002) and lymphadenectomy during surgery (P = 0.02) were associated with poor prognosis. Patients with stage I-III disease treated with surgical resection had significantly better median OS (63 vs 8 months; P < 0.001). In stage IV disease, better median OS occurred in patients treated with surgery (19 vs 6 months; P < 0.001), and postsurgical radiation (29 vs 10 months; P < 0.001) or chemotherapy (22 vs 13 months; P = 0.004). Conclusion: OS varied with increasing age, higher comorbidity index, grade, and stage of ACC at presentation. There was improved survival with surgical resection of primary tumor, irrespective of disease stage; postsurgical chemotherapy or radiation was of benefit only in stage IV disease.

Vitamin D levels in subjects with or without chronic kidney disease among Veterans with diabetes in North East United States.

AIM: To evaluate the prevalence of vitamin D deficiency and its relation to diabetes and kidney disease in Veterans residing in the North East United States (VISN 2). METHODS: In this retrospective study, we used data from the computerized patient record system at Stratton Veterans Administration Medical Center at Albany, NY (VHA) for those patients who had 25-hydroxyvitamin D levels and 1,25 (OH) vitamin D levels measured between 2007 and 2010. We collected demographic information including age, sex, body mass index and race; clinical data including diabetes, hypertension and CAD; and laboratory data including calcium, creatinine and parathyroid hormone (PTH) (intact). Vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng/mL (50 nmol/L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng/mL (50 to 75 nmol/L). RESULTS: Data was available for approximately 68000 subjects. We identified 64144 subjects for analysis after exclusion of duplicates. Among them, 27098 had diabetes. The mean age of subjects with diabetes was 68 ± 11 with a mean body mass index (BMI) of 32 ± 7 and duration of diabetes of 5.6 ± 3.2 years. The mean 25 (OH) vitamin D level among subjects with diabetes was 27 ± 11.6. There was no significant difference in 25 (OH) vitamin D levels between subjects with diabetes and glomerular filtration rate (e-GFR) < 60 compared to those with e-GFR ≥ 60. As expected, subjects with e-GFR < 60 had significantly lower 1,25 (OH) vitamin D levels and significantly elevated PTH-intact. Of the 64144 subjects, 580 had end-stage renal disease. Of those, 407 had diabetes and 173 did not. Vitamin D levels in both groups were in the insufficiency range and there was no significant difference irrespective of presence or absence of diabetes. Subjects with vitamin D levels less than 20 ng/mL had a higher BMI and elevated PTH, and higher HbA1C levels compared to those with vitamin D levels more than 20 ng/mL. CONCLUSION: We conclude that we need to keep a close eye on vitamin D levels in subjects with mild chronic kidney disease as well as those with moderate control of diabetes.

Metastases to the thyroid presenting as a metabolically inactive incidental thyroid nodule with stable size in 15 months.

Though the thyroid gland has a rich vascular supply, incidence of metastatic disease from distant organs is rare. Here we present an unusual case of metastases to the thyroid with several interesting features. A 63-year-old male with history of adenocarcinoma of the right lobe lung (5 years prior to presentation), treated with surgery and chemotherapy, followed by new adenosquamous lung cancer in the left lobe of the lung (one year prior to presentation), treated surgically followed by adjuvant chemotherapy, was referred to Endocrinology section for evaluation of an incidental thyroid nodule on CT chest. Ultrasound (US) of the thyroid revealed a complex, predominantly hypoechoic lesion measuring 1.8 cm within the lower pole of the right thyroid lobe and a subcentimeter lesion in the left lobe of the thyroid. Review of prior CT chests showed that the lesion in the right lobe was stable for 15 months, with no evidence of a hypermetabolic lesion on PET scan. The subcentimeter lesion was not seen on prior CT scans. US guided fine needle aspiration (FNA) and pathology of the lobectomy of the thyroid confirmed adenosquamous carcinoma. Interesting features in this case are that the thyroid metastases occurred without any evidence of synchronous lesions elsewhere, the size was stable over 15 months, and the lesions were metabolically inactive.

Insulin therapies: Current and future trends at dawn.

Insulin is a key player in the control of hyperglycemia for type 1 diabetes patients and selective individuals in patients of type 2 diabetes. Insulin delivery systems that are currently available for the administration of insulin include insulin syringes, insulin infusion pumps, jet injectors and pens. The traditional and most predictable method for the administration of insulin is by subcutaneous injections. The major drawback of current forms of insulin therapy is their invasive nature. To decrease the suffering, the use of supersonic injectors, infusion pumps, sharp needles and pens has been adopted. Such invasive and intensive techniques have spurred the search for alternative, more acceptable methods for administering insulin. Several non-invasive approaches for insulin delivery are being pursued. The newer methods explored include the artificial pancreas with closed-loop system, transdermal insulin, and buccal, oral and pulmonary routes. This review focuses on the new concepts that are being explored for use in future.

Vitamin d levels in subjects with prostate cancer compared to age-matched controls.

Prostate cancer (PCa) is the second most common cancer in men worldwide and the second leading cause of cancer deaths in men in the United States. Vitamin D is considered to have anticancer properties, currently thought to work mainly through its nuclear receptor or vitamin D receptor. In this retrospective study, we compared vitamin D levels in subjects with PCa with those of age-matched men without PCa. Study subjects included 479 in each group with a mean age of 73 and a mean creatinine of 1.05 and 1.15. Levels of 25 (OH) vitamin D were 28.4 ± 0.54 and 28.05 ± 0.62 in subjects with and without PCa. Levels of 1,25 (OH) vitamin D were 47.2 ± 6.8 and 47.1 ± 7.11 in subjects with and without PCa. In contrast to other studies, we did not find a significant difference in vitamin D levels. Among prostate cancer patients, vitamin D levels correlated positively with age (r = 0.12, P < 0.02), and were negatively associated with BMI (r = -0.13, P = 0.003), glucose (r = -0.12, P < 0.007), HbA1C (r = -0.16, P = 0.001), and PTH (r = -0.21; P < 0.0001). The data do not show the causal effect of vitamin D levels on PCa.

Metabolic complications and increased cardiovascular risks as a result of androgen deprivation therapy in men with prostate cancer.

Prostate cancer is one of the most common malignancies in men. Charles Huggins and Clarence V. Hodges reported the androgen dependence of prostate cancer in 1941. That led to the utilization of androgen deprivation therapy as an important therapeutic modality to treat prostate cancer. Androgen deprivation therapy has additional systemic effects that include sexual dysfunction, psychological changes and more important are the metabolic changes. Metabolic changes in particular include insulin resistance, increase fat mass and low-density lipoprotein cholesterol, and induce type 2 diabetes. In this review we will focus on the cardiovascular risk associated with androgen deprivation therapy that includes the mechanisms involved.

Prevalence of Decreased Vitamin D Levels is High among Veterans with Diabetes and/or CKD.

Objective. Vitamin D deficiency is associated with a variety of skeletal and extraskeletal problems. The aim of this study was to evaluate the prevalence of vitamin D deficiency among veterans in sunny Louisiana. Methods. Using the VA computerized patient record system, we searched for all 25 (OH) Vitamin D and 1, 25 (OH) vitamin D levels that were measured between 2007 and 2009. The information collected for each patient included age, body mass index, creatinine, history of diabetes and hypertension, and levels of vitamin D and PTH. We determined the number of individuals who were vitamin D insufficient and deficient. Results. Among 2990 studies evaluated, the mean concentration of 25 (OH) D was 22.5 ± 0.2 ng/mL, and that of 1, 25 (OH) vitamin D was 29.2 ± 0.4 ng/mL. Among them, only 695 subjects (23%) had normal values, while 889 (30%) had insufficiency, and 1405 (47%) had deficiency. Subjects with diabetes (1041) had significantly (P < 0.0001) lower levels (21 and 25 ng/mL) of both 25 (OH) and 1,25 (OH) vitamin D compared to subjects without diabetes (23 and 32 ng/mL). Similarly, subjects with chronic kidney disease (1128) had much lower vitamin D levels than subjects without CKD. Among subjects with diabetes, those with chronic kidney disease (512) had much lower levels of both 25 (OH) and 1,25 (OH) vitamin D than with those with normal creatinine levels. Conclusions. We conclude that vitamin D insufficiency and deficiency is highly prevalent in veterans, more so among subjects with diabetes and/or CKD.

Thyroid nodule with eggshell calcification and oncocytic thyroid cancer.

BACKGROUND: To report an interesting case of Hurthle cell cancer of the thyroid with eggshell calcification, including ultra-sonographic, surgical, histological, and immuno-histochemical findings and discussion of diagnostic and therapeutic strategies. CASE REPORT: A 62 year old asymptomatic man with negative history of radiation, referred for evaluation of a thyroid nodule, had a 3-4 cm firm, mobile nodule in the left lobe of his thyroid. US of the thyroid revealed a normal right lobe and a large heterogeneous mass that was iso- and hyper-echoic, with peripheral halo and intra-nodular and peripheral coarse calcifications, measuring 2.8 x 3.0 cm, in the left lobe. US-guided FNA revealed a richly cellular specimen with numerous sheets of Hurthle cells with nuclear pleomorphism and intranuclear vacuoles. At macroscopic examination after thyroidectomy, an encapsulated tumor mass measuring 5.0 x 3.5 x 2.6 cm was found to have replaced the entire left lobe. The capsule was thick and hard, preventing the specimen from being cut, and requiring 3 days of pretreatment with a decalcifying agent before sections could be made. Microscopic examination revealed oncocytic or Hurthle cell carcinoma with pericapsular and vascular invasion. The patient received radioiodine ablation and was placed on suppressive doses of levothyroxine. At follow up, the thyroid ultrasound and scan remain negative with undetectable thyroglobulin. We could not find any reports of Hurthle cell thyroid cancer with such coarse or eggshell calcification. CONCLUSIONS: Egg shell calcification does not exclude the presence of camcer.

Metabolic syndrome and cancer.

Since its first description by Reavan in 1988, accepted criteria for clinical identification of the components of metabolic syndrome have been promulgated by the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) and the World Health Organization (WHO) as well as the International Diabetes Federation (IDF), and the American Association of Clinical Endocrinologists (AACE). Insulin resistance is a common metabolic abnormality underlying type 2 diabetes mellitus and is also an independent risk factor for cardiovascular disease. Although ATP III identified cardiovascular disease (CVD) as the primary clinical outcome of the metabolic syndrome, we now have evidence that metabolic syndrome is associated with type 2 diabetes mellitus, polycystic ovarian disease, nonalcoholic fatty liver disease, and possibly some cancers. This review summarizes evidence in support of the relationship between metabolic syndrome and various cancers and possible underlying mechanisms and therapeutic interventions.

Decreased bone mineral density in men with metabolic syndrome alone and with type 2 diabetes.

BACKGROUND: Metabolic syndrome is associated with decreased physical activity and increased incidence of diabetes. Bone Mineral density (BMD) is positively associated with physical activity. Lower BMD is a risk factor for bone fractures. Whether subjects with metabolic syndrome alone show early signs of lower BMD and osteoporosis similar to those present in diabetic is not known. MATERIAL/METHODS: This cross-sectional study in male veterans examined the BMD in 3458 non-diabetic men and 735 men with type 2 diabetes. In addition, the BMD changes in non-diabetic men without any metabolic syndrome were compared with non-diabetic men with metabolic syndrome as established by the criteria of the Adult Treatment Panel III. RESULTS: BMD of hip was significantly lower and incidence of osteoporosis higher in diabetic subjects compared with age and body mass index (BMI) matched non-diabetic subjects. BMD of AP spine was significantly higher in diabetic subjects compared with non-diabetics but similar when subjects were matched for BMI. Men with metabolic syndrome alone had higher osteoporosis and lower BMD of hip compared with those without metabolic syndrome. CONCLUSIONS: The BMD of hip is lower in diabetics compared with age and BMI-matched non-diabetic men, and its level is similar in age and BMI-matched diabetics and non-diabetic men with metabolic syndrome. This suggests that both diabetes and metabolic syndrome are associated independently with higher osteoporosis and lower BMD of hip and are risk factors for increased incidence of hip fractures in men.

Diabetes and skeletal health.

Osteoporosis and diabetes affect a large proportion of the elderly population. The prevalence of diabetes and osteoporosis is increasing. Compared with individuals without diabetes, both men and women with diabetes have a higher risk of fractures, particularly at the hip, with consequent significant morbidity and mortality. Type 1 diabetes is associated with decreased bone mass and although bone mass data for Type 2 diabetes may or may not be decreased, there is evidence of altered bone quality in diabetes. The mechanisms involved include effects of insulin, insulin-like growth factor 1, cytokines, advanced glycation end products, and altered calcium homeostasis. In addition, a drug-induced increase in the incidence of fractures has been noted with the use of thiazolidinediones (TZDs). TZDs improve insulin sensitivity and have multitude other beneficial effects. Osteoblasts and adipocytes are derived from a common multipotential mesenchymal stem cell progenitor, with activation of peroxisome proliferator-activated receptor γ2 by both currently available TZDs (i.e. rosiglitazone and pioglitazone) stimulating adipogenesis and inhibiting osteoblastogenesis. The use of both rosiglitazone and pioglitazone is associated with an increased fracture risk, with changes in bone turnover markers and decreased bone mineral density.

Relationship of elevated osteoprotegerin with insulin resistance, CRP, and TNF-alpha levels in men with type 2 diabetes.

AIM: Our objective of this study is to investigate the relationship between plasma osteoprotegerin (OPG) levels in type 2 diabetes and its relationship with the insulin resistance, HbA(1c), CRP, and TNF-alpha levels. METHODS: In a cross-sectional study, levels of OPG were determined in 50 subjects with type 2 diabetes and 59 control subjects without diabetes. The OPG levels between the groups were compared and their correlation with insulin resistance, glycemia and inflammatory markers CRP and TNF-alpha was determined. RESULTS: OPG levels were elevated in subjects with diabetes (6.8+/-0.27 pmol/l), compared to control subjects (5.7+/-0.26 pmol/l). OPG levels significantly correlate with insulin, insulin resistance, CRP, and TNF-alpha. CONCLUSION: OPG levels are significantly correlated with insulin resistance and may reflect the proinflammatory state in type 2 diabetes.

Plasma and urine levels of resistin and adiponectin in chronic kidney disease.

BACKGROUND: Subjects with chronic kidney disease (CKD) have an increased risk of developing coronary atherosclerosis. Adipocyte hormones, resistin and adiponectin are implicated in insulin resistance and atherosclerosis. However, few studies in the literature address the role of adipocyte hormones in CKD. The aim of this study was to compare the levels of resistin, adiponectin and other inflammatory markers in subjects with CKD with those of the control subjects. MATERIALS AND METHODS: In a cross-sectional study, we measured basal metabolic panel, fasting lipid panel and levels of glucose, resistin, adiponectin, insulin, C-reactive protein (CRP) and TNF-alpha in 43 subjects with CKD compared with those of 34 control subjects. We also measured the resistin and adiponectin levels in urine samples (16). RESULTS: Subjects with CKD have increased insulin levels and insulin resistance index (IRI). Compared with controls, subjects with CKD had increased levels of resistin (5.12+/-3.2 vs.7.5+/-5.9; p<0.05), CRP (1.7+/-2.2 vs. 5.97+/-6.0; p<0.0005), and TNF-alpha (3.4+/-2.0 vs. 5.2+/-3.5; p<0.005). Resistin levels correlate with CRP and TNF-alpha, even with BMI as a covariate. Although 60% of subjects with CKD have CAD, e plasma levels of adiponectin were not decreased in subjects with CKD compared with controls (17.02+/-9.8 vs. 16.40+/-9.0 with p value 0.78). Urinary adiponectin levels correlate inversely with GFR (r=-0.4; p<0.05) and plasma adiponectin levels (r=0.9; p<0.0001). CONCLUSIONS: Subjects with CKD had normal levels of plasma adiponectin despite the adverse metabolic environment for CAD. In addition, this study demonstrates the relationship between resistin and TNF-alpha in subjects with CKD and suggests that resistin may play a role in the sub-clinical inflammation associated with CKD, suggesting that adiponectin clearance may be decreased as shown by the inverse correlation of urinary adiponectin with GFR.

Symptomatic ascites in a patient with hypothyroidism of short duration.

Symptomatic ascites as a presenting symptom of hypothyroidism is quite rare. In most of the case reports, patients with ascites requiring therapeutic abdominal paracentesis have long-standing hypothyroidism. We present a case of symptomatic ascites in a subject with hypothyroidism following radioiodine therapy for Graves disease. A 70-year-old African-American man presented with increasing weakness, shortness of breath, weight gain, constipation, and abdominal distention. Past history was significant for coronary artery disease, diabetes, hypertension and history of radioiodine therapy for Graves disease 9 months prior to the presentation. He was taking levothyroxine at 50 microg per day for 3 months prior to the presentation. Physical examination findings were significant for puffiness around the eyes, decreased breath sounds at the lung bases, and distended abdomen with free fluid, hung-up reflexes, and cold extremities. The thyroid-stimulating hormone level at the time was 64 with a free T4 less than 0.4 ng/dL. Analysis of the ascitic fluid revealed an exudative effusion with a serum to ascitic fluid albumin gradient of 1.2. The patient required therapeutic abdominal paracentesis twice, with 4 L each time, to relieve the symptoms. Work-up to rule out other causes did not reveal any other relevant abnormality. After initiation of thyroid hormone replacement, the patient responded very well and the ascites resolved within 2 months. We conclude that ascites associated with hypothyroidism is rare but must be recognized early, since thyroid replacement is the definitive therapy.

Resistin and adiponectin levels in subjects with coronary artery disease and type 2 diabetes.

BACKGROUND: Resistin and adiponectin are implicated in insulin resistance and atherosclerosis. The objective of this study was to evaluate the association between plasma resistin levels and the presence of coronary artery disease (CAD) or diabetes compared to the controls. In a cross-sectional study, we measured glucose, fasting lipid panel, resistin, adiponectin, insulin, C-reactive protein (CRP) and TNF-alpha in 57 subjects with CAD, 58 subjects with diabetes compared to 45 normal control subjects. RESULTS: Subjects with CAD compared to the control subjects had increased insulin resistance index (39+/-32 vs. 13.45+/-12.73 with p<0.0001), CRP levels (3.8+/-4.03 vs. 2.0+/-2.0 with p<0.05) and decreased levels of adiponectin (12.5+/-4.8 vs. 17.26+/-10.4 with p<0.0003). Subjects with diabetes compared to the controls had had increased insulin resistance index (69+/-19 vs. 13.45+/-12.73 with p<0.001), CRP levels (4.1+/-4.8 vs. 2.0+/-2.0 with p<0.01) and decreased levels of adiponectin (11.58+/-4.8 vs. 17.26+/-10.4 with p<0.001). Compared to the controls, there was no significant difference in the levels of resistin in subjects with CAD (4.92+/-3.2 vs. 4.1+/-2.4) as well as diabetes (4.92+/-3.2 vs. 4.6+/-2.6). Both CRP and resistin levels correlate with TNF-alpha (r=0.557, p<0.000001; r=0.84, p<0.000001). CONCLUSIONS: The present study shows decreased plasma adiponectin levels in subjects with diabetes as well as in subjects with CAD is similar to the literature. Plasma levels of resistin in subjects with CAD or diabetes are similar to the controls. However, there was a strong correlation of resistin levels with inflammatory markers. This suggests resistin as an inflammatory marker associated with CAD.

Decreased levels of plasma adiponectin in prediabetes, Type 2 diabetes and coronary artery disease.

BACKGROUND: Adiponectin, an adipocyte-derived hormone is implicated in insulin resistance and atherosclerosis. The aim of our study is to compare the levels of adiponectin in subjects with prediabetes and diabetes with subjects with normal glucose. MATERIAL/METHODS: In a cross sectional study, we measured adiponectin and insulin in addition to fasting lipid panel and glucose in 28 subjects with prediabetes, 28 subjects with normal fasting glucose and 33 subjects with type 2 diabetes. RESULTS: Adiponectin levels negatively correlate with insulin resistance index (r = -32.7). There is a significant difference in the levels of adiponectin between subjects with prediabetes and normal fasting glucose. There is a significant difference in adiponectin levels in subjects with prediabetes with Coronary artery disease (CAD) compared to those without CAD (10.24+/-1.02 vs. 7.02+/-0.92 with p<0.01). There is a significant difference in adiponectin levels in subjects with CAD compared to those without coronary artery disease (9.94+/-1.02 vs. 5.02+/-0.82 with p<0.01). CONCLUSIONS: We conclude that decreased plasma adiponectin and insulin resistance coexist in subjects with prediabetes, diabetes and atherosclerosis. Adiponectin concentration is an independent correlate of insulin resistance and atherosclerosis.

Anaplastic thyroid cancer and hyperthyroidism.

We report a rare case of thyrotoxicosis in a patient with anaplastic thyroid cancer. A 65-yr-old male presented with a 2-d history of rapidly enlarging neck mass and back pain. Physical examination revealed a large, hard thyroid mass and resting tachycardia. He did not have any symptoms suggestive of airway compression at presentation. Thyroid hormone levels were consistent with a hyperthyroid state. CT scan of the neck and thorax showed a heterogeneous mass replacing the thyroid, bilateral pulmonary nodules, and a metastasis with pathological fracture at the level of T-8. Technetium-pertechnetate scan failed to show any uptake in the region of the thyroid. Fine needle aspiration of the thyroid revealed anaplastic thyroid cancer. The patient was started on steroids and radiation therapy of his spine lesion. Brief surgical exploration of the thyroid revealed extensive local infiltration of adjacent neck tissues and marked tumor necrosis. Immunohistochemical stains of the tumor were positive for p53, thyroglobulin, and thyroid transcription factor-1. The tumor had an extremely aggressive course and the patient died of asphyxiation from severe airway compromise 11 d after his initial presentation.

Preliminary evidence of genetic anticipation in type 2 diabetes mellitus.

BACKGROUND: The term "anticipation" in genetic diseases refers to earlier age at onset and/or increased severity in successive generations. Several diseases with genetic anticipation include rheumatoid arthritis, Crohn's disease, Schizophrenia, Graves' disease and several other neuropsychiatric disorders. The aim of the present study was to investigate whether genetic anticipation may occur in diabetes. MATERIAL/METHODS: The medical records of 485 subjects with type 2 diabetes, seen in the Diabetes Clinic were screened for subjects with a family history of diabetes and also aware of a definite date of diagnosis for both the subject and their family member. Ninety-six parent-child pairs with a known definite date of diagnosis of type 2 diabetes were identified and the age at onset of diabetes between two parent-child generations was compared. RESULTS: The age at diagnosis of the subjects with positive family history of diabetes was lower than those with no family history of diabetes (48.82+/-12 vs. 56.18+/-13; p<0.001). There was a significant difference in the mean age at diagnosis between the 1(st) generation and 2(nd) generation (57.39 vs. 52.03 years p<0.0001). When the age at diagnosis of the subjects with siblings was compared (38 sibling pairs), there was no significant difference noted (52.21 vs. 50.57; p=0.35). CONCLUSIONS: Patients in the second affected generation seem to acquire the disease at an earlier time in life, indicating strong evidence of anticipation. We conclude that genetic anticipation might occur in type 2 diabetes.

Changes in adipocyte hormones leptin, resistin, and adiponectin in thyroid dysfunction.

Thyroid hormones as well as the recently discovered secretory products of adipose tissue adiponectin and resistin take part in energy metabolism. To study the changes in the adipocyte hormones with changes in the thyroid functional status, we measured adiponectin, resistin, and leptin in 69 subjects with Graves' disease before and 32 patients at follow up after treatment for hyperthyroidism at hypothyroid state. Concentrations of serum adiponectin and resistin were higher in hyperthyroid state than in hypothyroid state (adiponectin: 5.73 +/- 1.1 vs. 3.0 +/- 0.5 ng/ml, P = 0.03) (resistin: 6.378 +/- 0.6 vs. 5.81 +/- 0.57 ng/ml, P < 0.0001). Resistin levels correlate positively with free t4(r = 0.37, P < 0.01), free t3 levels(r = 0.33, P < 0.01) and negatively with TSH(r = -0.22, P < 0.05). Adiponectin levels correlate with free t4(r = 0.33, P < 0.01) and free t3 (r = 0.44, P < 0.01). Though the adiponectin levels did not correlate with leptin or resistin levels, strong positive correlation of both resistin and adiponectin with thyroid hormones is noted. Serum levels of leptin did not change with change in the thyroid functional status (leptin: 53.38 +/- 2.47 vs. 55.10 +/- 2.58 NS). Leptin levels did not correlate with resistin and adiponectin. We conclude that thyroid function has effect on adipocyte hormones adiponectin and resistin but not leptin.