INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)
Year:2011 | Volume:9 | Issue:3|Papers Count:9

Background: Laparoscopic leal inter Position (II) with sleeve gastrectomy (SG) is an upcoming procedure that helps to improve metabolic profile and leads to weight reduction without causing significant malabsorption, paving the way for usage of the term "metabolic surgery." Objectives: To determine the impact of this novel procedure on glycemic control and the accompanying metabolic abnormalities of type 2 diabetes mellitus (T2DM).Patients and Methods: The II and SG procedures were performed in 38 patients (M: F=24: 14). Despite their usage of optimum dosage of oral hypoglycemic agents (OHAs) and/ or insulin, all patients exhibited poorly controlled T2DM (mean glycosylated hemoglobin [HbA1C]: 9.57±2 %). The primary outcome was a remission of diabetes (HbA1C<6.5% without OHA/insulin). Secondary outcomes included a reduced need for antidiabetic agents and a reduction in symptoms of metabolic syndrome.Results: The mean follow up time was 11.3±9 months (range: 3–32 months). Participants were 47.5±8.8 years of age (range: 29–64 years), had diabetes for a mean duration of 9.7±8.8 years (range: 1–32 years), and had a mean preoperative body mass index (BMI) of 32.05±7.5 kg/m2. Thirty patients (79%) exhibited hypertension, 19 (50%) had dyslipidemia, and 19 (50%) harbored significant micro albuminuria. Postoperatively, glycemic parameters (fasting and post lunch blood sugars, and HbA1C) improved for all patients (P<0.05) at all intervals. Eighteen patients (47%) experienced a remission in diabetes and the remaining patients received a significantly lower OHA dosage. All patients demonstrated 15–30% weight loss (P<0.05). Twenty-seven patients (90%) experienced a remission in hypertension.At 2 years, the mean reduction in HbA1C (36%) was greater than the reduction in BMI (20%). A declining trend in postoperative levels of lipids and micro albuminuria became evident, although the reduction was significant for micro albuminuria only.Conclusions: The laparoscopic II with SG procedure appears promising for gaining control of T2DM and associated morbidities. To substantiate our preliminary findings, additional long-term data that involves a larger number of patients is necessary.

Background: Previous studies used western blotting to show that prolactin (PRL) released from the adenohypophysis (AP) of lactating rats in vitro contains size variants from 7–14 kDa to 70–97 kDa. These variants when eluted from sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) gels and incubated with AP lactotrophs from male rats and rats in other conditions, promoted the selective stimulation and/or inhibition of the in vitro release of PRL variants.Objectives: In the present study, we determined the regulatory effects of dopamine (DA), thyrotropin-releasing hormone (TRH), and oxytocin (OT) on release of PRL variants from AP lactotrophs.Materials and Methods: Primary cultures of lactotrophs from lactating rats, which were non-suckled (NS) for 6 h or suckled (S) for 15 min after NS, were incubated with PRL variants that were electro eluted from SDS-PAGE gels along with different doses of DA (0.5, 1.0, 1.5 µM), TRH (0.1, 1.0, 10 µM), or OT (0.1, 1.0, 10 µM). The secretion of PRL from the lactotrophs was determined by enzyme-linked immunosorbant assay.Results: The results showed stimulatory and/or inhibitory effects of DA, TRH, and OT on the release of PRL variants from AP lactotrophs both by the presence of PRL variants.Conclusions: These results indicate that PRL variants are released from AP lactotrophs, and, in concert with hypothalamic hormones, they regulate the release of PRL from lactating rat APs.

Background: The muscle-bone unit represents an evolutionary system, in which both of its components are under the common control of the insulin-like growth factor I (IGF-I), sex hormones, and vitamin D. The mutual interactions between these hormones maintain integrity, growth and maturation of pubertal bone mass. Thus, insufficiency of any of these hormones will negatively influence development of the skeleton during puberty.Objectives: The aim of the study as to analyse the correlation between muscle mass, total bone mineral content (BMC), bone mineral density (BMD) of the lumbar spine (BMD L1-L4), and serum or urine hormones.Materials and Methods: Total BMC (g) and areal BMD L1-L4 (g/cm2 and Z-score) as well as muscle mass and fat mass (g) were assessed by means of dual-energy X-ray absorptiometry (DXA).The Z-score is the number of standard deviations a patient's BMD which differs from the average BMD of their age, sex, and ethnicity. This Parameter is used in children. Muscle force (N) was measured using a dynamometer.Results: The simple correlations showed strong positive associations between BMC or BMD L1-L4 (g/cm2) and serum phosphate, estradiol, insulin-like growth factor (IGF-I), leptin and fat masses, and muscle force (P<0.001 for all parameters). Positive correlations were also observed between BMD and serum phosphate (P<0.01), IGF-I (P<0.01), estradiol (P<0.001), leptin (P<0.01), fat and lean mass (P<0.001 and P<0.001, respectively) and muscle force (P< 0.001). The partial correlations, after eliminating the impact of height, Tanner stage, and physical activity level, confirmed positive relationships between either BMC or BMD L1-L4 and lean mass (P<0.001 and P<0.001, respectively) and fat mass (P<0.001 for BMC and BMD).Furthermore, a positive relationship was observed between serum leptin and both BMC and BMD (Z score) (P<0.05 and P<0.05, respectively). After removing the effects of height, Tanner stage, and physical activity, positive associations were observed between lean mass and IGF-I (P<0.01), leptin levels (P<0.05), and muscle force (P<0.01).Conclusions: On the basis of the study results, it can be expected that low values of lean or fat mass, and insufficient production of IGF-I or leptin, could negatively influence bone development in pubertal girls.

Background: Graves' disease (GD) is an autoimmune disease that develops as a result of a complex interaction between genetic and environmental factors. Numerous studies have demonstrated the important role ofCTLA4 gene polymorphisms in the susceptibility to this disease. TheCTLA4 gene is located on chromosome 2q33 and codes for the T-cell receptor, which negatively modulates the immune response by disabling T cells.Objectives: The aim of the present work was to determine whether A/G dimorphism at position+49 of exon 1 in theCTLA4 gene contributes to the severity and clinical manifestations of GD.Patients and Methods: We performed clinical and genetic studies on 100 Graves’ patients and 50 healthy controls. We determined the subjects' genotypes for the+49 A/G polymorphism of theCTLA4 gene by PCR and an enzyme restriction test. Comparison of individual clinical and laboratory variables between genotypes was performed using SPSS 17.0 (SPSS, Chicago, IL, USA).Results: We found a statistically significant relationship between CTLA4 gene polymorphism and ophthalmopathy in Graves' patients.Conclusions: The+49A/G SNP of the CTLA4 gene is related to the development of Graves' disease, however, more studies are necessary to clarify the role of theCTLA4 gene in influencing GD susceptibility and to explore other potential costimulation pathways in this disorder.

Background: Clomiphene citrate (CC) has been considered as the most effective drug to treat female infertility which is highly effective in inducing ovulation in females with anovulation or oligo-ovulation, however, it may induce partial inhibition of ovulation because of its inhibitory action on follicular growth and atresia of nonantral and mature follicles.Objectives: The present experiment was conducted to study the effect of CC on follicular development (experiment 1) and superovulation (experiment 2) during the first follicular wave in Rahmani sheep with a 22-day ovulation cycle.Patients and Methods: In experiment 1, the animals were divided into 2 groups, namely, control (n=7) and CC (n=6) groups. The estrous cycles of the animals in both groups were synchronized by administering two 15-mg/mL doses of Dinoprost at a 10-day interval. Onset of ovulation (day 0 [D0]) was confirmed by performing transrectal ultrasonography. The animals in the CC group received 100 mg of oral CC daily for 5 consecutive days. In experiment 2, the estrous cycles of the animals were synchronized as mentioned previously, and the animals were divided into 2 groups: (1) the equine chorionic gonadotropin (eCG) group (n=4), in which the animals received 2000 IU of eCG intramuscularly (i.m.) for 5 days, and (2) the eCG and CC group (n=5), in which the animals received 2000 IU of eCG i.m and 100 mg CC orally for 5 days.Results: We observed a significant (P<0.05) increase in the number of follicles from D2 to D5 and in the levels of estradiol (E2) from D1 to D4 after CC treatment, with no significant differences between the progesterone (P4) levels in both the groups. The increase in the number of follicles in the eCG and CC group was not as significant as that in the eCG group. The E2 level in the eCG group was significantly higher than that in the eCG and CC group from D1 to D3.Conclusions: In conclusion, administration of CC increased the number of the growing follicles and plasma E2 levels. However, CC administered during superovulation did not increase the number of ovulating follicles and negatively affected the E2 level.

Metabolic programming (MP) is defined the induction, deletion, or impaired development of a somatic structure or "setting" of a physiological system by an early life stimulus.Epidemiological and animal studies support the theory that suboptimal intrauterine conditions are associated with non-communicable disease (NCD) in adulthood. Using ovine models, we investigated the long-term consequences of late gestation under nutrition on glucose–nsulin axis function and energy metabolism. We found that early life under nutrition had life-lasting consequences on insulin-secretory and adipose lipolytic capacity as well as intermediary metabolism later in life. Furthermore, we showed that suboptimal intrauterine nutrition impairs energy expenditure (EE) in gestation, apparently via an increase in the energy cost of conceptus development. Our findings, and those of other studies, support the hypothesis that energy balance is, to a certain extent, programmed early in life, presumably through appetite, EE, physical activity, and/or disproportional postnatal growth programming.

Pheochromocytomas have been described to be associated with rare vascular abnormalities, most common of them being renal artery stenosis. A 40-year-old woman was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting, and severe hypertension. Examination revealed absent carotid and upper-limb pulses with an intact lower-limb pulse. Abdominal computed tomography revealed the presence of a left adrenal pheochromocytoma. An aortogram showed total occlusion of the aortic arch arteries. the Pheochromocytoma was surgically removed, and the patient was then administered steroid treatment for arteritis. To the best of our knowledge, the occurrence of pheochromocytoma along with aortoarteritis has not been reported thus far. The possible mechanisms underlying such an involvement have been discussed in this study.

Metformin, a diabetes drug, has been used to control hyperglycemia in patients with type 2 diabetes for more than 50 years. Metformin exerts its antidiabetic activity by counteracting insulin resistance to hepatic glucose production and/or increasing the insulin-stimulated glucose uptake in muscle and fat. In addition to controlling blood glucose levels, it has also been shown to reduce the long-term complications of diabetes, including micro- and macrovascular diseases (1). Metformin has also been reported to reduce the incidence of type 2 diabetes in high-risk individuals with impaired glucose tolerance (2). Although lactic acidosis has been reported in patients treated with metformin, the drug is considered as the safest hypoglycemic agent to date. In contrast to treatment with other oral drugs and insulin, metformin monotherapy is not associated with the risk of hypoglycemia, nor does it cause weight gain (3). Moreover, recent studies have shown that metformin reduces the risks of developing solid organ cancer (4) and osteoporosis (5). Thus, the drug has been recently recognized as the first-line oral agent for the treatment of type 2 diabetes, particularly in overweight patients...

The role of insulin and insulin growth factor-1 (IGF-1) in the brain has been extensively revaluated in the last two decades. Several previous studies have shown that insulin is involved in a number of neurotrophic, neuromodulatory, and/or neuroendocrine effects, including the appetite control and energy expenditure and the interaction between insulin resistance, diabetes, and amyloid deposition in Alzheimer's disease (1, 2).Insulin acts as a growth factor in the brain, providing a neuroprotective action by activating dendritic sprouting, regeneration and stem cell proliferation (3). Together with other peptides, like ghrelin or cholecystokinin, insulin is involved in the complex neuropeptidergic signaling network in the hypothalamus which regulates anabolic and catabolic balance (4)...