ACTA ENDOCRINOLOGICA (BUC)

Context. Nesfatin-1 is a novel peptide with both central and peripheral anorexigenic regulatory properties. Besides its effects on food intake, few studies have suggested a possible role for this peptide in the pathogenesis of diabetes mellitus type 2. Objective. To compare serum levels of nesfatin-1 between healthy, normal-weight persons and three groups including healthy underweight, healthy obese and diabetic subjects. Design. Prospective, case-control study, performed between January 2015 and January 2016. Subjects and Methods. Fasting levels in serum nesfatin-1 were measured in 30 healthy, normal-weight individuals (controls), 30 healthy underweight persons, 30 healthy obese persons, and 30 patients with newly diagnosed diabetes type 2 using standard enzyme-linked immunosorbent assay (ELISA) kits. Results. The mean serum nesfatin-1 level was significantly higher in controls (2.61 ng/mL) compared to that in obese (1.13 ng/mL) and diabetic (0.99 ng/mL) patients; and significantly lower than that in the underweight group (3.50 ng/mL). The obese and diabetic groups were comparable in this regard. No significant association was found between serum nesfatin-1 level and age, sex, or body mass index. Conclusions. Serum nesfatin-1 is possibly associated with weight-related abnormalities in otherwise healthy subjects and diabetes type 2. Obesity and diabetes type 2 may share a common pathologic point in this regard.

Context: rising incidence of Gestational diabetes mellitus (GDM) has been reported in the recent years and it has become an important public health problem, mainly among women aged 35-39 years. Objectives: Frequency of GDM in the females who are living in the northwest of Iran was evaluated. Subjects and Methods: two hundred and fifty pregnant women at 24-28th weeks of gestation were screened using 50 g oral glucose challenge test (OGCT), and the subjects with blood sugar levels equal or greater than 130 mg/dl were referred to diagnostic 100 g oral glucose tolerance test (OGTT). GDM was diagnosed according to Carpenter and Coustan criteria. Results: eighty six women (34.4%) with positive result of screening test were selected for subsequent OGTT with 100 g oral glucose. GDM was diagnosed in twenty four women (9.6 %) with at least 2 abnormal values. Frequency of GDM in the older subjects or the subjects with high pre-pregnancy or 24-28th weeks’ body mass index(BMI) were significantly higher than younger pregnant females or the subjects with low BMI. Conclusion: Prevalence of GDM in the current study was 11.9%, which is higher than earlier reports and implicates that the prevalence of gestational diabetes mellitus has markedly been increasing in Iran and associated with maternal age and body mass index.

Background. Occult papillary thyroid carcinoma presented as isolated cervical lymphadenopathy without clinical and radiologic findings has been rarely reported. Case report. A 47 years old female patient admitted to otorhinolaryngology clinic with 4X3 cm sized cervical mass. Physical examination of the patient was noted as a nontender, firm, mobile lymph node at right lateral cervical region. There was no inflammatory or infection disease in the history of patients anamnesis and no abnormal value on laboratory tests. Ultrasound screening of the neck detected a lymph node with suspicious features for malignancy. Head and neck examination was normal and there is no evidence of a tumoral mass or nodule in the thyroid gland. Whole body scan of MRI showed no pathologic sign both in the neck and body. Excisional biopsy was performed and revealed a carcinoma with papillary morphology. Immunohistochemical staining features of the tumor confirmed a papillary carcinoma derived from the thyroid gland. Second look USG of the neck and thyroid was performed but it revealed no tumoral mass. The patient underwent total thyroidectomy with right functional and central lymph node dissection. Histological examination of the thyroid gland showed multicentric 2 mm sized, three foci of papillary carcinoma located in bilateral thyroid lobes and metastatic lymph nodes in the right side of the neck. Conclusion. A metastatic cervical lymph node can be evidence of a clinically undetected occult papillary thyroid carcinoma. Specific immunohistochemistry staining of specimen may lead to appropriate surgery and progression of carcinoma may be hindered by application of additional RAI therapy.

Aim. The aim of our study was to investigate the effect of pioglitazone on glycemic and blood pressure control, on inflammation markers in diabetic patients.\r\nPatients and methods. Forty-nine diabetic patients who had been followed up as outpatients for 2.7 years and HbA1c was >7% were included in the study. The patients had never received thiazolidinedione therapy before. Clinical, metabolic variables, high-sensitive Creactive protein (hsCRP), homocysteine (HCY) and asymmetric dimethylarginine (ADMA) levels were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison.\r\nResults. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and HsCRP were decreased. Insulin resistance was improved and HOMA-IR index was decreased after pioglitazone treatment [8 (?6.5) vs 4(?3.1); p<0.0001]. Pioglitazone improved lipid metabolism. Mean total cholesterol and LDL cholesterol levels were decreased and HDL cholesterol was increased after treatment. The decrease in triglyceride and homocysteine levels did not reach significance. Mean ADMA level did not change after therapy [0.62 (?0.39) vs 0.61 (?0.44); p=0.85].\r\nConclusion. Pioglitazone treatment in type 2 DM produced significant improvements in measures of glycemic control, plasma lipids, blood pressure and homocysteine levels. Pioglitazone had no influence on ADMA levels.

Context. Health anxiety was rarely investigated in Type II Diabetes Mellitus (T2DM). Objectives. The present study examines the effect of health anxiety on glycemic control and evaluates factors associated with health anxiety in patients with T2DM according to HbA1c level. Design. Cross-sectional. Subjects and Methods. Socio Demographic Data Form (SDVF), Health Anxiety Inventory-Short Form(SHAI), The Hospital Anxiety and Depression Scale (HADS) were administered to 185 patients with Type II DM . Patients were divided into two groups according to HbA1 c level (HbA1c levels below 7 (Group 1, n=69) and above 7 (Group 2, n=185)). We analyzed prevalence of health anxiety, factors associated with health anxiety between poor and good glycemic control and evaluated of T2DM patients according to health anxiety scale scores. Results. SHAI scale scores were low in 52 (28%), intermediate in 58 (31.2%) and high in 76 (40.8%) of the patients. We found the severity of depressive symptoms was positively correlated with health anxiety in both groups. As a result of this study, there was a relationship between high education and low socioeconomic level, having a job, exercise and anxiety level and low SHAI score in T2DM patients. Depression, stressful life events in the last 6 months were related with high health anxiety. Although the level of health anxiety was not different between groups, low blood sugar levels were related with high health anxiety. Conclusions. This study found that the prevalence of health anxiety in T2DM patients was higher than expected irrespective to poor or good glycemic control, but level of health anxiety in patients with T2DM is not a good predictor for the HbA1c level.

Context. Overproduction of proinflammatory cytokines plays a significant role in the pathogenesis of Hashimoto’s thyroiditis (HT). Recent studies revealed a prominent role of newly discovered Th17 subset in the induction of autoimmune disorders and that the signaling induced by IL-23 on Th17 cells is crucial to obtain a pathogenic and sustained phenotype. The objective of this study was to provide the involvement of interleukin IL-23/ IL-17 axis in pathologic processes. Design. Serum levels of IL-23 and IL-17 in controls and HT patients were studied in different stages of disease activity. Subjects and methods. We investigated 93 patients with HT: 33 patients with newly diagnosed euthyroid HT (Group I), 11 patients with newly diagnosed hypothyroid HT (Group II), and 49 subjects treated with Levothyroxine (Group III). Thirty healthy subjects were included as controls. Concentrations of IL-23 and IL-17 in the serum samples of patients and controls were evaluated by enzymelinked immunosorbent assay. Results. Serum level of IL-23 was significantly higher in all HT patients (p<0.0001) as well as in subgroups of patients in comparison with controls (p<0.01). Serum concentrations of IL-17 were statistically increased in the group of HT patients (p=0.014); the differences in IL-17 levels between groups I and III in comparison to healthy controls were also significant, but not for group II. Conclusions. Our results highlight the involvement of the IL-23/IL-17 axis in the development of HT and its severity. Moreover, upregulated secretion of IL-23 could be a biomarker for progression and monitoring of HT.

Purpose. To investigate the association between papillary thyroid cancer (PTC) and Hashimoto’s thyroiditis (HT). Design. This study is a retrospective study that conducted during 7 consecutive years with a median 119.5 months follow-up. Subjects and Method. Patients who underwent thyroidectomy in Dokuz Eylül University Hospital during 7 consecutive years were included. Patients’ demographics, biochemical, radiological, and pathological results were retrospectively assessed. Results. Four hundred sixty nine patients were evaluated. Among 469 patients who underwent thyroidectomy, 132 (28.1%) were malignant, while 182 patients were diagnosed with HT (38.8%). PTC was ranked first at 92.4% (n: 122). The prevalence of HT was 54.9% in patients with PTC and 33.1% in patients without PTC diagnosis (p<0.001). Younger age and the presence of HT were independently associated with PTC. The presence of HT was associated with increased risk of development of PTC (OR: 2.2, %95 CI: 1.4-3.5, p<0.001) but not with TNM stage or recurrence. Lymph node metastasis at presentation was the strongest predictor of recurrence (OR: 13.9, CI: 3.5-54.6, p<0.001) Conclusions. HT was an independent risk factor for development of PTC. According to our findings, HT patients (particularly with nodular HT) should be observed carefully and thyroid fine needle aspiration biopsy (TFNAB) should be encouraged if necessary.

Background. Heart rate recovery after exercise is a predictor of mortality that is thought to reflect autonomic imbalance. The association between heart rate recovery and prediabetic stages is unclear. Aim. To evaluate the heart rate recovery in patients with diabetes and prediabetes. Patients and Methods. Thirtyfive patients with impaired fasting glucose, 32 patients with impaired glucose tolerance, and 34 patients with diabetes mellitus were included. The control group consisted of 30 healthy individuals. All study participants underwent a maximal graded exercise test, and heart rate recovery was calculated by subtracting the 1st, 2nd and 3rd minute heart rates from the maximum heart rate achieved during the stress testing. Results. The 1st, 2nd and 3rd minute heart rate recovery values of the diabetes mellitus, impaired glucose tolerance and impaired fasting glucose groups were significantly lower than that of the control group. For the 1st minute, heart rate recovery values of the diabetes mellitus patients were significantly lower than that of the control group (19.8±9.4 vs. 25.4±9.9, p<0.001) and the impaired fasting glucose group (19.8±9.4 vs. 22.1±9.3, p<0.01), and the 1st minute heart rate recovery of the diabetes mellitus patients was similar to that of the impaired glucose tolerance group (19.8±9.4 vs. 20.7±5.8, p=0.88). Similar results were obtained in the 2nd and 3rd minute heart rate recovery measurements. The heart rate recovery values of the impaired fasting glucose were significantly higher than those of the diabetes mellitus and impaired glucose tolerance patients. In comparing the impaired glucose tolerance and diabetes mellitus groups in terms of heart rate recovery values, there was no significant difference.

Context. Nonalcoholic fatty liver disease (NAFLD) includes simple steatosis, steatohepatitis (NASH) which can evolve with progressive fibrosis, cirrhosis and hepatocellular carcinoma. As liver biopsy cannot be used as a screening method, noninvasive markers are needed. Objective. The aim of this study was to test if there is a significant association between vitamin D deficit and the severity of NAFLD. Design. The patients were divided into two groups (vitamin D insufficiency/deficiency) and statistical analyses were performed on the correlation of clinical and biochemical characteristics with histopathological hepatic changes. Subjects and methods. We prospectively studied 64 obese patients referred for bariatric surgery between 2014 and 2016 to our Surgical Unit. Anthropometric, clinical measurements, general and specific biological balance were noted. NAFLD diagnosis and activity score (NAS) were evaluated on liver biopsies. Results. Increased serum fibrinogen was correlated with NASH (p=0.005) and higher NAS grade. T2DM was positively correlated with liver fibrosis (p=0.002). 84.37% of the patients had vitamin D deficit and 15.62% were vitamin D insufficient. Lobular inflammation correlated with vitamin D deficit (p=0.040). Fibrosis (p=0.050) and steatohepatitis (p=0.032) were independent predictors of low vitamin D concentration. Conclusions. Vitamin D status in conjunction with other parameters - such as T2DM - or serum biomarkers – namely fibrinogen level and PCR level - may point out the aggressive forms of NAFLD and the need for liver biopsy for appropriate management.