Cardiovascular complications are the most common causes of morbidity and mortality in acromegaly. However, there is little data regarding cardiac autonomic functions in these patients. Herein, we ...aimed to investigate several parameters of cardiac autonomic functions in patients with acromegaly compared to healthy subjects. We enrolled 20 newly diagnosed acromegalic patients (55 % female, age:45.7 ± 12.6 years) and 32 age- and gender-matched healthy subjects. All participants underwent 24 h Holter recording. Heart rate recovery (HRR) indices were calculated by subtracting 1st, 2nd and 3rd minute heart rates from maximal heart rate. All patients underwent heart rate variability (HRV) and QT dynamicity analysis. Baseline characteristics were similar except diabetes mellitus and hypertension among groups. Mean HRR1 (29.2 ± 12.3 vs 42.6 ± 6.5,
p
= 0.001), HRR2 (43.5 ± 15.6 vs 61.1 ± 10.8,
p
= 0.001) and HRR3 (46.4 ± 16.2 vs 65.8 ± 9.8,
p
= 0.001) values were significantly higher in control group. HRV parameters as, SDNN standard deviation of all NN intervals (
p
= 0.001), SDANN SD of the 5 min mean RR intervals (
p
= 0.001), RMSSD root square of successive differences in RR interval (
p
= 0.001), PNN50 proportion of differences in successive NN intervals >50 ms (
p
= 0.001) and high-frequency HF (
p
= 0.001) were significantly decreased in patients with acromegaly; but low frequency LF (
p
= 0.046) and LF/HF (
p
= 0.001) were significantly higher in acromegaly patients. QTec (
p
= 0.009), QTac/RR slope (
p
= 0.017) and QTec/RR slope (
p
= 0.01) were significantly higher in patients with acromegaly. Additionally, there were significant negative correlation of disease duration with HRR2, HRR3, SDNN, PNN50, RMSSD, variability index. Our study results suggest that cardiac autonomic functions are impaired in patients with acromegaly. Further large scale studies are needed to exhibit the prognostic significance of impaired autonomic functions in patients with acromegaly.
Dermal Neurovascular Dysfunction in Type 2 Diabetes
Aaron I. Vinik , MD, PHD ,
Tomris Erbas , MD ,
Tae Sun Park , MD ,
Kevin B. Stansberry , BS ,
John A. Scanelli and
Gary L. Pittenger , PHD
...Department of Medicine and Pathology/Anatomy/Neurobiology, the Strelitz Diabetes Research Institutes, Eastern Virginia Medical
School, Norfolk, Virginia
Abstract
OBJECTIVE —To review evidence for a relationship between dermal neurovascular dysfunction and other components of the metabolic syndrome
of type 2 diabetes.
RESEARCH DESIGN AND METHODS —We review and present data supporting concepts relating dermal neurovascular function to prediabetes and the metabolic syndrome.
Skin blood flow can be easily measured by laser Doppler techniques.
RESULTS —Heat and gravity have been shown to have specific neural, nitrergic, and independent mediators to regulate skin blood flow.
We describe data showing that this new tool identifies dermal neurovascular dysfunction in the majority of type 2 diabetic
patients. The defect in skin vasodilation is detectable before the development of diabetes and is partially correctable with
insulin sensitizers. This defect is associated with C-fiber dysfunction (i.e., the dermal neurovascular unit) and coexists
with variables of the insulin resistance syndrome. The defect most likely results from an imbalance among the endogenous vasodilator
compound nitric oxide, the vasodilator neuropeptides substance P and calcitonin gene-related peptide, and the vasoconstrictors
angiotensin II and endothelin. Hypertension per se increases skin vasodilation and does not impair the responses to gravity,
which is opposite to that of diabetes, suggesting that the effects of diabetes override and counteract those of hypertension.
CONCLUSIONS —These observations suggest that dermal neurovascular function is largely regulated by peripheral C-fiber neurons and that
dysregulation may be a component of the metabolic syndrome associated with type 2 diabetes.
Ang, angiotensin
CGRP, calcitonin gene-related peptide
eNOS, endothelial NOS
ET, endothelin
iNOS, inducible NOS
IR, insulin resistance
l-NAME, NG-nitro-arginine-methyl ester
NGF, nerve growth factor
nNOS, neuronal NOS
NO, nitric oxide
NOS, nitric oxide synthase
PGP 9.5, protein gene product 9.5
VIP, vasoactive intestinal polypeptide
VR1, vanilloid receptor 1
Footnotes
Address correspondence and reprint requests to Adrienne E. Nagy, Managing Editor, SCP Communications, Inc., 134 W. 29th St.,
4th Fl., New York, NY 10001. E-mail: adrienne.nagy{at}scp.com .
Received for publication 8 August 2000 and accepted in revised form 20 April 2001.
A.I.V. has acted as a consultant and/or served on the Speaker’s Bureau for the following companies: Pfizer, Parke-Davis, Amgen,
Asta Medica, Merck, Athena, Pharmacia & UpJohn, SmithKline Beecham, Boston Medical Technologies, Global Medical Products,
Sandoz Pharmaceuticals, Genetech, Alteon, Myelos Corporation, Eli Lilly, Bristol-Myers Squibb, Knoll Pharmaceuticals, Wyeth-Ayerst
Laboratories, and Neurometrix. He has also received grant support from multiple organizations.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The objective of this study was to investigate the effect of hyperprolactinemia and high levels of insulin-like growth factor-I (IGF-I) on bone resorption and their relation with receptor activator ...of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) in patients with prolactinoma and acromegaly. Thirty-one patients with acromegaly, 28 patients with prolactinoma, and 33 healthy individuals were included in the study. Serum concentrations of RANKL, OPG, bone alkaline phosphatase (bone ALP), osteocalcin (OC), C-terminal telopeptide of type 1 collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP) and urine deoxypyridinoline (DPD) levels were detected and bone mineral density (BMD) was measured. Groups were not statistically different from each other with regard to serum levels of RANKL and OPG. The RANKL/OPG ratio was higher in the prolactinoma group than in the control group (p=0.046). A positive correlation between OPG and increasing age was detected in both the prolactinoma and control groups (r=0.524, p=0.004 and r=0.380, p=0.029, respectively). An inverse correlation was observed between IGF-I and OPG after excluding age in the prolactinoma group (r=-0.412, p=0.046). OC and bone ALP were negatively associated with RANKL in the acromegaly group (r=-0.384, p=0.036 and r=-0.528, p=0.003, respectively). There was an inverse correlation between OPG and BMD at the femoral neck in the acromegaly group (r=-0.422, p=0.02). The effect of IGF-I on bone remodeling may be partly mediated by RANKL and OPG. The RANKL/OPG ratio plays an important role in prolactinoma. A positive correlation of OPG with age and an inverse correlation with IGF-I favor the compensatory response of OPG against bone loss in the aging skeleton.
Objective: To evaluate the effects of treatment on left ventricular (LV) performance and endothelial function in patients with acromegaly. Method: Nineteen patients with active acromegaly (AA), 18 ...patients with cured/well‐controlled acromegaly (CA), and 25 healthy control subjects were studied. LV performance was evaluated by two‐dimensional/Doppler echocardiography and Doppler tissue imaging (TDI). Flow‐mediated dilatation (FMD) was measured by B‐mode ultrasound. Endothelial cell markers; thrombomodulin (TM), and P‐selectin were also measured. Results: Tei index was higher than the control subjects in both acromegaly groups. The ratio of early and late diastolic annular velocities (Em′/Am′) was significantly lower in the AA group than the other groups (P < 0.05). FMD in both acromegaly groups was significantly lower than the controls (P < 0.001) but difference between acromegaly groups was not significant (P > 0.05). In the CA group, P‐selectin was higher than the controls and was even higher in the AA (P < 0.05). TM was significantly higher in the active group (P < 0.05) and not different than the controls in the CA group. Conclusion: TDI determine LV performance changes in acromegaly earlier than conventional echocardiographic methods. Endothelial function both in the form of FMD and endothelial cell markers is impaired in acromegaly. While in cured acromegaly endothelial cell injury, as evidenced by TM levels, is decreased, endothelial dysfunction still persists. (Echocardiography 2010;27:990‐996)
The goals of Type 2 diabetes treatment are to eliminate the hyperglycemia resulting from insulin insufficiency and/or insulin resistance, delay beta cell damage/depletion, and prevent other metabolic ...co-morbidities and complications. In the current treatment algorithms, lifestyle changes (medical nutrition therapy, physical exercise) and oral anti-diabetics are followed by insulin therapy, which is considered a replacement therapy for Type 2 diabetes. Pre-mixed insulin preparations, which are an option for patients with poor blood glucose level control under oral anti-diabetics treatment, have been developed to meet both basal and prandial insulin needs by simulating the physiological changes in insulin levels. The consensus on the necessity of individualizing insulin therapy requires physicians to have a detailed knowledge of the various uses of insulin. Therefore, this comprehensive consensus statement has been prepared by a panel of expert endocrinologists from different regions of Turkey to help physicians use biphasic insulin aspart 30 in suitable patients at the right time. In this statement, expert panel opinions on (a) Recommendations for the appropriate initiation, titration, and intensification of insulin treatment, and (b) The treatment algorithms in initiation, titration, and intensification of biphasic insulin aspart 30 treatment and special conditions specific to changing treatment regimen are presented.
This study aims to examine the acute and short-term effects of prebiotics, probiotics, and their combination on appetite, energy intake and satiety related hormones in two phases. The first phase was ...a randomized, double blind, placebo controlled crossover study. Prebiotic (16 g inulin), probiotic (Lactobacillus paracasei subsp. paracasei 431 (L. casei 431) (>106 cfu/ml), synbiotic (their combination) and control (16 g maltodextrin) dairy drinks were consumed by 16 healthy men with a standard breakfast on four separate test days, and the following satiety responses and ad libitum food intake at lunch and over 24 h were assessed. In the second phase, the effects of 21 days of synbiotic (n = 10) or control (n = 11) drink consumption on appetite sensation, energy intake, serum glucose, insulin, peptide YY, ghrelin, obestatin and adiponectin concentration were assessed in a randomized double-blind placebo-controlled design. In the first phase, energy intake values during ad libitum lunch were the lowest in the prebiotic drink, followed by probiotic, synbiotic and control drinks, respectively (p = 0.017); also the rest of the day and 24-h dietary energy intake was lower by prebiotic and probiotic drinks compared to the control drink (p < 0.05 for each). For short-term effects, no significant difference in anthropometric measurements, hunger-satiety scores and serum glucose, insulin, PYY, ghrelin, obestatin and adiponectin concentrations were recorded. Despite the potential of prebiotics and probiotics to reduce energy intake, further studies are required for a better understanding of their role in satiety related mechanisms.
Objective
Prolactinoma can increase the risk of cardiovascular diseases (CVDs), such as arterial stiffness, atherosclerosis, dysrhythmia and heart failure. This study aimed to evaluate and compare ...muscle function, exercise capacity, physical activity (PA) level, CVD risk factor knowledge level, sleep quality, fatigue and quality of life between prolactinoma patients and healthy controls.
Methods
Nineteen female patients with prolactinomas and 19 healthy women were included in this study. Quadriceps muscle strength (QMS) was measured using a hand dynamometer, and muscular endurance was evaluated via the squat test. The 6-minute walking test (6MWT) distance was also measured. CVD risk factor knowledge levels were evaluated with the Cardiovascular Diseases Risk Factors Knowledge Level Scale (CARRF-KL), PA levels were assessed with the International Physical Activity Questionnaire-short form (IPAQ), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), fatigue was assessed with the Multidimensional Fatigue Rating Scale (MAF), and quality of life was assessed with the Short Form-36 questionnaire (SF-36).
Results
Patients with prolactinomas had significantly lower 6MWT distances; CARRF-KL total scores; SF-36 general health and physical limitation scores; and higher IPAQ-sitting scores than did healthy controls
(p
<
0.05)
. Moreover, there were no significant differences between the groups in terms of QMS score; number of squats; severity of IPAQ score; severity, moderate, or total walking score; total PSQI score; or total MAF score
(p
>
0.05)
.
Conclusions
Exercise capacity and quality of life are adversely affected, and sedentary behavior is observed in prolactinomas. Patients with prolactinomas have less knowledge about CVD risk factors than healthy individuals. CVD incidence and knowledge and functional capacity should be improved in patients with prolactinomas by the use of a multidisciplinary team for cardiac rehabilitation.
Clinical trial registration
This study is part of a larger clinical trial registered on ClinicalTrials.gov prior to participant enrollment (NCT05236829).
Abstract
Context
Nonalcoholic fatty liver disease (NAFLD) is a metabolical disorder and can lead to liver fibrosis. Because it is commonly seen, several noninvasive scores (NS) have been validated to ...identify high-risk patients. Patients with NAFLD have been shown to have higher serum angiopoietin-like protein-8 (ANGPTL-8) levels.
Objective
The risk of NAFLD is known insufficiently in acromegaly. Moreover, the utility of the NS and the link between NAFLD and ANGPTL-8 in acromegaly is unknown.
Methods
Thirty-two patients with acromegaly (n = 15, active AA and n = 17, controlled acromegaly CA) and 19 healthy controls were included. Magnetic resonance imaging (MRI)-proton density fat fraction (PDFF) was used to evaluate hepatic steatosis, and magnetic resonance elastography to evaluate liver stiffness measurement. ANGPTL-8 levels were measured with ELISA.
Results
Median liver MRI-PDFF and NAFLD prevalence in AA were lower than in CA (P = .026 and P < .001, respectively). Median magnetic resonance elastography-liver stiffness measurement were similar across groups. Of the NS, visceral adiposity index, fatty liver index, hepatic steatosis index, and triglyceride-glucose index (TyG) all showed positive correlation with the liver MRI-PDFF in the control group. However, only TyG significantly correlated with liver fat in the AA and CA groups. There was no correlation between traditional NAFLD risk factors (body mass index, waist circumference, C-reactive protein, homeostasis model assessment for insulin resistance, visceral adipose tissue) and liver MRI-PDFF in the AA and CA. Patients with acromegaly with NAFLD had lower GH, IGF-1, and ANGPTL-8 levels than in those without NAFLD (P = .025, P = .011, and P = .036, respectively).
Conclusion
Active acromegaly may protect from NAFLD because of high GH. In patients with acromegaly, NAFLD risk cannot be explained with classical risk factors; hence, additional risk factors must be identified. TyG is the best score to evaluate NAFLD risk. Lower ANGPTL-8 in patients with acromegaly and NAFLD implies this hormone may be raised because of insulin resistance rather than being a cause for NAFLD.
Introduction & Objective: Eating disorders are a common issue in T1DM. The use of diabetes technologies in this patient group is controversial. In this study, we investigated the impact of eating ...disorders on the clinical course of T1DM and how insulin pumps affect treatment goals. Methods: In a prospective, case-control study, the Diabetes Eating Problem Survey-Revised (DEPS-R) was used as a screening tool for diabetes-specific eating disorders in T1DM. A total score of ≥20 indicates a high risk for eating disorders. All patients were divided into 2 groups based on DEPS-R scores: those at high risk for eating disorders (n:42 cases, F/M: 26/16, age: 26.5 years, disease-duration: 11.5 years, HbA1c: %8.4, rates of minor hypoglycemic events >1 per week: %57.1, history of major hypoglycemic events on treatment: %11.9, hypoglycemia unawareness: %11.9) and those not at high risk (n:75 controls, F/M: 48/27, age: 29 years, disease-duration: 16 years, HbA1c: %7.5, rates of minor hypoglycemic events >1 per week: %60, history of major hypoglycemic events on treatment: %22.7, hypoglycemia unawareness: %13.3). Patients with confirmed or suspected Munchausen Syndrome were excluded. These 2 groups were compared in terms of clinical predictors, complications, and comorbidities. Patients at high risk for eating disorders using insulin pumps were compared with those not using pumps in terms of HbA1c, glycemic variability, and hypoglycemia. Results: Younger age, shorter disease duration, and higher HbA1c are associated with a higher risk of eating disorders. When cases with DEPS-R scores ≥20 were compared as active pump users (n:13) versus MDI (n:29), pump provides lower HbA1c (%7.8 vs %9.4, p=0.005), lower major hypoglycemic events (%0 vs %17.2, p=0.302), and lower glycemic variability (0.66 vs 0.90, p=0.041). Conclusion: When Munchausen Syndrome is excluded, we suggest with these data that insulin pump therapy is also safe and efficient for patients with high risk of eating disorders in T1DM. Disclosure B. Sasmazer: None. S. Keles: None. U. Ünlütürk: None. A. Gürlek: None. T. Erbas: None. S. Dagdelen: None.
Pituitary apoplexy (PA) during pregnancy is a rare acute clinical situation which could have life-threatening consequences. Here we reported a case of 26-year-old nulliparous woman presenting with PA ...at the second trimester of her pregnancy. We also have reviewed reported cases of PA during pregnancy and conducted a detailed discussion on presenting symptoms, underlying pituitary pathology, management of apoplexy during pregnancy and outcomes.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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