مجله‌ي بین المللی غدد درون‌ريز و متابوليسمInt J Endocrinol MetabMedical Scienceshttp://www.ijem.org1726-913Xen

Randomized Controlled Trial on Comparison of the Course of Hyperthyroid Patients with and Without Antithyroid Drugs During the Immediate Post Radioactive Iodine Treatment PeriodGafate MFR, Mercado-Asis LGafate MFR Mercado-Asis L Section of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Sto Tomas Hospital, Manila, Philippnes Original ArticleThis study was done to compare the clinical course of hyperthyroid patients with and without anti-thyroid drugs immediately post radioactive iodine treatment. Materials and Methods: Patients with mild to moderate hyperthyroidism, aged 18 to 60 years, were divided into 2 groups, those who received RAI plus anti-thyroid (ATD) (propylthiouracil 100 mg q8H) (group A) and those who received RAI only (group B). Fixed doses of 8 mCi 131I were given and symptoms were scored daily for 3 weeks, using 3-severe, 2-moderate, 1-mild scores. Descriptive analysis using mean and standard deviation was used to determine the demographic profiles and Mann Whitney t-test for independent samples was utilized to com-pare the symptoms between the two groups. All statistical tests were pegged at .05 alpha level and p-values less than .05 were considered sig-nificant. Results: There were 3 males and 5 females in group A (n=8, mean age: 38±12.82 yrs) and 2 males and 6 females in group B, (n=8, mean age: 41.37±15.14 yrs). TSH was suppressed in both groups and the mean FT4 for group A was 13.87±16.51 pmol/L, and for group B was 28.51±15.86 pmol/L. There was no significant dif-ference in age, FT4 and TSH. Mean scores were as follows: (Group A vs. Group B), week one: 1.36 vs. 1.55 (p=0.01); week two: 1.08 vs. 0.94 (p= 0.110), and week three: 0.71 vs. 0.92 (p= 0.006). A highly significant decrease in symptoms was noted in week three. Conclusion: Analysis of our data showed that patients given ATD immediately post RAI ex-perienced lesser symptoms of thyrotoxicosis dur-ing the first and third week after RAI treatment, favoring treatment with ATD. Hyperthyroidism, Antithyroid drugs, Radioactive iodineHyperthyroid patients after radioactive treatmentLeilani B6/17/2007 12:00:00 AM12/23/2008 12:00:00 AMm_gafate@yahoo.com115http://www.ijem.org/Default.aspx

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Cyclic Pamidronate Therapy in Children with Osteogenesis ImperfectaSalehpour Sh, Tavakkoli SSalehpour Sh Tavakkoli SDepartment of Pediatric Endocrinology and Metabolism, Mofid Childrens Hospital, Shaheid Beheshti University (M.C.), Tehran, I.R. Iran Original Articlehe main objective of this study was to determine the efficacy and safety of pamidronate in improving bone mineralization and reducing fracture incidence in osteogenesis imperfecta (OI). Materials and Methods: Intravenous pamidro-nate was administered to 64 children, aged 18 months to 10 years old, with severe OI, in a 1 mg/kg single daily dose for 3 sequentional days at 4 month intervals, for over a period of 24-48 months. Clinical status, biochemical characteris-tics including bone turnover markers, the bone mineral density of the lumbar spine and femoral neck, and radiologic changes were assessed regularly during treatment. Results: The number of fractures decreased from median of 8 (range 4-11) to 0 fractures/year (range 0-4) (P<0.05). After 16 months of treat-ment, there was significant improvement in bone mineral density (BMD-DEXA) z-scores of the lumbar spine from median of -5.90 (range -7.01 to -4.76) to -2.70 (range -4.46 to -1.98) (P<0.001). Serum alkaline phosphatase (ALP) (bone formation marker) decreased from a me-dian of 731.0 U/L (range 438-998 U/L) to 183 U/L (range 95-286 U/L) (P<0.001), implying a signifi-cant reduction in bone turnover and its resorp-tion and increase in bone mineralization. There was no improvement either in their height growth velocities or in their standard deviation scores. Mobility and ambulation improved in all but 5 children, (all five took the drug for less than 2.5 years).There was a significant relief in chronic pain and fatigue but no adverse effects in any of the children using the drug. Conclusion: Cyclic pamidronate administration is effective in improving bone mineralization and reducing fracture incidence in childhood os-teogenesis imperfecta. Osteogenesis imperfecta, PamidronateCyclic pamidronate therapyShadab Salehpour6/28/2007 12:00:00 AM2/6/2008 12:00:00 AMshadabshadab@yahoo.com1612http://www.ijem.org/Default.aspx

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Effects of Acarbose in Metabolic Control of Patients with Type 1 Diabetes MellitusSharifi F^a, Ghazi Saidi M^b, Mousavi Nasab N^aSharifi F^a Ghazi Saidi M<sup>b</sup> Mousavi Nasab N<sup>a</sup><sup>a</sup>Metabolic Diseases Research Center; <sup>b</sup> Department of Internal Medicine, Vali Asr Hospital, Zanjan University of Medical Sciences, Zanjan, I.R. IranOriginal ArticleA carbose is a reversible inhibitor of the intestinal alpha-glucosidases, the oral administration of which delays absorption of carbohydrates. The aim of this study was to investigate the effect of administration of acarbose on parameters of gly-caemic control, lipid parameters and tolerability in ambulant type 1 diabetic subjects. Materials and Methods: Entry criteria included being: diabetic, age below 30 years and a history of at least one episode of diabetic ketoacidosis insufficiently controlled with diet and insulin. The data of 17 patients (6 men and 11 women, mean age 17.2&amp;amp;#177;3.5 (range 14–26) years, median duration of diabetes 8 (range 1–20) years were valid for statistical analysis. Results: During the run-in period HbA1c levels tended to decrease from 9.5&amp;amp;#177;1.1 to 9&amp;amp;#177;1.7%. After 12 weeks of acarbose treatment, the mean level had decreased further to 7.6&amp;amp;#177;1.6% (P: 0.002). Af-ter discontionuing acarbose, HbA1c levels in-creased to a mean level of 8.8&amp;amp;#177;0.9%. A significant reduction in Fasting Plasma Glucose (FPG) (from 195&amp;amp;#177;62 to 139&amp;amp;#177;73 mg/dL, P&amp;amp;lt;0.01) and 2 hour post prandial glucose (2 hppG) was observed with acarbose (from 231&amp;amp;#177;82 to 159&amp;amp;#177;72 mg/dL, P&amp;amp;lt;0.001). Reduction in total cholesterol (from 159&amp;amp;#177;36 to 146&amp;amp;#177;26 mg/dL, p: 0.09) and triglycerides (from100&amp;amp;#177;22 to 81&amp;amp;#177;23 mg/dL, p: 0.02) was de-tected after treatment with acarbose. No signifi-cant changes were observed in HDL cholesterol. The most frequent reported adverse events were flatulence (7 subjects) and mild abdominal pain (2 subjects). Conclusion: We conclude that acarbose up to 3&amp;amp;#215;100 mg/day can be a valuable adjunct to insu-lin in improving metabolic control in persons with type 1 diabetes Type 1 diabetes; Glycemic control; Acarbose; Alpha glucosidase inhibitorsAcarbose in type 1 diabetes Faranak Sharifi10/31/2007 12:00:00 AM1/27/2008 12:00:00 AMfaranaksharifi@hotmail.com11319http://www.ijem.org/Default.aspx

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Erythrocyte Membrane Fluidity in Ageing, Type 2 Diabetes and Stroke PatientsEmam SJ^a, Nikzamir AR^b, Nakhjavani M^c, Esteghamati AR^cEmam SJ^a Nikzamir AR<sup>b</sup> Nakhjavani M<sup>c</sup> Esteghamati AR<sup>c</sup>aDepartment of Laboratory Medicine, Paramedical School, Ahwaz Jondi Shapour University of Medical Sciences bDepartment of Medical Biochemistry, Faculty of Medicine, Ahaz, I.R. Iran cEndocrinology and Original ArticleThis study was conducted to investigate the values of the order parameter (S) and correlation time (τc) in electron spin resonance spectra for 5-DS(doxyl-stearic acid) and 16-DS (doxyl-stearic acid) in old normal controls and in patients with type 2 diabetes and stroke in order to assess any association between age-related disorders and membrane fluidity. Materials and Methods: We measured the mem-brane fluidity (a reciprocal value of membrane microviscosity) of erythrocytes in old healthy controls and in individuals with age-related dis-orders by using an electron paramagnetic reso-nance and spin-labeling method. The subjects were eleven type II diabetic patients (5 males and 6 females) with poor blood glucose (HbA1c 8.48&amp;#177;1.05%), eight old healthy volunteers (4 males and 4 females) with (HbA1c 5.3&amp;#177;1.03%), and ten diabetic stroke patients (5 males and 5 females) with (HbA1c 7.65&amp;#177;1.3). Erythrocyte membrane fluidity was determined by probes, 5- and 16- doxyl-stearic acid methyl ester (SALM) inserted into the erythrocyte membrane bilayer, after which electron spin resonance (ESR) spectra were obtained. Fasting plasma glucose and other blood tests, were measured by standard methods. Results: The order parameter (S) for the spin label agent (5-DS) and the correlation time for 16-DS in the electron spin resonance spectra of erythrocytes were significantly higher in stroke and diabetic patients than in old healthy controls (OH), indicating that membrane fluidity of erythrocytes was decreased in age-related disorders, compared with old healthy controls. The results indicated the lower levels of erythrocyte membrane fluidity using 16-DS with a motion parameter (p&amp;lt;0.05) but not using 5-DS (p&amp;lt;0.05) in diabetic and stroke patients compared with OH individuals. Conclusion: Use of the 16-DS probe showed a significant decrease in membrane fluidity in pa-tients with Type 2 diabetes and cerebrovascular diseases. Aging, Electron spin resonance, Spin label, Erythrocyte, Membrane fluidity, Type 2 diabetes Erythrocyte Membrane Fluidity in DiabetesAbdolrahim Nikzamir10/18/2007 12:00:00 AM11/17/2007 12:00:00 AMnikzamirar@yahoo.com12027http://www.ijem.org/Default.aspx

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Effect of Ghrelin on Plasma Concentration of Gonadotropins in the Female Sannan GoatsFarifteh F ^a, Khazali H ^a, Emami M^bFarifteh F ^a Khazali H <sup>a</sup> Emami M<sup>b</sup><sup>a</sup> College of Biological Sciences, Shaheed Beheshti University, Tehran <sup>b </sup>Center of Agricultural Institute of Yazd, Yazd, I.R. IranOriginal ArticleGhrelin is a 28 amino acid peptide which is secreted from the brain and the gastrointestinal system. Recent studies indicate that ghrelin negatively affects energy balance in most mammals. Based on its neuron distributions in hypothalamus, ghrelin coexists with many other neurons. Therefore, ghrelin controls different physiological actions on many different tracts; one of the physiological actions is its effect on gonadotropins secretions. The present investigation was carried out to analyze the potential involvement of ghrelin in the control of gonadotropin secretion. Materials and Methods: Forty female Sannan goats were randomly divided into two groups; each group received daily injections of either 1 or 2 mg ghrelin/kg of body weight (BW) into the jugular vein for ten days. Blood samples were collected every 30 minutes, for two hours after injection of ghrelin, for three days before first injection, till three days after last injection; the samples were assayed for plasma FSH and LH concentration by the Radioimmunoassay (RIA) technique. Results: Injections of 1 and 2 mg ghrelin/kg BW decreased the mean plasma concentration of LH throughout the injection period in all animals in the two groups. The results indicated that ghre-lin significantly decreased mean plasma concen-tration of LH in the female Sannan goats (p&lt;0.01); it however had no significant effect on the mean plasma concentration of FSH. Conclusions: It was concluded that while ghrelin has no effect in the secretion of FSH, it does have an inhibitory effect on LH. Ghrelin; Follicle stimulating hormone; Luteinizing hormone; Sannan goatGhrelin and GonadotropinsFarifteh F12/19/2007 12:00:00 AM4/16/2008 12:00:00 AMf.farifteh@yahoo.com12833http://www.ijem.org/Default.aspx

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A Case of Hashimoto’s Thyroiditis Presenting with Chronic Upper eye Lid Retraction and Positive Calsequestrin and Collagen XIII AntibodiesGopinath B^a, Ma G^b, Lahooti H^a, Wall JR^aGopinath B^a Ma G<sup>b</sup> Lahooti H<sup>a</sup> Wall JR<sup>a </sup><sup>a</sup> Department of Medicine, University of Sydney, Nepean Hospital, Penrith <sup>b</sup> Laboratory of Endocrine Research, ICPMR, Westmead Hospital, Sydney, NSW, AustraliaCase ReportThe pathogenesis of thyroid-associated ophthalmopathy (TAO) and the mechanism for its unique link with thyroid autoimmunity are poorly understood, in part due to the absence of specific diagnostic clinical signs and confirmatory “gold standard” laboratory tests. We report a patient who highlights the potential clinical role for eye muscle and collagen XIII antibody testing in the diagnosis and management of thyroid-related eye, eyelid and orbital disorders. A healthy euthyroid woman member of the Thyroid Research Laboratory presented with the incidental finding of positive calsequestrin and collagen XIII antibody tests carried out in the context of our research. She was pregnant at the time. Examination revealed marked upper eyelid retraction (UER) and a small goitre. Seven months after an uneventful pregnancy, which was 12 months after the initial blood test, she re-presented with overt hypothyroidism. Thyroglobulin and microsomal antibodies were strongly positive (25,600, &amp;gt; 25,600, respectively) and TSH was 40. We then tested the earlier serum sample for thyroid antibodies, which were positive at a low titre (1600, 1600, respectively) indicating that she had Hashimoto’s thyroiditis at that time. The hypothyroidism persisted, requiring long term management with L-thyroxine. UER can occur in the absence of other features of ophthalmopathy except for mild protopsis in patients with Hashimoto’s thyroiditis in whom antibodies targeting eye muscle or collagen XIII antibodies are detected in about 50% of cases. Overall about 20% of patients with Hashimoto’s thyroiditis have eye signs. Calsequestrin antibodies are specific and sensitive markers for extra ocular and upper eyelid muscle inflammation and damage in patients with thyroid autoimmunity and collagen XIII antibodies appear to be good markers for the congestive ophthalmopathy subtype of TAO.Autoimmunity, Eye muscle, Antibodies, Thyroid-associated ophthalmopathy, Calsequestrin, Collagen XIII, Eyelid retraction Calsequestrin antibodies in thyroid-associated ophthalmopathyJack R Wall12/19/2007 12:00:00 AM4/16/2008 12:00:00 AMjackw@med.usyd.edu.au13437http://www.ijem.org/Default.aspx

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Achieving Glycaemic Targets in Type 2 Diabetes: the Role of the Basal Insulin Analogue Insulin Glargine and How to Use it in Clinical Practice: Moving from Evidence to PracticeDavies MJ^a, Jarvis J^b, Khunti K^aDavies MJ^a Jarvis J<sup>b</sup> Khunti K<sup>a</sup><sup>a</sup> Department of Cardiovascular Sciences, University of Leicester; <sup>b</sup> Diabetes Research, University Hospital of Leicester Leicester, UKReview ArticleThis review examines the role of the basal insu-lin analogue, insulin glargine in the treatment of type 2 diabetes, focusing on how research evi-dence can inform its use in clinical practice. The importance of achieving optimal glycaemic con-trol has been emphasised by bodies such as the IDF who have set strict targets for HbA1c levels. We know that FPG plays an important role in helping to achieve optimal glycaemic control and basal insulin therapy can play a role in this area. Insulin glargine is a once-daily, peakless basal insulin which has been shown to achieve the same degree of glycaemic control as NPH insulin but with significantly reduced rates of hypogly-caemia. This allows patients to improve self management of their diabetes by optimising treatment without the risk of hypoglycaemia. Research has shown that patients can safely op-timise therapy with a patient-led titration algo-rithm based on an insulin dose adjustment of 2 units every 3 days. Initiation of insulin glargine has been shown to be effective within a group as well as individually, allowing health care pro-fessionals to manage their time more effectively between the growing numbers of people requir-ing insulin therapy. Conclusions: This basal insulin analogue is a welcome addition to the plethora of treatments available to treat type 2 diabetes and efficacy data can now be converted into practical meth-ods of optimising insulin therapy for the type of patients healthcare professionals routinely en-counter in their practice. Glycaemic control, Insulin ana-logues, Basal insulin, Insulin glargine Insulin Glargine: Achieving glycaemic targetsJanet Jarvis12/31/2007 12:00:00 AM2/1/2008 12:00:00 AMjanet.jarvis@uhl-tr.nhs.ukja13849http://www.ijem.org/Default.aspx

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Primary Hyperparathyroidism in Iran: A ReviewBahrami ABahrami ADepartment of Internal Medicine, Division of Endocrinology, Tabriz University of Medi-cal Sciences, Tabriz, I.R. IranReview ArticleOver the past half century, the pattern of clinical presentation of primary hyperparathyroidism (PHPT) has changed dramatically in Western countries; indeed it has evolved from a severe disease to an asymptomatic condition. The story is completely different in Eastern countries, where PHPT still presents with the traditional pattern of bones and stones. The aim of the pre-sent review is to analyze Iranian experiences in the clinical, biochemical, radiological, and pathological findings of PHPT and to compare these features with those of patients from devel-oped and developing nations. Materials & Methods: An extensive search of PHPT literature was carried out. Of the relevant publications from 1980-2006 (3 international, 3 local) five yielded compressive data in large se-ries of Iranian patients. The information was evaluated, analyzed, summarized and compared to that of patients from other Eastern and West-ern countries. Results: A total of 356 patients were included in these studies; there were 317 females and 49 males, age range 11 to 72 years, mean age 38.2±12.4 years with a female to male ratio of 6.4 to 1. Most patients presented with advanced skeletal involvement. Nephrolithiasis was diag-nosed in 14–47% patients. Majority of patients had high serum PTH and low serum phosphorus levels; nearly all displayed some radiological changes suggestive of hyperparathyroid bone disease. Osteoporosis, subperiosteal bone re-sorption, salt and pepper appearance, brown tu-mor and pathologic fractures were frequent x-ray findings. Single adenoma was discovered in most patients. There were few cases with para-thyroid carcinoma. Mean parathyroid gland weight, reported in 177 cases, was 4.1 grams, (range 0.8 – 25 grams). Conclusion: PHPT is a severe, symptomatic dis-ease with serious complications and high mor-bidity in Iran. Advanced skeletal disease is the most common pattern of presentation at a young age.Hyperparathyroidism, I.R. Iran, De-veloping countries Primary Hyperparathyroidism in Iran Amir Bahrami5/19/2007 12:00:00 AM12/13/2007 12:00:00 AMt.u.end.d1@tbzmed.ac.ir15057http://www.ijem.org/Default.aspx

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