Effects of metformin plus rosuvastatin on hyperandrogenism in polycystic ovary syndrome patients with hyperlipidemia and impaired glucose tolerance

AIM

We aimed to compare the effects of metformin and metformin-rosuvastatin combination therapies on hyperandrogenism in patients with polycystic ovary syndrome (PCOS).

PATIENTS AND METHODS

Thirty-eight PCOS patients with hyperlipidemia and impaired glucose tolerance, who were followed at Department of Endocrinology and Metabolism out-patient clinic of Cerrahpasa Medical School were included in the study. Twenty patients had lifestyle changes and metformin (2000 mg/day) therapy (M group) and 18 had statin (rosuvastatin 10 mg/day) in addition to this therapy (MR group). Total and free testosterone, DHEAS, FSH, LH, estrodiol, fasting glucose, insulin, and high-sensitivity C-reactive protein (hs-CRP) levels, lipid parameters and homeostasis model assesment index (HOMAIR) were evaluated for each patient before and 12 weeks after the treatment.

RESULTS

After 12 weeks of treatment body mass index (BMI), insulin and glucose levels, HOMA-IR had similar decreaments in both groups, whereas there was a greater decline of the total and free testosterone levels in MR group (p<0.001, p=0.004, respectively). DHEAS levels did not change in M group, however, significantly decreased in MR group after treatment (p=0.8, p=0.002, respectively). As expected hsCRP, triglyceride, total and LDL-cholesterol levels decreased more in MR group.

CONCLUSION

Metformin and rosuvastatin combination therapy could lead to a better reduction on hyperandrogenism and on atherosclerosis-related factors in PCOS, in addition to improving lipid parameters.

Ornithine transcarbamylase deficiency diagnosed in pregnancy

Urea cycle enzymes deficiencies are rare metabolic disorders. Ornithine transcarbamylase (OTC) deficiency is the most common type. The syndrome results from a deficiency of the mitochondrial enzyme OTC which catalyses the conversion of ornithine and carbamoyl phosphate to citrulline. It shows X-linked inheritance and typically remains asymptomatic until late infancy or early childhood. The severity of the symptoms depends on the age of the patient and the duration of hyperammonemia. Female heterozygotes are more difficult to diagnose. They suffer from hyperammonemic periods which can be triggered by trauma, infections, surgery, childbirth, parenteral nutrition, and by the initiation of sodium valproate therapy. The prognosis of OTC deficiency is better for those with an onset after infancy, but morbidity from brain damage does not appear to be linked to the number of episodes of hyperammonemia that have occurred. However, early diagnosis and prompt initiation of ammonia-lowering treatment are essential for survival of these patients. This case presents a patient who was diagnosed with OTC deficiency following mental confusion during pregnancy.

Plasma viscosity, an early cardiovascular risk factor in women with subclinical hypothyroidism

OBJECTIVE

It is controversial, if subclinical hypothyroidism increases cardiovascular risk. Plasma viscosity is a hemorheological parameter, which is accepted as an early cardiovascular risk factor. We investigated the alterations in plasma viscosity in women with subclinical hypothyroidism.

DESIGN

40 female patients with subclinical hypothyroidism and 31 age- and weight-matched healthy women were included. Free thyroxine (FT4), thyroid stimulating hormone (TSH), lipid parameters, fibrinogen, C-reactive protein (CRP) levels, hematocrit and plasma viscosity were measured in all subjects.

MAIN OUTCOME

Plasma viscosity, total cholesterol and low density lipoprotein were significantly increased and high density lipoprotein was significantly decreased in patients with subclinical hypothyroidism. No significant correlation was found among the parameters.

CONCLUSION

Increased plasma viscosity in patients' group suggests that cardiovascular risk might be increased in patients with subclinical hypothyroidism. As far as we could reach, this is the first study concerning plasma viscosity in subclinical hypothyroidism.

Investigation of microalbuminuria in nondiabetic, normotensive obese women

AIM

To investigate if obesity which is not accompanied by diabetes and/or hypertension is associated with microalbuminuria in female patients.

MATERIALS AND METHODS

A total of 77 obese female patients from the Outpatient Clinic of Endocrinology of Istanbul University Cerrahpasa Medical Faculty and 30 age-matched, lean, healthy women were enrolled in the study. Patients with accompanying diabetes mellitus, hypertension, obesity associated with any endocrine abnormality, hepatic or renal disease, fever, infectious disease, malignancy were excluded. Weight, height, body-mass index (BMI), waist circumference, waist/hip ratio (WHR) and systolic and diastolic blood pressures were recorded. Albumin excretion in 24-hour urine samples (UAE) were measured using SYNCHRON LX System with MA Microalbumin kit in two separate 24-hour urine samples from every patient. Statistical analysis was performed using t-test and Pearson's correlation in SPSS 12.0 for Windows Program.

RESULTS

The median albumin excretion in 24-hour urine sample was similar in obese and control groups (12.01 +/- 10.69 mg/day vs 9.35 +/- 4.09 mg/day; p= 0.211). There were no correlations between the albumin excretion in 24 hour urine samples and BMI, waist circumference, WHR, systolic or diastolic blood pressure.

CONCLUSION

Diabetes mellitus and hypertension are known to be associated with microalbuminuria. In our study, microalbuminuria was not detected in obese women without diabetes and/or hypertension and UAE was similar in obese and lean women.

Autoimmune thyroiditis and anti-thyroid antibodies in primary Sjogren's syndrome: a case-control study

OBJECTIVE

To determine the frequency of antithyroid antibodies and the presence of autoimmune thyroiditis among patients with primary Sjögren's syndrome.

DESIGN

A case-control study.

METHODS

53 consecutive patients with primary Sjögren's syndrome, 30 with rheumatoid arthritis, 12 with secondary Sjögren's syndrome associated with rheumatoid arthritis, 17 with autoimmune thyroiditis, and 53 apparently healthy controls were studied for anti-TG and anti-TPO antibodies as well as serum thyroid hormones and TSH levels.

RESULTS

The overall frequencies of thyroid antibodies were 6/53 (11%) in primary Sjögren's syndrome, 2/30 (7%) in rheumatoid arthritis, 2/12 (17%) in secondary Sjögren's syndrome, 4/53 (8%) in healthy controls, and 16/17 (94%) in autoimmune thyroiditis. There was no difference in the frequency of the thyroid antibodies among the groups if patients with autoimmune thyroiditis were excluded (p = 0.415 for anti-TPO; p = 0.275 for anti-TG; p = 0.696 for either anti-TG and/or anti-TPO). Only two patients with primary Sjogren's syndrome had clinical hypothyroidism associated with autoimmune thyroiditis.

CONCLUSIONS

In this Turkish population, no association between primary Sjögren's syndrome and autoimmune thyroiditis was found.

A case of anthracosis presenting with mediastinal lymph nodes mimicking tuberculous lymphadenitis or malignancy

Anthracosis is a form of pneumoconiosis caused by coal dust or by a smoky and polluted environment. Anthracosis often presents in pulmonary form; only rarely are extrathoracic, esophageal, and mediastinal anthracoses documented. We report a rare case of anthracosis with multiple mediastinal lymphadenopathy.