Improvement in metabolic indices including thyroid hormones via enhanced absorption of nutrients by Teduglutide in short bowel syndrome.

Introduction And Importance: Short bowel syndrome is characterized by maldigestion and malabsorption resulting in deficiencies of multiple nutrients including vitamins and minerals. Most subjects required parental elimination for survival. GLP-2 RA Teduglutide was recently approved for treatment of short bowel syndrome especially for those requiring parenteral support.

Low 25-Hydroxyvitamin D in Primary Hyperparathyroidism: Enhanced Conversion Into 1,25-Hydroxyvitamin D May Not Be "True" Deficiency.

Vitamin D deficiency is reported in individuals with primary hyperparathyroidism (PHP). However, decreased 25OHD may be attributed to enhanced conversion into 1,25-hydroxyvitamin D [1,25(OH)D]. To examine vitamin D metabolism in individuals with PHP, serum calcium, PTH, 25OHD, and 1,25(OH)D levels were determined in 210 adults: 102 with PHP, 40 with normal 25OHD, and 68 with vitamin D deficiency.

MORE THAN MEETS THE EYE IN A PATIENT WITH PCOS: ANDROGEN-SECRETING GRANULOSA CELL OVARIAN TUMOR IN A VIRILIZED WOMAN WITH POLYCYSTIC OVARIAN SYNDROME (PCOS).

Objective: Granulosa cell ovarian tumors are known to secrete estrogen. Herein we report a patient presenting with primary amenorrhea and virilization with markedly high androgen levels, all thought to be disproportional to be attributed to polycystic ovary syndrome (PCOS) alone. Bilateral oophorectomy revealed a rare androgen-secreting granulosa cell ovarian tumor and bilateral cysts (PCOS) both contributing to manifestations.

Major Pathophysiology in Prediabetes and Type 2 Diabetes: Decreased Insulin in Lean and Insulin Resistance in Obese.

Context: Lowering of body mass index (BMI) to ≥25 kg/m as obesity by ADA suggests insulin resistance as a major mechanism of impaired glucose metabolism (IGM) in Asians. However, glimepiride, an insulin secretagogue, delayed onset of type 2 diabetes (DM2) from prediabetes (PreDM), indicating decreased insulin secretion (IS) as a major factor in lean (L; BMI < 27 kg/m) subjects with IGM.

Objective: Assessment of IS and insulin resistance (IR) in L and obese (Ob; BMI ≥ 27 kg/m) subjects with euglycemia (N), PreDM, and new onset DM2.

Case of diabetic ketoacidosis as an initial presentation of Cushing's syndrome.

Summary: Diabetic ketoacidosis (DKA) is commonly encountered in clinical practice. The current case is a unique and rare presentation of DKA as the initial manifestation of Cushing's disease secondary to ACTH-secreting pituitary adenoma. Appropriate management as elaborated in the article led to total remission of diabetes as well as the Cushing's disease.

Intensive insulin therapy in critical care settings.

Hyperglycemia in hospitalized patients has been shown to increase both morbidity and mortality, regardless of the presence of preexisting diabetes. In order to achieve recommended glycemic goals, many patients require the use of intravenous insulin therapy in the critical care setting. Following the publication of a landmark trial evaluating the benefits of intensive insulin therapy in critically ill patients, a worldwide increased effort to achieve strict glycemic control has ensued.

Elevated fructosamine levels in acquired immunodeficiency syndrome.

Objective: To investigate whether the mechanism of increased glycation in acquired immunodeficiency syndrome (AIDS) is due to an alteration in a circulatory plasma enhancer.

Methods: We assessed glycation of serum protein and hemoglobin in patients with AIDS without altered carbohydrate metabolism. Fasting concentrations of glucose, ethanol, vitamin E, fructosamine, hemoglobin, hemoglobin A1c (A1C), and partial pressure of alveolar oxygen (PAO2) were determined in 50 men with AIDS and in 25 age-matched healthy men in whom normal glucose tolerance was established by oral glucose tolerance tests.

Deleterious outcomes after abrupt transition from insulin glargine to insulin detemir in patients with type 1 diabetes mellitus.

Background And Objective: Iowa Care (Iowa Medicaid), USA, switched insulin glargine to insulin detemir in subjects with diabetes mellitus without the approval of healthcare providers. This study set out to examine the impact of transition on parameters of diabetes management in type 1 diabetes.

Methods: This was a retrospective review of the records of subjects with type 1 diabetes up to August 2007 in whom transition occurred.

Starting insulin in type 2 diabetes: Overcoming barriers to insulin therapy.

Background: Several barriers to insulin therapy are encountered by both the providers and the patients with type 2 diabetes mellitus. These barriers include the fear of the needles i.e.

Is beta-cell failure in type 2 diabetes mellitus reversible?

Background: In the UK Prospective Diabetes Study (UKPDS), many subjects maintained glycemic goal (HbA(1c) < 7.0%) at 9 years, showing that beta-cell function was preserved and that the initial decline in beta-cell function recovered with sulphonylureas. Moreover, obese subjects using high daily doses of insulin for several years rarely require insulin or oral hypoglycemic agents to maintain their glycemic goal following weight loss achieved by gastric bypass surgery.

Serum thyrotropin in Graves' disease: a more reliable index of circulating thyroid-stimulating immunoglobulin level than thyroid function?

Objective: To assess the relationship between serum thyrotropin (thyroid-stimulating hormone or TSH) on one hand and thyroid-stimulating immunoglobulin (TSI), free thyroxine (T4), and triiodothyronine (T3) levels on the other in Graves' disease, inasmuch as TSH may be suppressed in the presence of TSI because TSI may bind to the TSH receptor on the thyroid gland membrane and thus eliminate the need for circulating TSH for stimulating the thyroid gland.

Methods: We determined serum TSI levels in 37 women and 13 men with Graves' disease, stratified into 4 groups on the basis of serum TSH levels irrespective of serum free T4 and T3 levels. Our reference ranges were 0.

Role of thyrotropin in metabolism of thyroid hormones in nonthyroidal tissues.

T(4) conversion into T(3) in peripheral tissues is the major source of circulating T(3). However, the exact mechanism of this process is ill defined. Several in vitro studies have demonstrated that thyrotropin facilitates deiodination of T(4) into T(3) in liver and kidneys.

Comparative efficacy of glimepiride and/or metformin with insulin in type 2 diabetes.

Background And Aims: The data regarding comparison of efficacy of metformin with glimepiride, newest Sulfonylurea, or with the use of both drugs in combination with insulin is rare in the literature. Therefore, we assessed the daily insulin dose, hypoglycemic events and body weight on achieving desirable glycemic control after addition of insulin, to glimepiride 8 mg and/or metformin 2500 mg, in subjects with type 2 DM manifesting lapse of glycemic control.

Methods: S.

Optimizing treatment of hypothyroidism.

Several thyroid hormone preparations are currently available, including levothyroxine sodium (thyroxine), liothyronine (triiodothyronine), and desiccated thyroid extract, as well as a combination of levothyroxine sodium and liothyronine. Levothyroxine sodium monotherapy at an appropriate daily dose provides uniform levels of both thyroxine and triiodothyronine in the circulation without diurnal variation. Therefore, it is the preparation of choice in most patients with hypothyroidism of both the primary and central types.

Cost-effective management of hyperglycemia in patients with type 2 diabetes using oral agents.

Diabetes exacts an enormous toll on health care resources, with extremely high costs attributable to care of diabetes patients in proportion to the afflicted population. Though individual treatment strategies are required for each patient, newer long-acting sulfonylureas may be the initial drugs of choice, as they may be the only oral agents that inhibit the processes inducing hyperglycemia--hepatic glucose production and glucose utilization by the tissues--by improving insulin secretion and insulin resistance. Sulfonylureas also represent the most cost-effective therapeutic option, alone or in combination with other oral agents or insulin.

Serum thyrotropin determinations: comparison of second- and third-generation assays.

Objective: To compare thyrotropin (thyroid-stimulating hormone or TSH) levels determined by second- and third-generation assays in sera extracted from blood samples withdrawn randomly from 34 subjects attending outpatient clinics.

Methods: Serum specimens were separated into two fractions and were frozen and stored at -20 degrees C for subsequent determination of TSH concentrations by second-and third-generation assays. The results were analyzed statistically.

Successful outcome with methimazole and lithium combination therapy for propylthiouracil-induced hepatotoxicity.

Objective: To assess the efficacy and safety of combination therapy with methimazole and lithium carbonate in management of severe thyrotoxicosis and propylthiouracil-induced hepatotoxicity.

Methods: We present a case report of a patient with severe thyrotoxicosis and worsening liver dysfunction after propylthiouracil therapy, and we review the pertinent literature.

Results: In a 49-year-old man with severe thyrotoxicosis and propylthiouracil-induced hepatotoxicity, indices of liver function continued to increase despite discontinuation of propylthiouracil treatment.

Inhibited hypothalamic-pituitary-thyroid axis in type I pseudohypoparathyroidism.

Objective: To assess the hypothalamic-pituitary-thyroid axis in two patients with the diagnosis of type I pseudohypoparathyroidism established previously by characteristic clinical features and laboratory findings, including low serum Ca++, high parathyroid hormone concentration, and subnormal urinary cyclic adenosine monophosphate (cAMP) responses to exogenous administration of parathyroid hormone.

Methods: We determined serum thyroxine, triiodothyronine (T(3)), T(3) resin uptake, and 24-hour thyroidal uptake of 123 I before and after subcutaneous administration of thyroid-stimulating hormone (TSH), 10 U daily for 3 days. Serum TSH levels were determined before and again at 15, 30, 45, and 60 minutes after intravenous administration of thyrotropin-releasing hormone (TRH) (400 microg) after an overnight fast.

Effects of carbamazepine on the hypothalamic-pituitary-thyroid axis.

Objective: To evaluate the effects of treatment with carbamazepine on the hypothalamic-pituitary-thyroid axis and thyroid hormone concentrations in patients with epilepsy.

Methods: We undertook a prospective study in seven subjects in whom the diagnosis of epilepsy had been established and a regimen of carbamazepine (200 mg three times a day) was initiated. All participants underwent 24-hour 123 I thyroid uptake studies, as well as assessment of the basal thyrotropin concentration and the thyrotropin response to intravenous administration of thyrotropin-releasing hormone.

Thyroid hormone indices during illness in six hypothyroid subjects rendered euthyroid with levothyroxine therapy.

Purpose: We wanted to evaluate changes in the natural course of serum thyroxine (T4), tri-iodothyronine (T3), reverse tri-iodothyronine (rT3), and thyroid stimulating hormone (TSH) concentrations during hospitalization for an acute illness, in subjects rendered euthyroid with Levothyroxine (LT4) replacement therapy.

Methods: Six male subjects ranging in age 30 - 65 years with a history of primary hypothyroidism were included. They were euthyroid prior to hospitalization.

Effects of glimepiride on insulin secretion and sensitivity in patients with recently diagnosed type 2 diabetes mellitus.

Background: The exact mechanism of the efficacy of glimepiride in the achievement of glycemic control has not yet been clearly defined.

Objective: This study was conducted to examine the influence of glimepiride on insulin secretion and sensitivity in patients with type 2 diabetes mellitus (DM) of recent onset.

Methods: This 24-week, open-label, controlled trial was conducted at the Division of Endocrinology and Metabolism, Veterans Affairs Medical Center (Phoenix, Arizona).

Efficacy of sulfonylureas with insulin in type 2 diabetes mellitus.

Background: In subjects with type 2 diabetes mellitus, glycemic control deteroriates while patients use sulfonylurea drugs during the course of the disease. Adjunctive therapy with insulin at this stage requires a lesser daily insulin dose in comparison with insulin monotherapy while restoring desirable glycemic control. However, data regarding direct comparison between various sulfonylureas in this regard are lacking.