ACTA ENDOCRINOLOGICA (BUC)

Context. Foetal asphyxia, a frequent birth complication, detrimentally impacts the immature brain, resulting in neuronal damage, uncontrolled seizure activity and long-term neurological deficits. Oxytocin, a neurohormone mediating important materno-foetal interactions and parturition, has been previously suggested to modulate the immature brain’s excitability, playing a neuroprotective role. Our aim was to investigate the effects of exogenous oxytocin administration on seizure burden and acute brain injury in a perinatal model of asphyxia in rats. Animals and methods. Asphyxia was modelled by exposing immature rats to a 90-minute episode of low oxygen (9% O2) and high CO2 (20% CO2). Control rats were kept in ambient room-air for the same time interval. In a third group of experiments, oxytocin (0.02 UI/g body weight) was nasally administered 30 minutes before the asphyxia episode. Seizure burden was assessed by the cumulative number of loss of righting reflex (LRR) over a two-hour postexposure period. Acute brain injury was assessed through hippocampal S-100 beta, a biomarker of cellular injury, 24-hours after exposure. Results. Asphyxia increased both LRR and hippocampal S-100 beta protein compared to controls, and these effects were significantly reduced by oxytocin administration. Conclusion. Oxytocin treatment decreased both seizure burden and hippocampal injury, supporting a potential neuroprotective role for oxytocin in perinatal asphyxia.

Objective. Obese people may have nutritional deficiencies, although they are exposed to excessive food intake. We aim to assess relationship of vitamin D, B12, and folic acid levels and dietary vitamin intake and insulin resistance in obese people. Design. This case-control study was performed at the obesity outpatient clinics between March 2014 and April 2015. Subjects and Methods. We included 304 nondiabetic obese subjects in patient group and 150 normal weight individuals in control group. Patients were questioned in detail about their food intake. Results. Mean age of obese patients was 37.3±10.1 years, the mean duration of obesity was 7.9±5.4 years, and the percentage of female patients was 65.8%. Mean vitamin D, B12, and folic acid levels were significantly lower in patients than in controls. Vitamin D deficiency (<20 ng/mL) in 69.7%, vitamin B12 deficiency (<200 pg/mL) in 13.5%, and folic acid deficiency (<4 ng/mL) was found in 14.2% of the patients. BMI negatively correlated with vitamin D, B12, and folic acid levels. B12 levels negatively correlated with duration of obesity. Insulin resistance was found in 55.9% of patients and HOMA-IR levels negatively correlated with vitamin D and B12 levels. While dietary vitamin D and folic acid intakes were inadequate in all of patients, only 28.3% of patients had inadequate vitamin B12 intake. There was no relation between vitamin levels and dietary vitamin intakes. Conclusions. The study reveals that vitamin D, B12, and folic acid levels were low and poor vitamin D and B12 status were associated with insulin resistance in nondiabetic obese patients.

Objective. The goal of this study is to evaluate the effectiveness of the Exercise Physiology Clinic by assessing weight loss profiles of patients who attended the clinic. Study design. The data on 2039 visits performed between April 2010 and March 2011 by 1102 individuals who attended the Exercise Physiology Clinic were assessed. Subjects and methods. Patients who attended two to three visits were classified as Group 1 and those who paid four or more visits were classified as Group 2. Body analyses were performed by bioimpedance technique and Body Mass Indices (BMIs) were calculated and then personal exercise programs were prescribed according to measurements made in each visit. Results. Mean age and mean BMI of the patients at baseline were 47.1±14.0 (16-92 years) and 32.2±6.7 kg/m2 (15.1-63.7 kg/m2), respectively. According to the visit frequency, in patients who visited our clinic two or more times, monthly mean differences in body weight and body fat were calculated as 0.72±0.9 kg and 0.53±0.8 kg/month, respectively. The differences between the baseline and the final measurements of body weight and body fat were higher in Group 2 when compared to Group 1 (p<0.01). While no statistical significance was found between the two groups in terms of weight loss, the change in body fat mass was found to be significantly greater at every visit in Group 2 compared to that of Group 1 (p=0.2 and p=0.05, respectively). Conclusions. A decrease was demonstrated in the body weight and fat mass of the patients who were followed up in our Exercise Physiology Clinic. The results suggested that the increase in the number of exercise physiology clinics will have an important role in preventing metabolic disorders associated with obesity.

Context. Bone mineral density (BMD) loss and progressive bone loss have been detected in patients with untreated\r\nhyperprolactinemia. It is unclear in patients with mild hyperprolactinemia.\r\nObjective. The aim of the study was to evaluate bone metabolism through bone mineral density by using dual energy X-ray absorptiometry (DXA) and bone turnover markers in premenopausal women with prolactinoma.\r\nDesign, Subjects and Methods. Twenty five patients newly diagnosed with prolactinoma and treated surgically and/or\r\nmedically, but whose prolactin levels were above the normal limits (PRL > 25 &#956;g/L) and 25 healthy controls were included in the study, which was conducted at the Cerrahpasa Medical School, Division of Endocrinology and Metabolism outpatient\r\nclinic. Bone mineral density was measured using the DXA method. Bone turn-over markers such as alkaline phosphatase\r\n(ALP), osteocalcin, Type I collagen Ntelopeptide (NTX) and Type I collagen CTelopeptide (CTX) levels were determined.\r\nResults. The only significant difference in bone density (p=0.02) was in L4 lumbar vertebrae. There were no significant differences between the patient\r\nand the control groups in ALP, osteocalcin, NTX, and CTX levels.\r\nConclusion. There were no significant differences between the patient and the control groups in bone mineral\r\ndensity and bone turnover markers, except in the L4 lumbar vertebrae.

Background. Primary hyperparathyroidism is the third most common endocrine disorder, diagnosed by elevated parathyroid hormone (PTH) in hypercalcaemia. Several biochemical factors have been described to suggest severity of disease and may be correlated with preoperative imaging. Methods. This was a retrospective study of patients who underwent parathyroidectomy over a 3-year period. Preoperative calcium, PTH, vitamin D levels, ALP (alkaline phosphatase), vitamin D, serum phosphate and US and SPECT-CT positivity was noted. Results. 176 patients underwent parathyroidectomy and these were divided into 4 groups based on preoperative calcium. Overall, 61% of patients showed concordance between imaging and operative findings. Severe hypercalcaemia was associated with higher PTH levels, lower vitamin D levels, an increased rate of abnormal ALP levels, lower phosphate, male gender and highest rate of imaging concordance. Imaging positivity was associated with severe hypercalcaemia and elevated PTH levels. Level of PTH >125 pmol/L and hypercalcaemia >2.8 mmol/L are the most accurate cut-off levels for scan positivity. Conclusion. Biochemical factors associated with severity of the disease are directly correlated with positivity of preoperative imaging while ALP and vitamin D did not influence the preoperative imaging positivity but are associated with disease adversity. Serum phosphate level independently predicted results of parathyroid US.

Background. Blood glucose levels in the human body continuously fluctuate within a certain range. Intermittent hyperglycemia has adverse effects on vascular endothelial\r\ncells and pancreatic beta cells. A few studies have found that blood glucose fluctuation induced apoptosis of both endothelial cells and pancreatic beta cells, possibly due to oxidative stress. This study aimed to determine the\r\neffects of blood glucose fluctuation on hepatocytes in vivo.\r\nMaterials and Methods. To induce intermittent hyperglycemia, rats were intermittently treated with 50% glucose\r\ninjection to fluctuate blood glucose between 5.5 mmol/L and 20.0 mmol/L. The rats with intermittent hyperglycemia were treated with either low dose (0.35 mg/kg?min) or high dose\r\n(0.70 mg/kg?min) N-acetylcysteine (NAC). The rats infused with saline were used as control. Apoptosis was assessed by TUNEL assay. Malondialdehyde (MDA) and superoxide dismutase (SOD) in the liver, as well as plasma ALT, AST, TBIL, and IBIL, were examined using colorimetric kits.\r\nResults. Liver function was lower in the rats with intermittent hyperglycemia than in control rats. Hepatocytes exposed to blood glucose fluctuation were more likely\r\nto undergo apoptosis compared to control group (0.07?0.016 vs. 0.015?0.009, P<0.01). The expression of Caspase-3 and\r\ncleaved Caspase-3 was significantly higher in the IHG group than in the SAL group (0.111?0.015 vs. 0.07?0.011; 0.064?0.012 vs. 0.004?0.001, P<0.05).The expression of\r\nBax and the ratio of Bax to Bcl-2 were significantly higher in the IHG group than in the SAL group (0.20?0.05 vs. 0.10?0.02; 0.55?0.20 vs. 0.20?0.05, both P<0.01). When treated with NAC, the liver function of rats with intermittent hyperglycemia improved remarkably, and hepatocyte apoptosis decreased.\r\nConclusion. Blood glucose fluctuation appears to be detrimental to liver function, but this effect can be ameliorated by NAC.

Context. Sleeve gastrectomy is an effective method for management of obesity. The Bariatric Analysis and Reporting Outcome System (BAROS) is a comprehensive and standard system for the assessment of outcomes of weight loss surgery. It is consisted of weight loss, changes in obesityrelated comorbidities and quality of life measurements. We investigated results of the sleeve gastrectomy based on the BAROS. Material and Methods. Outcomes of laparoscopic sleeve gastrectomy surgery was studied in 45 patients with obesity (11 male, 34 female), after 45 months in Turkey. Results. Total weight loss was 26.4±0.1% of body weight at 45 months. Weight regain was seen in 97.8% of the patients with an average 14.5 kg and 13.7% body mass index points. The surgery caused 76% decrease in incidence of obstructive sleep apnea, 73% decrease in type 2 diabetes, 63% decrease in hyperlipidemia and 62% decrease in hypertension. Significant improvement is observed in all quality-of-life parameters. The final score of the BAROS was 4.23±1.02. Conclusion. Based on BAROS, sleeve gastrectomy provides significant improvements in weight loss, incidence of medical comorbidities and quality of life after surgery. Future studies should address prevention of weight regain after the surgery.

Objective. We aimed to investigate the prevalence of obesity and visceral obesity (VO) within children living on the small Greek island of Tinos and their associated factors. Methods. Three hundred and fifty two healthy children and pre-adolescents (54% boys) attending the primary schools of Tinos island were evaluated, aged (mean±SD) 8.53±1.72 years (range 6-11), from which 286 (81.25%) were of Greek origin and 65 (18.46%) foreign immigrants. Body weight, height and waist circumference (WC) were measured, plus BMI and WC percentiles were calculated. Children with WC > 90th percentile were categorized as having VO. Results. Among our patients, 235 (66.76%) were of normal weight, 88 (25%) overweight and 29 (8.2%) obese. Obese children, as opposed to their normal weight counterparts, were more likely to be of younger age (p=0.009). VO was found in 65 (18.47%) children, with a higher prevalence among the obese than overweight ones (96.43% vs. 42%, p<0.001). There was no difference in the prevalence of VO between children and pre-adolescents. However, foreign immigrants had lower frequency of overweight and obese children (p=0.026) and less viscerally obese children (9.09% vs. 20.63%, p=0.018) than the Greek participants. Conclusions. The prevalence of childhood obesity in rural Tinos was 8.24%, which was lower than the reported national prevalence of obesity in Greece, whilst almost all of the obese and 42% of the overweight children presented VO. The low prevalence of childhood obesity and VO on this small island could possibly be attributed to a more healthy diet and natural way of life.

Objective. Thyroid fine-needle aspiration (FNA) and cytology is a reliable diagnostic method used in the assessment of malignancy when evaluating thyroid nodules, in conjunction with clinical and ultrasonographic findings. The aim of this study is to compare clinical, ultrasonographic, cytological and histopathological findings in children who underwent thyroid FNA. Methods. Subjects comprised 80 patients (52 female) aged 13.7±2.8 years at the time of FNA who where evaluated for thyroid nodules. Clinical, ultrasonographic and cytological findings of patients were evaluated retrospectively. Results. Autoimmune thyroiditis was present in 30% and history of radiotherapy to the head or neck in 10%. The cytological diagnosis of patients included: inadequate or hemorrhagic sample in 10%; benign in 42.5%; atypia or follicular lesion of undetermined significance (AUS/FLUS) in 15%; suspicion of follicular neoplasia (SFN) in 7.5%; suspicion of malignancy (SM) in 8.8%; and malignant in 16.3%. Thirty-seven patients underwent thyroidectomy. Malignancy rates for histopathologic follow-up were 75%, 85.7% and 100% for SFN, SM and malignant categories, respectively. Only one benign and two AUS/FLUS FNAs were found to be malignant on histopathological examination. Among patients who had received radioiodinetherapy, 87.5% had malignancy. In this study, the sensitivity of FNA was 96%, specificity 50%, positive predictive value 90.9%, negative predictive value 75%, and diagnostic value of FNA was 89.2%. Conclusion. Thyroid FNA results were highly compatible with histopathological examination. Sensitivity, positive predictive value and diagnostic value of FNA were high.

Background. The frequency of subclinical hypothyroidism (SH) in patients with obesity is increased compared with the normal population. However, data on the risk of cardiovascular disease (CVD) in patients with SH are still scarce. Lipid parameters are strong predictors of early CVD. We aimed to investigate the role of lipid indices in predicting CVD risk compared to conventional lipid components. Methods. A total of 220 euthyroid obese children (EU) and 90 obese children with SH were included in the study. All data were collected from hospital files. Lipid indices were evaluated. Atherogenic index of plasma (AIP), cardiac risk ratio (CRR) and atherogenic coefficient (AC) were calculated. AIP>0.24, CRR>5 ve AC>3 were considered as cardiovascular risk criteria. Results. The presence of SH increased the risk of higher AIP and the risk of CRR, compared to euthyroid obese children. Conclusion. Subclinical hypothyroidism in obese children may cause dislipidemia carrying a high cardiovascular disease risk.