Endocrine Outpatient Clinic Research Articles

MON-LB007 Incidence and Characteristics of Thyroid and Pituitary Dysfunction in Patients Treated with Immunotherapy

Background Endocrinopathies are well recognised immune-related adverse events associated with immunotherapy. Incidence rates of hypophysitis and thyroid dysfunction are widely variable in the literature. Hypophysitis has been reported in between 0.4% and 27% in patients treated with CTLA-4 inhibitors such as ipilimumab (1) while the incidence of thyroid dysfunction varies between 8% and 20% in patients treated with PD-1 inhibitors such as nivolumab and pembrolizumab (1). Aims Our aim was to determine real world rates of thyroid and pituitary dysfunction in patients treated with immunotherapy. We also sought to evaluate the characteristics of same-e.g. time to onset of adverse events and presence of autoantibodies. Methods A retrospective cohort study was performed in 347 patients who received treatment with PD-1 inhibitors nivolumab and pembrolizumab, anti-CD52 antibody alemtuzumab and CTLA-4 inhibitor ipilimumab between January 2013 and December 2017 at a tertiary referral metropolitan hospital in Melbourne, Australia. Patients were identified from pharmacy records and assessment of the clinical and biochemical records pertaining to thyroid function (TFT) and serum cortisol was performed. Results 45 patients (12.9%) had evidence of thyroid or pituitary dysfunction from the therapies. 34 of the 267 (12.7%) patients on PD-1 inhibitors developed thyroid dysfunction, 15 (5.6%) of whom had a clear thyroiditis picture-i.e. thyrotoxic phase with subsequent hypothyroidism. 3 of the 34 (8.8%) patients who received CTLA-4 inhibitor ipilimumab developed hypophysitis, all of whom were on combined treatment with a PD-1 inhibitor. Median time to onset of adverse effects was 30days. 12 out of 27 patients with thyroid dysfunction had positive anti-thyroid peroxidase antibodies. 25 of the 45 (55.6%) patients were reviewed in endocrine outpatient clinics. Only 2 of the 45 endocrinopathies were recorded in the hospital’s adverse drug reactions database. Conclusions In our tertiary centre, endocrinopathies are common in patients treated with immunotherapies; however reportage to the adverse drug reaction database is low and endocrinology services appear underutilised. Current guidelines suggest TFT monitoring every 4-6weeks on therapy (2) with baseline monitoring of early morning ACTH and cortisol concentrations to be considered in patients treated with CTLA-4 inhibitors. Greater clinician awareness and adherence to guidelines is needed for optimal patient care.

SAT-210 Autoimmune Progesterone Dermatitis: A Rare Case Report in a Young Woman with Chronic Dermatitis

Back ground: Autoimmune progesterone dermatitis (APD) or progesterone hypersensitivity (PH) is a rare hypersensitivity reaction to progestogen that exclusively occur in women of childbearing age of which is the underlying mechanism remains not well understood. Clinical case: A 44 years old lady was referred to our endocrine outpatient clinic by her dermatologist for treatment of a recently diagnosed autoimmune progesterone dermatitis. She was initially evaluated for a skin rash that started during the second trimester of her second pregnancy in 2009. Her initial diagnosis was pregnancy induced eczema which was treated with topical steroid with no significant improvement. Her rash worsens after delivery and had persisted since then. She failed chronic systemic steroid treatment and multiple immunosuppressive medications over the years. She had regular menstrual period since her menarche at age of 11 years old. She was on oral contraceptive medication prior to her second pregnancy which she resumed after delivery. She then switched to IUD. Her rash typically gets worse 7-10 days before the onset of her menstrual period with some improvement after her period. Her initial clinical exam showed erythematous papules over her extensor elbows, thighs and genital area with scattered eczematous excoriated plaques over her extremities and trunk. She underwent skin patch test which showed that she is allergic to class A, B, and D1 steroids PH was suspected based on her history and confirmed by a positive progesterone skin test. She was referred to reproductive endocrinology for consideration of ovulation suppression using GnRH agonist. Conclusion: APD is a rare hypersensitivity reaction that can be triggered by endogenous progesterone (menses, pregnancy) or exogenous progestin (OCP, IUD, IVF) exposure. Women between menarche and menopause can be affected with the average age of onset to be in the third decade of life. The underlying mechanism is not well known with several hypotheses being postulated (e.g hypersensitivity reaction type I and IV, hormone cross reactivity and autoimmunity) Clinical presentation is variable and can range from mild dermatitis to life threatening anaphylaxis with some extra dermal manifestations have been described. Detailed history taking is the key to diagnosis as the most consistent features is the presentation of symptoms during the luteal phase of the menstrual cycle. The goal of treating APD is to suppress ovulation which can be achieved by the use of GnRH agonist, selective estrogen receptor modulator or oophorectomy. Progesterone desensitization has been tried in women desiring pregnancy.

MON-LB078 Desmopressin Stimulated Salivary Cortisol as a Suplementary Tool in the Diagnosis of Cushing's Syndrome

The classic desmopressin test consists of serum cortisol and plasma ACTH measurements after intravenous administration of desmopressin. This test has been shown to have good accuracy in the context of exclusion of Cushing's syndrome in patients with non-tumoral hypercortisolism; with an equal or greater precision than the synthetic corticotrophin-releasing hormone (CRH) test. Meanwhile, salivary cortisol samples are independent of fluctuations in the serum transcortin, reflect the plasma free fraction (about 70%), and are not influenced by the alteration of salivary flow ; It has been largely employed in the evaluation of hypercortisolism states, however its role in the desmopressin test has not been fully evaluated. Aim: To compare salivary cortisol measurements during the desmopressin test in active Cushing’s disease as opposed to obese patients without clinical or biochemical evidence of hypercortisolism. Methods: Nineteen individuals, from endocrine outpatient clinics of an university were enrolled: 11 patients with active Cushing's disease and 8 obese individuals (BMI greater than 35kg / m2). Salivary cortisol plasma ACTH and serum cortisol were collected at baseline, 15, 30, 45, 60 and 120 minutes after IV administration of desmopressin (10 mcg). Salivary cortisol and plasma ACTH were performed by an electrochemiluminescence immunoassay, while serum cortisol was made by competitive immunoassay using direct chemiluminescence. Results: The groups were epidemiologic and clinical homogenous. In comparison to baseline, plasma ACTH, serum and salivary cortisol after desmopressin stimulation were significantly elevated at 45 (P<0,01) and 60 minutes (P<0,01) . The increment in salivary cortisol at 15 (P<0,01) and 30 minutes (P<0,01) was significantly different in patients with Cushing`s disease in comparison to obese patients. Salivary cortisol increased in comparison to baseline in patients with Cushing’s disease (range: 66 to 309%) mainly at 60 minutes, declining thereafter. A positive correlation between salivary and serum cortisol at 30, 45, 60,and 120 minutes was observed in patients with Cushing’s disease, particularly at 120 minutes (rho 0,90, p<0,01). In obese patients, salivary cortisol did not respond to desmopressin administration and there was no correlation between serum and salivary cortisol. Conclusion: Inclusion of the measurement of salivary cortisol to the desmopresin test may add value to its interpretation, combined with serum cortisol and plasma ACTH. Desmopressin stimulated salivary cortisol at 60 minutes could be used as an additional tool in differentiating Cushing`s disease from of non-tumoral hypercortisolism . Further studies in larger and more a diverse populations are needed to confirm the role of desmopressin -stimulated cortisol in the diagnosis of Cushing`s syndrome. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

MON-001 Assessment of Endocrine Clinic Attendance Rates to Guide Interventions to Reduce Patient No-Show Rates

As a part of our endocrine fellowship quality improvement training, we sought to improve patient access to endocrine outpatient clinic appointments at our institution. From the physician perspective, patients who do not show up for a 30-45 minute new patient visit slot disrupt clinic flow and limits access for other patients. Therefore, we decided to focus our attention on reducing the new patient no-show rate. Here, we assessed the efficacy of our current scheduling system from 2014-2016. This analysis was performed as part of a quality improvement project to inform future interventions. Previously, only a few studies have attempted to identify baseline no-show rates (1,2). Our institution utilizes an automated telephone appointment reminder system (Televox) which calls patients three to four business days prior to a scheduled appointment and gives the patient an opportunity to confirm or cancel the appointment. Televox data for 7,556 patients over 34 months (1/2014-10/2016) revealed a 95% show frequency for patients who confirmed their appointment, 82% show frequency for patients for which there was no response to the Televox reminder, and 78% show frequency of patients who were not reached (Televox call not made). P-Chart of the show frequencies of patients who did not respond or were not reached fluctuated between 70-90% over this period. This analysis shows that new patients who did not respond or were not reached are a potential target for intervention. By identifying this cohort early, we will be able to implement intervention and reschedule patients in a timely manner to improve clinic flow and clinic access.

Effects of Vitamin D Supplementation on Bone Turnover and Bone Mineral Density in Healthy Men: A Post-Hoc Analysis of a Randomized Controlled Trial.

Vitamin D is well known for its effects on calcium and mineral metabolism. However, vitamin D effects on bone turnover markers (BTMs), which are used together with bone mineral density (BMD) to evaluate bone health, are less clear. We therefore examined vitamin D effects on BTMs (beta-cross laps (CTX) and osteocalcin (OC)) and BMD in a post-hoc analysis of a randomized controlled trial (RCT). This is a post-hoc analysis of the Graz Vitamin D&TT-RCT, a single-center, double-blind, randomized placebo-controlled trial conducted between December 2012 and November 2017 at the endocrine outpatient clinic at the Medical University of Graz, Austria. A total of 200 healthy men with serum 25-hydroxyvitamin D (25(OH)D) levels <75 nmol/L participated in the trial. Subjects were randomized to receive 20,000 IU of vitamin D3/week (n = 100) or placebo (n = 100) for 12 weeks. Outcome measures were BTMs, BMD, and trabecular bone score (TBS). A total of 192 men (mean age and 25(OH)D: 43 (±13) years and 54.9 (±18.3) nmol/L, respectively) completed the study. We found no significant treatment effect on BTMs, BMD, or TBS (p > 0.05 for all). In middle-aged healthy men, vitamin D treatment for 12 weeks had no significant effect on BTMs or BMD.

Metabolomics and Their Ability to Distinguish Thyroid Disorders: A Retrospective Pilot Study.

Early diagnosis of thyroid disorders is key to further treatment. We assessed the ability of a high-throughput proton NMR metabolomic profile to distinguish disease type amongst of Graves' disease (n=87), Hashimoto's thyroiditis (n=17), toxic goiter (n=11), and autoimmune thyroiditis [i. e., subacute thyroiditis (n=4), postpartum thyroiditis (n=1)]. This observational study was conducted investigating patients presenting with a thyroid disorder at a Swiss hospital endocrine referral center and an associated endocrine outpatient clinic. The main outcome was diagnosis of thyroid disorder based on classical parameters. Blood draws took place as close as possible to treatment initiation. We performed one-way ANOVA and partial least squares discriminant analysis (PLS-DA) as multivariate classification and feature ranking method. One-way ANOVA analysis yielded following significantly different metabolites, triglycerides in small VLDL, triglycerides in very small VLDL, and triglycerides in large LDL (FDR=0.04). There was no distinct separation of any of the 4 diagnoses by PLS-DA. We did not find a metabolomic biomarker combination capable of predicting diagnosis. Preanalytical issues might have influenced our results. We strongly suggest replicating our work in another cohort.

Influence of ferritin levels and inflammatory markers on HbA1c in the Type 2 Diabetes mellitus patients.

Objective:Diabetes Mellitus (DM) is a significant public health issue worldwide due to the associated comorbidities. Recent studies have demonstrated a strong relationship between blood glucose levels and serum ferritin levels in patients with type 2 DM. The aim of the study was to investigate the association between Ferritin Levels and Inflammatory Markers on HbA1c in the Type 2 Diabetes Mellitus Patients.Methods:This single-center, cross-sectional, controlled study included patients who were admitted to the Endocrine and Metabolic Disorders outpatient clinics of the Private Kütahya Hospital in the province of Kutahya in the Western Turkey. The study included a total of 172 patients, 84 of whom had type 2 DM and 88 without diabetes and constituted the control group. A total of 190 patients with DM were admitted to the Adult Endocrine and Metabolic Diseases Outpatient Clinics of the hospital between July 1, 2018 and September 1, 2018, and among these, the study was conducted on 172 volunteer patients who met the study inclusion criteria and who did not have any missing data. The HbA1c levels, serum ferritin, hemoglobin (Hb), insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), C-Reactive Protein (CRP), lipid profiles, and uric acid levels were compared between the groups.Results:The serum ferritin levels of the patients with type 2 DM significantly increased with increasing HbA1c levels (p<0.01). A strong positive correlation was found between serum ferritin levels and HbA1c and fasting blood glucose (FBG) levels (p<0.01).Conclusions:Our study results show a significant relationship between HbA1c levels and serum ferritin and CRP levels, suggesting that serum ferritin and CRP levels can be used as a routine screening tool for the early diagnosis of DM. However, further large-scale, prospective studies are needed to confirm these findings.

Expression of Amylin and Preptin in Iraqi Patients with Type 2 Diabetes Mellitus

This study was planned to investigate the relationship between serum amylin and preptin levelsin patients with T2DM compared to healthy controls. And to study their associations together (preptin and amylin) with serum levels of insulin and HOMA-IR. Sixty-four (64) patients were recruited from the Endocrine Outpatient clinic in Al-Imamain Al-Kadhimain city hospital from March of 2018 to May of 2018. Fasting serum samples were obtained on enrolment. (Mean age, (61.73± 8.05) years;mean duration of diabetes, (8.77±2.66) years; mean HbA1c, (8.1 ± 1.7)withT2DM and body mass index (BMI) > 25.1 kg/m2 underwent examination. Age, sex and (BMI) matched with thirty eight(38) healthy controls were also in ruled, Serum preptin and amylin levels were measured by ELISA technique. There was statistically significant difference between patients and controls serum amylin (p=0.023) and preptin (p=0.01).Patients with T2DM had significantly higher blood glucose (p=0.0001), HbA1c (p=0.0001), insulin (p=0.0001), and homeostaticmodel assessment of insulin resistance (HOMA-IR) (p=0.001)compared to healthy control, while total cholesterolwas positively related (p=0.111)triglyceride, low-density lipoprotein cholesterol values were (p<0.001 for each), and significantly lower high-density lipoprotein cholesterol levels comparedwith the control group (p<0.0001). The preptin level demonstrated asignificant positive association with insulin and HOMA-IR compared with healthy control. For healthycontrol group: r=0.381, p=0.146, r=0.133, p=0.438respectively; for T2DM group: (r=0.411, p=0.02, r=0.332, p=0.003), The amylin level also showed a significant positive correlation with insulin and HOMA-IR compared with healthy control. (for healthy control group: r= 0.188, p=0.309, r=-0.039, p=0.911) respectively; for T2DM group: (r=0.279, p=0.002, r=0.291, p=0.003), Conclusions: There were significant differences between healthy control and patients with T2DM concerning amylin and preptin levels. Serum Amylin and preptin increase in association with insulin in diabetic conditions. The present study suggests a potential role of amyline and preptin in the pathogenesis of T2DM.

Effects of vitamin D supplementation on androgens in men with low testosterone levels: a randomized controlled trial

PurposeIt has been hypothesized that vitamin D is associated with androgen levels in men. We, therefore, aimed to evaluate whether vitamin D supplementation increases serum total testosterone (TT) levels in men with low TT levels at baseline.MethodsThe Graz Vitamin D&TT-RCT is a single-center, double-blind, randomized placebo-controlled trial conducted between March 2013 and November 2017 at the endocrine outpatient clinic at the Medical University of Graz, Austria. One-hundred healthy men with serum TT levels < 10.4 nmol/l and 25-hydroxyvitamin D [25(OH)D] levels < 75 nmol/l participated in the trial. Subjects were randomized to receive 20,000 IU of vitamin D3/week (n = 50) or placebo (n = 50) for 12 weeks. Primary outcome was TT measured using mass spectrometry. Secondary outcomes were free testosterone, free androgen index, sex hormone-binding globulin, estradiol, follicle-stimulating hormone, luteinizing hormone, metabolic characteristics, and body composition.ResultsNinety-four men [mean age and 25(OH)D: 47 (± 12) years and 56.3 (± 18.3) nmol/l, respectively] completed the study. We found no significant treatment effect on serum TT or on the remaining secondary outcome variables.ConclusionVitamin D treatment had no effect on serum TT levels in middle-aged healthy men with low TT levels.

Metabolomics for Prediction of Relapse in Graves' Disease: Observational Pilot Study.

Background: There is a lack of biochemical markers for early prediction of relapse in patients with Graves' disease [GD], which may help to direct treatment decisions. We assessed the prognostic ability of a high-throughput proton NMR metabolomic profile to predict relapse in a well characterized cohort of GD patients.Methods: Observational study investigating patients presenting with GD at a Swiss hospital endocrine referral center and an associated endocrine outpatient clinic. We measured 227 metabolic markers in the blood of patients before treatment initiation. Main outcome was relapse of hyperthyroidism within 18 months of stopping anti-thyroid drugs. We used ROC analysis with AUC to assess discrimination.Results: Of 69 included patients 18 (26%) patients had a relapse of disease. The clinical GREAT score had an AUC of 0.68 (95% CI 0.63–0.70) to predict relapse. When looking at the metabolomic markers, univariate analysis revealed pyruvate and triglycerides in medium VLDL as predictors with AUCs of 0.73 (95% CI 0.58–0.84) and 0.67 (95% CI 0.53–0.80), respectively. All other metabolomic markers had lower AUCs.Conclusion: Overall, metabolomic markers in our pilot study had low to moderate prognostic potential for prediction of relapse of GD, with pyruvate and triglycerides being candidates with acceptable discriminatory abilities. Our data need validation in future larger trials.

Temporal relationship of sleep apnea and acromegaly: a nationwide study

PurposePatients with acromegaly have an increased risk of sleep apnea, but reported prevalence rates vary largely. Here we aimed to evaluate the sleep apnea prevalence in a large national cohort of patients with acromegaly, to examine possible risk factors, and to assess the proportion of patients diagnosed with sleep apnea prior to acromegaly diagnosis.MethodsCross-sectional multicenter study of 259 Swedish patients with acromegaly. At patients’ follow-up visits at the endocrine outpatient clinics of all seven university hospitals in Sweden, questionnaires were completed to assess previous sleep apnea diagnosis and treatment, cardiovascular diseases, smoking habits, anthropometric data, and S-IGF-1 levels. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale. Patients suspected to have undiagnosed sleep apnea were referred for sleep apnea investigations.ResultsOf the 259 participants, 75 (29%) were diagnosed with sleep apnea before the study start. In 43 (57%) of these patients, sleep apnea had been diagnosed before the diagnosis of acromegaly. After clinical assessment and sleep studies, sleep apnea was diagnosed in an additional 20 patients, yielding a total sleep apnea prevalence of 37%. Higher sleep apnea risk was associated with higher BMI, waist circumference, and index finger circumference. Sleep apnea was more frequent among patients with S-IGF-1 levels in the highest quartile.ConclusionSleep apnea is common among patients with acromegaly, and is often diagnosed prior to their acromegaly diagnosis. These results support early screening for sleep apnea in patients with acromegaly and awareness for acromegaly in patients with sleep apnea.

SLC6A4 5HTTLPR Polymorphism Affects Insulin Secretion in Patients with Polycystic Ovary Syndrome.

Purpose To investigate in a pilot study of genetic polymorphisms in serotonin system influencing basal- and glucose-stimulated insulin secretion in women with polycystic ovary syndrome (PCOS). Methods A cross-sectional study included 65 female patients with PCOS followed up at the endocrine outpatient clinic of the University Medical Center Ljubljana and a control group of 94 young healthy female blood donors. Oral glucose tolerance test was performed only in PCOS patients and basal- and glucose-stimulated blood glucose and insulin levels were measured. All the subjects were genotyped for 5HTR1A rs6295, 5HTR1B rs13212041, and SLC6A4 5HTTLPR polymorphisms in the serotonin system. Results Genotype distributions were in accordance with the Hardy-Weinberg equilibrium (HWE), except for 5HTR1A rs6295 in healthy controls and 5HTR1B rs13212041 in PCOS patients that were not consistent with HWE. SLC6A4 5HTTLPR polymorphism was significantly associated with insulin secretion (p = 0.030) and with the area under the curve of insulin blood levels during OGTT (p = 0.021). None of the investigated polymorphisms was significantly associated with basal- or glucose-stimulated blood glucose levels at any point in time during OGTT or with the basal insulin concentration. Conclusions Serotonin system may play a role in glucose-stimulated insulin secretion in patients with insulin resistance (IR) and decreased insulin sensitivity. Further studies are needed to conclude whether the observed effect is characteristic for PCOS-related metabolic disturbances or for the identified mutation in different high metabolic risk populations.

Pitfalls in the management of inadequate TSH in the outpatient endocrine clinic: a case report

Pitfalls in the management of inadequate TSH in the outpatient endocrine clinic: a case report

Osteoporosis in men: management of bone health in the endocrine outpatient clinic

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Diabetes duration and thyroid stimulating hormone levels in children with type 1 diabetes mellitus

Background Children with type 1 diabetes mellitus (T1DM) are at risk of thyroid dysfunction. An association between diabetes duration and thyroid stimulating hormone level remains inconclusive.Objective To assess for a possible association between diabetes duration and thyroid stimulating hormone levels in children with T1DM.Methods We conducted a cross-sectional study from January to June 2017 in the Pediatric Endocrine Outpatient Clinic at Dr. Soetomo Hospital. Subjects were children with T1DM aged 7 to &lt;18 years. Exclusion criteria were children with diabetic ketoacidosis, previously diagnosed thyroid problems, and hospitalization in the pediatric intensive care unit (PICU). Results From the 55 regular patients in our outpatient clinic, 34 patients were included in the study. Nineteen (54.3%) subjects were male, and the overall mean age was 11.3 years. Subjects’ mean duration of diabetes was 3 years and their mean thyroid stimulating hormone concentration was 3.76mIU/L. Pearson’s correlation test revealed no significant association between duration of diabetes and thyroid stimulating hormone level (rs=-0.068; P=0.703).Conclusion There is no significant association between duration of diabetes and thyroid stimulating hormone levels in children with T1DM.

Abstract #1212 Real Life Efficacy of the Minimed 670g Hybrid Closed-Loop System in an Endocrine Outpatient Clinic

Abstract #1212 Real Life Efficacy of the Minimed 670g Hybrid Closed-Loop System in an Endocrine Outpatient Clinic

Double-Blind, Placebo-Controlled, Randomized Trial of Selenium in Graves Hyperthyroidism

Supplemental selenium (Se) may affect the clinical course of Graves disease (GD). Evaluate efficacy of add-on Se on medical treatment in GD. Double-blind, placebo-controlled, randomized supplementation trial. Academic endocrine outpatient clinic. Seventy untreated hyperthyroid patients with GD. Additionally to methimazole (MMI), patients received for 24 weeks either sodium selenite 300 µg/d po or placebo. MMI was discontinued at 24 weeks in euthyroid patients. Response rate (week 24), recurrence rate (week 36), and safety. A response was registered in 25 of 31 patients (80%) and in 27 of 33 (82%) at week 24 [odds ratio (OR) 0.93; 95% confidence interval (CI), 0.26 to 3.25; P = 0.904] in the Se (+MMI) and placebo (+MMI) groups, respectively. During a 12-week follow-up, 11 of 23 (48%) and 12 of 27 (44%) relapsed (OR 1.13; 95% CI, 0.29 to 2.66; P = 0.81) in the Se and placebo groups, respectively. Serum concentrations of Se and selenoprotein P were unrelated to response or recurrence rates. At week 36, 12 of 29 (41%) and 15 of 33 (45%) were responders and still in remission in the Se and placebo groups, respectively (OR 0.85; 95% CI, 0.31 to 2.32; P = 0.80). Serum levels of free triiodothyronine/free tetraiodothyronine, thyroid-stimulating hormone receptor antibody, prevalence of moderate to severe Graves orbitopathy, thyroid volume, and MMI starting dose were significantly lower in responders than in nonresponders. A total of 56 and 63 adverse events occurred in the Se and placebo groups, respectively (P = 0.164), whereas only one drug-related side effect (2.9%) was noted in 35 patients on placebo + MMI. Supplemental Se did not affect response or recurrence rates in GD.

Vitamin D and Testosterone in Healthy Men: A Randomized Controlled Trial.

Available evidence shows an association of vitamin D with androgen levels in men. However, results from preliminary randomized controlled trials (RCTs) are conflicting. To evaluate whether vitamin D supplementation increases total testosterone (TT) levels in healthy men. The Graz Vitamin D&TT-RCT is a single-center, double-blind, randomized, placebo-controlled trial conducted between December 2012 and January 2017. Endocrine outpatient clinic at the Medical University of Graz, Austria. Ninety-eight healthy men with TT levels ≥10.4 nmol/L and 25-hydroxyvitamin D [25(OH)D] levels <75 nmol/L completed the study. Subjects were randomly assigned to receive 20,000 IU/wk of vitamin D3 (n = 50) or placebo (n = 50) for 12 weeks. Primary outcome was TT measured using mass spectrometry. Secondary outcomes were free testosterone, sex hormone-binding globulin, estradiol, follicle-stimulating hormone, and luteinizing hormone levels; free androgen index; metabolic characteristics; and body composition. In healthy men [mean values ± standard deviation: age, 39 years (±13 years); 25(OH)D level, 53.3 nmol/L (±18.3 nmol/L); TT, 19.1 nmol/L (±5.6 nmol/l)], no significant treatment effect on TT was found; however, there were significant effects on quantitative insulin sensitivity check index (QUICKI) and a trend toward decreased Matsuda index. In the treatment group, median (interquartile range) changes for TT, QUICKI, and Matsuda index were 0.5 nmol/L (-0.63 to 0.63 nmol/L; P = 0.497), -0.02 (-0.04 to 0.01; P = 0.034), and -0.9 (-3.2 to 0.8; P = 0.051), respectively. Vitamin D treatment had no effect on TT levels in middle-aged healthy men with normal baseline TT, but it significantly decreased QUICKI. Additional studies investigating vitamin D effects on TT and insulin sensitivity in healthy men are required.

Subclinical hypothyroidism and endocrine metabolic characteristics in women with polycystic ovary syndrome

To explore associations of subclinical hypothyroidism (SCH) with endocrine metabolic characteristics in women with polycystic ovary syndrome (PCOS). Methods: A total of 321 women who were newly diagnosed as PCOS were recruited from two endocrine outpatient clinics. The diagnosis of PCOS was established according to the 2003 Rotterdam consensus criteria. Thyroid function was examined by chemiluminescent immunoassay. Patients who had normal free thyroxine (FT4) were divided into different SCH subgroups according to two thyroid stimulating hormone (TSH) cutoff points (4.2 and 2.5 mU/L). Endocrine metabolic characteristics in different subgroups were compared and analyzed. Results: In PCOS women with normal FT4, the patients with TSH≥4.2 mU/L had higher prolactin (PRL), luteinizing hormone-to-follicle stimulating hormone ratio, and visceral adipose index (all P<0.05). There were trends toward an increase in triglyceride (P=0.085) and a decrease in high-density lipoprotein cholesterol (HDL-C) (P=0.060) in the patients with TSH≥4.2 mU/L compared with that in the patients with TSH<4.2 mU/L. Also in PCOS women with normal FT4, the patients with TSH≥2.5 mU/L had higher body mass index, PRL, triglyceride, visceral adipose index and lower HDL-C in comparison of that in the patients with TSH<2.5 mU/L (all P<0.05). Conclusion: SCH is associated with more severe endocrine abnormality, dyslipidemia, and visceral obesity in PCOS women. PCOS women with normal FT4 and endocrine metabolic characteristics are more prone to be different between the SCH group and the euthyroid group when setting 2.5 mU/L as a TSH cutoff for SCH, indicating that 2.5 mU/L is a good TSH cutoff for SCH in PCOS women.

Study of Serum Irisin in Patients with Thyroid Dysfunction

Background: irisin, identified as a proteolytic cleavage product of the fibronectin type III domain-containing protein 5 (FNDC5), It is a novel myokine secreted by contracting skeletal muscle, possibly mediating some exercise health benefits via ‘browning’ of white adipose tissue. Irisin causes a significant increase in total body energy expenditure and resistance to obesity-associated insulin resistance in mice, while controversy still exists concerning irisin origin, regulation and function in humans. Aim of the work: our study aimed to detect relation of thyroid status (hypo, hyperthyroid) with serum irisin, ck and peripheral neuropathy. Patient and methods: this study was conducted on 60 candidates consisted of 40 patients with thyroid dysfunction selected from Endocrine outpatient Clinic and Inpatient Department of Ain Shams University Hospitals and 20 healthy volunteers from April 2016 to October 2016. Informed consent was obtained from all participants. Patients of both genders, age more than 18 years old, 20 patients with hypothyroidism, 20 patients with hyperthyroidism and 20 healthy volunteers. We excluded significant renal, hepatic and cardiac disease, severe associated acute illness or depression, pregnant females, diabetes, hypercortisolism, hypocortisolism, muscular or neurological disorders, routinely taking drugs as statins, intensively involved in a sport or any strenuous physical activity. All participants were subjected to full medical history taking, general clinical examination and laboratory investigations as thyroid and thyroid-related hormone concentrations as well as a thyroid ultrasound examination and thyroid scan for patients with hyperthyroidism. Serum irisin level, CK and nerve conduction velocity were measured. Results: irisin level was higher in hyperthyroid group than euthyroid group with a significant difference. In comparison with normal NCV candidates and reduced NCV candidates with other variables there was only border line significant difference with irisin p-value. Non significant value of irisin and CK level were detected for diagnosis of hypothyroidism. Irisin has highly significant value for diagnosis of hyperthyroidism with (sen 95%, sp 42.5). Increased BMI is the only independent predictor for hypothyroidism by using multivariable binary logistic regression analysis. Decreased BMI and irisin are independent predictors for hyperthyroidism. Conclusion: serum irisin level is one of predictors for hyperthyroidism, on the other hand irisin does not have a significant value to predict hypothyroidism. Serum irisin was found to be higher in patients with hyperthyroidism in comparison with euthyroid participant with non statistically significant difference between hypo and hyperthyroidism. Serum CK level does not have a significant value in diagnosis of thyroid dysfunction (hypothyroidism or hyperthyroidism). Serum irisin level was low in thyroid dysfunction cases with delayed NCV compared to thyroid dysfunction cases and normal NCV with border line significant difference.