Muscular effects of vitamin D in young athletes and non-athletes and in the elderly

Nikolaos E. Koundourakis, Pavlina D. Avgoustinaki, Niki Malliaraki, Andrew N. Margioris

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Muscles are major targets of vitamin D. Exposure of skeletal muscles to vitamin D induces the expression of multiple myogenic transcription factors enhancing muscle cell proliferation and differentiation. At the same time vitamin D suppresses the expression of myostatin, a negative regulator of muscle mass …

Laparoscopic surgery for pancreatic insulinomas: an update

Chrysanthi Aggeli, Alexander M. Nixon,Ioannis Karoumpalis, Gregory Kaltsas, George N. Zografos

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Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity …

Glycemic control in patients with insulinoma

Agata Matej, Hanna Bujwid, Jakub Wroński

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Insulinoma is the most common neuroendocrine tumor of the pancreas. Surgical management of insulinomas is considered to be the only curative method. However, effective glycemic control preoperatively and in unresectable insulinomas remains a significant issue …

More news from IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial)

Niki Katsiki, Vasilios G. Athyros, Dimitris P. Mikhailidis

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The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) reported a significant reduction in first primary endpoint (PEP) post-acute coronary syndrome (ACS) in patients (n=18,144) on ezetimibe + simvastatin compared with placebo + simvastatin.1 The low-density lipoprotein cholesterol (LDL-C) levels in the combination group were significantly lower than in the monotherapy group (53.7 vs 69.5 mg/dl; 1.4 vs 1.8 mmol/l) …

Hormones in pain modulation and their clinical implications for pain control: a critical review

Xueyin Chen, Jinyuan Zhang, Xiangrui Wang

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Recently, more and more studies have found that pain generation, transmission and modulation are under hormonal regulation. Indeed, hormonal dysregulation is a common component of chronic pain syndromes. Studies have attempted to determine whether the relationship between the pain and its perception and hormones is a causative relationship and how these processes interrelate …

Thyroid hormones: a potential ally to LDL-cholesterol-lowering agents

Leonidas H. Duntas, Gabriela Brenta

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L-thyroxine (LT4) treatment of hypothyroidism, particularly in patients with thyroid- stimulating hormone (TSH) >10mU/L, results in improved lipid profile, as LT4 stimulates low-density lipoprotein cholesterol (LDL-C) degradation and the conversion of cholesterol in bile acids by inducing LDL-receptor and 7 alpha hydroxylase expression …

Postprandial dysmetabolism: Too early or too late?

Christos Pappas, Eleni A. Kandaraki, Sofia Tsirona, Dimitrios Kountouras, Georgia Kassi, Evanthia Diamanti-Kandarakis

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Postprandial dysmetabolism is a postprandial state characterized by abnormal metabolism of glucose and lipids and, more specifically, of elevated levels of glucose and triglyceride (TG) containing lipoproteins. Since there is evidence that postprandial dysmetabolism is associated with increased cardiovascular mortality and morbidity, due to macro- and microvascular complications …

Cardiovascular safety of type 2 diabetes medications: Review of existing literature and clinical implications

Sílvia Paredes, Claudia Matta-Coelho, Ana Margarida Monteiro, Alice Brás, Olinda Marques, Marta Alves, Laura Ribeiro

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Type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD) and the cardiovascular effect of antidiabetic drugs are today critical medical issues, with the prevalence of T2DM in particular showing a steep increase worldwide, mainly due to unhealthy lifestyle habits. T2DM in association with obesity and other cardiovascular risk factors, results in the development of CVD, the leading cause of morbidity and mortality in patients with T2DM …

Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis

Marina Michalaki, Panagiotis Bountouris, Nikolaos D Roupas, Anastasia Theodoropoulou, Niki Agalianou, Theodoros Alexandrides, Kostas Markou

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BACKGROUND: The current trend in the management of low risk differentiated thyroid carcinoma is to follow less aggressive strategies. Objective: To assess the long-term morbidity and mortality outcomes of low-risk papillary thyroid carcinoma (PTC) patients undergoing minimal intervention. DESIGN: We retrospectively analyzed 137 patients with low-risk PTC …

Expert consensus on the rational clinical use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors

Apostolos Achimastos, Theodoros Alexandrides, Dimitrios Alexopoulos, Vasilios Athyros, Alexandra Bargiota, Eleni Bilianou, Christina Chrysochoou, Evridiki Drogari, Moses Elisaf, Emanouel Ganotakis, Ioannis Goudevenos, Ioannis Ioannidis, Genovefa Kolovou, Vasilios Kotsis, Ioannis Lekakis, Evangelos Liberopoulos, Andreas Melidonis, Vasilios Nikolaou, George Ntaios, Nikolaos Papanas, Stavros Pappas, Christos Pitsavos, Loukianos Rallidis, Dimitrios Richter, Ioannis Skoumas, Nicolaos Tentolouris, Dimitrios Tousoulis, Alexandros Tselepis, KonstantinosTsioufis, Dimitrios Tziakas, Konstantinos Tziomalos, Panagiotis Vardas, Charalabos Vlachopoulos, Dimitrios Vlahakos

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Two proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, evolocumab and alirocumab, have recently been approved by both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of hypercholesterolemia. These fully human monoclonal antibodies selectively block PCSK9, thus permitting the low-density lipoprotein (LDL) receptor to effectively recycle to the surface of liver cells. The administration of these antibodies leads to robust LDL …

Adiponectin and end-stage renal disease

Anastasia Markaki, Emmanuel Psylinakis, Aspasia Spyridaki

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Adiponectin (ADPN) is an adipokine with significant anti-inflammatory, insulin-sensitizing and anti-atherogenic properties, which is generally associated with a beneficial cardiometabolic profile. Paradoxically, end-stage renal disease (ESRD) is characterized by markedly increased plasma ADPN levels and increased cardiovascular risk. In spite of the cardioprotective properties …

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

Michael S. Shawky

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Continuous development of quick parathyroid hormone assays has resulted in a corresponding expansion of their applications in the practical landscape. In-theatre measurement of the parathyroid hormone has long been recognized as a valuable adjunct in parathyroid surgery, with other applications being incorporated in thyroid surgery and out-of-theatre uses …

Leydig cell clustering and Reinke crystal distribution in relation to hormonal function in adult patients with testicular dysgenesis syndrome (TDS) including cryptorchidism

Rikke R. Soerensen, Trine H. Johannsen, Niels E. Skakkebaek, Ewa Rajpert-De Meyts

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OBJECTIVE: Testicular dysgenesis syndrome (TDS) comprises testicular germ cell cancer, cryptorchidism and some cases of male infertility and hypospadias, which can be linked to impairment of intrauterine gonadal development. Among histological signs of TDS, large Leydig cell (LC) clusters (micronodules) are frequently present. This study aimed to investigate possible associations …

Neoadjuvant therapy for advanced pancreatic neuroendocrine tumors: an emerging treatment modality?

Iraklis Perysinakis, Chrysanthi Aggeli, Gregory Kaltsas, George N. Zografos

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OBJECTIVE: Complete surgical resection is the only potentially curative treatment of localized pancreatic neuroendocrine tumors. Unfortunately, a significant proportion of these patients present with unresectable locally advanced tumors or massive metastatic disease. Recently, a new therapeutic approach for this subset of patients has emerged consisting of neoadjuvant therapy followed by surgical exploration in responders …

Effects of ghrelin in energy balance and body weight homeostasis

Laura Mihalache, Andreea Gherasim, Otilia Niță, Maria Christina Ungureanu, Sergiu Serghei Pădureanu, Radu Sebastian Gavril, Lidia Iuliana Arhire

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Ghrelin is a gut peptide composed of 28 amino acids mostly secreted in the gastric fundus mucosa. It was isolated and described in 1999 by Kojima et al. and only three years later its specific receptor, GHSR1a, was also identified. Ghrelin, the endogenous ligand for the GH secretagogue receptor, is the only peripheral orexigenic hormone that activates the receptors to be found especially in the appetite center (hypothalamus and pituitary gland) …

Parathyroid hormone response to severe vitamin D deficiency is associated with femoral neck bone mineral density: an observational study of 405 women with hip-fracture

Marco Di Monaco, Carlotta Castiglioni, Rosa Tappero

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OBJECTIVE: Hip-fracture patients with vitamin D deficiency can have either secondary hyperparathyroidism or normal levels of parathyroid hormone (PTH). We hypothesized that bone mineral density (BMD) could be lower in patients with high PTH levels than in those with normal levels of PTH, irrespectively of the severity of vitamin D depletion …

Therapeutic trends and outcome of acromegaly: a single center experience over a 40-year period

Olga Karapanou, Marinella Tzanela, Marietta Christoforaki, Lida Papastathopoulou, Paraskevi Moutsatsou, Efi Botoula, Stylianos Tsagarakis

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OBJECTIVE: To evaluate the therapeutic trends and long-term outcome of treatment modalities for acromegaly in our center over a 40-year period. Design: We retrospectively studied 321 acromegalic patients (145 males/176 females) diagnosed and treated from the 1970s until September 2013 …

A new TRβ mutation in resistance to thyroid hormone syndrome

Corina Neamţu, Claudiu Ţupea, Diana Păun, Anca Hoisescu, Adina Ghemigian, Samuel Refetoff, Chutintorn Sriphrapradang

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Thyroid hormones (TH) exert their actions by binding nuclear receptors alpha (TRα1) and beta (TRß1 and TRß2). Resistance to thyroid hormone (RTH) is a clinical syndrome with various clinical manifestations, its hallmark being decreased tissue sensitivity …

Comparison of color-Doppler and qualitative and quantitative strain-elastography for differentiation of thyroid nodules in daily practice

Manuela Götzberger, Susanne Krueger, Roland Gärtner, Martin Reincke, Matthias Pichler, Gerald Assmann, Thomas Mussack, Michael Zimmermann, Veit Gülberg

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OBJECTIVE: Strain-elastography provides a new ultrasound-based method that can offer information about the stiffness of thyroid nodules as an indicator of malignancy. The aim of our study was to compare the utility of color-Doppler and strain-elastography in differentiating between benign and malignant nodules. DESIGN AND METHODS: 77 thyroid nodules (70 benign and 7 malignant) from 70 unselected patients (48 female/22 male, mean age 49.7±14.3 years) were evaluated with color-Doppler …

The measurement of urinary gonadotropins for assessment and management of pubertal disorder

Laura Lucaccioni, Jane McNeilly, Avril Mason, Claudio Giacomozzi, Andreas Kyriakou, Mohammed Guftar Shaikh, Lorenzo Iughetti, Syed Faisal Ahmed

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OBJECTIVE: Measurement of urinary LH (uLH) and FSH (uFSH) may facilitate non-invasive pubertal assessment but there is a need for further validation by studying children and adolescents with disorders of puberty. DESIGN: 65 cases (Male: 25) with a median age of 12 years (2.9-18.1) supplied at least one non-timed urine sample

Urinary steroid metabolites in a case of florid Ectopic Cushing’s syndrome and clinical correlations

Angelos Kyriacou, Karolina M. Stepien, Basil Issa

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A 51-year old woman was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascular necrosis led to a clinical diagnosis of Cushing’s syndrome (CS) …

Recent advances in the molecular mechanisms causing primary generalized glucocorticoid resistance

Nicolas C. Nicolaides, Agaristi Lamprokostopoulou, Amalia Sertedaki, Evangelia Charmandari

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Primary Generalized Glucocorticoid Resistance is a rare condition characterized by generalized, partial, target tissue insensitivity to glucocorticoids owing to inactivating mutations, insertions or deletions in the human glucocorticoid receptor (hGR) gene (NR3C1). Recent advances in molecular and structural biology have enabled us to elucidate the molecular mechanisms of action of the mutant receptors and to understand how certain conformational alterations …

Young adult patient with headache, fever and blurred vision

Stavroula A. Paschou, Konstantinos Tzioras, Vasiliki Trianti, Stavroula Lyra, Vasileios-Arsenios Lioutas, Andreas Seretis, Andromachi Vryonidou

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BACKGROUND AND IMPORTANCE:This case highlights the fact that acute pituitary apoplexy may be misdiagnosed due to being confused with other entities exhibiting similar symptoms, such as meningitis or subarachnoid hemorrhage. CLINICAL PRESENTATION: A patient in his late 30s presented with sudden and severe frontal headache …

Lipid accumulation product is associated with metabolic syndrome in women with polycystic ovary syndrome

Djuro Macut, Ivana Božić Antić, Jelica Bjekić-Macut, Dimitrios Panidis, Konstantinos Tziomalos, Danijela Vojnović Milutinović, Olivera Stanojlović, Biljana Kastratović-Kotlica, Milan Petakov, Nataša Milić

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OBJECTIVE: There is a need for a simple and accurate method for the assessment of cardiovascular risk in polycystic ovary syndrome (PCOS). Lipid accumulation product (LAP) is based on the assessment of waist circumference and serum triglycerides that yield an estimation of lipid overaccumulation. We aimed to determine whether LAP is associated with metabolic syndrome (MetS) in Caucasian women with PCOS …

Vitamin D levels in a large Mediterranean cohort: reconsidering normal cut-off values

Marianna Katrinaki, Marilena Kampa, Andrew Margioris, Elias Castanas, Niki Malliaraki

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OBJECTIVE: The determination of the normal range of 25-hydroxyvitamin D [25-(OH)D], though currently based on suppression of PTH levels, still remains a controversial issue. The 25-(OH)D levels exhibit gender and seasonal variability, the latter attributed in part to changes of insolation. DESIGN: The aim of this cross-sectional study was to estimate the levels of 25-(OH)D on the island of Crete …