Diabetes and Endocrinology Unit

Clayton, Australia

Diabetes and Endocrinology Unit

Clayton, Australia

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Tripto-Shkolnik L.,Diabetes and Endocrinology Unit | Bronshtein M.,Haifa University | Salmon A.,Hadassah University Hospital | Jaffe A.,Diabetes and Endocrinology Unit
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Context: Adrenocortical carcinoma (ACC) affects patients in a broad age group, including young women. Mitotane, an adrenolytic agent, is the mainstay of treatment after surgical removal of the tumor. There is extreme paucity of information regarding the effect of mitotane on childbearing potential and pregnancy outcome. Objective: The aim of the study was to describe and discuss the case of an ACC patient who conceived while on mitotane treatment. Current literature is reviewed. Patient and Methods: A 33-year-old woman received mitotane treatment for 4 years due to metastatic ACC. Despite nearly therapeutic blood levels of the drug, the patient had regular menstruation and was able to conceive. Mitotane was stopped at gestation week 6. Although the dru continued to be detected in considerable amounts, the fetus developed normally, including morphologically intact adrenal glands. At gestation week 21, pregnancy was terminated due to ACC recurrence. Mitotane levels were undetectable in fetal cord blood and amniotic fluid. Conclusion: Our report suggests that mitotane, despite its action as an endocrine disruptor, does not affect normal gonadal function or an ability to conceive. The concern of placental transfer by this hydrophobic compound is not supported by our findings. However, we do not recommend drawing conclusions regarding the safety of mitotane in pregnancy, based on 1 or several case reports. Until more data are available, pregnancy should be avoided in women being treated with mitotane for ACC. Copyright © 2013 by The Endocrine Society.


Rowlands I.J.,University of Queensland | Teede H.,Monash University | Teede H.,Diabetes and Endocrinology Unit | Lucke J.,La Trobe University | And 2 more authors.
Human Reproduction | Year: 2016

Study question: Do young women with polycystic ovary syndrome (PCOS) or endometriosis report more psychological distress than their peers without a history of these conditions? summaryanswer: Youngwomen(aged 18-23 years) withPCOSor endometriosis had a greater risk ofmoderate to severe psychological distress than women without a history of these conditions. what is known already: Psychological distress appears common among women with PCOS and endometriosis. However, population- based studies that examine the psychological outcomes for adolescents and young women are generally absent from the literature. study design, size, duration: This is a secondary analysis of data collected from 17 015 young, Australian women participating in a national, longitudinal cohort study.Womenwere first surveyed in 2012-2013 when they were aged 18-23 years. In 2014,womencompleted the second survey when they were aged 19-24 years and 11324 (67%) women responded. participants/materials, setting, methods:We analysed data from11 238 women who participated in both Surveys 1 and 2 and who responded to questions about PCOS and endometriosis. Using logistic regression, we compared the odds of moderate to severe psychological distress at Surveys 1 and 2 for women reporting a recent diagnosis (within the last 12 months) of PCOS or endometriosis and women with a pre-existing diagnosis, with that for women without a history of these conditions. main results and the role of chance: At Survey 2, around 60% of women reporting a diagnosis of PCOSor endometriosis had moderate to severe levels of psychological distress. Compared to women without a history of these conditions, the odds of moderate to severe psychological distress at Survey 2 were significantly higher for women recently diagnosed with PCOS [Adjusted Odds Ratio (AOR) = 1.62, 95% CI = 1.21-2.18] or endometriosis (AOR= 1.77; 95% CI = 1.20-2.63) and for women with a pre-existing diagnosis of PCOS (AOR = 1.57, 95% CI = 1.30-1.89) or endometriosis (AOR = 1.61; 95% CI = 1.26-2.06).Women recently diagnosed with PCOS or endometriosis also had a greater likelihood of moderate to severe distress in the year prior to their diagnosis. The association between PCOS and psychological distress was attenuated when adjusting for BMI, but hormonal contraceptive use did not attenuate the risk of distress among the women with PCOS or endometriosis. limitations, reasons for caution: All datawere self-reported and, therefore, the diagnoses ofPCOSor endometriosis were not confirmed by a medical practitioner. wider implications of the findings: Health professionals should be aware of the potential psychosocial and healthcare needs among young women with these conditions, particularly women with PCOSwho are obese. While hormonal contraceptives may help to regulate the hormonal aspects of these conditions, theydo not appear to reducewomen's psychological distress. Because psychological distressamongthe youngwomenin this study remained elevated even after diagnosis, this supports the need for multidisciplinary health care to helpwomenadjust to their diagnosis and treatment regimens and facilitate positive, long-term mental health outcomes. Future research that examines medical and psychosocial sources of distress for young women with PCOS and endometriosis is needed. study funding/competing interest(s): I.J.R. was supported by an Australian National Health and Medical Research Council Centre for Research Excellence (grant number: APP1000986). G.D.M. is funded by the Australian Research Council Future Fellowship (FT120100812). The Australian Longitudinal Study onWomen's Health is funded by the Australian Government Department of Health. H.T. is supported by an Australian National Health and Medical Research Council Practitioner Fellowship. The authors declare that no competing interests exist. Trial registration number: N/A. © The Author 2016.


Tatti P.,Diabetes and Endocrinology Unit | Masselli L.,Diabetes and Endocrinology Unit | Di Mauro P.,Diabetes and Endocrinology Unit | Pipicelli G.,Diabetes and Dietology Unit | And 2 more authors.
Mediterranean Journal of Nutrition and Metabolism | Year: 2012

We evaluated if a nutritional supplement containing arginine, glutamine, β-hydroxy-β-methyl butyrate commonly used to improve the healing of diabetic foot ulcers had any effect on the kidney function in the diabetic patients. We hypothesized that the action on the skin may be nonspecific and that the supplement might also act on other structural elements of the kidney. We compared the evolution of the blood creatinine and of the overnight albumin excretion in 16 diabetic subjects with mild to moderate nephropathy 6 months prior to and during the 6 months of treatment. The creatinine level remained stable during the treatment, while microalbuminuria decreased to nearly 50% of the initial value (p < 0.000). © 2011 Springer-Verlag.


Klein P.,Diabetes and Endocrinology Unit | Polidori D.,Janssen Research and Development LLC | Twito O.,Diabetes and Endocrinology Unit | Jaffe A.,Diabetes and Endocrinology Unit
Diabetes/Metabolism Research and Reviews | Year: 2014

Background: The renal threshold for glucose (RTG) is determined by the nephron's reabsorptive capacity. Glucose is reabsorbed through sodium-coupled glucose cotransporters in the proximal tubules. During pregnancy, renal glucose reabsorptive capacity decreases, possibly, due to reduced glucose transporter expression. Our hypothesis is that inadequate decrease in RTG during pregnancy will make women more prone to develop gestational diabetes mellitus (GDM). Methods: Pregnant women (n=40) who were referred to our center for oral glucose tolerance test (OGTT) were included in the analysis. Plasma glucose levels and urinary glucose excretion were measured for 4h after 100g oral glucose load. These data were used to calculate RTG. The subjects were divided into two cohorts, GDM and non-GDM, according to the OGTT results. Mean RTG was compared between the two groups. Results: Fifteen (37.5%) of the women were diagnosed with GDM. Seventeen participants had only trace amounts of urinary glucose excretion, and no value of RTG could be determined; RTG was determined in the other 23 subjects. Among these 23 women, 13 were diagnosed as GDM, and 10 had normal OGTT. RTG was lower in the non-GDM women (146±14mg/dL) than in the GDM women (182±18mg/dL), p<0.001. Conclusions: Gestational diabetes mellitus is associated with higher RTG during pregnancy compared with non-GDM. These results support our hypothesis that inadequate decrease of the RTG may have a pathophysiological role in the development of GDM. © 2013 John Wiley & Sons, Ltd.


El-Khair S.M.A.,Mansoura University | Metwali A.E.-H.A.,Diabetes and Endocrinology Unit | El-Maksoud M.A.,Mansoura University | Besheer T.,Mansoura University
American Journal of Biochemistry and Biotechnology | Year: 2012

Thyroid autoimmunity and dysfunction have reported as side effects of interferon-α treatment. The CT60 and exon 1+49 A/G polymorphisms in the Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) gene have linked to susceptibility to autoimmune disease. The aim of this research was to analyze the frequencies of CTLA-4 CT60 and +49 A/G polymorphisms and evaluate both polymorphisms as indicators of thyroid disorder susceptibility in chronic HCV Egyptian patients under interferon therapy. This study was carried out on 114 chronic HCV patients under combined therapy of interferon-α and Ribavirin. From them, 60 chronic HCV patients without thyroid disorder were considered the control group. The other 54 patients were having thyroid disorder either hypothyroidism (N = 35) or Grave's Disease (GD) (N = 19). For all subjects, the genotypes of CTLA-4 gene CT60 and +49 A/G polymorphisms were studied using RFLP technique. For +49 A/G polymorphism, the genotypes frequencies in controls were: AA (30), AG (31.7) and GG (38.3%). Whereas, in hypothyroidism patients, the AA, AG and GG genotypes frequencies were (20), (57.1%) and (22.9%) respectively, while in grave's disease, the AA, AG and GG genotypes frequencies were (26.3 (57.9) and (15.8%) respectively. The AG genotype was significantly associated with thyroid disease. As regards CT60 polymorphism, the genotypes frequencies in controls were: CC (38.3), CT (35) and TT (26.7%). Whereas, in hypothyroidism patients, the CC, CT and TT genotypes frequencies were (60), (20) and (20%) respectively, while in grave's disease, the CC, CT and TT genotypes frequencies were (68.4), (15.8) and (15.8%) respectively. The CC genotype was significantly associated with thyroid disorders. CTLA-4 gene +49A/G and CT60 polymorphisms confer susceptibility to autoimmune thyroid disorder and confirm usefulness of CTLA-4 genotyping in predicting thyroid disorder in chronic HCV patients under interferon therapy. © 2012 Science Publication.


Hendy G.N.,McGill University | Hendy G.N.,Royal Victoria Hospital | Canaff L.,McGill University | Canaff L.,Royal Victoria Hospital | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: Familial hypocalciuric hypercalcemia (FHH) is an autosomal dominant disorder with three known subtypes: FHH1, FHH2, and FHH3. About 65% of FHH cases are FHH1, caused by inactivating mutations of the calcium-sensing receptor (CASR) gene. FHH3 was recently found to be caused by codon Arg15 (p.R15) mutations in the adaptor-related protein complex 2, σ-2 subunit that interacts with the CaSR and is encoded by the AP2S1 gene. Objective: The objective of the study was to assess the prevalence of AP2S1 mutations, and describe the phenotype of FHH3, in an independent cohort of FHH subjects lacking CASR mutations. Patients and Methods: Thirty-nine patients presenting with some combination of hypercalcemia, hypermagnesemia, nonsuppressed serum PTH levels, and reduced urinary calcium excretion were studied. Exon 2 of the AP2S1 gene was PCR amplified from patient genomic DNA and Sanger sequenced. The presence of p.R15 mutations was confirmed by restriction enzyme analysis. Results: Five of the 39 subjects had AP2S1 p.R15 mutations, a frequency of 13%. The three recurrent mutations reported previously were all found in our cohort (p.R15C in two, p.R15L in two, and p.R15H in one subject). The FHH3 phenotype did not differ materially from that of FHH1 due to CASR mutations. Conclusions: The results affirm that a significant number of patients suspected of having FHH but proven negative for CASR mutation have AP2S1 p.R15 mutations. Screening for AP2S1 p.R15 mutations in such cases should be considered, given the clinical benefits (avoiding unnecessary parathyroidectomy) that have already been demonstrated for CASR screening in FHH1. Copyright © 2014 by the Endocrine Society.


PubMed | Diabetes and Endocrinology Unit
Type: Journal Article | Journal: Diabetes/metabolism research and reviews | Year: 2014

The renal threshold for glucose (RT(G)) is determined by the nephrons reabsorptive capacity. Glucose is reabsorbed through sodium-coupled glucose cotransporters in the proximal tubules. During pregnancy, renal glucose reabsorptive capacity decreases, possibly, due to reduced glucose transporter expression. Our hypothesis is that inadequate decrease in RT(G) during pregnancy will make women more prone to develop gestational diabetes mellitus (GDM).Pregnant women (n=40) who were referred to our center for oral glucose tolerance test (OGTT) were included in the analysis. Plasma glucose levels and urinary glucose excretion were measured for 4h after 100g oral glucose load. These data were used to calculate RT(G) . The subjects were divided into two cohorts, GDM and non-GDM, according to the OGTT results. Mean RT(G) was compared between the two groups.Fifteen (37.5%) of the women were diagnosed with GDM. Seventeen participants had only trace amounts of urinary glucose excretion, and no value of RT(G) could be determined; RT(G) was determined in the other 23 subjects. Among these 23 women, 13 were diagnosed as GDM, and 10 had normal OGTT. RT(G) was lower in the non-GDM women (14614mg/dL) than in the GDM women (18218mg/dL), p<0.001.Gestational diabetes mellitus is associated with higher RT(G) during pregnancy compared with non-GDM. These results support our hypothesis that inadequate decrease of the RT(G) may have a pathophysiological role in the development of GDM.

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