Open Access Case Study

Atypical Presentation of Conn’s Syndrome

Faten Hadjkacem, Khouloud Boujelben, Houcine Bouchaala, Omar Kammoun, Ibrahim Mejdoub, Ayedi Lobna, Zghal Mouna, Mohamed Amine Mseddi, Mourad Hadjslimen, Mohamed Abid

Asian Journal of Research and Reports in Endocrinology, Page 25-31

Primary Aldosteronism (PA) is a common cause of secondary hypertension, arising from aldosterone-producing adenomas.

It mostly presents with resistant hypertension, hypokalemia and metabolic alkalosis, secondary to excess secretion of aldosterone and a suppressed plasma renin activity (PRA).

Hypokalemia typically presents with myalgia, cramps and muscle weakness. Rhabdomyolysis associated with hypokalemia. Paralysis represent an uncommon presentation of PA, described in few cases in medical literature.

Herein, we report a 41-year-old male with an initial presentation of an acute onset paraplegia and malignant hypertension.

The biochemical evaluation revealed rhabdomyolysis potentially due to severe hypokalemia. Then, investigations for primary hyperaldosteronism showed an elevated aldosterone-renin ratio (ARR).

Preoperative localization study with contrast-enhanced computed tomography (CT) scan revealed a left adrenal adenoma. 

Laparoscopic adrenalectomy resulted in a complete clinical resolution, normalization of kalemia, muscle enzymes and ARR.

Open Access Minireview Article

Neuronal Control of Pituitary Function

M. O. Nwokike, A. U. Mbah, A. O. Ogbonna, S. I. Ghasi

Asian Journal of Research and Reports in Endocrinology, Page 16-24

The pituitary gland secretes a collection of hormones that jointly influence all cells and affect virtually all physiologic processes. The anterior pituitary (also called the adenohypophysis or pars anterior), is the glandular, anterior lobe that together with the posterior lobe (posterior pituitary, or the neurohypophysis) makes up the pituitary gland (hypophysis). The anterior pituitary is the central regulator of the endocrine system, coordinating signals from the hypothalamus centrally and endocrine organs peripherally. The posterior pituitary is not glandular as is the anterior pituitary, but is largely a collection of axonal projections from the hypothalamus that terminate behind the anterior pituitary, and serve as a site for the secretion of neurohypophysial hormones (oxytocin and vasopressin) directly into the blood. The Pituitary gland and the hypothalamus together act as master regulators of the entire endocrine system. Its function is controlled by Humoral, hormonal and neural stimuli. With humoral stimuli the endocrine glands secrete hormones directly according to the concentration of various ions and nutrients in the blood surrounding them. Neural stimuli are involved where hormones are released directly due to stimulation of the endocrine gland by nerves. This review is intended to highlight once again the neural control of pituitary function.

Open Access Original Research Article

Eating Habits and Dietetic Management of Obesity in Children and Adolescent

Ben Salah Dhoha, Mohamed Elmoctar Sidina, Elleuch Mouna, Mohamed Ahmed Mohamed Abdallahi, Safi Wajdi, Boujelban Khouloud, Mnif Fatma, Charfi Nadia, ReKik Nebila, Mnif Mouna, Haj Kacem Faten, Abid Mohamed

Asian Journal of Research and Reports in Endocrinology, Page 1-9

Introduction: dietary management is the most important step in the childhood obesity care.The aim of this study is to analyze dietary habits in a pediatric population who are obese and to evaluate the effectiveness and adherence of patients to the prescribed diet at 6 months of follow-up.

Methods: We carried out a cross-sectional study, which concerns obese children who are referred to the endocrinology department in Hédi Chaker hospital in Sfax. Then we have assessed the weight status after 6 months under regime. A sample of 84 children who are overweight and obese were recruited into the study. All the children included in our study were put under diet adapted according to the age during 6 months.

Results: 84 children, 44 boys and 40 girls. The average age was 11.83 years. The average BMI was 31.55kg/m² (21-47), average BMI Z score was 7,9SD (2,7-16). The daily calorie intake was 2484kcal/day. This weight loss was not statistically significant.

After 6 months of Fallow up: good adherence was observed in 23%. The average BMI was 29,6 kg/m², the average BMI Z score was 7,5 SD. The half of our patients have decreased their BMI Z-score. The prescribed diet was more effective in boys than in girls, in patients without a family history of obesity, in patients who were physically active, in patients who are overweight without obesity and in those who were more adherent. But this efficiency remains statistically insignificant.

Conclusions: This study showed that there is a positive impact of dietary management on weight reduction in children. Other studies have shown the value of dietetic management on childhood obesity care particularly through multidisciplinary interventions.

Open Access Original Research Article

Non High-Density Lipoprotein Cholesterol in Type2 Diabetic Patients

Mouna Elleuch, Hana Charfi, Sahar Mekki, Dhoha Ben Salah, Wajdi Sefi, Kaouthar El Arbi, Khouloud Boujelbene, Nedia Charfi, Fatma Mnif, Mouna Mnif, Faten Hadj Kacem, Mohamed Abid

Asian Journal of Research and Reports in Endocrinology, Page 10-15

Aims: To study the relationship between non high-density lipoprotein cholesterol (non-HDL-C) and metabolic disorders in type2 diabetic patients and to prove the incrimination of non-HDL-C in the genesis of chronic complications of diabetes.

Study Design: Retrospective study.

Place and Duration of Study: Endocrinology-Diabetology Department of Hedi Chaker University Hospital of Sfax for a period of two months, January and February 2020.

Methodology: We included80 type2 diabetic patients (34 men and 46 women; age range: 22-72 years) with metabolic syndrome. Each patient had undergone a complete clinical examination and biochemistry test, then, the non-HDL-C was calculated.

Results: Out of 80 patients, 57 suffered from diabetic complications like micro vascular and macro vascular complications. Unbalanced diabetes was identified in 73.75% of the patients. All the patients had a high level of non-HDL-C.

No significant positive correlation was confirmed between non-HDL-C with body mass index, glycemic parameters, triglycerides, or total cholesterol.

Correlation between the level of non-HDL-C and coronary artery disease, myocardial infarction (MI), and stroke was identified with p values of 0.016, 0.05, and 0.04, respectively.

Patients with microvascular complications had higher levels of non-HDL-C but a positive correlation was only relevant with diabetic nephropathy (p=0.026).

Conclusion: Our study confirmed that non-HDL-C is a simple and reliable indicator of the overall risk of cardiovascular disease, thus, it may be equivalent, if not superior, to low-density lipoprotein cholesterol (LDL-C). Therefore, it should be our primary lipid treatment target for diabetic patients.

Open Access Original Research Article

A New Algorithm in the Diagnosis of Thyroid Nodules

Hasan Zafer Acar, Nazmi Özer

Asian Journal of Research and Reports in Endocrinology, Page 42-50

The most important problems in the follow-up of thyroid nodules are missing cancer cases or performing unnecessary thyroidectomy.

The aim of this study is to create a more sensitive, risk free and cost-effective algorithm in the follow-up of thyroid nodules. For this purpose, the current methods used in the diagnosis of thyroid nodules were examined in our study.

As a method to achieve our aim in our study; based on the results of current studies on this subject, noninvasive serum molecular marker diagnosis methods, which have been shown to be superior to invasive biopsy methods in the diagnosis of thyroid cancers in terms of sensitivity, risk and cost, were given priority over invasive biopsy methods in the algorithm and as a result, in this new algorithm; it has been demonstrated that the possibility of missed thyroid cancer cases may be less, and unnecessary surgeries can be prevented at a lower cost.

However, to come to a definitive conclusion about this, our model should be applied in large case series and results should be compared with others.

Open Access Original Research Article

Effect of Emzor Omega 3 Fish Oil on Beta Cell Function of Streptozotocin Induced Diabetic Rats

U. J. O. Orji, H. Brown, E. O. Nwachuku, N. Boisa

Asian Journal of Research and Reports in Endocrinology, Page 51-61

Aim: The aim of this study was to evaluate the effect of Emzor Omega 3 Fish Oil on Beta Cell function of Streptozotocin Induced Diabetic Rats.

Study Design:  An experimental study.

Place and Duration of Study:  Animal House, Department of Applied and Environmental Biology, Rivers State University, Port Harcourt and University of Port Harcourt Rivers State, Nigeria, between February 2020 and August 2020.

Methodology: Thirty Six (36) albino rats were purchased and allowed to acclimatize for two (2) weeks in the laboratory at the animal farm house of the Department of Animal and Environmental Biology, Rivers State University. They were fed the normal rat feed (Chow feed) and water was allowed ad libitum.  The rats were weighed and randomly grouped into six (6) groups with six rats in each group. Group 1 (Negative control) was placed on normal diet while groups 2 to 6 were placed on a high fat diet (HFD) prior to the induction with Streptozotocin to achieve diabetes and the animals were treated according to their groupings for four weeks by means of oral gavage. The dose of Emzor Omega 3 Fish Oil administered to the rats was extrapolated from human doses. The high fat diet was prepared by mixing the animal feed (Chow diet) with margarine in a ratio of 3:1. After each period of treatments, blood samples were collected from the rats at the end of the treatments via cardiac puncture by anaesthetizing the rats with chloroform after a six (6) hour fast. Fasting blood glucose was determined using the Glucose Oxidase method, Insulin Resistance was determined using the homeostatic model assessment for Insulin resistance, plasma insulin and C-peptide levels were measured by ELISA and molecular study was carried out by three stages involving Lysate, Extraction and Real time PCR, and the GC–MS analysis of bioactive compounds from Emzor Omega 3 Fish Oil was done using Agilent Technologies GC systems with GC-7890A/MS-5975C model. Data generated were analysed using SPSS version 22.0 of windows statistical package. Results were considered statistically significant at 95% confidence interval (p < 0.05).

Results: After week 1 - 4 of exposure, the mean INS (Insulin) value of the Negative control group (NC), Positive control (PC) group, diabetic groups exposed for weeks 1, 2, 3 and 4 expressed in mU/ml were 3.78 ± 0.11, 4.94 ± 0.19, 4.58 ± 0.12, 4.31 ± 0.05, 4.03 ± 0.02 and 3.81 ± 0.03  respectively. The mean C-pep (C-peptide) value expressed in ng/ml were 2.91 ± 0.1, 3.98 ± 0.19, 3.95 ± 0.11, 3.89 ± 0.03, 3.75 ± 0.08 and 3.29 ± 0.05 respectively. The mean FBS (Fasting blood sugar) value expressed in mmol/l were 4.36 ± 0.14, 18.65 ± 0.41, 13.43 ± 0.65, 13.30 ± 0.70, 10.85 ± 0.19 and 8.35 ± 0.27 respectively.  The mean HOMA-IR, HOMA-B and HOMA-S (Homeostatic model assessment of insulin resistance and beta cell function) values were respectively 0.71 ± 0.04, 4.10 ± 0.20, 2.70 ± 0.19, 2.56 ± 0.16, 1.95 ± 0.03 and 1.41 ± 0.04 for HOMA-IR, 84.57 ± 12.11, 6.53 ± 0.25, 9.35 ± 0.46, 9.06 ± 0.63, 11.00 ± 0.38 and 16.00 ± 1.10  for HOMA-B and 1.47 ± 0.12, 0.25 ± 0.01, 0.37 ± 0.02, 0.39 ± 0.03, 0.51 ± 0.01 and 0.71 ± 0.02 for HOMA-S. The mean Abl1 gene value were 40.70 ± 1.55, 24.07 ± 0.17, 47.04 ± 0.41, 49.83 ± 0.96, 51.76 ± 1.23 and 55.77 ± 0.56 respectively. The mean GLUT 2 gene value were 66.09 ± 17.52, 23.34 ± 19.53, 51.08 ± 18.06, 57.53 ± 10.56, 59.87 ± 9.41 and 63.16 ± 4.35 respectively.

Conclusion:In this study, supplementation with Emzor Omega 3 Oil had measurable therapeutically potential effect on streptozotocin induced diabetic rats and as such provides evidence that Emzor Omega 3 Oil improve insulin sensitivity in insulin resistant diabetic rats and the expression of GLUT 2 gene which is the major transporter of glucose in pancreatic beta cells is improved in the treated groups as against that seen in the untreated diabetic induced group.

Open Access Original Research Article

Autoantibodies Associated with Diabetes Mellitus in Nigerian Subjects Resident in Port-Harcourt Metropolis

T. Neebee-Sordum, D. G. Tamuno-Emine, D. Onwuli

Asian Journal of Research and Reports in Endocrinology, Page 62-68

Aim: The aim of this study was to determine the autoantibodies associated with diabetes mellitus among diabetics in Port- Harcourt  of Rivers State, Nigeria

Study Design:  This study is a cross-sectional study.

Place and Duration of Study: This study was conducted at Chemical Pathology Department, Rivers State University Teaching Hospital, Port Harcourt, Nigeria, between December, 2019 and February, 2020.

Methodology: A total of 244 subjects, both male and females, 132 subjects 112 controls, aged within 30-70 years. Five (5) ml of blood sample for Islet cell cytoplasm autoantibodies (ICA), Glutamic acid decarboxylase autoantibodies (GADA), Insulinoma-associated-2 autoantibodies (1A-2A) and zinc transporter 8 autoantibodies (ZnT8A), were collected  serum obtained was analyzed  using Enzyme-linked  immunoasorbent assay. Data were analyzed statistically with SPSS version 22.0 and value considered significant at p≤ 0.05.

Results: The mean ± S.D  of serum ICA were 4.48± 2.18u/ml (control)  and 14.91±11.11 u/ml (subject), GADA value were 0.99 ± 0.22u/ml(control) and 1.78 ±0.77u/ml (subjects), IA-2A values were 3.83±1.56 u/ml (control) and 4.20±3.26u/ml and ZnT8A values were 5.61±4.29u/ml (control) and 6.02±3.80u/ml (subjects). The comparison of mean showed significant difference at p=0.0001 for ICA but no significant differences observed GADA, IA-2A and ZnT8A at p=0.152, p=0.595 and p=0.686 respectively.

Conclusion: Diabetes mellitus patient with positive ICA, GADA and IA-2A autoantibodies, higher HbA1c and lower C-peptide suggest an autoimmune or intracellular damage of beta-cells in T2DM and need for insulin dependence or progression to LADA.

Open Access Original Research Article

Effect of Gestational Subclinical Hypothyroidism on the IQ of Offspring

Tamar Peshkova, Irina Nakashidze, Koba Kamashidze, Nino Kedelidze

Asian Journal of Research and Reports in Endocrinology, Page 69-74

Subclinical hypothyroidism (SCH) is the most common endocrine dysfunction during pregnancy. Its impact on the intellectual development of the offspring is not entirely clear. We aimed to evaluate the association between maternal SCH in pregnancy and the Intellectual Quotient (IQ) of offspring and assess benefits from prenatal maternal thyroid hormonal replacement. IQ scores were compared among 8-9-year-old offspring of 146 healthy mothers (control group) whose thyroid-stimulating hormone (TSH) concentrations were < 4.1 mIU/l, of 32 untreated hypothyroid women whose TSH was between 4.1-5.0 mIU/l, and of 29 women (TSH 5-10 mIU/l) who underwent thyroid hormone replacement during pregnancy. In all cases the serum free thyroxine (fT4) was within their respective reference ranges. The IQs of children of healthy and treated for hypothyroid mothers were 105.7 +14.1 and 108.5+14.7, respectively, which was significantly higher (p<0.05) than the mean IQs (98.3+11.4) of offspring from untreated hypothyroid women. Our study demonstrates that the treatment of maternal hypothyroidism during pregnancy appears to be beneficial for the child's intellectual development.

Open Access Original Research Article

Prevalence of Hypertension among Patients with Type-2 Diabetes Mellitus

Md. Ejaj Bari Chowdhury, Farida Yesmin, Tarafder Shahniam Ahmed, Mohammad Mahmudul Huda

Asian Journal of Research and Reports in Endocrinology, Page 75-81

Background: In today’s world diabetes mellitus (DM) and hypertension (HTN) are considered to be the first and second leading causes of all deaths and morbidities. Increasing age, trend of obesity and worsening renal function intensifies the prevalence of hypertension in people with diabetes.

Objective: The aim of this study was to assess the prevalence of hypertension among patients with type-2 diabetes mellitus (T2DM).

Materials and Methods: This was a cross-sectional study was conducted in the Department of Endocrinology of Monowara Sikder Medical College, Shariatpur and Dhaka National Medical College, Dhaka, Bangladesh from January 2020 to December 2020. Total 138 diabetic patients with proper documents were selected as the study population. Besides data regarding T2DM, data about blood pressure as well as hypertension complications were also collected. A predesigned questionnaire was used to obtain patient data. All data were processed and analyzed by MS Office and SPSS version 20.0.

Results: We observed that, out of 138 diabetic patients about 31% were suffering from hypertension. Among them 42.03% patients were pre-hypertensive, 21.01% had stage I HTN and 10.14% had stage II HTN. Besides these, 10.14% participants were with diabetes for 1-5 years, 9.42% for 6-10 years, 6.52% for 11-15 years and 5.07% for more than 15 years.

Conclusion: Prevalence of hypertension among diabetic patients of Bangladesh is pretty alarming. A variety of anthropometrical, physical & personal factors are contributory towards making diabetic patients a potentially vulnerable group for developing hypertension.

Open Access Original Research Article

Ruinous Effect on Male Reproductive Hormones of Wistar Albino Rats Exposed to Air Freshener

Odinga, Tamuno-Boma, Anyalebechi, Eberechukwu Okwuchi, Nwachoko, Ndidi, Gabriel-Brisibe, Christine Umanu, Aleruchi-Didia, Tarila Iwowari, Okwuonu, Cordelia

Asian Journal of Research and Reports in Endocrinology, Page 82-87

Background: Air fresheners have become indispensible in many living homes and offices, marketed with the promise of creating a clean, healthy, and sweet-smelling indoor atmosphere. Many of these products contain harmful chemicals, hence are of public health significance. This study evaluated the effects of acute exposure to gel air freshener on male reproductive hormones of wistar albino rats.

Aim: This study was designed to examine the effects of exposure to air-freshener on male reproductive hormones of Wistar Albino rats.

Study Design: Eighteen (18) Male wistar albino rats were divided into 6 groups (A-F) and three in each group. Rats in groups B-F were exposed to Air Freshener 194g via inhalation in their cages for 28 days. Rats in group A (control) were not exposed to Air Freshener. At the end of the experiment, rats were sacrificed. Blood samples were collected via cardiac puncture, male reproductive hormones; Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Testosterone (TET) and Prolactin (PRL) were determined using standard methods.

Results: The results obtained revealed that exposure to air freshener led to an adverse alteration in the levels of the hormones. The serum concentration of FSH and PRL increased significantly at p<0.05, while LH and TET serum concentration were significantly decreased at p<0.05.

Conclusion: This result has revealed that exposure of male wistar albino rats to gel air freshener adversely affected male reproductive hormones, and suggests that it may cause infertility in men.

However, the effect is dependent on the duration of exposure, therefore, the reduction in duration of exposure to air freshener is suggested.

Open Access Review Article

What is the Impact of Serum Molecular Markers on the Diagnosis of Thyroid Cancers? A Comparison of Serum Molecular Markers with Invasive Biopsy Methods

H. Z. Acar, N. Özer

Asian Journal of Research and Reports in Endocrinology, Page 32-41

Background: Tissue molecular markers have taken their place as an effective, invasive method in the diagnosis of thyroid cancers. However, if the superiority of serum molecular markers to invasive diagnostic methods as a noninvasive method can be proven, it will have a great impact on the diagnostic approach and screening programs for thyroid nodules.

Aim: The aim in this study is to investigate the effectiveness of serum molecular markers compared to invasive methods in the diagnosis of thyroid cancers.

Methods: In our study, results obtained in publications in which serum molecular markers were used in the diagnosis of thyroid cancers and absolute sensitivity was measured were compared with the absolute sensitivity rates obtained in cases where invasive methods such as fine needle aspiration biopsy and core needle biopsy were used. The results were evaluated statistically.

Results: In cases where serum molecular markers were used in the diagnosis of thyroid cancer, absolute sensitivity rates were found to be statistically significantly higher than invasive methods.

Conclusion: According to the results we have obtained, molecular markers in serum are a noninvasive method that can be used safely in thyroid cancer screening, definitive diagnosis and follow-up. Although it is a noninvasive method, its definitive diagnosis rates are higher compared to methods such as invasive fine needle aspiration biopsy and core needle biopsy.

Therefore, in the near future, it is likely to take a higher priority in the diagnostic approach and screening programs for thyroid nodules.