Iron Levels Should Be Checked During Pregnancy

MedicalResearch.com Interview with:
Kris Poppe, MD, PhD
Co-Head Endocrine Unit
CHU St-Pierre UMC
Université libre de Bruxelles

MedicalResearch.com: What is the background for this study? 

Response: Pregnant women are often referred by gynecologists to my endocrine practice, for altered thyroid function. At that occasion, I often noticed that the women also had low iron/ferritin levels (ferritin is the iron reserve). Searching in literature did not reveal many publications on the association between iron (deficiency) and thyroid function during pregnancy and so that was the background/aim to perform this study.

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Testosterone Therapy Improved Sexual Function in Older Men

MedicalResearch.com Interview with:
Glenn Cunningham, MD
Departments of Medicine and Molecular and Cellular Biology
Division of Diabetes, Endocrinology and Metabolism
Baylor College of Medicine and Baylor St. Luke’s Medical Center
Houston, Texas 77030

MedicalResearch.com: What is the background for this study?

Response: The Testosterone Trials are a coordinated set of seven trials to determine the efficacy of testosterone in symptomatic men ≥65 years with unequivocally low testosterone levels. Previous studies in older men have been limited and the results have been conflicting. Initial results of the Sexual Function Trial showed that testosterone improved sexual activity, sexual desire and erectile function.

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Long Term Exposure to Air Pollutants Linked To Metabolic Alterations Especially in Diabetics

MedicalResearch.com Interview with:

Maayan Yitshak Sade MPH Chief Scientific Officer, Clinical Research Center, Soroka University Medical Center, Israel

Maayan Yitshak Sade

Maayan Yitshak Sade MPH
Chief Scientific Officer
Clinical Research Center,
Soroka University Medical Center, Israel and

 

Dr-Victor-Novack

Dr. Victor Novack

Victor Novack, MD, PhD
Soroka University Medical Center and Ben-Gurion University in Beer Sheva, Israel

 

MedicalResearch.com: What is the background for this study?

Response: Numerous studies found association between exposure the air pollution and increased risk of cardiovascular and respiratory diseases. In recent years links were found between air pollution and diabetes as well. The scientific evidence supports a causal association between air pollution and oxidative stress, possibly involving impaired metabolism of glucose and lipids. In a recent study performed by our group, we observed a significantly increased risk for ischemic stroke among young adults, associated with air pollution exposure. Following these findings, and as a part of the possible theory linking the association air pollution exposure and cardiovascular diseases, we sought to investigate if this association might be mediated through the well-established cardiovascular risk factors such as abnormal lipid and glucose metabolism.
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Polycystic Ovary Syndrome Linked To Multiple Skin Findings

Kanade Shinkai, MD PhD Associate Professor of Clinical Dermatology Director, Residency Program Endowed Chair in Dermatology Medical Student Education UCSF Department of Dermatology San Francisco, CA 94115

Dr. Shinkai

MedicalResearch.com Interview with:
Kanade Shinkai, MD PhD
Associate Professor of Clinical Dermatology
Director, Residency Program
Endowed Chair in Dermatology Medical Student Education
UCSF Department of Dermatology
San Francisco, CA 94115 

Medical Research: What is the background for this study? What are the main findings?

Dr. Shinkai: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in the United States that has important skin manifestations including acne, hair loss, hirsutism, and acanthosis nigricans. We performed a retrospective cross-sectional study of women referred to a multidisciplinary PCOS clinic at UCSF to determine whether skin findings and systemic associations differ between women who meet diagnostic criteria for PCOS versus those suspected of having PCOS but do not meet diagnostic criteria. We found that women with PCOS commonly have skin findings, however, present across a broad spectrum of cutaneous manifestations.

Comparing the skin findings in women who meet diagnostic criteria for PCOS with women who are suspected of having PCOS suggests that it can be very difficult to distinguish a patient with PCOS based on skin findings alone.  Hirsutism and acanthosis nigricans are the most helpful findings to suggest PCOS and require a comprehensive skin examination to diagnose; acne and androgenic alopecia are common findings but do not differentiate. The finding of hirsutism and acanthosis were associated with important systemic abnormalities including elevated free testosterone levels, insulin resistance, obesity, and dyslipidemia. This is the first study to perform systematic comprehensive skin exams on women with PCOS and link the skin findings to key systemic associations that have significant implications for the treatment and prognosis of women with the disease.

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Parathyroidectomy Superior To Medications For Hypercalcemia in Transplant Patients

MedicalResearch.com Interview with:
Josep M Cruzado, MD
Head, Nephrology Department
Hospital Universitari de Bellvitge 

Medical Research: What is the background for this study? What are the main findings?

Dr. Cruzado: Tertiary hyperparathyroidism is frequent after renal transplantation. Inappropriately high parathyroid hormone levels are associated with hypercalcemia, hyperphosphatemia, both allograft and vascular calcification and bone mineral density loss. Cinacalcet is highly effective to control hypercalcemia in this setting although there were no studies comparing cinacalcet with subtotal parathyroidectomy.

Main findings are that subtotal parathyroidectomy is superior to cinacalcet in normalizing hypercalcemia amb iPTH, increased bone mineral density at femoral neck and is more cost effective (the cost of subtotal parathyroidectomy is equal to 14 months of cinacalcet and this drug should be maintained overtime).

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Can Menopause Be Prevented In Young Women on Chemotherapy For Early Breast Cancer?

Rodrigo R. Munhoz, MD Hospital Sírio Libanês São Paulo, Brazil MedicalResearch.com Interview with:
Rodrigo R. Munhoz, MD
Hospital Sírio Libanês
São Paulo, Brazil 

Medical Research: What is the background for this study? What are the main findings?

Dr. Munhoz:  Chemotherapy-induced early menopause and its impact on quality of life is clinically relevant issue that often arises during the treatment with curative intent of premenopausal patients with early breast cancer. The use of neo-/adjuvant chemotherapy is associated with risks of ovarian dysfunction, permanent or transient amenorrhea, infertility and symptoms of menopause with a premature onset. In addition to osteoporosis, loss of libido, increased cardiovascular risk and atrophic vaginitis, early ovarian dysfunction may adversely impact quality of life and result in significant psychosocial burden.

Currently available guidelines addressing fertility preservation in young women undergoing treatment for early breast cancer recommend that patients at reproductive ages should be advised about the potential risks of fertility impairment and additional effects of adjuvant chemotherapy and that preservation techniques should be carefully considered. However, “evidence regarding the effectiveness of ovarian suppression” is quoted as “insufficient” and the use GnRH agonists as “experimental” .

The current meta-analysis includes a large number of patients and also the results of recently presented clinical trials, and suggest that the use of GnRH agonists is associated a higher rate of recovery of regular menses in patients with breast cancer undergoing chemotherapy.These results summarize the findings of different clinical trials and has immediate clinical implications – this was not clear in the literature, since negative results had been reported across different clinical trials.

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Bilateral Adrenal Incidentalomas May Have Different Etiology Than Unilateral

Quan-Yang Duh MD Endocrine surgeon UCSF Medical CenterMedicalResearch.com Interview with:
Quan-Yang Duh MD
Chief, Section of Endocrine Surgery
UCSF Medical Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Quan-Yang Duh: At UCSF we have a monthly Adrenal Conference (involving surgeons, endocrinologists and radiologists) to discuss patients we are consulted for adrenal tumors. About 30% of these are for incidentally discovered adrenal tumors (versus those found because of specific indications such as clinical suspicion or genetic screening). Of these 15-20% has bilateral adrenal tumors.

The evaluation of unilateral incidentaloma has been very well studied and many national guidelines have been published with specific management recommendations. So during our monthly adrenal conference, we have a routine “script” for evaluation and recommendations (rule out metastasis by looking for primary cancer elsewhere, rule out pheochromocytoma and Cushing, resect secreting tumors or large tumors, and if no operation recommended repeat scan in 6 months, etc.). This “script” has worked very well for patients with unilateral incidentaloma.

However, we were less certain when we made recommendations about bilateral incidentalomas because there was very little literature or guidelines written about it. We had some gut feelings, but we were not sure that we were recommending the right things. We needed more data. That was the main reason for the study.

What we found in our study was that although the possible subclinical diseases were the same – hypercortisolism and pheochromocytoma, the probabilities were different. The patients with bilateral incidentalomas were more likely to have subclinical Cushing’s and less likely to have pheochromocytomas than those with unilateral incidentalomas.

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Panel Recommends Improvements in Estrogen Testing Accuracy

MedicalResearch.com Interview with:
Hubert W. Vesper, PhD

Director, Clinical Standardization Programs in the National Center for Environmental Health, Centers for Disease Control and Prevention
Co-author, “Measuring Estrogen Exposure and Metabolism: Workshop Recommendations on Clinical Issues”
Co-chair of the PATH Steering Committee

Medical Research: What is the background for this study? What are the main findings?

Dr. Vesper: Accurate data on estrogen levels are needed to ensure appropriate and effective patient care. Research studies found high inaccuracies among different estrogen tests, especially at low estrogen levels commonly observed in postmenopausal women, men and children.

Accurate estrogen measurements can be achieved through standardization. Stakeholders should support standardization efforts of the Centers for Disease Control and Prevention (CDC) or alternative strategies to arrive at estrogen measurement methods that are accuracy-based and reliable.

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Adolescent Hyperinsulinemic Androgen Excess: Insulin Sensitization May Slow Biologic Aging

MedicalResearch.com Interview with:
Francis de Zegher, MD, PhD
Department of Development and Regeneration, University of Leuven
Leuven, Belgium
&
Lourdes Ibáñez, MD, PhD
Hospital Sant Joan de Déu, University of Barcelona
Barcelona, Spain

Medical Research: What is the background for this study?

Response: Hyperinsulinemic androgen excess is the most frequent hormonal disorder of adolescent girls. It seems to be mainly driven by an excessive and/or inappropriate storage of fat due to a chronically positive energy balance.

The traditional approach (not approved by FDA or EMA) is to silence the ovaries by giving an oral contraceptive.

An alternative approach is to change the storage of fat by giving an insulin-sensitizing combination of generics in low dose.

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High Testosterone Low Estrogen Linked To Men’s Cardiovascular Health

MedicalResearch.com Interview with:Elaine W. Yu, MD, MMSc Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital  MGH Endocrine Unit
Elaine W. Yu, MD, MMSc

Assistant Professor of Medicine
Harvard Medical School
Massachusetts General Hospital
MGH Endocrine Unit

Medical Research: What is the background for this study? What are the main findings?

Dr. Yu: It is well known that cardiovascular disease is more common in men than in women.  The exact reasons for this are unknown, but may be related to gender differences in levels of sex hormones such as testosterone and estrogen.  As compared to premenopausal women, men have higher testosterone and lower estrogen levels.  It is currently unclear whether the actions of testosterone and/or estrogen affect cardiovascular risk factors.

In this study, we explored the regulation of cardiovascular risk factors by testosterone and estrogen in men. We found that higher levels of testosterone led to lower HDL levels (“good” cholesterol), whereas estrogen did not regulate HDL.  In contrast, low levels of estrogen led to worsening insulin resistance and increased muscle fat, markers for developing diabetes.  Importantly, LDL cholesterol (“bad” cholesterol”) was not affected by either testosterone or estrogen in men.   Continue reading

Most Benign Thyroid Nodules Remain Benign

Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma RomaMedicalResearch.com Interview with;
Sebastiano Filetti MD

Dipartimento di Medicina Interna
Università di Roma Roma

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Filetti: Thyroid nodule diagnosis is becoming more and more frequent in clinical practice. This trend stems largely from the incidental discovery of small nodules due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Ultrasound studies, for example, are widely used for evaluating other structures in the neck, such as the carotid arteries, parathyroid glands, lymph nodes, and salivary glands. Over 90% of detected thyroid nodules are clinically insignificant, in that they have been cytologically proven to be benign or they have no ultrasound features that raise the suspicion of malignancy. However, consensus is lacking regarding the best way to follow these nodules, mainly because little is known about the actual frequency and magnitude of their growth. The results of our study suggest that most benign nodules exhibit no significant size changes over time, and some actually decrease in size. Only a small subgroup of nodules can be expected to grow, about 15% in our series. However, the growth is slow and limited in magnitude. Most important, the occurrence of cancer is very rare in nodules like this, that appear to be benign.

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Gender Identity Is A Biologic Process

Joshua D. Safer MD, FACP Director, Endocrinology Fellowship Training and Endocrinology Education Boston University Medical Center Associate Professor of Medicine and Molecular Medicine Boston University School of Medicine MedicalResearch.com Interview with:
Joshua D. Safer MD, FACP
Director, Endocrinology Fellowship Training and Endocrinology Education
Boston University Medical Center
Associate Professor of Medicine and Molecular Medicine
Boston University School of Medicine

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Safer: This is a review of the current medical literature in favor of the biologic nature of gender identity.  The main barrier to medical care for transgender patients is lack of physicians with the knowledge and willingness to provide that care. A major concern of physicians is that this is a mental health issue, meaning that transgender hormone therapy and surgery may be too drastic a response to an individual who should be counseled instead.  The review lays out the evidence to make it clear that a major component of gender identity is biologic even if we don’t have the exact details worked out.  Therefore, counseling alone cannot address the disconnect between transgender individuals’ gender identity and their physical bodies.

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Live Longer…Don’t Reproduce?

John Tower, PhD Professor, Molecular and Computational Biology Program Department of Biological Sciences USC Dana and David Dornsife College of Letters, Arts and Sciences University of Southern California Los Angeles, CA 90089-2910MedicalResearch.com Interview with:
John Tower, PhD

Professor, Molecular and Computational Biology Program
Department of Biological Sciences
USC Dana and David Dornsife College of Letters, Arts and Sciences University of Southern California
Los Angeles, CA 90089-2910

Medical Research: What is the background for this study? What are the main findings?

Response: One of the main causes of aging is thought to be the trade-off between reproduction and life span – in other words, the body uses its resources for mating and producing offspring instead of repairing and maintaining its tissues and organs.   What exactly these resources are and how this works is not yet known.

The drug mifepristone inhibits reproduction in human females.  Mifepristone antagonizes (inhibits) the activity of the female hormone progesterone, which is required for normal reproduction.  We found that mifepristone could also inhibit reproduction in the laboratory fruit fly Drosophila melanogaster, and could increase the life span of mated female flies by up to +68%.  Drosophila are not thought to contain progesterone, but the results suggest that some similar steroid hormone may be functioning in Drosophila to regulate the trade-off between reproduction and life span. We found that many of the genes that were altered by mifepristone in the fly are genes that also exist in humans; these genes are therefore promising targets for future interventions in aging.

One exciting possibility suggested by our results is that mifepristone might be able to favor the life span of human females.  This could be tested using mice and/or in human clinical trials.

Citation:

The progesterone antagonist mifepristone/RU486 blocks the negative effect on life span caused by mating in female Drosophila.

Landis GN1, Salomon MP1, Keroles D1, Brookes N1, Sekimura T1, Tower J1.

Aging (Albany NY). 2015 Jan 15. [Epub ahead of print]

 

MedicalResearch.com Interview with:, & John Tower, PhD (2015). Live Longer…Don’t Reproduce? MedicalResearch.com

Endocrinology Journal Editor Discusses Effects of Environmental Endocrine-Disrupting Chemicals

Dr. Andrea Gore PhD Gustavus & Louise Pfeiffer Professor University of Texas Austin/Div of Pharmacology/ToxicoMedicalResearch.com Interview with:
Dr. Andrea Gore PhD
Gustavus & Louise Pfeiffer Professor
University of Texas Austin/Div of Pharmacology/Toxicology

MedicalResearch.com Editor’s Note: Dr. Gore, Editor-in-Chief of the Journal Endocrinology, has graciously answered several questions regarding the recent concerns of environmental chemicals linked to both early puberty and early menopause.

Medical Research: How can chemicals found inside the home impact onset of menopause?

Dr. Gore: It is important to clarify that the cause-and-effect relationship between chemicals and menopause is not established. The timing of menopause in women is due to a variety of factors including genetic traits, nutritional status, and general health or chronic disease. Some research on humans, including the recent study by Grindler et al., also suggests that environmental chemicals may contribute to the timing of earlier menopause. Animal models also suggest an advance in the timing of reproductive failure following earlier life exposures to endocrine-disrupting chemicals (EDCs). [See references below]. The question of exactly how chemicals may change the timing of menopause is therefore unresolved, but based on animal studies it is likely that the mechanisms include effects of endocrine-disrupting chemicals on the expression of genes and proteins involved in ovarian function that may lead to premature loss of follicles (eggs). Because the control of reproduction involves the brain and the pituitary gland, as well as the ovary, it is possible that endocrine-disrupting chemicals also impair how these organs regulate reproductive hormones.

  1. Gore AC, Walker DM, Zama AM, Armenti AE, Uzumcu M. Early
    life exposure to endocrine-disrupting chemicals causes lifelong molecular
    reprogramming of the hypothalamus and premature reproductive
    aging. Mol Endocrinol. 2011;25:2157–2168.
  2. Shi Z, Valdez KE, Ting AY, Franczak A,GumSL, Petroff BK. Ovarian
    endocrine disruption underlies premature reproductive senescence
    following environmentally relevant chronic exposure to the
    aryl hydrocarbon receptor agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin.
    Biol Reprod. 2007;76:198–202.
  3. Akkina J, Reif J, Keefe T, Bachand A. Age at natural menopause and
    exposure to organochlorine pesticides in Hispanic women. J Toxicol
    Environ Health A. 2004;67:1407–1422.
  4. Cooper GS, Savitz DA, Millikan R, Chiu Kit T. Organochlorine
    exposure and age at natural menopause. Epidemiology. 2002;13:
    729–733.
  5. Hatch EE, Troisi R, Wise LA, et al. Age at natural menopause in
    women exposed to diethylstilbestrol in utero. Am J Epidemiol.
    2006;164:682–688.
  6. KnoxSS, Jackson T, Javins B, Frisbee SJ, Shankar A, DucatmanAM.
    Implications of early menopause in women exposed to perfluorocarbons.
    J Clin Endocrinol Metab. 2011;96:1747–1753.
  7. Farr SL, Cai J, Savitz DA, Sandler DP, Hoppin JA, Cooper GS.
    Pesticide exposure and timing of menopause: the Agricultural
    Health Study. Am J Epidemiol. 2006;163:731–742.

Medical Research: What are the primary sources of exposure to these chemicals?

Dr. Gore: Endocrine-disrupting chemicals exposures come from a variety of sources, including plastic containers (e.g. water bottles) and other products, certain foods, personal care products, pesticides, and many others.

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Diabetes, Age and Obesity Drive Demand for Endocrinologists

Robert A. Vigersky, MD Walter Reed National Military Medical Center Bethesda, MDMedicalResearch.com Interview with:
Robert A. Vigersky, MD
Walter Reed National Military Medical Center
Bethesda, MD

Medical Research: What type of patients do endocrinologists typically treat and why is the demand for their services anticipated to grow?

Dr. Vigersky: Endocrinologists are physicians trained in managing, diagnosing, and treating disorders of the endocrine system:  thyroid, parathyroid, adrenal glands, hypophyseal and hypothalamic axes, ovaries, testes, and pancreas.  Their role involves controlling diabetes mellitus, menopause, hyperthyroidism and other conditions involving metabolism.

A major factor affecting the anticipated demand for health care services is the aging population.  In 2010, there were 37.5 million people age 65 or over, constituting about 12.7 percent of the total population, and by 2025 the population age 65 or over will number 62.5 million (17.9 percent of the population).  Due to the greater prevalence of many of the diseases in older age groups, like osteoporosis, diabetes, obesity, and thyroid nodules, the growth in the population age 65 or over will exert a major influence on the demand for endocrine services.

Diabetes, by itself, is a major driver of demand.  The incidence of Type 2 diabetes rises dramatically with age, and with obesity.  In an increasingly overweight population an estimated 22.3 million people in the U.S. are diagnosed with diabetes as of 2012, representing about 7 percent of the population. This estimate is higher than but consistent with those published by the CDC for 2010.  The percentage of the population with diagnosed diabetes continues to rise, with one study projecting that as many as one in three U.S. adults could have diabetes by 2050 if current trends continue.
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Nervous System Peptides May Contribute To Ovarian Failure

Sergio R. Ojeda, D.V.M. Division Head and Senior Scientist Division of Neuroscience Division of Neuroscience, OR National Primate Research Center/Oregon Health and Science University, Beaverton OR 97006MedicalResearch.com Interview with:
Sergio R. Ojeda, D.V.M.
Division Head and Senior Scientist Division of Neuroscience
Division of Neuroscience, OR National Primate Research Center/Oregon Health and Science University,
Beaverton OR 97006

MedicalResearch: What are the main findings of the study?

Dr. Ojeda: The study shows that a receptor for two growth factors (brain-derived neurotrophic factor [BDNF] and neurotrophin 4/5  [NT4/5]) that are known to be important for development of the nervous system is also essential for maintaining oocyte integrity and survival in the mammalian ovary. Intriguingly, the full-length form of this receptor (known as NTRK2-FL) is not expressed in oocytes until the time of the first ovulation. At this time,  the pre-ovulatory gonadotropin discharge stimulates granulosa cells of ovarian follicles to produce not only more BDNF, but also more of a peptide known as kisspeptin, to induce the formation of NTRK2-FL in oocytes. To date, kisspeptin was known to be  only critical for the hypothalamic control of reproduction. To induce NTRK2-FL, BDNF binds to truncated NTRK2 receptors (NTRK2-T1), which are abundant in oocytes throughout prepubertal development.  Kisspeptin, on the other hand, does so by activating its receptor KISS1R, also expressed in oocytes. Once present after the first ovulation, NTRK2-FL is able to activate a survival pathway in oocytes following gonadotropin stimulation, presumably at every cycle. In the absence of NTRK2-FL, oocytes die, follicular structure disintegrates and a condition of premature ovarian failure ensues.
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Fracking: Chemicals In Process May Disrupt Hormones

MedicalResearch.com Interview with:
Christopher D Kassotis  (MU-Student)
Department of Obstetrics, Gynecology and Women’s Health and Division of Biological Sciences University of Missouri, Columbia, MO 65211;

MedicalResearch.com: What are the main findings of the study?

Answer: The main findings of our study are twofold:

First, we found that 12 chemicals used in the fracking process disrupt hormone action. Specifically, we found that they inhibited the action of estrogens such as estradiol and androgens such as testosterone; classes of reproductive hormones that are critical for normal development and reproductive maturation.

Second, we found that surface and ground water from a drilling-dense area in Colorado has much greater hormonal activity than samples from areas with limited drilling. Specifically, ground water had elevated estrogenic activity (mimicking the effects of estrogens), while surface water exhibited anti-estrogenic and anti-androgenic activities, similar to the chemicals we tested.
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