The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 21
Slide Session
OS-END-45 Endocrinology
Effect of Business Life on Obesity in Women
Yildiz OKUTURLAR1, Gülseren GÜNDÜZ2, Nilgül AKALIN3, Meral MERT4, Didem ACARER1, Ozlem SOYLUK4, Ozlem HARMANKAYA1, A.Baki KUMBASAR1
Internal Medicine, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey1, Dietetics and Nu- trition, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey2, Nephrology,Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey3, Endocrinology and Metabolism, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey4
Background: The most important factor in the fi ght against obesity is thought to be change in lifestyle. Business life can effect weight and body fat distribution through its effects on levels of eating, sleeping, exercise and stress. In our study the relation between BMI, body fat distribution, 25-hydroxycholecalciferol (25-OH-D3), home- ostasis model assessment (HOMA-R) and A1c levels were evaluated in working and non-working obese patients having a BMI of 30.
Methods: Total number of 122 patients (62 of working and 60 of non-working) were enrolled in to the study. Medical history, weight-height-BMI- body fat ratio measure- ments and A1c- insülin- glucose- cortisol- 25-OH-D3- HOMA-R levels of all patients were recorded.
Results: Between the working and non-working groups there were signifi cant differ- ences in average age (35.30±11.96 and 44.51±11.84 respectively, p=0.0001), weight (89.18±11.90 kg and 94.34±13.45 kg respectively, p=0.029), BMI (34.47±4.167 kg/
m2 and 37.39±5.65 kg/m2 respectively, p=0.002), body fat ratio (41.23±5.447%
and 43.53±6.077% respectively, p= 0.029) and cortisol level (11.66±4.441 μg/dL and 14.12±5.402 μg/dL, respectively, p=0.029). Unlikely there were no signifi cant differ- ences in insulin, A1c, glucose, 25-OH-D3 and HOMA-R values. There were positive correlations between age and A1c and between BMI and age.
Conclusions: Business life may lead to increase in weight and BMI. But in our study weight and BMI was signifi cantly lower in the working group. This fi nding may be related to certain meal times, sleeping regime and physical activity of the working life which are effective on fat distribution and weight management.
OS-END-46 Endocrinology
A Rare Cause of Secondary Hypertension: An Unusual Case of Conn’s Syndrome
Samet SAYILAN1, Yildiz OKUTURLAR1, Meral MERT2, Özlem SOYLUK2, Serkan ENKI1, Yesim özden INAN1, Özlem HARMANKAYA1, A. Baki KUMBASAR1
Internal Medicine, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey1, Endocrinology and Metabolism, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey2
Background: Primary hyperaldosteronism (PHA) is a syndrome arising from autono- mous aldosterone secretion from the adrenal gland and suppression of plasma renin activity. PHA is usually seen due to unilateral adenoma or bilateral hyperplasia. We present a case of Conn’s syndrome with bilateral adrenal lesions but unilateral func- tioning adenoma.
Methods: A 43 years old female admitted to the emergency service due to inability to walk for 3 days, fatigue and generalised pain. She had a history of diabetes mellitus and hypertension for 15 years. She was receiving angiotensin receptor blocker with thiazide, calcium channel blocker, beta-blocker and insulin treatment. Her blood tests revealed alkalosis and severe hypokalemia with normal renal function. In the examina- tions for the causes of secondary hypertension; 24-hour urinary cortisol, metaneph- rine, normetanephrine and VMA levels were normal.
Results: After cessation of diuretic treatment plasma renin activity (PRA) was meas- ured 0.17 ng / mL/ h while plasma aldosterone level (PAL) was measured 71 ng / dl.
The ratio of PAL / PRA was very high. Her abdominal MRI revealed bilateral adrenal lesions with 23x14 mm and 12x8 mm in diameters in the right and left adrenal gland respectively compatible with adenoma. On the other hand adrenal venous sampling (AVS) showed lateralisation for the right side.
Conclusions: Most common causes of PHA are unilateral aldosterone secreting ade- noma and bilateral adrenal hyperplasia. Although the appearance of bilateral adrenal lesions in MRI in our case, results of AVS were compatible with autonomous aldoster- on production on the right side. According to these fi ndings we accepted the case as a unilateral functioning adenoma with an incidentaloma on the other side.
OS-END-47 Endocrinology
Denosumab-Associated Hypocalcaemia: Incidence, Se- verity and Patient Characteristics in a Tertiary Hospital Setting
Andrew HUYNH1, Scott BAKER2, Andrew STEWARDSON3, Douglas JOHNSON1 Department of General Medicine, Austin Health, Australia1, Department of Endocrinology, Austin Health, Australia2, Department of Infectious Diseases, Austin Health, Australia3
Background: Denosumab, a humanised monoclonal antibody against receptor activa- tor of nuclear factor kappa beta ligand (RANKL), reduces bone turnover via inhibition of osteoclasts and osteoclastogenesis and is used in the management of osteoporosis and metastatic bone disease. While hypocalcaemia complicating denosumab treatment has been reported, the real world incidence, clinical and biochemical risk factors are not fully elucidated. This study aims to investigate the incidence of denosumab-asso- ciated hypocalcaemia (DAH) and identify relevant clinical and investigation features.
Methods: We performed a retrospective observational audit of patients administered denosumab (60mg/120mg) over a 12 month period at a tertiary hospital in Australia.
Data collected: denosumab dosage and indication, 25-hydroxyvitamin D concentration, parathyroid hormone, estimated glomerular fi ltration rate (eGFR),nadir and duration of hypocalcaemia (albumin adjusted serum calcium concentration <2.15 mmol/L or ionised calcium <1.13 mmol/L upto 6 months post denosumab administration), calcium and colecalciferol pre- and post-administration of denosumab. The primary outcome was the incidence proportion of DAH.
Results: Of 161 patients administered denosumab (106 osteoporosis, 55 bone me- tastases), 20 patients (12.4%, mean age 78.5 years, 11 male, 11 osteoporosis, 9 bone metastases) developed hypocalcaemia. Median calcium nadir was 2.06 mmol/L (in- terquartile range (IQR) 1.81-2.11), with the median time to diagnosis 24.50 days (IQR 9.25-41.25). One patient required intravenous calcium gluconate treatment. 75% of affected patients had a 25-hydroxyvitamin D concentration >50nmol/L and 90% of affected patients were on calcium or colecalciferol supplementation. DAH was asso- ciated with sex (27% males versus 8% females, p=0.004), but not age (8% under 60 years versus 13% aged 60 or more, p=0.74) or indication (16% with bone metastases versus 10% with osteoporosis, p=0.32).
Conclusions: Denosumab-associated hypocalcaemia occurred in over 12% of patients in this population, despite wide use of appropriate calcium and colecalciferol supple- mentation.
OS-END-48 Endocrinology
The Effect of Inhaled Corticosteroid Treatment on Glu- cose Level on Inpatients
Munevver Mertsoylu AYDIN3, Meral MERT2, Yildiz OKUTURLAR1
Internal Medicine, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey1, Endocrinology and Metabolism, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey2, Kayseri Research and Training Hospital, Turkey3
Background: Although Inhaled corticosteroids (ICS) have been considered as a safe therapy, some systemic effects may be observed. Many patients with type 2-diabetes have an indication to use inhaled corticosteroids (ICS) for coexisting asthma or COPD.
But their effect on glucose metabolism in patients with type 2 diabetes has not been well defi ned. The aim of the study was to investigate the effect of ICS’s on glucose level on the inpatient with COPD acute exacerbation.
Methods: 25 (female/male: 16/9) patients were enrolled the study. The glucose levels were recorded for a week while their oral antidiabetic therapy continues. A1c, CRP levels were measured on admission. Statistical analyses were performed on glucose change due to steroids.
Results: Mean ages were found 68.8 9.91 years in female and 67 12.18 years in male patients respectively. No signifi cant difference was found between two groups (p>0,05). There were no signifi cant differences on the fi rst, second, third, fourth, fi fth and sixth days of week in all patients. We found signifi cant difference in glucose level on between the fi rst (151.32±58.902) and seventh days (205.28±99.192) (p= 0.043) and also eighth day (221.88±111.061) (p=0.017). Parenteral steroids added on 11 pa- tients during clinical course. We compared the patients with and without parenteral steroids about glucose levels. There is a signifi cant difference in glucose levels on sev- enth day between those two groups.
Conclusions: Steroids are known as agents which affect glucose level. Inhaler steroid usage even causes increasing glucose levels in prolonged periods and it is more appar- ent during intravenous steroid treatment.
