WCIM 2014 SEOUL KOREA 99
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0203 Endocrinology
Effect of Life Style Modifi cation and Metformin on Adma Level in Obesity
Sari HARAHAP1, Dharma LINDARTO2
Department of Internal Medicine, Faculty of Medicine Sumatera Utara University, Indonesia1, Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine Sumatera Utara University, Indonesia2
Background: Obesity, accumulation of excessive adipose tissue, is a risk factor of cardiovascular diseases. Human adipocytes produce asymmetrical dimethyl arginine (ADMA) an inhibitor nitric oxide synthase which has important role in endothel dys- function, and express the full enzymatic machinery responsible for ADMA metabolism (biosynthesis and degradation). Life style modifi cation and metformin have lowering body weight and ADMA level effects. This study intends to fi nd out whether life style modifi cation with metformin in obese subjects can make the improvement of ADMA level better.
Methods: This was a randomized double blind clinical trial held in 12 weeks on 40 obese subjects which divided into 2 group, life style modification plus metformin group and life style modifi cation plus placebo group. Antropometric parametre and ADMA level were measured before and after intervention.
Results: After intervention, there were decreament in ADMA level, body weight, waist circumfrence and body mass index in both group. Mean of ADMA reduction in met- formin versus placebo group was 0,0235 ± 0,12 ug/l vs 0,03 ± 0,1ug/l (p=0,726). Mean of weight reduction in metformin versus placebo group was 3,88 ± 1,23 kg vs 2,36 ± 1,12 kg (p=0,0001). Mean of waist circumfrence reduction in metformin versus place- bo group was 6,39 ± 0,99 cm vs 5,75 ± 1,71 cm (p=0,0001). Mean of body mass index reduction in metformin and placebo group was 1,76 ± 0,85 kg/m2 vs 1,08 ± 0,61 kg/m2 (p=0,0001).
Conclusions: Implementation of lifestyle modification in 12 weeks could improve some antropometric parametres but addition of metformin did not improve the ADMA level signifi cantly in obese subjects.
PS 0204 Endocrinology
Fenofi brate Induced Myopathy in Patient with Hypo- thyroid
Gulcin GUNGOR OLCUM1, Guven KOC1, Fidan Canan CELIK YAGAN2, Hanife Serife AKTAS1, Fatih AKDOGAN1, Sati Sena YILDIZ1, Senem ERTILAV1, Sema BASAT1 Umraniye Training and Research Hospital, Turkey1, Zeynep Kamil Womens and Children Training and Research Hospital, Turkey2
Introduction: Thyroid hormone defi ciency can lead to hyperlipidemia by reducing lipid peroxidation. In addition, disorders of thyroid function may cause some neuromuscular disorders. Herein, we would like to present a case developing myopathy due to initia- tion of antilipidemic treatment.
Case-report: 42-year-old male patient was admitted to the internal medicine outpa- tient clinic because of fatigue, muscle pain. Medical history included hypothyroidism, hyperlipidemia. The patient had been started to take Fenofi brate (250 mg. once a day) three weeks before. He did not receive treatment for hypothyroidism. Physical exam- ination revealed that dry skin, edematous facial appearance and muscle tenderness in the extremities. His abnormal biochemical parameters are shown in Table 1. We stopped the Fenofi brate treatment and Levothyroxine sodium 25μg treatment was started and gradually increased. And also we advised the hydration therapy (at least daily 3000 cc. of liquid). During the follow-up, we observed that the patient’s labora- tory fi ndings became to normal level and all the clinical symptoms improved.
Discussion: Fibrates are fi bric acid derivative drugs. Fibrates are frequently used in the treatment of Dyslipidemia and hypertriglyceridemia. One of the most important side effects of Fibrates is rhabdomyolysis. Abnormalities in thyroid function is also one of the reasons causing myopathy. In hypothyroid myopathy, proximal muscle weakness, muscle stiffness, cramps, refl exes slow down can occurred. In our case, physical exam- ination was unremarkable except muscle tenderness. Our patient’s complaint has de- creased after stopping the intake of Fenofi brate. The TFT levels and other biochemical parameters became to normal levels. We think that subclinical myopathy seen in the existence of hypothyroidism may become symptomatic myopathy by using Fenofi - brate.
Conclusion: Myopathies depending on thyroid disorder may be worse with the usage of lipid-lowering treatment. Therefore, too much attention should be needed before starting an antilipidemic treatment for these patients.
PS 0205 Endocrinology
31yrs. Old Young Female Presented with Weight Loss, Polyuria, Polydipsia and Hypertensive Urgency; Diag- nosed to Have Malignant Phaechromocytoma
Faisal BUTT1
Tan Tock Seng hospital, Singapore1
31yrs. old female known to have hypertension and dyslipidemia for 1 yr.presented with h/o weight loss around 10 kg for 1 yr,palpiations,diaphoresis and hypertensive urgen- cyBp 210/110 mmhg)and also found to have diabetes (newly diagnosed)further investi- gations shows large adrenal mass (left side)suspicion of phaechromocytoma and urine catecholamoines was high, urology was consulted and she underwent left adrenalec- tomy and biopsy confi rm the diagnosis of malignant phaechromcytoma. Repeat Urine catecholamines which was quite high on presentation later normalized after surgey.
Now she is under active follow up with endocrinologist and on antihypertensive med- ications very minimal doses and for her diabetes she is not on any medications as well after surgery.
