Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hypoglycemia is seen with increasing frequency after bariatric surgery. After the diagnosis of hypoglycemia has been clarified, malnutrition, drugs, hormone deficiencies, insulinoma, extra-islet tumors, post-bariatric hypoglycemia (PBH), early or late dumping syndrome, and nesidioblastosis should be considered in the differential diagnosis. A few case reports of insulinomas presenting after bariatric surgery have been reported in the literature. The coexistence of insulinoma and type 2 diabetes mellitus (T2D) is very rare. We herein report a clinical case of insulinoma presenting with severe hypoglycemia in a patient with a history of gastric transit bipartition. A patient with type 2 diabetes mellitus underwent gastric transit bipartition surgery due to the inability of medical therapy to provide adequate hyperglycemia control. After the operation, hypoglycemic symptoms appeared, and a reversal operation was performed, considering the diagnosis as PBH. After the reverse operation, the patient's hypoglycemia symptoms did not regress. The patient was admitted to our endocrinology clinic due to the persistence of hypoglycemia and symptoms such as fatigue, palpitation, and syncope. The patient's detailed anamnesis was examined, additional tests were performed, and the patient was diagnosed with insulinoma. The symptoms of hypoglycemia and the need for treatment for diabetes mellitus disappeared after the Whipple operation. This is the first case of insulinoma after gastric transit bipartition and subsequent reversal operations. In addition, the patient's diagnosis of diabetes mellitus makes this case unique. Although this is a very rare case, clinicians must be aware of it, especially if the patient has hypoglycemic symptoms during the fasting state.

Obesity and associated comorbidities reach epidemic proportions nowadays. Several treatment strategies exist, but bariat-ric surgery has the only longstanding effects. Since a few years, there is increasing interest in the effects of gastro-intesti-nal hormones, in particular Glucagon-Like Peptide-1 (GLP-1) on the remission of Type 2 Diabetes (T2DM) and its effects on cardiac cardiovascular morbidity, cardiac remodeling, and mortality. In the past years several high quality multicenter randomized controlled trials were developed to assess the effects of GLP-1 receptor agonist therapy on cardiovascular morbidity and mortality. Most of the trials were designed and powered as non-inferiority trials to demonstrate cardiovas-cular safety. Most of these trials show a reduction in cardiovascular morbidity in patients with T2DM. Some follow-up studies indicate potential beneficial effects of GLP-1 receptor agonists on cardiovascular function in patients with heart failure, however the results are contradictory, and we need long-term studies to make firm conclusions about the pleio-tropic properties of incretin-based therapies. However, it seems that GLP-1 receptor agonists have different effects than the increased GLP-1 production after bariatric surgery on cardiovascular remodeling. One of the hypotheses is that the blood concentrations of GLP-1 receptor agonists are three times higher compared to GLP-1 increase after bariatric and metabolic surgery. The purpose of this narrative review is to summarize the effects of GLP-1 on cardiovascular morbidity, mortality and remodeling due to medication but also due to bariatric and metabolic surgery. The second objective is to explain the possible differences in effects of GLP-1 agonists and bariatric and metabolic surgery.

Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149–100 ng/mL; and group 3, 99–88 ng/mL. A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88–455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1–13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH)D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000–1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1–3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89–216)]. High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.

The aim of this systematic review is to provide an overview of the literature on the effects of bariatric surgery on obesity-associated electrocardiogram (ECG) abnormalities and cardiac arrhythmias. Fourteen studies were included with a methodological quality ranging from poor to good. Majority of the studies showed a significant decrease of QT interval and related measures after bariatric surgery. Seven studies were included in the meta-analysis on effects of bariatric surgery on QTc interval and a significant decrease in QTc interval of - 33.6 ms, 95%CI [- 49.8 to - 17.4] was seen. Bariatric surgery results in significant decrease in QTc interval and P-wave dispersion, i.e., a normalization of initial pathology. The effects on atrial fibrillation are conflicting and not yet fully understood.

Acute pancreatitis is an inflammatory event of the pancreas which may affect seriously all other tissues and organ systems. Generally, acute pancreatitis is induced by alcoholism or gallstones. However pathogenetic mechanisms of drug induced pancreatitis are not clearly understood. A minocycline derivative, tigecycline is a glycylcycline class of antibiotic which is structurally similar to the tetracyclines. It has perfect tissue and organ distribution and favorable microbial coverage, including many kind of Gram-positive and Gram-negative bacteria and also anaerob agents. Tigecycline’s side-effect profile is similar to the tetracyclines. Pancreatitis is a well-known adverse effect of tetracyclines. However, tigecycline-induced pancreatitis is an uncommon side-effect. We report here a rare case of tigecycline-induced pancreatitis during the treatment of a diabetic food infection.

Nowadays, obesity and related comorbidities like type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea syndrome are considered one of the medical challenges of the 21st century. Even with the rise of bariatric and metabolic surgery, obesity and metabolic syndrome are reaching endemic proportions. Even in 2020, obesity is still a growing problem. There is increasing evidence that next to bariatric surgery, exercise interventions in the perioperative period could give extra beneficial effects. In this regard, effects on anthropometrics, cardiovascular risk factors and physical fitness. The aim of this review is to summarise effects of preoperative and postoperative exercise, tools for screening and directions for future research and implementations.

Giriş: CTLA-4 (sitotoksik T-lenfosit ilişkili antijen 4) geni, immünoglobulin gen süper ailesinin bir üyesidir ve T hücrelerine inhibe edici bir sinyal ileten proteini kodlamaktadır. Son günlerde immün kontrol noktası olan CTLA-4 geni araştırılan genler arasındadır. Bu çalışmada amaç; CTLA-4 geninde oluşan çeşitli polimorfizmlerin, CTLA-4 geni ile benzer genlerin Otoimmün Tiroid Hastalığı (OTH) patogenezine katkıda bulunabileceğini in silico olarak değerlendirmektir. Gereç ve Yöntem: Çalışmamızda CTLA-4 geni ile benzer genleri bulmak için GeneMania ve STRING veri tabanları, tek nükleotid polimorfizmlerini (SNP’leri) bulmak için Polyphen2, Exome Variant Server ve SIFT veritabanları, mikro RNA’ları tespit etmek için; miRDB ve miRWalk veritabanları kullanıldı. Bulgular: Çalışmamızdan elde ettiğimiz verilere göre; FYN geninin OTH’nın patogenezine katkıda bulunabileceğini, CTLA-4 geniyle ilişkili (rs201778935, rs138279736, rs369567630 ve rs376038796) şüpheli SNP’lerin olduğunu tespit ettik. Sonuç: Çalışmamızda 31 miRNA’nın mesajcı RNA’ların protein üretmesini düzenleyici rol üstlendiğinden, terapötik açıdan önemli olduğunu düşünmekteyiz. Biyoinformatik yöntemlerle değerlendirdiğimiz bu çalışma, ilerde laboratuvar ortamında uygulanarak, birçok hastalığın patogenezinin aydınlatılmasına katkıda bulunabileceğini düşünmekteyiz.

1Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands; 2University of Health Sciences Turkey, Sultan Abdulhamid Han Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, Istanbul, Uskudar, 34668, Turkey; 3Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; 4Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA; 5Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; 6Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA Abstract: Nowadays, obesity and related comorbidities like type 2 diabetes, hypertension,

Objective: The aim of this study is to investigate how acute hyperglycaemic changes affect the choroid in patients with prediabetes. Material and Method: Each subject underwent a 75 g oral glucose tolerance test (OGTT) after overnight fasting. The measurement of choroidal thickness (ChT) was done with new generation spectral domain optical coherence tomography (SD-OCT). Results: Fasting Plasma Glucose (FPG) levels of the patients with only isolated Impaired Fasting Glucose (IGT) patients are higher (all p<0.0001). Mean insulin levels were also higher in patients with prediabetes than in healthy volunteers during the entire experiment (all p<0.0001). Changes in ChT differed between the groups, a transient increase was observed in the mean ChT as well as subfoveal, nasal and temporal locations at the 500 mu m distance to fovea in prediabetes individuals. While the subfoveal ChT difference was 1.52 +/- 4.11 mu m (range, -11.00/24.00 mu m) in prediabetes, -0.22 +/- 1.74 mu m (range -2.00/8.00 mu m) in the con- trol group at the first hour of the OGTT. A transient choroidal thickening occurred in the prediabetes group, while there was no change in the healthy volunteers. Conclusion: Detecting acute hyperglycemic changes with instant measurements may help us to better understand the effect of the disease on ocular structures.

Objective: Toll-like receptors (TLRs) are significant receptors to the innate immune system which symbolizes a family of pattern recognition receptors. We aimed to investigate associations between rs4833095 polymorphism of TLR1, rs3804099 polymorphism of TLR2, rs5744174 polymorphism of TLR5, and rs10004195 polymorphism of TLR10 in dyspeptic individuals with Helicobacter pylori infection. Methods: Genomic DNA was isolated and genotyping of rs4833095 polymorphism in TLR1, rs3804099 polymorphism in TLR2, rs5744174 polymorphism in TLR5, and rs10004195 polymorphism in TLR10 were investigated in 400 individuals (205 in dyspeptic individuals with H. pylori-positive subjects and 195 dyspeptic individuals with H. pylori-negative subjects) by real-time PCR. Statistical analysis was performed by Pearson’s Chi-square test. Results: According to our study; rs4833095 polymorphism in TLR1 C allele, rs3804099 polymorphism in TLR2 C allele, rs5744174 polymorphism in TLR5 C allele, and rs10004195 polymorphism in TLR10 A allele increased the risk of H. pylori infection [odds ratio (OR), 2.01; 95% confidence interval (CI), 1.39–3.16; OR, 1.78; 95% CI, 1.19–2.6; OR, 1.87; 95% CI, 1.25–2.78; OR, 2.66; 95% CI, 1.72–4.099, respectively]. Conclusion: This is the first study that investigates TLRs in H. pylori infection in Turkey. Our findings may support the hypothesis that polymorphisms in certain TLRs may cause a genetic predisposition to H. pylori-related gastric problems.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

[This corrects the article DOI: 10.2147/DMSO.S215157.].

Aim To compare the impact of four surgical procedures (mini-gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition) vs medical management on gut peptide secretion, beta-cell function and resolution of hyperglycaemia in people with type 2 diabetes. Research design and methods A mixed-meal tolerance test was administered 6-24 months after each surgical procedure (mini-gastric bypass, sleeve gastrectomy, ileal transposition and transit bipartition; n=30 in each group) and the results were compared with those obtained in matched lean (n=30) and obese (n=30) people with type 2 diabetes undergoing medical management. Results Participants in the mini-gastric bypass and ileal transposition groups had a greater increase in plasma glucose concentration after the mixed-meal tolerance test than those in the sleeve gastrectomy and transit bipartition groups. Participants in the mini-gastric bypass group exhibited the greatest increase in the incremental area under the curve of plasma glucose concentration above baseline (P<0.0001). Insulin sensitivity was similar across surgical groups, and statistically greater in participants in the surgical groups than in obese participants in the non-surgical group (P<0.0001). beta-cell responsiveness to glucose was greater in participants in the sleeve gastrectomy and transit bipartition groups than in the mini-gastric bypass and ileal transposition groups (P<0.001) despite a smaller incremental increase above baseline in the area under the plasma glucagon-like peptide-1 concentration curve relative to ileal transposition. Postoperative beta-cell function was the strongest predictor of hyperglycaemia resolution. Conclusions The present study showed that the level of beta-cell function after bariatric surgery is the strongest predictor of hyperglycaemia resolution. The study also demonstrates a disconnect between postprandial GLP-1 levels and beta-cell function among the studied surgical procedures.

Pouwels S, Sanches EE, Cagiltay E, Severin R, Philips SA. Diabetes Metab Syndr Obes. 2020;13:1813–1823. The authors have advised there is an error in the author list on page 1813. The author “Shane A Philips” should read “Shane A Phillips”. The authors apologize for this error. Read the original article

Medical treatment fails to provide adequate control for many obese patients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT).

Background Insulin-induced hypoglycemia has been demonstrated to prolong the corrected QT (QTc) interval. Prolongation of the QTc interval, especially in diabetic patients using insulin, can cause fatal ventricular arrhythmias. The aim of this study was to evaluate the effects of metoprolol, diltiazem, and pilocarpine on hypoglycemia-induced QTc prolongation. Methods Thirty male rats were randomly distributed into the following five groups: Group 1 (1 mL/kg saline, n=6), Group 2 (40 U/kg crystalline insulin + saline, n=6), Group 3 (40 U/kg crystalline insulin + 1 mg/kg metoprolol, n=6), Group 4 (40 U/kg crystalline insulin + 0.8 mg/kg pilocarpine, n=6), and Group 5 (40 U/kg crystalline insulin + 2 mg/kg diltiazem, n=6). Three hours after insulin injection, the blood glucose level was measured in all groups. Blood glucose <40 mg/dl was defined as hypoglycemia. Electrocardiograms (ECG) were taken in lead I (DI), and QTc was calculated by using Bazett's formula. Results Group 2 (insulin + saline) showed that it had a significantly prolonged QTc interval as compared to the control group (p<0.0001). However, treatments of the rats with metoprolol, pilocarpine, and diltiazem significantly prevented prolongation of the QTc interval as compared to the insulin + saline group (p<0.005, p<0.005, and p<0.01, respectively). Conclusion The findings of the present study demonstrated the efficacy of metoprolol, pilocarpine, and diltiazem in the prevention of hypoglycemia-induced QTc prolongation in male rats.