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LIVER FUNCTION TEST DURING METFORMIN THERAPY IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME (PCOS

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LIVER FUNCTION TEST DURING METFORMIN THERAPY IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME (PCOS
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  Oral Communications Saturday, 10 May 2008 Saturday, 10 May 2008, 09.45–11.15 Room A Endocrinology, Diabetes, Nutrition SA-01 SUBCUTANEOUS SMALL RESISTANCE ARTERY REMODELINGIN PATIENTS WITH CUSHING’S SYNDROME Gianluca E.M. Boari, Carolina De Ciuceis, Enzo Porteri, Nicola Rizzardi,Caterina Platto, Silvia Paiardi, Guido A.M. Tiberio, Stefano M. Giulini,Damiano Rizzoni, Enrico Agabiti Rosei.  University of Brescia, Department of Clinica Medica, Brescia, Italy Objectives:  Structural alterations of small resistance arteries in essentialhypertensives (EH) are mostly characterized by inward eutrophic remodeling.However, we observed hypertrophic remodeling in patients with renovascularhypertension, in those with acromegaly as well as in patients with noninsulin-dependent diabetes mellitus, suggesting a relevant effect of humoral growthfactors on vascular structure, even in addition to the hemodynamic load.Cortisol may stimulate the renin-angiotensin system, and induce cardiachypertrophy. However, no data are presently available about small arterystructure in patients with Cushing’s syndrome. Methods:  We have investigated the structure of subcutaneous small resistancearteries in 12 normotensive (NT) subjects, in 12 EH subjects, and in 7patients with Cushing’s syndrome (CS). Small arteries from subcutaneous fatwere diassected and mounted on a micromyograph. The normalized internaldiameter (ID), media thickness (MT), media-to-lumen ratio (ML) and themedia cross-sectional area (MCSA) were measured. Results:  Demographic variables were similar in the three groups, ex-cept for clinic blood pressure (BP, 127/79 ± 2.4/2.1 mm Hg in NT vs169/99 ± 1.5/1.7 and 160/90 ± 5.4/3.9 mm Hg in EH and CS, p < 0.01/p < 0.001and p < 0.01/p < 0.05, respectively) and 24-hour urinary cortisol levels (CS:1.540 ± 40 nmol/day). M/L was significantly greater in EH and CS comparedwith NT (0.099 ± 0.003 and 0.0916 ± 0.004 versus 0.0684 ± 0.004, p < 0.001and p < 0.01, respectively). No difference was observed between EH and CS.The media cross-sectional area was significantly greater in CS compared withEH and with NT. Conclusion:  Our results suggest the presence of hypertrophic remodeling of subcutaneous small resistance arteries of CS, probably as a consequence of growth promoting or profibrotic properties of circulating cortisol and/or otherhormones. SA-02 LIVER FUNCTION TEST DURING METFORMIN THERAPY INPATIENTS WITH POLYCYSTIC OVARY SYNDROME (PCOS) Luca Miele 1 , Consuelo Cefalo 1 , Daniela Martinez 2 , Alessandra Forgione 1 ,Maurizio Pompili 1 , Francesca Sagnella 2 , Simona Racco 1 , Rosanna Apa 2 ,Giovanni Gasbarrini 1 , Antonio Grieco 1 .  Departments of   1  Internal Medicineand   2 Ginaecology. “A. Gemelli” Hospital, Rome, Italy. Background:  Polycystic ovary syndrome (PCOS) is considered one of themost common form of ovarian disease in young women. PCOS shares severalfeatures of Metabolic Syndrome (MS) with nonalcoholic fatty liver disease(NAFLD). Metformin therapy is the standard of care for insulin resistance(IR) in these patients. Aim:  to evaluate the prevalence of NAFLD and the effect of standard therapywith Metformin on non-invasive fibrosis markers in patients with PCOS andhyperinsulinaemia. Patients and Methods:  We enrolled 50 non-diabetic consecutive patients withPCOS. NAFLD was assessed by abdominal ultrasound (US). Anthropometricvariables, OGTT, serum lipids and aminotransferases, and HOMA index weredetermined at basal visit and after 6 months of therapy with Metformin(1500 mg/die for 24 weeks). ATPIII criteria were used for defining metabolicsyndrome (MS). The Wilcoxon paired test was used to assess the modificationafter treatment, p=0.05 was considered significant. Results 13 patients (age:  25.69 ± 7.38 years; BMI: 30.96 ± 8.23) completedthe treatment. At the entry basal visit 30.8% (4/13) showed MS. NAFLDat US was decteted in 10/13 (76.9%) subjects with PCOS. Subjects withPCOS and NAFLD were younger than subjects without NAFLD (24.10 ± 6.84VS 31 ± 7.81) with higher waist-hip-ratio (0.87 ± 0.09 vs 0.73 ± 0.04, p < 0.05).The only adverse event reported was the diarrhoea in 6/13 (46.2%) but inall cases it did not lead to the discontinuation of therapy. After 6 monthsof Metformin therapy the AUC was significantly improved in all subject(18730.50 ± 8105.35 vs 12531.81 ± 6515.14, p: 0,002), HDL-Cholesterol sig-nificantly increased (45.83 ± 11.08 vs 49.53 ± 9.41, p < 0.05) and the AST/ALTratio was significantly improved (0.90 ± 0.39 vs 0.72 ± 0.32, p:0.028) even if asignificant reduction of the ultrasound degree of steatosis was not observed. Discussion:  Six months therapy with Metformin in patients with PCOS wasable to improve severity of liver disease assessed by AST/ALT ratio even if wedid not observed a significant modification of steatosis at US. The reductionof IR incidence and the increase the HDL Cholesterol levels could lead to areduction of cardiovascular risk and improving liver function tests in womenwith PCOS SA-03 HYPOTHYROIDISM DUE TO HASHIMOTO’S DISEASE,RADIOIODINE THERAPY AND POST THYROIDECTOMY: ARETHERE ANY DIFFERENCES IN CARDIOVASCULARY RISK? Cemil Bilir, Hakan Cinemre, Feyzi Gokosmanoglu, Ramazan Büyükkaya,Necip Aytug.  Duzce University School of Medicine,Department of Internal Medicine Objective:  The most common cause of hypothyroidism is chronic autoim-mune thyroiditis,radioiodine treatment and thyroidectomy. Hypothyroidismis a cardiovascular risk factor. We investigated the possible differences incardiovascular risk between different etiology of hypothyroidism. Methods:  116 patients (28 male, 88 female) hypothroid patients who pre-sented to our outpatient clinic from Feb, 2007 to Aug, 2007 were included.Patients with a history of diabetes mellitus, hypertension, renal failure, dys-lipidemia, have 10-year Framingham risk score  >  5%, previous or currentuse of medications effect carotid intima media and thyroid hormone levelsexcluded. 32 patients were diagnosed as Hashimoto’s disease according toantithyroid antibody levels and/or thyroid ultrasonography. 19 pateints hadhypothyroidism due to thyroid surgery and 8 were hypothyroid because of radioiodine therapy. Remaining 59 patients were evaluated for carotis intimamedia thickness (CIMT) using carotid duplex ultrasonography.Age and sexmatched 67 healty subjects were selected as controls.All measurements wereperformed by the same radiologist who is experienced in the area. Results:  CIMT was found to be 0.71 mm (0.45-1.14) in Hashimoto group,0.70 mm (0.53-1.02) in the post surgical group and 0.71mm (0.55-1.3) in thepost radioiodine threatment group while measured as 0.52 mm (0.39-0.76) incontrols. CIMT were found to be very significantly higher in all three groupscompared to the controls (p=0.0001). No statistically significant differencewere found between three groups (p=0.80). CIMT were measured as mean0.74 mm and 0.72 mm in antithyroid antibody positive and negative patients,respectively (p=0.82). Conclusion:  This is the first study evaluating possible differences in CIMTas a cardiovascular risk factor among hypothyroidism patients related to threemajor etiologies as well as antithyroid antibody positivity. Further studiesmight be needed to evaluate other cardiovascular risk factors. 47
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