Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two distinct types of thyroid carcinoma with considerable difference in terms of cellular origin, histopathological appearance, clinical course and prevalence. The histogenetic origin and possible molecular mechanisms responsible for the development of mixed medullary-papillary carcinoma of the thyroid are still unclear. The most widely accepted hypotheses considering co-occurrence of MTC and PTC are stem cell theory, collision effect theory and hostage theory. Herein we describe two rare cases of mixed medullary-papillary thyroid carcinoma with co-occurrence of MTC and PTC which developed with concomitant MEN 2A and different sites of lymph node metastasis in the first patient, while with atypical clinical presentation in the second patient. In conclusion, co-expression of thyroglobulin, synaptophysin and chromogranin by the papillary component of mixed tumor seems to support stem cell theory in our first case, whereas positive staining for calcitonin but not for thyroglobulin in the medullary component of the tumor along with separation of these two tumors from each other by a normal thyroid tissue seem to indicates the likelihood of collision effect theory in our second case.
Background
Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians’ attitudes on the treatment of diabetic dyslipidemia were also examined.
Methods
A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported.
Results
A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59–0.83).
Conclusions
Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.
Aim:
We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal incidentalomas (NFAIs) via
the coronary-artery-calcium (CAC) score.
Materials and Method:
The participants were patients with an NFAI (n = 55). They were compared to patients with chest
pain, a low-intermediate Framingham-risk score and a non-diagnostic treadmill-exercise test, which served as the control
group (n = 49). Subsequently, the NFAI group was subdivided according to a CAC score of <100 Agatston units – mild coronary-artery calcification (n = 40) – and ≥100 Agatston units – moderate-to-severe calcification (n = 15).
Results:
Similar rates of traditional risk factors were observed between the NFAI and control groups, and lower low-density
lipoprotein cholesterol rates were observed in the NFAI group. The CAC score was significantly higher for the NFAI group
than the control group. Glucose, potassium, adrenocorticotropic-hormone and basal-cortisol levels were higher in those with
a CAC score of ≥100. High-density-lipoprotein cholesterol, estimated glomerular filtration rate and ejection fraction (EF)
were higher in those with a CAC score of <100. Adenoma size and location were similar between the groups. Age, EF and
glucose were the most significant variables related to CAC score in patients with an NFAI, at ≥100 Agatston units.
Discussion:
Patients with a low-intermediate CV risk profile and an NFAI have a higher risk of atherosclerosis, when compared to patients with a low-intermediate CV risk profile, but no NFAI.
Conclusion:
In cases where an NFAI exists, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.
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