Vitamin D deficiency is very common in Chilean healthy postmenopausal women with normal sun exposure but without vitamin D fortification in their diets. This finding is associated with higher bone resorption during winter time and emphasizes the need to increase vitamin D intake in healthy postmenopausal women.

ACTH stimulation of glucocorticoid production by the adrenal cortex involves an intrinsic adrenal circadian clock [8 -10] . These clocks are sustained by the stimulatory and inhibitory transcriptional-translational feed-back loops of a group of genes, named clock genes, and their proteins. Of these, PER1 is part of the inhibitory loop and BMAL1 is part of the stimulatory loop. BMAL1 [Brain-Muscle (ARNT)-like] protein also drives a number of genes containing E-boxes in their promoters like the steroidogenic acute regulatory protein (StAR) [11] , mediating cholesterol transport to the mitochondria; a limiting step in ACTH-stimulated adrenal cortisol production [12] . A possible relationship between melatonin, human adrenal cortisol response to ACTH and clock genes, is suggested by the direct inhibitory eff ect of melatonin on BMAL1 and PER2 mRNA expression demonstrated in the capuchin monkey adrenal gland [13] .Abstract ▼ * Both authors contributed equally to this work.

Four children with 11 beta-hydroxysteroid dehydrogenase deficiency are described. All patients had severe hypertension, hypokalaemia, and low plasma aldosterone and renin activities. Two of the patients were siblings and two were unrelated. The most noticeable biochemical feature of these individuals was the extremely low excretion of cortisol metabolites containing an 11-carbonyl group compared to the excretion of the 11 beta-hydroxyl containing metabolites. Although this condition is readily diagnosed in affected individuals by urinary steroid analysis, carriers of the defect do not differ from normal in their urinary steroids. Both parents of the affected siblings had normal 11-oxo-steroid/11 beta-hydroxysteroid ratios under baseline conditions and the lesions could not be revealed by ACTH administration.

Objective:To determine the frequency of occult macroscopic metastasis detected by preoperative US evaluation of the neck in patients with PTC. Papillary thyroid carcinoma (PTC) is a malignancy with a high rate of lymph node metastasis. The findings of routine thyroid ultrasonography(US)andphysicalexaminationmayunderestimatemetastatic disease. Thus, we propose that patients diagnosed as having PTC undergo preoperative US staging of the neck.Design: This prospective study included 60 patients diagnosed as having PTC from January 1 through June 30, 2006. Patients had undergone previous thyroid US evaluation with no palpable adenopathy. Lymph nodes were deemed suspicious by US findings with a minor axis greater than 10 mm, a minor axis greater than 50% of the major axis, or hyperechogenicity with or without microcalcifications. Metastasis was confirmed by fineneedle aspiration biopsy or frozen section analysis. Patients with confirmed metastasis underwent a neck dissection. The location of adenopathy reported by US was correlated with the pathological report. Results:The US evaluation identified 12 of 60 patients (20%) with adenopathy suggestive of metastasis. Metastasis was confirmed in 11 of 12 patients (92%). Metastasis was found in 1 of 48 patients who had a negative US finding. Overall, sensitivity, specificity, and positive and negative predictive values were 92%, 98%, 92%, and 98%, respectively. All neck levels with suspicious adenopathy detected by US evaluation, with 1 exception, were confirmed by pathological findings. Nine patients had additional neck levels involved with microscopic disease undetected by the US evaluation. Conclusions:In patients with PTC, preoperative US evaluation of the neck is effective in detecting nonpalpable metastasis. Therefore, routine preoperative neck US evaluation is recommended to optimize primary surgical planning.