The Study Of The Correlation Between Postmenopausal Osteoporosis And Plasma Aldosterone/renin/the Study Of The Correlation Between Indole And Type 2 Diabetes/a Case Report Of 21-hydroxylase Deficiency

POSTMENOPAUSAL OSTEOPOROSIS IS ASSOCIATED WITH ELEVATED ALDOSTERONE/RENIN RATIOObjective:Plasma aldosterone/renin ratio(ARR)is a useful method for primary aldosteronism(PA)screening.However some confounders,such as medications and dietary,affect plasma renin and aldosterone levels,resulting in false-positive or-negative plasma ARR.This study investigated the association between postmenopausal osteoporosis(PMO)and plasma ARR.Methods:Bone mineral density(BMD)was measured by dual-energy X-ray-absorptiometry(DXA)in 324 normotensive postmenopausal women.Based on clinical characteristics and BMD,186 and 96 subjects were diagnosed as postmenopausal osteoporosis and osteopenia respectively,and the remaining 42 subjects were grouped as normal BMD.Plasma aldosterone concentration(PAC),plasma renin concentration(PRC),parathyroid hormone(PTH),bone alkaline phosphatase(BALP)and 25-Hydroxyvitamin D(25-(OH)D)were determined.Result:Subjects with postmenopausal osteoporosis showed significantly higher levels of PAC(121.0±78.8 vs.81.8±71.5 pg/ml,p<0.01 and 121.0±78.8 vs.91.7±56.2 pg/ml,p<0.01)and ARR(32.0±53.6 vs.9.0±9.3 pg/?U,p<0.01 and 32.0±53.6 vs.16.3±32.1 pg/?U,p<0.01),compared to women with normal BMD and osteopenia,respectively.Using ARR?37.0 pg/?U as the cutoff for positive screening,more false-positive was found in the postmenopausal osteoporosis group when compared to the normal BMD group(24%vs.2%)and osteopenia group(24%vs.7%),respectively.PAC was negatively associated with lumbar spine BMD T-score(r=-0.239,p<0.001),femur neck BMD T-score(r=-0.234,p<0.001)and total hip BMD T-score(r=-0.228,p<0.001).PTH was positively associated with PAC(r=0.119,p<0.05)and ARR(r=0.136,p<0.05).Conclusions:PAC and ARR are elevated in women with postmenopausal osteoporosis,which might be related to the increased PTH.INCREASED SERUM INDOLE IS ASSOCIATED WITH RISK OF TYPE2 DIABETESObjective:Indole is a tryptophan metabolite of tryptophan that is derived from gut microbiota.This study aimed to evaluate the relationship between serum indole concentration and type 2 diabetes(T2D).Method:A total of 248 participants[79 with normal glucose tolerance(NGT),82 with Pre-Diabetes(PDM)and 87 with newly diagnosed T2D]were recruited based on the results of oral glucose tolerance test(OGTT).Serum samples were used to measure the serum indole concentration measured by HPLC.The HOMA2-?,IGI,AUC-ins/AUC-g and ISSI-2 were used to assess the pancreatic islet ?-cell function.HOMA2-IR and Matsuda index were used to assess insulin resistance and sensitivity.Simple correlations and multiple linear regressions between serum indole and glucose metabolic parameters were analyzed.Participants were stratified into tertiles according to low,median,and high serum indole levels,and logistic regression models were used to analyze association between serum indole with T2D.Results:Patients with T2D or PDM exhibited an increase in levels of serum indole compared with participants with NGT.[94.17(66.95,147.83)vs.92.92(58.15,125.57)vs.66.13(53.56,116.41)?gg/l,respectively p<0.05].The levels of serum indole level were positively associated with the values of hemoglobin glycosylated(HbAlc)(r=0.141,p=0.026),fasting plasma glucose level(FPG)(r=0.193,p=0.002),postprandial plasma glucose level(r=0.121,p=0.047),and negatively correlated to values of HOMA2-?(r=-0.202,p=0.003),IGI(r=-0.178,p=0.006),AUC-ins/AUC-g(r=-0.141,p=0.026)and ISSI-2(r=-0.186,p=0.003).Multiple linear regression showed the negative associations between indole and insulin secretion indexs were also significant after adjusted for age?gender?BMI?SBP?DBP?HbA1c?TG and TC.No significant association was observed between indole and HOMA2-IR or Matsuda index.When adjusted for potential confounders,subjects in the median or high indole tertiles exhibited a higher risk of T2D compared to subjects in the low indole tertile[odds ratio(OR):1.70(95%Cl 0.79,3.67)for median tertile;2.14(1.02,4.54)for high tertile,by reference to the low tertile].Conclusion:Serum indole concentration in T2D patients is elevated;Higher concentration of serum indole is associated with an increased risk of T2D.A CASE OF CONGENITAL ADRENAL HYPERPLASIA OWING TO 21-HYDROXYLASE DEFICIENCYObjective:This study aimed to report a case of congenital adrenal hyperplasia owing to 21-hydroxylase deficiency and explore the gene mutation and genetic mode.Method:The related data about clinical charcteritics,laboratory examination and imageology were collected and analysed.The next generation sequencing screening and sanger sequencing were used to identify the genotype and inheritance mode in proban and family members.Results:The microsomia and bilateral adrenal hyperplasia,combined with increased levels of ACTH,progesterone and renin,decreased level of cortisol and the markedly elevated 17a-hydroxyprogesterone(baseline level as 11200ng/ml;>30000 ng/ml after the excitement of ACTH),strongly supporting the diagnosis of 21-hydroxylase deficiency.Gene analysies revealed CAH due to 21-hydroxylase deficiency by a compound heterozygote for CYP21 mutations:c.518T>A and c.1069C>T.Parents were heterozygous carriers,and younger brother was wild type.Conclusion:A case of 21-hydroxylase deficiency was identified by clinical manifestations and gene detection.