RESUMEN
A 67-year-old trout fisherman presented with a six-week history of polyuria, polydipsia, dyspnoea on exertion and the development of subcutaneous extensor surface skin nodules. He was hypercalcaemic with acute renal impairment. Parathyroid hormone was suppressed and vitamin D levels were within normal limits. The patient had a past history of hypothyroidism, but thyroid replacement was adequate. Hypoadrenalism, myeloma and metastatic malignancy were excluded. Biopsy of a subcutaneous nodule revealed dermally based non-caseating granulomata, consistent with sarcoidosis. Serum angiotensin-converting enzyme was elevated, and computerized tomography scanning of the chest and abdomen revealed widespread lymphadenopathy with multiple lung nodules and splenomegaly. Prednisolone therapy produced rapid resolution of his skin lesions and normalization of his bone and renal biochemistry. The mechanism of hypercalcaemia in sarcoidosis is poorly understood but is thought to involve parathyroid hormone-independent 1-hydroxylation of 25-hydroxyvitamin D within sarcoid lesions. This process may be exacerbated by exposure to UV light and it is of interest that this patient developed symptoms after a period of intense trout fishing in the good weather of April and May 2007.
Asunto(s)
Hipercalcemia/complicaciones , Sarcoidosis/complicaciones , Sarcoidosis/patología , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/patología , Anciano , Explotaciones Pesqueras , Glucocorticoides/uso terapéutico , Humanos , Hipercalcemia/tratamiento farmacológico , Masculino , Prednisolona/uso terapéutico , Radiografía , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
AIMS/HYPOTHESIS: Sedentary offspring of patients with type 2 diabetes are often more insulin-resistant than persons with no family history of diabetes, but when active or fit offspring of type 2 diabetic patients are compared with non-diabetic persons, differences in insulin resistance are less evident. This study aimed to determine the effects of an exercise training intervention on insulin sensitivity in both groups. METHODS: Women offspring (n = 34) of type 2 diabetic patients (offspring age 35.6 +/- 7.0 years, BMI 28.1 +/- 5.1 kg/m(2)) and 36 matched female controls (age 33.6 +/- 6.1 years, BMI 27.3 +/- 4.7 kg/m(2)) participated. Body composition, fitness and metabolic measurements were made at baseline and after a controlled 7 week exercise intervention. RESULTS: At baseline, insulin sensitivity index (ISI) was 22% lower in offspring than controls (p < 0.05), despite similar body fat and maximal oxygen uptake (.VO(2max)) values in the two groups. ISI increased by 23% (p < 0.05) in offspring following the exercise intervention, compared with 7% (NS) in the controls. Increases in .VO(2max) were similar in both groups (controls 12%, offspring 15%, p < 0.05 for both). Plasma leptin concentrations decreased significantly in the offspring (-24%, p < 0.01) but not in controls (0%, NS). Change in ISI correlated significantly with baseline ISI (r = -0.47, p < 0.0005) and change in leptin (r = -0.43, p < 0.0005). The latter relationship was not attenuated by adjustment for changes in body fat. CONCLUSIONS/INTERPRETATION: Offspring, but not controls, significantly increased ISI in response to an exercise intervention, indicating that insulin sensitivity is more highly modulated by physical activity in daughters of patients with type 2 diabetes than in women with no family history of the disease.