Unusual clustering of diseases in a Canadian Old Colony (Chortitza) Mennonite kindred and community.

We investigated a large Old Colony (Chortitza) Mennonite kindred with branches across Canada. Six generations of the kindred were traced. There was intermarriage among numerous family members. Insulin-dependent diabetes mellitus (IDDM) was identified in 10 members; all 7 living patients were found to carry the immunogenetic marker HLA-DR4. Nine other close relatives had disorders of carbohydrate metabolism, including gestational diabetes mellitus and non-insulin-dependent diabetes mellitus progressing to insulin use. Ten other relatives had autoimmune diseases, including rheumatoid arthritis, hyperthyroidism, hypothyroidism and multiple sclerosis. Cases of Alport's syndrome, congenital malformations, inborn errors of metabolism and unusual malignant diseases were also found in the kindred. In the small Alberta community in which the kindred was ascertained there were people of Old Colony Mennonite descent with genetic conditions such as Gilles de la Tourette's syndrome and congenital malformations, including congenital heart disease. This kindred represents the largest reported familial aggregation of IDDM. This disease and other disorders of carbohydrate metabolism occur in the context of a strong familial predisposition to autoimmune disease. Study of this family may permit empiric testing of proposed models of inheritance of diseases of complex origin such as IDDM. We report this Old Colony (Chortitza) Mennonite community because it is one of the settlements populated by this religious and genetic isolate, which extends across Canada and Central and South America and affords opportunities for the study of both common and rare inherited diseases.     

Schmidt's syndrome – Case report

When immune dysfunction affects two or more endocrine glands and other non-endocrine immune disorders are present, the polyglandular autoimmune (PGA) syndromes should be considered. The PGA syndromes are classified as two main types: PGA type I and PGA type II. We are reporting this case in which a patient had primary adrenal insufficiency, autoimmune hypothyroidism and insulin dependent diabetes mellitus and was diagnosed as "Schmidt''s syndrome" (PGA type II). This syndrome is a very rare autoimmune disorder and difficult to diagnose because the symptoms of this syndrome depends on the gland which gets involved first. Our patient was treated and improved with corticosteroid, thyroxine and insulin therapy.     

二甲双胍治疗2型糖尿病与亚临床甲状腺功能减退症关系的研究

目的：：观察临床应用二甲双胍治疗2型糖尿病与亚临床甲状腺功能减退症的关系。方法：选取2013年6月至2014年7月在我院诊治的124例2型糖尿病患者，按随机数字表法随机分为对照组和观察组各62例，对照组患者给予拜糖苹口服治疗，观察组则应用二甲双胍治疗，观察两组患者治疗后亚临床甲状腺功能减退症的发生情况。结果：实验室检查表明，观察组患者的 TSH 及 HOMA－IR均明显低于对照组( P<0.05)，其他各项指标比较无明显差异( P>0.05)，应用二甲双胍是减少甲状腺功能减退症发生的保护因素，性别是其危险因素。结论：临床应用二甲双胍治疗2型糖尿病能减少甲状腺功能减退症的发生率，值得推广应用。     

Diabetes mellitus and hypothyroidism

It would appear from the literature that hypothyroidism is rare in male diabetics. Serologically, there is an established association between autoimmune thyroiditis and diabetes mellitus. However, very little clinical evidence has been produced to confirm these findings.     

Addison's disease in type 1 diabetes presenting with recurrent hypoglycaemia

Primary adrenal insufficiency (Addison's disease) often develops insidiously. Although a rare disorder, it is more common in type 1 diabetes mellitus. A 19 year old male with type 1 diabetes and autoimmune hypothyroidism experienced recurrent severe hypoglycaemia over several months, despite a reduction in insulin dose, culminating in an adrenal crisis. Recurrent severe hypoglycaemia resolved after identification and treatment of the adrenocortical insufficiency. In type 1 diabetes, undiagnosed Addison's disease can influence glycaemic control and induce severe hypoglycaemia.     

Rare association of chronic lymphocytic thyroiditis with dermatomyositis

Autoimmune thyroid disease (AITD) has been associated with other autoimmune diseases such as chronic urticaria, insulin-dependent diabetes mellitus, Sj?gren's syndrome, inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, psoriasis, ankylosing spondylitis, and dermatomyositis (DM). AITD is a common disorder affecting primarily women, and both genetic and environmental factors are included in its pathogenesis. DM is considered an autoimmune disease of the muscles and skin. Although AITD is the most common cause of hypothyroidism, to the best of our knowledge, only three cases of DM and AITD in the same patient have been reported in the last 40 years. We consider that both are developed from the same autoimmune background. Herein, we present a case of a 30-year-old man with a 4-year history of AITD who was diagnosed as suffering as well from DM.     

自身免疫性多内分泌腺病综合征Ⅱ型一例报道并文献复习

自身免疫性多内分泌腺病综合征（APS）即同一患者同时或先后出现2种或2种以上内分泌腺自身免疫疾病。本文报道于2018-07-10入住南京中医药大学附属中西医结合医院1例甲状腺功能亢进（Graves病）合并1型糖尿病的APSⅡ型患儿。患儿为12岁女性,因颈前肿大伴双眼突出6年就诊,多年抗甲状腺药物治疗甲状腺功能亢进及突眼效果差,病程中伴发1型糖尿病。予以甲状腺切除术,并以胰岛素控制1型糖尿病,使得甲状腺功能亢进、甲状腺相关性眼病、1型糖尿病得以良好控制。     

The Vogt-Koyanagi-Harada syndrome: association with hypothyroidism and diabetes mellitus

A 45 year old Saudi male with poliosis, alopecia areata, vitiligo, anterior uveitis, inflammatory changes in the posterior pole of the retina and paraparesis presented with features of the Vogt-Koyanagi-Harada syndrome, uncontrolled diabetes mellitus and hypothyroidism. To the best of our knowledge the association of diabetes mellitus and hypothyroidism in this syndrome has not been reported previously.     

老年糖尿病冠心病合并甲状腺机能减退症30例分析

目的:对老年糖尿病(DM)冠心病(CHD)合并甲状腺机能减退症(甲减)进行临床分析及探讨其病因。方法:对住院老年DMCHD合并甲减的患者30例进行回顾性临床分析,着重分析其DM、CHD、甲减的临床症状、体征、辅助检查的结果,及治疗转归情况。结果:老年DMCHD合并甲减的病人甲功5项明显低于正常值,P<0.05。结论:老年DM患者CHD并发甲减,与DM血管病变垂体缺血、缺氧致使垂体机能受损,使促甲状腺激素(TSH)分泌减少,甲状腺机能受损有关。     

Postpartum thyroiditis

Three women presented 4-6 months after delivery with a goitre and spontaneously changing thyroid function believed to be due to autoimmune thyroiditis. All three patients had transient hypothyroidism and one initially had evidence of thyrotoxicosis. Hypothyroidism in autoimmune thyroiditis is generally regarded as permanent. However, evidence is now accumulating, and is reviewed here, to suggest that relapses or onset with transient thyrotoxicosis and hypothyroidism followed by spontaneous, more or less complete, remission occur in one or more varieties of thyroiditis in the postpartum period.     

A study on prevalence of thyroid auto-immunity in type 1 diabetes mellitus

Type 1 diabetes mellitus is an auto-immune disease. It is associated with other auto-immune endocrine disorders and auto-immune impairment of non-endocrine tissue. Auto-immune thyroid disease is one of the most frequent auto-immune diseases associated with it. Hypothyroidism can decrease insulin requirement in such patients and hyperthyroidism may cause glucose intolerance. This study attempts to review this concept and detect overt and subclinical forms of auto-immune thyroid disease in type 1 diabetics and to find its correlation with age, sex and duration of diabetes. Fifty type 1 diabetes mellitus patients were selected from SSG Hospital, Vadodara between April 2007 and September 2008. After detailed history and examination, haemogram, urine analysis, fasting and 2-hour postprandial blood glucose level, serum free T4, TSH and antithyroid peroxidase antibody level were performed. The prevalence of auto-immune thyroid disease in type 1 diabetics was 60% with 40% having thyroid disorders (24% overt hypothyroidism, 8% subclinical hypothyroidism and 8% hyperthyroidism). Patients who were females (70% versus 53% in males), older (53.3% in 15-20 years age group versus 71% in 25-30 years age group), had a longer duration of diabetes (25% in those with the disease for <2 years and 100% in those >6 years) were more likely to have auto-immune thyroid disease than their counterparts. Thyroid auto-immunity is frequently associated with type 1 diabetes mellitus and patients should undergo antibody screening to detect the same and to find out assosiated undiagnosed thyroid dysfunction.     

糖尿病与亚临床甲状腺功能减退

糖尿病患者甲状腺功能异常的发生率明显高于普通人群,主要表现为亚临床甲状腺功能减退,目前机制尚不清楚,可能与甲状腺自身抗体及葡萄糖毒性有关。糖尿病合并亚临床甲状腺功能减退者,总胆固醇和低密度脂蛋白明显升高,血压升高,左心室功能受损,心血管事件的风险增加,糖尿病视网膜增殖性病变及重度非增殖性病变增多。此外,尚可能影响糖尿病患者的胰岛B细胞功能以及认知能力。     

Autoantibodies,human T lymphotropic virus type 1 and type 1 diabetes mellitus in Jamaicans

The clinical characteristics, autoantibody profiles and seroprevalence of human T lymphotropic virus Type 1 (HTLV-1) were assessed in 30 Jamaican patients with Type 1 diabetes mellitus. Two hundred and fifty-two blood donors and 108 patients with Graves' disease were included as controls for the HTLV-1 component of the study. The mean age of onset of diabetes mellitus was 20.5 +/- 9.2 years and the mean duration of diabetes mellitus was 10.5 +/- 6.1 years. The remarkable clinical data included an absence of other associated organ-specific autoimmune diseases, and clinical evidence and history of congenital rubella in one patient. Islet cell cytoplasmic antibodies (ICA) were absent but 17% (5/30) of the diabetic patients tested positive for glutamic acid decarboxylase (GAD) antibodies. No other organ-specific autoantibodies were detected but non-organ-specific autoantibodies were present in 9 (30%) of the sera of diabetic patients. The seroprevalence of HTLV-1 in the patients with diabetes mellitus was significantly higher than that in the healthy controls (17% (5/30) versus 4% (11/252), p = 0.05). Autoantibodies were found in the sera of 4/5 (80%) of the diabetic patients who were positive for HTLV-1. None of the patients with onset of diabetes mellitus below age 15 years was HTLV-1 positive. The likely polyaetiological nature of Type 1 diabetes mellitus in Jamaicans is being further investigated at the molecular level.     

Clinical presentation of thyroid dysfunction and Addison's disease in young adults with type 1 diabetes

In a clinic population of 509 type 1 diabetic patients aged 16-45 years, 5.5% had received treatment for thyroid disorders (20 hypothyroid, three males; eight thyrotoxicosis, four males), and Addison's disease was present in four patients (0.8%, one male). In all patients, type 1 diabetes preceded the diagnosis of the other autoimmune disorder. The clinical presentation of hypothyroidism was usually insidious with few symptoms, although an increased frequency of hypoglycaemic symptoms and/or raised serum cholesterol levels often prompted thyroid function testing. In contrast, the patients with thyrotoxicosis had florid symptoms, weight loss (mean 8.12 kg), palpable goitres, increasing insulin requirements, and low cholesterol levels. Six patients did not achieve remission or had recurrent thyrotoxicosis after oral antithyroid treatment and required 131I or thyroid surgery. A family history of autoimmune disease was present in 25% of patients with thyroid disorders (seven thyrotoxic and one hypothyroid) and in three of the four patients with Addison's disease. In this population of young adult type 1 diabetic patients, appropriate tests for thyroid dysfunction and Addison's disease should be carried out if there is clinical suspicion and/or unexplained changes in diabetic metabolic control or serum cholesterol. Careful follow-up of patients with a family history of these conditions is recommended.     

慢性丙型肝炎和糖尿病相关性研究进展

肝脏在血糖代谢中起重要作用,各种导致慢性肝实质损害的慢性肝病均可影响正常的糖代谢,甚至可出现糖耐量减退或糖尿病。近年来有很多流行病学调查证实了慢性丙型肝炎与糖尿病有密切的相关性,慢性丙型肝炎的患者中糖尿病的患病率明显高于普通人群和其他原因所致的慢性肝病患者,其发病机制可能与胰岛素抵抗、自身免疫、丙型肝炎病毒肝外复制等有关,其中胰岛素抵抗为最主要发病机制,肿瘤坏死因子α在丙型肝炎病毒相关的胰岛素抵抗中起着重要的作用。     

中国汉族人白癜风伴发自身免疫疾病与遗传关系

目的了解中国汉族人白癜风及相关常见自身免疫性疾病的关系。方法以调查表形式收集患者的临床及家系资料,应用Epiinfo6.0和SPSS15.0软件对资料进行统计学处理和分析。结果和无家族史患者相比,有家族史白癜风患者发病年龄较早、病程较长。白癜风患者及一级亲属中类风湿性关节炎、慢性荨麻疹、斑秃、银屑病的患病率高于普通人群。有家族史患者类风湿性关节炎、慢性荨麻疹、银屑病、类风湿性关节炎、哮喘的患病率显著高于普通人群。结论自身免疫因素及遗传因素在白癜风发病机制中有一定的作用,白癜风可能与其它的自身免疫性疾病有共同的发病基础。白癜风免疫机制受遗传因素影响。     

Coronary artery bypass grafting in a patient with history of esophagectomy, hypothyroidism, hypertension and type 2 diabetes mellitus: a case report

Coronary artery bypass grafting (CABG) is a mature procedure in treating patients with coronaty artery diseases. We report a patient undergoing CABG had history of esophageal cancer and multiple underlying diseases: hypothyroidism, type 2 diabetes mellitus and hypertension. A CABG with midline sternotomy was safely performed in the presence of thyroid replacement therapy and intensive control of blood pressure and blood glucose. The patient recovered postoperatively with supportive care. coronary artery bypass grafting; esophagectomy; hypothyroidism; type 2 diabetic mellitus

     

GADA和ICA联合检测对成人隐匿性自身免疫性糖尿病早期诊断及预测胰岛功能的意义

①目的　探讨早期诊断成人迟发型自身免疫性糖尿病 (LADA)的临床标准 ,及 1型糖尿病相关抗体与胰岛功能之间的关系。②方法　检测 10 6例初诊的 2型糖尿病病人的谷氨酸脱羧酶抗体 (GADA)和胰岛细胞抗体(ICA) ,比较发病年龄、体质量指数 (BMI)和典型症状与抗体阳性的关系 ,并进行为期 1.5年的随访 ,比较基础和随访结束时C 肽水平的变化。③结果　抗体阴性组 84例 (79.2 % ) ,抗体阳性组 2 2例 (2 0 .8% ) ,GADA+ 组 17例 (16 .0 % ) ,ICA+ 组 19例 (17.9% ) ,仅 1种抗体阳性组 15例 (14 .2 % ) ,双阳性组 7例 (6 .6 % )。抗体阳性组与抗体阴性组之间的C 肽水平无明显差异 ,在随访 1.5年后 ,抗体阳性组餐后 2hC 肽水平明显高于抗体阴性组 (t=9.84 1,P <0 .0 1)。④结论　发病年龄、BMI和多尿、多饮等症状并不能预测是否有抗体阳性 ,出现抗体阳性的 2型糖尿病病人的胰岛功能将迅速恶化     

自身免疫糖尿病患者谷氨酸脱羧酶抗体表位的研究

自身免疫糖尿病患者体内存在胰岛自身抗体,其中谷氨酸脱羧酶抗体(GADA)被广泛应用于自身免疫糖尿病的诊断及预测。GADA表位变化与自身免疫糖尿病的发生和发展密切相关,新诊断的1型糖尿病患者血清中GADA倾向于与谷氨酸脱羧酶(GAD)65 M段和C端结合,而与N端罕见结合。GAD65-CAb阳性的成人隐匿性自身免疫糖尿病患者其胰岛功能较差,而GAD65-NAb阳性者与2型糖尿病相似。对GADA表位的研究不仅能为临床提供更多的信息,而且对于阐明自身免疫糖尿病的发病机制有重要的意义。