Sema HEPŞEN ,
Pınar AKHANLI ,
Hakan DÜĞER ,
Murat ÇALAPKULU ,
Bekir UÇAN ,
Muhammed Erkam SENCAR ,
Davut SAKIZ ,
İlknur Öztürk ÜNSAL ,
Seyit Murat BAYRAM ,
Mustafa ÖZBEK ,
Erman ÇAKAL
Background/aim: The known pathogenesis of diabetes mellitus (DM) in acromegaly is mainly based on growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess. Fatty acid-binding protein 4 (FABP-4), a novel adipokine, is found to induce insulin resistance and type 2 DM. We aimed to investigate the possible effect of FABP-4 on glucose metabolism in patients with acromegaly. Materials and methods: This case-control study included 28 patients newly diagnosed with acromegaly and 57 healthy volunteers. The patients with acromegaly were classified according to their glycemic status as with DM, prediabetes, and normal glucose tolerance. Anthropometric measurements, laboratory test results, and FABP-4 levels of the subjects were evaluated. Results: Although no difference was observed in FABP-4 levels between acromegaly and control groups, the FABP-4 level was higher in the patients with acromegaly having DM compared to the patients with acromegaly having prediabetes and NGT, and the control group (p = 0.004, p = 0.001, p = 0.004, respectively). Logistic regression analysis suggested that the FABP-4 is an independent predictor of DM in acromegaly (β = 7.382, OR = 38.96, 95% CI: 1.52-5.76, p = 0.018). Conclusion: The FABP-4 may be a helpful predictor of acromegaly-associated DM. Key words: Acromegaly, adipokin, FABP-4, diabetes mellitus
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Background/aim: The management of nodules with indeterminate cytology [atypia of undetermined significance (AUS), follicular lesion of undetermined significance (FLUS), follicular neoplasm (FN), suspicious for a follicular neoplasm (SFN), and suspicious for malignancy (SM)] results is controversial. To assess the role of the elastography technique in the diagnosis of malignancy in the subtypes of indeterminate thyroid nodules. Materials and methods: We included 132 patients with indeterminate cytology who underwent thyroid surgery. Sensitivity, specificity, area under the curve, and optimal cut-off points were calculated with receiver operating characteristic (ROC) analysis for elastography score (ES) and strain index (SI). Results: Malignancy was observed in 27/95 (28.4%) of the AUS-FLUS cytology and 12/24 (50%) of FN, SFN cytology. All of the 13 patients (100 %) with SM are found to be malignant on histology. In the FLUS group, nodules with ES greater or equal to 3, the presence of malignancy was higher 17/41 (41.5%) when compared with nodules with ES smaller than 39/46 (19.6 %) (p = 0.023). In the SFN group, 2 of 2 nodules with an ES score of 4 and 1 of 1 nodule with an ES score of 5 were malignant. In the FLUS group, 4 of 10 nodules with an ES score of 4 and 2 of 2 nodules with an ES score of 5 were malignant. Conclusion: Thyroid elastography may reduce unnecessary surgery for both patients with AUS/FLUS and selected SFN cytology. Elastography appears to be helpful in follicular variants and other types of papillary thyroid cancer, however, not in follicular thyroid cancer. Key words: Elastography, indeterminate cytology, malignancy, thyroid
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Background/aim: It is known that the increased growth hormone (GH) and insulin-like growth factor-1 (IGF-1) have mitogenic and antiapoptotic properties in breast cells in acromegaly. Our study aims to evaluate breast findings in patients with acromegaly by comparing them to the control group. Materials and methods: Sixty-one patients followed with acromegaly diagnosis and 180 healthy controls were included in our study. Demographic data, laboratory results, Breast Imaging-Reporting and Data System (BI-RADS) scores, and breast density evaluated via mammography, malign and benign breast lesions evaluated via mammography, breast ultrasonography (USG), and breast magnetic resonance imaging (MRI) of patients were compared to the control group. Results: While BI-RADS scores were similar in patient and control groups, breast density in acromegaly patients was found out to be higher compared to the control group (p = 0.754, p = 0.001, respectively). In acromegaly patients, the breast calcification rate was higher than controls (p = 0.021). t was observed that mass frequency in USG in acromegaly patients increased when GH level increased as well (p = 0.021). No difference was detected between benign and malign breast lesions diagnosed histopathologically (p = 0.031, p = 0.573, respectively). There was not any difference in terms of BI-RADS scores, breast types, and breast lesions in acromegaly patients that were in remission and not in remission (p > 0.05). Conclusion: Benign and malign breast lesions were found out to be similar to the control group, although breast density rate was detected to be higher in acromegaly patients. A regular follow-up is required in these patients via suitable breast visualization techniques considering their age and clinical status due to mass formation risk derived from increased GH level and extreme breast density despite the absence of any detected breast lesion frequency in acromegaly patients. Key words: Acromegaly, breast density, breast neoplasm, breast cancer
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Objective: To investigate the effects of surgical treatment on blood parameters in patients with parathyroid adenoma. Methods: Patients with a diagnosis of parathyroid adenoma, who underwent surgery between November 2011 and April 2016, were investigated retrospectively. These patients were evaluated according to white blood cell, lymphocyte, neutrophil, and platelet counts, hematocrit, mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and calcium and parathormone (PTH) levels before and after the surgery. Results: The study included 103 patients. The number of male patients was 22 (21.4%), and the number of female patients was 81 (78.6%). The age of the patients ranged between 7 and 87, and the mean age was 54.7 ± 14.3. Preoperative and postoperative changes in lymphocyte, platelet, hematocrit, MPV, calcium and PTH levels were found to be statistically significant in our study, but the changes in NLR and PLR were not. Conclusion: Hyperparathyroidism is a reason for chronic inflammation and may affect blood inflammation parameters. However, the correlation between NLR, PLR, and serum PTH levels was not statistically significant. This can be explained by the fact that surgery causes a significant change in the number of both platelets and lymphocytes. We found a positive correlation between lymphocyte, neutrophil, and platelet counts, hematocrit, MPV, and serum PTH levels.
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Amaç: Feokromositomalar kromaffin hücrelerinden kaynaklanan nöroendokrin tümörlerdir. Bu çalışmanın amacı feokromasitoma hastalarının klinik, laboratuvar ve görüntüleme bulgularını gözden geçirmektir. Materyal ve Metot: Araştırmamızda 2009–2019 yılları arasında feokromasitoma tanısı almış 19 olguya ait klinik, laboratuvar ve radyolojik veriler geriye dönük olarak değerlendirilmiştir. Bulgular: Feokromasitoma tanısı konan 19 hastadan 13’ü kadın, 6’sı erkek olup ortalama yaş 44,1±11,3 yıl olarak saptandı. Hastaların 8 tanesi yeni tanı olmak üzere 18’inde hipertansiyon mevcuttu. Feokromositoma hastalarına eşlik eden hastalıklar incelendiğinde, hipertansiyondan sonra en sık tiroid patolojilerinin olduğu bulundu. Tansiyon yüksekliğinden sonra en sık semptom terleme ve baş ağrısı olarak saptandı. Tüm hastalarda vitamin D eksikliği ya da yetersizliği mevcuttu. Hastaların %94,1’inde 24 saatlik idrarda bakılan normetanefrin düzeyi yüksek olarak saptandı. Yerleşim yerleri açısından on birinde sağda, beşinde solda ve üçünde tümör bilateral adrenal yerleşimliydi. Lezyon boyutu %36,8’inde 4 cm’den küçük, %42,1’inde 4–6 cm arasında saptanırken, %21,1’inde 6 cm’den büyük saptandı. Sonuç: Bu çalışma feokromasitomanın nonspesifik ve değişken bir kliniğinin olduğunu gösterdi. Feokromasitoma şüphesi olan hastalarda özellikle ataklar sırasında tarama testi olarak 24 saatlik idrarda normetanefrin ve metanefrin düzeyleri istenmeli ve görüntüleme yöntemleri ile kitle lokalize edildikten sonra cerrahi tedavi uygulanmalıdır.
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Background/aim: Autoimmune thyroid disease in women is associated with subfertility and early pregnancy loss, and patients with primary ovarian insufficiency have a high prevalence of thyroid autoimmune disorders. The aim of this study was to investigate the association between Hashimoto thyroiditis (HT) and ovarian reserve. Materials and methods: Levels of serum thyroid stimulating hormones, thyroid autoantibodies, and anti-Müllerian hormone (AMH) were measured in women with HT and a healthy control group between 2018 and 2019. Results: Evaluation was made of 108 premenopausal women with HT, and a control group of 172 healthy females with normal antithyroid antibody levels and thyroid function. Serum AMH levels were determined to be significantly lower in the HT group compared to the control group. Conclusion: Ovarian reserve evaluated by serum AMH concentration is affected by thyroid autoimmunity independently of antithyroid antibodies type or titers. Key words: Hashimoto thyroiditis, anti-Müllerian hormone, ovarian reserve, miscarriage
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Tip 1 diabetes mellitus (T1DM) pankreasta bulunan beta hücrelerinin hasarı sonucu gelişen ve insülin eksikliği ile karakterize kronik metabolik bir hastalıktır. Nefropati, retinopati ve nöropati diyabetin bilinen mikrovasküler komplikasyonlarıdır. T1DM hastalarında serum ürik asit (SÜA) düzeyini değerlendiren az sayıda çalışma mevcuttur ve SÜA düzeyinin mikrovasküler komplikasyonlar ile ilişkisi tartışmalıdır. Bu çalışmada T1DM hastalarında SÜA düzeyini değerlendirmeyi ve SÜA düzeyinin mikrovasküler komplikasyonlar ile ilişkisini incelemeyi amaçladık. Bu çalışma 18 yaşından büyük T1DM tanısı ile takipli 160 hastanın ve 85 sağlıklı kontrolün dosyalarının retrospektif değerlendirilmesi ile yapıldı. T1DM hastalarında kontrol grubuna göre SÜA düzeyi düşük bulundu (p:0.035) ve SÜA düzeyi ile HbA1c arasında negatif kolerasyon saptandı (r:-0.172, p:0.03). SÜA ile kreatinin düzeyi arasında pozitif kolerasyon saptandı (r:0.269, p:0.001). Nefropati gelişen hastalarda SÜA düzeyi diyabet süresinden bağımsız olarak yüksek saptanırken (r2:0.185, p:0.027) nöropati ve retinopatisi mevcut olan hastalarda SÜA yüksekliği bağımsız bir risk faktörü olarak saptanmadı. Sonuç olarak T1DM hastalarında kontrol grubuna göre daha düşük SÜA düzeyi bulunmasına rağmen diyabetik nefropati gelişen hastalarda SÜA düzeyinin yüksek olduğu saptandı. Yüksek SÜA düzeyinin diyabetik nefropati gelişiminde risk faktörü olup olmadığını belirlemek için daha ileri prospektif çalışmalar gereklidir.
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Objective: Although subacute thyroiditis (SAT) is not an autoimmune disease, the presence of antithyroid antibodies hasbeen reported in this disease too. This study aims to determinethe frequency of antithyroid antibodies at the time of diagnosis of SAT. Material and Methods: Quantitative measurements of antithyroid peroxidase antibody (anti-TPO),antithyroglobulin antibody (anti-Tg), and thyroid-stimulatinghormone (TSH) receptor autoantibodies (TRAb) were made in76 patients at the diagnosis of SAT. Cytopathological examination and iodine uptake test was performed to exclude Graves’disease and Hashimoto’s disease in suspected patients. Multiple multinuclear giant cells and granulomatous formations, including epithelioid histiocytes, were the cytological findingsemployed to support the diagnosis of SAT in suspicious cases.Results: The median erythrocyte sedimentation rate and Creactive protein levels were found to be 49 mL/hour (21-130)and 54 mg/L (8-179), respectively. TSH, free T4, and free T3levels were determined to be 0.01 mIU/L (0.003-5.2), 1.98ng/dL (0.78-6.1) and 5.51 ng/L (3.07-14), respectively. During the initial presentation, 88% of the patients werehyperthyroid, and 9% of the patients were euthyroid. Anti-TPOand anti-Tg antibody levels were detected to be above theassay-specific cut-off in 11.8% and 10.5% of SAT patients, respectively, at the time of diagnosis. Elevated TRAb was detectedin 6.6% of all SAT patients. The median anti-TPO, anti-Tg, andTRAb levels of antibody-positive patients were 55 IU/mL (38-1.078), 163 IU/mL (5.5-876), 5 IU/L (1.9-23), respectively.Conclusion: Although uncommon, antibody positivity can alsobe observed in SAT disease. This study has proved that the previous studies claiming the absence of thyroid antibodies in SATare flawed. SAT must be considered while assessing the differential diagnosis of Graves’ and Hashimoto’s disease.
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Amaç: Bu çalışmada primer hiperparatiroidi (PHP) hastalarında25-hidroksivitamin D (25(OH)D) eksikliğinin frekansını belirlemeyive mevsimsel değişikliğin 25(OH)D düzeyine etkisi olup olmadığınıaraştırmaya çalıştık.Gereç ve Yöntem: Çalışmaya PHP tanısı almış 144 hasta ve 80kontrol hastası alındı. Demografik ve laboratuvar veriler kaydedildi.Bulgular: PHP hastalarının parathormon (PTH) (p<0,001),kalsiyum (Ca) (p<0,001), ve alkalen fosfataz (ALP) (p<0,001) değerlerikontrol grubuna göre anlamlı oranda yüksek saptanırken, 25(OH)D(p=0,006) ve fosfor (P) (p<0,001) düzeyi anlamlı olarak düşük saptandı.PHP hastalarında 25(OH)D eksikliği %76 oranında saptanırken,25(OH)D yetersizliği %17 düzeyinde saptandı. Kontrol grubunda25(OH)D eksikliği %70 oranında saptandı. PHP hastalarının 25(OH)Ddüzeyini tanı aldıkları mevsime göre inceldiğimizde ortalama 25(OH)D düzeylerinde istatiksel açıdan anlamlı farklılık saptanmadı (p=0,66).PHP hastalarında; 25(OH)D eksikliği bulunanlarda PTH (p=0,02)düzeyi, 25(OH)D yetersiz ve yeterli gruba göre anlamlı oranda yüksekbulunurken P (p=0,04) düzeyi anlamlı oranda düşük saptandı. Üç gruparasında Ca düzeyleri arasında anlamlı bir farklılık saptanmamıştır(p=0,47). 25(OH)D düzeyi ile PTH düzeyi arasında negatif korelasyonsaptanırken (r=-0,308, p<0,001) 25(OH)D düzeyi ile Ca düzeyiarasında herhangi bir korelasyon saptanmamıştır (p=0,31).Sonuç: PHP hastalarında 25(OH)D eksikliği prevalansı sağlıklıpopülasyona göre daha yüksek oranda saptanmıştır. PHP hastalarında25(OH)D düzeyi mevsimden bağımsız olarak düşüktür.
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Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroids and commonly involves femur head leading to significant morbidity. However, the development of AVN in the femoral head due to low-dose oral corticosteroid therapy in a short time is a rare occurrence. Management by stopping corticosteroid treatment can be challenging in many cases due to the adrenal crisis. Glucocorticoids may have to be continued in the lowest possible dose using a physiological preparation, such as hydrocortisone, when the stoppage is not possible. In this article, we report a 34-year-old male patient with hypopituitarism who developed bilateral AVN while receiving a mild physiological replacement oral prednisolone dose for only three years for secondary adrenal insufficiency of hypopituitarism after transsphenoidal surgery. The patient was switched to hydrocortisone and underwent core decompressive surgery resulting in a reduction of hip pain and improvement. The case report intends to highlight the occurrence of AVN of the femur even with a very low dose of corticosteroid used for the treatment of panhypopituitarism. Avascular necrosis should be considered in the differential diagnosis in patients with hip pain, even in low-dose steroid use because early diagnosis is essential to prevent progression, collapse, and eventually the need for hip replacement in AVN.
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