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Background: This case report provides detailed experiences of a patient with Multiple Endocrine Neoplasia type 2A (MEN-2A) who underwent surgery for pheochromocytoma and medullary thyroid cancer (MTC). Case Report: A 58-year-old male patient with resistant hypertension, despite triple anti-hypertensive drug therapy, was diagnosed with pheochromocytoma after investigation into the underlying etiology. Although the adrenalectomy performed was unilateral rather than bilateral, and there were no signs of Cushing's syndrome or adrenal insufficiency before the operation, temporary adrenal insufficiency developed after the excision of the large adrenal mass. Additionally, the biochemical diagnosis of MTC was primarily established using a calcium stimulation test (CST) rather than basal calcitonin levels. Conclusion: In cases where unilateral adrenalectomy is performed for a large adrenal mass, postoperative hypotension resistant to conservative therapy should raise suspicion of adrenal insufficiency. Furthermore, when basal calcitonin levels fall within the gray zone, a CST may be necessary for the diagnosis of MTC. [ABSTRACT FROM AUTHOR]

Copyright of Kafkas Journal of Medical Sciences / Kafkas Tıp Bilimleri Dergisi is the property of Kafkas Journal of Medical Sciences, Kafkas Tip Bilimleri Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Current guidelines recommend the use of inhaled corticosteroids (ICS) for suppression of airway inflammation in patients with asthma. Although it is well known that ICS cause dose-related adrenocortical suppression, it is less known that they can lead to iatrogenic Cushing’s syndrome (CS). Fluticasone propionate (FP) is an ICS more potent than beclomethasone and budesonide. FP is metabolized as mediated by cytochrome P450 3A4 in the liver and the gut. Systemic bioactivity of FP can increase with the use of drugs that affect the cytochrome P450. Herein, we report the rapid development of iatrogenic CS in a patient receiving paroxetine and mirtazepine for 12 weeks in addition to inhaled FP.

Hypoparathyroidism usually responds to oral active vitamin D and calcium, but, although rare, some patients do not respond to this treatment. A 47-year-old Caucasian female presented to our medical unit with classical oral treatment-resistant hypocalcemia after thyroidectomy. Teriparatide was infused through the insulin pump with dosage set to 1 unit which equals to 2.5 μg of teriparatide. In conclusion, intermittent subcutaneous infusion of teriparatide using an insulin pump is a safe and effective treatment modality to ensure normocalcemic conditions in patients with classical treatment-resistant hypoparathyroidism. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Endocrinology & Metabolism is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Endocrinology & Metabolism is the property of Aves Yayincilik Ltd. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hypertension is common in renal transplant recipients (RTRs). Ambulatory blood pressure (BP) monitoring (ABPM) is important in diagnosing hypertension and diurnal BP variation. The authors set out to compare office BP and ABPM measurements to determine diurnal pattern and to evaluate echocardiographic findings in RTRs. ABPM and office BP measurements were compared in 87 RTRs. Echocardiographic evaluation was performed for each patient. The correlations between office and 24-hour ABPM were 0.275 for mean systolic BP (P=.011) and 0.260 for mean diastolic BP (P=.017). Only 36.8% had concordant hypertension between office BP and ABPM, with a masked hypertension rate of 16.1% and white-coat effect rate of 24.1%. Circadian BP patterns showed a higher proportion of nondippers (67.8%). Left ventricular mass index was increased in 21.8% of all recipients. There was a significant but weak correlation between office BP and ABPM. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical & Experimental Investigations is the property of Modestum Publications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical & Experimental Investigations is the property of Modestum Publications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: Pituitary apoplexy is a rare but serious condition. It is caused by infarction and/or haemorrhage of the pituitary gland. In this case report, we will present outpatient who has been suffering from lack of breastfeeding and headache at postpartum period. Case: 28-year-old female patient was applied outpatient clinic suffering from lack of breastfeeding and headache at postpartum period. On presentation, her blood pressure was normal. Patient pituitary hormones levels ACTH <5 pg/mL (0-46) kortizol: 0.08 µg/dL (morning: 6.28-18) TSH:0.42 µIU/mL (0.27-4.2) free T4:9.76 pmol/L (12-22) free T3: 6.42 pmol/L (3.1-6.8) prolactin: 2.74 ng/ml (4.79-23.3) were found. Other laboratory tests, glucose: 89 mg/dl (70- 109) urea: 18 mg/dl (10-45) creatine: 0.68 mg/dl (0.5-1.4) sodium: 137 mmol/L (135-145) potassium: 4.3 mmol/L (3.5-5.1), were normal. At first, we tought Sheehan syndrome or postpartum pituitary necrosis secondary to excessive postpartum blood losses. Because Sheehan syndrome is very common in our society. But the patient did not have much bleeding at postpartum. Magnetic resonance imaging showed a sellar heterogeneous mass with suprasellar extension and contact with the optic chiasm, compatible with adenoma apoplexy (Figure 1, 2). No evidence for pituitary apoplexy except headache and lack of breastfeeding. The patient's visual fields were normal. Oral prednisolone 5 mg/day was started. One week later, the patient felt well. Added 50 mcg/day levothyroxine. After a month's followup, re-evaluation was decided. Conclusion: Pituitary apoplexy is a life-threatening condition. Pregnancy and postpartum period are risky periods for apoplexy. Patients may have mild symptoms. Steroid therapy is life-saving. [ABSTRACT FROM AUTHOR]

Aim: Primary hyperparathyroidism (PHPT) is a prevalent mineral metabolism disorder usually caused by a single parathyroid adenoma. Although PHPT is the most frequent cause of hypercalcemia, severe hypercalcemia cases are rarely encountered. Some patients admitted because of hypercalcemia require intravenous bisphosphonate treatment. The present study aimed to investigate the efficacy of intravenous ibandronate, which is a more cheap drug than other parenteral bisphosphonates, in the preoperative treatment of symptomatic hypercalcemia in patients with PHPT. Material-Metods: The medical records of patients operated in a Dicle University Endocrinology clinic between 2010 and 2017 due to PHPT were retrospectively evaluated. Patients who were admitted because of hypercalcemia associated with parathyroid adenoma and underwent minimally invasive surgery subsequent to the lowering of calcium levels via preoperative intravenous ibandronate and zolendronate were included. Results: Totally, 24 of 167 patients received a preoperative bisphosphonate due to hypercalcemia associated with PHPT. Five female and two male patients were treated with zoledronate only. Thirteen were treated with ibandronate only. Seven of the 13 patients were female and six were male. The mean calcium level in patients before ibandronate treatment was 14.31±0.92 mg/dL, and the mean duration of calcium regulation after ibandronate treatment was 3.31±1.03 days. The mean calcium level after ibandronate treatment was 10.19±0.89 mg/dL (p=0.001). Conclusion: In Turkey, ibandronate use reduces the cost of hypercalcemia treatment by 8570%. Parenteral ibandronate for treating severe hypercalcemia associated with PHPT may thus be an effective and cheap drug. Hypocalcemic period was shorter in the ibandronate group. [ABSTRACT FROM AUTHOR]

Copyright of Eurasian Journal of Medicine is the property of Ataturk University, School of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pseudohypoparathyroidism (PHPT); is a hereditary disorder in which the target organ does not respond to parathormone (PTH). Biochemically; it is characterized by the hypocalcemia, hyperphosphatemia, and elevated PTH. The response to PTH administration is markedly lower. In addition to it's biochemical properties, Type 1A also has a characteristic somatic phenotype known as Albright hereditary osteodystrophy (AHO). This phenotype is characterized by short stature, round face, frontal bubble, brachydactyly, obesity. Here, we present a patient, diagnosed with Albright's hereditary osteodystrophy and hypocalcemia that is treated by calcium, vitamin D. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the relationship between hemogram values, neutrophil lymphocyte ratio, platelet lymphocyte ratio and bone mineral densitometry values in postmenopausal women and thus to determine which parameter is in a stronger relationship with bone mineral densitometry values. Method: In this study, bone mineral densitometry values, neutrophil lymphocyte ratio, platelet lymphocyte ratio and hematological parameters (white blood cell, red blood cell, hemoglobin, platelet, lymphocyte, monocyte, basophil, neutrophil, eosinophil) of 64 postmenopausal female patients aged 50-60, with a body mass index in the range of 25-30 were retrospectively reviewed. Clinical conditions that may affect bone mineral density or hemogram values (acute and chronic infections, oncological, rheumatological and hematological diseases, chronic liver and kidney diseases, hyperparathyroidism, hypothyroidism, hyperthyroidism, vitamin D deficiency, steroid use, and a history of trauma or blood transfusion in the last one year) were excluded from the study. Then, correlation analysis was performed between bone mineral densitometry values and hematological parameters. Results: In our study, a statistically significant negative correlation was found between platelet lymphocyte ratio and femoral neck bone mineral density, femoral neck Z-score and femoral neck T-score (p=0.004, r=-0.353; p=0.005, r=-0.344; p=0.004, r=-0.359, respectively). In addition, a statistically significant positive correlation was found between monocyte values and femoral neck bone mineral density, femoral neck Z-score and femoral neck T-score. (p=0.030, r=0.272; p=0.038, r=0.259; p=0.022, r=0.285, respectively). There was no relationship between neutrophil lymphocyte ratio and bone mineral densitometry parameters. Conclusion: High platelet lymphocyte ratio and low monocyte value can be simple markers that can be used to help predict changes in bone density ratio after menopause. [ABSTRACT FROM AUTHOR]

Amaç: Uzun dönemdeki surviye ve allograft fonksiyonuna etkili olan faktörler her merkezde farklılıklar gösterebilmektedir. Bu nedenle ünitemizden takipli renal allograft biyopsi yapılmış olan hastaların biyopsi sonuçları ve greft sağ kalımları arasındaki ilişkilerin değerlendirilmesi amaçlanmıştır. Yöntemler: 70 hastaya yapılan 94 adet biyopsi retrospektif olarak incelemiştir. Ultrason rehberliğinde tek kullanımlık 16G otomatik iğne ile 2 kore biyopsi alınmıştır. Her biyopsi ışık mikroskopisi ve immunfloresan boyama ile incelenmiştir. Hastalar akut selüler rejeksiyon (ASR), kalsinörin inhibitörü(KNI) toksisitesi, intersitisyel fibrozis tübüler atrofi (IFTA), akut tubüler hasar(ATH) ve greft kaybı gelişenler olarak gruplara ayrılarak alt analizleri yapılmıştır. Bulgular: Toplamda 34(%36,2) biyopsi ile en sık tespit edilen patolojiyi akut selüler rejeksiyon oluşturmaktadır. IFTA, ATH, nüks/de novo glomerülonefrit biyopsi sayıları sırasıyla 21(%22,3), 20(%21,3), 15(%16) olarak bulunmuştur. Akut rejeksiyon öyküsü olanlarda greft sürvisinin daha kısa olduğu tespit edilmiştir (p<0.05). Greft kaybı olan grupta IFTA daha fazla görülmüştür (p<0.05). Surviler logrank testi ile IFTA ya göre kıyaslandığında istatistiksel anlamlılığını yitirmiştir. Çalışmaya alınan hastalarda KNI toksisitesi, ATH ile greft sürvileri arasında anlamlı fark tespit edilememiştir. Biyopsi sırasındaki albümin seviyesi greft kaybı olan grupta anlamlı olarak daha düşük bulunmuştur (p<0.05). Sonuç: Biyopsilerin yaklaşık üçte birinde öntanıdan farklı bir tanı ile karşılaşılmıştır. Bu da biyopsi olmadan diğer klinik ve laboratuvar bulguların yetersizliğini göstermektedir. Greft survisini ön görmede biyopsi önemli yer teşkil etmektedir. Non-invaziv olarak biyopsi öncesi bakılan serum albumin seviyesi greft kaybını öngörmede bir parametre olarak değerlendirilebilir. Objective: Factors affecting long-term survival and allograft function may differ in each center. Therefore, it is aimed to evaluate the relation between biopsy results and graft survival of patients who have undergone renal allograft biopsy. Methods: We retrospectively analyzed 94 biopsies of 70 renal transplant recipients. Disposable 16 G needles were used to perform 2 ultrasound-guided core biopsies. Each specimen was examined under light and immunofluorescence microscopy. Patients were divided into acute cellular rejection (ACR), calcineurin inhibitor (CNI) toxicity, graft loss, interstitial fibrosis tubular atrophy (IFTA), acute tubular damage (ATD) groups and analyzed. Results: The most frequent pathology was ACR, diagnosed in total of 34 (36.2%) specimens. IFTA, ATD and recurrent de novo glomerulonephritis biopsy were 21 (22.3%), 20 (21.3%) and 15 (16%), in number, respectively. Graft survival in patients with a history of acute rejection was shorter than without history (p<0.05). IFTA was more common in the group with loss of graft (p<0.05). When compared with survival in log-rank test IFTA have lost their statistical significance. There was no significant difference between CNI toxicity, ATD and graft survival. Graft loss was more common in patients with lower albumin levels during biopsy (p<0.05). Conclusions: Approximately one third of the biopsies were diagnosed differently than presumed. This demonstrates the inadequacy of other clinical and laboratory findings without biopsy. Renal allograft biopsy is an important tool to predict graft survival. Serum albumin level before biopsy can be considered as a parameter for predicting loss of graft. [ABSTRACT FROM AUTHOR]

Objective: Acute kidney injury (AKI) is an important clinical entity that is known to increase mortality in patients with sepsis. Erythrocyte maturation and proliferation are inhibited by pro-inflammatory cytokines; these cytokines exert effects on red cell distribution width (RDW) well. Based on this knowledge; our aim in this study was to evaluate the impact of RDW on acute kidney injury in patients with sepsis. Methods: 120 patients diagnosed with sepsis and admitted to intesive care unit (ICU) and treated between 2009-2013 were retrospectively evaluated. Patients were divided into two groups as follows: group 1 (RDW≥16.8) and group 2 (RDW<16.8). Multiple logistic regression analysis was used to determine the association between RDW and AKI and mortality. Results: There was a statistically significant relationship between AKI and RDW (p<0.001, OR=11.52) but there were no statistically significant relationship between AKI and sex, age, serum lactate levels as well as SOFA score. Also, there were statistically significant relationship between mortality and RDW (p=0.044, OR=5), serum lactate levels (p=0.030) and SOFA score (p<0.001). RDW was found associated with both AKI and mortality. Conclusions: Results suggest that RDW is an important parameter for predicting development of AKI and mortality in ICU patients with sepsis. [ABSTRACT FROM AUTHOR]

McCune-Albright syndrome is characterized by polyostatic fibrous dysplasia, brown spots on the skin (café au lait pigmentation) and autonomous endocrine hyperfunction. Early puberty and other endocrinological manifestations, such as acromegaly, gigantism and hypercortisolism are widely observed in the syndrome. Acromegaly is seen in 20% of patients. We report a case of acromegaly accompanied with this syndrome. [ABSTRACT FROM AUTHOR]