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Pituitary adenomas are a group of disease with broad different clinical characteristics and complications. We aimed to present the data of patients being followed in a single center and discuss the pituitary adenomas based on the literature. Two hundred and twenty patients followed at Department of Endocrinology and Metabolism, Medical School of Ondokuz Mayis University, were included into study. Clinical characteristics, laboratory findings and treatment modalities were examined retrospectively. 59% of patients were female and 41% were male. Mean age during the diagnosis was 43.7 years. Pituitary macroadenomas were 62% of all adenomas and 73% of pituitary adenomas were functional. Among the functional adenomas, the most frequently seen types were prolactin-secreting adenoma and growth-hormone secreting adenoma. Treatment options were surgical treatment (67%), medical treatment (20%) and radiotherapy (7%). Post-operative complications were developed in 27 (13.2%) of patients. In patients with non-functional adenoma, the cure after surgery was detected as 19.6% and the remission after the surgery was detected as 8.9%. In this study, the characteristics of the pituitary adenomas were found similar to the literature in general. The early diagnosis of the disease has a significant importance in terms of treatment and the response to the treatment.

Purpose To investigate the diagnostic and prognostic significance of the blood-count derived systemic immunoinflammatory parameters in patients with thyroid-associated ophthalmopathy (TAO). Methods In this retrospective case-control study, the blood-count parameters and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, and systemic immune-inflammatory index (SII), thyroid peroxidase antibody, and anti-thyroglobulin antibody were evaluated in 46 patients with TAO and 46 matched controls. The associations of the immunoinflammatory parameters with clinical outcomes were analyzed among TAO patients. Results Significant differences were found in NLR, PLR, SII, and lymphocyte count between the controls and the TAO group (p < 0.05 for all). In logistic regression analysis, these inflammatory parameters did not have any prognostic effect on the clinical outcomes of the TAO (p > 0.05 for all). The patients, who needed systemic treatment due to any ocular involvement of TAO during the follow-up period, had significantly lower platelet count (p = 0.001) and PLR (p = 0.02) at the time of initial diagnosis when compared to the no treatment-needed group of the TAO patients. The initial platelet count was significantly associated with the subsequent steroid need due to TAO during the follow-up period (β = −0.02, p = 0.03). Conclusions NLR, PLR, and SII may serve as potential inflammatory markers in the identification of the TAO, although they have no evident prognostic significance in TAO. However, the relatively lower platelet count at initial diagnosis may be associated with the need for systemic therapy during the follow-up in patients with TAO.

Objective: Hypoglycemia is a serious adverse effect of hydroxychloroquine (HCQ) which is very rare in non-diabetic patients. This case report describes a non-diabetic patient without any other chronic diseases, who experienced mild hypoglycemia related to HCQ used for COVID-19 treatment.Methods: All etiologies causing hypoglycemia were investigated and a 72-hour fast test was performed.Results: A 34-year-old male patient was admitted to our hospital with a high fever, cough, and chest pain. The result of his COVID-19 PCR test was positive. He received HCQ for 10 days for the treatment of COVID-19 infection. He experienced fatigue, dizziness, severe headache, weakness and feeling of hunger after discontinuation of HCQ during his isolation at home. Before COVID-19 infection, he never experienced hypoglycemia symptoms. He did not have a history of chronic diseases, drug use, alcohol consumption, or smoking. A 72-hour fasting test was performed. He complained about headache and weakness during the 72-hour test period. The PG level was determined as 49 mg/dl during these symptoms. Concurrent insulin and C-peptide levels were

WOS: 000522673900009 Pheochromocytoma are the functional adrenal lesions originating from the chromaffin cells. For the cases of pheochromocytoma observed in multiple endocrine neoplasia Type 2 and Von Hippel syndrome, the bilateral adrenal glands are involved. In classical approach, total adrenalectomy is applicable on such masses while adrenal failure is almost inevitable. Lifelong cortisol and fludrocortisones replacement are necessary for the patients with adrenal failure while the rate of morbidity and mortality has significantly increased. With the introduction of the minimal invasive surgical approach, cortex sparing adrenalectomy has been brought forward for the adrenal tumors. The primary objective of the cortex sparing surgery is to prevent the lifelong replacement and the permanent adrenal failure after adrenalectomy. Therefore, it is particularly preferred in the case of genetic pheochromocytoma with bilateral adrenal involvement. However, in the case of the selected cases, it can also be applicable for adenoma producing aldostrerone and Cushing syndrome. The adrenal tumor will be completely removed and if sufficient tissue is reserved in the manner to preserve the cortex function, no long-term recurrence and adrenal failure is to be developed. Therefore, cortex-sparing surgery may be a good alternative to total adrenalectomy for the patients with small benign functional adrenal tumors or bilateral genetic pheochromocytoma.

Objectives: We sought to evaluate the possible correlation between serum vitamin D levels and exudative age-related macular degeneration (AMD). Methods: We conducted a cross-sectional study including 95 patients with exudative AMD and 95 healthy age-and sex-matched controls. The participants’ serum 25-hydroxyvitamin D3 (25(OH)D3) levels were measured, and the results were classified into three categories: deficient (< 20.0 ng/mL), insufficient (20.1–29.9 ng/mL), and sufficient (>30.0 ng/mL). We compared serum 25(OH)D3 levels between the two study groups and the AMD ratio between the patients with deficient serum 25(OH)D3 levels and those with levels in the sufficient and insufficient ranges. Results: The median 25(OH)D3 levels were significantly lower in patients with AMD compared to the control subjects (p = 0.042). The frequencies of patients with AMD among the vitamin D categories were statistically significant (p = 0.043). Subgroup analysis showed that the frequency of patients with AMD and deficient vitamin D levels was significantly higher than that found in the patients who had sufficient and/or insufficient ranges of vitamin D levels (55.0% vs. 36.0%, p = 0.043, respectively). Conclusions: Serum 25(OH)D3 levels may have an impact on the neovascular type of AMD. As 25(OH)D3 levels decrease, the frequency of AMD increases. © 2020, Oman Medical Specialty Board. All rights reserved.

Generalized osteoporosis associated with gestation and lactation is a rarely-seen case, which is seen during the final period of gestation or right after birth/delivery. The etiology and pathogenesis are not fully known. The fact that the pre-existing osteoporosis may be aggravated by gestation, that it may stem from genetic susceptibility, or that it may even be random are still under discussion. The most commonly-seen symptom is particularly the short stature due to lumbar pain during the lactation period as well as the vertebral compression fractures. In this study, we aimed to draw the attention to this rare case seen in the patients applying to the clinic with the complaint of post-natal lumbar pain, by starting from the two cases whose diagnoses and treatments were performed in our clinic.

Noduler tiroit hastaligi sik gorulen endokrinolojik bir hastalik olup prevalansi iyot alimina gore onemli olcude degismektedir. Her iki cinsiyette de yas ile birlikte noduler guatr prevalansinda artis saptanmistir. Tiroit nodulu ile karsilasildiginda ilk yapilmasi gereken malign-benign ayirimi, sonrasinda kompresyon belirtileri, tiroit fonksiyonlarinin degerlendirilmesi ve cerrahi gereken nodul ile medikal tedavi gereken nodul ayirimini yapmak olmalidir. Klinik degerlendirme sonrasindaki ilk degerlendirme serum TSH olcumu ve ultrasonografik inceleme olmalidir. Preopeartif olarak tiroit kanserinin teshisinde Tiroit ince igne aspirasyon biyopsisi sitolojik incelemesinin en etkili ve spesifik metod oldugu ispatlanmistir. J. Exp. Clin. Med., 2012; 29:S315-S320 Approach to thyroid nodules Nodular thyroid disease is a common endocrinopathy that prevalence varies according to the iodine uptake. Nodular goiter becomes more prevalent in both gender as the age increases. When patient with a thyroid nodule is seen compression symptoms, thyroid function and malign-benign separation are the first investigations that should be performed. The next step should be the evaluation of the nodule to decide whether surgery or medical treatment is required. After clinical evaluation of a patient with a thyroid nodule, serum TSH measurement and ultrasonographic evaluation are the first investigations that should be performed. Cytological examination of fine needle aspiration biopsy (FNAB) specimens has been proved to be the most efficient and specific method of diagnosing thyroid cancer preoperatively. J. Exp. Clin. Med., 2012; 29:S315-S320

ObjectiveDiabetes mellitus and obesity are well-known risk factors associated with obstructive sleep apnea (OSA). Cushing’s syndrome (CS) is also characterized by obesity and diabetes mellitus. However, the association between CS and OSA remains unclear. Therefore, we investigated the possible associations between CS and OSA in this study.Patients and methodsThirty female patients with newly diagnosed active CS and 30 age-, gender- and body mass index (BMI)-matched controls were included in this study. All participants were evaluated by overnight polysomnography. OSA was defined as having an apnea–hypopnea index (AHI) score of ≥5 events/h. Insulin resistance was calculated by homeostasis model assessment (HOMA) scores. Fasting serum cortisol was also determined.ResultsThe prevalence of OSA was higher (50% vs 23%,P = 0.003) in patients with CS compared with the control subjects. The mean HOMA (P = 0.046) and AHI (P = 0.028) scores were higher in patients with CS compared with the control subjects. AHI was positively correlated with the HOMA scores (r = 0.281,P = 0.046) in both groups. Linear regression analysis showed that serum cortisol remained as an independent predictor for AHI after controlling for BMI and HOMA score (P ConclusionsThe prevalence of OSA increased in patients with CS compared with control subjects with similar ages and BMI levels. Hypercortisolemia is an independent risk factor for developing OSA. The presence of OSA needs to be considered in patients with CS.

Antidiyabetik ilaçların sayısının artışı tip 2 diyabette hedeflenen HbA1C seviyesini düşürmüştür. Diyabetin uzun dönem komplikasyonlarını azaltmak için sıkı HbA1C kontrolü oldukça önemlidir. Oral antidiyabetiklerin çoğu glisemik kontrolü iyileştirmede etkilidirler ancak açlık hiperglisemisi ve HbA1C ≥ %7 seviyeleri olan tip 2 diyabetli hastalarda glisemiyi normale yakın seviyelere indirmede ender olarak başarılı olurlar. Farklı etki mekanizmalı oral ilaçların kombine kullanımı HbA1C düzeylerini düşürmede ilave etki sağlar. Aynı zamanda daha fazla terapötik güç, daha fazla kolaylık, daha az doz ve yan etki sağlanabilir. Metformin ve yaşam stili değişikliği ile başarısız olunan hastalarda tedavi seçenekleri ya ikinci bir oral ya da enjektabl ajan eklemektir. Eğer HbA1C değeri metformin ve sülfonilüre veya bazal insülin ile başarılamazsa, intensif insülin tedavisi başlanması önerilmektedir. Geleneksel basamaklı yaklaşım basamaklar arasında önemli gecikmelerin yaşanabileceği ve glisemik kontrolün sağlanamadığı sürenin uzayabileceği bir yaklaşımdır. Kısa süreli hiperglisemi dönemleri bile komplikasyon riskini büyük oranda artırır. Basamaklı tedavi yaklaşımdan uzaklaşarak kombinasyon tedavisine erken başlamayı içeren yeni bir tedavi anlayışına geçmek gerekir. Combination treatment of type 2 diabetes mellitus The increasing number of antidiabetic drugs decreased HbA1C levels in type 2 diabetes. Strict HbA1C control is very important to decrease the long term complications of diabetes. Although most of the oral antidiabetic drugs are adequate for glycemic control, they are not successful to control patients whose HbA1C levels are more than 7% and who have fasting hyperglycemia. The combined use of the oral drugs that affect in different ways provides additional success to lower HbA1C levels. Moreover, not only are they useful and provide additional power but also they have less side effects with lower doses. In patients whose medical treatment is unsuccessful with metformin and altered life style, adding a second oral or an injectable drug are the other therapeutic alternatives. If the HbA1C levels could not be decreased with metformin, sulfonilurea and basal insulin, intensive insulin therapy must be started. Traditional “step by step” approach may cause worse glycemic control and delay the steps of the therapy. Although hyperglycemia pe¬riods last in short periods it may increase the complications. Traditional “step by step” approach should be avoided and new therapeutic approachs should be preferred including early combined therapy. J. Exp. Clin. Med., 2012; 29:S39-S43

SEZER, OZLEM/0000-0001-5727-7965 WOS: 000361339400009 PubMed: 26067744 Although colchicines are the only effective treatment of familial Mediterranean fever (FMF), resistance to colchicines (CR) which is observed in up to 30% of the patients is still a problem. Clinically, resistance to colchicine is defined as three or more attacks within the last 6 months period while using >= 2 mg/day colchicine. Previous studies have shown decreased vitamin D levels in FMF patients compared with healthy controls. The aim of this study is to evaluate whether vitamin D levels differ between CR and non-CR FMF patients. This study included 64 FMF patients who were being followed in Nephrology Clinic of Samsun Research and Education Hospital for at least 1 year. FMF was diagnosed according to the criteria defined by Livneh et al. Serum 25-hydroxy vitamin D (25-OHD) concentration (ng/mL) was detected in all FMF patients who were not in an acute attack period. From 64 patients 29 were accepted as CR. Mean 25-OHD level was 9.39 +/- 1.00 ng/mL in CR patients and 18.48 +/- 1.09 ng/mL in colchicine responsive patients (p

The adrenal gland consists of two endocrine tissues of different embryological origin, namely the primarily steroid-producing adrenocortical tissue, and the catecholamine-producing chromaffin cells. 1 Adrenal catecholamines and steroids are important regulators of the stress response, immune function, blood pressure and energy homeostasis. 2 Chromaffin cells regulate steroid hormone release by the adrenal cortex. Steroids induce catecholamine production in the medulla. Consequently, disorders of the adrenal cortex have been shown to affect chromaffin cell function and vice versa. 3 We report on a patient with an unusual combination of Addison’s disease and phaeochromocytoma, whose initial presentation was adrenocortical failure. After replacement therapy for adrenocortical failure, a clinical presentation of phaeochromocytoma emerged.

Objective: We aimed to examine the knowledge and consciousness levels of participators about Graves orbitopathy (GO) by conducting an investigation of ophthalmopathy consciousness of Graves patients, providing coordination among all health institutions and ophthalmologists and giving information about the subject to patients.Materials and Methods: A total of 50 Graves patients applying to the Ondokuz Mayis University Endocrinology outpatient service were included in the study. Specially prepared questionnaire forms were used for the evaluation. The education levels of the patients were evaluated in four groups as illiterates and graduates of primary school, secondary school-high school, and university.Results: Overall, 38.8% of the graduates of primary school, 71.4% of the graduates of secondary school-high school, and 63.6% of university graduates had GO consciousness. Although 24% of the patients had this consciousness, they were not going to regular eye check-ups; 86% of the patients had this GO information through their physicians. Also, 46% of the patients were smoking, and it was detected that just half of them were warned about smoking.Conclusion: It was observed that although the patients who were followed up with Graves were seen by all healthcare centers, they were not adequately informed about eye involvement. Thus, these patients should be informed at the first visit, and regular ophthalmologic examinations should be provided for them. © 2014 by Erciyes University School of Medicine.

Akromegali, artmis buyume hormonu (BH) sekresyonu ve artmis insulin benzeri buyume hormonu-1 (IGF-1) seviyeleri ile karakterize kronik bir hastaliktir. Akromegalide tedavi secenekleri cerrahi, radyoterapi ve medikal tedavidir. Medikal tedavide somatostatin analoglari, dopamin agonistleri ve pegvisomant kullanilmaktadir. Pegvisomant, buyume hormonu reseptor antagonisti olup etkisini reseptor dimerizasyonunun engellenmesi ile birlikte IGF-1 salinimi icin gerekli intraseluler yolaklari engelleyerek gosterir. Cerrahi ve maksimum doz ve kombinasyonda medikal tedaviye ragmen biyokimyasal yanit saglanamayan hastalarda ucuncu basamak tedavide kullanilir. Bu derlemede, akromegali tedavisinde diger seceneklere gore nispeten yeni olan pegvisomant tedavisi klinigimizdeki tedavi sonuclarimiz ile birlikte guncel literatur isiginda tekrar gozden gecirilmistir.