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Background Post-adolescent acne has been defined as acne in a patient aged >25 years. Acne vulgaris first develops at the onset of puberty as a result of hormonal changes. During puberty, there is a transient decline in insulin sensitivity. We hypothesized that insulin resistance might persist after puberty in patients with post-adolescent acne. Objectives This study was conducted in order to investigate the relationship between post-adolescent acne and insulin resistance. Methods The study population comprised 35 patients with post-adolescent acne and 35 healthy control subjects. The parameters measured were fasting blood glucose, insulin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). The homeostasis model assessment of insulin resistance (HOMA-IR) index was calculated for each individual. Results No significant differences were observed between patients with post-adolescent acne and control subjects in fasting blood glucose, fasting insulin, AST, ALT, triglyceride and HDL-C levels, and HOMA-IR index. There were also no correlations between these parameters and the severity of acne. Conclusions This study suggests that insulin resistance may not play a major role in the pathogenesis of post-adolescent acne. Hormonal changes, genetic susceptibility, stress, the use of cosmetics, drugs, and environmental factors should be considered in the development of post-adolescent acne.

Objectives To evaluate the effect of mean platelet volume (MPV) on diabetic retinopathy in patients with type 2 diabetes mellitus.

BACKGROUND A limited number of human and animal studies suggest that a relationship exists between phthalates and obesity, although this is not supported by all research. The purpose of this study was to investigate the relationship between Body Mass Index (BMI) and the levels of phthalates in human blood and urine samples. METHODS Sixty-four overweight or 132 obese individuals (total=196) of different ages (min-max, 17-62; mean ± SD, 42.07±11.3) and genders (F:M 97:99) enrolled in the study. BMI and waist circumference were measured to diagnose obesity. Venous blood samples were taken after overnight fasting. To compare the urine phthalates among participants, single spot urine (at least 10 mL) was collected from the subject after blood samples were taken. Urine and blood phthalate concentrations were measured using gas chromatography. RESULTS Total blood/urinary phthalate levels significantly increased in proportion to the degree of obesity. There was a high correlation between the level of total phthalates in serum and BMI (ρ=0.697, P

To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit.The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit.The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23-75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p 0.05).A statistically significant association was determined between Vitamin D and calcium metabolism in patients with idiopathic BPPV. It can be considered that Vitamin D deficiency and decreased ionized Ca level may be a risk for BPPV, not only in patients with osteoporosis but also in all patients. Very low levels of 25(OH)-D seem to be associated with recurrence of BPPV. The recurrences might possibly be prevented with supplementary Vitamin D especially in those with recurrent idiopathic BPPV but further studies would be necessary to determine this.

Riedel's thyroiditis (RT) is a rare inflammatory disease that results in fibrosis of the thyroid gland and invasion to the surrounding structures of the neck. Follicular adenoma (FA) of the thyroid is the most common benign neoplasm of the gland.A 42-year-old woman was referred to the outpatient clinic due to a multinodular goiter and thyroiditis. The patient was euthyroid and thyroid function tests were within normal limits. Thyroid antibodies (thyroid peroxidase antibody and thyroglobulin antibody) were high. Thyroid ultrasonography showed multiple iso-hypoechoic nodules and thyroiditis. Fine-needle aspiration cytology was performed, and it was consistent with 'suspicious for a follicular neoplasm' according to the Bethesda system. Due to the clinical findings, which included weight loss and sweating, and the cytological results indicative of a follicular neoplasm, the patient underwent a total thyroidectomy. The histopathological diagnosis was RT associated with FA. The patient was started on thyroid hormone (thyroxine) replacement therapy after surgery and was evaluated for additional fibrosis related to RT.To our knowledge, this is the first case of RT associated with FA in an asymptomatic patient with a multinodular goiter and high thyroid antibodies reported in the literature.

OBJECTIVE Atherosclerosis is the major cause of the morbidity and mortality in type 1 diabetes mellitus (DM). Carotid intima-media thickness (CIMT) is the early sign of atherosclerosis and thereby, also the sign of macrovascular diseases. In this study, we aimed to evaluate the CIMT in patients with type 1 DM, and its association with diabetic microvascular complications (nephropathy-retinopathy). METHODS One hundred and thirteen consecutive patients with type 1 DM without macrovascular disease were enrolled into this cross-sectional study. Age, gender, and body mass index matched 59 healthy subjects, were taken as the control group. Microvascular complications in diabetic patients were scanned. Ultrasonographic analysis of the carotid artery was performed with a high-resolution ultrasound scanner. Student's t, Mann Whitney U, Chi-square and Kruskal-Wallis tests, as well as multiple linear regression analysis were used for the statistical analysis. RESULTS Patients with type 1 DM had significantly higher CIMT compared to control group (p

The aim of the study was to determine the frequency and titers of anti-thyroid peroxidase (Anti-TPO), anti-thyroglobulin (Anti-TG), and anti-glutamic acid decarboxylase (Anti-GAD) antibodies in Turkish patients with type 1 diabetes mellitus (DM), and to compare the frequency of anti-TPO and anti-TG titers in the presence or absence of anti-GAD. A total of 104 patients including 56 males and 48 females with type 1 DM and their age-, gender-, and body mass index-matched control group, including 31 males and 27 females, 58 cases in total with an age range of 15-50 years, were recruited into this study. In patients with type 1 DM, positive anti-GAD was detected in 30.8% (n=32). In patients with positive anti-GAD, rate of positive anti-TPO was 37.5%; however, in patients with negative anti-GAD, the rate of positive anti-TPO was 9.7% and the difference was statistically significant (p=0.001). In patients with positive anti-GAD, the rate of positive anti-TG was 18.8%. In patients with negative anti-GAD, the rate of positive anti-TG was 2.8%, and the difference between them was statistically significant (p=0.005). In patients with positive and negative anti-GAD, rates of both positive anti-TPO and anti-TG were 15.6% and 1.4%, respectively, with the difference showing statistical significance (p=0.004). Thyroid autoimmunity in type 1 DM patients with positive anti-GAD was apparently higher; therefore, these patients should be followed more frequently and carefully.

Aim To determine the rate of major congenital anomalies and complications retrospectively in offspring of women with diabetes mellitus treated insulin lispro. Material and methods Twenty-seven patients had used insulin lispro (ILYS) and 59 patients had used regular human insulin (RHI) during the pregnancy period were evaluated. We also evaluated and analyzed the results of 53 of the 86 women who had gestational diabetes mellitus only. They were not using insulin aspart or insulin glarjine. We evaluated the birth weight, congenital anamolies, mode of delivery, abortus and stillbirth rates. Results Mean HbA1c level was 6.27 + 2.23 for ILYS group and 7.07 + 2.09 for RHI group ( p : 0.067). The duration of diabetes, gestational age, mode of delivery, type of diabetes, number of liveborn, stillbirth and miscarriages were not stastically different between all groups ( p > 0.05). Nine (15.25%) of 59 infants treated with RHI had congenital anomalies and one stillborn. The infants in ILYS-receiving group had no congenital anomalies but one pregnant (3.70%) had a stillborn. The difference in incidence of congenital anomalies between those using ILYS and RHI was not statistically significant ( p : 0.157). There was also no difference in respect to congenital anomalies of gestational diabetic groups which used either ILYS or RHI. Conclusion Major congenital anomalies for offspring of mothers treated with ILYS are similar with RHI group. Although HbA1c levels were lower in ILYS group, all outcomes are similar with RHI. So ILYS is an alternative choice in treatment of pregnant women with DM.

The aim of this study was to determine underweight, overweight, and obesity prevalence in representative sample of adult (≥ 18 years old) Turkish population living in urban and rural area of Turkey. Turkish citizens aged ≥ 18 who can represent adult population and permanently resident in Turkey were taken to this study in 1999–2000. The nationally representative sample population was selected from the target population using the census which was performed by national institute of statistics at 1997. Target population was 13.570 individuals living in these houses and 8674 people who aged ≥ 18 are chosen for the study. BMI was used as widely accepted diagnostic criteria of obesity. This study demonstrated that the prevalence of underweight was 10.7% in men, 5.9% in women and 8.1% for overall. The prevalence of overweight was 17.4% in men, 20.4% in women and 19% for overall. The prevalence of obesity was 7.8% in men, 22.1% in women and 15.6% for overall. The prevalence of overweight is higher (19.6%) in urban areas but prevalence of obesity is higher (17%) in rural areas of Turkey. Age, educational level and marital status seem to have association with obesity prevalence. The data we obtained showed us that while the underweight is still an issue for men, the overweight and obesity prevalence is high and needs to take early prevention steps for Turkish population.

Background: Bisphenol A (BPA) has been implicated as an ‘endocrine disruptor'. We aimed at exploring the association between serum BPA levels and patient characteristics, particularly the presence of diabetes mellitus, and laboratory parameters in hemodialysis patients. Methods: This study included 47 chronic hemodialysis patients. Patient characteristics were recorded. Blood was drawn before and after hemodialysis session. Serum BPA levels were measured by the high-performance-liquid-chromatography and laboratory parameters were measured by using standard methods. Results: In hemodialysis patients, postdialysis serum BPA levels were significantly higher than predialysis after a single hemodialysis session (5.57 ± 1.2 vs. 4.06 ± 0.73, p < 0.0001). Predialysis serum BPA levels were significantly higher in patients with diabetes than non-diabetics (4.4 ± 0.6 vs. 3.9 ± 0.7, p = 0.025). No association was found between serum BPA levels and patient characteristics, and particularly laboratory parameters. Conclusion: Serum BPA levels were rising significantly after a single dialysis session. Diabetic hemodialysis patients had higher predialysis serum BPA levels.

Lactic acidosis generally occurs in those who have kidney, liver, lung or heart dysfunction. Herein, a 73-year-old woman diagnosed as type B lactic acidosis due to metformin without any organ dysfunction was presented.

Amaç: Vitamin D eksikliğinin, romatoid artrit (RA) ve ankilozan spondilit (AS) gibi otoimmun hastalıklarda başlatıcı bir neden mi yoksa hastalık aktivitesiyle ilişkili mi olduğu hala merak edilen bir konudur. Çalışmamızın amacı, Th1 baskın hastalıklardan olan RA ve AS hastalarında serum vitamin D seviyeleri ile hastalık aktiviteleri arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntem: Çalışmamız, retrospektif olarak 92 RA’li hasta, 100 AS’li hasta ve 62 sağlıklı kontrolün dosyalarından elde edilmiş bilgileri içermektedir. Çalışmaya alınanların yaşı, cinsiyeti, hastalık süreleri, kullandığı ilaçlar, vitamin D seviyeleri, kalsiyum, C-reaktif protein (CRP) ve eritrosit sedimentasyon hızı (ESH) değerleri kayıt edildi. Hastalık aktiviteleri RA’li hastalarda hastalık aktivite skoru-28 (DAS28) ile, AS’li hastalarda ise bath ankilozan spondilit hastalık aktivite indeksi (BASDAİ) ile değerlendirildi. Bulgular: Vitamin D seviyeleri tüm gruplarda düşüktü. AS hastalarında, vitamin D seviyeleri ile BASDAİ, ESH ve CRP arasında istatiksel olarak negatif korelasyon yoktu (sırasıyla, r=-0.059, p=0.560, r=-0.072, p=0.473, r=-0.112, p=0.268). RA’li hastalarda ise vitamin D düzeyi ile DAS28 arasında anlamlı negatif korelasyon yoktu (r=-0.090, p=0.392). Tartışma: Çalışmamızda, tüm gruplarda vitamin D seviyeleri düşük bulundu ve bu vitamin D eksikliğinin, RA ve AS’in etyolojisinden ziyade hastalık aktivitesi ile ilişkili olabileceğini akla getirmektedir., Aim: Vitamin D deficiency in autoimmune disorders such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS), whether an initiator cause or associated with disease activity is still wondered. The aim of our study is to investigate the association between serum vitamin D levels and disease activity in subjects with RA and AS which are known to be Th1 dominant diseases. Material and Method: The study included the data of 92 patients with RA, 100 patients with AS and 62 healthy controls, which were retrospectively obtained from the patient files. The age, gender, duration of the disease, medications, levels of vitamin D, calcium, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded. Disease activities were evaluated by Disease Activity Score-28 (DAS28) in patients with RA and Bath Ankylosing Spondylitis Disease Index (BASDAI) in patients with AS. Results: Vitamin D levels were low in all groups. In AS patients, there was no statistical negative correlation among vitamin D levels and BASDAI, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (r=-0.059, p=0.560, r=-0.072, p=0.473, r=-0.112, p=0.268, respectively). In RA patients, there was also no significant negative correlation between vitamin D levels and DAS28 (r=-0.090, p=0.392). Discussion: In our study, low serum vitamin D levels were found in all groups, and it is suggested that vitamin D deficiency may be associated with the disease activity rather than the etiology of RA and AS.

Introduction Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite. Case presentation We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite. Conclusions Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot.

Objective Leukocytosis is thought to be directly associated with the pathogenesis of atherosclerosis and metabolic syndrome. Increased white blood cell (WBC) count is related to cardiovascular disease in patients with type 2 diabetes mellitus; raised neutrophil lymphocyte ratio (NLR) is associated with metabolic syndrome. There is little information, however, concerning a correlation between glycosylated haemoglobin (HbA1c) and NLR. The aim of the present study was to investigate the relationship between NLR and blood glucose regulation. Methods This retrospective study was conducted in patients with type 2 diabetes mellitus, divided into two groups according to HbA1c levels: group 1, HbA1c levels ≤ 7%; group 2, HbA1c levels > 7%. Venous WBC, neutrophil and lymphocyte counts were determined. Results Of 71 patients included, fasting serum glucose, neutrophil and WBC counts were significantly higher in group 2 compared with group 1. NLR had a positive correlation with HbA1c. Conclusion There may be a significant relationship between NLR and blood glucose regulation. The authors propose that increased NLR may be associated with elevated HbA1c in patients with type 2 diabetes mellitus.

Hyperlipidemia in the general population is strongly associated with atherosclerotic cardiovascular disease. Dyslipidemia is a common finding in patients with chronic kidney disease (CKD) at all stages. Trial results from the general population may not be applicable to all patients with CKD because they have a different lipid profile with increased atherogenic lipid fractions. Lipid-lowering therapies in these patients may have substantial benefit. Statin therapy is recommended in patients with CKD of any stage if they have elevated serum cholesterol levels. Treatment of dyslipidemia in patients with early stage CKD clearly reduces cardiovascular risk; however, available data do not support a strong nephroprotective role for statins in CKD population. In contrast to the predialysis patient population, statins do not seem to have substantial improvement in cardiovascular outcomes in dialysis patients. Although fibrates can be used to treat mixed dyslipidemia, they need to be used carefully in patients with CKD, and limited available data suggest that fibrates may have a place in reducing cardiovascular risk in patients with mild to moderate CKD.

Accompanying comorbidities observed during the cancer treatment usually affect the course and outcome of the therapy. Hypovitaminosis D, which is one of these conditions, is a resolvable problem, if recognized. In this study, we investigated whether the serum 25(OH) D levels of the patients who were presented to our outpatient clinic were different from the serum levels of the healthy population living in the same area. Our study included 90 patients who were presented to the Medical Oncology outpatient clinic and 90 age, gender, body mass index and ethnic origin matched controls without a known disease, who were presented to the outpatient clinics of the Departments of Internal Diseases and Family Medicine for routine controls. Blood count tests, detailed biochemistry tests (including serum levels of Cr, Ca and P), measurement of serum 25(OH) D levels and C-reactive protein were performed in serum samples of all of the patients and controls. Mean serum levels of 25(OH) D were 13.5 ng/ml (SD 5.1) in all cancer patients, 13.1 ng/ml (SD 4.2) in the patients who were presented for adjuvant therapy, 13.8 ng/ml (SD 5.5) in the patients who were presented at metastatic stage and 18.4 ng/ml (SD 12.5) in the controls. Mean serum CRP levels were 5.4 mg/dl (SD 1.2) in the control group, 8.4 mg/dl (SD 4.3) in the adjuvant therapy group and 20.3 (SD 16.8) in the patients with metastatic disease. Generally, all cancer patients (p 0.003) and the patients with metastatic cancer (p 0.004) had lower serum 25(OH) D levels compared to controls, and there was an inverse correlation between serum 25(OH) D and CRP levels in patients with metastatic cancer (p 0.036). In metastatic cancer patients, hypovitaminosis D may be a comorbidity and it is recommended to consider during initial evaluation and follow-up. Because it might improve these patients quality of life and chemotherapy adherence.

Objectives To measure the rate of Demodex folliculorum mite infestation in patients with type 2 diabetes mellitus and to investigate if it was related to blood glucose control. Methods Patients with type 2 diabetes were classified according to their glycosylated haemoglobin (HbA1c) level into two groups: a well controlled blood glucose group (HbA1c ≤ 7%) and a poorly controlled blood glucose group (HbA1c > 7%). A standardized skin surface biopsy method was used to determine if the patients had D. folliculorum infestation (>5 mites/cm2 of skin). Results A total of 69 patients (38 female) were enrolled in the study. Seventeen (24.6%) patients had D. folliculorum infestation. There were no significant differences in age, sex or body mass index between patients with and without D. folliculorum infestations. A significantly higher proportion of patients with poor blood glucose control had D. folliculorum infestation compared with patients with well controlled blood glucose. Conclusions These current findings suggest that poor blood glucose regulation increases the susceptibility to D. folliculorum mite infestation in patients with type 2 diabetes.

Dear Editor: In our manuscript, the sentence, “Mean platelet volume is a parameter indicating platelet activation and function,” was based on the literature [1–3]. The purpose of our study was to identify the risk for diabetic retinopathy (DR) using complete blood count, which is routinely used because it is a simple and inexpensive test. As the authors mentioned, light transmission aggregometry (LTA) is the best test to indicate platelet function [4]. However, LTA is time-consuming and challenging, and it must be supervised by an expert that several analytic and para-analytic changes. In addition, LTA is only available at specialized laboratories [4]. Beyan et al. mentions that although it implicitly shows the hemostatic function of platelets, LTA isn’t routinely used; it is also a very expensive test [5]. In our study, the blood samples were placed into dipotassium ethylenediaminetetraacetic acid (EDTA) tubes. The complete blood count was performed using an automated hematology analyzer (CELL-DYN 3700, Abbott Diagnostics, Abbott Park, IL, USA). All blood samples are evaluated within 60 min of the blood sampling.

A 61-year-old man was referred to our outpatient clinic because of severe bilateral upper leg pain for 1 year. On admission, the patient had anemia and a high serum alkaline phosphatase level. Lumbar and femoral neck T-scores were +10.5 and +9.6, respectively. His radius 33 % T-score was −2.8. Plain radiographs of the patient's pelvis, spine, and long bones revealed osteosclerosis. The patient had previously undergone a prostate biopsy, which showed prostate adenocarcinoma (Gleason score 3 + 4). The patient's total and free prostate-specific antigen were very high. According to previous records, the patient did not have anemia, and his serum alkaline phosphatase (ALP) level was normal. An abdominal radiograph taken 2 years earlier revealed a normal spine and pelvic bone. Bone scintigraphy yielded nontypical findings for prostate cancer metastasis. Computed tomography of the patient's thorax and abdomen showed heterogeneous sclerotic areas in all bones consistent with prostate cancer metastasis. A bone marrow biopsy disclosed disseminated carcinomatosis of bone marrow in association with prostate cancer. Clinicians should be aware of the possibility of prostate malignancy as a cause of high bone mineral density (BMD), even in the absence of typical localized findings on plain radiographs.

Obstructive sleep apnea syndrome (OSAS) is a common health problem, and associated with obesity, metabolic syndrome (MetS), and diabetes. Growing evidence shows that 25-hydroxyvitamin-D3 (25-OH-D) insufficiency and high parathyroid hormone (PTH) levels may be correlated to glucose intolerance, MetS, obesity, and cardiovascular abnormalities similar to OSAS. Bisphenol A (BPA) is an endocrine disruptor agent which exerts a wide variety of metabolic effects. It has estrogenic activity and its exposure may contribute to weight gain, obesity, impaired glucose metabolism, and the development of diabetes, also similar to OSAS. The aim of this study is to investigate the relationships between OSAS and serum BPA, 25-OH-D, and PTH levels. This study enrolled 128 subjects, with all of the OSAS patients having been diagnosed by polysomnography. The 128 subjects were divided into three groups: a control (n = 43), a moderate OSAS (n = 23) (AHI = 15–30), and a severe OSAS groups (n = 62) (AHI > 30). The serum BPA, 25-OH-D, and PTH levels for each subject were analyzed. 25-OH-D was lower in both OSAS groups, and PTH was higher in the OSAS groups than in the control subjects. The BPA levels were higher in the severe OSAS group than the moderate OSAS and control. There was a positive correlation between the BPA and body mass index, and a negative correlation between the 25-OH-D and BPA levels in all of the individuals. OSAS is related to high BPA and PTH levels, and low vitamin D levels. There is a positive association between BPA levels and OSAS, and the severity of OSAS. These results suggest that the BPA levels may have a role in the pathogenesis of OSAS.

To determine the prevalence of carotid artery calcification (CAC) detected in routine dental radiography (PRs) in patients with kidney stones (KSs) and to investigate the relationship between CAC-atherosclerosis and KSs. Materials and methods: A total of 108 patients with renal stones were included in the present study. A history of renal colic, with confirmed hematuria and voiding of the calculus, radiographic evidence of KSs, or previous surgical and endoscopic removal of KSs, was used to define the nephrolithiasis. KS patients were evaluated by PR in terms of the presence of CAC. Subjects with either unilateral or bilateral CAC on these radiographs were identified. Results: Of the 108 patients included in the data analysis, 18 (16.6%) were detected as having CAC upon PR; of these, there were 8 males (11.5% of all males) and 10 females (25.6% of all females) (P > 0.05). There was no significant difference between the patients with CAC and the patients without CAC in any aspect of biochemical parameters, and also in the history of predisposing factors (P > 0.05). The CAC prevalence (16.6%) was significantly higher in patients with KSs when compared to the normal population (5.06%) in our previous study (P > 0.05). Conclusion: Our study shows that CAC is significantly higher in patients with KSs when compared to the normal population. This study may draw the attention of clinicians to the fact that patients with KSs should be evaluated further for atherosclerosis and treated for vascular risk factors.

Ectopic thyroid tissue (ETT) is a rare embryological abnormality characterized by the occurrence of thyroid tissue in a site other than its usual location. Thyroid hemiagenesis (HA) is also a very rare abnormality in which one thyroid lobe does not develop properly during embryology. We report a patient with left HA, submandibular ETT, and persistent mildly suppressed serum thyrotropin (TSH).A 38-year-old female patient was admitted with complaints of sweating and palpitations. She had no symptoms of neck compression. Thyroid ultrasonography revealed heterogeneity and hypoechogenicity of the right lobe and absence of the left lobe, the latter being confirmed by computed tomography. There was no ETT in the neck. A thyroid Tc-99m pertechnetate scan demonstrated two distinct areas of radiotracer uptake, one in the right lobe of the thyroid gland and one in the right submandibular region and lobe, but no uptake in the left thyroid bed. The serum free triiodothyronine was 2.89 pg/mL (2.5-3.9 pg/mL), and the serum free thyroxine was 0.86 ng/dL (0.61-1.12 ng/mL). The serum TSH was 0.11 mIU/L (0.34-5.60 mIU/L).This may be the first reported patient with HA and submandibular ETT. The patient probably also had thyroiditis with mild intermittent thyrotoxicosis based on her suppressed TSH and ultrasonography imaging of the right thyroid lobe.

Isotretinoin is a retinoic acid derivative mostly used in the treatment of cystic acne vulgaris. The adverse effects of isotretinoin are well defined being the major limitation factor for its usage. The decrement of testosterone during isoretinoin treatment is defined in literature. We present a case with 20 years old man who developed gynecomastia after treatment with isotretinoin. To the best of our knowledge, this is the third report of the development of gynecomastia after isotretinoin treatment.

Objective To describe the first case of syndrome of inappropriate antidiuretic hormone secretion with lifethreatening hyponatremia due to rosiglitazone therapy. Methods We describe the clinical, laboratory, and imaging findings of the study patient. Results An 89-year-old woman with a 5-year history of type 2 diabetes mellitus was admitted to the emergency department because of unconsciousness. She had reported generalized weakness for 15 days and nausea and vomiting for 3 days. Findings from laboratory analysis showed severe hyponatremia (sodium, 110 mEq/L). She had normal renal, cardiac, and adrenal function, and she did not have edema or volume depletion. The cause of hyponatremia was syndrome of inappropriate antidiuretic hormone secretion. We did not find any cause for her condition other than rosiglitazone, an antihyperglycemic drug that is increasingly being used in patients with type 2 diabetes mellitus. According to her medical history, rosiglitazone was prescribed 1 month previously after withdrawal of gliclazide. We stopped the rosiglitazone and administered hypertonic saline infusion to treat the hyponatremia. Saline infusion was stopped and blood sodium levels were stabilized in the normal range after 2 days. The patient’s plasma sodium concentration has remained in the reference range at follow-up visits. Conclusions This is the first reported case of syndrome of inappropriate antidiuretic hormone secretion as an adverse effect of rosiglitazone, and this drug should possibly be considered for addition to the list of drugs that cause this condition. (Endocr Pract. 2008;14:1017-1019)

The need to perform fine-needle aspiration biopsy (TFNAB) on subcentimeter thyroid nodules is less clear than for larger nodules. We compared the ultrasonographic features of thyroid nodules less than and greater than one centimeter and correlated this information with the cytological results for TFNAB and the final histopathological diagnosis in selected patients.We evaluated 520 thyroid nodules (247 subcentimeter [group 1], 273 supracentimeter [group 2]) in 426 patients. Ultrasonography-guided fine-needle aspiration biopsy was performed on all nodules. Surgery was recommended for patients with TFNAB results that were read as malignant or suspicious. The results of ultrasonography, TFNAB, and histopathology were compared between the groups.Out of 426 patients, 337 had one nodule, 84 had two, and five had three. There was indeterminate cytology in 20 cases, 10 from each group. Inadequate cytology was obtained in 41/247 (16.6%) nodules in group 1 and 61/273 (22.3%) nodules in group 2, and the difference in rate was not significant (p = 0.067). The malignancy rate as determined by TFNAB was 4.9% in group 1 and 1.5% in group 2 (p0.025). In patients who underwent surgery for thyroid nodules the malignancy rate was 6% in group 1 and 2.9% in group 2 (p = 0.08). Hypoechoic pattern, microcalcification, and a long axis/short axis ratio (LA/SA) of1.5 were associated with malignancy in subcentimeter thyroid nodules (group 1), while only a hypoechoic pattern was associated with malignancy in supracentimeter thyroid nodules (group 2).The incidence of cancer in thyroid nodules1 cm does not appear to be lower than in larger nodules and may even be higher. Physicians should consider obtaining biopsy samples from subcentimeter hypoechoic nodules that contain microcalcification and have a relatively round shape (LA/SA1.5).

Cushing's syndrome occurs rarely in pregnancy because of ovulatory disturbances including anovulation which is caused by hypercortisolism, but it can cause maternal complications such as hypertension, gestational diabetes, spontaneous abortion, premature birth, pre-eclampsia and stillbirth. Herein we present the case of a 22-year-old patient in the 11th week of pregnancy who was admitted to our hospital with Cushing's syndrome complicated by early pre-eclampsia. Severe pre-eclampsia has high maternal and perinatal morbidities, and therefore the possibility of this complication requires that Cushing's syndrome, although rare in pregnancy, be given a high clinical suspicion. Medical therapy and/or surgical therapy should be considered promptly to influence outcome favorably.

A 65-year-old woman came to the endocrinology clinic of our hospital with fatigue, muscle weakness and urinary incontinence. She has had these complaints for five months and was hospitalized at the neurology department and diagnosed with hyponatremia, urge incontinence, hypertension, diabetes mellitus and cerebrovascular disease. Her history included hospitalization for recurrent hyponatremia two times in the last five months; she could not walk due to muscle weakness. Her medications were tolterodine (six months), metformin, amlodipin and insulin aspart 30% and aspart protamin 70% (for three years). On admission, her blood pressure was 130/80 mmHg, pulse rate 80/min and neurological examination revealed left hemiparesis. Laboratory analyses are listed in Table 1. Table 1 Laboratory analyses Ejection fraction was 60% by echocardiography. After 2 liters of saline infusion, her blood sodium level was 126 mmol/L. After discontinuing tolterodine the serum sodium levels returned to normal in a few days. Hyponatremia is a common and important electrolyte abnormality in hospitalized patients causing a wide range of neurological symptoms. The differential diagnosis of hyponatremia is mandatory since there is a risk of neurological sequels during the treatment. Tolterodine-associated hyponatremia is especially seen in the elderly; our case is the fourth case of tolterodine-associated hyponatremia.1,4,5 Drug-induced syndrome of inappropriate antidiuretic hormone secretion (ADH) can occur due to an increase in ADH production centrally or an increased sensitivity to ADH in the nephron.3,5 Tolterodine (Detrol, Detrusitol) is an anti-muscarinic used to treat urinary incontinence. Tolterodine might induce hyponatremia by either increasing the ADH secretion or ADH action.4 Laboratory findings in diagnosis of syndrome of inappropriate ADH include:3 (1) hyponatremia 20 mEq/L; (3) normal serum creatinine; (4) low uric acid; and (5) normal adrenal and thyroid function. Our findings were consistent with syndrome of inappropriate ADH; when we stopped tolterodine, serum sodium levels returned to normal. Urinary incontinence is a common and distressing complaint in the elderly.2 In this report, we wanted to draw attention to a very rare adverse event caused by tolterodine, a drug mostly prescribed for the elderly.

Background Ankylosing spondilitis (AS) is a systemic chronic inflammatory disorder of unidentified etiology. Bisphenol A (BPA) which act as a protective lining on the inside of metal-based food and beverage cans, is a chemical produced in large quantities for use primarily in the production of polycarbonate plastics such as hard plastic bottles and epoxy resins. BPA is an estrogenic endocrine disruptor that exerts an extensive variety of metabolic effects. Objectives The objective of present study was to measure serum BPA levels in patients with AS and to explore a possible link between serum BPA levels and disease activity scores. Methods A total of 50 AS patients (40 male, 10 female, mean age 41.14±11.65 years, mean body mass index 26.78±3.94 kg/m 2 ) and 30 age-sex- and body mass index-matched healthy controls (23 male, 7 female, mean age 41.44±6.98, mean body mass index 27±3.06 kg/m 2 ) were taken to the study. Disease activity of the AS patients was measured by Bath ankylosing spondylitis disease activity index (BASDAI). Results The median disease duration of the AS patients was 10.68±10.43 years. Forty-three patients were taking NSAID and/or DMARD. Seven patients were taking an anti-TNF agent. Serum BPA levels of the patients with AS was significantly higher than that of healthy controls (3.98±2.35 vs. 0.49±0.29; p=0.001). There was significant positive correlation between the serum BPA levels and BASDAI scores (r=0.321, p=0.025). Conclusions These data clearly show that serum BPA levels are significantly higher in patients with AS in comparison to age-sex-BMI-matched healthy controls. Furthermore, levels of BPA in AS patients were positively correlated with disease activity scores. References Ozgocmen S, Akgul O, Altay Z, et al. Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. International journal of rheumatic diseases 2012;15(3):229-38. Vandenberg LN, Maffini MV, Sonnenschein C, Rubin BS, Soto AM. Bisphenol-A and the great divide: a review of controversies in the field of endocrine disruption. Endocrine reviews 2009;30(1):75-95. Rogers JA, Metz L, Yong VW. Review: Endocrine disrupting chemicals and immune responses: a focus on bisphenol-A and its potential mechanisms. Molecular immunology 2013;53(4):421-30. Wells EM, Jackson LW, Koontz MB. Association between bisphenol A and waist-to-height ratio among children: National Health and Nutrition Examination Survey, 2003-2010. Annals of epidemiology 2013. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1383

A 53-year-old female patient with Graves disease developed severe agranulocytosis and perirectal infection on the 50th day of propylthiouracil (PTU) therapy. After cessation of PTU, broad spectrum antibiotic regimens plus recombinant human granulocyte colony stimulating factor (G-CSF) were instituted, but C-GSF did not elevate the granulocyte count after 14 days of treatment. We added corticosteroid (CS) treatment because of the lack of response to G-CSF. The second day of CS treatment a response was seen in granulocyte count. We concluded that if there is no response to G-CSF in PTU-induced agranulocytosis in severe cases, CS treatment should be added and accepted as a part of standard therapy for this serious complication of PTU.

The authors present the case of a 17-year-old shepherd who was diagnosed with diffuse proliferative glomerulonephritis and diffuse tubulointerstitial nephritis during the course of Brucella infection. The pathogenesis and the mechanism of renal involvement in brucellosis is discussed in light of the pertinent literature.

Dear Editor: As MPV values are affected by cardiovascular diseases, cerebrovascular diseases, and hypertension, patients with these disorders were excluded from the study. The MPV values may be affected by smoking, obesity, prediabetes, diabetes mellitus, hyperlipidemia, metabolic syndrome, and cardiovascular risk factors [1]. However, Kutlucan et al. failed to identify an association between body mass index (BMI) and MPV in their study of 2,298 patients [2]. Therefore, we didn’t take BMI values into account during our study. In our study, smoking wasn’t mentioned, as there was no significant relationship among the groups regarding smoking. Also, lipid profile was not included in the assessments. Blood glucose levels affect MPV values; however, our study HbA1c levels weren’t mentioned as there was no significant difference in the groups’ HbA1c levels in our study. The mean platelet volume (MPV) values from the routine blood count were used in our manuscript. The reason this was not mentioned in our paper is that the MPV value measurement was performed during the standard blood count. In our study, the blood samples were placed into dipotassium ethylenediaminetetraacetic acid (EDTA) tubes. The complete blood count was performed using an automated hematology analyzer (CELL-DYN 3700, Abbott Diagnostics, Abbott Park, IL, USA). As mentioned by Varol et al., platelets swell after the blood samples are placed into EDTA tubes, causing increased MPV values [3]. Therefore, the blood samples are evaluated within 60 min of the blood sampling. All the cases’ blood samples were evaluated in the laboratory of our hospital.