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© Author(s).Objective: Vitamin D deficiency is a common health problem around the world. This study aimed to evaluate the nationwide prevalence of vitamin D status in tertiary care hospitals in Turkey. Methods: Retrospectively, the data on vitamin D levels from 33 tertiary care hospitals’ clinical biochemistry laboratories around Turkey between January and December were collected. Results: In total, 706 434 serum samples from adult subjects (female/male: 469 028/237 406; 66.4%/33.6%) were included. While vitamin D levels were sufficient in 20.3% (n = 14 222), they were insufficient in 21.9% (n = 154 360) and deficient in 57.8% (n = 408 882). We observed the highest rates of deficiency in those aged between 18 and 29 years (62.9%, n = 70 235) and lowest rates between 60 and 69 years (52.3%, n = 61 121) and between 70 and 79 years (52.3%, n = 32 397). Hypervitaminosis D was detected in 5.5% of adult subjects; highest rates of hypervitaminosis D were observed in those who were over 80 years (6.6%) and 70-79 years (6.5%) and the lowest in 18-29 years (2.8%). Discussion: In this cohort, over half of the subjects admitted to the tertiary care hospitals in Turkey had vitamin D deficiency and required vitamin D supplementation. The elderly population had the lowest prevalence of vitamin D insufficiency and the highest prevalence of hypervitaminosis D.

Concomitant diseases in elderly individuals with diabetes (renal failure, heart failure, ischemic heart disease, stroke, urinary incontinence, cognitive impairment, dementia, sarcopenia, and osteoporosis) make diabetes management difficult. Therefore, other comorbid conditions should be taken into account in elderly diabetics when considering a treatment approach. The use of oral antidiabetic agents in individuals older than 75 years may be limited. Although the diabetes treatment is not any different in healthy elderly patients, hypoglycemia is one of the most feared conditions, especially in the elderly. Therefore, metformin, DPP-IV inhibitors, and SGLT2 inhibitors should be considered in the first place with less risk of hypoglycemia. Low-dose sulfonylureas may also be used in selected cases. The use of new antidiabetic drugs, such as GLP-1 anologues and SGLT2 inhibitors, has strengthened our ability to cope with the risk of hypoglycemia and cardiovascular events, which are the two most important drawbacks in the treatment of elderly people with diabetes. Insulin treatment should be individualized, and the most rare injection regimens should be used. In case of failure of OAD, basal insulin should be added to the current treatment, and if necessary, a basal + plus regimen should be planned by adding bolus insulin 1/2/3 times per day to the meals. As a result, in elderly diabetics, an inadequate treatment or excessive treatment and individualizing the treatment should be the most appropriate approach.

Objectives: Recently, only anti-thyroid peroxidase (anti-TPO) has been suggested as an autoantibody in the diagnosis of chronic lymphocytic thyroiditis (CLT). In contrast, anti-thyroglobulin (anti-Tg) positivity has also been reported to be important. To evaluate this relationship more clearly, we planned to retrospectively investigate the autoantibody levels of the patients who underwent thyroid surgery for various reasons and those with CLT in postoperative pathology. Methods: We evaluated 670 patients who underwent thyroid surgery (total/subtotal thyroidectomy) for various reasons at our hospital between January 2015 and March 2017. Patients with indications of Graves’ disease, toxic multinodular goiter, and all malignancies except for thyroid papillary carcinoma (TPC) were excluded. Eighty-nine patients whose pathology findings were compatible with CLT and preoperative thyroid autoantibodies were identified enrolled in to the study. Patients with absence and presence of thyroid antibodies were included in the seronegative CLT group and seropositive CLT group, respectively. In addition, patients were divided into thyroid papillary carcinoma (TPC) and benign groups. Results: According to the study criteria, 89 (83 females, six males) (mean age, 46.08±11.19 years) patients who had preoperatively identified autoantibodies were detected. Anti-TPO positivity was found in 47 (52.8%) cases, whereas anti-Tg positivity was found in 49 (55.1%). Only anti-TPO positivity was found in 18 (20.2%) cases, whereas only anti-Tg positivity was detected in 20 (22.5%). Twenty-two (24.7%) of the patients were seronegative. On comparing the seronegative and seropositive groups, seronegativity was more frequent in male patients (p=0.03). Thyroid-stimulating hormone was found to be significantly higher in the seropositive group (p=0.01). TPC was detected in 36 (40.4%) of all cases. No difference regarding age, thyroid function tests, and antibody levels was found between the benign and TPC groups. Conclusion: Although all of our cases were histopathologically diagnosed with CLT, serologically, 75.3% of thyroid autoimmunities could be shown when both antibodies were evaluated together. When only anti-TPO was considered, this rate decreased to 52.8%. Therefore, anti-Tg appears to be still important in showing autoimmunity. Prospective studies are needed to evaluate this relationship more clearly.

Zuhur, Sayid/0000-0001-8084-848X; Elbuken, Gulsah/0000-0002-0920-6895; Kadioglu, Pinar/0000-0002-8329-140X WOS:000488472400001 PubMed ID: 31499558 Recently, the Graves & apos; Recurrent Events After Therapy score (GREAT) was proposed as a useful tool to predict relapse before starting antithyroid drugs (ATD) in patients with Graves & apos; disease (GD). Therefore, we intended to assess the validity of the GREAT score in Turkish patients with GD, including patients who experienced a poorly controlled disease (multiple episodes of hyperthyroidism followed by euthyroidism or rarely hypothyroidism) during ATD dose titration. This is a retrospective multicenter study including 517 patients with the first episode of GD who were treated for at least 12 months. The patients were classified as relapse+poorly controlled disease (non-remission) and remission groups. During a median follow-up time of 35 months (12-144 months), 191 (37%) patients experienced a relapse, 136 (26.3%) a poorly controlled disease, and 190 (36.7%) remained in remission. Patients with non-remission disease tended to have significantly higher serum levels of TRAb, fT4, and fT3, and have larger goiter sizes on palpation at baseline, as compared with the remission group. Non-remission disease occurred in 12, 35, and, 53% of the patients falling into GREAT class I, II, and III, respectively (hazard ratio 2.56, 95% CI 2.02-3.51, p=0.012, and hazard ratio 3.54, 95% CI 2.12-5.91, p

Purpose: It is not clear if Hashimoto's thyroiditis leads to Empty sella syndrome. In the present study, we aimed to investigate if Hashimoto's thyroiditis was associated with Empty sella syndrome, and Hashimoto's thyroiditis was a secondary cause od some cases of primary Empty sella syndrome. Material and Method: Eighty-one patients who were diagnosed with primary Empty sella syndrome were included in the study. All patients underwent thyroid ultrasonography and biochemical tests for thyroid-stimulating hormone, free triiodothyronine, free thyroxine, anti thyroid peroxidase, anti thyroglobulin, follicle stimulating hormone, luteinizing hormone, 17 beta estradiol, growth hormone, insulin-like growth factor 1, adrenocorticotropic hormone and total testosterone for Hashimoto's thyroiditis and pituitary hormone deficiency. Results: Out of 81 patients, thyroid disease was diagnosed in 34 (42%) patients; 18 of them had Hashimoto's thyroiditis (22.2%) and 16 (19.8%) had central hypothyroidism. Among Hashimoto's thyroiditis patients, 11 (13.6%) had hypothyroidism and 7 (8.6%) were euthyroid. Discussion: In conclusion, it is possible that some cases of primary Empty sella syndrome are caused by Hashimoto's thyroiditis. It is recommended that the presence of Hashimoto's thyroiditis should be investigated in patients with primary Empty sella syndrome. Further studies investigating anti-pituitary antibody in patients with primary Empty sella syndrome, are needed to further declare this relationship.

Introduction: Late-night salivary cortisol is a frequently used and easily implemented diagnostically valuable test for the diagnosis of overt Cushing's syndrome. The use of late-night salivary cortisol in the diagnosis of subclinical Cushing's syndrome is somewhat controversial. In this study, we aimed to determine the diagnostic value of late-night salivary cortisol in diagnosing subclinical Cushing's syndrome and compare it with 24-hour urinary free cortisol levels (UFC). Material and methods: The study consisted of 33 cases of subclinical Cushing's syndrome, 59 cases of non-functioning adrenal adenoma, and 41 control subjects. Late-night salivary cortisol and UFC were measured in all the cases. The diagnosis of subclinical Cushing's syndrome was based on combined results of 1 mg dexamethasone suppression test > 1.8 mu g/dL and ACTH < 10 pg/mL. Results: Mean late-night salivary cortisol levels in subjects with subclinical Cushing's syndrome were significantly higher than in subjects with non-functioning adrenal adenoma and the control group (p < 0.001). Using a cut-off value of 0.18 mu g/dL, the sensitivity and specificity of late-night salivary cortisol for diagnosing subclinical Cushing's syndrome were determined as 82% and 60%, respectively. Using a cut-off value of 137 mu g/day, the sensitivity and specificity of UFC was determined as 18% and 90%, respectively. Conclusions: Because the sensitivity of late-night salivary cortisol for the diagnosis of subclinical Cushing's syndrome is limited, using it as the sole screening test for subclinical Cushing's syndrome may lead to false negative results. However, using it as an adjunct test to other tests may be beneficial in the diagnosis of subclinical Cushing's syndrome.

Insulinoma is a rare neuroendocrine tumor of the pancreas and is the most common cause of endogenous hyperinsulinemic hypoglycemia. Although 90% of insulinomas are benign tumors, recurrent episodes of hypoglycemia may lead to life-threatening consequences. Since surgery is the only curative method for patients with insulinomas, the preoperative localization of these tumors by appropriate imaging methods is important. In this case series, we report 5 patients with endogenous hyperinsulinemic hypoglycemia, including one with MEN-1 syndrome, who were diagnosed with insulinoma according to the prolonged fasting test. All patients had normal pancreas on upper abdominal magnetic resonance imaging (MRI), therefore, they underwent endoscopic ultrasonography (EUS) for localization of the insulinomas and were operated according to the EUS results. EUS demonstrated well-demarcated tumors in the tail of the pancreas in 4 subjects and in the head of the pancreas in one patient. However, in contrast to EUS results, one patient with MEN-1 syndrome had a glucagonoma and two insulinomas and one patient had not any tumor on histopathological evaluation of the distal pancreas after surgery. In this case series, we aimed to present the diagnostic performance of EUS and the treatment outcomes in a cluster of patients with insulinomas who had not a pancreatic lesion on upper abdominal MRI and to briefly review the currently available imaging methods for localization of insulinomas.

Objective. To assess the relation between fetal and maternal blood type (ABO, Rh) incompatibility and development of gestational diabetes mellitus (GDM). Materials and Methods. A total of 500 pregnant women underwent diagnostic test for GDM by a 100-g oral glucose tolerance test (OGTT) after an 8 to 12-h overnight fast participated in this study. OGTT was performed between the 24-28 weeks of gestation, but participants who were at high risk for GDM were tested after the first prenatal visit. In the postpartum period, maternal and infant blood types were determined. Presence of GDM was evaluated in terms of matched and unmatched fetal and maternal ABO and Rh blood types separately. Results. GDM was detected in 235 participants. Unmatched ABO blood types between the mother-infant pairs were present in 44.7% (n=105) of GDM (+) and 35.8 % (n=95) of GDM (-) patients. Incompatible feto-maternal ABO blood type was positively correlated with development of GDM which was marginally significant. (p=0.045; R=1.2;95% CL; 1.004-1.48). However, Rh feto-maternal blood type incompatibility was not related with development of GDM. Conclusions. Feto-maternal ABO blood type incompatibility may be a weak risk factor for the development of GDM.

WOS: 000319889300005 PubMed ID: 22522662 To compare insulin and GLP-1 analogues therapy on glycemic control in poorly controlled Type 2 diabetes (T2DM) subjects failing on oral therapy. Methods: The electronic database PubMed was systematically searched for randomized controlled trial (RCT) with duration >16 weeks comparing the addition of insulin therapy vs glucagon-like peptide (GLP-1) analogues in poorly controlled T2DM subjects on oral therapy. Results: We identified 7 RCT with 2199 patients of whom 1119 were assigned to insulin therapy and 1080 received a GLP-1 analogue. Both insulin and GLP-1 analogues were effective in lowering glycated hemoglobin (HbA(1c)) with no statistically significant difference between the mean decreases in HbA(1c). However, insulin was more effective than GLP-1 analogues in lowering the fasting plasma glucose concentration, while GLP-1 agonists were more effective in lowering the postprandial glucose concentration. Insulin therapy was associated with weight gain while GLP-1 analogues consistently caused weight loss and the difference between the mean change in body weight between the two therapies was highly statistically significant. Despite a similar decrease in HbA(1c), the risk of hypoglycemia was 35% lower (p=0.001) with GLP-1 therapy compared to insulin. Compared to insulin, GLP-1 analogues caused a significant decrease in systolic blood pressure and were associated with greater rate of gastrointestinal adverse events. Conclusion/interpretation: In poorly controlled T2DM subjects on oral therapy, GLP-1 analogues and insulin are equally effective in lowering the HbA(1c). However, GLP-1 analogues have additional non-glycemic benefits and lower risk of hypoglycemia. Thus, GLP-1 analogues should be considered as a treatment option in this group of diabetic individuals.

The north of Algeria is the main earthquake-related tsunami generation zone that threatens the Balearic Islands. In this work we review the major seismic series of the area -the 1980 El Asnam and the 2003 Boumerdes- Zemmouri earthquakes- in order to obtain a probable worst characteristic earthquake rupture. We estimate rupture dimensions of 55 km × 16 km, reaching the fault plane a depth of 13 km. The dip and rake have been taken as constants, with values of 50° and 90° respectively, while the strike is adjusted to the local tectonic structure. With these characteristics a magnitude MW= 7.3 earthquake is obtained for an average slip of 4 metres; these values being reasonable for the seismotectonics of the area. Nine sources along the northern coast of Algeria have been proposed, some of them have been mapped offshore and others that are less known are probable continuations of onshore structures. Based on numerical simulations the tsunami impacts of the nine potential events on Majorca have been studied. Catastrophic tsunamis cannot be triggered from these sources in the Balearic Islands. However, wave elevations up to 2 m can generate flooding in low areas and wave amplifications in bays and harbours that can be damaging, as witnessed in historical events.

48 ÖZET 21 yeni başlamış ve hiçbir tedavi almamış hipertiroidi hastası ile yaş cins ve BMI bakımından benzer 10 sağlıklı bireyde hipofiz-adrenal rezervi Lysine-vasopressin (LVP) testi ile değerlendirildi. Hipertiroidi grubunda bazal ve 10Ü LVP İM uygulamadan 5 ve 15 dakika sonraki ACTH düzeyleri sırasıyle 47±57.4, 54.3±64.2 ve 48.5±70.1 pg/ml (p>0.05), kortizol düzeyleri ise 12.5±5.2, 13.9±4.2 ve 14.5±4.4 /0.05) olarak bulundu. Kontrol grubunda ACTH düzeyleri 67.8±83.6,105±74.5 ve 128.6±85.5 pg/ml (p=0.02) kortizol düzeyleri ise 11.2 ±6.9, 17.4±11.5 ve 22.3±10.4 /ıg/ml (p=0.007, p0.05). Sonuç olarak hipertiroidi'de artmış AVP düzeyine bağlı olarak hipofizer CRH reseptörlerinde dovvn-regülasyon oluşabileceğini ve dışarıdan verilen LVP'e karşı hipofizer duyarlılık azalması oluşarak ACTH cevabımn baskılanabileceğini düşünmekteyiz. 62