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Insulinoma is a pancreatic endocrine tumour which origins from beta cells and characterized by excessive insulin secretion and hypoglycemia due to this. Symptoms seen in hypoglycemia are due to brain’s lack of glucose (neuroglycopenia) such as somnolence, irritability, confusion, abnormal behaviour, epileptic seizure and even coma. In this study, we presented two insulinoma cases who applied to our clinic with neuroglycopenic symptoms. Patients followed up with epilepsy diagnosis were referred to us because of low blood glucose rates. Hyperinsulinemic hypoglycemia in the prolonged fasting test and a mass in pancreas were detected in both patients and so they were diagnosed as insulinoma. The mass was excised by laparoscopic ways in surgical clinic and patients clinic were completely recovered postoperative. In conclusion, it is necessary to determine whether there is an underlying organic brain lesion or a metabolic condition in order to prevent long-term use of unnecessary antiepileptic in patients presenting with seizures.

Charcot neuropathic osteoarthropathy (CN) is a chronic progressive disease that affects foot and ankle bone commonly. Osteoarticular deformities and functional disability may develop in the affected bone and joints. Various diseases may play role in the etiology. The most common causes are tabes dorsalis, leprosy, syringomyelia, diabetes mellitus, myelomeningocele, spinal cord trauma, tumors, poliomyelitis, Riley-oayer syndrome, cystic bone disease, congenital pain, loss, progressive feeling neuropathy, amyloid neuropathy, progressive muscular atrophy, cerebral hemorrhage after hemiplegia, druds such as thalidomide. Clinical findings are joint instability, soft tissue calcifications, misshapen and deformed joint appearance. There is no joint tenderness. Case Study Gokosmanoglu et al.; IJMPCR, 7(1): 1-4, 2016; Article no.IJMPCR.24657 2 Treatment of CN is the treatment of primary disease. In this case report we present a 59 years old women with CN. She had a poor glycemic control. The diagnosis was based on foot radiography and magnetic resonance imaging (MRI) findings. Edema and widespread destruction in the bone, joints and surrounding soft tissue can be seen in MRI. Firstly, osteomyelitis was considered in this patient and this situation had led to delays in diagnosis and unnecessary drug use. In conclusion, if there is doubt in the diagnosis of foot lesions in diabetic neuropathic patients for preventing the development of foot deformities and avoiding longterm unnecessary antibiotic use; multidisciplinary approaches should be applied.

Background Sufficient clinical data are not available on the effect of hypothyroidism on olfactory function in adults. In this study, we aimed to evaluate the olfactory function of adult patients diagnosed with primary hypothyroidism. Methods Forty-five patients aged between 18 and 60 years who were diagnosed with clinical primary hypothyroidism and 45 healthy controls who had normal thyroid function tests were included in the study. Sniffin’ Sticks olfactory test results of the 2 groups were compared. The relationships between thyroid function tests and olfactory parameters were evaluated. Results Odor threshold, identification, and discrimination scores of the hypothyroid group were significantly lower than those of the control group (p < 0.001). A significant positive correlation was detected between free triiodothyronine (FT3) levels and odor threshold, identification, and discrimination scores (p < 0.001). There was no significant relationship between thyroid-stimulating hormone (TSH) or free thyroxine (FT4) levels and olfactory parameters. Conclusion Our study revealed diminished olfactory function in adults with hypothyroidism. FT3 levels were found to have a more significant relationship with olfactory parameters than TSH or FT4 levels.

In this study, we aimed to determine the role of a novel peptide – nesfatin 1- in appetite control and define its anorectic mechanism in order to reveal whether it can be used in fight against obesity. We reviewed the articles in the literature investigating the structure, mechanism of effect and experimental usefulness of nesfatin-1. We entered the word “nesfatin” to medical databases and reviewed the literature. Administration of nesfatin-1 maintains a significant reduce in food intake. Its effectiveness in rats is proven. More and more, new researches are in progress to determine its exact mechanism of effect. Nesfatin-1 is a satiety agent. However, use of nesfatin-1 as an anti-obesity agent in humans remains an unclarified field and needs further investigations. Turk Jem 2015; 19: 60-64

WOS: 000447811100009 PubMed: 29542030 PurposeThe aim of this study was to investigate the possible association of insulin-like growth factor-1 (IGF-1) with the pathogenesis of non-functioning adrenocortical adenomas (NFAs).MethodsThis study included 50 female patients (mean age 54years) with NFAs, 55 patients (mean age 48years; 20 male, 35 female) with acromegaly and 38 female control subjects (mean age 58years). Body mass index (BMI) and waist circumference (WC) of the subjects were recorded and blood samples for IGF-1 were taken. Insulin resistance was calculated using the homeostatic model assessment (HOMA) score. Since most of the acromegaly patients had been using medicine that could have effected insulin resistance, HOMA scores were calculated only in patients with NFAs and the controls. Computerized tomography or magnetic resonance imaging was taken of the acromegalics and controls to detect adrenal mass frequency.ResultsThe mean age was similar among the groups. As expected, the serum IGF-1 levels were significantly higher in patients with acromegaly than in patients with NFAs and the controls (p

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.

Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Symptoms are caused by a decrease or absence of one or more of the pituitary hormones, and vary, among others, from failure to lactate and nonspecific symptoms (such as fatigue) to severe adrenal crisis. In accordance with the location of hormone-secreting cells relative to the vasculature, the secretion of growth hormone and prolactin is most commonly affected, followed by follicle-stimulating hormone and luteinizing hormone; severe necrosis of the pituitary gland also affects the secretion of thyroid-stimulating hormone and adrenocorticotropic hormone. Symptoms usually become evident years after delivery, but can, in rare cases, develop acutely. The incidence of Sheehan syndrome depends, to a large extent, on the occurrence and management of PPH. Sheehan syndrome is an important cause of hypopituitarism in developing countries, but has become rare in developed countries. Diagnosis is based on clinical manifestations combined with a history of severe PPH; hormone levels and/or stimulation tests can confirm clinical suspicion. Hormone replacement therapy is the only available management option so far.

WOS: 000397870700001 PubMed ID: 28004764 Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Symptoms are caused by a decrease or absence of one or more of the pituitary hormones, and vary, among others, from failure to lactate and nonspecific symptoms (such as fatigue) to severe adrenal crisis. In accordance with the location of hormone-secreting cells relative to the vasculature, the secretion of growth hormone and prolactin is most commonly affected, followed by follicle-stimulating hormone and luteinizing hormone; severe necrosis of the pituitary gland also affects the secretion of thyroid-stimulating hormone and adrenocorticotropic hormone. Symptoms usually become evident years after delivery, but can, in rare cases, develop acutely. The incidence of Sheehan syndrome depends, to a large extent, on the occurrence and management of PPH. Sheehan syndrome is an important cause of hypopituitarism in developing countries, but has become rare in developed countries. Diagnosis is based on clinical manifestations combined with a history of severe PPH; hormone levels and/or stimulation tests can confirm clinical suspicion. Hormone replacement therapy is the only available management option so far.

Diabetes mellitus tüm dünyada prevalansı gittikçe artan kronik bir hastalıktır. Farmakolojik tedavi optimal glisemik kontrolü sağlamak için çoğu zaman gereklidir. Günümüzde klinisyenlere tip 2 diyabet tedavisi için çok geniş yelpazede oral antidiyabetik ilaçlar sunulmaktadır. Bu oral antidiyabetik ilaçlar; insülin sekresyonunu stimüle edenler (sülfonilüreler ve hızlı etkili sekretagoglar), hepatik glukoz üretimini azaltanlar (biguanidler), intestinal karbonhidrat sindirimi ve emilimini geciktirenler (α-glukozidaz inhibitörleri) ve insülin etkisini iyileştirenler (tiazolidindionlar) olarak ayrılabilir. Bu makalede farklı oral antidiyabetik ilaçların etki mekanizmaları, etkinlikleri ve yan etkileri ile birlikte kullanımları ile ilgili en son öneriler tartışılacaktır., Diabetes mellitus is a chronic disease that is growing in prevalence worldwide. Pharmacologic therapy is often necessary to achieve optimal glycemic control in the management of diabetes. Today’s clinicians are presented with an extensive range of oral antidiabetic drugs for type 2 diabetes. These main drug classes include agents that stimulate insulin secretion (sulphonylureas and rapid-acting secretagogues), reduce hepatic glucose production (biguanides), delay digestion and absorption of intestinal carbohydrate (α-glucosidase inhibitors) or improve insulin action (thiazolidinediones). We review the mechanism of action, efficacy and side effects of the different classes of oral antidiabetic drugs and discuss the current recommendations for their use.

Aim: The aim of this study was to assess the insulin resistance and serum leptin levels in patients with obstructive sleep apnea syndrome (OSAS), and to compare body mass indexes (BMI) of OSAS patients with matched controls without OSAS. Method: Twenty eight patients having apnea-hypopnea index (AHI)≥5 included in the study. Thirty two healthy subjects assumed as a control group. Venous blood was obtained in the fasting state for the measurement of glucose, insulin and leptin levels. Insulin resistance index was based on the homeostasis model assesment method (HOMAIR).

BackgroundThe aims of this study were to evaluate the validity of preoperative basal serum cortisol levels measured in predicting preoperative adrenal insufficiency and also the validity of basal serum cortisol levels and early postoperative insulin tolerance test (ITT) in predicting postoperative adrenal insufficiency.MethodsThe study was prospectively designed and included 64 patients who underwent pituitary surgery for conditions other than Cushing's disease. An ITT was performed preoperatively, on the 6th postoperative day and at the 1st postoperative month. Basal serum cortisol levels were measured on the 2nd, 3rd, 4th, 5th, and 6th postoperative days.ResultsPatients with a preoperative basal cortisol level of ConclusionSerum basal cortisol levels may be used as the first-line test in the assessment of the hypothalamic–pituitary–adrenal axis both preoperatively and postoperatively. Dynamic testing should be limited to the patients with indeterminate basal cortisol levels.

WOS: 000380224800019, PubMed ID: 27144933, Context: Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by near-total lack of body fat. Objective: We aimed to study natural history and disease burden of various subtypes of CGL. Design: We attempted to ascertain nearly all patients with CGL in Turkey. Setting: This was a nationwide study. Patients or Other Participants: Participants included 33 patients (22 families) with CGL and 30 healthy controls. Main Outcome Measure(s): We wanted to ascertain genotypes by sequencing of the known genes. Whole-body magnetic resonance imaging was used to investigate the extent of fat loss. Metabolic abnormalities and end-organ complications were measured on prospective follow-up. Results: Analysis of the AGPAT2 gene revealed four previously reported and four novel mutations (CGL1; c.144C>A, c.667_705delinsCTGCG, c.268delC, and c.316 + 1G > T). Analysis of the BSCL2 gene revealed four different homozygous and one compound heterozygous possible disease-causing mutations (CGL2), including four novel mutations (c.280C > T, c. 631delG, c. 62A > T, and c. 465-468delGACT). Two homozygous PTRF mutations (c.481-482insGTGA and c. 259C > T) were identified (CGL4). Patients with CGL1 had preservation of adipose tissue in the palms, soles, scalp, and orbital region, and had relatively lower serum adiponectin levels as compared to CGL2 patients. CGL4 patients had myopathy and other distinct clinical features. All patients developed various metabolic abnormalities associated with insulin resistance. Hepatic involvement was more severe in CGL2. End-organ complications were observed at young ages. Two patients died at age 62 years from cardiovascular events. Conclusions: CGL patients from Turkey had both previously reported and novel mutations of the AGPAT2, BSCL2, and PTRF genes. Our study highlights the early onset of severe metabolic abnormalities and increased risk of end-organ complications in patients with CGL.

The present study was designed to investigate the relationship between the serum levels of oxidant-antioxidant system (malondialdehyde (MDA) level, Paraoxonase (PON1) activity, nitric oxide (NO) level and superoxide dismutase (SOD) activity) and thyroid hormone status in hypothyroidism pre and posttreatment. The study group comprised 33 patients with primary hypothyroidism. 18 of these patients were reevaluated after euthyroid state i.e. at least 6 months of thyroxine replacement. The patients were compared with 26 normal healthy controls. Serum MDA level, PON1 activity, NO level and SOD activity were measured according to an enzymatic spectrophotometric method. MDA levels were found higher in patients with hypothyroidism before the treatment than the controls. MDA levels were also found to be decreased after the treatment in patients with hypothyroidism. However MDA were found still higher than the controls after the treatment. PON1 activity was found to be lower in patients pretreatment when compared to posttreatment hypothyroidism and controls. Posttreatment of hypothyroidism mean PON1 activity significantly increased compared to pretreatment level but it was still significantly lower than control level. NO level was higher in pretreatment hypothyroidism when compared to controls. SOD activity was not found different in patients before treatment when compared to controls. SOD activity was significantly higher in after treatment when compared to both pretreatment and control levels. In conclusion, increased ROS levels in hypothyroidism may result in a pro-oxidation environment, which in turn could result in decreased antioxidant PON1 activity, increased MDA and NO levels. As a result, lipid peroxidation may have a role in the pathogenesis of the atherosclerosis in hypothyroidism.

OBJECTIVE: The presence of GH receptor in human skin and its appendages suggests a direct effect of GH on skin characteristics. The skin is usually thin and dry in patients with GH deficiency (GHD). Sheehan's syndrome classically refers to postpartum hypopituitarism and GH is one of the earliest pituitary hormones lost. While severe GHD is a well-established feature of Sheehan's Syndrome, skin characteristics and the effects of GH replacement therapy (GHRT) have been investigated neither in Sheehan's syndrome nor in other disorders of GHD. The aim of this study was to investigate the skin characteristics, including the sebum content, hydration (skin capacitance), transepidermal water loss (TEWL), pH and skin temperature, and particularly the effects of 6 months of GHRT on these parameters in GH deficient patients with Sheehan's syndrome. PATIENTS AND DESIGN: Sixteen severely GH deficient women with Sheehan's syndrome (48.1 +/- 10.9 years), and 20 age and menopausal status similar women as control subjects were included. Ten patients received recombinant GH for 6 months (treatment group) and 6 patients received placebo (placebo group) during this period. Skin properties were measured at baseline and after 6 months of GHRT using noninvasive and well-established measuring methods. RESULTS: At baseline the skin capacitance was significantly decreased on the forehead and forearm, and sebum content was significantly decreased on forehead in patients with Sheehan's syndrome compared to control subjects (P < 0.05). In the treatment group there was a significant increase in sebum content on forehead after 6 months of GHRT compared to the baseline value (P < 0.05). However there were no significant changes in other parameters including sebum content on the forearm, TEWL, Ph, skin capacitance and temperature of both the forearm and forehead. In the placebo group there were no changes in any of the evaluated parameters after 6 months of treatment compared to baseline values. CONCLUSIONS: The present study clearly shows that the sebum content on the forehead and skin hydration of the forehead and forearm are significantly decreased in GH deficient patients with Sheehan's syndrome. However 6 months of GHRT significantly increased only the sebum content on the forehead. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics.

Objecti{dotless}ve: To investigate the prevalence of polycystic ovary syndrome (PCOS) and polycystic ovary (PCO) among premenopausal women with type 2 diabetes mellitus (DM). Desi{dotless}gn: Case-control study of women with type 2 DM. Setti{dotless}ng: Tertiary referral university hospital. Pati{dotless}ent(s): Ninety-two premenopausal women with DM, ?30 years of age, and 20 age- and body mass index-matched healthy premenapousal eumenorrheic women were recruited into the study. Interventi{dotless}on(s): An oral glucose tolerance test was performed according to the American Diabetes Association criteria for each healthy woman. After an overnight fasting, blood samples were obtained for the determination of fasting blood glucose, LH, FSH, free T, androstenedione (A4), 17-hydroxyprogesterone (17-OHP), DHEAS, PRL, free T4, TSH, E2, and sex hormone-binding globulin (SHBG) levels. A GnRH analog (buserelin) test was carried out in 36 patients with DM and PCO (including PCOS subjects), 20 patients with DM without PCO or PCOS, and 20 healthy subjects. Mai{dotless}n Outcome Measure(s): The prevalence of PCO and PCOS in women with type 2 DM. Result(s): Fifty-seven (62%) of diabetic patients had normal ovaries, 31 (33.7%) had PCO, and 4 (4.3%) had PCOS. The women with DM (n = 92) and healthy women (n = 20) had similar basal A4, FSH, E2, 17-OHP, free T, and DHEAS levels. The LH and SHBG levels were lower and the hirsutism score higher in diabetic patients than in healthy women (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.

Traumatic brain injury (TBI) has long been known as a cause of hypopituitarism, and it is characterized by a high prevalence of neuroendocrine abnormalities. Boxing, one of the most common combative sports, may also result in TBI. As far as we know, pituitary functions including GH status have not been investigated in boxers. Therefore, in this preliminary study, we have assessed the pituitary functions in boxers. Eleven actively competing or retired male boxers with a mean age of 38.0 +/- 3.6 yr and 7 age-, sex- and BMI-matched healthy non-boxing controls were included in the study. Biochemical and basal hormonal parameters including IGF-1 levels were measured. To assess GH secretory status in boxers and healthy controls, GHRH (1 mug/kg) +GHRP-6 (1 mug/kg) test was performed. After GHRH+GHRP-6 test, mean peak GH level in boxers and in controls were 10.9 +/- 1.7 and 41.4 +/- 6.7 mug/l, respectively (p

The major causes of hepatomegaly and elevated transaminases in patients with diabetes mellitus are glycogenosis or fatty liver and non-alcoholic steatohepatitis (NASH). Although hepatic glycogenosis is common in this population, hepatomegaly or elevated transaminase are more often attributed to steatosis than to glycogen excess, and so as glycogenosis may be considered a rare cause of these findings. Accordingly, information on adult diabetic patients with glycogen-induced hepatomegaly is scant. The accumulation of excessive amounts of glycogen in the hepatocytes is a consequence of intermittent episodes of hyperglycemia and hypoglycemia and the use of excessive insulin. Hepatic glycogenosis occurs in patients with poorly controlled type 1 or type 2 diabetes; whereas steatosis is associated with obesity and insulin resistance. The distinction between steatosis and glycogenosis is important. Steatosis may progress to fibrosis and cirrhosis, whereas glycogenosis improves dramatically in response to the institution of euglycemic control. In addition, true diagnosis avoids the unnecessary and invasive investigations. We present a case clinically suggesting hepatic glycogenosis that led to symptomatic hepatomegaly and markedly elevated serum aminotransferases in patient with type 1 diabetes mellitus. Turk Jem 2012; 16: 79-81

ObjectiveSheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients.Study designA retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations.ResultsThe mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whose basal prolactin was below 4.0 ng/ml had adequate prolactin responses to TRH test, while all patients whose basal prolactin was above 7.8 ng/ml had adequate responses. Mean sella volume was found to be significantly lower in the SS group (340.5±214 mm3) than that in the healthy group (602.5±192 mm3).ConclusionsSS is a common cause of hypopituitarism in underdeveloped and developing countries. The main reasons for diagnostic delay seem to be the high frequency of patients with nonspecific complaints and neglect of SS. In addition, the TRH stimulation test was found to have a high sensitivity and specificity to recognize PRL deficiency. Furthermore, small sella size may have an important contributing role in the etiopathogenesis of SS.

WOS: 000342072600014 PubMed: 24068455 …

WOS: 000344087600025, PubMed ID: 24366641, Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 +/- 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: nonsecretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndromeis still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries.

WOS: 000346034000004 PubMed: 25538382 Background: Diabetes mellitus type 1 that results from immunologically mediated damage to the beta-cells in the pancreas. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia. Hyperglycemia can be associated with salivary gland dysfunction and alterations in the oral epithelial cells. Aim: The aim of this study was to evaluate the qualitative and quantitative changes in buccal and tongue dorsum epithelial cells using an exfoliative cytology method in type 1 diabetic patients. Materials and Methods: We performed light microscopic analysis of the buccal and tongue dorsum smears in thirty type 1 diabetic patients and thirty healthy individuals. The oral smears were stained using Papanicolaou method for cytological examination and nuclear morphometric analysis. In each case, the mean nuclear area, perimeter, length, breadth, and roundness factor were evaluated in each smear using the image analysis software (Q Win, Leica (TM)). Results: The nuclear area, length, breadth, and perimeters were significantly higher in the diabetic group from tongue dorsum smear than that of the control group (P < 0.05). In the cytological examination, karyorrhexis-karyolysis-karyopyknosis, binucleation, nuclear membrane irregularity, cytoplasmic polymorphism, perinuclear halo were observed in oral smears with type 1 diabetic patients. Binucleation (P = 0.002) and nuclear membrane irregularity (P = 0.024) were significantly more common in buccal smears of diabetic group. Furthermore, the sensitivity of buccal mucosa was significantly higher in the diabetic group (P = 0.006). Conclusion: The light microscopic and nuclear morphometric study indicates that type 1 diabetes can produce morphological and nuclear morphometric changes in the oral mucosa that are noticeable with exfoliative cytology.

PubMed: 23397103 Pituitary tumors are the third most common primary intracranial neoplasm. Pathologic proliferation of the somatotrophs results as overproduction of growth hormone presenting as acromegaly. In pituitary adenomas typical visual field (VF) defect is bitemporal hemianopsia but tumor size and optic chiasmal position may cause variable VF defects and VF examination may remain normal. We retrospectively reviewed the medical records of 23 acromegalic patients with pituitary adenomas who received VF tests in the Department of Ophthalmology and Endocrinology, Ondokuz Mayis University Hospital, between 2000 and 2012. Pituitary tumor volume was calculated after performing measurements of tumor diameter in three orthogonal planes using Cavalieri's principle. VF test was performed with a Humphrey field analyzer 750 using a 4-mm Goldmann size III stimulus. The mean age of the 23 patients (11 male/12 female) was 50.4 ± 11.9 years. 15 patients (65.2 %) had normal VF, two patients (9 %) had quadrantanopsia, three patients (13 %) had hemianopsia and three patients (13 %) had three quadrantanopsia. Among the patients with normal VF, four patients had a suprasellar mass that was elevating the chiasm and spreading along the optic tracts. We also observed VF defects typical of a chiasmal compression even though no suprasellar extension was detected in a few cases. Tumor volume of the patients with VF defects was significantly larger than tumor volume of patients with normal VF (p = 0.02). Tumor volume is an important parameter in VF defects. Advanced neuroimaging assesments should always be complemented in patients even with normal VF. © 2013 Springer Science+Business Media Dordrecht.

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.

tekin, ishak ozel/0000-0002-9969-4254; Yazici, Zihni Acar/0000-0003-1603-6545 WOS: 000319295500011 PubMed: 22752347 The role of autoimmunity in the development of Sheehan's syndrome is obscure. There are a limited number of studies investigating the immunological alterations accompanying Sheehan's Syndrome. Our objective was to evaluate lymphocyte subsets in these patients. We conducted a cross-sectional clinical study. Cytofluorometry was used for the immunophenotyping of peripheral blood leukocytes from patients with Sheehan's syndrome followed up in the endocrine clinic during 2005-2009. Fifteen consecutive patients (mean age 61.6 +/- A 11.3, range 34-75 years) and 25 healthy controls (mean age 56.7 +/- A 10.6, range 34-80 years) were included. There was no statistically significant difference between the groups in terms of mean age. The percentages of CD19(+), CD16(+)/56(+), CD8(+)28(-), gamma delta TCR+, CD8(+); the total lymphocyte counts; and the ratio of CD8(+)28(-)/CD8(+)28(+) were similar (p > 0.05) between patients and controls. Whereas the leucocyte counts (p = 0.003), the percentage of CD3 (+) DR (+) (p < 0.001), CD8(+)28(+) (p = 0.030), CD4(+)CD25(+) (p = 0.007), the ratio of CD3 (+) DR+/CD3 (p < 0.001) were higher; the percentage of CD3 (p = 0.020), CD4 (p < 0.001) and the ratio of CD4/CD8 (p = 0.006) were lower in patients with Sheehan's syndrome compared to healthy controls. There was a positive correlation between the duration of illness and the percentage of CD3(+)DR(+) (r = 0.53, p = 0.03) expression. Some peripheral lymphocyte cell subsets show marked variation in patients with Sheehan's syndrome in comparison to matched healthy subjects, which may have implications for altered immune regulation in these patients. High CD3 (+) DR (+) expression that correlates with the duration of illness in Sheehan's patients is suggestive of an ongoing inflammation accompanying the slow progression of pituitary dysfunction in Sheehan's syndrome. It is not clear if these cellular alterations contribute to the cause or consequence of pituitary deficiency in Sheehan's syndrome.

Fizik aktivitenin azalması ve obezitenin artması ile tip 2 diyabet yaygınlığı da artmaktadır. Egzersiz, plazma glukozunu ve HbA1C’yi düşürür, bazal ve postprandiyal insulin seviyelerini azaltır, insulin duyarlılığını arttırır, lipid profilini düzeltir. Ayrıca, bozulmuş glukoz toleransı olanlarda aşikar diyabete ilerlemeyi yavaşlatır. Diyabetik hastalara haftada en az 150 dakikalık orta dereceli aerobik egzersiz önerilir. Hastalar, haftada 3-4 kez, 30-60 dakikalık egzersizler ile aktiviteye özendirilmelidirler., The incidence of type 2 diabetes mellitus increases with the decrease in physical activity and increase in obesity. Exercise decreases plasma glucose, HbA1C, basal and postprandial insulin levels; increases insulin sensitivity and improves lipid profile. It also slows down progress into type 2 diabetes mellitus those with impaired glucose tolerance. At least 150 minutes of moderate aerobic exercise per week is recommended to diabetic patients. Patients should be encouraged for activity for 30-60 minutes of exercises 3-4 times a week.

İnsülin, tip 2 diyabetteki hiperglisemi tedavisinde mevcut tedaviler içerisinde en etkili olanıdır. Uygun şekilde kullanıldığında, artmış HbA1C’yi arzulanan hedefe düşürebilir. Tüm tip 1 diyabetiklere insulin tedavisi gerekli iken, tip 2 diyabetiklerde insulin tedavisinin nasıl olacağı veya ne zaman başlanacağı konusu o kadar açık değildir. Belirgin kilo kaybı, ciddi hiperglisemi veya ketosis durumlarında insulin hemen başlanmalıdır. Bu durumların dışında, insulin dışındaki tedavilerle veya bir veya daha fazla non-insülin ajanlarla glisemik hedeflere ulaşılamıyorsa insülin tedavisi eklenmelidir. Glukoz kontrolü sağlandıktan ve semptomlar düzeldikten sonra insulin tedavisi kesilebilir veya devam edilebilir. Burada kısaca tip 2 diyabette insulin tedavisi gözden geçirilecektir., Insulin is the most effective available medication for treating hyperglycemia in type 2 diabetes. If appropriately used, it can decrease any level of elevated HbA1C to, or close to, the desired goal. Whereas insulin therapy is required in all patients with type 1 diabetes, the decision of how and when to start insulin in type 2 diabetes is not as straightforward. Insulin usually should be started immediately in patients with marked weight loss, severe hyperglycemia, or ketosis. In the absence of these features, insulin should be added when glycemic goals are not met with one or more non-insulin agents, or when glycemic goals are unlikely to be achieved with non-insulin therapy. After the glucose is controlled and symptoms are relieved, it may be possible to withdraw the insulin or to be continued. Here, insulin therapy in patients with type 2 diabetes will be briefly reviewed.

Yamaner, F, Atmaca, H, Bayraktaroglu, T, Aydin, M, and Aydemir, S. Gonadal function in male mountain bikers. J Strength Cond Res 25(8): 2311-2315, 2011-Some studies reported testicular disorders associated with biking in mountain cyclists, which include injuries, erectile dysfunction, and higher scrotal temperatures. But none of these studies evaluated gonadal function. Therefore, the aim of this study was to evaluate gonadal function in male mountain bikers. Twenty-two male professional mountain bikers and 30 healthy noncyclist controls were included in the study. The mean age and body mass index were similar in both groups. Fasting blood samples for the measurement of the levels of total testosterone (TT), sex-hormone binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were obtained from all study participants before any physical activity. In addition, because insulin sensitivity and leptin modulate gonadal function, the concentrations of insulin, glucose, and leptin were also measured in the same samples. Calculated free testosterone (cFT) and bioavailable testosterone (bioT) were calculated from SHBG and TT. Basal hormonal levels including insulin, leptin, LH, FSH, SHBG, TT, glucose, and homeostasis model assessment scores were similar between the groups. However, bioT and cFT levels were significantly lower (p ? 0.05) in the mountain bikers than those in the controls. Despite the lower mean testosterone levels in the study group, the levels of LH and FSH were similar to controls. Insulin and leptin do not contribute to lower testosterone levels. In conclusion, male mountain bikers have lower testosterone concentrations compared to controls. This alteration cannot solely be explained by testicular dysfunction. The etiology of lower testosterone levels in cyclists appears to be complex and requires further research. The influence of such a decline on the athlete's performance, quality of life, and muscle strength is not known as yet. © 2011 National Strength and Conditioning Association.

Macroprolactinemia is often a cause of misdiagnosis, unnecessary expensive investigation, and unsuitable treatment. The aim of the present study was to investigate the clinical findings and the concentrations of macroprolactin in patients with hyperprolactinemia in our region. Eighty-four female hyperprolactinemic patients were screened for macroprolactinemia. Prolactin was measured by chemiluminesans method on an Immulite 2000 analyzer (Siemens Health Diagnostics, Deerfield, IL, USA). Recoveries less than or equal to 40% after polyethylene glycol precipitation were indicative of macroprolactinemia. Clinical features and biochemical values were compared in true hyperprolactinemic and macroprolactinemic patients. Macroprolactinemia was detected in 31 patients (36.9%), with 84 hyperprolactinemic female patients. There was no difference in frequency of galactorrhea and oligomenorrhea/ amenorrhea between the two groups. When we evaluated the clinical features of patients according to prolactin levels, no significant difference was found between the groups. In conclusion, our initial data show that no clinical features could reliably differentiate macroprolactinemic from true hyperprolactinemic patients, but at least one of these symptoms was present in most macroprolactinemic patients. © 2011 Published by Elsevier Inc.

WOS: 000274578300015, PubMed ID: 19718570, The prevalence of non-classic adrenal hyperplasia (NCAH) among Turkish women with hirsutism has not been established so far. Thus, we aimed to evaluate the prevalence of 21-hydroxylase (21-OH) deficiency by ACTH stimulation test among hirsute women. The study population consisted of 285 premenopousal women, aged 16-46 years (mean: 23.2 +/- 0.3). All were hirsute and hyperandrogenic. Androgen secreting tumors of the ovaries and the adrenal glands were excluded as well as thyroid dysfunction and hyperprolactinemia. All the patients were evaluated by 0.25 mg (i.v.) ACTH stimulation test and 17-OHP responses were obtained at 30 and 60 min. The diagnosis of NCAH due to 21-OH deficiency was considered in patients with the poststimulation 17-OHP level exceed 10 ng/ml. Six (2.1%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. The rest of the patients were polycystic ovary syndrome (n = 166, 58.2%) and idiopathic hyperandrogenemia (n = 113, 39.7%). There were no patients with idiopathic hirsutism because patients with normal serum androgen levels were excluded. This first and most extensive national study investigating NCAH prevalence among Turkish population showed that NCAH is not prevalent in this population., The Scientific and Technical Research Council of Turkey, TUBITAK [SBAG-3170], This study was supported by The Scientific and Technical Research Council of Turkey, TUBITAK, (SBAG-3170).

OBJECTIVE: To investigate the hypothalamic-pituitary-adrenal (HPA) axis via the insulin-tolerance test (ITT), standard-dose (250 mu g) ACTH test (SDT) and low-dose (1 mu g) ACTH test (LDT) in patients with ankylosing spondylitis (AS). DESIGN: The study group included 13 male patients with AS who were diagnosed according to the Modified New York criteria, and 8 healthy male subjects and was carried out at the Department of Physical Medicine and Rehabilitation, Erciyes University Medical School. ACTH stimulation tests were carried out by using 1 mu g and 250 mu g i.v. ACTH as a bolus injection, and blood samples were drawn at 0, 30 and 60 min. ITT was performed by using intravenous (i.v.) soluble insulin, and serum glucose and cortisol levels were measured before and after 30, 60, 90 and 120 min. All of the tests were performed consecutively with 3-day intervals, after an overnight fast. RESULTS: There were no significant differences between the patients with AS (mean age 36.9+/-6.7 years) and the healthy subjects (mean age 37.4 +/- 5.7 years) in terms of age. The basal cortisol levels in the AS group measured during LDT, SDT and ITT (556 +/- 204 nmol/l; 524 +/- 169 nmol/l; 418 +/-232 nmol/l, respectively) were comparable to the values of the control group (572 +/- 199 nmol/l; 520 +/- 182 nmol/l; 424 +/- 194 nmol/l, respectively). There were also no significant differences in peak cortisol responses between the two groups using LDT (patients 1025 +/- 339 nmol/l; controls 844 +/- 236 nmol/l), SDT (patients 1082 +/- 243 nmol/l; controls 1120 +/- 131 nmol/l) and ITT (patients 834 +/- 256 nmol/; controls 820 +/- 239 nmol/). CONCLUSION: In contrast with findings in other inflammatory diseases such as rheumatoid arthritis and polymyalgia rheumatica, the present data indicate that there is no apparent abnormality of the HPA axis activity in patients with AS.

Background: The metabolic syndrome is a cluster of cardiovascular risk factors and essential components of metabolic syndrome are hyperglycemia, hypertension, visceral obesity, hypertriglyceridemia and low high-density lipoprotein cholesterol. Oxidative stress plays a critical role in the pathogenesis of metabolic syndrome components and insulin resistance. The aim of this study was to investigate the role of oxidative stress, C-reactive protein and heat shock protein 70 levels in the pathogenesis of this disease. Methods: A total of 36 patients diagnosed with metabolic syndrome and 33 controls were included in the study. Malondialdehyde, carbonyl protein, C-reactive protein and heat shock protein 70 levels and xanthine oxidase and superoxide dismutase activities were measured in the serum of the subjects. Results: Mean serum malondialdehyde, carbonyl protein, C-reactive protein (p

This study was designed to determine if serum cystatin C (Cys C) levels are affected by metabolic syndome and whether they correlate with lipid peroxidation and total antioxidant status (TAS) in this disorder.Cases with metabolic syndrome diagnosed according to the ATP III criteria (18 females, 12 males) were compared with healthy control subjects (20 females, 17 males) matched by age and gender. Plasma Cys C, malondialdehyde (MDA), and TAS levels were studied.Compared with the controls, Cys C and MDA levels were significantly higher (p0.001 and p0.001, respectively), whereas TAS was lower (p0.001) in metabolic syndrome patients. A significant positive correlation between MDA and Cys C (r=0.308, p0.05) and a significant negative correlation between TAS and Cys C levels (r=-0.358, p0.01) were found.As Cys C and MDA levels increased but TAS decreased, Cys C may be an important indicator in the pathogenesis of metabolic syndrome.