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Introduction Ectopic ACTH secretion is a rare cause of endogenous hypercortisolism. Herein, a case of an immunhistochemically ACTH (+) adrenocortical adenoma with typical pheochromocytoma-like clinical and imaging findings on admission is presented. Clinical Case A 41 years-old male was admitted because of an incidentally detected adrenal mass. He complained about attacks of hypertension, headache and facial flashing that occurred unregularly for the last four years although he was on candesartan. Hypertension was common in his family with no sudden death. BMI was 36.61kg/m2, blood pressure was 130/80mmHg. The only pathologic finding was fire-red flashing at his face. Abdominal MRI exhibited a mass, 91×89×86mm in size, at left adrenal gland, compatible with pheochromocytoma. His 24 hours urinary metanephrine was 375.49mcg (44–261), normetanephrine was 786.26mcg (119–451). Routine laboratory tests, electrolytes were normal. Following two-weeks of preparation with hydration and doxazosin, an open-left adrenalectomy was performed safely. His postoperative follow-up was uneventful. Hypertension resolved completely. 24-hour urinary metanephrines returned to normal, 5-HIIA was normal, as well. Pathological examination of the operation specimen was reported as adrenocortical neoplasia, 420 gr. in weight. Only necrosis was positive considering about Weiss criteria. Chromogranin-A and synaptophysin were positive. Ki-67 index was below 1%. The unexpected pathological results alarmed us for measurement of adrenal steroids. DHEA-S was low [60.60mcg/dl (80–560)], total testosterone normal [3.08ng/ml (2.41–8.27)], early-morning cortisol was 9.56µg/dL. Short synacthen test was performed, stimulated cortisol was 12.14µg/dL, which was compatible with adrenal failure. Prednisolon 5mg/day was introduced. He was considered as adrenal Cushing syndrome and preoperative mildly high metanephrines were attributed to induction of Phenylethanolamine N Methyltransferase activity in adrenal medulla by high cortisol in neighbourhood. At follow-up visits, he seemed well with any complaints. His periodic abdominal imagings were normal. He was compliant to glucocorticoid replacement, but surprisingly his baseline cortisol levels kept being low, dropped to lower levels; even to 2.7mcg/dl. At third post-operative year, he still required prednisolon, his plasma ACTH was 320pg/ml and early-morning cortisol was 4.8mcg/dl. His baseline medical records were re-evaluated, contralateral adrenal seemed normal at diagnosis. ACTH immunohistochemical staining of operation specimen was performed and was found positive. Conclusion This case has serious take home messages. First, glucocorticoid axis should be evaluated for each adrenal mass regardless of clinical and imaging findings. Second, although it is very rare, ectopic ACTH secretion should be kept in mind in cases, who exhibit long-lasting adrenal failure with even worsening cortisol levels following adrenalectomy.

Background/aim Advanced chronic periodontitis is observed rarely in acromegaly. Periodontal tissue including the alveolar bone is seemed to be spared from the systemic metabolic derangements of bone in this patient population. Chronic elevation of growth hormone, IGF-1, and bone morphogenetic proteins may play a role in periodontal tissue regeneration in acromegalics. In this study, we aimed to evaluate the potential roles of local gingival bone morphogenetic proteins (BMP) in periodontal tissue pathology in acromegaly. Materials and methods Thirty-five patients with acromegaly and 22 healthy subjects were recruited. All the participants were examined by the same periodontologist for the diagnosis of periodontal diseases. BMP-2 and -4 were studied in gingival crevicular fluid. Results Gingival BMP-2 and BMP-4 levels were similar in acromegaly and control groups in general, with and without chronic periodontitis. For all the participants, gingival BMP-2 levels were statistically lower in those participants with chronic periodontitis then those without periodontitis (29.4 ± 11.2 vs. 41.2 ± 23.2, respectively, p = 0.027). Causal relation between the gingival BMP levels and periodontal tissue health status was tested with one way ANOVA which revealed a significant difference between gingival BMP- 2 levels in those with different degrees of periodontal tissue pathology (p = 0.025). When analyzed separately, gingival BMP-2 levels revealed a causal relation with the degree of periodontal pathology with borderline significance only in patients with acromegaly (p = 0.057). Conclusion Acromegaly is a disease with an unexpectedly low frequency of advanced periodontitis, irrespective of the long disease duration and pathognomonic oral manifestations. BMP-2 might have a protective role against chronic advanced periodontitis in these patients.

Purpose: Graves’ disease (GD) is an autoimmune disease that is the most common cause of thyrotoxicosis. Thyrotoxicosis can cause a decrease in platelet survival time. Inflammation is an important stimulus for platelets and mean platelet volume (MPV) could be used a diagnostic marker which is an important determinant of platelet activity. In this study we aimed to evaluate whether MPV would be a useful inflammatory marker for evaluation of disease activity in patients with Graves’ disease.Materials and Methods: Two hundred twenty-nine patients (GD patients (Group 1); n=102 and patients with euthyroid nodular goiter (Group 2); n= 127) were included in this retrospective study. Serum TSH, fT3, fT4 and MPV levels were recorded at presentation and at first euthyroid period under ATD treatment in GD patients and at presentation in patients with euthyroid nodular goiter.Results: The mean age was 40.3±13.5 in Group 1 and 50.2±11.6 in Group 2. Mean initial MPV level did not differ between groups; 8.3±1.2 fL and 8.3±1.1 fL, respectively (p=0.9). We found that mean initial MPV was higher than the first euthyroid period MPV in Group 1; Graves’ group (8.3±1.2 fL vs 8.0±1.3 fL, p= 0.02). Conclusion: Higher initial MPV levels in Graves patients and significant drop following the restoration of hyperthyroidism may be due to hypermetabolism of hyperthyroidism., Amaç: Graves hastalığı, tirotoksikozun en sık nedeni olup, otoimmün bir hastalıktır. Tirotoksikoz, trombosit yaşam süresinde azalmaya neden olan bir durumdur. İnflamasyonun trombositler için önemli bir uyaran olduğu bilinmektedir. Ortalama trombosit hacmi (MPV) ise trombosit fonksiyonlarının önemli bir belirleyicisi olup, çeşitli inflamatuar hastalıklarda tanısal bir belirteç olarak kullanılabileceği söylenmektedir. Bu çalışmada MPV’nin, Graves hastalarında, hastalık aktivitesini değerlendirmede yararlı bir inflamatuar belirteç olup olmadığnı değerlendirmeyi amaçladık.Gereç ve Yöntem: Bu retrospektif çalışmaya 229 hasta (Graves hastalığı olanlar (Grup 1); n=102 ve ötiroid nodüler guatr hastaları (Grup 2); n= 127) dahil edildi. Graves hastalarında başlangıçta ve antitiroid ilaç tedavisi ile ilk ötiroid oldukları anda, ötiroid noduler guatr hastalarında ise başlangıçta ölçülen serum TSH, fT3, fT4 and MPV değerleri kaydedildi. Bulgular: Hastaların ortalama yaşı Grup 1’de 40.3±13.5 ve Grup 2’de 50.2±11.6 idi. Başvuru anındaki ortalama MPV düzeyi gruplar arasında farklı değildi; sırasıyla 8.3±1.2 fL ve 8.3±1.1 fL, (p=0.9). Graves hastalarında (Grup 1), başlangıç MPV düzeyini, ilk ötiroid oldukları andaki MPV düzeyine göre daha yüksek olarak saptadık (8.3±1.2 fL vs 8.0±1.3 fL, p= 0.02). Sonuç: Graves hastalarında başvuru anındaki yüksek MPV düzeyinde hipertiroidizmin düzelmesi ile izlenen anlamlı düşüş, hipertiroidizm ilişkili platelet yıkımının artışına bağlı olabilir.

We aimed to determine the influence of diabetes mellitus (DM) on uropathogens and antibiotic resistance pattern in urinary tract infection (UTI) in our center. Three hundred fifty-five DM patients and 165 non-DM patients with UTI were included in this retrospective study. Urine samples were processed in the laboratory following standard protocol. Mean age was higher in DM group (63.9 ± 12.4 vs 59.6 ± 17.3 years, respectively, P = 0.001). Females showed much higher UTI prevalence in both groups (85.6% in DM vs 70.3% in non-DM group, P = 0.000). Mean HbA1c level on admission was 9.3% (78 mmol/mol). Mean duration of DM was 13.9 ± 8.5 yr. E.coli was the predominant uropathogen for both (67.3% in DM and 61.8% in non-DM group). Most isolated microorganisms were sensitive to nitrofurantoin (87.0% in DM, vs 83.6% in non-DM group, P = 0.265). Mean DM duration of higher than 10,5 years showed greatest risk of multidrug resistance (MDR) (AUC = 0.58, sensitivity of 63.7% and specificity of 50%, P = 0.019). Diabetic patients with UTI had poor glycemic control and long-standing DM. Nitrofurantoin was the most appropriate antimicrobial agent for empirical use. The MDR was higher in patients with DM lasting longer than 10.5 years. [Med-Science 2019; 8(4.000): 881-6]

The efficacy and safety of triglyceride (TG) apheresis in patients with type 2 diabetes mellitus (DM) is unclear. Diabetic complications may predispose patients to adverse events (AEs) associated with the apheresis procedure, and diabetic dyslipidemia may negatively affect the efficacy of therapeutic apheresis (TA). We investigated the effect of DM on the efficacy and complications of TA. Patients with severe hypertriglyceridemia who underwent apheresis for treatment or for the prevention of acute pancreatitis were included in this retrospective study. Epidemiological data, lipid parameters, and AEs were recorded before and after each therapeutic session. A total of 166 procedures were performed in 27 patients. Group 1 included 17 patients with type 2 DM, and Group 2 included 10 patients without DM. The mean percentage decrease in TG levels (TG%) was higher in Group 1 (71.9% vs 60.6%, P < .001). The TG% was negatively correlated with the duration of DM in Group 1 (r = -.49, P < .001). The total number of TA sessions was 142 in patients who underwent double filtration plasmapheresis and 24 in patients who underwent therapeutic plasma exchange. We observed 9 (5.4%) mild-to-moderate AEs. No intergroup difference was observed in the total number of AEs (P = .06). TA is safe and effective in patients with type 2 DM with severe hypertriglyceridemia.

Objectives: To describe biochemical and clinical features, and therapeutic outcomes of acromegaly patients in Turkey. Methods: Retrospective multicenter epidemiological study of 547 patients followed in 10 centers of the Turkish Acromegaly registry. Results: A total of 547 acromegaly patients (55% female) with a median age of 41 was included in this study. Majority of patients had a macroadenoma (78%). Transsphenoidal surgery was performed as primary treatment in 92% of the patients (n = 503). Surgical remission rate was 39% (197/503) in all operated patients. Overall disease control was achieved in 70% of patients. Remission group were significantly older than non-remission group (p = .002). Patients with microadenomas had significantly higher remission rates than patients with macroadenomas (p < .001). Patients with microadenomas were significantly older at the time of diagnosis when compared to patients with macroadenomas (p < .001). Preoperative growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were significantly lower in the remission group (p < .001). Initial IGF-1 and GH levels were significantly higher in macroadenomas compared to microadenomas (p < .001). Medical treatment was administered as a second-line treatment (97%) in almost all patients without remission. Radiotherapy was preferred in 21% of the patients mostly as a third line treatment. Conclusions: This is one of the largest real life studies evaluating the epidemiological characteristics and treatment outcomes of patients with acromegaly who were followed in different centers in Turkey. Transsphenoidal surgery in the treatment of acromegaly still remains the most valid method. Medical treatment options may improve long-term disease outcomes in patients who cannot be controlled with surgical treatment (up to 70%). C1 [Keskin, Caglar; Demir, Ozgur; Sahin, Mustafa; Emral, Rifat; Corapcioglu, Demet] Ankara Univ, Fac Med, Dept Endocrinol & Metab Dis, Ankara, Turkey. [Karci, Alper Cagri; Berker, Dilek] Ankara Numune Training & Res Hosp, Dept Endocrinol & Metab Dis, Ankara, Turkey. [Canturk, Zeynep] Kocaeli Univ, Fac Med, Dept Endocrinol & Metab Dis, Kocaeli, Turkey. [Yaylali, Guzin Fidan; Topsakal, Senay] Pamukkale Univ, Fac Med, Dept Endocrinol & Metab Dis, Denizli, Turkey. [Ersoy, Reyhan] Yildirim Beyazit Univ, Fac Med, Dept Endocrinol & Metab Dis, Ankara, Turkey. [Bayram, Fahri] Erciyes Univ, Fac Med, Dept Endocrinol & Metab Dis, Kayseri, Turkey. [Ertorer, Melek Eda; Bozkirli, Emre; Haydardedeoglu, Filiz] Baskent Univ, Adana Dr Turgut Noyan Training & Res Hosp, Dept Endocrinol & Metab Dis, Adana, Turkey. [Dilekci, Esra Nur Ademoglu] Abant Izzet Baysal Univ, Fac Med, Dept Endocrinol & Metab Dis, Bolu, Turkey. [Ay, Seyid Ahmet] GATA Haydarpasa Training Hosp, Dept Endocrinol & Metab Dis, Istanbul, Turkey. [Cansu, Guven Baris] Eskisehir Yunus Emre Hosp, Dept Endocrinol & Metab Dis, Eskisehir, Turkey.

Betatrophin is defined as a new marker in glucose homeostasis and lipid metabolism. We aimed to investigate the role of serum betatrophin in full-blown polycystic ovary syndrome (PCOS) patients and 47-aged healthy women, 51 full-blown PCOS patients were included in this cross-sectional study. Betatrophin concentrations were significantly lower in PCOS group and displayed a positive correlation only with serum tryglyceride in control group (p .05). A cutoff level (464.5 ng/L) was determined for betatrophin according to Receiver Operating Characteristic curve. Using this value, 64.7% of PCOS patients were classified as below the cutoff and in this group betatrophin was found to correlate negatively with fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (p = .038, p = .020, and p = .014, respectively), and positively with total testosterone (p = .041). In the rest of PCOS cases (35.3%) who had betatrophin higher than cutoff, positive correlation was found with low-density lipoprotein cholesterol (p = .009). In conclusion, betatrophin levels are reduced in full-blown PCOS patients who had worse metabolic phenotype.

Objectives: Detection rate of thyroid nodules is increasing with the use of new imaging modalities, especially in screening for malignancies. Positron emission tomography/computed tomography (PET/ CT)-positive thyroid nodules should be differentiated for malignancy to avoid unnecessary operations and further follow-up. Most trials evaluate the role of SUVmax, but there is no definitive information about the utility of Hounsfield unit (HU) values for prediction of malignancy. This study aimed to evaluate the HU values beside SUVmax for detecting malignancy risk of PET/CT-positive thyroid nodules. Subjects and methods: Results of 98 cancer patients who had fine needle aspiration biopsy (FNAB) for thyroid nodules detected on PET/CT between January 2011 and December 2015 were assessed. The FNABs and surgical pathological results were recorded. Results: FNABs revealed benign results in 32 patients (32.7%), malignant in 18 (18.4%), non-diagnostic in 20 (20.4%), and indeterminate in 28 (28.5%). Twenty-four patients underwent thyroidectomy. The mean HU values were not significantly different in benign and malignant nodules (p = 0.73). However, the mean SUVmax was significantly higher (p < 0.001) in malignant ones. Area under curve (AUC) was 0.824 for SUVmax; the cut-off value was over 5.55 (p < 0.001), with 80% sensitivity, 84.5% specificity. Conclusions: Our current study demonstrated that HU value does not add any additional valuable information for discriminating between malignant and benign thyroid nodules. We also defined a SUV cut-off value of 5.55 for malignant potential of thyroid nodules detected on PET/CT Arch Endocrinol Metab. 2018;62(4):460-5

Purpose: To evaluate bone mineral density (BMD) measurements and the presence of periodontitis in patients with acromegaly, as well as to inquire the impact of interfering factors. Material and Method: Forty-seven acromegalic patients with any accompanying condition known to affect calcium-bone metabolism and 60 age-matched healthy controls were included. Age, gender, duration and activity of acromegaly, past-present therapy options, pituitary hormone profiles, replacement therapies, and the results of periodontal analysis were recorded. Results: Eighteen patients were male (38.3%), 29 were female (61.7%). The mean age of the patients was 46.6±11.5 years, twenty-five (53.1%) had active, 22 (46.8%) had inactive acromegaly. The latter were older and had longer disease duration (p=0.04, p=0.003, respectively). Serum calcium and phosphorus levels, 24-hour urinary calcium excretion and BMD at the lumbar spine and femur neck insignificantly associated with disease activity (p>0.05). Osteoporosis was detected in 6 patients (12.76%). Periodontitis and advanced periodontitis were more common in control group (66.7% vs. 44.7%), (43.3% vs. 12.8%) (p=0.022, p=0.0001, respectively). There was no difference in chronic periodontitis and severity between active and inactive groups (48% vs. 40.9%; p=0.279). No difference was noted in other study parameters, as well. Repeated measures analysis of variance demonstrated statistically insignificant distribution between GH change in time and periodontitis subgroups. Discussion: We demonstrated that acromegaly exerted no clear negative impact on vertebral BMD in the absence of overt hypogonadism. Regardless of disease activity, acromegaly cases exhibited lower rates of periodontitis with less severity which remained unchanged in the presence of accompanying metabolic disorders known to have negative impact on periodontal tissue. Chronic exposure to excess GH may have a protective role against periodontitis. Turk Jem 2015; 19: 42-48

Objective: To evaluate the impact of mean platelet volume (MPV) on predicting disease course among patients with Graves’ disease (GD). Methods: This retrospective study was performed between 2013-2016 at the Outpatient Endocrinology Clinic of Baskent University Faculty of Medicine, Adana hospital on 65 patients with GD. Among participants, 30 cases experienced thyrotoxicosis again during the first six months after discontinuing anti-thyroid drug (ATD) sessions that had been carried out for at least 12 months prior to stopping (Relapse group). We also observed 35 patients who exhibited normal thyroid functions within six months following ATD withdrawal (Remission group). MPV levels and thyroid function tests were recorded and total duration of ATD therapy was calculated for all participants. Results: The mean MPV level that was measured at the time of drug withdrawal did not differ between groups, being 8.0±1.2 fL in the Relapse group vs. 8.0±1.0 fL in the Remission group (p=0.81). However, we found that the relapse MPV was higher than the withdrawal MPV in the Relapse group (9.2±1.3 fL) than it was in the Remission group (8.0±1.2 fL, p=0.00). Conclusions: Higher relapse MPV in Relapse group but similar MPV levels in both groups at ATD withdrawal may be attributed to hypermetabolism or hyperthyroidism rather than autoimmunity of GD. Abbreviations: BMI: Body mass index GD: Graves’ disease MPV: Mean platelet volume TSH: Thyroid-stimulating hormone TRAbs: Thyrotropin receptor antibodies ATD: Anti-thyroid drug fT4: Free thyroxine fT3: Free triiodothyronine CBC: Complete blood count PTC: Papillary thyroid carcinoma

Objective: Regular physical exercise has been shown to be substantial for health. For this purpose, walking on most days of the week is considered an appropriate choice. This study was de - signed to determine the rate of compliance to walking type exercise among healthy obese women and the results of 12-week exercise. Material and Methods: Six hundred and forty-eight healthy women aged 18-55 years with a body mass index (BMI) between 30-35 kg/m 2 and with adequate SF-36 scores for continuing physical activity were randomly assigned into a walking group (gr-I), a treadmill group (gr-II), a treadmill group supported by a visual apparatus (gr-III) and finally a fitness center group (gr-IV). The compliance of the subjects to walking was determined for a 12-week period. Body weight of the cases were mesured once at the beginning of the study and once at the end whereas the follow up was performed monthly. Results: The compliance from highest to lowest was in gr-I, followed by gr-III, gr-II and gr-IV and showed a significant fall during the three-month period for all groups. The weight loss was highest in gr-I and lowest in gr-III. Subgroup analysis showed that advanced age was associated with low compliance as well as low body weight loss. Conclusion: Ex - ercise prescription is needed to be established with respect to the compliance pattern of the obese, which may be related to safety, environmental and time-related factors. It should be kept in mind that age and rational use of time are important determinants of exercise compliance.

Insulin resistance, which provides a convenient milieu for platelet activation, has been closely associated with atherosclerotic disorders. Although it often accompanies hyperprolactinemia, findings conflict concerning its clinical impact in macroprolactinemia. In order to investigate the relationship between hyperprolactinemia and platelet activation evidenced by ADP-stimulated P-selectin expression on flow cytometry, we studied hyperprolactinemic, macroprolactinemic, and normoprolactinemic subjects. Thirty-four hyperprolactinemic and 44 age- and body mass index-matched euprolactinemic premenopausal women were included. They were matched regarding insulin sensitivity status, waist circumference, blood pressures, and plasma lipids. In order to detect macroprolactinemia among hyperprolactinemic cases, prolactin was measured before and after polyethylene glycol (PEG) precipitation in patients’ sera. P-selectin expression was significantly higher in the hyperprolactinemic group (P = 0.001), and 41.2% of them exhibited macroprolactinemia. Expression of P-selectin was comparable between the macroprolactin-negative (monomeric hyperprolactinemia; n = 20) and -positive (n = 14) subgroups (P = 0.90). Both subgroups showed greater expression compared with normoprolactinemic controls (P = 0.014 and 0.005, respectively). Platelet activation accompanies the atherosclerotic disorders closely associated with insulin resistance. Among groups matched with regard to insulin-sensitivity markers, both monomeric hyperprolactinemia and macroprolactinemia appeared to promote platelet activation.

Women with familial hypercholesterolemia (FH) should be treated effectively during pregnancy, as elevated low-density lipoprotein cholesterol (LDL-C) levels may result in life-threatening consequences. Hydroxymethylglutaryl-coenzyme A reductase inhibitors are contraindicated during pregnancy, therefore LDL apheresis should be considered in the management of such pregnant cases. There are five different methods of selective LDL apheresis: heparin-induced extracorporeal LDL precipitation, double filtration plasmapheresis, direct adsorption of lipoproteins, dextran sulfate adsorption, and LDL immunoadsorption. The cascade filtration system is another modern and effective method for the extracorporeal elimination of LDL-C, although it is not as selective as the methods mentioned above. Herein, we present the case of a pregnant woman with heterozygous FH and extremely elevated LDL-C levels who has been successfully treated with the cascade filtration system until delivery. As far as we can ascertain, LDL apheresis with the cascade filtration system during pregnancy has not yet been reported in the literature.

Kocer, Abdulkadir/0000-0003-2866-555X; WOS: 000252532800023 PubMed: 17897330 Objective Thyrotoxic hypokalaemic periodic paralysis (THPP) is an uncommon condition with intermittent episodes of muscle weakness and occasionally severe paralysis. THPP is a common complication of hyperthyroidism in Asian populations, and has also been reported in other ethnic groups including Caucasians. This study aimed to conduct an analysis of THPP in a Turkish population, and is to our knowledge the first analysis of a homogeneous Caucasian group. Subjects Forty cases with THPP were identified in the Turkish population. Three out of the 40 were new cases and were assigned as index cases. Two cases were not included in the analysis because of lack of data. Results THPP was diagnosed in 10 cases during the first attack and was observed to have a significant shorter complete recovery time statistically in this group (P < 0.01). The majority of cases were hypokalacmic, while there were two normokalaemic cases. Classification of the cases according to their potassium (K) levels revealed that the group with K levels < 2.5 mEq/l had a statistically longer amelioration time than the group with K levels >= 2.5 mEq/l. When the cases were classified according to intravenous or oral application of K, the mean amelioration time was 6.8 +/- 3.6 h for the intravenous group and 13.1 +/- 7.6 for the oral group. Mean complete recovery times of the groups were 29.4 +/- 16.2 h and 52.8 +/- 18.0 h, respectively. The intravenous group had a shorter amelioration time and complete recovery time, and both were statistically significant (P < 0.05 for each). Conclusions THPP may be seen among Caucasians. Diagnosing THPP during the first attack might decrease the recovery time. The level of hypokalaemia seems to affect the recovery time and initial low K levels may lead to more deterioration in a patient's health compared with mild or near-normal levels. Intravenous, rather than oral, application of K may be advantageous for shortening both the amelioration and complete recovery times.

Objective: Increased QT interval dispersion (QTd) is an electrocardiographic parameter shown to be associated with malignant ventricular arrhythmias and sudden death, and QT dispersion corrected for heart rate (QTc) has emerged as a potentially important predictor of cardiac death. Increased QTd has been detected to be directly related to thyroid-stimulating hormone (TSH) levels in overt hypothyroidism, however not much is known about subclinical hypothyroidism (SH). This study was conducted to investigate the QTc in SH and determine the changes following normalization of TSH levels with L-thyroxine. Subjects and Methods: Fifty-eight women with naive SH due to Hashimoto’s thyroiditis, mean age 39.37 ± 10.43 years, and 54 age-, sex- and weight-matched controls with normal TSH were included after exclusion of any factor that might interfere with cardiac conductibility. Electrocardiographic measurements were performed with a magnifier and Bazett’s formula was used to calculate QTc. The patients were separated into two groups regarding basal TSH levels (subgroup A: 5 > TSH > 10 mIU/l, n = 36; subgroup B: TSH > 10 mIU/l, n = 22). L-Thyroxine 1–2 µg/kg/day was administered to subgroup B. Results: Mean QTc interval of the study group was significantly longer than that of the control group (100 ± 30 vs. 76 ± 30 ms, p = 0.000). It was also longer in subgroup A (5 > TSH > 10 mIU/l, n = 36) and subgroup B (p = 0.001, p = 0.000, respectively). In subgroup B, following normalization of serum TSH, mean post-treatment QTc measurement was similar to that of the control group (75 ± 40 vs. 76 ± 30 ms, p > 0.05). Conclusion: We detected prolonged QTc among SH cases. Prolongation remained significant for the whole group as well as the two subgroups. The differences in QTc were corrected when TSH levels of >10 mIU/l returned to normal.

PubMedID: 14740277 The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of ?70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187-13.659), hypertension (OR=5.564; 95% CI, 1.446-21.400) and retinopathy (OR=3.766; 95% CI, 1.096-12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.

SummaryObjective Recent studies have shown close association between serum Immunoglobulin G4 (IgG4) levels and forms of autoimmune thyroiditis. However, there are limited data about the relationship between IgG4 and Graves’ ophthalmopathy (GO). In the present study, we aimed to determine the possible association between IgG4 and GO. Design Cross-sectional study. Patients Sixty-five patients with Graves’ disease (GD) and 25 healthy controls were recruited into the study. Thirty-two of these patients had GO. Measurements Serum IgG4 levels, thyroid functions and thyroid volumes were measured in all participants. Ophthalmological examination including Hertel's exophthalmometer readings (HER), Schirmer's test (ST), ‘NO SPECS’ classification and clinical activity score evaluation (CAS) were performed to all patients with GD. Results IgG4 levels were significantly elevated in patients with Graves’ disease compared to controls (P = 0·0001). Also, IgG4 levels were significantly higher in patients with and without GO when compared to control subjects (P = 0·0001 and P = 0·002, respectively). Furthermore, IgG4 levels were significantly higher in the GO group compared with GD patients without GO (P = 0·024). IgG4 levels were observed to increase in parallel to CAS. Compared with other GD patients, 15 GD patients with serum IgG4 levels ≥135 mg/dl had higher CAS scores (P = 0·012). None of the factors including, TSH, T3, T4 levels, thyroid volume, HER and ST measurements, affect IgG4 levels as an independent factor. Conclusion IgG4 levels are evidently increased in patients with GD, and there is a possible relationship between IgG4 and GO. Our results suggest that IgG4 may be helpful in screening GD patients with high risk for GO and may well become a good indicator for the selection of right medication in the future.

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.

To determine prevalence of newly diagnosed hyperglycemia (NDH) among patients with acute coronary disease, inquire relationship of stress hyperglycemia (SH) with functional outcomes.Admission (APG) and first morning fasting plasma glucose (FPG) measurements were obtained, capillary glucose measurements (CGM) every 6-h within first day were performed-Group 1: Normoglycemics. Group 2: NDH cases: No known diabetes, APG200mg/dl and/or FPG126 and/or any of CGM200. Group 2a: unrecognized glycemic disorder, HbA1c6.0%. Group 2b: stress hyperglycemia, HbA1c6.0%. Group 3: Recognized diabetes. Duration of ICU stays, APACHE-II scores were recorded. Logistic regression analysis was performed using ICU stay as dependent variable and age, groups, co-morbidities, problems in hospital, APACHE-II scores, CGMs were used as independent risk factors.There were 255 (51.6%) in Group 1, 82 (16.6%) in Group 2; 37 (7.5%) cases in Group 2a, 45 (9.1%) in Group 2b and 157 (31.8%) in Group 3. Group 2b spent longer time in ICU, had higher APACHE-II scores (p=0.0001, p=0.0001). Regression analysis demonstrated SH as an independent risk factor for duration of ICU stay (OR: 2.8, 95% CI: 1.3-6.2).Hyperglycemia was present in 48.4%; 16.6% had NDH, 9.1% had SH. Poor functional conditions of SH cases pointed that they need to be considered carefully.

Women with familial hypercholesterolemia (FH) should be treated effectively during pregnancy, as elevated low-density lipoprotein cholesterol (LDL-C) levels may result in life-threatening consequences. Hydroxymethylglutaryl-coenzyme A reductase inhibitors are contraindicated during pregnancy, therefore LDL apheresis should be considered in the management of such pregnant cases. There are five different methods of selective LDL apheresis: heparin-induced extracorporeal LDL precipitation, double filtration plasmapheresis, direct adsorption of lipoproteins, dextran sulfate adsorption, and LDL immunoadsorption. The cascade filtration system is another modern and effective method for the extracorporeal elimination of LDL-C, although it is not as selective as the methods mentioned above. Herein, we present the case of a pregnant woman with heterozygous FH and extremely elevated LDL-C levels who has been successfully treated with the cascade filtration system until delivery. As far as we can ascertain, LDL apheresis with the cascade filtration system during pregnancy has not yet been reported in the literature.

Papillary microcarcinoma (PMC) is a thyroid tumor measuring 10mm or less in maximum diameter and comprise up to 30% of all papillary thyroid cancers. Most of them are detected incidentally and defined as incidental papillary microcarcinoma (IPCor=10mm). The incidence of such incidental cancers found in surgical specimens of benign thyroid diseases is high. Although most PMC are incidental, all incidental papillary cancers cannot be classified as microcarcinoma, owing to their size that may be larger than 10mm. Not much is known about the biological behavior and clinical course of IPCor=10mm. There is an ongoing discussion among endocrinologists, endocrine surgeons and nuclear medicine specialists about the optimal therapeutic strategy for the patients with IPCor=10mm. Some investigators advocate in favor of not performing further treatment in addition to initial thyroid surgery, whereas others suggest an aggressive surgical approach followed by radioiodine ablation therapy. Randomized prospective trials of observation versus standard thyroid cancer care are required to high-lighten this dilemma.

Aim of this prospective study is to evaluate the effect of repaglinide t.i.d. (three times a day) plus single-dose insulin glargine regimen in low-risk type 2 diabetic patients during Ramadan fasting. Participants had been taking the regimen for at least 3 months. Patients with a history of diabetic coma, severe hypoglycemic crisis or repeating attacks of hypoglycemia were excluded. Hypoglycemic unawareness, kidney or liver disease or HbA1c over 8% were also accepted as exclusion criteria. Eleven patients who insisted on this worship and eight non-fasting cases were involved. All were told to make home-glucose-monitorisation weekly and report any hypoglycemic event throughout Ramadan. Fasting blood glucose (FBG), post-prandial blood glucose (PBG) and fructosamine levels, body weights and blood pressures were recorded just before and after Ramadan. Seven patients in each group concluded the follow-up. Any significant change was detected in the parameters in either groups (P > 0.05). Glucose control remained unchanged; fructosamine 318.14 ± 65.38 versus 317.28 ± 52.80 mmol/L in fasting group, 290.71 ± 38.48 versus 290 ± 38.56 mmol/L in non-fasting group. None of them exhibited either a major or a minor hypoglycemic event. The results of this pilot study indicated that repaglinide t.i.d. plus single-dose insulin glargine regimen was safe for low-risk type 2 diabetic patients who insisted on fasting during Ramadan.

To evaluate the short-term effects of Lanreotide Autogel on insulin sensitivity markers among acromegalic patients with pituitary tumors.Prospective clinical trial with six months of follow-up.A tertiary endocrinology clinic.Naïve patients (patient No. 1 and patient No. 3) and patients who experienced prior somatostatin analogue treatment (patient No. 2, patient No. 4, and patient No. 5) were included. Before and after 6 months of Lanreotide Autogel therapy, insulin sensitivity in each subject was determined using homeostasis model assessment of insulin resistance and beta-cell function formula. Euglycemic hyperinsulinemic clamp test was also performed to evaluate whole insulin sensitivity and was indicated as an 'M' index.All patients experienced reduction in their HOMA-beta. We noted major HOMA-beta decreases accompanied by pronounced increases in M indices for patients Nos. 1, 2 and 3 (1.03 vs. 8.22, 2.98 vs. 4.70, and 5.09 vs. 13.09, respectively). The increases in M indices of these patients were with marked decreases in GH levels (34.20 vs. 15.30 microg/l, 4.25 vs. 0.74 and 5.0 vs. 0.66 ng/mL, respectively). Minor decline in HOMA-beta and worsened M index and almost stable GH were observed in patients Nos. 4 and 5. Except for patient No. 3, all participants showed declining HOMA-IR.Short-term Lanreotide Autogel treatment has been observed to improve M indices of acromegalic patients whose GH levels exhibited marked reduction. This amelioration seemed to be related to decreases in GH levels rather than to a direct drug effect.

Our aim was to determine the relationship between body fat percentage (BF%) and body mass index (BMI) and to evaluate the validity of World Health Organisation's BMI cut-off values for obesity. Adult out-patients (n=909, 249 men, 660 women), mean age; 40.5 +/- 14.1 years were included. According to WHO's BMI criteria, 440 subjects were obese (79 men, 361 women). The BF% of participants were measured using a bioelectrical impedance analysis (BIA) system (TANITA). Randomly selected 30 patients were also subjected to the dual-energy X-ray absorptiometry (DEXA) procedure for evaluation of the validity of TANITA measurements. The BF% results obtained by DEXA and TANITA revealed good correlation (r =0.952, p= 0.382). There was a positive correlation between BF% and BMI (p0.001) for both methods. Cut-off values for BMI were calculated as 28.0 kg/m2 for women, 28.2 kg/m2 for men, if obesity was defined as BF= 25% in men,= 35% in women according to WHOfs criteria. Using the new cut-off values, the frequency of obesity increased up to 33.9% in our group. The increase was more pronounced in men (67.1% vs. 26.6%). The WHO cut-off values underestimated the frequency of obesity in this population. Further studies are warranted for different ethnic groups.

Background: Strontium ranelate (SR) is a new antiosteoporotic agent with antiresorptive and bone-forming properties. The exact mechanism by which SR exerts its effects is not clearly understood. Bone resorption requires interaction between osteoblasts and osteoclasts. Osteoblasts produce a ligand for receptor activator of nuclear factor-κB (RANK). They also secrete osteoprotegerin, a decoy protein that blocks the interaction of RANK with its ligand, thereby inhibiting the differentiation and activity of osteoclasts. SR also has been associated with osteoblast proliferation and decreased osteoblast-induced osteoclast differentiation via increased osteoprotegerin messenger RNA expression in human osteoblasts. Objective: The aim of this study was to investigate the relationship between SR treatment and serum osteoprotegerin concentration in women with post-menopausal osteoporosis (PMO). Methods: This open, prospective study was conducted in women admitted to the outpatient endocrinology clinic of Baskent University Faculty of Medicine, Adana Medical Center, Ankara, Turkey, for the evaluation of PMO. Women with PMO who enrolled were administered elemental calcium 1000 mg/d and vitamin D 800 IU/d for 1 month before the study period. After obtaining baseline serum samples for determining osteoprotegerin concentrations, patients were assigned to the treatment or control groups at a 5:2 ratio and SR 2 g/d was administered to the treatment group. The control group continued to receive only calcium and vitamin D. Serum osteoprotegerin concentration was measured again after 3 months of treatment. Results: Thirty-five women (treatment group: n = 25; mean [SD] age, 59.80 [7.38] years; control group: n = 10; mean [SD] age, 56.60 [5.06] years) enrolled in the study. A total of 32 women—24 in the treatment group and 8 in the control group—completed the study. Compared with baseline, mean [SD] serum osteoprotegerin concentration did not change significantly after 3 months in either the treatment group (4.91 [1.24] pmol/L vs 4.71 [1.19] pmol/L) or the control group (5.36 [2.82] pmol/L vs 5.10 [2.19] pmol/L). Conclusion: The results of this small study found that serum osteoprotegerin concentrations were not significantly changed by SR treatment for 3 months among women with PMO.

Recently, the term of "possible" polycystic ovary syndrome (PCOS) has been used for defining cases in which biochemical evaluations are incomplete but clinical phenotypes are suggestive of PCOS. The aim of this study was, by using Rotterdam 2003 criteria, to detect possible PCOS cases and compare their characteristics and insulin sensitivity status with confirmed PCOS subjects. One-hundred-eighteen women who admitted with complaints and symptoms suggesting PCOS were included. Insulin sensitivity status of the cases was calculated with Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Cases fulfilling Rotterdam 2003 criteria were defined as confirmed PCOS, whereas indeterminate subjects as possible PCOS. Confirmed PCOS was detected in 70 (59.3%) and possible PCOS in 48 (40.7%) cases. Confirmed PCOS was most prevalent among subjects with hirsutism and menstrual dysfunction; 32 (80.0%) vs. 8 (20%), (p=0.000). Body mass index and HOMA-IR values did not differ between groups: confirmed PCOS versus possible PCOS; 25.46+/-5.55 kg/m(2) vs. 26.75+/-7.55 kg/m(2), 3.37+/-4.12 vs. 3.21+/-2.50, (p>0.05). Family history of type-2 diabetes mellifus was similar within both groups (p>0.05). Many PCOS patients seem to be undiagnosed due to inadherence to diagnostic work-up and/or to not fulfill Rotterdam 2003 criteria. These criteria may not be sufficient to cover the entire spectrum of PCOS.

Objectives Controversy remains as to the effects of type 2 diabetes on bone metabolism. The aims of this study were to assess the association between type 2 diabetes and bone mineral density (BMD) and to evaluate the possible relationship between chronic diabetic complications and bone density. Methods Bone mineral densities at the lumbar spine, femur, and radius in 206 postmenopausal Turkish women with type 2 diabetes were evaluated by dual-energy X-ray absorptiometry and compared with those in 61 age-matched postmenopausal nondiabetic women. Medical and lifestyle characteristics, body mass index (BMI), hemoglobin A 1c level, and status of microvascular and macrovascular diabetic complications were recorded. Frequency of osteoporosis and that of osteopenia as well as the relationship between microvascular and macrovascular complications and BMD were evaluated. Results The groups did not differ on BMDs and T scores at the hip, lumbar spine, and radius. Patients with radial and/or lumbar and/or hip osteoporosis had a longer duration of diabetes ( P =.000), were older ( P =.000), and had a lower BMI ( P =.000). No correlation was found between osteopenia or osteoporosis and hemoglobin A 1c level, presence of microalbuminuria, retinopathy, neuropathy, peripheral artery disease, cerebrovascular event, and coronary artery disease. Among the three sites, BMD at the hip was positively correlated with BMI ( P =.000) but negatively correlated with age ( P =.000) and duration of diabetes ( P =.000). Presence of microalbuminuria revealed a negative correlation with BMD at the femoral neck ( P =.042). Conclusion There is no evidence that type 2 diabetes influenced BMD in our postmenopausal patient group.

OBJECTIVE—To determine the prevalence of diabetes and glucose intolerance and their relationship with risk factors in Adana, a southern province of Turkey, where risk factors are more prominent, probably because of social and economic reasons. RESEARCH DESIGN AND METHODS—The study population included 1,637 randomly selected adults aged 20–79 years. Diagnosis of diabetes was based on plasma glucose values using the 1999 diagnostic criteria recommended by the World Health Organization. RESULTS—The crude prevalence of diabetes was 12.9% in men and 10.9% in women (P = 0.207). Total prevalence of diabetes was 11.6%. The screening process identified previously undiagnosed diabetes in 4.2% of individuals and impaired glucose homeostasis (consisting of impaired glucose tolerance and impaired fasting glucose) in an additional 4.3% of subjects. The prevalence of hypertension was 26.4% among men and 36.6% among women (P < 0.0001). Total prevalence of hypertension was 32.9%, and prevalence of obesity was 43.4%. Age, sex, BMI, waist circumference, hypertension, family history of diabetes, and triglycerides were independently associated with diabetes. CONCLUSIONS—The prevalence of diabetes in Adana is higher than expected in both urban and rural areas. Obesity and hypertension also seem to be common metabolic disorders in this area. Age, hypertension, obesity, high triglyceride level, and family history of diabetes are independently associated with diabetes. Therefore, primary prevention through lifestyle modifications may have a critical role in the control of diabetes.

Background: We aimed to evaluate plasma viscosity in subjects with polycystic ovary syndrome (PCOS) and detect its relationship with cardiovascular risk factors. Materials and Methods: A total of 96 newly diagnosed women with PCOS aged between 17 and 30 years, along with 67 age, sex, and body mass index matched healthy control subjects were recruited in the study. The diagnosis of PCOS was based on revised 2003 Rotterdam consensus criteria. Plasma viscosity, hormonal and metabolic parameters were measured. Plasma viscosity was measured using a Brookfield DV-II Pro viscometer at 37°C. Results: Total testosterone, luteinizing hormone, plasma viscosity, and fibrinogen levels were significantly higher in women with PCOS ( P 0 P r = 0.223, P Conclusions: Plasma viscosity is an important hemorheologic variable and directly determines the blood flow at the microcirculatory level. High plasma viscosity indicates increased resistance to blood flow at the tissue level. Because of direct contact of endothelial cells to plasma, high plasma viscosity seems to associate with endothelial dysfunction. In this study, we clearly demonstrated that plasma viscosity was elevated in patients with PCOS, probably indicating that they had higher cardiovascular risk.

Objective: Insulin treatment is mandatory for some diabetic patients. Although physicians explain the advantages and essentiality of insulin therapy, patients may refrain from using it due to the pain factor. The aim of this study was to determine the level of pain perceived with 4 and 8 mm insulin needles on a group of diabetic patients with respect to age, gender and body mass index (BMI). Methods: 296 diabetic patients (165 female, 131 male) under insulin therapy were recruited in the study. Patients rated pain associated with the injection of both needles according to a 100 mm visual analogue scale (VAS). Results: The perceived pain was higher with 8 mm needles with respect to age, BMI and gender. The perceived pain increased with age with both needles but was more intense with 8 mm. Pain was positively associated with BMI with 4 mm needles, whereas for 8 mm needles it showed high intensity regardless of BMI. Gender was not found to be an effective factor for perceived pain. Conclusion: Although pain is unique for everyone, primary care health givers need to consider altering insulin needles to shorter ones. It may keep patients comply with the regimen and even if compliance exists it may help with the clinical results.