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Giriş Hipogonadotropik hipogonadizm, gonadotropik hormonların farklı nedenlerle salınımındaki eksikliğe bağlı gelişen gonadal yetmezlik tablosudur ve önemli klinik sonuçlara yol açar. En önemli sebepleri arasında hipofizer hastalıklar yer almakta olup hipofize yönelik görüntüleme tanısal amaçlı önemli bir yere sahiptir. Biz bu çalışmada kliniğimizde son beş yılda takip edilen hipogonadotropik hipogonadizm tanılı erkek hastaların hipofiz MR (Manyetik Rezonans) görüntüleme sonuçlarını ve laboratuvar bulgularını inceledik. Materyal ve Metod 2017-2021 yılları arasında endokrinoloji polikliniğimize başvuran ve hipofiz MR görüntüleme sonuçları hastane bilgi işlem sisteminde mevcut olan hipogonadotropik hipogonadizm tanılı 56 hasta retrospektif olarak incelendi. Hastaların yaşları, geliş şikayetleri, hipofiz MR görüntüleme bulguları ve hormon düzeyleri irdelendi. IBM SPSS Versiyon 22.0 programı kullanılarak verilerin istatistiksel analizi yapıldı. Bulgular Hastaların yaş ortalaması 37.75 ± 10.95 olarak saptandı. Hastaların başvuru şikayetleri incelendiğinde en sık libido kaybı %37.5 (n=21) olduğu görüldü. %42.9 hastanın (n=24) hipofiz MR’ının normal saptandığı görüldü. Hastalar MR bulgularına göre alt gruplara ayrılarak hormon değerleri analiz edildiğinde “Makroadenom” grubunda “Mikroadenom” grubuna göre ortalama total testosteron düzeyi anlamlı olarak daha düşük saptandı (p < 0.05). Sonuç Hipogonadotropik hipogonadizm tanılı hastalarda hipofize yönelik görüntüleme yapılmasının özellikle laboratuvar bulgularına göre endikasyonları net olmayıp bu konuda yapılacak geniş kapsamlı çok merkezli çalışmalara ihtiyaç bulunmaktadır.

Giriş/Amaç:Kronik seyri ve hastalığın yönetimindeki zorluklar nedeniyle tip 2 diyabetli bireyler tamamlayıcı ve alternatif tedavi yöntemlerine sıklıkla başvurabilmektedir. Bu çalışmada, Tip 2 diyabetli bireylerde bitkisel destek kullanım sıklığı ve bitkisel destek kullanımı ile ilişkili etmenlerin ortaya konulması amaçlanmıştır.Gereç ve Yöntemler:Tanımlayıcı tipte planlanan araştırmaya, tip 2 diyabet tanısı almış toplam 193 yetişkin birey dahil edilmiştir. Veriler, yapılandırılmış bir anket kullanılarak yüz yüze görüşme yöntemi ile toplanmıştır.Bulgular:Çalışmaya katılan yaklaşık her üç kişiden birinin (%30,1) diyabetin yönetimi için bitkisel desteklere başvurduğu belirlenmiştir. Bitkisel destek kullanan bireylerin sırasıyla %25,9 ve %24,1?i tarafından kullanıldığı beyan edilen tarçın ve karışım ürünler en çok tercih edilen ürünler olmuştur. Ürünlerin temin edildiği yerlerin başında aktarlar (%50,7) gelmektedir. Bireylerin önemli bir kısmı kullandıkları bitkisel desteğe ilişkin araştırma yapmadığını (%82,8) ve kullandıkları ürün hakkında doktorlarına bilgi vermediğini (%81,0) bildirmiştir. Bitkisel destek kullanan bireylerin %67,3?ünün ürünleri komşu ya da tanıdık tavsiyesi üzerine kullanmaya başladığı kaydedilmiştir. Hem bitkisel destek kullanan (%79,3) hem de kullanmayanların (%67,4) büyük çoğunluğu bitkisel ürünlere yönelik sağlık çalışanlarından bilgi almak istediklerini bildirmişlerdir.Sonuç:Bu çalışmada diyabetik bireyler arasında bitkisel destek kullanımının yaygın olduğu ortaya konmuştur. Ürünlerin bilinçsiz kullanımını önlemek için sağlık çalışanlarının konuya ilişkin farkındalığının yüksek olmasının gerekli olduğu düşünülmektedir., Objective:Due to its chronic course and the difficulties in the management of disease, individuals with type 2 diabetes may frequently use complementary and alternative therapies. The aim of this study was to investigate the frequency of herbal supplement use and factors associated with it in individuals with type 2 diabetes.Methods:A total of 193 adults diagnosed with type 2 diabetes was included in this descriptive study. Data were collected with face to face interview method using a structured questionnaire.Results:It was detected that approximately one third of people (30.1%) participating in this study used herbal supplements in diabetes management. Cinnamon and mixed products, used respectively by 25.9% and 24.1% of herbal supplement users, were the most preferred products. The products were usually purchased from herbalists (50.7%). Majority of the individuals reported that they did not make a research for the product (82.8%) and did not give information to their doctors about the product they use (81.0%). Among 67.3% of the herbal supplement user indicated that they started to use the products with the recommendation of neighbors or acquaintances. Both the majority of the herbal product users (79.3%) and non-users (67.4%) stated that they want to get information from healthcare professionals for herbal products.Conclusion:This study revealed that the use of herbal supplements is common among individuals with type 2 diabetes. It is considered that health professionals should be aware of the issue in order to prevent misuse of the products.

Introduction Pituicytoma is a rare tumor of the pituitary gland derived from neurohypophyseal pituicytes. Case 1 A 58-year-old female presented with decreased vision; she was admitted to the neurosurgery department of Ege University after the detection of a pituitary macroadenoma. Magnetic resonance imaging (MRI) showed a 28 * 18 * 17-mm suprasellar mass, and laboratory tests revealed hypopituitarism. Hydrocortisone and L-thyroxine treatment were initiated, and the patient underwent resection through the endoscopic endonasal approach (EEA). The histopathological examination revealed a pituicytoma. The recurrence of tumor was detected during the 1-year follow-up, and the patient is awaiting surgery. Case 2 A 70-year-old woman presented with visual changes; she had a past medical history of hypophyseal macroadenoma and pituicytoma resected through an EEA in 2012 and 2017, respectively. During follow-up, 2 years after the second surgery, MRI showed progression of the pituicytoma then measuring 38 x 23 x 22 mm; it had invaded the cavernous sinus and was causing hydrocephaly and panhypopituitarism. The patient underwent the third resection through the transcranial approach in order to minimize bleeding. After this surgery, the patient developed diabetes insipidus and underwent treatment with desmopressin. Histopathological examination revealed a pituicytoma. At 6-month follow-up, imaging showed a sellar suprasellar mass 37 x 22 x 24 mm invading the cavernous sinus, indicative of recurrence. In the postoperative period, the patient applied to the department of radiation oncology to have fractionated radiotherapy. Discussion Pituicytomas are known to be low-grade tumors; because of their rarity, they are a real challenge. These patients should be followed up closely.

Purpose Vitamin D deficiency may cause glucose intolerance, diabetes mellitus, and metabolic syndrome. However, there are conflicting data the relationship between vitamin D levels and prediabetes in the literature. Our aim in this study is to evaluate serum 25-hydroxyvitamin D levels in prediabetic patients and to determine if vitamin D deficiency or insufficiency is a factor for developing prediabetes. Material and Method: Our study included a total of 220 patients, including 85 with isolated Impaired Fasting Glucose (IFG), 50 with isolated Impaired Glucose Tolerance (IGT), and 85 with combined IFG and IGT, and 80 healthy normoglycemic individuals similar in age, gender and BMI. Results The mean vitamin D levels between the patient group diagnosed as IGT and IFG+IGT and the control group were statistically significantly different (IGT: 11.69±6.48 ng/ml vs. control group: 16.63±9.78 ng/ml, p

Objective: Paget disease of bone (PDB) is a metabolic bone disease that has been rarely reported in the Eastern countries. This study aimed to evaluate the clinical and demographic characteristics of patients with PDB followed up at endocrinology clinics in Turkey. Methods: an invitation was sent to tertiary endocrinology clinics to complete a survey on the demographic, clinical, radiological, and laboratory parameters, as well as treatment modalities of patients with PDB. This study enrolled clinically and radiologically proven 185 patients with PDB from 18 endocrinology centers based in 10 cities of Turkey. Results: this cohort of PDB had female preponderance (women/men: 105/80) with a mean age, during diagnosis, of 57±10 years. Most of the patients (59.6%) were symptomatic at diagnosis. Bone pain and headache were the predominant clinical symptoms. Polyostotic disease was observed in 67.5% (n=125) of patients. Frequently affected bones were skull (41.6%), pelvis (53.5%), spine (41%), and femur (25.4%). Moreover, 17 patients with skull involvement had hearing loss. Mean serum alkaline phosphatase (ALP) level (552±652 IU/L; range: 280-5762 IU/L) was over the normal reference cutoff with normal serum calcium levels. Intravenous bisphosphonates (zoledronic acid, 5 mg; pamidronate, 60-90 mg) were the most used drugs (75%) for the treatment of PDB. Most of the patients (87.1%) treated with intravenous bisphosphonates responded well, with a decrease in serum ALP level (117±114 IU/L) in the 12th month of therapy. Furthermore, 16 patients relapsed after the second year of therapy; 3 patients did not respond to the initial intravenous bisphosphonate treatment. Conclusion: the patients with PDB followed up by endocrinology clinics of Turkey exhibited polyostotic disease with classical clinical, radiological, and biochemical features and women's predominance with good response to intravenous bisphosphonate therapy., NA

Background: Diabetes mellitus has been associated with many different musculoskeletal system problems. Objective: This study aims to show the prevalence of musculoskeletal disorders in patients with diabetes and to reveal their relationship to the metabolic parameters and microvascular complications. Methods: Seven hundred two diabetic patients who consecutively applied to our clinic between March 2017 and February 2018 were included in this prospective cross-sectional study. The relationship of the musculoskeletal disorders including carpal tunnel syndrome, Dupuytren’s contracture, adhesive capsulitis, flexor tenosynovitis, limited joint mobility syndrome, Charcot arthropathy, diabetic foot and gout to the patients’ age, gender, type of diabetes, duration of diabetes, metabolic parameters, and microvascular complications were evaluated. Results: Musculoskeletal system disorders were detected in 45.9% (n = 322) of the 702 diabetic patients evaluated in our study. The most common disorders were carpal tunnel syndrome 17.7% (n = 124), Dupuytren’s contracture 14.4% (n = 101), and adhesive capsulitis 13.8% (n = 97). A statistically significant relationship of the HbA1c level with Dupuytren’s contracture, carpal tunnel syndrome, and adhesive capsulitis was detected (p

Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149–100 ng/mL; and group 3, 99–88 ng/mL. A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88–455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1–13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p

In this manuscript, almost para-contact metric structures on 5 dimensional nilpotent Lie algebras are studied. Some examples of para-Sasakian and para-contact structures on five-dimensional nilpotent Lie algebras are given.

Bilgiye erisimin kolaylastigi gunumuzde, maalesef her birimiz zaman zaman; pratik, ayrintidan uzak ve hedefe yonelik bilgiye ulasmakta zorlanmisizdir. Elinizdeki bu eser, sahada birebir vaka gorup aktif calisan hekimlerimiz tarafindan kaleme alinmis olup kolay, anlasilir, ayrintidan uzak ve hedefe yonelik bilgileri vakalar uzerinden okuyucuya ulastirmayi hedeflemektedir. Aile hekimleri, ic hastaliklari hekimleri, endokrinoloji alaninda calisan ya da tiroid hastaliklari ile ilgilenen tum meslektaslarimizin ilgiile okuyup faydalanabilecegi bir kaynak olusturuldugu kanaatindeyiz. Siz degerli meslektaslarimizin geri bildirimleri ile bir sonraki baski ve eserde huzurlariniza daha oz guvenli cikmayi umuyoruz

Introduction. Fahr's syndrome is an infrequent disorder characterized by bilateral symmetrical calcification of basal ganglia and the cerebral cortex. It can be seen genetic, idiopathic, or secondary to endocrine diseases. This disease is related to different metabolic disorders particularly with diseases of the parathyroid gland. Case 1. A 63-year-old female patient applied to our clinic due to having hypoparathyroidism with bilateral basal ganglia calcification in head computed tomography(CT). She had subtotal thyroidectomy 25 years ago. in the neurological examination, mild symmetrical parkinsonism was determined. in laboratory examination Ca:8 mg/dL (8.6- 10.2), P:5.1 mg/dL (2.3-4.5), PTH:9.53 pg/mL (15-65) were detected. Calcitriol 0.25 mu/day was added to her treatment. Her parkinsonism disappeared after the treatment. Case 2. A 49-year-old male patient was consulted when he was admitted to the department of neurology in our hospital. the physical examination demonstrated the characteristics of Albright's hereditary osteodystrophy. the neurological examination shows bilateral symmetrical bradykinesia, dysphagia, and moderate dysarthria. in the laboratory examination PTH: 46.5 ng/L(15-65), Ca:8.6 mg/dL (8.6-10.2), P:2.7 mg/dL (2.3-4.5) were detected and were all within the normal ranges. Consequently, pseudopseudohypoparathyroidism was decided as a diagnosis. G protein alpha subunit mutation (Gs alpha) was not detected due to technical limitations. Conclusion. When a patient is diagnosed as Fahr's syndrome, we should keep in mind parathyroid disorders. Fahr's syndrome must be evaluated in patients showing intracranial calcification accompanied by parathyroid diseases.

WOS: 000435081200008, PubMed ID: 29722904, ObjectivesLipodystrophy syndromes are a group of heterogeneous disorders characterized by adipose tissue loss. Proteinuria is a remarkable finding in previous reports. Study designIn this multicentre study, prospective follow-up data were collected from 103 subjects with non-HIV-associated lipodystrophy registered in the Turkish Lipodystrophy Study Group database to study renal complications in treatment naive patients with lipodystrophy. MethodsMain outcome measures included ascertainment of chronic kidney disease (CKD) by studying the level of proteinuria and the estimated glomerular filtration rate (eGFR). Kidney volume was measured. Percutaneous renal biopsies were performed in 9 patients. ResultsSeventeen of 37 patients with generalized and 29 of 66 patients with partial lipodystrophy had CKD characterized by proteinuria, of those 12 progressed to renal failure subsequently. The onset of renal complications was significantly earlier in patients with generalized lipodystrophy. Patients with CKD were older and more insulin resistant and had worse metabolic control. Increased kidney volume was associated with poor metabolic control and suppressed leptin levels. Renal biopsies revealed thickening of glomerular basal membranes, mesangial matrix abnormalities, podocyte injury, focal segmental sclerosis, ischaemic changes and tubular abnormalities at various levels. Lipid vacuoles were visualized in electron microscopy images. ConclusionsCKD is conspicuously frequent in patients with lipodystrophy which has an early onset. Renal involvement appears multifactorial. While poorly controlled diabetes caused by severe insulin resistance may drive the disease in some cases, inherent underlying genetic defects may also lead to cell autonomous mechanisms contributory to the pathogenesis of kidney disease., NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [RO-1DK88114], NIH, Grant/Award Number: RO-1DK88114

Objective Familial partial lipodystrophy (FPLD) is a rare genetic disorder characterized by partial lack of subcutaneous fat. Methods This multicenter prospective observational study included data from 56 subjects with FPLD (18 independent Turkish families). Thirty healthy controls were enrolled for comparison. Results Pathogenic variants of the LMNA gene were determined in nine families. Of those, typical exon 8 codon 482 pathogenic variants were identified in four families. Analysis of the LMNA gene also revealed exon 1 codon 47, exon 5 codon 306, exon 6 codon 349, exon 9 codon 528, and exon 11 codon 582 pathogenic variants. Analysis of the PPARG gene revealed exon 3 p.Y151C pathogenic variant in two families and exon 7 p.H477L pathogenic variant in one family. A non-pathogenic exon 5 p.R215Q variant of the LMNB2 gene was detected in another family. Five other families harbored no mutation in any of the genes sequenced. MRI studies showed slightly different fat distribution patterns among subjects with different point mutations, though it was strikingly different in subjects with LMNA p.R349W pathogenic variant. Subjects with pathogenic variants of the PPARG gene were associated with less prominent fat loss and relatively higher levels of leptin compared to those with pathogenic variants in the LMNA gene. Various metabolic abnormalities associated with insulin resistance were detected in all subjects. End-organ complications were observed. Conclusion We have identified various pathogenic variants scattered throughout the LMNA and PPARG genes in Turkish patients with FPLD. Phenotypic heterogeneity is remarkable in patients with LMNA pathogenic variants related to the site of missense mutations. FPLD, caused by pathogenic variants either in LMNA or PPARG is associated with metabolic abnormalities associated with insulin resistance that lead to increased morbidity.

Aim: The detection rate of adrenal incidentaloma with the increasing use of imaging techniques has increased. In this study, we present the clinical features of our cases with adrenal incidentaloma. Materials and Methods: We investigated the data of the cases with adrenal incidentaloma admitted to Endocrine clinic of Ege University between February 2013 and February 2014. Age, sex, comorbidity, localization, size, function, operation method, histological findings were retrospectively recorded. Results: Out of 80 patients, 55 were female (68.7%) and 25 were male (31.3%). Mean age was 55.7±9.7 (30-72). Adrenal incidentaloma was often found between 50 and 60 years of age. In the localization analysis, 51.3% of adrenal mass was detected on the left side, 38.5% on the right and 10.2% was bilateral. When 76 out of 80 patients undertook a hormonal analysis, 73.7% of the adrenal masses were found to be non-functioning. 19.7% of our patients were diagnosed as subclinical Cushing syndrome (when threshold value was taken as 1.8μg/dL in 1mg dexamethasone suppression test-DST), 5.3% pheochromocytoma and 1.3% Conn syndrome. When threshold value was taken as 5μg/dL in 1mg DST, the rate of subclinical Cushing syndrome decreased to 2.6%. Out of 17 patients underwent adrenalectomy, it was observed in the ones with available medical reports that 10 patients were operated with laparoscopic and 5 with robotic surgery. In the pathological data analysis, there were 9 adenoma, 4 pheochromocytoma, 2 myolipoma and 1 oncocytoma. Conclusion: The features of our cases with adrenal incidentaloma were generally found to be in compliance with the the literature data. However, the number of the patients with subclinical Cushing syndrome after 1mg DST may vary according to threshold values. When threshold value was taken as 1.8 μg/dL in 1mg DST, specificity of the test may decrease., Amaç: Görüntüleme yöntemlerinin kullanımının artmasıyla birlikte adrenal insidentaloma tespit edilme oranı da artmıştır. Bu çalışmada adrenal insidentalomalı vakalarımızın klinik özelliklerini sunuyoruz. Gereç ve Yöntem: Şubat 2013 ve Şubat 2014 tarihleri arasında Ege Üniveristesi Endokrin polikliniğimize başvuran adrenal insidentalomalı hastalarımızın kayıtları incelendi. Yaş, cinsiyet, komorbidite, lokalizasyon, büyüklük, fonksiyon, operasyon şekli ve histolojik bulguları retrospektif olarak kaydedildi. Bulgular: Toplam 80 hastanın 55'i kadın (%68.7), 25'i erkekti (%31.3). Ortalama yaş 55.7 (30-72) olarak bulundu. Adrenal adenomların sıklıkla 50-60 yaş aralığında olduğu görüldü. Lokalizasyon açısından analiz yapıldığında, adrenal kitlelerin %51.3'nün solda, %38.5'nin sağda, %10.2'sinin bilateral olduğu tespit edildi. Verisi incelenen 80 hastadan hormonal taranması yapılan 76 hastanın verileri analiz edildiğinde; adrenal kitlelerin %73.7'sinin nonfonksiyone olduğu tespit edildi. Hastaların %19.7'sine subklinik Cushing sendromu (1 mg DST'nde eşik değer 1.8 μg/dL alındığında), %5.3'ünde feokromositoma, %1.3'ünde Conn sendromu tanısı kondu. Bir mg DST'nde eşik değer 5μg/dL alındığında subklinik Cushing sendromu oranı %2.6'ya geriledi. Adrenalektomi uygulanan 17 hastadan verilerine ulaşılabilen 10 hastada kapalı adrenalektomi ve 5'inde robotik cerrahi ile adrenalektomi uygulandığı görüldü. Patolojik verileri analiz edildiğinde; 9 adenom, 4 feokromositoma, 2 myelipoma ve 1 onkositom tespit edildi. Sonuç: Kliniğimizdeki adrenal insidentaloma vakalarındaki özellikler genel olarak literatür verisiyle uyumu bulunmuştur. Ancak subklinik Cushing sendromunda alınan tanı kriterine göre oran değişiklik gösterebilmektedir. Bir mg DST sonrası eşik değer 1.8 μg/dL alındığında testin spesifisitesi azalabilmektedir.

WOS: 000407338700010, 3-Sasakian manifolds in dimension seven have cocalibrated and nearly parallel G(2)-structures. In this work, cocalibrated G(2)-structure is deformed by one of the characteristic vector fields of the 3-Sasakian structure and a new G(2) structure is obtained whose metric has negative scalar curvature. In addition, the new G(2) structure has a nonzero Killing vector field. Then, by using this deformation, new covariant derivative on the spinor bundle is obtained and the new Dirac operator is written in terms of the Dirac operator before deformation.