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Context Dopamine agonist (DA)–induced impulse control disorder (ICD) represents a group of behavioral disorders that are increasingly recognized in patients with prolactinoma. Objective We aimed to examine the genetic component of the underlying mechanism of DA-induced ICD. Methods Patients with prolactinoma receiving dopamine agonist (cabergoline) treatment were included in the study. These patients were divided into 2 groups: patients who developed ICD due to DA and patients who did not. Patients were evaluated for polymorphisms of the DRD1, DRD3, COMT, DDC, GRIN2B, TPH2, OPRK1, OPRM1, SLC6A4, SLC6A3, HTR2A genes. Results Of the 72 patients with prolactinoma using cabergoline, 20 were diagnosed with ICD. When patients with and without ICD were compared according to genotype frequencies, OPRK1/rs702764, DRD3/rs6280, HTR2A/rs6313, SLC6A4/rs7224199, GRIN2B/rs7301328, TPH2/rs7305115, COMT/rs4680, DRD1/rs4532 polymorphisms significantly increased in patients with DA-induced ICD. Conclusion Our results show that multiple neurotransmission systems affect DA-induced ICD in patients with prolactinoma.

PURPOSE: Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided breast irradiation. The purpose of this study is to evaluate the reproducibility and variability of breath-hold level (BHL) using breath-hold curves and lateral kV setup images together. MATERIAL/METHOD: A retrospective analysis of 30 left breast cancer patients treated using the v-DIBH technique in our department is performed. The BHL difference is measured from breath hold curves and lateral (LAT) kilo-Voltage (kV) setup images. The planning CT image and the selected treatment fraction data are collected. If the changes in BHL relate to the displacement of various bones in the kV setup, images are assessed. Furthermore, the maximum heart distance inside the treatment field is compared from LAT MV portal images. RESULTS: The median and mean values of the BHL are nearly identical in different fractions (good reproducibility). However, the mean BHL values between planning and all measured fractions are statistically different; 16.3 vs. 20.8 mm for the planning and measured fractions (p

Purpose: Various problems related to the gender-affirming therapy (GAT) can adversely affect both the physical and mental health of people diagnosed with gender dysphoria (GD). In this study, we aimed to highlight the reasons for loss to follow-up during the gender-affirming hormone therapy (GAHT), which is an important component of GAT. Methods: People diagnosed with GD who were followed for GAHT between January 2014 and June 2019 (female-to-male: 349; male-to-female: 89) were enrolled. The prepared questionnaire was administered to participants at routine follow-up visits. We arranged tele-interviews for those who did not attend the follow-up visits. Results: During GAHT process, the health problems most frequently reported by people diagnosed with GD were related to mental health. The most important factors in regular follow-up were the completion of legal procedures in Turkey required for GAT and citizenship alteration, financial barriers, lack of time for clinical visits, and dissatisfaction with health care setting. In addition, we found that the frequency of desire for supervised GAHT and family support were higher in regularly followed people diagnosed with GD. On the contrary, self-initiation of GAHT and mental disorders were more common in people diagnosed with GD lost to follow-up. Conclusion: The present study provides important information regarding the reasons for loss to follow-up during GAT in Turkey. Elucidation of reasons for loss to follow-up can aid in identifying the gaps in medical care, improve compliance, and outcomes of people diagnosed with GD.

The purpose of this study was to determine possible cut-off levels of basal DHEA-S percentile rank in the differential diagnosis of patients with Cushing’s syndrome (CS) with ACTH levels in the gray zone and normal DHEA-S levels. In this retrospective study including 623 pathologically confirmed CS, the DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within reference interval. The patients were classified as group 1 (n=265 Cushing’s disease; CD), group 2 (n=104 adrenal CS) and group 3 (n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate the optimal cut-off level of DHEA-S percentile rank in the reference interval in the differential diagnosis of CS, and the effectiveness of this cut-off level in the identification of the accurate etiology of CS was assessed in patients who were in gray zone according to their ACTH levels. The DHEA-S percentile rank in the reference interval were significantly lower in group 2 compared to the other two groups (p This study showed that the cut-off value of DHEA-S level less than 20% of the reference interval could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, and it should be taken into the initial evaluation.

Aim: Various parameters are used to differentiate between complicated-uncomplicated appendicitis cases and even scoring systems are created where these parameters are used together. The aim of this study is to evaluate the effectiveness of one of these scoring systems by external validation.Method: Retrospective evaluation was performed on the clinical, radiological and laboratory findings of patients who underwent appendectomy between January 2018 and January 2021. Scoring was performed using the previously described scoring systems for each patient considered to have acute appendicitis as a result of imaging. They were divided into complicated appendicitis and uncomplicated appendicitis groups according to clinical and pathological evaluation results.Results: While evaluating 425 patients, ultrasonography was used in 48% and tomography in 52% of the patients. Significant effectiveness of the score of ≤6 was observed in the group using tomography (p

Hypophysitis is a heterogeneous condition that includes inflammation of the pituitary gland and infundibulum, and it can cause symptoms related to mass effects and hormonal deficiencies. We aimed to evaluate the potential role of machine learning methods in differentiating hypophysitis from non-functioning pituitary adenomas.The radiomic parameters obtained from T1A-C images were used. Among the radiomic parameters, parameters capable of distinguishing between hypophysitis and non-functioning pituitary adenomas were selected. In order to avoid the effects of confounding factors and to improve the performance of the classifiers, parameters with high correlation with each other were eliminated. Machine learning algorithms were performed with the combination of gray-level run-length matrix-low gray level run emphasis, gray-level co-occurrence matrix-correlation, and gray-level co-occurrence entropy.A total of 34 patients were included, 17 of whom had hypophysitis and 17 had non-functioning pituitary adenomas. Among the 38 radiomics parameters obtained from post-contrast T1-weighted images, 10 tissue features that could differentiate the lesions were selected. Machine learning algorithms were performed using three selected parameters; gray level run length matrix-low gray level run emphasis, gray-level co-occurrence matrix-correlation, and gray level co-occurrence entropy. Error matrices were calculated by using the machine learning algorithm and it was seen that support vector machines showed the best performance in distinguishing the two lesion types.Our analysis reported that support vector machines showed the best performance in distinguishing hypophysitis from non-functioning pituitary adenomas, emphasizing the importance of machine learning in differentiating the two lesions.

Introduction In 2019, The EWGSOP2 group made updates on the definition and diagnosis of sarcopenia. The aim of this study is to determine the possible risk factors for chemotherapy dose-limiting toxicity (DLT). Methods Newly diagnosed gastrointestinal (GI) cancer patients were included in this prospective observational study. Chemotherapy DLTs were recorded in patients receiving platinum-based therapy. The patients were divided into two groups according to the current sarcopenia criteria. Results 75 patients were included in the final analysis. Chemotherapy DLT occurred in 52% (n = 39) of all patients who received platinum-based chemotherapy. DLT rates were 78.9% and 42.9% in sarcopenic and non-sarcopenic patients, respectively (p = 0.007). According to the results of the multivariate analysis, the only sarcopenia was found as a statistically significant risk factor for DLT. Conclusion Assessment of sarcopenia evaluated with the current EWGSOP2 diagnostic criteria is useful in predicting chemotherapy DLT development in patients with a diagnosis of GI cancer. In the future, current EWGSOP2 recommendations should be considered while designing a study investigating the correlation between sarcopenia and chemotoxicity.

Background/aim: To evaluate the impact of treatment with sodium-glucose co-transporter-2 (SGLT2) Inhibitors on quality of life (QoL), sleep quality (SQ), and anxiety levels in patients with Type 2 diabetes mellitus (T2DM). Materials and methods: Ninety-seven patients with type 2 diabetes admitted to tertiary care hospital diabetes clinic were included. Fifty patients were randomized to receive SGLT2 inhibitors in addition to baseline treatment (Group A), 47 subjects continued with their baseline treatment or were added other medications as needed (Group B). Thirty healthy controls (HC) were recruited (Group C). All groups were subjected to the Turkish version of Short Form-36 (SF-36), Pittsburgh Sleep Quality (PSQ), and Beck Anxiety Inventory (BAI) scales both at baseline and final visit. Results: Physical function, emotional role limitation, vitality, mental health, pain, general health perception scores of SF-36 were significantly improved in Group A, at the end of the follow-up period. There was no significant change in terms of PSQ, BAI scores, and hypoglycaemia documented in all groups. The intervention-related change in HbA1c level, body weight, and body mass index were significantly higher in Group A. Conclusion: The QoL was improved in people with diabetes who were taking SGLT2 inhibitors. This may be explained by weight loss observed in participants.

Transgender people are exposed to many health inequality practices while receiving healthcare. In this study, we aimed to investigate the levels of transphobia among physicians who play an active role in the gender-affirming treatment (GAT) in Turkey. In this cross-sectional study, 530 physicians from the disciplines of psychiatry, endocrinology, gynecology, urology, and plastic surgery were assessed. Respondents completed a web-based survey consisting of sociodemographic data form and Genderism and Transphobia Scale (GTS) from May to June 2020. Among the 530 physicians, 126 were psychiatrists, 107 were endocrinologists, 119 were gynecologists, 111 were urologists, and 67 were plastic surgeons. We concluded that the transphobic attitude was the lowest in psychiatrists and the highest in urologists. In addition, we found that males were more transphobic than females (for GTS, p

Objectives: We aimed to compare tympanic membrane temperature changes and the incidence of inadvertent perioperative hypothermia (IPH) in patients undergoing laparoscopic cholecystectomy under general anesthesia in laminar airflow systems (LAS-OR) and conventional turbulent airflow systems (CAS-OR). Background: Different heating, ventilation, and air-conditioning (HVAC) systems are used in the operating room (OR), such as LAS and CAS. Laminar airflow is directed directly to the patient in LAS-OR. Does laminar airflow in ORs cause faster heat loss by convection? Methods: This is a prospective, randomized study. We divided 200 patients with simple randomization (1:1), as group LAS and group CAS, and took the patients into the LAS-OR or CAS-OR for the operation. Clinical trial number: IRCT20180324039145N3. The tympanic membrane temperatures of patients were measured (°C) before anesthesia induction ( T 0) and then every 15 min during surgery ( Tn). Changes (Δ n) between T 0 and Tn were measured. Results: In the first 30 min, there was a temperature decrease of approximately 0.8 °C (1.44 °F) in both groups. Temperature decreases at 45 min were higher in group LAS than in group CAS but not statistically significant, Δ45, respectively, 0.89 (95% confidence interval [CI] [0.77, 1.02]) versus 0.77 (95% CI [0.69, 0.84]; p = .09). IPH occurred in a total of 60.9% (112 of 184) of patients in the entire surgical evaluation period in group LAS and group CAS (58.9% vs. 62.8%, p = . 59). Conclusions: IPH is seen frequently in both HVAC systems. Clinically, the advantage of HVAC systems relative to each other has not been demonstrated during laparoscopic cholecystectomy.

© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.Purpose: Our aim was to investigate the changes in the composition of oral and gut microbiota in patients with newly diagnosed acromegaly and their relationship with IGF-1 levels. Methods: Oral and fecal samples were collected from patients with newly diagnosed acromegaly without comorbidities and from healthy controls. The composition of the microbiota was analyzed. The general characteristics, oral and stool samples of the patients and healthy control subjects were compared. The changes in microbiota composition in both habitats, their correlations and associations with IGF-1 were statistically observed using machine learning models. Results: Fifteen patients with newly diagnosed acromegaly without comorbidities and 15 healthy controls were included in the study. There was good agreement between fecal and oral microbiota in patients with acromegaly (p = 0.03). Oral microbiota diversity was significantly increased in patients with acromegaly (p < 0.01). In the fecal microbiota, the Firmicutes/Bacteroidetes ratio was lower in patients with acromegaly than in healthy controls (p = 0.011). Application of the transfer learned model to the pattern of microbiota allowed us to identify the patients with acromegaly with perfect accuracy. Conclusions: Patients with acromegaly have their own oral and gut microbiota even if they do not have acromegaly-related complications. Moreover, the excess IGF-1 levels could be correctly predicted based on the pattern of the microbiome.

Objective: Thyroid gland diseases are one of the most important endocrineproblems. The main role of thyroid fine needle aspiration biopsy (TFNAC); todistinguish patients in terms of surgical and conservative treatment options.The aim of this study was to compare the results of thyroid fine needleaspiration biopsy (TFNAC) and histopathology report of patients who underwentthyroidectomy at the Ankara Training and Research Hospital, and to evaluate theTFNAC efficacy in thyroid nodules.Material and Methods: The histopathological dataof patients who were diagnosed with atypia of unidentifiedsignificance (AUS) at the Ankara Training and Research Hospitalbetween 2007 and 2012 and who underwent a thyroidectomy operation werecompared.Results: A total of 87 patients were included inour study. 77 (88.5%) patients were female and 10 (11.5%) patients were male.77 female patients were diagnosed as benign nodules, 55 (71.4%) and 22 (28.6%)malignant nodules. Eight (80%) of 10 male patients were diagnosed as benign,and 2 (20%) of malignant nodules.Conclusion: Patients diagnosed with atypicalsignificance should be evaluated clinically as a whole, including demographicfeatures such as age and gender, radiological examination, detailed history andphysical examination, and surgical decisions should be made according to thesefeatures., Amaç: Tiroid bezhastalıkları en önemli endokrin sorunlarından biridir. Tiroidince iğne aspirasyon biyopsisi (TİİAB)'nin anarolü; hastaları cerrahi ve konservatif tedavi seçenekleri açısından ayırtetmektir. Bu çalışma ile Ankara Eğitim ve Araştırma Hastanesi’ndetiroidektomi operasyonu uygulanmış hastalara ilişkin tiroid ince iğneaspirasyon biyopsisi (TİİAB) sonuçları ile histopatoloji rapor sonuçlarınınkarşılaştırılarak, tiroid nodüllerindeki İİAB etkinliğinin değerlendirilmesiamaçlanmıştır.Gereç ve Yöntemler: AnkaraEğitim ve Araştırma Hastanesi’nde 2007-2012 yılları arasında TİİAB sonucu önemibelirsiz atipi (AUS) tanısı konulan ve troidektomi operasyonu yapılan hastalarınhistopatolojik verileri karşılaştırıldı.Bulgular: Çalışmamızatoplam 87 hasta dahil edildi. 77 (% 88.5) hasta kadın, 10 (% 11.5) hastaerkekti. 77 kadın hastaya 55'i (% 71.4) benign, 22'si (% 28.6) malign nodülteşhisi konuldu. On erkek hastanın 8'ine (% 80) benign, 2'sine (% 20) malignnodül teşhisi konmuştur.Sonuç: Önemi belirsiz atipiteşhisi konan hastalar, yaş ve cinsiyet gibi demografik özellikleri, radyolojikinceleme, ayrıntılı öykü ve fizik muayene dahil olmak üzere klinik olarak birbütün olarak değerlendirilmeli ve cerrahi kararları bu özelliklere göreverilmelidir.

Purpose To evaluate the effectiveness of cabergoline and the parameters affecting cabergoline response as add-on treatment to somatostatin analaogues (SSA) in patients with acromegaly uncontrolled with SSAs. Material and Method One hundred and twenty-nine acromegalic patients uncontrolled with SSA who had cabergoline added to their treatment were included in this retrospective study. Patients were divided into the SSAs + cabergoline-responsive (group 1) and non-responsive groups (group 2), and biochemical, pathologic, and radiologic parameters were assessed. Results IGF-1 normalization was achieved in 75 of 129 patients (58%) when cabergoline was added to the SSA treatment. Female patients were significantly higher in group 1 compared to group 2 (p=0.006). Group 1 had significantly smaller pre- and post-cabergoline tumor size (p=0.011, p=0.007 respectively), lower levels of IGF-1 in pre-and post-operative period (p=0.040, p=0.001), and lower levels of IGF-1 in pre- and post-cabergoline treatment (p Conclusion Cabergoline can be added to the treatment of acromegalic patients uncontrolled with SSAs due to its ease of use and low economic cost, especially in patients with acromegaly who have small adenomas and no fibrous bodies.

Objective: Chronic diseases such as acromegaly affect psychological health. This study aimed to evaluate the effects of a 1-year-long psychological focus group therapy on the quality of life of patients with acromegaly. Material and Methods: Seven female patients with acromegaly, followed-up at the endocrinology outpatient clinic of Cerrahpasa Medical Faculty, were evaluated. The weekly group psychotherapy sessions were conducted by a psychoanalyst and a clinical psychologist between May 2018 and May 2019. Beck Depression Inventory (BDI) and Acromegaly Quality of Life (AcroQoL) scales were assessed at baseline, 3-months, 6-months, and 1-year of group therapy. Results: The mean age of the patients was 43.7 +/- 6.2years, and the median duration of disease was 8 [3-10] years. Six patients were in disease remission. There was a significant improvement in the BDI (p=0.008) and AcroQoL-total scores (p=0.04) from the beginning till the end of the study. A strong negative correlation was observed between BDI and AcroQoL-2 (p=0.003; r=-0.91 vs. p=0.04; r=-0.77) and AcroQoL-t(o)tal (p=0.03; r=-0.78 vs. p=0.01; r=-0.85) scores at baseline and the 3-months of therapy, respectively. Moreover, the psychoanalyst reported that the patients showed an improved ability to face difficulties caused by their illnesses, expressed their emotional reactions more freely, and were more capable of enduring the disease. Conclusion: Patients with acromegaly benefited from the 1-year psychological focus group therapy in terms of psychological well-being, along with improved AcroQoL and BDI scores. Psychotherapeutic approaches, starting with the diagnosis of the disease, might be a significant intervention that improves the quality of life of patients with acromegaly.

Despite receiving Gender-Affirming Hormone Therapy or Gender-Affirming Surgery, which may adversely impact their fertility, people with Gender Dysphoria (GD) may desire to form families. In this study, we aimed to quantitatively display fertility desire from the perspective of these individuals, despite all the legal challenges they face. The single center, cross-sectional comparative study included individuals with GD and cisgender volunteers. A Sociodemographic Data Form, the Fertility Desire Data Form, the Childbearing Motivations Scale and the Fertility Desire Scale were used. Of the 414 participants, 171 were individuals with GD (110 FtM; 61 MtF) and 243 were cisgender volunteers (142 cis-males; 101 cis-females). While 22% of the people with GD stated that they had regrets about not undergoing fertility preservation, 16% stated that they would like this process if it were legal. People with GD, particularly MtF, want to have children more than cisgenders. Moreover, people with MtF exhibited less negative motivations toward becoming parents, despite having reservations regarding the socioeconomic aspect of parenthood. Our findings indicate that fertility desire in people with GD is not less in comparison to cisgender people. Healthcare professionals should not forget to offer fertility preservation options as part of clinical practice before Gender-Affirming Therapy.

To evaluate the role of metformin on thyroid cancer risk in patients with acromegaly.Medical charts of 534 patients with acromegaly that were followed-up between 1983 and 2019 were reviewed. Patients with follow-up duration at least 6 months were included. Cohort entry was defined as first visit date. The date of each case's thyroid cancer diagnosis was defined as index date. Patients were followed until the index date, death, or last visit date, whichever came first. Nested case-control study design was selected to evaluate the association between metformin and the thyroid cancer risk in patients with acromegaly.291 patients with acromegaly were included into final analysis. The mean age at acromegaly diagnosis was 42.3 ± 1.3 years. The median follow-up duration was 76 [34-132] months. Among 291 patients, 13 patients (4.5%) had thyroid cancer. Thirty-one percent (n = 92) of the patients used metformin for 6 months or longer. One standard deviation (SD) increase in average growth hormone increased the odds of having thyroid cancer by 1.164 folds (p = 0.017). One SD increase of the average insulin-like growth factor 1 to upper limit of normal ratio increased the odds of having thyroid cancer by 1.201 folds (p = 0.004). If a patient used metformin for at least 6 months, the odds to have thyroid cancer was decreased, multiplied by 0.62 with a 95% confidence interval of [0.47, 0.83] (p = 0.0013). The risk of thyroid cancer decreased with increasing duration of metformin use.Metformin may decrease the thyroid cancer risk in patients with acromegaly.

The aim of this study was to investigate the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on the glomerulus through the evaluation of podocyturia in patients with diabetic kidney disease (DKD).The study population was composed of 40 male patients with type 2 diabetes mellitus; 22 of them received SGLT2i (SGLT2i group), and the others who did not were the control. The DKD-related parameters of patients were monitored before SGLT2i initiation, and then in the third and sixth month of the follow-up period. Patients' demographic, clinical, laboratory, and follow-up data were obtained from medical charts. Microalbuminuria was measured in 24-h urine. The number of podocytes in the urine was determined by immunocytochemical staining of two different markers, namely podocalyxin (podx) and synaptopodin (synpo). Concentrations of urine stromal cell-derived factor 1a and vascular endothelial growth factor cytokines were quantified with an enzyme-linked immunosorbent assay kit.At the end of the follow-up period, decreases in glycosylated hemoglobin, glucose, systolic and diastolic blood pressure, uric acid level, and microalbuminuria, and improvement in body mass index level and weight loss were significant for the SGLT2i group. On the other hand, there was no significant difference in terms of these parameters in the control group. The excretion of synaptopodin-positive (synpoAt the end of the follow-up period, male patients receiving SGLT2i had better DKD-related parameters and podocyturia levels compared to baseline and the control group. Our data support the notion that SGLT2i might have structural benefits for glomerular health.背景: 本研究旨在通过对糖尿病肾病(DKD)患者尿足细胞的评估, 探讨钠葡萄糖共转运体2抑制剂(SGLT2i)对肾小球的影响。 方法: 研究对象为40例男性2型糖尿病患者, 其中22例接受SGLT2i治疗(SGLT2i组), 另22例未接受SGLT2i治疗作为对照组。在SGLT2i治疗前、随访期第3个月和第6个月监测患者的DKD相关参数。从病历中获得患者的人口学、临床、实验室和随访数据。24小时中测定尿微量白蛋白。通过两种不同的标记物, 即Podocalyxin (podx)和Synaptopodin (synpo)的免疫细胞化学染色来确定尿足细胞的数量。用酶联免疫吸附分析试剂盒检测尿基质细胞衍生因子1a和血管内皮生长因子细胞因子的浓度。 结果: 在随访结束时, SGLT2i组糖化血红蛋白、血糖、收缩压、舒张压、尿酸水平、微量白蛋白尿均显著下降, 体重指数和体重减轻明显改善。另一方面, 对照组的这些参数没有显著差异。SGLT2i组synpo+和podx+的排泄量在随访期结束时显著减少, 而对照组无明显变化。 结论: 在随访期结束时, 接受SGLT2i治疗的男性患者与基线和对照组相比, 有更好的DKD相关参数和尿足细胞水平。我们的数据支持SGLT2i对肾小球健康有结构性益处的观点。.

SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, in particular, secondary adrenal insufficiency, using a dynamic test and the role of autoimmunity in pituitary dysfunction in patients with COVID-19. The single-center, prospective, case-control study included patients with polymerase chain reaction (PCR)-confirmed COVID-19 and healthy controls. Basal hormone levels were measured, and the adrenocorticotropic hormone (ACTH) stimulation test was performed. Antipituitary (APA) and antihypothalamic antibodies (AHA) were also determined. We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. Patients with COVID-19 had lower free T3, IGF-1, and total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. In conclusion, COVID-19 may result in adrenal insufficiency, thus routine screening of adrenal functions in these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormalities in COVID-19.

Based on the possible effects of androgens on the course of COVID-19, it can be posited that Gender-Affirming Hormone Therapy (GAHT) may affect the course of the disease in people with GD. We aimed to investigate the relationship between GAHT and contracting COVID-19, as well as the severity of the disease in individuals with Gender Dysphoria (GD). The single center, cross-sectional, web-based survey was completed by people with GD who received GAHT. The questionnaire contained three parts: a sociodemographic data form; a GAHT data form; a COVID-19-related data form. Of the 238 participants, 179 were individuals with female-to-male (FtM) and 59 male-to-female (MtF) GD. We detected that the risk of contracting COVID-19 increased 3.46 times in people with FtM GD, who had received testosterone therapy, in comparison to people with MtF GD, who received estrogen and anti-androgen therapy. Additionally, people with FtM GD who contracted COVID-19 had received longer testosterone therapy when compared to those who did not contract COVID-19. Our findings indicate that individuals with FtM GD who receive testosterone treatment within the scope of GAHT are at higher risk of contracting COVID-19 and that the clinicians who follow-up on GAHT should be more careful about this issue.

Background: We aimed to establish an acute treatment protocol to increase serum vitamin D, evaluate the effectiveness of vitamin D3 supplementation, and reveal the potential mechanisms in COVID-19. Methods: We retrospectively analyzed the data of 867 COVID-19 cases. Then, a prospective study was conducted, including 23 healthy individuals and 210 cases. A total of 163 cases had vitamin D supplementation, and 95 were followed for 14 days. Clinical outcomes, routine blood biomarkers, serum levels of vitamin D metabolism, and action mechanism-related parameters were evaluated. Results: Our treatment protocol increased the serum 25OHD levels significantly to above 30 ng/mL within two weeks. COVID-19 cases (no comorbidities, no vitamin D treatment, 25OHD &lt, 30 ng/mL) had 1.9-fold increased risk of having hospitalization longer than 8 days compared with the cases with comorbidities and vitamin D treatment. Having vitamin D treatment decreased the mortality rate by 2.14 times. The correlation analysis of specific serum biomarkers with 25OHD indicated that the vitamin D action in COVID-19 might involve regulation of INOS1, IL1B, IFNg, cathelicidin-LL37, and ICAM1. Conclusions: Vitamin D treatment shortened hospital stay and decreased mortality in COVID-19 cases, even in the existence of comorbidities. Vitamin D supplementation is effective on various target parameters, therefore, it is essential for COVID-19 treatment.

Purpose: The SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, particularly, secondary adrenal insufficiency using a dynamic test and the role of autoimmunity in pituitary dysfunction in the patients with COVID-19.Methods: The single-center, prospective, case-control study included PCR-confirmed COVID-19 patients and healthy controls. Basal hormone levels were measured and ACTH stimulation test was performed. Anti-pituitary (APA) and anti-hypothalamic antibodies (AHA) were also determined. Results: We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. The patients with COVID-19 had lower free T3, IGF-1, total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also, demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. Conclusions: The COVID-19 may result in adrenal insufficiency, so the routine screening of adrenal functions is these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Also, pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormality in COVID-19.

Purpose: Vitamin B12 causes hematologic and neuropsychiatric disorders, so it is important to evaluate it in risky situations. In this study, we aimed to evaluate the association between somatostatin receptor ligands and vitamin B12 levels in patients with acromegaly.Methods: Patients who were followed up with the diagnosis of acromegaly in the Endocrinology and Metabolism outpatient clinic of Istanbul University-Cerrahpaşa Medical Faculty were evaluated. Patients were divided into groups according to their somatostatin receptor ligand use status. The groups were evaluated according to their vitamin B12 levels, demographic data, and biochemical parameters.Results: One hundred fifty-two patients were evaluated. Thirteen patients had vitamin B12 deficiency. The majority (11/13) of patients with vitamin B12 deficiency were patients using somatostatin receptor ligand. In addition, the number of patients with vitamin B12 deficiency who received lanreotide autogel treatment was significantly higher compared with patients who did not use somatostatin receptor ligand (p = 0.011). Vitamin B12 levels were higher in patients who received lanreotide autogel treatment than in patients who did not use somatostatin receptor ligand treatment (p = 0.040). There was a negative correlation between vitamin B12 levels and lanreotide autogel use time, cumulative lanreotide autogel dose.Conclusion: It is important to evaluate the level of vitamin B 12 in the follow-up of patients with acromegaly using somatostatin receptor ligand treatment.

Purpose To investigate the relationship of Fibroblast Growth Factor Receptor-4 (FGFR-4) expression with radiologic, pathologic, and clinical parameters in pituitary adenomas. Methods Among 307 patients who underwent pituitary surgery for a pituitary adenoma between 2000 and 2015, we included 161 patients (53 gonadotroph, 26 corticotroph, 25 null cell, 22 lactotroph, 13 somatotroph, 8 adenomas with unusual combination, 7 Pit-1 positive adenomas, and 7 lactosomatotroph) based on availability of pathology specimens. Patients’ radiologic, pathologic, and clinical parameters were determined. FGFR-4 immunostaining was evaluated using a semi-quantitative histologic score (H-score). Results The mean follow-up period was 61 (IQR=32–84) months. The median H-scores for FGFR-4 were higher in patients without remission, those with residual lesion, and T2-hyperintense adenoma (p0.05). There was no significant difference (p>0.05) when the H-score and Ki-67 levels were assessed in terms of sex, sellar-dural invasion, Knosp and a grading system for superior, inferior, parasellar, anterior and posterior tumor extension Classification, tumor function or presence of poor subtype. Adenomas with Ki-67 expression ≥3% had higher FGFR4 expression levels than those with Conclusions Higher levels of FGFR-4 in pituitary adenomas could be use a marker for more aggressive tumor behavior.

Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly. This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device. The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior–posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left–right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward–backward and medial–lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A. Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.

To investigate the effects of preoperative somatostatin analogue (SSA) treatment on the annual cost of all acromegaly treatment modalities and on remission rates. The medical records of 135 patients with acromegaly who were followed at endocrinology clinic of Cerrahpasa Medical Faculty for at least 2 years after surgery between 2009 and 2016 were reviewed. The mean follow-up time was 50.9 ± 25.7 months. Early remission was defined according to 3rd month values in patients who didn’t achieve remission, and 6th month values in patients who achieved remission at the 3rd month after surgery. The early and late remission rates of the entire study population were 40% and 80.7%, respectively. The early remission of the preoperative SSA-treated group (61.5%) was significantly higher than SSA-untreated group (31.2%) (p = 0.002). The early remission of the preoperative SSA-treated patients with macroadenomas (52.2%) was also significantly higher than the SSA-untreated group (23.5%) (p = 0.02). In the subgroup analysis; this difference was much more pronounced in invasive macroadenomas (p = 0.002). There were no differences between the groups in terms of late remission.The median annual cost of all acromegaly treatment modalities in study population was €3788.4; the cost for macroadenomas was significantly higher than for microadenomas (€4125.0 vs. €3226.5, respectively; p = 0.03). Preoperative SSA use in both microadenomas and macroadenomas didn’t alter the cost of treatment. The increase in the duration of preoperative medical treatment had no effect on early or late remissions (p = 0.09; p = 0.8). Preoperative medical treatment had no effect on the costs of acromegaly treatment. There was a benefical effect of pre-operative SSA use on early remission in patients with macroadenomas; however, this effect didn’t persist long term.

Although the age at diagnosis has been suggested as a major determinant of disease-specific survival in the recent TNM staging system, it is not included in the recent American Thyroid Association (ATA) guidelines to estimate the risk of recurrence. Nevertheless, the effect of sex on differentiated thyroid carcinoma (DTC) recurrence is controversial. Therefore, this multicenter study was conducted to assess whether age at diagnosis and sex can improve the performance of the ATA 3-tiered risk stratification system in patients with DTC with at least 5 years of follow-up.In this study, the computer-recorded data of the patients diagnosed with DTC between January 1985 and January 2016 were analyzed. Only patients with proven structural persistent/recurrent disease were selected for comparisons.This study consisted of 1691 patients (female, 1367) with DTC. In Kaplan-Meier analysis, disease-free survival (DFS) was markedly longer in females only in the ATA low-risk category (P = .045). Nevertheless, a markedly longer DFS was observed in patients aged45 years in the ATA low- and intermediate-risk categories (P = .004 and P = .009, respectively), whereas in patients aged55 years, DFS was markedly longer only in the ATA low-risk category (P.001). In the Cox proportional hazards model, ages of ≥45 and ≥55 years at diagnosis and the ATA risk stratification system were all independent predictors of persistent/recurrent disease.Applying the age cutoff of 45 years in the ATA intermediate- and low-risk categories may identify patients at a higher risk of persistence/recurrence and may improve the performance of the ATA risk stratification system, whereas sex may improve the performance of only the ATA low-risk category.

Background: To investigate the relationship between visceral adiposity index (VAI) and other metabolic syndrome (MetS)-related parameters, and thyroid nodules. Methods: This single-center, prospect...

Purpose Patients with acromegaly and Cushing's disease (CD) may experience significant problems related to the COVID-19 outbreak. We aimed to investigate the psychosocial effects of the pandemic and reveal the follow-up characteristics. Methods The single center, cross-sectional, web-based survey study included patients with acromegaly and CD, PCR-confirmed COVID-19 patients and healthy volunteers without known any chronic disease. The semi-structured sociodemographic data form, The State-Trait Anxiety Inventory (STAI) and Impact of Event Scale-Revised (IES-R) were used. Results We examined 583 people (217 acromegaly, 127 CD, 102 PCR-confirmed COVID-19 patients and 137 healthy controls). The frequency of abnormal state anxiety and post-traumatic stress disorder (PTSD) were similar in patients with acromegaly and CD and healthy controls, and higher in PCR-confirmed COVID-19 patients than in these three groups (p < 0.001 for both). The frequency of abnormal trait anxiety was higher in patients with acromegaly and PCR-confirmed COVID-19 compared to patients with CD and healthy controls (p = 0.027, p < 0.001, respectively). There were no significant differences between the acromegaly and CD groups in terms of follow-up characteristics and perception of the severity of the COVID-19 outbreak (p > 0.05 for all). But, the treatment discontinuation rate was higher in patients with acromegaly than CD (p = 0.012). Conclusions Our findings indicate that acromegaly and CD patients are psychologically less affected than PCR-confirmed COVID-19 patients and exhibit similar findings the general population. The clinicians should consider the psychosocial effects, as well as focus on the regular follow-up and medical treatments of these patients during the outbreak.

Introduction: the aim of this was to describe the predictors of mortality related to COVID-19 infection and to evaluate the association between overweight, obesity, and clinical outcomes of COVID-19. Methods: we included the patients >18 years of age, with at least one positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction. Patients were grouped according to body mass index values as normal weight = 35 kg/m(2) (Group D). Mortality, clinical outcomes, laboratory parameters, and comorbidities were compared among 4 groups. Results: there was no significant difference among study groups in terms of mortality. Noninvasive mechanical ventilation requirement was higher in group B and D than group A, while it was higher in Group D than Group C (Group B vs. Group A [p = 0.017], Group D vs. Group A [p = 0.001], and Group D vs. Group C [p = 0.016]). Lung involvement was less common in Group A, and presence of hypoxia was more common in Group D (Group B vs. Group A [p = 0.025], Group D vs. Group A [p < 0.001], Group D vs. Group B [p = 0.006], and Group D vs. Group C [p = 0.014]). The hospitalization rate was lower in Group A than in the other groups; in addition, patients in Group D have the highest rate of hospitalization (Group B vs. Group A [p < 0.001], Group C vs. Group A [p < 0.001], Group D vs. Group A [p < 0.001], Group D vs. Group B [p < 0.001], and Group D vs. Group C [p = 0.010]). Conclusion: COVID-19 patients with overweight and obesity presented with more severe clinical findings. Health-care providers should take into account that people living with overweight and obesity are at higher risk for COVID-19 and its complications., European Association for the Study of Obesity

Purpose Microbiota has crucial biological importance for human well-being. Bidirectional interaction exists between microbiota and the host, and there have been no studies investigating this interaction in patients with acromegaly. We aimed to analyze the composition of microbiota in patients with newly diagnosed acromegaly. Method Stool samples were obtained from the patients with newly diagnosed acromegaly in the Endocrinology Clinic of Erciyes University Medical School. The composition of microbiota was analyzed, and the results were compared to healthy volunteers matched to the patients in terms of age, gender and body mass index. Results Seven patients (three male, four female) with a mean age of 48 +/- 17.6 years were included in the study. The stool analysis revealed a significantly lower bacterial diversity in the patients with acromegaly. Bacteroidetes phylum was predominating in the patient group, and Firmicutes/Bacteroidetes ratio was altered significantly. Bifidobacterium, Collinsella, Bacteroides, Butyricimonas, Clostridium, Oscillospira, and Dialister were predominating in the control group. Conclusion The gut microbiota is significantly altered in patients with newly diagnosed acromegaly. Further prospective studies are needed to elucidate the causative relationship between acromegaly, colorectal pathologies, and microbial alterations.

To evaluate the effects of somatostatin analogs and disease activity status on the upper gastrointestinal system in patients with acromegaly. One hundred eighty-one patients with acromegaly were retrospectively assessed. The demographic, biochemical, pathologic, and radiologic data of the patients were evaluated. The upper gastrointestinal endoscopies and endoscopic biopsies were investigated. We divided patients into four groups according to the use of somatostatin analogs, and into two groups according to disease activity. We compared the data of patients between groups A, B, C, and D, and controlled/uncontrolled groups separately. Before and in the peri-endoscopic period, 67 and 27 patients were being treated with octreotide long-acting release (LAR) (group A) and lanreotide autogel (group B), respectively. Twenty-one patients used somatostatin analogs, but they were stopped for various reasons before upper gastrointestinal endoscopy (group C), and 66 patients did not use a somatostatin analog (group D). In the peri-endoscopic period, 103 (60%) patients were responsive to medical and/or surgical treatment and 67 (40%) patients were non-responsive. The rate of gastritis was higher in group A than in groups B and D. The incidence of duodenitis and gastric ulcer was much higher in group D. The rate of gastritis was higher in the controlled group compared to the uncontrolled group. The study showed that octreotide LAR treatment could be a risk factor in addition to known factors for the development of gastritis in patients with acromegaly.