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Objective: To investigate the impact of vertebral fracture (VF) on long-term mortality of patients with COVID-19. Methods: In this single-center retrospective study, patients with COVID-19 who were admitted during the first wave of the pandemic and who had undergone a thorax computerized tomography scan were consecutively included. Patients with VFs due to trauma or malignancy were excluded. A Multivariate Cox proportional hazard model was used for survival analyses. Results: Of the 349 patients, 249 (71.3%) had at least one VF. Patients with VF were older (55.3 ± 15 vs. 43.4 ± 13.3, P < .001) and had higher rates of diabetes mellitus (19.7% vs. 11%), hypertension (34.1% vs. 17%), dyslipidemia (11.6% vs. 4%), cardiovascular disease (15.3% vs. 6.1%), and acute kidney injury (23.5% vs. 13%) (P < .05 for all). The mean survival was lower in patients with VF (1285.6 days, SE: 24.3, 95% CI [1238-1333]) compared to patients without VF (1388.6 days, SE: 16.3, 95% CI [1356-1420]) (P = .024). The mean survival was particularly decreased in patients with moderate-severe (1168 days, P = .001) or multiple VFs (1276 days, P = .016). The association between VF and mortality was adjusted for diabetes mellitus, hypertension, cardiovascular and renal failure. Multivariate Cox proportional hazard model showed that malignancy, renal failure, and VFs were independent predictors of decreased survival. Conclusion: Vertebral fractures were found to be one of the most common comorbidities in patients with COVID-19. It also represents a potential marker of frailty and an important predictor of decreased survival. Vertebral fractures should be considered in all patients who have had COVID-19. The causal link between VFs and mortality requires large-scale prospective research. [ABSTRACT FROM AUTHOR]

This study aimed to explore disordered eating behaviors in gender-affirming treatment (GAT)-seeking transgender (TG) adults and cisgender people, in addition to analyzing the association between gender dysphoria intensity, body mass index, and disordered eating behaviors. Data were collected from 132 GAT-seeking TG people with gender dysphoria who had never received GAT (91 TG men, 41 TG women), and 153 cisgender (99 cisgender men, 54 cisgender women) participants from Turkey. The Utrecht Gender Dysphoria Scale was used to evaluate the intensity of gender dysphoria. Eating Disorder Examination Questionnaire and Questionnaire on Eating and Weight Patterns-5 were utilized to assess disordered eating. There was no difference between TG women and TG men in terms of ED psychopathology. The most prominent characteristic in all four groups was shape concern, which was significantly higher in TG men and TG women when compared to cisgender men and cisgender women. Binge eating was notably more frequent in TG men and TG women compared to cisgender men, with 11% of the TG men and 7.3% of the TG women meeting the criteria for possible binge eating disorder. Screening for disordered eating behaviors, particularly binge eating, may be recommended in routine care for TG people. [ABSTRACT FROM AUTHOR]

Objective Spermatozoa are susceptible to oxidative radicals when antioxidant defenses are inadequate. The extent to which oxidative radicals contribute to sperm damage in patients with acromegaly remains unclear. This study aimed to investigate and elucidate this relationship. Methods The overall status of oxidants and antioxidants in both seminal plasma and serum of patients with acromegaly compared to a control group of healthy individuals was investigated. In addition, sperm parameters, including important measures such as growth hormone and insulin-like growth factor-1 concentrations. Results Twenty-two patients with acromegaly with controlled disease and 14 healthy controls were included. The total oxidant status was significantly higher in the semen samples of the patients with acromegaly. A negative correlation was found between sperm total oxidant status and total sperm count and sperm concentration. Similarly, a negative correlation was found between the total sperm count and the sperm oxidative stress index. In individuals diagnosed with acromegaly, there was a statistically significant increase in sperm growth hormone levels. Conversely, the level of insulin-like growth factor 1 was significantly increased in the sperm of the control group, which consisted of healthy individuals. The correlation analysis revealed a significant relationship between venous total oxidant status and growth hormone levels in semen. Conclusion The elevated levels of reactive oxygen radicals in individuals with acromegaly suggest a possible link between oxidative stress and its effects on semen quality. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the influence of ectopic and pituitary Cushing’s syndrome, diagnosed by sampling the inferior petrosal sinus and cavernous sinus, on comorbidities and clinical complications. Methods: Medical records of patients with Cushing’s syndrome who presented to the Endocrinology, Metabolism, and Diabetes Clinic of İstanbul University-Cerrahpaşa, Faculty of Cerrahpaşa Medicine between 2010 and 2020 and underwent inferior petrosal and cavernous sinus sampling were reviewed. Sociodemographic data, clinical signs and symptoms, laboratory parameters, comorbidities, medical and surgical treatments applied, current disease status, and mortality data were recorded from all patients. Two groups were defined for the study: Cushing’s disease and ectopic Cushing’s syndrome. Data were compared between these 2 identified groups. Results: This study was conducted with 106 patients. Ninety-four (88.7%) of the patients were women. The mean age at diagnosis was 52.1 ± 13.7 years. Twenty patients had ectopic Cushing’s syndrome, and 86 patients had Cushing’s disease. There were no statistical differences in age, sex, and follow-up time in the 2 groups. Basal cortisol level and cortisol level after a 2 mg low-dose dexamethasone suppression test were higher in ectopic Cushing’s disease than in Cushing’s disease (P = .04 and .05, respectively). Complications and comorbidities correlated with hypercortisolemia indicators. Body mass index was lower in ectopic Cushing’s syndrome than in Cushing’s disease (P < .001). There were no differences between groups in tests assessing glucose and lipid metabolism. Hypertension was present in 62.8% (n = 54) of patients with Cushing’s disease. This rate was significantly higher than in ectopic Cushing’s syndrome, as hypertension was significantly higher in patients with Cushing’s disease than in patients with ectopic Cushing’s syndrome (62.8% vs. 40%, P = .04). In terms of other comorbidities, the groups were similar. During the follow-up period, ectopic foci were detected in 3 patients with ectopic Cushing’s syndrome, while no foci were found in the other patients. Forty-seven of 86 patients with pituitary Cushing’s syndrome had adenoma on magnetic resonance imaging of the sella. All patients underwent hypophysectomy. Conclusion: The clinical presentation in ectopic and pituitary Cushing’s syndrome is determined by the cortisol level and the duration of the disease. In ectopic Cushing’s syndrome, the acute or insidious onset of the disease affects the “clinical presentation,” complications, and comorbidities depending on the underlying cause. [ABSTRACT FROM AUTHOR]

Aim: To investigate the relationship of serum lipoprotein(a) [Lp(a)] and other serum lipids with presence of Graves' ophthalmopathy (GO). Methods: A total of 99 consecutive patients diagnosed with Graves' disease (GD), aged 18–65 years, who had not received prior treatment for GO, thyroid surgery, or radioactive iodine therapy, were recruited between June 2020 and July 2022. In addition, 56 healthy controls (HCs) were included as the control group. All patients underwent an ophthalmological examination, and were classified based on the presence of GO into the GO group (n = 45) and no GO group (n = 54). Fasting blood samples were collected from all participants to analyze serum lipid parameters, including Lp(a), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. Results: The median serum levels of Lp(a) were 5.7 [4.3–9.2] in the GO group, 6.7 [3.7–9.9] in the no GO group, and 4.7 [3–7.6] in the HC group. The intergroup comparisons of serum Lp(a) levels showed no significant result. The serum levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were also similar between the groups (P > 0.05 for all). However, when analyzing only euthyroid GD patients and the control group, the serum LDL cholesterol levels were found to be significantly higher in the euthyroid GO group [median: 132 interquartile range (IQR) (110–148) mg/dL] than in the HCs [median: 96 IQR (94–118) mg/dL] (P = 0.002). Conclusion: The findings of our study did not support the association between serum Lp(a) levels and GO. [ABSTRACT FROM AUTHOR]

Aim To investigate the autoimmune and genetic relationship between primary hypophysitis (PH) and celiac disease (CD). Methods The study was retrospective and patients with PH followed in our clinic between 2007 and 2022 were evaluated. Clinical, endocrinologic, pathologic, and radiologic findings and treatment modalities were assessed. Patients diagnosed with CD in the Gastroenterology outpatient clinic in 2020–2022 were included in the study as a control group. Information such as sociodemographic data, year of diagnosis, human leukocyte antigen (HLA) DQ2/8 information, CD-specific antibody levels, pathologic results of duodenal biopsy, treatment received, follow-up status, additional diseases, hormone use, and surgical history was obtained from patient records at PH. In patients diagnosed with PH, a duodenal biopsy was obtained, and the tissue was examined for CD by experienced pathologists. Anti-pituitary antibody (APA) and anti-arginine-vasopressin (AAVP) antibody levels of individuals with PH and CD were measured. Results The study included 19 patients with lymphocytic hypophysitis, 30 celiac patients, and 30 healthy controls. When patients diagnosed with lymphocytic hypophysitis were examined by duodenal biopsy, no evidence of CD was found in the pathologic findings. The detection rate of HLA-DQ2/8 was 80% in celiac patients and 42% in PH (p=0.044). (APA and AAVP antibodies associated with PH were tested in two separate groups of patients and in the control group. APA and anti-arginine vasopressin (AAVP) levels in PH, CD and healthy controls, respectively M [IQR]: 542 [178–607];164 [125–243]; 82 [74–107] ng/dL (p=0.001), 174 [52–218]; 60 [47–82]; 59 [48–76] ng/dL (p=0.008) were detected. The presence of an HLA-DQ2/8 haplotype correlates with posterior hypophysitis and panhypophysitis (r=0.598, p=0.04 and r=0.657, p=0.02, respectively). Conclusion Although patients with PH were found to have significant levels of HLA-DQ2/8, no CD was found in the tissue. Higher levels of pituitary antibodies were detected in celiac patients compared with healthy controls, but no hypophysitis clinic was observed at follow-up. Although these findings suggest that the two diseases may share a common genetic and autoimmune basis, the development of the disease may be partially explained by exposure to environmental factors. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to present our experience with medullary thyroid cancer and to identify the characteristics of patients in relapse or remission. Methods: In this study, data from medullary thyroid cancer (MTC) patients followed at Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Endocrinology and Metabolism outpatient clinic. Electronic records and files of patients older than 18 years of age between January 2000 and June 2022 were retrospectively reviewed. Patients with medullary thyroid cancer were selected from patients with thyroid malignancy. Patient information was obtained from files. Results: A total of 855 thyroid cancer patient files were reviewed. Medullary thyroid cancer accounted for 3.5% of all thyroid cancers. A total of 30 patients with medullary thyroid cancer [median (interquartile range): age, 45 (34–59) years; 17 female (56.7%)] were included in the analysis. Data were analyzed with a median follow-up of 60 (24–120) months. The median tumor size was 15 mm (8-30), and 20% of patients had multifocal and/ or bilateral tumors. While 40% of the patients had N1 disease, 30% of the patients had distant metastases and 30% of patients had clinical stage 4C, according to The American Joint Committee on Cancer, 8th edition. Another aim is to try to identify the characteristics of patients at risk of disease recurrence or non-remission were examined, more extrathyroidal spread (P = .01), larger tumor size (P = .003), and more lymph node metastases (P < .001) and distant metastases (P < .001) were observed, and postoperative third-month calcitonin and carcinoembryonic antigen levels were higher (P = .01, for all). In the survival analysis, at 25th and 80th months, we found that survival decreased despite chemotherapy (P = .017 and .002, respectively) and radiotherapy (P = .002 and <.001, respectively) treatment. Calcitonin and carcinoembryonic antigen cut-off values predicting relapse in medullary thyroid cancer were determined to be 5.3 pg/mL and 8.6 ng/mL, respectively. Conclusion: Medullary thyroid cancer is a rare cancer and has a good prognosis when detected at an early stage. In cases of advanced or metastatic disease, the prognosis is poor despite treatment. Calcitonin and carcinoembryonic antigen levels measured at postoperative third month can be used to predict recurrence. [ABSTRACT FROM AUTHOR]

Background The nociceptive flexion reflex (NFR) is a polysynaptic and multisegmental spinal reflex that develops in response to a noxious stimulus and is characterized by the withdrawal of the affected body part. The NFR possesses two excitatory components: early RII and late RIII. Late RIII is derived from high-threshold cutaneous afferent A-delta fibers, which are prone to injury early in the course of diabetes mellitus (DM) and may lead to neuropathic pain. We investigated NFR in patients with DM with different types of polyneuropathies to analyze the role of NFR in small fiber neuropathy (SFN). Methods We included 37 patients with DM and 20 healthy participants of similar age and sex. We performed the Composite Autonomic Neuropathy Scale-31, modified Toronto Neuropathy Scale, and routine nerve conduction studies. We grouped the patients into large fiber neuropathy (LFN), SFN, and no overt neurological symptom/sign groups. In all participants, NFR was recorded on anterior tibial (AT) and biceps femoris (BF) muscles after train stimuli on the sole of the foot, and NFR-RIII findings were compared. Results We identified 11 patients with LFN, 15 with SFN, and 11 with no overt neurological symptoms or signs. The RIII response on the AT was absent in 22 (60%) patients with DM and 8 (40%) healthy participants. The RIII response on the BF was absent in 31 (73.8%) patients and 7 (35%) healthy participants (P  = .001). In DM, the latency of RIII was prolonged, and the magnitude was reduced. Abnormal findings were seen in all subgroups; however, they were more prominent in patients with LFN compared to other groups. Conclusions The NFR-RIII was abnormal in patients with DM even before the emergence of the neuropathic symptoms. The pattern of involvement before neuropathic symptoms was possibly related to an earlier loss of A-delta fibers. [ABSTRACT FROM AUTHOR]