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Ertorer ME, Anaforoglu I, Yilmaz N, Akkus G, Turgut S, Unluhizarci K, Selcukbiricik OS, Merdin FA, Karakilic E, Pehlivan E, Yorulmaz G, Gul OO, Emral R, Kebapci MN, Acubucu F, Tuzun D, Gorar S, Topuz E, Bagir GS, Genc SD, Demir K, Tamer G, Yaylali G, Omma T, Firat SN, Koc G, Saygili ES, Yurekli BS. Landscape of congenital adrenal hyperplasia cases in adult endocrinology clinics of Türkiye-a nation-wide multicentre study. Endocrine 2024:10.1007/s12020-024-03799-z. [PMID: 38587785 DOI: 10.1007/s12020-024-03799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/24/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS Congenital adrenal hyperplasia (CAH) is a group of disorders that affect the production of steroids in the adrenal gland and are inherited in an autosomal recessive pattern. The clinical and biochemical manifestations of the disorder are diverse, ranging from varying degrees of anomalies of the external genitalia to life-threatening adrenal insufficiency. This multicenter study aimed to determine the demographics, biochemical, clinical, and genetic characteristics besides the current status of adult patients with CAH nationwide. METHODS The medical records of 223 patients with all forms of CAH were evaluated in the study, which included 19 adult endocrinology clinics. A form inquiring about demographical, etiological, and genetic (where available) data of all forms of CAH patients was filled out and returned by the centers. RESULTS Among 223 cases 181 (81.16%) patients had 21-hydroxylase deficiency (21OHD), 27 (12.10%) had 11-beta-hydroxylase deficiency (110HD), 13 (5.82%) had 17-hydroxylase deficiency (17OHD) and 2 (0.89%) had 3-beta-hydroxysteroid-dehydrogenase deficiency. 21OHD was the most prevalent CAH form in our national series. There were 102 (56.4%) classical and 79 (43.6%) non-classical 210HD cases in our cohort. The age of the patients was 24.9 ± 6.1 (minimum-maximum: 17-44) for classical CAH patients and 30.2 ± 11.2 (minimum-maximum: 17-67). More patients in the nonclassical CAH group were married and had children. Reconstructive genital surgery was performed in 54 (78.3%) of classical CAH females and 42 (77.8%) of them had no children. Thirty-two (50.8%) NCAH cases had homogenous and 31 (49.2%) had heterogeneous CYP21A2 gene mutations. V281L pathological variation was the most prevalent mutation, it was detected in 35 (55.6%) of 21OHD NCAH patients. CONCLUSION Our findings are compatible with the current literature except for the higher frequency of 110HD and 17OHD, which may be attributed to unidentified genetic causes. A new classification for CAH cases rather than classical and non-classical may be helpful as the disease exhibits a large clinical and biochemical continuum. Affected cases should be informed of the possible complications they may face. The study concludes that a better understanding of the clinical characteristics of patients with CAH can improve the management of the disorder in daily practice.
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Affiliation(s)
- Melek Eda Ertorer
- Baskent University Faculty of Medicine, Endocrinology and Metabolism, Adana, Turkey
| | - Inan Anaforoglu
- Mehmet Ali Aydınlar University Faculty of Medicine, Endocrinology and Metabolism, Istanbul, Turkey.
| | - Nusret Yilmaz
- Akdeniz University Faculty of Medicine, Endocrinology and Metabolism, Antalya, Turkey
| | - Gamze Akkus
- Cukurova University Faculty of Medicine, Endocrinology and Metabolism, Adana, Turkey
| | - Seda Turgut
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Endocrinology and Metabolism, Istanbul, Turkey
| | - Kursad Unluhizarci
- Erciyes University Faculty of Medicine, Endocrinology and Metabolism, Kayseri, Turkey
| | | | - Fatma Avci Merdin
- Ankara University Faculty of Medicine, Endocrinology and Metabolism, Ankara, Turkey
| | - Ersen Karakilic
- Canakkale 18 Mart University Faculty of Medicine, Endocrinology and Metabolism, Canakkale, Turkey
| | - Esma Pehlivan
- Ege University Faculty of Medicine, Endocrinology and Metabolism, Izmir, Turkey
| | - Goknur Yorulmaz
- Eskisehir Osmangazi University Faculty of Medicine, Endocrinology and Metabolism, Eskisehir, Turkey
| | - Ozen Oz Gul
- Uludag University Faculty of Medicine, Endocrinology and Metabolism, Bursa, Turkey
| | - Rifat Emral
- Ankara University Faculty of Medicine, Endocrinology and Metabolism, Ankara, Turkey
| | - Medine Nur Kebapci
- Eskisehir Osmangazi University Faculty of Medicine, Endocrinology and Metabolism, Eskisehir, Turkey
| | - Fettah Acubucu
- University of Health Sciences, Adana Training and Research Hospital, Endocrinology and Metabolism, Adana, Turkey
| | - Dilek Tuzun
- K. Maras Sutcu Imam University Faculty of Medicine, Endocrinology and Metabolism, K.Maras, Turkey
| | - Suheyla Gorar
- University of Health Sciences, Antalya Training and Research Hospital, Endocrinology and Metabolism, Antalya, Turkey
| | - Emek Topuz
- K. Maras Sutcu Imam University Faculty of Medicine, Endocrinology and Metabolism, K.Maras, Turkey
| | - Gulay Simsek Bagir
- Baskent University Faculty of Medicine, Endocrinology and Metabolism, Adana, Turkey
| | - Selin Dincer Genc
- Inonu University Faculty of Medicine, Endocrinology and Metabolism, Malatya, Turkey
| | - Kezban Demir
- Istanbul Medeniyet University Faculty of Medicine, Endocrinology and Metabolism, Istanbul, Turkey
| | - Gonca Tamer
- Istanbul Medeniyet University Faculty of Medicine, Endocrinology and Metabolism, Istanbul, Turkey
| | - Guzin Yaylali
- Pamukkale University Faculty of Medicine, Endocrinology and Metabolism, Denizli, Turkey
| | - Tulay Omma
- University of Health Sciences, Ankara Training and Research Hospital, Endocrinology and Metabolism, Ankara, Turkey
| | - Sevde Nur Firat
- University of Health Sciences, Ankara Training and Research Hospital, Endocrinology and Metabolism, Ankara, Turkey
| | - Gonul Koc
- University of Health Sciences, Ankara Training and Research Hospital, Endocrinology and Metabolism, Ankara, Turkey
| | - Emre Sedar Saygili
- Canakkale 18 Mart University Faculty of Medicine, Endocrinology and Metabolism, Canakkale, Turkey
| | - Banu Sarer Yurekli
- Ege University Faculty of Medicine, Endocrinology and Metabolism, Izmir, Turkey
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Ciftci S, Soyluk O, Selek A, Erol S, Hekimsoy Z, Esen A, Dursun H, Sahin S, Oruk G, Mert M, Soylu H, Yurekli BS, Ertorer ME, Omma T, Evran M, Adas M, Tanrikulu S, Aydin K, Pekkolay Z, Can B, Karakilic E, Karaca Z, Bilen H, Canturk Z, Cetinarslan B, Kadioglu P, Yarman S. The Importance of DHEA-S Levels in Cushing's Syndrome; Is There a Cut-off Value in the Differential Diagnosis? Horm Metab Res 2022; 54:232-237. [PMID: 35413744 DOI: 10.1055/a-1783-7901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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<0.001), while group 1 and group 3 had similar levels. The optimal cut-off level of DHEA-S percentile rank in the reference interval providing differential diagnosis between group 1 and group 2 was calculated as 19.5th percentile (80.8% sensitivity, 81.5% specificity) and the level demonstrated the accurate etiology in 100% of CD and 76% of adrenal CS patients who were in the gray zone. 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.
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Affiliation(s)
- Sema Ciftci
- Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Soyluk
- Department of Endocrinology and Metabolism, Istanbul University, Fatih, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey
| | - Selvinaz Erol
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ayse Esen
- Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Dursun
- Department of Endocrinology and Meatbolism, Erciyes University School of Medicine, Kayseri, Turkey
| | - Serdar Sahin
- Department of Endocrinology and Metabolism, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Gonca Oruk
- Department of Endocrinology and Metabolism, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
| | - Meral Mert
- Department of Endocrinology and Metabolsim, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Soylu
- Department of Endocrinology and Metabolism, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | - Banu Sarer Yurekli
- Department of Endocrinology and Metabolism, Ege University Faculty of Medicine, Izmir, Turkey
| | - Melek Eda Ertorer
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana, Turkey
| | - Tulay Omma
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mehtap Evran
- Department of Endocrinology and Metabolism, Çukurova University Medical Faculty, Adana, Turkey
| | - Mine Adas
- Department of Endocrinology and Metabolism, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Seher Tanrikulu
- Department of Endocrinology and Metabolsim, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Aydin
- Department of Endocrinology and Metabolism, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, Dicle Faculty of Medicine, Diyarbakır, Turkey
| | - Bülent Can
- Department of Endocrinology and Metabolism, Istanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Ersen Karakilic
- Department of Endocrinology and Metabolism, Canakkale Onsekiz Mart University Medical Faculty, Çanakkale, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology and Meatbolism, Erciyes University School of Medicine, Kayseri, Turkey
| | - Habib Bilen
- Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Ezurum, Turkey
| | - Zeynep Canturk
- Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey
| | - Berrin Cetinarslan
- Department of Endocrinology and Metabolism, Kocaeli University, Kocaeli, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Sema Yarman
- Department of Endocrinology and Metabolism, Istanbul University, Fatih, Turkey
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Bagir GS, Bakiner OS, Haydardedeoglu FE, Araz F, Ertorer ME, Kozanoglu İ. Effect of type 2 diabetes mellitus on efficacy and safety of therapeutic apheresis for severe hypertriglyceridemia. Ther Apher Dial 2020; 25:681-686. [PMID: 33098371 DOI: 10.1111/1744-9987.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/16/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Gulay Simsek Bagir
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Okan Sefa Bakiner
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Filiz Eksi Haydardedeoglu
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Filiz Araz
- Department of Gastroenterology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Melek Eda Ertorer
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - İlknur Kozanoglu
- Department of Physiology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Teaching and Medical Research Center, Apheresis Unit, Adana, Turkey
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Eksi Haydardedeoglu F, Bagir GS, Haydardedeoglu B, Bozkirli E, Bakiner O, Metin K, Ertorer ME. Serum betatrophin levels are reduced in patients with full-blown polycystic ovary syndrome. Gynecol Endocrinol 2019; 35:224-227. [PMID: 30241452 DOI: 10.1080/09513590.2018.1519791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Filiz Eksi Haydardedeoglu
- a Department of Endocrinology and Metabolism , Başkent University Faculty of Medicine , Adana , Turkey
| | - Gulay Simsek Bagir
- a Department of Endocrinology and Metabolism , Başkent University Faculty of Medicine , Adana , Turkey
| | - Bulent Haydardedeoglu
- b Division of Reproductive Endocrinology and IVF Unit, Department of Obstetrics and Gynecology , Başkent University Faculty of Medicine , Adana , Turkey
| | - Emre Bozkirli
- a Department of Endocrinology and Metabolism , Başkent University Faculty of Medicine , Adana , Turkey
| | - Okan Bakiner
- a Department of Endocrinology and Metabolism , Başkent University Faculty of Medicine , Adana , Turkey
| | - Kerem Metin
- c Department of Biochemistry , Başkent University Faculty of Medicine , Adana , Turkey
| | - Melek Eda Ertorer
- a Department of Endocrinology and Metabolism , Başkent University Faculty of Medicine , Adana , Turkey
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Haydardedeoglu FE, Bagir GS, Torun N, Kocer E, Reyhan M, Ertorer ME. Hounsfield unit value has null effect on thyroid nodules at 18F-FDG PET/CT scans. Arch Endocrinol Metab 2018; 62:460-465. [PMID: 30304111 PMCID: PMC10118740 DOI: 10.20945/2359-3997000000063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/18/2018] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
| | - Gulay Simsek Bagir
- Baskent University Faculty of Medicine Department of Endocrinology and Metabolism, Adana, Turkey
| | - Nese Torun
- Baskent University Faculty of Medicine Department of Nuclear Medicine, Adana, Turkey
| | - Emrah Kocer
- Baskent University Faculty of Medicine Department of Pathology, Adana, Turkey
| | - Mehmet Reyhan
- Baskent University Faculty of Medicine Department of Nuclear Medicine, Adana, Turkey
| | - Melek Eda Ertorer
- Baskent University Faculty of Medicine Department of Endocrinology and Metabolism, Adana, Turkey
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Bagir GS, Haydardedeoglu FE, Bakiner OS, Bozkirli E, Ertorer ME. Mean Platelet Volume in Graves' disease: A Sign of Hypermetabolism Rather than Autoimmunity? Pak J Med Sci 2017; 33:871-875. [PMID: 29067056 PMCID: PMC5648955 DOI: 10.12669/pjms.334.12659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
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
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Affiliation(s)
- Gulay Simsek Bagir
- Gulay Simsek Bagir, MD. Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
| | - Filiz Eksi Haydardedeoglu
- Filiz Eksi Haydardedeoglu, MD. Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
| | - Okan Sefa Bakiner
- Okan Sefa Bakiner, Associate Professor of Endocrinology, Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
| | - Emre Bozkirli
- Emre Bozkirli, Associate Professor of Endocrinology, Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
| | - Melek Eda Ertorer
- Melek Eda Ertorer, Professor of Endocrinology, Baskent University Faculty of Medicine, Division of Endocrinology Adana, Turkey
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Simsek Bagir G, Civi S, Kardes O, Kayaselcuk F, Ertorer ME. Stubborn hiccups as a sign of massive apoplexy in a naive acromegaly patient with pituitary macroadenoma. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170044. [PMID: 28567295 PMCID: PMC5445435 DOI: 10.1530/edm-17-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/19/2017] [Indexed: 11/30/2022] Open
Abstract
Pituitary apoplexy (PA) may very rarely present with hiccups. A 32-year-old man with classical acromegaloid features was admitted with headache, nausea, vomiting and stubborn hiccups. Pituitary magnetic resonance imaging (MRI) demonstrated apoplexy of a macroadenoma with suprasellar extension abutting the optic chiasm. Plasma growth hormone (GH) levels exhibited suppression (below <1 ng/mL) at all time points during GH suppression test with 75 g oral glucose. After treatment with corticosteroid agents, he underwent transsphenoidal pituitary surgery and hiccups disappeared postoperatively. The GH secretion potential of the tumor was clearly demonstrated immunohistochemically. We conclude that stubborn hiccups in a patient with a pituitary macroadenoma may be a sign of massive apoplexy that may result in hormonal remission.
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Bozkirli E, Bakiner OS, Ersozlu Bozkirli ED, Eksi Haydardedeoglu F, Sizmaz S, Torun AI, Ertorer ME. Serum Immunoglobulin G4 levels are elevated in patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf) 2015; 83:962-7. [PMID: 25400133 DOI: 10.1111/cen.12671] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/30/2014] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE 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.
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Affiliation(s)
- Emre Bozkirli
- Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Okan Sefa Bakiner
- Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Adana, Turkey
| | | | - Filiz Eksi Haydardedeoglu
- Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Selcuk Sizmaz
- Department of Ophthalmology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Aysenur Izol Torun
- Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Melek Eda Ertorer
- Department of Endocrinology and Metabolism Diseases, Faculty of Medicine, Baskent University, Adana, Turkey
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Tanriverdi F, Dokmetas HS, Kebapcı N, Kilicli F, Atmaca H, Yarman S, Ertorer ME, Erturk E, Bayram F, Tugrul A, Culha C, Cakir M, Mert M, Aydin H, Taskale M, Ersoz N, Canturk Z, Anaforoglu I, Ozkaya M, Oruk G, Hekimsoy Z, Kelestimur F, Erbas T. Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database. Endocrine 2014; 47:198-205. [PMID: 24366641 DOI: 10.1007/s12020-013-0127-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/13/2013] [Indexed: 02/02/2023]
Abstract
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: non-secretory 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 syndrome is 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.
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Affiliation(s)
- F Tanriverdi
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey,
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10
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Abstract
Cushing's disease (CD) is a rare endocrine disorder resulting from excessive production of adrenocorticotrophin hormone by a pituitary adenoma. The consequent hypercortisolaemia gives rise to characteristic features of the disease and its morbidities. Treatments aim to restore normal cortisol levels, provide long-term control of the disease and the tumour, and the improvement of patient well-being. The first line of treatment remains transsphenoidal surgery with remission rates of 65-90% in CD secondary to a pituitary microadenoma. Second-line treatment includes repeat surgery, radiotherapy, medical therapy, and bilateral adrenalectomy. The success rate of radiotherapy ranges from 46% to 74% and is probably independent of the mode of delivery of the radiation, but may take several years to become effective. Medical therapy is useful in acutely unwell patients or while awaiting radiotherapy to become effective. The most often-used medical agents include metyrapone and ketoconazole, which inhibit steroidogenesis; less often, centrally-acting drugs or a glucocorticoid receptor blocker are used, but experience with them is more limited. Bilateral adrenalectomy remains an important treatment option to control unresponsive severe hypercortisolism, particularly in patients with severe CD.The management of childhood CD does not differ from adult disease, with transsphenoidal surgery as successful as in adults but radiotherapy is more rapid in onset. Regardless of the age of the patient, Cushing's disease remains a challenge to the physician and requires a multidisciplinary approach to achieve the most desirable outcome.
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Affiliation(s)
- A Juszczak
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK.
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Ertorer ME, Haydardedeoglu FE, Erol T, Anaforoglu I, Binici S, Tutuncu NB, Sezgin A, Demirag NG. Newly diagnosed hyperglycemia and stress hyperglycemia in a coronary intensive care unit. Diabetes Res Clin Pract 2010; 90:8-14. [PMID: 20674059 DOI: 10.1016/j.diabres.2010.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 05/20/2010] [Indexed: 01/08/2023]
Abstract
AIMS To determine prevalence of newly diagnosed hyperglycemia (NDH) among patients with acute coronary disease, inquire relationship of stress hyperglycemia (SH) with functional outcomes. METHODS 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, APG>200mg/dl and/or FPG>126 and/or any of CGM>200. Group 2a: unrecognized glycemic disorder, HbA1c>6.0%. Group 2b: stress hyperglycemia, HbA1c<6.0%. 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- M E Ertorer
- Baskent University Faculty of Medicine, Division of Endocrinology and Metabolism, Adana, Turkey.
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12
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Anaforoglu I, Ertorer ME, Kozanoglu I, Unal B, Haydardedeoglu FE, Bakiner O, Bozkirli E, Tutuncu NB, Demirag NG. Macroprolactinemia, like hyperprolactinemia, may promote platelet activation. Endocrine 2010; 37:294-300. [PMID: 20960266 DOI: 10.1007/s12020-009-9304-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 12/20/2009] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Inan Anaforoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Baskent University Faculty of Medicine, Ankara, Turkey
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13
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Anaforoglu I, Nar-Demirer A, Bascil-Tutuncu N, Ertorer ME. Prevalence of osteoporosis and factors affecting bone mineral density among postmenopausal Turkish women with type 2 diabetes. J Diabetes Complications 2009; 23:12-7. [PMID: 18413190 DOI: 10.1016/j.jdiacomp.2007.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 04/28/2007] [Accepted: 06/01/2007] [Indexed: 11/19/2022]
Abstract
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 A1c 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 A1c 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.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Bone Density/physiology
- Bone Diseases, Metabolic/complications
- Bone Diseases, Metabolic/epidemiology
- Bone Diseases, Metabolic/physiopathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/physiopathology
- Female
- Humans
- Middle Aged
- Osteoporosis, Postmenopausal/complications
- Osteoporosis, Postmenopausal/epidemiology
- Osteoporosis, Postmenopausal/physiopathology
- Prevalence
- Turkey/epidemiology
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Affiliation(s)
- Inan Anaforoglu
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey
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14
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Ertorer ME, Guvenc B, Haydardedeoglu B, Tekinturhan F. A Case Report of the Cascade Filtration System: A Safe and Effective Method for Low-density Lipoprotein Apheresis During Pregnancy. Ther Apher Dial 2008; 12:396-400. [DOI: 10.1111/j.1744-9987.2008.00616.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bakiner O, Ertorer ME, Haydardedeoglu FE, Bozkirli E, Tutuncu NB, Demirag NG. Subclinical hypothyroidism is characterized by increased QT interval dispersion among women. Med Princ Pract 2008; 17:390-4. [PMID: 18685279 DOI: 10.1159/000141503] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 08/18/2007] [Indexed: 12/14/2022] Open
Abstract
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 microg/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.
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Affiliation(s)
- O Bakiner
- Faculty of Medicine, Division of Endocrinology and Metabolism, Baskent University, Adana, Turkey.
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Cesur M, Bayram F, Temel MA, Ozkaya M, Kocer A, Ertorer ME, Koc F, Kaya A, Gullu S. Thyrotoxic hypokalaemic periodic paralysis in a Turkish population: three new case reports and analysis of the case series. Clin Endocrinol (Oxf) 2008; 68:143-52. [PMID: 17897330 DOI: 10.1111/j.1365-2265.2007.03014.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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 hypokalaemic, 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 > or = 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.
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Affiliation(s)
- Mustafa Cesur
- Ufuk University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey.
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Ertorer ME, Bakiner O, Anaforoglu I, Bozkirli E, Tutuncu NB, Demirag NG. Lanreotide autogel and insulin sensitivity markers: report of 5 acromegalic patients and literature review. Neuro Endocrinol Lett 2007; 28:727-733. [PMID: 18063933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 11/18/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To evaluate the short-term effects of Lanreotide Autogel on insulin sensitivity markers among acromegalic patients with pituitary tumors. DESIGN Prospective clinical trial with six months of follow-up. SETTING A tertiary endocrinology clinic. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Melek Eda Ertorer
- Baskent University Faculty of Medicine, Division of Endocrinology and Metabolism, Ankara, Turkey.
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Ertorer ME, Tutuncu NB, Ozyilkan O. Incidental papillary microcarcinoma of the thyroid. Asian Pac J Cancer Prev 2007; 8:631-634. [PMID: 18260743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
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 (IPC<or=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 IPC<or=10mm. There is an ongoing discussion among endocrinologists, endocrine surgeons and nuclear medicine specialists about the optimal therapeutic strategy for the patients with IPC<or=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.
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Affiliation(s)
- Melek Eda Ertorer
- Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey.
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Ertorer ME, Bakiner O, Anaforoglu I, Sezgin N, Demirag NG, Tutuncu NB. Serum osteoprotegerin concentration with strontium ranelate treatment for postmenopausal osteoporosis: an open, prospective study. Curr Ther Res Clin Exp 2007; 68:217-25. [PMID: 24683212 PMCID: PMC3967269 DOI: 10.1016/j.curtheres.2007.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2007] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Melek Eda Ertorer
- Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Okan Bakiner
- Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Inan Anaforoglu
- Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Nurzen Sezgin
- Department of Biochemistry, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Nilgun Guvener Demirag
- Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Neslihan Bascil Tutuncu
- Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey
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Ertorer ME, Anaforoglu I, Bozkirli E, Bakiner O, Tutuncu NB, Demirag NG. A new perspective in diagnosing polycystic ovary syndrome. J Natl Med Assoc 2007; 99:149-52. [PMID: 17366951 PMCID: PMC2569430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
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.
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Affiliation(s)
- Melek Eda Ertorer
- Division of Endocrinology and Metabolism, Baskent University, Faculty of Medicine, Ankara, Turkey.
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Bozkirli E, Ertorer ME, Bakiner O, Tutuncu NB, Demirag NG. The validity of the World Health Organisation's obesity body mass index criteria in a Turkish population: a hospital-based study. Asia Pac J Clin Nutr 2007; 16:443-7. [PMID: 17704025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
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 (p<0.001) 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.
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Affiliation(s)
- Emre Bozkirli
- Baskent University School of Medicine, Adana Medical Center, Dadaloglu mah. Serin Evler 39.sok. no: 6, 01250 Yuregir / Adana, Turkey.
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Ozdogu H, Boga C, Bolat F, Ertorer ME. Wegener's granulomatosis with a possible thyroidal involvement. J Natl Med Assoc 2006; 98:956-8. [PMID: 16775921 PMCID: PMC2569360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Wegener's granulomatosis (WG) is an autoimmune disorder characterized by the involvement of many organ systems. In patients with refractory disease, the efficacy of cyclophosphamide, corticosteroids and infliximab has been reported recently. Even in cases with serological response, disease progression has still been observed. Herein, we report a case of WG, most likely accompanied with subacute granulomatous thyroiditis while the patient was on cyclophosphamide, corticosteroid and infliximab therapy. As far as we know, this is the first time that such a copresentation has been observed, suggesting that mechanisms other than T-cell-mediated cytotoxicity may be important in the pathogenesis of granulomatous thyroiditis.
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Affiliation(s)
- Hakan Ozdogu
- Division of Hematology, Department of Pathology, Baskent University School of Medicine, Adana Medical Center, Adana, Turkey
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Gokcel A, Aydin M, Yalcin F, Yapar AF, Ertorer ME, Ozsahin AK, Muderrisoglu H, Aktas A, Guvener N, Akbaba M. Silent coronary artery disease in patients with type 2 diabetes mellitus. Acta Diabetol 2003; 40:176-80. [PMID: 14740277 DOI: 10.1007/s00592-003-0108-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2002] [Accepted: 07/31/2003] [Indexed: 10/26/2022]
Abstract
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 > or =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.
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Affiliation(s)
- A Gokcel
- Division of Endocrinology and Metabolism, Baskent University, Dadaloglu Mah Serin Evler 39 Sok No 6, 01250, Yuregir, Adana, Turkey
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Gokcel A, Ozsahin AK, Sezgin N, Karakose H, Ertorer ME, Akbaba M, Baklaci N, Sengul A, Guvener N. High prevalence of diabetes in Adana, a southern province of Turkey. Diabetes Care 2003; 26:3031-4. [PMID: 14578235 DOI: 10.2337/diacare.26.11.3031] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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 1637 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.
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Affiliation(s)
- Adnan Gokcel
- Division of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Adana, Turkey.
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