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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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Inci Coskun E, Omma T, Taskaldiran I, Firat SN, Culha C. Metabolic role of hepassocin in polycystic ovary syndrome. Eur Rev Med Pharmacol Sci 2023; 27:5175-5183. [PMID: 37318492 DOI: 10.26355/eurrev_202306_32635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a female endocrinopathy characterized by hyperandrogenemia, insulin resistance, glucose intolerance, dyslipidemia, non-alcoholic fatty liver disease (NAFLD), and obesity. Hepassocin (HPS) is a hepatokine involved in energy and lipid metabolism. We aimed to investigate the role of HPS in metabolic dysfunction and its relationship with fatty liver in patients with PCOS. PATIENTS AND METHODS A total of 45 newly diagnosed PCOS patients and 42 healthy women of similar age were included in the study. Routine anthropometric, biochemical, and hormonal information were recorded. Serum HPS and high-sensitivity C-reactive protein (hsCRP) were measured, and NAFLD fibrosis score (NFS) and Fibrosis-4 (FIB-4) were calculated and correlated. RESULTS HPS and hsCRP values of the PCOS group were found to be significantly higher than controls (p=0.005, p<0.001, respectively). A positive correlation was found between both HPS and hsCRP and luteinizing hormone (LH) (p<0.001). No correlation was observed between HPS and NFS and FIB-4, however, only a weak negative correlation was observed between hsCRP and FIB-4. A negative correlation was found between HPS and BMI, waist circumference, fat ratio, and HbA1c (p<0.05). In multivariate regression analysis for HPS, R-squared is 0.898, and hsCRP, neck circumference, fat amount, and LH are significant factors. CONCLUSIONS NAFLD is an important dysmetabolic component of PCOS. Serum HPS is elevated in PCOS patients. We found a positive correlation between hsCRP and LH and a negative correlation between obesity indices, although we did not find an association between NFS and FIB-4, and HPS. In the future, large-scale molecular studies of HPS may be beneficial.
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Affiliation(s)
- E Inci Coskun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.
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Gokbulut P, Koc G, Kuskonmaz S, Onder C, Omma T, Fırat S, Culha C. HIGH THYROPEROXIDASE ANTIBODY TITERS MAY PREDICT RESPONSE TO ANTITHYROID DRUG TREATMENT IN GRAVES DISEASE: A PRELIMINARY STUDY. Acta Endocrinol (Buchar) 2023; 19:195-200. [PMID: 37908881 PMCID: PMC10614590 DOI: 10.4183/aeb.2023.195] [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] [Indexed: 11/02/2023]
Abstract
Background and aim Antithyroid drugs are first treatment for Graves hyperthyroidism worldwide. Although remission can be achieved in approximately 40-50% of patients in 12-18 months with antithyroid drugs, this period can be extended up to 24 months. We aimed to evaluate the effect of individual clinical/biochemical variables and GREAT score in predicting response to antithyroid drug in Graves disease. Material and methods This is a retrospective single-center study including 99 patients with the first episode of Graves disease treated for at least 18 months. The patients were classified into two groups as those who responded to antithyroid medication at 18-24 months (group 1) and those who did not respond at 24 months and continued with low-dose antithyroid medication (group 2). Results Medical treatment response was obtained in 38 (38.3%) of the patients at 18 months, and in 19 (19.1%) patients at 24 months. Long-term medical treatment (>24 months) was given to the remaining 43 patients due to the lack of response to medical treatment. Thyroid volume and free T4 levels were higher in those followed up with long-term antithyroid drugs, and orbitopathy was more common in this group. Median anti TPO value was significantly higher in group 1 when compared to group 2 (593 U/l and 191.6 U/l respectively). More patients were classified as GREAT class 3 in group 2 when compared to group 1 (46.5% and 12,5% respectively). We analyzed the Thyroperoxidase Antibody(anti TPO) titers, which we divided into three levels, according to groups 1 and 2. Post-hoc Chi-Square analysis revealed that falling into the highest anti TPO category was significantly associated with response to medical therapy in 24 months (p <0.05). Conclusion According to our study, GREAT score and anti TPO Ab titers at presentation may help predict response to ATD in Graves disease.
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Affiliation(s)
- P. Gokbulut
- Ankara Training and Research Hospital, Dept. of Endocrinology and Metabolic Diseases, Ankar
| | - G. Koc
- Ankara Training and Research Hospital, Dept. of Endocrinology and Metabolic Diseases, Ankar
| | - S.M. Kuskonmaz
- Ankara Training and Research Hospital, Dept. of Endocrinology and Metabolic Diseases, Ankar
| | - C.E. Onder
- Nigde Ömer Halisdemir Training and Research Hospital, Dept. of Endocrinology and Metabolic Diseases, Nigde, Turkey
| | - T. Omma
- Ankara Training and Research Hospital, Dept. of Endocrinology and Metabolic Diseases, Ankar
| | - S. Fırat
- Ankara Training and Research Hospital, Dept. of Endocrinology and Metabolic Diseases, Ankar
| | - C. Culha
- Ankara Training and Research Hospital, Dept. of Endocrinology and Metabolic Diseases, Ankar
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Onder CE, Kuskonmaz SM, Koc G, Firat SN, Omma T, Culha C. Evaluation of management of patients with postoperative permanent hypoparathyroidism. How close are we to the targets? Minerva Endocrinol (Torino) 2023; 48:12-18. [PMID: 33269571 DOI: 10.23736/s2724-6507.20.03291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Postoperative hypoparathyroidism (PO-HypoPT) is a complication usually seen after thyroid surgery. PO-HypoPT, which lasts longer than 6 months is defined permanently. The aim of this study was to evaluate how close permanent PO-HypoPT patients can approach target values. METHODS One hundred seven patients who were followed-up with permanent diagnosis of PO-HypoPT between 2016-2020 were included in the study. The study protocol includes serum albumin corrected total calcium (Alb-sCa), phosphate (P), Ca-P product, and 24 h urine calcium measurements. Laboratory measurements of the patients include the values recorded in 4-year visits and in the last visit. In addition, radiological reports of renal/abdominal ultrasound and cranial tomography examinations performed in our hospital for any reason during this period were also reviewed. RESULTS When looking at the total measurements in the 4-year period, the Alb-sCa level was below the target in most of the measurements (68.1%). P level was higher than normal in 296 (46.2%) measurements. Twenty-four h urine ca excretion was measured 185 times in total visits, and 81 (43.7%) of these measurements showed hypercalciuric values. The patient's latest visit measurements were evaluated on 4 targets (Alb-sCa, P, Ca-P product and 24 h urine Ca excretion). The number of patients meeting all four targets was only 21 (19.6%). Six (7.5%) patients had kidney stones or nephrocalcinosis. Three (0.09%) patients with imaging had calcification in the basal ganglia. CONCLUSIONS Our study shows that the management of the patients with PO-HypoPT is suboptimal with active vitamin D and cholecalciferol treatment.
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Affiliation(s)
- Cagatay E Onder
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye -
| | - Serife M Kuskonmaz
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Gonul Koc
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Sevde N Firat
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Tulay Omma
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Cavit Culha
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Türkiye
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Omma T, Gokce A, Celik M, Karahan I, Culha C, Gulcelik NE. A New Predictor for Insulin Resistance in Polycystic Ovary Syndrome: InsuTAG. CWHR 2023. [DOI: 10.2174/1573404820666230301115706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background:
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age. PCOS leads to metabolic dysfunction such as dyslipidemia, obesity, and glucose intolerance based on hyperandrogenemia, hyperinsulinemia, and dysregulated adipokine secretion.
Objective:
The aim of this study was to investigate whether a new marker, InsuTAG (fasting insulin×fasting triglycerides) could predict insulin resistance (IR) in patients of PCOS.
Methods:
In this study, retrospective data of 300 female patients diagnosed with PCOS were analyzed. The relationship between InsuTAG and HOMA-IR, TyG, and TG/HDL-C scores related to insulin resistance was evaluated. In addition, the distribution of the cases according to the cut-off values was determined.
Results:
Log-transformed forms of InsuTAG and HOMA-IR, TyG and TG/HDL-C results were positively correlated, respectively. (r=0.85, p<0.001; r₌0.78,p<0.001; r₌0.72, p<0.001). Sensitivity, specificity, positive predictive value and negative predictive values for InsuTAG were calculated as 85%, 85%, 82% and 88%, respectively.
Conclusions:
This study is the first to compare the InsuTAG, another predictor of insulin resistance, with other IR markers in women with PCOS. InsuTAG is a novel biomarker based on plasma sampling of insulin and triglyceride, with minimally invasive, inexpensive and orientally accessible features.
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Affiliation(s)
- Tulay Omma
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230, Ankara, TURKEY
| | - Aksanur Gokce
- Department of Family Medicine, University of Health Sciences, Ankara Training and Research Hospital, 06230, Ankara, TURKEY
| | - Mustafa Celik
- Department of Family Medicine, University of Health Sciences, Ankara Training and Research Hospital, 06230, Ankara, TURKEY
| | - Irfan Karahan
- Department of Internal Medicine, University of Kırıkkale, Faculty of Medicine, 71450, Kırıkkale, TURKEY
| | - Cavit Culha
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230, Ankara, TURKEY
| | - Nese Ersoz Gulcelik
- Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane Training and Research Hospital, 06010, Ankara, TURKEY
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Fırat SN, Kuşkonmaz ŞM, Önder ÇE, Omma T, Genç H, Çulha C. Sonographic evaluation of subclinical entheseal involvement in patients with hypoparathyroidism: a case control study. J Endocrinol Invest 2023; 46:133-139. [PMID: 35982371 DOI: 10.1007/s40618-022-01891-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/29/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Hypoparathyroidism is a disease characterized by low serum calcium, increased serum phosphorus and low PTH levels. Although patients are treated with active vitamin D and calcium, a proper serum calcium phosphorus balance cannot always be achieved. Ectopic calcifications that develop in organs during treatment are the most common complications. To date, there is not any published study on enthesopathy in patients with hypoparathyroidism. The aim of this study was to evaluate subclinical enthesopathy in patients with hypoparathyroidism with ultrasound and to compare the results with those of the control group. METHODS The study included patients aged 18-65 years with postoperative hypoparathyroidism and hypothyroidism (group hypoP + hypoT), patients with postoperative hypothyroidism (group hypoT), and healthy age and sex-matched volunteers (group C). Ultrasonographic findings of enthesopathy in both extremities were documented according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). RESULTS GUESS scores in group hypoP + hypoT, were significantly higher when compared to the other groups. There was a statistically significant correlation between the total GUESS scores and total enthesophyte scores and the duration of hypoparathyroidism (p < 0.05, r = 0.43) (p < 0.05, r = 0.39) respectively. In the correlation analysis of all groups, a significant negative correlation was found between serum Ca and PTH levels and the total GUESS scores (p < 0.01, r = - 0.37; p < 0.01, r = - 0.54, respectively). CONCLUSION This study showed that GUESS scores were significantly higher in patients with hypoparathyroidism compared to those with hypothyroidism and control subjects. GUESS scores were positively correlated with disease duration. Patients with hypoparathyroidism need to be evaluated for subclinical enthesopathy during follow-up.
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Affiliation(s)
- S N Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey.
| | - Ş M Kuşkonmaz
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
| | - Ç E Önder
- Department of Endocrinology and Metabolism, Niğde Ömer Halisdemir University Training and Research Hospital, Niğde, Turkey
| | - T Omma
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
| | - H Genç
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - C Çulha
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, 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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Omma T, Gulcelik NE, Zengin FH, Karahan I, Culha C. Dietary Acid Load is Associated with Hypertension and Diabetes in the Elderly. Curr Aging Sci 2022; 15:242-251. [PMID: 35346013 DOI: 10.2174/1874609815666220328123744] [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] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diet can affect the body's acid-base balance due to its content of acid or base precursors. There is conflicting evidence for the role of metabolic acidosis in the development of cardiometabolic disorders, hypertension (HT), and insulin resistance (IR). OBJECTIVE We hypothesize that dietary acid load (DAL) is associated with adverse metabolic risk factors and we aimed to investigate this in the elderly. METHODS A total of 114 elderly participants were included in the study. The participants were divided into four groups such as HT, diabetes (DM), both HT and DM, and healthy controls. Anthropometric, biochemical, and clinical findings were recorded. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) results were obtained from three-day, 24-hour dietary records via a nutrient database program. (BeBiS software program). RESULTS The groups were matched for age, gender, and BMI. There was a statistically significant difference between the groups in terms of NEAP (p=0.01) and no significant difference for PRAL (p=0.086). The lowest NEAP and PRAL levels were seen in the control group while the highest in the HT group. Both NEAP and PRAL were correlated with waist circumference (r=0,325, p=0.001; r=0,231, p=0,016, respectively). CONCLUSION Our data confirmed that subjects with HT and DM had diets with greater acid-forming potential. High NEAP may be a risk factor for chronic metabolic diseases, particularly HT. PRAL couldn't be shown as a significantly different marker in all participants. Dietary content has a significant contribution to the reduction of cardiovascular risk factors such as HT, DM, and obesity.
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Affiliation(s)
- Tulay Omma
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230, Ankara, Turkey
| | - Nese Ersoz Gulcelik
- Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | - Fatmanur Humeyra Zengin
- Department of Nutrition and Dietetics, University of Health Sciences, Ankara Training and Research Hospital, 06230, Ankara, Turkey
| | - Irfan Karahan
- Department of Internal Medicine, University of Kırıkkale, Faculty of Medicine, 71450, Kırıkkale, Turkey
| | - Cavit Culha
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230, Ankara, Turkey
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Konca Degertekin C, Gogas Yavuz D, Pekkolay Z, Saygili E, Ugur K, Or Koca A, Unubol M, Topaloglu O, Aydogan BI, Ozdemir Kutbay N, Hekimsoy Z, Yilmaz N, Balci MK, Tanrikulu S, Aydogan Unsal Y, Ersoy C, Omma T, Keskin M, Yalcin MM, Yetkin I, Soylu H, Karakose M, Yilmaz M, Karakilic E, Piskinpasa H, Batman A, Akbaba G, Elbuken G, Tura Bahadir C, Kilinc F, Bilginer MC, Turhan Iyidir O, Canturk Z, Aktas Yilmaz B, Sayiner ZA, Eroglu M. Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study. Calcif Tissue Int 2022; 110:204-214. [PMID: 34495356 DOI: 10.1007/s00223-021-00908-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 05/31/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5-10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients.
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Affiliation(s)
- Ceyla Konca Degertekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ufuk University, Ankara, Turkey.
- Endokrinoloji BD, Ufuk Üniversitesi Hastanesi, Mevlana Bulvarı (Konya Yolu) No:86-88 Balgat, Ankara, Turkey.
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Emre Saygili
- Endocrinology and Metabolism Clinic, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Kader Ugur
- Department of Endocrinology and Metabolism, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Arzu Or Koca
- Endocrinology and Metabolism Clinic, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Mustafa Unubol
- Department of Endocrinology and Metabolism, Faculty of Medicine, Aydın Adnan Menderes University, Aydin, Turkey
| | - Omercan Topaloglu
- Endocrinology and Metabolism Clinic, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Berna Imge Aydogan
- Endocrinology and Metabolism Clinic, Batman Training and Research Hospital, Batman, Turkey
| | - Nilufer Ozdemir Kutbay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Nusret Yilmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mustafa Kemal Balci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Seher Tanrikulu
- Endocrinology and Metabolism Clinic, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Aydogan Unsal
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Canan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Tulay Omma
- Endocrinology and Metabolism Clinic, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muge Keskin
- Endocrinology and Metabolism Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hikmet Soylu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kırsehir Ahi Evran University, Kirsehir, Turkey
| | - Melia Karakose
- Department of Endocrinology and Metabolism, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Merve Yilmaz
- Endocrinology and Metabolism Clinic, Samsun Gazi Training and Research Hospital, Samsun, Turkey
| | - Ersen Karakilic
- Department of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Hamide Piskinpasa
- Endocrinology and Metabolism Clinic, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Adnan Batman
- Endocrinology and Metabolism Clinic, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Cigdem Tura Bahadir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Faruk Kilinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Muhammet Cuneyt Bilginer
- Endocrinology and Metabolism Clinic, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ozlem Turhan Iyidir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Zeynep Canturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Banu Aktas Yilmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Zeynel Abidin Sayiner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Nigde University, Nigde, Turkey
| | - Mustafa Eroglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Balıkesir University, Balikesir, Turkey
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Gokce A, Omma T, Çelikc M, Taşkaldıran I. An overview of the hematological picture with antithyroid therapy in Graves' disease. Acta fac medic Naissensis 2022. [DOI: 10.5937/afmnai39-36192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Aim: Graves' disease is an autoimmune thyroid disease that is the most common cause of hyperthyroidism. Peripheral blood cell parameters such as neutrophils, lymphocytes, and platelets play a role in inflammation control. Several studies have proven that neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio are indicators of chronic subclinical inflammation in various diseases. In our study, we aimed to review the peripheral blood picture by evaluating these parameters before and after antithyroid treatment in patients with Graves' disease. Patients and methods: A total of 120 patients (93 female, 27 male) between the ages of 18-65 were included. Demographic data, hemogram and biochemical data of the patients were recorded retrospectively at the time of diagnosis and after euthyroidism was achieved with medical treatment. Results: During the treatment, there was an increase in hemoglobin, lymphocytes, neutrophils and red cell distribution width, while a decrease in monocytes was observed. There was no significant difference between white blood cell, platelet and mean platelet volume. In addition, while there was no statistically significant difference between neutrophil-lymphocyte ratio (p = 0.8) and thrombocyt-lymphocyte ratio (p = 0.078) after euthyroid state, a statistically significant difference was found in favor of a decrease in monocyte-lymphocyte ratio (p = 0.006). Conclusion: Changes in hematopoiesis are relatively common in patients with newly diagnosed Graves' disease, and initiation of antithyroid therapy leads to improvement in these parameters. Although neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio are accepted as new, non-invasive markers in clinical evaluation, in our study only a significant decrease in monocyte-lymphocyte ratio levels was observed after euthyroidism was achieved with antithyroid treatment.
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Omma T, Tunc AR, Fırat SN, Taskaldıran I, Culha C, Ersoz Gulcelik N. Pedabarography May Play a Role in Foot Plantar Scanning in Acromegaly. Int J Clin Pract 2022; 2022:9882896. [PMID: 35685582 PMCID: PMC9158791 DOI: 10.1155/2022/9882896] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS Acromegaly is associated with symptoms in many organs, including the heart, colon, skin, bones, and many joints. Patients with long-term treatment or biochemical control still suffer from acromegaly arthropathy (AA). Primarily, the weight-bearing joints of the lower extremity are affected and at last deformation emerges. The aim of this study is to detect the changes in the feet with pedabarography in patients with acromegaly. MATERIALS AND METHODS Nineteen patients with acromegaly (4 males and 15 females) and 13 healthy controls (1 male and 12 females) were included in the study (p=0.31). There was no difference between acromegaly patients and controls in terms of gender, age, and BMI; median age and BMI were (54 (20-67) vs. 52 (30-58), p=0.85) and (32.5 (20.3-42.7) vs. 29.5 (22.4-38.6), p=0.93), respectively. Static plantar pressures of bilateral foot of all participants in the standing position were measured by pedabarography. RESULTS In pedabarographic analysis, there were only significant difference in rearfoot surface right and rearfoot surface left (p=0.04 and p=0.01), respectively. The mean of the right rearfoot surface (43.5 cm2 vs. 36.6 cm2) and the mean of the left rear foot surface were higher than the controls (47.4 cm2 vs. 40.2 cm2). Forefoot surface, forefoot load, forefoot weight ratio, rearfoot load, total foot surface, total load, total peak pressure, and total average pressure were higher in left foot in both groups, but there was no difference between the two groups. CONCLUSION In our study, there was a significant difference between acromegaly patients and healthy controls, only on the right rarefoot surface and the left rarefoot surface, and was higher on the left in both groups. These patients often experience changes in the hindfoot and heel, and foot surface area and pressure distribution may vary. Early diagnosis and proper treatment of the disease can prevent the development of complications and improve the quality of life. Foot scanning using pedabarography in the management of AA is a useful tool that can be used to manufacture customized orthopedic insoles and ergonomic shoe designs to prevent irreversible damage and reduce overload and lower extremity pain.
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Affiliation(s)
- Tulay Omma
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Azize Reda Tunc
- Department of Physiotherapy, Lokman Hekim University, Faculty of Health Sciences, 06510 Ankara, Turkey
| | - Sevde Nur Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Isılay Taskaldıran
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Cavit Culha
- Department of Endocrinology and Metabolism, University of Health Sciences, Ankara Training and Research Hospital, 06230 Ankara, Turkey
| | - Nese Ersoz Gulcelik
- Department of Endocrinology and Metabolism, University of Health Sciences, Gulhane Training and Research Hospital, 06010 Ankara, Turkey
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Onder CE, Kuşkonmaz SM, Koc G, Firat S, Omma T, Taskaldiran I, Gokbulut P, Culha C. Factors that affect the Glycemic Control Achieved by Switching to Insulin Degludec/ Aspart in Insulin-Treated Patients with Type 1 and Type 2 Diabetes in a Real-World Setting: a Non-interventional, Retrospective Cohort Study. Acta Endocrinol (Buchar) 2021; 16:443-448. [PMID: 34084235 DOI: 10.4183/aeb.2020.443] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Insulin degludec/aspart (IDegAsp) is a co-formulation with IDeg and IAsp. Different insulin regimens may be switched to IDegAsp. In this study, we aimed to find out the effect of switch to IDegAsp on glycemic control and whether the basal characteristics and treatment modalities of the patients affect the change in glycemic control brought by switch to IDegAsp. Methods We retrospectively analyzed the records of 78 patients whose insulin therapies (basal+bolus, premixed analogues or basal only) were switched on a 1:1 unit basis to IDegAsp±bolus insulin. Oral antidiabetic agents (OADs) given were recorded. At the end of 12th and 24th week, total insulin doses of patients and HbA1c were compared to the baseline. Results There was a statistically significant decrease at HbA1c at 12 weeks (1.4%; p<0.001). There was not a significant difference in HbA1c between the OAD added group and the group with no new OADs(p=0.1). Basal insulin dose was not statistically different from baseline, whereas bolus insulin dose was significantly lower (p=0.007). At the end of 24 weeks the decrease in HbA1c level from baseline was preserved. Conclusion Regardless of the baseline insulin regimen, diabetes type and oral antidiabetic drugs given, HbA1c is significantly lowered after switching to IDegAsp.
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Affiliation(s)
- C E Onder
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - S M Kuşkonmaz
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - G Koc
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - S Firat
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - T Omma
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - I Taskaldiran
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - P Gokbulut
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - C Culha
- Ankara Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
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Onder CE, Kuskonmaz SM, Koc G, Firat SN, Omma T, Culha C. Evaluation of management of patients with postoperative permanent hypoparathyroidism. How close are we to the targets? MINERVA ENDOCRINOL 2020:S0391-1977.20.03291-5. [PMID: 33269571 DOI: 10.23736/s0391-1977.20.03291-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative hypoparathyroidism (PO-HypoPT) is a complication usually seen after thyroid surgery. PO-HypoPT, which lasts longer than 6 months is defined permanently. The aim of this study is to evaluate how close permanent POHypoPT patients can approach target values. MATERIALS AND METHODS 107 patients who were followed up with permanent diagnosis of PO-HypoPT between 2016-2020 were included in the study. The study protocol includes serum albumin corrected total calcium (Alb-sCa), phosphate (P), Ca-P product, and 24 h urine calcium measurements. Laboratory measurements of the patients include the values recorded in 4-year visits and in the last visit. In addition, radiological reports of renal/abdominal ultrasound and cranial tomography examinations performed in our hospital for any reason during this period were also reviewed. RESULTS When looking at the total measurements in the 4-year period; the Alb-sCa level was below the target in most of the measurements (68.1%). P level was higher than normal in 296 (46.2%) measurements. 24 h urine ca excretion was measured 185 times in total visits, and 81 (43.7%) of these measurements showed hypercalciuric values. The patient's latest visit measurements were evaluated on 4 targets (Alb-sCa, P, Ca-P product and 24 h urine Ca excretion). The number of patients meeting all four targets was only 21 (19.6%). 6 (7.5%) patients had kidney stones or nephrocalcinosis. 3 (0.09%) patients with imaging had calcification in the basal ganglia. CONCLUSIONS Our study shows that the management of the patients with PO-HypoPT is suboptimal with active vitamin D and cholecalciferol treatment.
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Affiliation(s)
- Cagatay E Onder
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey -
| | - Serife M Kuskonmaz
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gonul Koc
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Sevde N Firat
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Tulay Omma
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Cavit Culha
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
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Omma A, Erden F, Colak S, Can Sandikci S, Omma T, Kasim I, Ozkara A, Erden A. AB0812 IS THE VISCERAL ADIPOSITY INDEX ASSOCIATED WITH THE PRESENCE OF CARDIOVASCULAR RISK SCORES AND COMORBIDITY IN PSORIATIC DISEASE? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Psoriatic disease (PsD) is a chronic immune-mediated inflammatory disorder and predominantly involves the skin and joints. There is a better known relationship between the severity of PsD with some comorbidities such as metabolic syndrome, cardiovascular disease and obesity. Visceral Adiposity Index (VAI) has been shown to be an important marker, gender- dependent for insulin resistance, adipose tissue function and distribution.Objectives:The aim of this study was to evaluate the relationship between the VAI and cardiovascular risk scores of patients with psoriatic arthritis.Methods:This study was conducted with 101 PsD patients who fulfilled the classification criteria for Psoriatic Arthritis (CASPAR) criteria and 98 healthy subjects. Demographic and clinical data were recorded. Disease activity was evaluated with the Health Assessment Questionnaire (HAQ), Disease Activity Index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Disease Activity Index (BASFI) and Psoriasis Area Severity Index (PASI). The SCORE, Framingham index, metabolic syndrome (MetS), Body mass index (BMI) and VAI values of the patients and the VAI values of the healthy subjects were calculated.Results:Mean BMI (kg/m2) was calculated as 29.63 5.66. According to the SCORE measurements, 53 (52.5%) patients were at low risk, 45 (44.6 %) at moderate risk, and 3 (3 %) at high risk. No patients were at very high risk. According to the Framingham score, 72 patients (71.3%) were at low risk, 22 patients (21.8%) at intermediate risk and 7 patients (6.9%) at high risk. The risk was found to be statistically significantly higher in the PsD group compared to the healthy control group in respect of metabolic syndrome, obesity (BMI >30) and VAI levels (p<0.05). Significantly higher VAI levels were determined in PsD patients with metabolic syndrome, BMI> 30 (obesity), diabetes mellitus and hypertension compared to without these comorbidities (p<0.05). A statistically significant correlation was determined between low and moderate risk Framingham score, and the VAI levels of PsD patients. Correlations were determined between disease activity and metabolic and cardiovascular risks of patients. A weak correlation was observed between VAI levels and the Framingham score (Table).Conclusion:Patients with psoriasis are more susceptible to obesity and other diseases such as metabolic syndrome, dyslipidemia, cardiovascular diseases, insulin resistance and diabetes. Therefore, control of bodyweight in PsD patients is important for management of the disease. Since VAI can be calculated simply from routinely taken measurements, the VAI level can be used to determine cardiovascular risk and VAI may also provide clues about comorbidities in patients with newly diagnosed PsD.Table.Correlations (r) between disease activity and metabolic and cardiovascular risks of patientsParametersBASDAIPASIDAPSABASFIHAQVAISCOREFramingham risk scoreFramingham risk score0.020.0950.285**0.202**0.0670.299**0.5231SCORE-0.079-0.0260.0950.065-0.010.05810.523**VAI0.1280.1920.1010.1050.01910.0580.299**HAQ0.1290.1350.421**0.284**10.019-0.010.067BASFI0.764**0.140.484**10.284**0.1050.0650.202*DAPSA0.462**0.341**10.484**0.421**0.1010.0950.285**PASI0.09210.341**0.1400.1350.192-0.0260.095BASDAI10.0920.462**0.764**0.1290.128-0.0790.024Abbreviation; VAI: Visceral Adiposity Index, SCORE: Systematic Coronary Risk Evaluation Index, Health Assessment Questionnaire (HAQ), Disease Activity Index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Disease Activity Index (BASFI) and Psoriasis Area Severity Index (PASI).*p<0.05, **p<0.001Disclosure of Interests:None declared
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Can Sandikci S, Omma A, Yucel C, Omma T. SAT0513 ASSOCIATION OF SERUM OMENTIN LEVELS WITH COLCHICINE RESISTANCE IN FAMILIAL MEDITERRANEAN FEVER. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Omentin is an anti-inflammatory adipokine, which plays important roles in the adjustments of glucose metabolism, cardiovascular homeostasis, atherosclerosis (1).Objectives:To investigate the omentin levels in Familial Mediterranean fever (FMF) patients and to assess the association with markers of subclinical inflammation in FMF patients such as serum amyloid A (SAA), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Methods:This cross-sectional study included 54 consecutive adult FMF patients (27 male, 27 female) and 28 healthy individuals (16 male, 12 female). The demographic and clinical features and MEFV gene mutations were recorded. The FMF patients were separated into 3 groups: 1) attack-free group, 2) active attack group and 3) colchicine-resistant group. Serum omentin levels were compared between the FMF patients and the healthy control group.Results:Serum omentin and SAA levels were higher in the study group than in the control group (108.05(19.97-343.22) vs. 199.5(42.98-339.41) p<0.05, 3.69(1.18-22.75) vs. 1.31(0.95-3.16) p<0.001) (Table 1). When the FMF patients were examined as separate groups, serum omentin values were lower in the colchicine resistant group than in the groups without resistance (Table 2). The correlation analysis showed a negative correlation between omentin and SAA levels (r = -0.240, p = 0.030).Table 1.Laboratory results of the FMF and the control groupVariablesFMF patients(n=54)Control(n=28)P valueOmentin, pg/mL108.05(19.97-343.22)199.5(42.98-339.41)0.03SAA, ng/mL3.7 (1.18-22.75)1.31(0.95-3.16)<0.001ESR, mm/h15(2-68)12(7-17)<0.001CRP, mg/L12(1-194)2.5(1-8)<0.001Variables were given as median (IQR).Calculated using Mann-Whitney U test for non-normal distribution.FMF=Familial Mediterranean fever, SAA=serum amyloid A, ESR=erythrocyte sedimentation rate, CRP=C-reactive protein, IQR=interquartile range.Table 2.Laboratory results of FMF patients with and without colchicine resistanceVariablesWith resistance(n=16)Without resistance(n=38)P valueOmentin, pg/mL76.64(19.77-224.33)186.47(28.41-343.21)0.006SAA, ng/mL3.69(1.18-22.75)3.77(1.18-21.49)0.784ESR, mm/h25.5(2-68)15(2-60)0.835CRP, mg/L11(1-67)19(1-194)0.111Variables were given as median (IQR).Calculated using Mann-Whitney U test for non-normal distribution.FMF=Familial Mediterranean fever, SAA=serum amyloid A, ESR=erythrocyte sedimentation rate, CRP=C-reactive protein, IQR=interquartile range.FOMConclusion:FMF patients with colchicine resistance are associated with decreased omentin concentrations, probably mediated by inflammation-driven mechanisms.References:[1]Yue J, Chen J, Wu Q, Liu X, Li M, Li Z, Gao Y. Serum levels of omentin-1 association with early diagnosis, lesion volume and severity of acute ischemic stroke. Cytokine. 2018;111:518–522.Disclosure of Interests:None declared
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Colak S, Omma A, Sandikci SC, Yucel C, Omma T, Turhan T. Vaspin, neutrophil gelatinase-associated lipocalin and apolipoprotein levels in patients with psoriatic arthritis. ACTA ACUST UNITED AC 2019; 120:65-69. [PMID: 30685995 DOI: 10.4149/bll_2019_010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To examine the relationship between disease activity and vaspin, neutrophil gelatinase-associated lipocalin (NGAL) and apolipoprotein levels in patients with psoriatic arthritis (PsA). BACKGROUND Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, which is related with psoriasis. Adipokines are the mediators which play a role in metabolic homeostasis and inflammatory conditions. METHODS The levels of vaspin, NGAL, apolipoproteins and their correlations with disease activity were compared in 50 psoriatic arthritis patients and 36 healthy controls. RESULTS The levels of vaspin, NGAL and apolipoprotein B/A1 ratio were significantly higher in the patient group (p 0.05). CONCLUSION This is the first study to have compared vaspin and NGAL levels in patients with PsA. Vaspin and NGAL can be used as a biomarker in PsA. Vaspin, NGAL and dyslipoproteinemia are not correlated with disease activity (Tab. 3, Ref. 63).
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Dogansen SC, Cikrikcili U, Oruk G, Kutbay NO, Tanrikulu S, Hekimsoy Z, Hadzalic A, Gorar S, Omma T, Mert M, Akbaba G, Yalin GY, Bayram F, Ozkan M, Yarman S. Dopamine Agonist-Induced Impulse Control Disorders in Patients With Prolactinoma: A Cross-Sectional Multicenter Study. J Clin Endocrinol Metab 2019; 104:2527-2534. [PMID: 30848825 DOI: 10.1210/jc.2018-02202] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 10/12/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Dopamine agonist (DA)-induced impulse control disorder (ICD) in patients with prolactinomas is not sufficiently known. OBJECTIVE To evaluate the prevalence of DA-induced ICDs and possible risk factors related to these disorders in patients with prolactinoma. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional multicenter study involving 308 patients with prolactinoma followed up in tertiary referral centers who received at least three months of DA therapy. DA-induced ICDs (pathological gambling, hypersexuality, compulsive shopping, and compulsive eating) and impulsivity were assessed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease and the Barratt Impulsiveness Scale-11, respectively. Patients were evaluated in terms of parameters related to ICD development. RESULTS Any ICD prevalence was 17% (n = 51). Hypersexuality was most common (6.5%). Although any ICD and hypersexuality were more common in male patients (P = 0.009, P < 0.001, respectively), compulsive eating was more common in female patients (P = 0.046). Current smoking, alcohol use, and gambling history were more frequent (P = 0.033, P = 0.002, P = 0.008, respectively) in patients with any ICD. In Barratt Impulsiveness Scale-11 total, attentional, motor, and nonplanning scores were higher in patients with any ICD (P < 0.001). Current smoking and alcohol use were more frequent (P = 0.007, P = 0.003, respectively) and percentage increase of testosterone levels at last visit was higher (P = 0.021) in male patients with prolactinomas with hypersexuality. CONCLUSION Any ICD may be seen in one of six patients with prolactinoma who are receiving DA therapy. Endocrinology specialists should be aware of this side effect, particularly in male patients with a history of gambling, smoking, or alcohol use.
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Affiliation(s)
- Sema Ciftci Dogansen
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ugur Cikrikcili
- Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul University Istanbul, Turkey
| | - Gonca Oruk
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
| | - Nilufer Ozdemir Kutbay
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Seher Tanrikulu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Zeliha Hekimsoy
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Celal Bayar University Medicine Faculty, Manisa, Turkey
| | - Aysa Hadzalic
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Erciyes University School of Medicine, Kayseri, Turkey
| | - Suheyla Gorar
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Antalya Training and Research Hospital, Antalya, Turkey
| | - Tulay Omma
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meral Mert
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Mugla Sıtkı Kocman University School of Medicine, Mugla, Turkey
| | - Gulsah Yenidunya Yalin
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey
| | - Fahri Bayram
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mine Ozkan
- Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul University Istanbul, Turkey
| | - Sema Yarman
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey
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Karaca A, Reyes M, Shumate LT, Taskaldiran I, Omma T, Ersoz Gulcelik N, Bastepe M. Severe brachydactyly and short stature resulting from a novel pathogenic TRPS1 variant within the GATA DNA-binding domain. Bone 2019; 123:153-158. [PMID: 30914275 PMCID: PMC6506180 DOI: 10.1016/j.bone.2019.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/04/2019] [Accepted: 03/21/2019] [Indexed: 12/22/2022]
Abstract
Brachydactyly type E, which can be an isolated finding or part of a syndrome in combination with other clinical anomalies, involves metacarpals and metatarsals with or without short phalanges. Herein we report two unrelated Turkish females who presented with brachydactyly type E and vitamin D deficiency in the absence of marked alterations in serum calcium, phosphate, and parathyroid hormone. After excluding disease-causing variants in two candidate genes, PTHLH and PDE4D, we identified different pathogenic variants in TRPS1, the gene mutated in patients with tricho-rhino-phalangeal syndrome (TRPS). In one of the patients, who displayed severe brachydactyly and short stature, we identified a novel heterozygous missense pathogenic variant in exon 6 (c.2783A>G, p.Tyr928Cys), located within the GATA DNA-binding domain. The second patient, who had relatively milder brachydactyly and was of normal height, carried a heterozygous nonsense pathogenic variant in exon 4 (c. 1870C>T, p.Arg624Ter), which has been previously described. Both pathogenic variants segregated in affected family members. The patients additionally showed sparse hair and a bulbous nose, consistent with the clinical features of TRPS. Our findings, in addition to identifying the genetic cause of brachydactyly in two unrelated kindreds, emphasize the role of pathogenic TRPS1 variants in the development of brachydactyly type E and highlight the GATA DNA-binding region of TRPS1 protein with respect to phenotype-genotype correlation.
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Affiliation(s)
- Anara Karaca
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Monica Reyes
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren T Shumate
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Isilay Taskaldiran
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Tulay Omma
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Nese Ersoz Gulcelik
- Department of Endocrinology and Metabolism, Ankara Training and Research Hospital, Ankara, Turkey
| | - Murat Bastepe
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Ozkaya H, Omma T, Bag YM, Uzunoglu K, Isildak M, Duymus ME, Kismet K, Senes M, Fidanci V, Celepli P, Hucumenoglu S, Aral Y. Topical and Systemic Effects of N-acetyl Cysteine on Wound Healing in a Diabetic Rat Model. Wounds 2019; 31:91-96. [PMID: 30802208] [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] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study evaluates the effects of topical and systemic N-acetyl cysteine (NAC) treatment on wound healing in a diabetic rat model. MATERIALS AND METHODS A total of 48 male Wistar Albino rats were randomly divided into 4 groups of 12. Diabetes was induced with an intraperitoneal injection of 60 mg/kg streptozotocin. A 2-cm x 1-cm full-thickness wound was created on the back of each animal. In group 1 (control) and group 3 (systemic NAC), the wounds were closed with 0.9% sodium chloride-treated sterile gauze. In group 2 (topical NAC) and group 4 (topical + systemic NAC), the wounds were closed with sterile gauze treated with 3 mL (300 mg) of NAC. The animals in groups 3 and 4 were administered 200 mg/kg of NAC once daily through an orogastric tube. On days 1 and 14, the wounded areas were measured. Tissue and blood samples were taken on day 14 for histopathological and biochemical examination. RESULTS On day 14, the wounded area in groups 2, 3, and 4 was found to be smaller than in group 1 (control). Histopathologically, epithelialization and fibrosis scores were significantly lower, whereas the inflammation score was higher in group 1 than in the other groups. Tissue oxidative stress parameters (malondialdehyde, fluorescent oxidation products, total oxidative stress) were higher in the control group than in the other groups. In groups 3 and 4 (which received systemic NAC), the oxidative stress parameters in serum samples were lower than those of the control group and group 2. Serum sulphydryl levels were the lowest in group 1. CONCLUSIONS The results of this study show that both topical and systemic administration of NAC improved wound healing in a diabetic rat model. This effect of NAC may be related to its antioxidant properties since a reduction in oxidative stress parameters in both tissue and serum were shown in the present study.
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Affiliation(s)
- Hilal Ozkaya
- Department of Health and Social Services, Istanbul Metropolitan Municipality, Kayisdagi Darulaceze Ministry, Istanbul, Turkey
| | - Tulay Omma
- Department of Endocrinology and Metabolism, Ankara Education and Research Hospital, Ankara, Turkey
| | - Yusuf Murat Bag
- Department of General Surgery, Ankara Education and Research Hospital, Ankara, Turkey
| | - Kevser Uzunoglu
- Department of General Surgery, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mehlika Isildak
- Department of Endocrinology and Metabolism, Ankara Education and Research Hospital, Ankara, Turkey
| | | | - Kemal Kismet
- Department of General Surgery, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mehmet Senes
- Department of Biochemistry, Ankara Education and Research Hospital, Ankara, Turkey
| | - Vildan Fidanci
- Department of Biochemistry, Ankara Education and Research Hospital Ankara, Turkey
| | - Pinar Celepli
- Department of Pathology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Sema Hucumenoglu
- Department of Pathology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Yalcin Aral
- Faculty of Medicine, Department of Endocrinology and Metabolism, Bozok University, Yozgat, Turkey
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Koc G, Taskaldiran I, Aslan Felek S, Saltabas MA, Omma T, Akbulut A, Culha C. ECTOPIC LINGUAL THYROID PRESENTING WITH MASSIVE HEMATEMESIS. Acta Endocrinol (Buchar) 2019; 15:244-246. [PMID: 31508184 DOI: 10.4183/aeb.2019.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ectopic lingual thyroid is a rare developmental abnormality caused by aberrant embryogenesis during thyroid migration. Even though, most patients are asymptomatic, uncommonly the mass can be enlarged and cause dysphagia, dyspnea, upper airway obstruction, dysphonia, hypothyroidism. We report a very rare case of ectopic lingual thyroid presenting with massive hematemesis.
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Affiliation(s)
- G Koc
- Health Science University, Ankara Training and Research Hospital - Endocrinology and Metabolism, Ankara, Turkey
| | - I Taskaldiran
- Health Science University, Ankara Training and Research Hospital - Endocrinology and Metabolism, Ankara, Turkey
| | - S Aslan Felek
- Health Science University, Ankara Training and Research Hospital - Otorhinolaryngology Head and Neck Surgery, Ankara, Turkey
| | - M A Saltabas
- Health Science University, Ankara Training and Research Hospital - Internal Medicine, Ankara, Turkey
| | - T Omma
- Health Science University, Ankara Training and Research Hospital - Endocrinology and Metabolism, Ankara, Turkey
| | - A Akbulut
- Health Science University, Ankara Training and Research Hospital - Nuclear Medicine, Ankara, Turkey
| | - C Culha
- Health Science University, Ankara Training and Research Hospital - Endocrinology and Metabolism, Ankara, Turkey
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