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Sagaltici DA, Kurt E, Seymenoglu RG, Mayali H, Hekimsoy Z. The Effect of Diabetic Retinopathy and Blood Glucose Regulation on Corneal Biomechanical Parameters. Curr Eye Res 2024:1-6. [PMID: 38587365 DOI: 10.1080/02713683.2024.2338219] [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: 09/30/2023] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The aim of this study was to evaluate the effects of different stages of diabetic retinopathy (DR) and metabolic control of blood glucose levels on corneal biomechanical parameters. METHODS Diabetic patients were categorized into three groups: no DR group, nonproliferative DR (NPDR) group, and proliferative DR (PDR) group. Of the 141 eyes examined, 40 belonged to the control group, 34 to no DR group, 34 to NPDR group, and 33 to PDR group. Using an Ocular Response Analyzer to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc). IOP was assessed using a Tono-Pen, while central corneal thickness (CCT) was determined using an ultrasonic pachymeter. HbA1c levels were also recorded. We conducted comparisons among these groups across biomechanical parameters and IOP (tonopen), and CCT, while also investigating the impact of HbA1c levels on these parameters. RESULTS Among any groups show a statistically significant difference in CCT, IOP (tonopen), CH, CRF, IOPg, and IOPcc. In diabetic patients, CRF, CTT, and IOPg values were significantly higher in those with HbA1c levels ≥ 7 mg/dl than in those with HbA1c levels < 7 mg/dl (p = 0.009, p = 0.013, p = 0.038), respectively, while there was no statistically significant difference in IOPcc, CH, and IOP (tonopen). Linear regression analysis showed that CH was positively associated with CCT (p < 0.001) and negatively associated with IOPcc (p < 0.001), while CRF was positively associated with CCT (p < 0.001), HbA1c (p < 0.05), and negatively associated with diagnosis of DR (p < 0.05). CONCLUSION This study underscores the influence of metabolic control, as reflected by HbA1c levels, on corneal biomechanical parameters in diabetic patients, emphasizing the importance of monitoring and managing glycemic control in this population.
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Affiliation(s)
- Duygu Akbulut Sagaltici
- University of Health Sciences, Bagcilar Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Emin Kurt
- Department of Ophthalmology, Manisa Celal Bayar University, Manisa, Turkey
| | | | - Huseyin Mayali
- Department of Ophthalmology, Manisa Celal Bayar University, Manisa, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Manisa Celal Bayar University, Manisa, Turkey
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Ozdemir N, Toraman A, Taneli F, Yurekli BS, Hekimsoy Z. An evaluation of both serum Klotho/FGF-23 and apelin-13 for detection of diabetic nephropathy. Hormones (Athens) 2023; 22:413-423. [PMID: 37458962 DOI: 10.1007/s42000-023-00464-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/26/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The aim of our study is to evaluate whether serum Klotho/FGF-23 and apelin-13 can be used as new biomarkers for detection of development of nephropathy. METHODS In this cross-sectional study, 88 type 2 diabetes mellitus (T2DM) patients and 38 healthy controls were included. The mean duration of T2DM was 11.4 ± 9.7 years. T2DM individuals were categorized into two groups as group 1 with e-GFR < 60 mL/min/1.73 m2 and group 2 with e-GFR > 60 mL/min/1.73 m2. They were also divided into two groups according to their 24 h urine albumin levels, classifying them as follows: normoalbuminuria if less than 30 mg/day and albuminuria if more than 30 mg/day. RESULTS Mean serum Klotho levels in the T2DM group were observed to be significantly higher than in the control group. Serum apelin-13 levels were observed to be significantly lower in the T2DM group compared to the control group (p < 0.001). In the diabetic group, apelin-13 levels were positively correlated with age, waist circumference, and albuminuria while they were negatively correlated with e-GFR. Apelin-13 levels were seen to be significantly higher in group 1 (p < 0.001). CONCLUSION Apelin-13 levels were found to be significantly higher in individuals with diabetic nephropathy than in those without diabetic nephropathy. In the diabetic group, a significant relationship was detected between apelin-13 levels and albumin excretion. Based on these findings, we consider that serum Klotho and apelin-13 levels may have a protective effect on diabetic nephropathy and can additionally be used as a biomarker to predict diabetic nephropathy.
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Affiliation(s)
- Nilufer Ozdemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey.
| | - Aysun Toraman
- Department of Nephrology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Fatma Taneli
- Department of Clinical Biochemistry, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Banu Sarer Yurekli
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Yavuz DG, Yazan CD, Hekimsoy Z, Aydin K, Gokkaya N, Ersoy C, Akalın A, Topaloglu O, Aydogan BI, Dilekci ENA, Alphan Uc Z, Cansu GB, Ozsari L, Iyidir OT, Olgun ME, Keskin L, Mert M, Can B, Gungor K, Galip T, Cantürk Z, Elbuken G, Pekkolay Z, Kutbay NO, Yorulmaz G, Kalkan AT, Unsal YA, Yay A, Karagun B, Bozkur E. Assesment of attainment of recommended TSH levels and levothyroxine compliance in differentiated thyroid cancer patients. Clin Endocrinol (Oxf) 2022; 97:833-840. [PMID: 35639050 DOI: 10.1111/cen.14787] [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: 01/10/2022] [Revised: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Thyroid-stimulating hormone (TSH) suppression treatment can induce signs and symptoms of hyperthyroidism and hypothyroidism due to inappropriate treatment or poor compliance to the treatment. The current study aimed to investigate TSH levels, frequency of being on target TSH, adherence to levothyroxine (LT4) suppression treatment in differentiated thyroid cancer (DTC) patients after surgery in a multicentric setting. DESIGN AND PATIENTS This multicentric cross-sectional study was conducted at 21 medical centres from 12 cities in Turkey. DTC patients followed at least one year in the same center included in the study. Clinical data, serum TSH, free thyroxine (FT4), thyroglobulin (Tg) and anti-Tg levels were recorded during the most recent visit. Body mass index, systolic and diastolic blood pressures, pulse rate were measured. LT4 doses were recorded and doses per kilogram of bodyweight were calculated. Pill ingestion habits recorded and adherence to the therapy were evaluated using the Morisky Medication Adherence Scale and categorized as good, moderate or poor compliant based on their scores. Risk stratification forpredicting the disease persistance and/or reccurence was assessed using the American Joint Committee on Cancer-7th edition thyroid cancer staging calculator. TSH serum concentrations were classified as severe suppression (TSH < 0.01 mU/L), moderate suppression (TSH: 0.01-0.1 mU/L), mild suppression (TSHL 0.1-0.5 mU/L), euthyroid (TSH: 0.5-4 mU/L) and hypothyroid (TSH > 4 mU/L). TSH levels can also be classified as on being on target, under the target, or beyond over the target, according to the American Thyroid Association recommendations. RESULTS A group of 1125 patients (F/M: 941/184, 50.7 ± 11.7 years) were included in the study. The mean LT4 daily dosage was 132.4 ± 39.6 mcg/day. TSH levels showed severe suppression in 99 (%8.8) patients, moderate suppression in 277 (%24.6) patients and mild suppression in 315 (%28) patients and euthyroid range in 332 (%29.5) patients and hypothyroid range in 97 (8.6%). TSH levels were in target in 29.2% of the patients 20.4% of the patients were undertreated, 50.4% overtreated. The daily LT4 dose and LT4 dose/kg were significantly higher in the severe suppression group (p < .001, p < .001). According to the Morisky scale, 564 patients (50.1%) were good compliant, 368 patients (32.7%) were moderate compliant, and 193 patients (17.1%) were noncompliant. Patients with poor compliance need a higher dose of LT4 compared to the good compliance group (p < .001). TSH levels of patients with good compliance were 0.67 ± 1.96 mU/L and TSH with poor compliance was 2.74 ± 7.47 mU/L (p < .001). TSH levels were similar in patients on fixed and alternating dosages. CONCLUSION In 29.2% of the DTC patients, serum TSH levels were at target levels. Remaining of the study group have TSH levels under or over treatment range, exposing the patient to medication side effects. Majorty of the study group 82.8% have good or moderate adherence to LT4 therapy. Reaching TSH targets requires simplified and applicable guidelines and following the guideline recommendations.
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Affiliation(s)
- Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Ceyda D Yazan
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Celal Bayar University, Manisa, Turkey
| | - Kadriye Aydin
- Department of Endocrinology and Metabolism, Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Naile Gokkaya
- Department of Endocrinology and Metabolism, Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Canan Ersoy
- Department of Endocrinology and Metabolism, Uludag University School of Medicine, Bursa, Turkey
| | - Aysen Akalın
- Department of Endocrinology and Metabolism, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Omercan Topaloglu
- Department of Endocrinology and Metabolism, Kocaeli Derince Research and Training Hospital, Kocaeli, Turkey
| | - Berna I Aydogan
- Department of Endocrinology and Metabolism, Batman Research and Training Hospital, Batman, Turkey
| | - Esra N A Dilekci
- Department of Endocrinology and Metabolism, Bolu Abant Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Ziynet Alphan Uc
- Department of Endocrinology and Metabolism, Usak Research and Training Hospital, Usak, Turkey
| | - Guven B Cansu
- Department of Endocrinology and Metabolism, Kutahya Health Sciences University, Kütahya, Turkey
| | - Levent Ozsari
- Department of Endocrinology and Metabolism, Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
| | - Ozlem T Iyidir
- Department of Endocrinology and Metabolism, Baskent University School of Medicine, Ankara, Turkey
| | - Mehtap E Olgun
- Department of Endocrinology and Metabolism, Cukurova University School of Medicine, Adana, Turkey
| | - Lezzan Keskin
- Department of Endocrinology and Metabolism, Malatya Research and Training Hospital, Malatya, Turkey
| | - Meral Mert
- Department of Endocrinology and Metabolism, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Bulent Can
- Department of Endocrinology and Metabolism, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Kaan Gungor
- Department of Endocrinology and Metabolism, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Tayfun Galip
- Department of Endocrinology and Metabolism, Medical Park Pendik Hospital, Istanbul, Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Nilufer O Kutbay
- Department of Endocrinology and Metabolism, Celal Bayar University, Manisa, Turkey
| | - Goknur Yorulmaz
- Department of Endocrinology and Metabolism, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Ahmet T Kalkan
- Department of Endocrinology and Metabolism, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Yasemin A Unsal
- Department of Endocrinology and Metabolism, Uludag University School of Medicine, Bursa, Turkey
| | - Adnan Yay
- Department of Endocrinology and Metabolism, Sultan Abdulhamid Han Research and Training Hospital, Istanbul, Turkey
| | - Baris Karagun
- Department of Endocrinology and Metabolism, Cukurova University School of Medicine, Adana, Turkey
| | - Evin Bozkur
- Department of Endocrinology and Metabolism, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
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Hekimsoy Z, Eniseler E, Erdem N, Ozdemir N. CATAMENIAL DIABETIC KETOACIDOSIS. Acta Endocrinol (Buchar) 2022; 18:538-540. [PMID: 37152889 PMCID: PMC10162832 DOI: 10.4183/aeb.2022.538] [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: 05/09/2023]
Abstract
Diabetic ketoacidosis (DKA) is a common medical emergency situation. In rare cases, glycemic changes associated with the menstrual cycle may create a predisposing factor for DKA. In the absence of facilitating factors that may cause DKA, catamenial DKA should be considered. In the patients with catamenial DKA, increasing the insulin dose 1-2 days before menstruation may prevent the development of hyperglycemia or DKA associated with menstrual cycle. In this study, we present a 21-year-old female with type 1 diabetes mellitus (DM) that recurrently applied to our hospital due to DKA a few days prior to menstrual bleeding.
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Affiliation(s)
- Z. Hekimsoy
- Division of Endocrinology, Celal Bayar University − Faculty of Medicine, Manisa, Turkey
| | - E.B. Eniseler
- Department of Internal Medicine, Celal Bayar University − Faculty of Medicine, Manisa, Turkey
| | - N. Erdem
- Department of Internal Medicine, Celal Bayar University − Faculty of Medicine, Manisa, Turkey
| | - N. Ozdemir
- Division of Endocrinology, Celal Bayar University − Faculty of Medicine, Manisa, Turkey
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Gogas Yavuz D, Ersoy R, Altuntas Y, Bilen H, Pamuk B, Apaydin T, Temizkan S, Altuntas H, Mert M, Akalin A, Sert M, Simsir IY, Hekimsoy Z, Canturk Z, Uc ZA, Iplikci S, Yasar M, Unubol M, Sezer K, Topaloglu O, Iyidir OT, Pekkolay Z, Atmaca A, Dikbas O, Ozdemir N, Gul K, Deniz F, Ertorer E, Karaca Z, Elbuken G, Arpaci D, Agbaht K, Turan E, Anaforoglu I, Bayraktaroglu T, Haklar G, Daglioglu G, Tuzcu A, Sahin I, Cetinkalp S. Prevalence of Vitamin D Deficiency and Hypervitaminosis D Among Adult Patients Admitted to the Tertiary Care Hospitals in Turkey. Turk J Endocrinol Metab 2022. [DOI: 10.5152/tjem.2022.22031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Almacan B, Ozdemir N, Onay H, Hekimsoy Z. CONGENITAL ADRENAL HYPERPLASIA WITH COMPOUND HETEROZYGOUS I2 SPLICE AND P453S MUTATIONS. Acta Endocrinol (Buchar) 2022; 18:228-231. [PMID: 36212252 PMCID: PMC9512366 DOI: 10.4183/aeb.2022.228] [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: 06/16/2023]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) is an autosomal recessive inherited disorder caused by congenital deficiency of enzymes involved in cortisol biosynthesis from cholesterol in the adrenal cortex. In this article, we aimed to present a 29-year-old female patient with I2 splice point mutation detected in one allele and P453S mutation on the other allele of CYP21A2 gene associated with 21-hydroxylase deficiency. Her further investigation revealed that her mother had P453S mutation and her father had I2 splice mutation. CASE REPORT A 29-year-old woman with CAH was admitted to our clinic with the request of pregnancy. Her physical examination revealed a height of 151 cm, weight 59 kg, body mass index 25.8 kg/m2. According to Tanner staging, she had Stage 3 breast development and pubic hair. Her laboratory test results were as follows: Glucose: 79 mg/dL (70-100 mg/dL), Creatinine: 0.6 (0.5-0.95 mg/dL), Sodium: 138 mEq/L (135-145 mEq/L), Potassium: 4.4 mEq/L (3.5-5.1 mEq/L), Cortisol: 0.05 µg/dL, ACTH: <5.00 pg/mL (5-46 pg/mL), 17-OH progesterone: 7.67 ng/mL (0-3 ng/mL). Chromosome analysis revealed a 46, XX karyotype. CYP21A2 gene mutation analysis was performed for the patient whose clinical history and laboratory results were compatible with congenital adrenal hyperplasia. During the reverse dot blot analysis, I2 splice mutation in one allele and P453S mutation in the other allele were detected. CONCLUSION Although the I2 splice mutation detected in our case was mostly associated with a salt-wasting form of CAH, it was thought that the other P453S mutation detected may explain the relatively good clinical course in our case.
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Affiliation(s)
- B. Almacan
- Celal Bayar University, School of Medicine - Endocrinology, Manisa
| | - N. Ozdemir
- Celal Bayar University, School of Medicine - Endocrinology, Manisa
| | - H. Onay
- Ege University, Izmir, Turkey
| | - Z. Hekimsoy
- Celal Bayar University, School of Medicine - Endocrinology, Manisa
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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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8
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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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9
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Almacan B, Ozdemir N, Gürkan H, Gul S, Guldiken S, Hekimsoy Z. Case Report. Acta Endocrinol (Buchar) 2021; 17:388-392. [PMID: 35344314 PMCID: PMC8919482 DOI: 10.4183/aeb.2021.388] [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: 06/14/2023]
Abstract
BACKGROUND Thyroid hormone resistance (RTH) is defined as a decrease in response to thyroid hormones in the target tissue. Most patients present with nonspecific findings. In this article, we aimed to represent a 22-year-old female patient who presented with palpitation, fatigue, and heat intolerance. She was thought to have thyroid hormone resistance and her genetic examination revealed NM_001128177.1 (THRβ): c.1034G > A (p.Gly345Asp) pathogenic variation in the THRβ gene. CASE REPORT A 22-year-old female patient presented with complaints of fatigue, heat intolerance and palpitations. She was taking Propranolol twice daily at admission. Her family history revealed hypothyroidism in her grandmother. Her physical examination results were as follows: height 160 cm, weight 65 kg, body mass index 25.4kg/m2, body temperature 36.5°C, respiratory rate 18/min, heart rate 86 beats/min, blood pressure 120/80 mmHg. Her palms were sweaty. The heart sounds were normal, and no heart murmur was auscultated. The laboratory results were TSH: 5.31uU/mL, fT3: 6.83 pg/mL, and fT4: 2.43 ng/dL. THRβ gene mutation analysis was requested for our patient whose clinical history and laboratory results were compatible with thyroid hormone resistance. The pathogenic variation NM_001128177.1(THRβ):c.1034G>A (p.Gly345Asp) was detected after analysis. CONCLUSION A diagnosis of RTH requires high clinical suspicion and a genetic mutation analysis should be requested in the case of clinical suspicion. In this way, unnecessary anti-thyroid treatment can be prevented.
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Affiliation(s)
- B Almacan
- "Celal Bayar" University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - N Ozdemir
- Division of Endocrinology and Metabolism, Manisa, Trakya University, Faculty of Medicine, Istanbul, Turkey
| | - H Gürkan
- Department of Medical Genetics, Istanbul, Turkey
| | - S Gul
- Istanbul University, Faculty of Sciences, Biology Department Biotechnology Division, Istanbul, Turkey
| | - S Guldiken
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Edirne, Istanbul, Turkey
| | - Z Hekimsoy
- Division of Endocrinology and Metabolism, Manisa, Trakya University, Faculty of Medicine, Istanbul, Turkey
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10
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Gogas Yavuz D, Aytürk S, Çetinkalp Ş, Bayraktar F, Kulaksızoğlu M, Hekimsoy Z, Aydın H, Uygur M, Deniz F, İpekçi S, Atmaca A, Saraç F, Özdemir N, Cantürk Z, Mert M, Sancak S, Ertörer E, Duran C, Akarsu E, Deyneli O, Selek A, Gürlek A. Clinical and demographic aspects of Paget disease of bone: A multicentric study from Turkey. Eur J Rheumatol 2021; 8:156-161. [PMID: 33284101 PMCID: PMC9770406 DOI: 10.5152/eurjrheum.2020.20139] [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] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Paget disease of bone (PDB) is a metabolic bone disease that has been rarely reported in the Eastern countries. This study aimed to evaluate the clinical and demographic characteristics of patients with PDB followed up at endocrinology clinics in Turkey. METHODS An invitation was sent to tertiary endocrinology clinics to complete a survey on the demographic, clinical, radiological, and laboratory parameters, as well as treatment modalities of patients with PDB. This study enrolled clinically and radiologically proven 185 patients with PDB from 18 endocrinology centers based in 10 cities of Turkey. RESULTS This cohort of PDB had female preponderance (women/men: 105/80) with a mean age, during diagnosis, of 57±10 years. Most of the patients (59.6%) were symptomatic at diagnosis. Bone pain and headache were the predominant clinical symptoms. Polyostotic disease was observed in 67.5% (n=125) of patients. Frequently affected bones were skull (41.6%), pelvis (53.5%), spine (41%), and femur (25.4%). Moreover, 17 patients with skull involvement had hearing loss. Mean serum alkaline phosphatase (ALP) level (552±652 IU/L; range: 280-5762 IU/L) was over the normal reference cutoff with normal serum calcium levels. Intravenous bisphosphonates (zoledronic acid, 5 mg; pamidronate, 60-90 mg) were the most used drugs (75%) for the treatment of PDB. Most of the patients (87.1%) treated with intravenous bisphosphonates responded well, with a decrease in serum ALP level (117±114 IU/L) in the 12th month of therapy. Furthermore, 16 patients relapsed after the second year of therapy; 3 patients did not respond to the initial intravenous bisphosphonate treatment. CONCLUSION The patients with PDB followed up by endocrinology clinics of Turkey exhibited polyostotic disease with classical clinical, radiological, and biochemical features and women's predominance with good response to intravenous bisphosphonate therapy.
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Affiliation(s)
- Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University School of Medicine, İstanbul,
Turkey
| | - Semra Aytürk
- Department of Endocrinology and Metabolism, Trakya University School of Medicine, Edirne,
Turkey
| | - Şevki Çetinkalp
- Department of Endocrinology and Metabolism, Ege University School of Medicine, İzmir,
Turkey
| | - Fırat Bayraktar
- Department of Endocrinology and Metabolism, Dokuz Eylül University School of Medicine, İzmir,
Turkey
| | - Mustafa Kulaksızoğlu
- Department of Endocrinology and Metabolism, Necmettin Erbakan University School of Medicine, Konya,
Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Celal Bayar University School of Medicine, Manisa,
Turkey
| | - Hasan Aydın
- Department of Endocrinology and Metabolism, Yeditepe University School of Medicine, İstanbul,
Turkey
| | - Melin Uygur
- Department of Endocrinology and Metabolism, Yeni Yuzyıl University School of Medicine, İstanbul,
Turkey
| | - Ferhat Deniz
- Department of Endocrinology and Metabolism, Health Sciences University School of Medicine, Abdulhamid Han Hospital, İstanbul,
Turkey
| | - Süleyman İpekçi
- Department of Endocrinology and Metabolism, Selçuk University School of Medicine, Konya,
Turkey
| | - Ayşegül Atmaca
- Department of Endocrinology and Metabolism, Ondokuz Mayıs University School of Medicine, Samsun,
Turkey
| | - Fulden Saraç
- Department of Geriatrics, İzmir Ege University School of Medicine, İzmir,
Turkey
| | - Nilüfer Özdemir
- Department of Endocrinology and Metabolism, Celal Bayar University School of Medicine, Manisa,
Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University School of Medicine, Kocaeli,
Turkey
| | - Meral Mert
- Department of Endocrinology and Metabolism, Health Sciences University School of Medicine, Sadi Konuk Hospital, İstanbul,
Turkey
| | - Seda Sancak
- Department of Endocrinology and Metabolism, Health Sciences University School of Medicine, Fatih Sultan Mehmet Hospital, İstanbul,
Turkey
| | - Eda Ertörer
- Department of Endocrinology and Metabolism, Başkent University School of Medicine, Adana Hospital, Adana,
Turkey
| | - Cevdet Duran
- Department of Endocrinology and Metabolism, Uşak University School of Medicine, Uşak,
Turkey
| | - Ersin Akarsu
- Department of Endocrinology and Metabolism, Gaziantep University School of Medicine, Gaziantep,
Turkey
| | - Oğuzhan Deyneli
- Department of Endocrinology and Metabolism, Koç University School of Medicine, İstanbul,
Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University School of Medicine, Kocaeli,
Turkey
| | - Alper Gürlek
- Hacettepe University Faculty of Medicine Section of Endocrinology and Metabolism, Ankara,
Turkey
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11
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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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12
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Ozgen Saydam B, Sonmez M, Simsir IY, Erturk MS, Kulaksizoglu M, Arkan T, Hekimsoy Z, Cavdar U, Akinci G, Demir T, Altay CT, Mihci E, Secil M, Akinci B. A subset of patients with acquired partial lipodystrophy developing severe metabolic abnormalities. Endocr Res 2019; 44:46-54. [PMID: 30182761 DOI: 10.1080/07435800.2018.1513029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/21/2023]
Abstract
UNLABELLED Purpose/Aim of the study: Acquired partial lipodystrophy (APL) is a rare disease characterized by selective loss of adipose tissue. In this study, we aimed to present a subset of patients with APL, who developed severe metabolic abnormalities, from our national lipodystrophy registry. MATERIALS AND METHODS Severe metabolic abnormalities were defined as: poorly controlled diabetes (HbA1c above 7% despite treatment with insulin more than 1 unit/kg/day combined with oral antidiabetics), severe hypertriglyceridemia (triglycerides above 500 mg/dL despite treatment with lipid-lowering drugs), episodes of acute pancreatitis, or severe hepatic involvement (biopsy-proven non-alcoholic steatohepatitis (NASH)). RESULTS Among 140 patients with all forms of lipodystrophy (28 with APL), we identified 6 APL patients with severe metabolic abnormalities. The geometric mean for age was 37 years (range: 27-50 years; 4 females and 2 males). Five patients had poorly controlled diabetes despite treatment with high-dose insulin combined with oral antidiabetics. Severe hypertriglyceridemia developed in five patients, of those three experienced episodes of acute pancreatitis. Although all six patients had hepatic steatosis at various levels on imaging studies, NASH was proven in two patients on liver biopsy. Our data suggested that APL patients with severe metabolic abnormalities had a more advanced fat loss and longer disease duration. CONCLUSIONS We suggest that these patients represent a potential subgroup of APL who may benefit from metreleptin or investigational therapies as standard treatment strategies fail to achieve a good metabolic control.
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Affiliation(s)
- Basak Ozgen Saydam
- a Division of Endocrinology and Metabolism , Dokuz Eylul University, Izmir
| | - Melda Sonmez
- b Department of Internal Medicine, Koc University, School of Medicine, Istanbul
| | | | | | - Mustafa Kulaksizoglu
- e Division of Endocrinology and Metabolism , Necmettin Erbakan University, Konya
| | - Tugba Arkan
- f Division of Endocrinology and Metabolism , Kocaeli Training Hospital, Kocaeli
| | - Zeliha Hekimsoy
- g Division of Endocrinology and Metabolism , Celal Bayar University, Manisa
| | - Umit Cavdar
- a Division of Endocrinology and Metabolism , Dokuz Eylul University, Izmir
| | - Gulcin Akinci
- h Division of Pediatric Neurology , Behcet Uz Pediatric Children's Hospital, Izmir
| | - Tevfik Demir
- a Division of Endocrinology and Metabolism , Dokuz Eylul University, Izmir
| | | | - Ercan Mihci
- j Division of Pediatric Genetics , Akdeniz University, Antalya
| | - Mustafa Secil
- i Department of Radiology , Dokuz Eylul University, Izmir
| | - Baris Akinci
- a Division of Endocrinology and Metabolism , Dokuz Eylul University, Izmir
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Toraman A, Aras F, Hekimsoy Z, Kursat S. IS THERE A RELATIONSHIP BETWEEN PARATHYROID HORMONE AND NEUTROPHIL LYMPHOCYTE RATIO OR PLATELET LYMPHOCYTE RATIO? Acta Endocrinol (Buchar) 2019; -5:96-101. [PMID: 31149066 DOI: 10.4183/aeb.2019.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Context Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are recent prognostic markers associated with inflammation in many diseases such as chronic kidney disease (CKD), malignancies, myocardial infarction. Objective In this study, we investigated the relationship between NLR-PLR and parathyroid hormone (PTH) and vitamin D in patients with high PTH levels. Design The patients with high PTH levels in Nephrology and Endocrinolgy Outpatient clinics were evaluated retrospectively. Subjects and methods The medical records of the patients were examined and clinical data, including demographic details, clinical and laboratory findings, treatment and follow-up data were obtained. NLR and PLR were calculated. Serum creatinine, calcium, phosphorus, magnesium, lipid levels, calcium phosphorus product, PTH and vitamin D values were investigated. The relationship between NLR-PLR and laboratory parameters, GFR (MDRD-GFR), PTH and vitamin D were investigated. Results 48 male and 253 female patients were enrolled in this study. The mean age was 57.57±13.28. NLR correlated negatively with albumin, hemoglobin, vitamin D, calcium and cholesterol and it positively correlated with creatinine and PTH. Multiple regression analysis showed that main determinants of NLR were PTH, albumin, LDL-cholesterol, hemoglobin and gender. Conclusions In this study NLR and PLR correlated negatively with hemoglobin and cholesterol. Positive correlation between NLR and creatinine could be explained by increased degrees of inflammation associated with more pronounced degrees of renal dysfunction. The impact of PTH on NLR was independent of GFR. In multiple regression model this suggests that PTH could be a pro-inflammatory parameter independent of the degree of renal dysfunction.
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Affiliation(s)
- A Toraman
- "Celal Bayar" University, Dept. of Nephrology, Manisa, Turkey
| | - F Aras
- "Celal Bayar" University, Dept. of Nuclear Medicine, Manisa, Turkey
| | - Z Hekimsoy
- "Celal Bayar" University, Dept. of Endocrinology, Manisa, Turkey
| | - S Kursat
- "Celal Bayar" University, Dept. of Nephrology, Manisa, Turkey
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14
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Korkmaz T, Kisabay A, Hekimsoy Z, Senol E, Selçuki D. Evaluation of visual pathways using visual evoked potentials in the patients with impaired fasting glucose and impaired glucose tolerance. Int J Neurosci 2018; 129:22-29. [PMID: 29965783 DOI: 10.1080/00207454.2018.1495631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE There are many studies on degeneration of the ganglion cells using visual evoked potential (VEP) in Diabetes mellitus (DM). The present study intended to investigate whether the retinopathy findings would be helpful for detecting the degeneration to develop or not in retinal ganglion cells with the VEP test before being detectable in ophthalmoscopic examination on prediabetic patients. MATERIALS AND METHODS The present study was conducted prospectively after obtaining approval from the Ethics Committee. In our study, the subjects were divided into three groups as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and normal patients. They also underwent physical, ophthalmological and VEP examination. Three main components of VEP obtained from these groups were N75, P100, and N145 latency and N75-P100 amplitude. RESULTS The study participants consisted of the IFG group (n: 30, female/male ratio: 21/9; mean age: 49.17 ± 10.52 years), the IGT group (n: 30, female/male ratio: 23/7; mean age: 47.00 ± 11.09 years), and the Control Group (n: 40, female/male ratio: 30/10; mean age: 48.03 ± 10.96 years). Difference in sex and age between the study groups (p > 0.05). P100 latency was found to increase significantly in comparison between the IGT and Control Group for both eyes (p right: 0.003, p left: 0.001) whereas it did not increase significantly in the comparison between the IFG and the Control Group (p right: 0.065, p left: 0.116). CONCLUSION It was observed that VEP may be a parameter of predictive value that might be used in evaluating prediabetic cases in terms of retinopathies similar to DM.
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Affiliation(s)
- Tuğba Korkmaz
- a Department of Neurology, Medicine Faculty , Celal Bayar University , Manisa , Turkey
| | - Aysın Kisabay
- a Department of Neurology, Medicine Faculty , Celal Bayar University , Manisa , Turkey
| | - Zeliha Hekimsoy
- b Department of Endocrinology and Metabolism Diseases, Medicine Faculty , Celal Bayar University , Manisa , Turkey
| | - Emel Senol
- b Department of Endocrinology and Metabolism Diseases, Medicine Faculty , Celal Bayar University , Manisa , Turkey
| | - Deniz Selçuki
- a Department of Neurology, Medicine Faculty , Celal Bayar University , Manisa , Turkey
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15
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Yavuz DG, Yazıcı D, Keskin L, Atmaca A, Sancak S, Saraç F, Şahin İ, Dikbaş O, Hekimsoy Z, Yalın S, Uygur M, Yılmaz M, Yirmibeşcik S, Asmaz Ö. Out-of-Reference Range Thyroid-Stimulating Hormone Levels in Levothyroxine-Treated Primary Hypothyroid Patients: A Multicenter Observational Study. Front Endocrinol (Lausanne) 2017; 8:215. [PMID: 28955301 PMCID: PMC5600911 DOI: 10.3389/fendo.2017.00215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/10/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid-stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey. DESIGN In this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit. RESULTS A total of 1,755 subjects (46 ± 13 years; F/M: 89.9/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5 mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9 ± 4.7 years and mean dose was 1.2 ± 0.6 μg/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9 ± 16 vs 3.8 ± 0.9 mIU/L, P = 0.01) compared to compliant patients. CONCLUSION The results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values, despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.
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Affiliation(s)
- Dilek Gogas Yavuz
- Marmara University, Istanbul, Turkey
- *Correspondence: Dilek Gogas Yavuz,
| | | | | | | | - Seda Sancak
- Fatih Sultan Mehmet Eǧitim Ve Araştırma Hastanesi, Istanbul, Turkey
| | | | | | - Oğuz Dikbaş
- Abant İzzet Baysal University, Düzce, Turkey
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Kutbay NO, Yurekli BS, Onay H, Altay CT, Atik T, Hekimsoy Z, Saygili F, Akinci B. A case of familial partial lipodystrophy caused by a novel lamin A/C (LMNA) mutation in exon 1 (D47N). Eur J Intern Med 2016; 29:37-9. [PMID: 26775134 DOI: 10.1016/j.ejim.2015.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/27/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Familial partial lipodystrophy (FPL) is a rare genetic disorder characterized by selective lack of subcutaneous fat which is associated with insulin resistant diabetes. The Dunnigan variety (FPL2) is caused by several missense mutations in the lamin A/C (LMNA) gene, most of which are typically located in exon 8 at the codon position 482. CASE REPORT Here, we report on a Turkish family with FPL2 which is caused by a novel heterozygous missense LMNA mutation in exon 1 (D47N, c.139G>A), in the rod domain of lamins A/C. Fat distribution and metabolic features of LMNA D47N mutation were similar to typical codon 482 mutation. Metabolic abnormalities were observed as a form of insulin resistant diabetes, hypertriglyceridemia, low HDL cholesterol and hepatic steatosis. There was no evidence for neuromuscular and cardiac involvement. CONCLUSION Although it is previously known that alterations in the rod domain of type A lamins are involved in cardiac and neuromuscular diseases, our current observation shows that exon 1 LMNA mutations may be associated with partial lipodystrophy without any cardiac and neurological abnormalities, at least at the time of the presentation.
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Affiliation(s)
| | | | - Huseyin Onay
- Ege University, Division of Medical Genetics, Izmir, Turkey
| | | | - Tahir Atik
- Ege University, Division of Medical Genetics, Izmir, Turkey
| | - Zeliha Hekimsoy
- Celal Bayar University, Division of Endocrinology, Manisa, Turkey
| | - Fusun Saygili
- Ege University, Division of Endocrinology, Izmir, Turkey
| | - Baris Akinci
- Dokuz Eylul University, Division of Endocrinology, Izmir, Turkey
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Yavuz DG, Bilen H, Sancak S, Garip T, Hekimsoy Z, Sahin I, Yilmaz M, Aydin H, Atmaca A, Sert M, Karakaya P, Arpaci D, Oguz A, Guvener N. Impact of telephonic interviews on persistence and daily adherence to insulin treatment in insulin-naïve type 2 diabetes patients: dropout study. Patient Prefer Adherence 2016; 10:851-61. [PMID: 27274207 PMCID: PMC4876103 DOI: 10.2147/ppa.s100626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the impact of sequential telephonic interviews on treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetes patients initiated on different insulin regimens in a 3-month period. METHODS A total of 1,456 insulin-naïve patients with type 2 diabetes (mean [standard deviation, SD] age: 56.0 [12.0] years, 49.1% were females) initiated on insulin therapy and consecutively randomized to sequential (n=733) and single (n=723) telephonic interview groups were included. Data on insulin treatment and self-reported blood glucose values were obtained via telephone interview. Logistic regression analysis was performed for factors predicting increased likelihood of persistence and skipping an injection. RESULTS Overall, 76.8% patients (83.2% in sequential vs 70.3% in single interview group, (P<0.001) remained on insulin treatment at the third month. Significantly higher rate for skipping doses was noted in basal bolus than in other regimens (27.0% vs 15.0% for premixed and 15.8% basal insulin, respectively, P<0.0001). Logistic regression analysis revealed sequential telephonic interview (odds ratio [OR], 1.531; 95% confidence interval [CI], 1.093-2.143; P=0.013), higher hemoglobin A1c levels (OR, 1.090; 95% CI, 0.999-1.189; P=0.049), and less negative appraisal of insulin therapy as significant predictors of higher persistence. Basal bolus regimen (OR, 1.583; 95% CI, 1.011-2.479; P=0.045) and higher hemoglobin A1c levels (OR, 1.114; 95% CI, 1.028-1.207; P=0.008) were the significant predictors of increased likelihood of skipping an injection. CONCLUSION Our findings revealed positive influence of sequential telephonic interview, although including no intervention in treatment, on achieving better treatment persistence in type 2 diabetes patients initiating insulin.
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Affiliation(s)
- Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University Faculty of Medicine, Istanbul, Turkey
- Correspondence: Dilek Gogas Yavuz, Department of Endocrinology and Metabolism, Faculty of Medicine, Marmara University, Fevzi Cakmak Mahallesi, Muhsin Yazicioglu Caddesi, No 10, Ust Kaynarca, Pendik, 34584 Istanbul, Turkey, Tel/fax +90 216 625 4685, Email
| | - Habip Bilen
- Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Seda Sancak
- Clinic of Endocrinology and Metabolism, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Tayfun Garip
- Clinic of Endocrinology and Metabolism, Sakarya State Hospital, Sakarya, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Murat Yilmaz
- Department of Endocrinology and Metabolism, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
| | - Hasan Aydin
- Department of Endocrinology and Metabolism, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Aysegul Atmaca
- Department of Endocrinology and Metabolism, Ondokuzmayıs University Faculty of Medicine, Samsun, Turkey
| | - Murat Sert
- Department of Endocrinology and Metabolism, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Pinar Karakaya
- Clinic of Endocrinology and Metabolism, Bakırkoy Training and Research Hospital, Istanbul, Turkey
| | - Dilek Arpaci
- Clinic of Endocrinology and Metabolism, Sakarya State Hospital, Sakarya, Turkey
| | - Aytekin Oguz
- Department of Internal Medicine, Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Nilgun Guvener
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Istanbul, Turkey
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Borazan S, Temeltaş G, Üçer O, Hekimsoy Z, Şenol E. Assessment of Lower Urinary Tract Symptoms and Sexual Function in Women with Metabolic Syndrome. jus 2015. [DOI: 10.4274/jus.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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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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Hekimsoy Z, Dinç G, Kafesçiler S, Onur E, Güvenç Y, Pala T, Güçlü F, Ozmen B. Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health 2010; 10:782. [PMID: 21176241 PMCID: PMC3022855 DOI: 10.1186/1471-2458-10-782] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 12/23/2010] [Indexed: 11/26/2022] Open
Abstract
Background Vitamin D is a lipid-soluble hormone found in certain foods and synthesized from precursors in the skin when exposed to ultraviolet light. Vitamin D plays a critical role in bone metabolism and many cellular and immunological processes and low levels have been associated with several chronic and infectious diseases. Vitamin D status is assessed by measuring the concentration of serum 25-hydroxyvitamin D [25(OH)D]. Vitamin D deficiency is reported to be common worldwide, but little has been reported about the vitamin D status of adults in Turkey. In this cross-sectional study, we determined the prevalence of 25(OH)D deficiency in adults residing in a city in the Aegean region of Turkey. Methods A survey was conducted on a representative sample of adults over 20 years old in a non-coastal city at the end of the winter season. Of the 209 households selected by random sampling, 8.6% (n = 18) were unoccupied and 21.5% (n = 45) refused to participate. Blood samples were taken and questions about medical history, vitamin supplementation, sunlight exposure, and dietary calcium and vitamin D intake were asked in face-to-face interviews of 391 adults living in the remaining households. Results The mean serum 25(OH)D concentration was 16.9±13.09 ng/mL, with 74.9% of the subjects having 25(OH)D deficiency (<20 ng/mL), 13.8% having insufficiency (20-29.99 ng/mL), and 11.3% of the subjects having sufficient 25(OH)D (≥30 ng/mL) levels. 25(OH)D deficiency was more common among females (78.7%) than males (66.4%, p < 0.05). Conclusion Adults living in an urban, non-coastal setting in Turkey have a high prevalence of vitamin D deficiency.
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Affiliation(s)
- Zeliha Hekimsoy
- Celal Bayar University Medical Faculty, Department of Internal Medicine, Division of Endocrinology and Metabolism, Manisa, Turkey.
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Özmen B, Eser E, Özkaya Kafesçiler S, Pala T, Güçlü F, Hekimsoy Z. Psychometric properties and responsiveness of the Turkish version of the Diabetes Treatment Satisfaction Questionnaire (s) on a sample of diabetics of three consecutive monitoring periods. Acta Diabetol 2010; 47 Suppl 1:123-31. [PMID: 19936604 DOI: 10.1007/s00592-009-0151-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 05/11/2009] [Accepted: 09/14/2009] [Indexed: 11/27/2022]
Abstract
The aim of this study is to test the psychometric properties and the responsiveness of the original (status) version of Turkish DTSQ. The study sample included 88 patients with diabetes mellitus who were evaluated in three consecutive time points. The first data collection time point was during their initial contact to the clinic, and the two following (3rd month and 6th month) were during the monitoring visits to the Celal Bayar University Endocrinology Department in 2007. After the adaptation of the DTSQ to Turkish language by following standard procedures, this instrument was applied to the patients along with WBQ-12 and World Health Organization Quality of Life Measure (WHOQOL-Bref). The reliability of the DTSQ was evaluated by running internal consistency analysis (Cronbach Alpha) and item analysis. Construct validity of the instrument was evaluated by various tests such as Principal Components analysis, Confirmatory Factor Analysis, Concurrent validity and "Known Groups" comparisons. Finally the sensitivity (responsiveness to change) of the DTSQ scores to the changes of the metabolic conditions were assessed. 50.0% of the participants were male with a mean age of 51.1 ± 11.4 (min 22, max 78). Majority of them had type 2 diabetes (86.4%) and 72.7% of these patients had at least one co-morbid chronic conditions. While 53.4% of the patients had been treated by insulin the remaining 46.6% had been taking oral anti-diabetic agents. The results revealed satisfactory alpha values for DTSQ (α > 0.70). All of the three metabolic measures (i.e., FBG, PBG, and HbA1c) had significant correlations with the DTSQ scores. The criterion and construct validity of the scale were found to be very satisfactory. The Turkish version of the DTSQ showed acceptable fit indices (RMSEA = 0.03, CFI > 0.90) with the original (hypothetic) construct. Almost all of the sub-dimensions of the WBQ and WHOQOL were correlated with the DTSQ as expected, indicating a good concurrent validity. DTSQ status version was found to be a reliable and valid instrument for the assessment of treatment satisfaction in Turkish diabetes mellitus patients.
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Affiliation(s)
- Bilgin Özmen
- Faculty of Medicine, Department of Endocrinology and Metabolism, Celal Bayar University, Manisa, Turkey.
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Abstract
The aims of this study were to: 1) determine the prevalence of hyperprolactinaemia in patients with newly diagnosed subclinical and overt hypothyroidism, and 2) investigate the change in PRL levels with treatment. In this observational study, patients with a new diagnosis of hypothyroidism in our endocrinology clinic were approached for participation, as were healthy controls. Patients with medical reasons for having elevated PRL levels, lactating and pregnant women were excluded from the study. No patient had kidney or liver disease. After examination to determine if clinical causes of PRL elevation were present, serum levels of thyrotropin (TSH), free thyroxine, free triiodothyronine and PRL were measured and correlation of PRL levels with the severity of hypothyroidism (overt or subclinical) was performed. Fifty-three patients (45 women, 8 men, mean age 45.3 ± 12.2 years) had overt hypothyroidism. One hundred forty-seven patients (131 women, 16 men, mean age 42.9 ± 12.6 years) had subclinical hypothyroidism. One hundred healthy persons (85 women, 15 men, mean age 43.9 ± 11.4 years) participated as controls. The same blood tests were repeated in patients after normalization of TSH levels with L-thyroxine treatment. PRL elevation was found in 36% of patients with overt hypothyroidism, and in 22% of patients with subclinical hypothyroidism. PRL levels decreased to normal in all patients after thyroid functions normalized with L-thyroxine treatment. In the hypothyroid patients (overt and subclinical) a positive correlation was found between TSH and PRL levels (r=0.208, p=0.003). PRL regulation is altered in overt and subclinical hypothyroidism, and PRL levels normalize with appropriate L-thyroxine treatment.
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Affiliation(s)
- Zeliha Hekimsoy
- Celal Bayar University, Medical Faculty, Department of Internal Medicine, Division of Endocrinology and Metabolism, Manisa, Turkey.
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Akinci G, Akinci B, Coskun S, Bayindir P, Hekimsoy Z, Ozmen B. Evaluation of markers of inflammation, insulin resistance and endothelial dysfunction in children at risk for overweight. Hormones (Athens) 2008; 7:156-62. [PMID: 18477553 DOI: 10.1007/bf03401507] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 10/28/2022]
Abstract
OBJECTIVE Childhood obesity is associated with impaired endothelial function, insulin resistance and inflammation. Being at risk for overweight has been defined as having a body mass index (BMI) between the 85th and 94th percentile for age and sex. In this study, we looked for features linked to cardiovascular risk in children who are at risk for overweight. DESIGN Twenty-one children who were at risk for overweight (study group) and 20 children with a BMI between the 25th-74th percentiles (controls) were studied. Fasting blood levels of glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, uric acid, fibrinogen and high sensitive C-reactive protein (CRP) were assessed in both groups. LDL-cholesterol, HOMA-IR and QUICKI indices were calculated. Flow-mediated Vasodilatation (FMD) was determined for the evaluation of endothelial function. RESULTS Increased HOMA-IR was observed in children who were at risk for overweight. Waist circumference was the main predictor of insulin resistance in these children. Higher levels of CRP were found in the study group compared to controls, while plasma fibrinogen did not differ in the two groups. The children who were at risk for overweight had lower FMD values and slightly elevated lipids compared to controls; however, these differences were not statistically significant. CONCLUSION Insulin resistance and inflammation indices were higher in children who were at risk for overweight as has been shown for obese children. The data suggest that appropriate treatment strategies for weight control are essential not only for obese children but also for those at risk for overweight.
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Affiliation(s)
- Gulcin Akinci
- Department of Pediatrics, Celal Bayar University Medical School, Manisa, Turkey
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Akinci G, Coskun S, Akinci B, Hekimsoy Z, Bayindir P, Onur E, Ozmen B. Atherosclerosis risk factors in children of parents with the metabolic syndrome. Atherosclerosis 2007; 194:e165-71. [PMID: 17210154 DOI: 10.1016/j.atherosclerosis.2006.12.008] [Citation(s) in RCA: 7] [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: 09/08/2006] [Revised: 12/10/2006] [Accepted: 12/11/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Metabolic syndrome is a constellation of disorders that produces a high risk of atherosclerosis. Endothelial dysfunction is the key event in atherosclerosis and already present even in the childhood. The aim of the present study is to investigate inflammatory and radiological signs of atherosclerosis in children who have parents with the metabolic syndrome. DESIGN AND METHODS Fifty children of parents with the metabolic syndrome and 38 age- and sex-matched controls were studied. Anthropometric measurements, blood pressure assessment, echocardiography, flow-mediated vasodilatation (FMD) which is a non-invasive test for the evaluation of endothelial function and fasting blood measurements including blood glucose, insulin, total cholesterol, HDL cholesterol, triglyceride, hsCRP and soluble CD40 ligand were performed. RESULTS Serum sCD40L and hsCRP levels were significantly higher in the study group compared to the controls. FMD values did not differ between the study and control groups. Increased serum sCD40L levels were positively correlated with body mass index, waist hip ratio, LDL/HDL cholesterol ratio, and the number of metabolic syndrome components in parents, whereas showed negative correlation with the serum HDL cholesterol levels. High hsCRP levels were positively correlated with body mass index and the number of metabolic syndrome components. Multiple regression analysis demonstrated that the number of metabolic syndrome components in parents presented as being a significant predictor of the serum sCD40L and hsCRP levels of their children. CONCLUSION Our results suggest that children of patients with metabolic syndrome have higher values of the serum markers of inflammation, which may be associated with increased risk for development of cardiovascular disease.
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Affiliation(s)
- Gulcin Akinci
- Department of Pediatrics, Celal Bayar University Medical School, Manisa, Turkey
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Ozmen B, Kirmaz C, Aydin K, Kafesciler SO, Guclu F, Hekimsoy Z. Influence of the selective oestrogen receptor modulator (raloxifene hydrochloride) on IL-6, TNF-alpha, TGF-beta1 and bone turnover markers in the treatment of postmenopausal osteoporosis. Eur Cytokine Netw 2007; 18:148-53. [PMID: 17823083 DOI: 10.1684/ecn.2007.0097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Osteoporosis that is encountered frequently in postmenopausal women, may cause an increased incidence of vertebral and iliac fractures that are associated with excess morbidity. Raloxifene hydrochloride, a selective oestrogen receptor modulator, has been shown to increase bone mineral density and decrease biochemical markers of bone turnover in postmenopausal women, without stimulatory effects on breast or uterus. Levels of proinflammatory cytokines, including IL-6, and TNF-alpha and TGF-beta1 which are important cytokines involved in remodeling, have been evaluated previously in in vitro studies of osteoporosis. However, there seems to be a paucity of in vivo research concerned with changes in these cytokines in osteoporosis. OBJECTIVE In this study, we evaluated the effects of raloxifene (Evista); Lilly Pharmaceutical Co. USA, 60 mg/day) on biochemical bone turnover markers, serum parathyroid hormone, and 25-OH vitamin D, as well as the serum levels of IL-6, TNF-alpha and TGF-beta1, in 22 postmenopausal, osteoporotic women before and after 12 weeks of raloxifene treatment. METHODS Well-matched, postmenopausal, non-osteoporotic control subjects were also enrolled in the study. Serum levels of all the parameters were measured in postmenopausal, osteoporotic women at baseline and end of the study. RESULTS It was found that serum osteocalcin and parathyroid hormone, and urine deoxypyridinoline levels decreased to normal levels with treatment. Serum 25-OH vitamin D levels after treatment in the patient group were higher than those in the control group. Serum IL-6, TNF-alpha and TGF-beta1 levels did not change significantly with treatment. However, serum levels of IL-6 and TGF-beta1 in the patient group after treatment, decreased to levels lower than those found in the control group. Serum TNF-alpha levels in the patient group before and after treatment, were lower than those in the control group. CONCLUSION Raloxifene treatment reduces bone turnover biochemical markers, parathyroid hormone and induces 25-OH vitamin D in postmenopausal women. Moreover, it also affects some serum cytokine levels in the postmenopausal period.
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Affiliation(s)
- Bilgin Ozmen
- Celal Bayar University, Medical Faculty, Department of Internal Medicine, Division of Endocrinology and Metabolism, Manisa, Turkey
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Kayýkçýolu O, Ozmen B, Seymenoglu G, Tunali D, Kafesçiler SO, Güclü F, Hekimsoy Z. Macular Edema in Unregulated Type 2 Diabetic Patients Following Glycemic Control. Arch Med Res 2007; 38:398-402. [PMID: 17416286 DOI: 10.1016/j.arcmed.2006.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 12/27/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND We undertook this study to evaluate the changes in macular edema of uncontrolled type 2 diabetes mellitus patients with the regulation of hyperglycemia. METHODS The study population was comprised of 35 type 2 diabetes mellitus patients who had poorly regulated blood glucose values. Ophthalmic examinations including baseline and 6-month macular edema index values of patients by Heidelberg Retinal Tomography (HRT) macular module were done. RESULTS Twenty four (68.6%) female patients and 11 (31.4%) male patients with a mean age of 50.7 +/- 10.3 (mean +/- SD) years and mean diabetic duration of 9.8 +/- 7.5 years participated in the study. Twenty two (62.9%) did not have diabetic retinopathy (DR), whereas 13 (37.2%) had background DR with macular edema. There was a significant correlation between duration of diabetes and HRT-II macula edema index for the right and left eyes (r = 0.40, p = 0.21 and r = 0.40, p = 0.22, respectively). CONCLUSIONS Macular edema did not change significantly by regulation of glycemic control in the study group.
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Affiliation(s)
- Ozcan Kayýkçýolu
- Ophthalmology Department, Celal Bayar University Medical Faculty, Manisa, Turkey.
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Gulseren S, Gulseren L, Hekimsoy Z, Cetinay P, Ozen C, Tokatlioglu B. Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res 2006; 37:133-9. [PMID: 16314199 DOI: 10.1016/j.arcmed.2005.05.008] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Accepted: 05/17/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid dysfunction may impair the quality of life (QoL) and may cause psychological symptoms. The aim of this study is to investigate prospectively the effects of thyroid dysfunction on quality of life, levels of depression/anxiety and the changes in these variables after treatment. METHODS A total of 160 subjects, consisting of an overt hypothyroidism group (n = 33), a subclinical hypothyroidism group (n = 43), an overt hyperthyroidism group (n = 51), a subclinical hyperthyroidism group (n = 13), and a healthy control group (n = 20) were included in the study. All groups were evaluated with the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Short Form-36 (SF-36), and Brief Disability Questionnaire (BDQ). Health-related quality of life (HRQL) was measured by SF-36. RESULTS Anxiety and depressive symptoms were more severe in patients with overt hypo- and hyperthyroidism (p <0.001). The QoL was worse in overt or subclinical hyper- and hypothyroidism groups than in the control group [p = 0.013 for physical composite score (PCS); p = 0.002 for mental composite score (MCS)]. Psychological symptoms and QoL were improved in overt and subclinical hypothyroidism and overt hyperthyroidism groups as a result of the treatment. The overt hyper- and hypothyroidism groups showed more improvement than the subclinical groups. CONCLUSIONS This study suggests that restoration of euthyroidism is accompanied by improvement on QoL and psychological symptoms in all groups except the subclinical hyperthyroidism group. Controlled, randomized studies in larger groups are, however, necessary.
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Affiliation(s)
- Seref Gulseren
- Department of Psychiatry, Ataturk Training and Research Hospital, Izmir, Turkey.
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Koral L, Hekimsoy Z, Yildirim C, Ozmen B, Yorgancioglu A, Girgin A. Does thyroid replacement therapy affect pulmonary function tests in patients with subclinical hypothyroidism? Saudi Med J 2006; 27:329-32. [PMID: 16532092] [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: 05/07/2023] Open
Abstract
OBJECTIVE Subclinical hypothyroidism is an elevation in serum thyroid-stimulating hormone (TSH) while having normal serum free thyroxine (FT4) and triiodothyronine (FT3) levels. The purpose of this prospective observational study was to evaluate the pulmonary function of patients diagnosed with subclinical hypothyroidism, both before and after treatment with thyroid hormone. METHODS This study took place at the Medical Faculty, Celal Bayar University, Manisa, Turkey between February 2003 and June 2004. Thirty-eight patients (37 females, one male) with subclinical hypothyroidism between 20 and 65 years of age were included in the study. Most were mildly obese. Arterial blood gases and pulmonary function tests were performed before treatment with thyroid hormone, and afterwards, the TSH value reached the normal range (indicating euthyroidism). RESULTS Oxygen saturation, but not partial oxygen pressure or partial carbon dioxide pressure, was statistically, but not clinically significantly higher after treatment with thyroid hormone (p=0.01). Pulmonary function tests were not significantly different before and after treatment with thyroid hormone. CONCLUSION In our subclinical hypothyroidism patients, pulmonary function tests were normal and did not significantly change with thyroid hormone replacement. The advantages of thyroid hormone replacement therapy, at least regarding respiratory function, seem to be clearly present in patients with overt, clinical hypothyroidism but not in patients with subclinical hypothyroidism.
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Affiliation(s)
- Lokman Koral
- Department of Internal Medicine, Medical Faculty, Celal Bayar University, Manisa, Turkey
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Hekimsoy Z, Ozmen B, Ulusoy S. Homocysteine levels in acromegaly patients. Neuro Endocrinol Lett 2005; 26:811-4. [PMID: 16380700] [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: 06/01/2005] [Accepted: 08/15/2005] [Indexed: 05/05/2023]
Abstract
Acromegaly is associated with a two to three-fold increase in mortality related predominantly to cardiovascular disease. The excess mortality is associated most closely with higher levels of growth hormone (GH). Survival in acromegaly may be normalized to a control age-matched rate by controlling GH levels; in particular, GH levels less than 2.5 ng/mL are associated with survival rates equal to those of the general population. Hyperhomocysteinemia has also been recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with acromegaly. Eighteen acromegaly patients (7 male, 11 female, mean age 42.8 +/- 11.0 years) in our endocrine clinic consented to having the following tests performed: complete blood count (CBC), thyroid hormones, folic acid, vitamin B12, plasma homocysteine levels, uric acid, fibrinogen, CRP, fasting glucose, insulin, C-peptide, total serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, GH, insulin-like growth factor-1 (IGF-1) and GH levels after an oral glucose tolerance test (OGTT). By history, fourteen had macroadenomas and four had microadenomas; eight had hypertension; two had glucose intolerance, and four had diabetes. Fifteen had had transsphenoidal or transfrontal surgery: two had been cured, but 13 others were taking long-acting octreotide. Five patients had undergone radiotherapy and the acromegaly in two was treated primarily with long-acting octreotide. CBC, thyroid hormone, folic acid, and vit B12 levels were normal in all patients. We divided the patients into two groups according to mean GH levels after an OGTT: Group 1 (GH<2.5 ng/mL, n=10), and Group 2 (GH<2.5 ng/mL, n=8). Comparison of the two groups using Mann-Whitney U testing revealed statistically significant lower levels in Group 1 of the following parameters: GH (1.91 +/- 0.90 vs. 8.58 +/- 5.55 ng/mL, p=0.002), IGF-1 (338.30 +/- 217.90 vs. 509.60 +/- 293.58 ng/dL, p=0.06), GH after an OGTT (1.42 +/- 0.81 vs. 9.01 +/- 4.53 ng/mL, p=0.001), plasma homocysteine (12.85 +/- 4.47 vs. 18.20 +/- 4.99 micromol/L, p=0.05), total cholesterol (164.0 +/- 20.81 vs. 188.0 +/- 22.26 mg/dL, p=0.05) and LDL cholesterol (81.0 +/- 9.64 vs. 116.70 +/- 13.03 mg/dl, p=0.01). Differences between the other parameters were not significantly different. Acromegaly patients with high GH levels after an OGTT have much higher levels of homocysteine than patients with lower GH levels. The role of elevated homocysteine levels as an independent cardiovascular risk factor in the mortality of acromegaly patients should be determined in future studies.
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Affiliation(s)
- Zeliha Hekimsoy
- Celal Bayar University Medical Faculty, Department of Internal Medicine, Division of Endocrinology and Metabolism, Manisa, Turkey.
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Gülseren L, Gülseren S, Hekimsoy Z, Mete L. Comparison of Fluoxetine and Paroxetine in Type II Diabetes Mellitus Patients. Arch Med Res 2005; 36:159-65. [PMID: 15847950 DOI: 10.1016/j.arcmed.2004.12.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 12/09/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aims to investigate the efficacy of fluoxetine and paroxetine on the levels of depression-anxiety, quality of life, disability, and metabolic control in type II diabetes mellitus (DM) patients. METHODS The patients were first applied the Hospital Anxiety-Depression Scale (HADS). After a psychiatric interview with patients who had scores above the cut-off point, those who were diagnosed as having a major depressive disorder according to DSM-IV criteria were applied the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Twenty three patients who scored 16 or above on the HDRS were included in the study and given the Short Form-36 (SF-36), and the Brief Disability Questionnaire (BDQ) and HbA1c levels were measured. Patients were randomized on 20 mg/day fluoxetine or 20 mg/day paroxetine treatment. The patients were evaluated with the same scales at the 2(nd), 4(th), 6(th), and the 12(th) weeks. RESULTS Both groups showed a statistically significant decrease in HDRS, HARS, and BDQ scores with comparison to the index assessment. At the end of treatment, though not statistically significant, a decrease was observed in HbA1c values of the fluoxetine-administered group. CONCLUSIONS Fluoxetine and paroxetine effectively reduce the severity of major depressive disorder in type II DM patients. There is need for further and longer-lasting monitoring studies with more patients in order to determine whether there is any difference in terms of their effects on glycemic control.
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Affiliation(s)
- Leyla Gülseren
- Department of Psychiatry, Atatürk Training and Research Hospital, Izmir, Turkey
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Abstract
The aims of this prospective study were to determine serum levels of creatine kinase (CK) in overt and subclinical hypothyroidism; to investigate the change in CK levels with treatment; and to evaluate the relationship between free triiodsothyronine (FT3), free thyroxine (FT4), and thyrotropin (TSH) levels and the degree of skeletal muscle involvement, as determined by serum CK levels. Patients with hypothyroidism presenting to our endocrinology clinic were eligible for inclusion in this study. Patients with other causes of CK elevation were excluded. We included 28 patients (25 women and 3 men, ages 41.75 +/- 13.65 years) with overt hypothyroidism, 38 patients (37 women, 1 man, ages 40.55 +/- 10.48 years) with subclinical hypothyroidism, and 30 age- and gender-matched controls (27 women, 3 men, ages 40.81 +/- 11.20 years) in the study. Serum levels of TSH, FT4, FT3, and CK were measured in all subjects. CK elevation was found in 16 patients (57%) with overt hypothyroidism and in 4 patients (10%) with subclinical hypothyroidism. Although a statistically significant elevation of CK levels was found in patients with overt hypothyroidism when compared with patients with subclinical hypothyroidism and controls (p = 0. 0001, p = 0. 01, respectively), no difference was found between the subclinical hypothyroidism and control groups (p = 0.14). In hypothyroid (overt and subclinical) patients, a positive correlation was found between CK and TSH (r = 0.432; p = 0.04), and a negative correlation between CK and FT3 (r = - 0.556; p = 0.002) and between CK and FT4 (r =0.448; p = 0.04). CK levels decreased to normal levels after thyroid function normalized with treatment. In conclusion, skeletal muscle is affected by hypothyroidism more profoundly in cases of overt hypothyroidism, less so when subclinical hypothyroidism is present.
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Affiliation(s)
- Zeliha Hekimsoy
- Celal Bayar University, Medical Faculty, Department of Internal Medicine, Division of Endocrinology and Metabolism, Manisa, Turkey.
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Güçlü F, Ozmen B, Hekimsoy Z, Kirmaz C. Effects of a statin group drug, pravastatin, on the insulin resistance in patients with metabolic syndrome. Biomed Pharmacother 2004; 58:614-8. [PMID: 15589072 DOI: 10.1016/j.biopha.2004.09.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In West of Scotland Coronary Prevention Study (WOSCOPS), development of type 2 diabetes mellitus (DM) was found to decrease by 30% in pravastatin-treated patients. In the study, it is suggested that pleiotropic effects of pravastatin may be responsible too as well as its lipid lowering effect. OBJECTIVE The aim of this study was to assess the effects of pravastatin treatment on the insulin resistance in patients with metabolic syndrome with impaired glucose tolerance (IGT), by Homeostasis Model Assessment (HOMA) test, insulin sensitivity indices and glucose half activation time (glucose t1/2). METHODS Study population consisted of 25 women who were diagnosed with metabolic syndrome. At baseline and 10 weeks after the 20 mg/daily tablet pravastatin treatment, waist/hip circumference, body weight and arterial blood pressure measurements, plasma glucose, total cholesterol, triglyceride, high density lipoprotein (HDL)-cholesterol, transaminases, glycosylated haemoglobin (A1C) and insulin level measurements were obtained along with HOMA test and insulin tolerance test after 12 h of fasting. Insulin sensitivity indices and glucose t1/2 were assessed. RESULTS After the treatment, a statistically significant decrease was observed in arterial blood pressure values (P < 0.0001). While plasma total cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were found to decrease significantly and HDL-cholesterol levels increased significantly, a decrease in baseline insulin levels, an increase in insulin sensitivity levels were observed along with an decrease in glucose t1/2. Related to the improvement in aforementioned parameters, statistically significant decreases were noted in HOMA, postprandial and fasting glucose levels and A1C values (P < 0.0001). CONCLUSION Our study suggests that using pravastatin in the dyslipidemia treatment of metabolic syndrome with IGT may be an effective approach by its advantageous effects on insulin resistance. Based on this result, it is possible to say that this can be a risk lowering treatment approach for the development of type 2 DM.
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Affiliation(s)
- Feyzullah Güçlü
- Department of Internal Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Hekimsoy Z, Yünten N, Sivrioglu S. Coexisting acromegaly and primary empty sella syndrome. Neuro Endocrinol Lett 2004; 25:307-9. [PMID: 15361823] [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: 10/24/2003] [Accepted: 04/24/2004] [Indexed: 04/30/2023]
Abstract
The normal functions of the pituitary gland may be suppressed when the gland is compressed onto the sella floor by arachnoid tissue extending through an impaired sella diaphragm. Interestingly, pituitary hormone hypo- and hypersecretion, including acromegaly, have been observed in patients with an 'empty sella'(1-4). This 'empty sella syndrome' has been classified into a primary form, in which no inciting factor (pituitary irradiation or surgery for a pituitary tumor) is present, and a secondary form, in which the empty sella occurs after pituitary procedures. In this report we describe a patient who presented with clinical and biochemical features of acromegaly and who had an empty sella on pituitary magnetic resonance imaging (MRI).
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Affiliation(s)
- Zeliha Hekimsoy
- Celal Bayar University Medical Faculty Department of Internal Medicine, Division of Endocrinology and Metabolism, Manisa, Turkey.
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Hekimsoy Z, Payzin B, Ornek T, Kandoğan G. Mean platelet volume in Type 2 diabetic patients. J Diabetes Complications 2004; 18:173-6. [PMID: 15145330 DOI: 10.1016/s1056-8727(02)00282-9] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.4] [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: 06/24/2002] [Revised: 11/22/2002] [Accepted: 12/19/2002] [Indexed: 11/29/2022]
Abstract
BACKGROUND Altered platelet morphology and function have been reported in patients with diabetes mellitus. They are likely to be associated with the pathological processes and increased risk of vascular disease seen in these patients. We aimed to determine the mean platelet volume (MPV) in diabetics compared to nondiabetics, to see if there is a difference in MPV between diabetics with and without macro- and microvascular complications, and to determine the correlation between MPV and fasting blood glucose, glycosylated hemoglobin (HbA(1)c), patient age, and duration of diabetes, respectively. METHODS We measured MPV in 145 consecutive Type 2 diabetic patients and 100 nondiabetic control subjects without known coronary artery disease who had complete blood count on venous blood sample taken into tripotassium EDTA, using a Roche Minos cell counter and automatic blood counter (CELL-DYN 3500). The blood glucose level was measured by glucose oxidase method and HbA1c by calorimetrical method in the autoanalyser. Statistical evaluation was performed by SPSS for Windows statistics programme using multivariate logistical regression analysis, Student's t, and Pearson correlation tests. RESULTS MPV was significantly higher and the mean platelet counts were significantly lower in diabetics compared to age- and sex-matched nondiabetic healthy controls [10.62+/-1.71 fl vs. 9.15+/-0.86 fl (P=.00), 260.38+/-68.65 x 10(9)/l vs. 292.33+/-79.19 x 10(9)/l (P=.001)], respectively. CONCLUSIONS Our results show significantly higher MPV in diabetic patients than in the nondiabetic controls. This suggests that platelets may play a role in the micro- and macrovascular complications of diabetic patients.
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Affiliation(s)
- Zeliha Hekimsoy
- Endocrinology and Metabolism Unit, Izmir Atatürk Training and Research Hospital, Izmir, Turkey.
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Abstract
Hyperthyroidism is characterized by accelerated bone turnover, caused from direct stimulation of bone cells by increased thyroid hormones. In this study, we aimed to investigate serum osteocalcin levels as a bone formation marker, before antithyroid (propylthiouracil) therapy at hyperthyroid stage and after antithyroid therapy at euthyroid stage of the patients. Twenty four hyperthyroid patients (18 females, 6 males) and 20 (13 females, 7 males) healthy controls were included into this study. Blood and urine samples were taken before medical treatment at hyperthyroid state, and after the antithyroid therapy until the patients reached the euthyroid state. Serum alkaline phosphatase, osteocalcin, calcium, phosphorus, Free T3, Free T4, TSH and urine calcium/creatinine levels were assessed. We found a significant decrease in serum osteocalcin (p=0.006), urinary calcium/creatinine (p=0.004), and serum phosphorus (p=0.038) levels in euthyroid state in comparison to hyperthyroid state. The increases in serum bone formation marker osteocalcin and bone resorption marker urinary calcium/creatinine levels in hyperthyroid state compared to euthyroid state in our study confirmed that hyperthyroid patients have high bone turnover. We conclude that, hyperthyroid patients has high bone turnover of formation and resorption even after attainment of euthyroidism. Osteocalcin and urine calcium/creatinine are sensitive markers in documenting bone remodeling during treatment of hyperthyroidism.
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Affiliation(s)
- Gulhan Barsal
- Biochemistry and Clinical Biochemistry Laboratory, Atatürk Training Hospital, Izmir, Turkey
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Abstract
BACKGROUND Obesity is known to be a risk factor for type 2 diabetes mellitus (DM), arterial hypertension (HT) and hyperlipidaemia (HL), but the relationship between the duration of obesity and these outcomes is variable in the literature. AIMS The aims of this study were 1) to evaluate whether the duration of obesity is a risk factor for type 2 DM, HT and HL, 2) to determine the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), type 2 DM, HT and HL in the patients attending our clinic because of obesity and 3) to determine the correlation between DM, HT and HL and age, body mass index (BMI), duration of obesity and waist-hip ratio (WHR). METHODS Informed consent was obtained from 200 consecutive women presenting to our Endocrinology and Metabolism Unit for the first time because of obesity. The patient's history of the age at onset of obesity, HT and family history of DM were obtained. Anthropometric measurements and a 75-g oral glucose tolerance test (OGTT) were performed. RESULTS On OGTT, 15 (7.5%) had IFG, 36 (18%) had IGT and 18 (9%) had type 2 DM; in addition, 96 (48%) had HT and 76 (38%) had HL. Upon multivariate logistic regression analysis, age was a common risk factor for IGT, type 2 DM, HT and HL, and a family history of diabetes was an additional risk factor for type 2 DM. CONCLUSION The duration of obesity, as reported by women presenting for treatment of obesity, is not a risk factor for type 2 DM, HT and HL.
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Affiliation(s)
- Z Hekimsoy
- Celal Bayar University Medical Faculty, Department of Internal Medicine, Division of Endocrinology, Manisa, Turkey.
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Tankurt E, Biberoglu S, Ellidokuz E, Hekimsoy Z, Akpinar H, Cömlekçi A, Okan A, Sagol O. Hyperinsulinemia and insulin resistance in non-alcoholic steatohepatitis. J Hepatol 1999; 31:963. [PMID: 10580597 DOI: 10.1016/s0168-8278(99)80301-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Cömlekçi A, Biberoglu S, Hekimsoy Z, Okan I, Pişkin O, Sekeroglu B, Alakavuklar M. Symptomatic hypocalcemia in a patient with latent hypoparathyroidism and breast carcinoma with bone metastasis following administration of pamidronate. Intern Med 1998; 37:396-7. [PMID: 9630201 DOI: 10.2169/internalmedicine.37.396] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 11/06/2022] Open
Abstract
Pamidronate is an effective drug used not only in patients with tumor-associated hypercalcemia, but also in normocalcemic patients with metastatic bone disease to relieve pains. We describe a 39-year-old normocalcemic patient with subclinical hypoparathyroidism and bone metastasis due to breast carcinoma. Following parenteral administration of 60 mg pamidronate, the corrected serum level of calcium decreased from 2.12 mmol/l (=8.9 mg/dl) to 1.42 mmol/l (5.7 mg/dl), accompanied with carpal pedal spasm. The present case indicates that the hypocalcemia due to latent hypoparathyroidism was compensated by extensive osteolysis due to bone metastasis, and that overt hypocalcemia may develop after intravenous administration of pamidronate in such a patient.
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Affiliation(s)
- A Cömlekçi
- Dokuz Eylül University, Medical Faculty, Department of Internal Medicine, Inciralti, Izmir, Turkey
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Hekimsoy Z, Biberoğlu S, Cömlekçi A, Tarhan O, Mermut C, Biberoğlu K. Trimethoprim/sulfamethoxazole-induced hypoglycemia in a malnourished patient with severe infection. Eur J Endocrinol 1997; 136:304-6. [PMID: 9100556 DOI: 10.1530/eje.0.1360304] [Citation(s) in RCA: 10] [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] [Indexed: 02/04/2023]
Abstract
Hypoglycemia resulting from the combination of sulfonylurea and sulfonamides is a recognized drug interaction. Hypoglycemia induced by sulfonamides alone may be encountered less frequently. Because of their structural similarities to sulfonylureas, sulfonamides are liable to facilitate hypoglycemia by increasing insulin release in susceptible individuals. Sulfonamides can potentiate the hypoglycemic effect of sulfonylurea agents when given in combination. We describe a malnourished patient with severe infection who developed hypoglycemia during high-dose trimethoprim/sulfamethoxazole therapy. Elevated C-peptide concentrations during the hypoglycemic episode indicate that hypoglycemia resulted from increased endogenous insulin secretion. As malnourished patients are prone to hypoglycemia, we suggest that they should be monitored carefully if they are on sulfonamide therapy.
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Affiliation(s)
- Z Hekimsoy
- Dokuz Eylül University, Medical Faculty, Department of Internal Medicine, Izmir, Turkey
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