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Demir AN, Sulu C, Kara Z, Sahin S, Ozaydin D, Sonmez O, Keskin FE, Tanriover N, Gazioglu N, Kadioglu P. Changing presentation of acromegaly in half a century: a single-center experience. Pituitary 2023; 26:573-582. [PMID: 37523026 DOI: 10.1007/s11102-023-01344-1] [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] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Investigate the changes in the characteristics of presentation, in patients with acromegaly over a period of approximately half a century. METHODS The medical records of patients diagnosed with acromegaly between 1980 and 2023 were retrospectively reviewed. The collected data were examined to assess any changes observed over the years and a comparison was made between the characteristics of patients diagnosed in the last decade and those diagnosed in previous years. RESULTS A total of 570 patients were included in the study, 210 (37%) patients were diagnosed in the last decade. Patients diagnosed before 2014 had longer symptom duration before diagnosis, advanced age, larger pituitary adenomas, higher incidence of cavernous sinus invasion, and higher GH and IGF-1 levels than those diagnosed last decade (p < 0.05, for all). Furthermore, the patients diagnosed before 2014 had a lower rate of surgical remission (p < 0.001), and a higher prevalence of comorbidities such as diabetes, hypertension, colon polyps, and thyroid cancer at the time of diagnosis (p < 0.05, for all). CONCLUSION There may be a trend for earlier detection of patients with acromegaly.
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Affiliation(s)
- Ahmet Numan Demir
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Cem Sulu
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Zehra Kara
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Serdar Sahin
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Dilan Ozaydin
- Department of Neurosurgery, Health Sciences University, Kartal Doktor Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Ozge Sonmez
- Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Fatma Ela Keskin
- Department of Endocrinology, Metabolism, and Diabetes, Demiroglu Bilim University, Istanbul, Türkiye
| | - Necmettin Tanriover
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Nurperi Gazioglu
- Department of Neurosurgery, Istinye University, Istanbul, Türkiye
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Pinar Kadioglu
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye.
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
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2
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Saydam O, Ozgen Saydam B, Adiyaman SC, Sonmez Ince M, Eren MA, Keskin FE, Bilen H, Dagdeviren M, Kaya S, Akinci G, Balci A, Altay C, Bayraktar F, Oral EA, Akinci B. Risk factors for diabetic foot ulcers in metreleptin naïve patients with lipodystrophy. Clin Diabetes Endocrinol 2021; 7:18. [PMID: 34593051 PMCID: PMC8485489 DOI: 10.1186/s40842-021-00132-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022] Open
Abstract
AIM Patients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population. METHODS Ninety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers). RESULTS Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95% CI: 3.31-503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95% CI: 2.97-246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95% CI: 1.96-90.67, p = 0.008). CONCLUSIONS Our study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.
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Affiliation(s)
- O Saydam
- Division of Cardiovascular Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - B Ozgen Saydam
- Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey
| | - S C Adiyaman
- Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey
| | - M Sonmez Ince
- Department of Internal Medicine, William Beaumont Royal Oak Hospital, MI, Royal Oak, USA
| | - M A Eren
- Division of Endocrinology and Metabolism, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - F E Keskin
- Division of Endocrinology and Metabolism, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey
| | - H Bilen
- Division of Endocrinology and Metabolism, Ataturk University Training and Research Hospital, Erzurum, Turkey
| | - M Dagdeviren
- Division of Endocrinology and Metabolism, Kecioren Training and Research Hospital, Ankara, Turkey
| | - S Kaya
- Department of Internal Medicine, Gulhane Training and Research Hospital, Ankara, Turkey
| | - G Akinci
- Division of Pediatric Neurology, Behcet Uz Children's Hospital, Izmir, Turkey.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - A Balci
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - C Altay
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - F Bayraktar
- Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey
| | - E A Oral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology and Diabetes, University of Michigan, 1000 Wall Street, 48105, Ann Arbor, MI, USA
| | - B Akinci
- Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey. .,Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology and Diabetes, University of Michigan, 1000 Wall Street, 48105, Ann Arbor, MI, USA.
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3
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Durcan E, Keskin FE, Ozkaya HM, Sirolu S, Sahin S, Korkmaz OP, Gazioglu N, Tanriover N, Comunoglu N, Oz B, Kizilkilic O, Kadioglu P. Fibroblast Growth Factor Receptor-4 Expression in Pituitary Adenomas is Associated with Aggressive Tumor Features. Exp Clin Endocrinol Diabetes 2021; 130:125-133. [PMID: 34255320 DOI: 10.1055/a-1523-7216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the relationship of Fibroblast Growth Factor Receptor-4 (FGFR-4) expression with radiologic, pathologic, and clinical parameters in pituitary adenomas. METHODS Among 307 patients who underwent pituitary surgery for a pituitary adenoma between 2000 and 2015, we included 161 patients (53 gonadotroph, 26 corticotroph, 25 null cell, 22 lactotroph, 13 somatotroph, 8 adenomas with unusual combination, 7 Pit-1 positive adenomas, and 7 lactosomatotroph) based on availability of pathology specimens. Patients' radiologic, pathologic, and clinical parameters were determined. FGFR-4 immunostaining was evaluated using a semi-quantitative histologic score (H-score). RESULTS The mean follow-up period was 61 (IQR=32-84) months. The median H-scores for FGFR-4 were higher in patients without remission, those with residual lesion, and T2-hyperintense adenoma (p<0.05). Ki-67 level was higher in patients without remission compared to those in remission (p<0.05). The mean Ki-67 levels did not differ between patients with and without residual lesion or T2-hyperintense tumor (p>0.05). There was no significant difference (p>0.05) when the H-score and Ki-67 levels were assessed in terms of sex, sellar-dural invasion, Knosp and a grading system for superior, inferior, parasellar, anterior and posterior tumor extension Classification, tumor function or presence of poor subtype. Adenomas with Ki-67 expression ≥3% had higher FGFR4 expression levels than those with <3% expression (p=0.002). There was a weak positive correlation between H-score and Ki-67 (p=0.011; r=0.201). CONCLUSIONS Higher levels of FGFR-4 in pituitary adenomas could be use a marker for more aggressive tumor behavior.
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Affiliation(s)
- Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatma Ela Keskin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, T.C. Demiroglu Bilim University, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabri Sirolu
- Department of Radiodiagnostic, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozge Polat Korkmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurperi Gazioglu
- Department of Neurosurgery, T.C. Demiroglu Bilim University, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiodiagnostic, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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4
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Ozkaya HM, Sayitoglu M, Comunoglu N, Sun E, Keskin FE, Ozata D, Hocaoglu RH, Khodzaev K, Firtina S, Tanriover N, Gazioglu N, Oz B, Kadioglu P. G-protein Coupled Estrogen Receptor Expression in Growth Hormone Secreting and Non-Functioning Adenomas. Exp Clin Endocrinol Diabetes 2020; 129:634-643. [PMID: 33091936 DOI: 10.1055/a-1274-1330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the expression of G-protein coupled estrogen receptor (GPER1), aromatase, estrogen receptor α (ERα), estrogen receptor β (ERβ), pituitary tumor transforming gene (PTTG), and fibroblast growth factor 2 (FGF2) in GH-secreting and non-functioning adenomas (NFA). METHODS Thirty patients with acromegaly and 27 patients with NFA were included. Gene expression was determined via quantitative reverse transcription polymerase chain reaction (QRT-PCR). Protein expression was determined via immunohistochemistry. RESULTS There was no difference, in terms of gene expression of aromatase, ERα, PTTG, and FGF2 between the two groups (p>0.05 for all). ERβ gene expression was higher and GPER1 gene expression was lower in GH-secreting adenomas than NFAs (p<0.05 for all). Aromatase and ERβ protein expression was higher in GH-secreting adenomas than NFAs (p=0.01). None of the tumors expressed ERα. GPER1 expression was detected in 62.2% of the GH-secreting adenomas and 45% of NFAs. There was no difference in terms of GPER1, PTTG, FGF2 H scores between the two groups (p>0.05 for all). GPER1 gene expression was positively correlated to ERα, ERβ, PTTG, and FGF2 gene expression (p<0.05 for all). There was a positive correlation between aromatase and GPER1 protein expression (r=0.31; p=0.04). CONCLUSIONS GPER1 is expressed at both gene and protein level in a substantial portion of GH-secreting adenomas and NFAs. The finding of a positive correlation between GPER1 and ERα, ERβ, PTTG, and FGF2 gene expression and aromatase and GPER1 protein expression suggests GPER1 along with aromatase and classical ERs might mediate the effects of estrogen through upregulation of PTTG and FGF2.
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Affiliation(s)
- Hande Mefkure Ozkaya
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul
| | - Muge Sayitoglu
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul
| | - Eda Sun
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul
| | - Fatma Ela Keskin
- Department of Endocrinology and Metabolism, Demiroglu Bilim University, Istanbul
| | - Duygu Ozata
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul
| | - Rabia Hacer Hocaoglu
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul
| | - Khusan Khodzaev
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul
| | - Sinem Firtina
- Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul.,Pituitary Center, Istanbul University-Cerrahpasa, Istanbul
| | - Nurperi Gazioglu
- Department of Neurosurgery, Demiroglu Bilim University, Istanbul
| | - Buge Oz
- Department of Pathology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul.,Pituitary Center, Istanbul University-Cerrahpasa, Istanbul
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5
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Saydam O, Ozgen Saydam B, Adiyaman CS, Sonmez Ince M, Eren MA, Keskin FE, Bilen H, Dagdeviren M, Kaya S, Akinci G, Balci A, Altay C, Bayraktar F, Arioglu Oral E, Akinci B. Diabetic Foot Ulcers: A Neglected Complication of Lipodystrophy. Diabetes Care 2020; 43:e149-e151. [PMID: 32801128 DOI: 10.2337/dc20-1655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/19/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Onur Saydam
- Division of Cardiovascular Surgery, Izmir University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Basak Ozgen Saydam
- Division of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Cem Suleyman Adiyaman
- Division of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Melda Sonmez Ince
- Department of Internal Medicine, William Beaumont Royal Oak Hospital, Royal Oak, MI
| | - Mehmet Ali Eren
- Division of Endocrinology and Metabolism, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Fatma Ela Keskin
- Division of Endocrinology and Metabolism, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Habib Bilen
- Division of Endocrinology and Metabolism, Ataturk University Training and Research Hospital, Erzurum, Turkey
| | - Murat Dagdeviren
- Division of Endocrinology and Metabolism, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Seher Kaya
- Department of Internal Medicine, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Gulcin Akinci
- Division of Pediatric Neurology, Behcet Uz Children's Hospital, Izmir, Turkey.,Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Ali Balci
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Firat Bayraktar
- Division of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Elif Arioglu Oral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
| | - Baris Akinci
- Division of Endocrinology and Metabolism, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey .,Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
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6
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Kadioglu P, Durcan E, Keskin FE, Ozkaya HM, Sirolu S, Sahin S, Korkmaz OP, Gazioglu N, Tanriover N, Comunoglu N, Oz B, Kizilkilic O. MON-269 FGFR-4 Expression in Pituitary Adenomas Is Associated with Aggressive Tumor Features. J Endocr Soc 2020. [PMCID: PMC7209749 DOI: 10.1210/jendso/bvaa046.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Biomarkers predicting tumor aggressiveness in pituitary adenomas have been largely investigated, albeit, with inconsistent results. We investigated the relationship of Fibroblast Growth Factor Receptor-4 (FGFR-4) expression and determined its relationship with radiological, pathological, and clinical parameters. In our study, 650 patients who were followed up for pituitary disease were reviewed from medical charts retrospectively. Of the 307 patients who underwent pituitary surgery for a pituitary adenoma between 2000 and 2015, we selected 161 cases on the basis of availability of pathology specimen of hypophysis tissue in our center. Patients’ radiological, pathological, and clinical parameters were obtained from medical charts. FGFR-4 immunostaining was evaluated using a semiquantitative Histologic score (H score). The mean age of the patients was 56.02 ± 14.80 years. Ninety-two (57.1%) were male and 69 (42.9%) were female. The mean follow-up period was 68.94 ± 44.15 months. Pathological examination revealed the following subtypes; 53 nonfunctioning pituitary adenomas, 26 corticotroph adenomas, 25 hormone receptor negative adenomas, 22 mammotroph adenomas, 13 somatotroph adenomas, 8 combined hormone secreting adenomas, 7 somatomammotroph, and 7 PIT-1 positive adenomas. The mean tumor size was 26.83 ± 14.92 mm. In patients with cavernous sinus invasion, the mean adenoma size was significantly higher than those without (p <0.001). Mean H-score and Ki-67 levels were not different between patients with and without cavernous sinus invasion (p>0.05 for all). The mean H-score, Ki-67, and adenoma size were significantly higher in patients without remission than those with remission (p <0.001, p = 0.014, p <0.001, respectively). The mean H score and adenoma size were significantly higher in patients with residual lesions than those without (p = 0.002, p <0.001; respectively); there was no significant difference in Ki- 67 levels (p>0.05). When the H-score and Ki-67 levels were assessed in terms of gender, sellar-dural invasion, tumor function or presence of poor subtype, no significant difference was detected (p>0.05 for all). The mean H score and adenoma size were significantly higher in patients with Ki-67≥ 3 than those with <3 (p = 0.002, p = 0.004; respectively). There was a weak positive correlation between H-score and Ki-67 (p = 0.005; r = 0.218); on the other hand, Ki-67 was not correlated with mitosis grade, p53 staining, and age, respectively (p>0.05 for all). In our study, we demonstrated that patients with residual lesion and those without remission had high expression of FGFR-4. Also FGFR-4 levels were positively correlated with Ki-67 which itself correlated with lack of remission. Taken together, our results indicate that higher levels of FGFR-4 and Ki-67 in pituitary adenomas might indicate a more aggressive tumor phenotype.
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Affiliation(s)
- Pinar Kadioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatma Ela Keskin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, T.C. Demiroglu Bilim University, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabri Sirolu
- Department of Radiodiagnostic, Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozge Polat Korkmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurperi Gazioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, T.C. Demiroglu Bilim University, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiodiagnostic, Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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7
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Demirci M, Bahar Tokman H, Taner Z, Keskin FE, Çağatay P, Ozturk Bakar Y, Özyazar M, Kiraz N, Kocazeybek BS. Bacteroidetes and Firmicutes levels in gut microbiota and effects of hosts TLR2/TLR4 gene expression levels in adult type 1 diabetes patients in Istanbul, Turkey. J Diabetes Complications 2020; 34:107449. [PMID: 31677982 DOI: 10.1016/j.jdiacomp.2019.107449] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 01/12/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to determine and compare the levels of both Bacteroidetes and Firmicutes in the gut microbiota and TLR2/TLR4 gene expression in the blood of patients with type 1 diabetes mellitus (T1DM) and healthy individuals. These results may serve as a preliminary assessment to guide future research. METHOD Between January and October 2014, stool and blood samples were collected from 53 adult T1DM patients and 53 age- and gender-matched healthy individuals. Bacteroidetes and Firmicutes levels were assessed from stool sample DNA and TLR2 and TLR4 expression levels were analyzed via qPCR using RNA from EDTA blood samples from both patients and healthy controls. RESULTS The amounts of Bacteroidetes and Firmicutes were statistically significantly higher and lower, respectively, in the T1DM group than in the healthy control group (p < 0.001 and p < 0.001, respectively). In addition, the Firmicutes/Bacteroidetes ratios in patients with T1DM were significantly lower than in healthy controls. The TLR4 and TLR2 gene expression levels in T1DM patients were significantly upregulated and downregulated, respectively, compared to those in the control group. CONCLUSION Our data are the first to show a relationship between T1DM and gut microbiota in our country. In addition, our results provide information about the connections between T1DM, gut microbiota, and TLR2 and TLR4 expression. We believe that Bacteroidetes and Firmicutes in the gut microbiota may play a role in the autoimmune process of T1DM and that these findings should be further investigated in the future.
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Affiliation(s)
- Mehmet Demirci
- Department of Medical Microbiology, Beykent University, School of Medicine, Istanbul, Turkey
| | - Hrisi Bahar Tokman
- Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Zeynep Taner
- Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Fatma Ela Keskin
- Department of Endocrinology, Gaziosmanpasa Taksim Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Penbe Çağatay
- Vocational School of Health Service, Department of Medical Services and Technics, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Yesim Ozturk Bakar
- Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mücahit Özyazar
- Department of Endocrinology, Gaziosmanpasa Hospital, Yeni Yuzyil University, Medical Faculty, Istanbul, Turkey
| | - Nuri Kiraz
- Department of Medical Microbiology, School of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Bekir S Kocazeybek
- Department of Medical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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8
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Ozkaya HM, Comunoglu N, Sayitoglu M, Keskin FE, Firtina S, Khodzhaev K, Apaydin T, Gazioglu N, Tanriover N, Oz B, Kadioglu P. Germline mutations of aryl hydrocarbon receptor-interacting protein (AIP) gene and somatostatin receptor 1-5 and AIP immunostaining in patients with sporadic acromegaly with poor versus good response to somatostatin analogues. Pituitary 2018; 21:335-346. [PMID: 29455389 DOI: 10.1007/s11102-018-0876-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine aryl hydrocarbon interacting protein (AIP) gene variations and AIP and somatostatin receptor (SSTR) 1-5 immunostaining in patients with apparently sporadic acromegaly with poor versus good response to somatostatin analogues (SRLs). METHODS A total of 94 patients (66 with poor and 28 with good response to SRLs) were screened for the AIP gene variations using Sanger sequencing. Immunostaining was performed in 60 tumors. RESULTS Several variations, albeit some with undetermined significance, were detected, especially in poor responder patients. The prevalence of AIP mutation was 2.1% in the whole group and 1.5% in patients with poor response to SRLs. AIP, SSTR2A, and SSTR2B immunostainings were decreased in patients with poor response (p < 0.05 for all), and other SSTRs did not differ between the groups (p > 0.05 for all). Patients with low AIP had decreased levels of SSTR2A and SSTR3 (p < 0.05 for all). AIP and SSTR2A immunostainings were positively correlated to the treatment response and age at diagnosis was negatively correlated (p < 0.05 for all). In poor responder patients with high SSTR2A immunostaining, SSTR2B immunostaining and preoperative tumor size were positively and negatively correlated, respectively, to SRL response (p < 0.05 for all). CONCLUSIONS Lack of response to SRLs does not necessarily increase the risk of harboring AIP mutations. The finding of decreased AIP, SSTR2A, and SSTR2B immunostaining in patients with poor response to SRLs and decreased SSTR2A and SSTR3 level in those with low AIP immunostaining suggests a possible interaction between AIP and some SSTR subtypes that might alter SRL sensitivity.
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Affiliation(s)
- Hande Mefkure Ozkaya
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, 34303, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Muge Sayitoglu
- Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Ela Keskin
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, 34303, Istanbul, Turkey
| | - Sinem Firtina
- Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Khusan Khodzhaev
- Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Tugce Apaydin
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, 34303, Istanbul, Turkey
| | - Nurperi Gazioglu
- Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
- Pituitary Center, Istanbul University, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
- Pituitary Center, Istanbul University, Istanbul, Turkey
| | - Buge Oz
- Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, 34303, Istanbul, Turkey.
- Pituitary Center, Istanbul University, Istanbul, Turkey.
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9
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Akinci B, Unlu SM, Celik A, Simsir IY, Sen S, Nur B, Keskin FE, Saydam BO, Ozdemir NK, Yurekli BS, Ergur BU, Sonmez M, Atik T, Arslan A, Demir T, Altay C, Tunc UA, Arkan T, Gen R, Eren E, Akinci G, Yilmaz AA, Bilen H, Ozen S, Celtik A, Erdeve SS, Cetinkaya S, Onay H, Sarioglu S, Oral EA. Renal complications of lipodystrophy: A closer look at the natural history of kidney disease. Clin Endocrinol (Oxf) 2018; 89:65-75. [PMID: 29722904 PMCID: PMC5999575 DOI: 10.1111/cen.13732] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/29/2018] [Revised: 04/02/2018] [Accepted: 04/24/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Lipodystrophy syndromes are a group of heterogeneous disorders characterized by adipose tissue loss. Proteinuria is a remarkable finding in previous reports. STUDY DESIGN In this multicentre study, prospective follow-up data were collected from 103 subjects with non-HIV-associated lipodystrophy registered in the Turkish Lipodystrophy Study Group database to study renal complications in treatment naïve patients with lipodystrophy. METHODS Main outcome measures included ascertainment of chronic kidney disease (CKD) by studying the level of proteinuria and the estimated glomerular filtration rate (eGFR). Kidney volume was measured. Percutaneous renal biopsies were performed in 9 patients. RESULTS Seventeen of 37 patients with generalized and 29 of 66 patients with partial lipodystrophy had CKD characterized by proteinuria, of those 12 progressed to renal failure subsequently. The onset of renal complications was significantly earlier in patients with generalized lipodystrophy. Patients with CKD were older and more insulin resistant and had worse metabolic control. Increased kidney volume was associated with poor metabolic control and suppressed leptin levels. Renal biopsies revealed thickening of glomerular basal membranes, mesangial matrix abnormalities, podocyte injury, focal segmental sclerosis, ischaemic changes and tubular abnormalities at various levels. Lipid vacuoles were visualized in electron microscopy images. CONCLUSIONS CKD is conspicuously frequent in patients with lipodystrophy which has an early onset. Renal involvement appears multifactorial. While poorly controlled diabetes caused by severe insulin resistance may drive the disease in some cases, inherent underlying genetic defects may also lead to cell autonomous mechanisms contributory to the pathogenesis of kidney disease.
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Affiliation(s)
- Baris Akinci
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Ali Celik
- Division of Nephrology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ilgin Yildirim Simsir
- Division of Endocrinology, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Sait Sen
- Department of Pathology, Ege University, Izmir, Turkey
| | - Banu Nur
- Division of Pediatric Genetics, Department of Pediatrics, Akdeniz University, Antalya, Turkey
| | - Fatma Ela Keskin
- Division of Endocrinology, Department of Internal Medicine, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Basak Ozgen Saydam
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Banu Sarer Yurekli
- Division of Endocrinology, Department of Internal Medicine, Ege University, Izmir, Turkey
| | | | - Melda Sonmez
- Koc University, School of Medicine, Istanbul, Turkey
| | - Tahir Atik
- Division of Pediatric Genetics, Department of Pediatrics, Ege University, Izmir, Turkey
| | - Atakan Arslan
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Tevfik Demir
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Ulku Aybuke Tunc
- Division of Endocrinology, Karabuk State Hospital, Karabuk, Turkey
| | - Tugba Arkan
- Division of Endocrinology, Kocaeli Training Hospital, Kocaeli, Turkey
| | - Ramazan Gen
- Division of Endocrinology, Department of Internal Medicine, Mersin University, Mersin, Turkey
| | - Erdal Eren
- Division of Pediatric Endocrinology, Department of Pediatrics, Uludag University, Bursa, Turkey
| | - Gulcin Akinci
- Division of Pediatric Neurology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
| | - Aslihan Arasli Yilmaz
- Division of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Habip Bilen
- Division of Endocrinology, Department of Internal Medicine, Ataturk University, Erzurum, Turkey
| | - Samim Ozen
- Division of Pediatric Endocrinology, Department of Pediatrics, Ege University, Izmir, Turkey
| | - Aygul Celtik
- Division of Nephrology, Department of Internal Medicine, Ege University, Izmir, Turkey
| | - Senay Savas Erdeve
- Division of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Semra Cetinkaya
- Division of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Huseyin Onay
- Division of Pediatric Genetics, Department of Pediatrics, Ege University, Izmir, Turkey
| | - Sulen Sarioglu
- Department of Pathology, Dokuz Eylul University, Izmir, Turkey
| | - Elif Arioglu Oral
- Division of Endocrinology and Metabolism, Brehm Center for Diabetes Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Keskin FE, Özkaya HM, Ortaç M, Salabaş E, Kadıoğlu A, Kadıoğlu P. Sexual function in women with Cushing's Syndrome: A controlled study. Turk J Urol 2018; 44:287-293. [PMID: 29932397 DOI: 10.5152/tud.2018.74240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/13/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study is to determine the severity of female sexual dysfunction (FSD), quality of life, and depression status in female patients with Cushing's syndrome (CS). MATERIAL AND METHODS This study included 29 sexually active women with CS and 30 healthy age and body mass index matched women. The Female Sexual Function Index (FSFI) questionnaire, Beck Depression Inventory (BDI) and Short Form Health Survey (SF-36) were filled by each participant. Plasma levels of FSH, LH, PRL, cortisol, DHEA-S, 17-hydroxyprogesterone, androstenedione, free testosterone, total testosterone and estradiol were measured. RESULTS Female sexual dysfunction was present in 88.9% of the women with CS and 24.1% of the control group. The CS group showed a lower total FSFI score [16.6 (IQR: 5-23)] compared to the healthy women [26.8 (IQR: 25.5-30.4) (p<0.001)]. The FSFI scores in the arousal, lubrication, orgasm, pain and satisfaction domains were all lower in the women with CS (p<0.001). Both summary scores of the SF-36 were reduced in women with Cushing's syndrome compared to the control group (p=0.001). The BDI scores of patients were significantly higher than those of the control subjects (p=0.007). In patients with CS, levels of LH, estradiol, and DHEA-S04 were significantly lower while cortisol (p<0.05), and 17 hydroxyprogestrone levels were higher than control subjects (p<0.05). CONCLUSION This study showed that majority of the women with CS had FSD. This may be related to the inhibitory effect of cortisol on sex hormones.
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Affiliation(s)
- Fatma Ela Keskin
- Department of Internal Medicine, Division of Endocrinology-Metabolism and Diabetes, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Hande Mefkure Özkaya
- Department of Internal Medicine, Division of Endocrinology-Metabolism and Diabetes, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Mazhar Ortaç
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Emre Salabaş
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ateş Kadıoğlu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Pınar Kadıoğlu
- Department of Internal Medicine, Division of Endocrinology-Metabolism and Diabetes, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.,Pituitary Center, İstanbul University, İstanbul, Turkey
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11
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Keskin FE, Ozkaya HM, Ferahman S, Haliloglu O, Karatas A, Aksoy F, Kadioglu P. The Role of Different Molecular Markers in Papillary Thyroid Cancer Patients with Acromegaly. Exp Clin Endocrinol Diabetes 2018; 127:437-444. [DOI: 10.1055/a-0629-9223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Purpose Prevalence of papillary thyroid cancer (PTC) is increased in patients with acromegaly. We aimed to determine the protein expression of BRAF, RAS, RET, insulin like growth factor 1(IGF1), Galectine 3, CD56 in patients with PTC related acromegaly and to compare the extensity of these expressions with normal PTC patients and benign thyroid nodules.
Methods We studied 313 patients with acromegaly followed in Cerrahpasa Medical Faculty, Endocrinology and Metabolism Clinic between 1998 and 2015. On the basis of availability of pathological specimen of thyroid tissues, thyroid samples of 13 patients from 19 with acromegaly related PTC (APTC), 20 normal PTC and 20 patients with multinodulary goiter (MNG) were histopathologically evaluated. Protein expressions were determined via immunohistochemical staining in ex-vivo tumor samples and benign nodules.
Results The incidence of PTC in acromegaly patients were 6% (n=19). Among patients with PTC, APTC and MNG, all the immunohistochemical protein expressions we have studied were higher in papillary thyroid cancer groups (p<0.01, for all). Between PTC group without acromegaly and APTC, galectin 3 and IGF1 expression was significantly higher in acromegalic patients (p<0.01 for all) while RAS was predominantly higher in PTC patients without acromegaly (p<0.01).
Conclusion BRAF expression was not higher in PTC with acromegaly patients compared to PTC patients without acromegaly. Galectine 3 and IGF1 were expressed more intensively in APTC. These positive protein expressions may have more influence on determining malign nodules among acromegaly patients.
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Affiliation(s)
- Fatma Ela Keskin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sina Ferahman
- Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozlem Haliloglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Adem Karatas
- Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Figen Aksoy
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
- Pituitary Center, Istanbul University, Istanbul, Turkey
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12
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Siva ZO, Uluduz D, Keskin FE, Erenler F, Balcı H, Uygunoğlu U, Saip S, Göksan B, Siva A. Determinants of glucose metabolism and the role of NPY in the progression of insulin resistance in chronic migraine. Cephalalgia 2017; 38:1773-1781. [PMID: 29260593 DOI: 10.1177/0333102417748928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 01/01/2023]
Abstract
Background Chronic migraine has a well-documented association with increased insulin resistance and metabolic syndrome. The hypothalamus may play a role in the progression of insulin resistance in chronic migraine through the regulation of orexigenic peptides such as neuropeptide Y. Insulin resistance may lead to increased risk of future type 2 diabetes mellitus in patients with chronic migraine, which is more likely to occur if other pathogenetic defects of type 2 diabetes mellitus, such as impaired pancreatic β-cell functions and defects in intestinal glucagon-like peptide-1 secretion after meals. We studied the relationship of fasting neuropeptide Y with insulin resistance, β-cell function, and glucagon-like peptide-1 secretion in non-obese female chronic migraine patients. We also aimed to investigate glucose-stimulated insulin and glucagon-like peptide-1 secretions as early pathogenetic mechanisms responsible for the development of carbohydrate intolerance. Methods In this cross-sectional controlled study, 83 non-obese female migraine patients of reproductive age categorized as having episodic migraine or chronic migraine were included. The control group consisted of 36 healthy females. We studied glucose-stimulated insulin and glucagon-like peptide-1 secretion during a 75 g oral glucose tolerance test. We investigated the relationship of neuropeptide Y levels with insulin resistance and β-cell insulin secretion functions. Results Fasting glucose levels were significantly higher in migraine patients. Plasma glucose and insulin levels during the oral glucose tolerance test were otherwise similar in chronic migraine, episodic migraine and controls. Patients with chronic migraine were more insulin resistant than episodic migraine or controls ( p = 0.048). Glucagon-like peptide-1 levels both at fasting and two hours after glucose intake were similar in chronic migraine, episodic migraine, and controls. Neuropeptide Y levels were higher in migraineurs. In chronic migraine, neuropeptide Y was positively correlated with fasting glucagon-like peptide-1 levels (r = 0.57, p = 0.04), but there was no correlation with insulin resistance (r = 0.49, p = 0.09) or β-cell function (r = 0.50, p = 0.07). Discussion Non-obese premenopausal female patients with chronic migraine have higher insulin resistance, but normal β-cell function is to compensate for the increased insulin demand during fasting and after glucose intake. Increased fasting neuropeptide Y levels in migraine may be a factor leading to increased insulin resistance by specific alterations in energy intake and activation of the sympathoadrenal system.
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Affiliation(s)
- Zeynep Oşar Siva
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Derya Uluduz
- 2 Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Ela Keskin
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Feyza Erenler
- 2 Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Huriye Balcı
- 3 Department of Biochemistry, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Uğur Uygunoğlu
- 2 Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Sabahattin Saip
- 2 Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Baki Göksan
- 2 Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aksel Siva
- 2 Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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13
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Bener A, Keskin FE, Kurtulus EM, Guzel M, Çekirdekçi EI, Kadıoğlu P, Konukoğlu D, Öztürk M. Essential parameters and risk factors of the patients for diabetes care and treatment. Diabetes Metab Syndr 2017; 11 Suppl 1:S315-S320. [PMID: 28285988 DOI: 10.1016/j.dsx.2017.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/03/2017] [Indexed: 12/25/2022]
Abstract
AIM The aim was to explore the association between Type 2 Diabetes Mellitus [T2DM] treatment satisfactions of patients regarding their socio-economic, life-style, history medication and clinical outcome in a Turkish population SUBJECT AND METHODS: A cross-sectional study conducted from February 2016 to September 2016. Of the total 1500 diabetic patients approached, 1094 (72.9%) gave their consent. Data analysis included, sociodemographic, serum lipid profiles (LDL, HDL), calcium, uric acid, blood pressure and glycated hemoglobin (HbA1c) at baseline and after six months. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) tools were used to measure the patient satisfaction. RESULTS The mean and standard deviation of age among gender, there were significant differences between males (51.81±14.40) and females (49.76±13.99) (p=0.024). There were statistically significant differences between males and females regarding place of living (city 76% vs town 26%) p<0.001) and consanguinity (p=0.040). Almost of the patients with diabetes were overweight (males 44.5% vs females 41.8%) while more than a quarter (31.2%) males were obese. Among patients with diabetes, significantly larger proportion were treated for DM with insulin (females 28.8% vs males 22.5%) and 'insulin & oral anti diabetic drugs' (females 21.6% vs males 18.4%%; p<0.001) in comparison. Reported average sleeping haours was significantly more among males (6.5±1.1 vs. 6.1±1.2; p<0.001) than females. Males and females reported significantly greater improvements in mean values of blood glucose (-2.07 p<0.001; vs. -2.36; p=0.007), HbA1c (-1.72 p<0.001; vs. -1.47 p=0.038), potassium (+0.98 p<0.001; vs. +0.93 p<0.005); albumin (-3.38 p<0.001; vs. -3.60; p<0.001); billirubin (-0.69 p=0.049; vs. -0.98; p<0.001); uric acid (+11.9 p=0.017; vs. +14.3; p<0.001); systolic blood pressure (-3.86 p<0.001; vs. -3.2 p<0.001) and diastolic blood pressure (-3.17 p<0.001; vs. -3.2 p<0.001) in comparison to 6 months before. Multivariate stepwise regression analysis showed that the satisfaction DTSQ scores for HbA1c (p<0.001), h of sleep (p<0.001), neuropathy (p=0.007), diabetic education (p=0.014), SBP (mmHg) (p=0.021) DBP (mmHg) (p=0.028) were identified as significantly associated with higher treatment satisfaction. CONCLUSION The study confirms a positive correlation between diabetes patient's satisfaction with care and treatment. Females DM patients compared to males had a better satisfaction score with current treatment, unacceptably low blood glucose level, flexibility in treatment and understanding of DM.
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Affiliation(s)
- Abdulbari Bener
- Dept. of Biostatistics & Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey; Dept. of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK; Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - Fatma Ela Keskin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Eda M Kurtulus
- Dept. of Medical Biochemistry, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Guzel
- Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Elif I Çekirdekçi
- Dept. of Biostatistics & Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey; Dept. of Cardiology, Çorlu Hospital, MOH, Çorlu, Turkey
| | - Pınar Kadıoğlu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dildar Konukoğlu
- Dept. of Medical Biochemistry, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Öztürk
- Medipol International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Keskin FE, Ozkaya HM, Bolayirli M, Erden S, Kadioglu P, Tanriover N, Gazioglu N. Outcomes of Primary Transsphenoidal Surgery in Cushing Disease: Experience of a Tertiary Center. World Neurosurg 2017; 106:374-381. [DOI: 10.1016/j.wneu.2017.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022]
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Akinci B, Onay H, Demir T, Savas-Erdeve Ş, Gen R, Simsir IY, Keskin FE, Erturk MS, Uzum AK, Yaylali GF, Ozdemir NK, Atik T, Ozen S, Yurekli BS, Apaydin T, Altay C, Akinci G, Demir L, Comlekci A, Secil M, Oral EA. Clinical presentations, metabolic abnormalities and end-organ complications in patients with familial partial lipodystrophy. Metabolism 2017; 72:109-119. [PMID: 28641778 DOI: 10.1016/j.metabol.2017.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 02/02/2017] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Familial partial lipodystrophy (FPLD) is a rare genetic disorder characterized by partial lack of subcutaneous fat. METHODS This multicenter prospective observational study included data from 56 subjects with FPLD (18 independent Turkish families). Thirty healthy controls were enrolled for comparison. RESULTS Pathogenic variants of the LMNA gene were determined in nine families. Of those, typical exon 8 codon 482 pathogenic variants were identified in four families. Analysis of the LMNA gene also revealed exon 1 codon 47, exon 5 codon 306, exon 6 codon 349, exon 9 codon 528, and exon 11 codon 582 pathogenic variants. Analysis of the PPARG gene revealed exon 3 p.Y151C pathogenic variant in two families and exon 7 p.H477L pathogenic variant in one family. A non-pathogenic exon 5 p.R215Q variant of the LMNB2 gene was detected in another family. Five other families harbored no mutation in any of the genes sequenced. MRI studies showed slightly different fat distribution patterns among subjects with different point mutations, though it was strikingly different in subjects with LMNA p.R349W pathogenic variant. Subjects with pathogenic variants of the PPARG gene were associated with less prominent fat loss and relatively higher levels of leptin compared to those with pathogenic variants in the LMNA gene. Various metabolic abnormalities associated with insulin resistance were detected in all subjects. End-organ complications were observed. CONCLUSION We have identified various pathogenic variants scattered throughout the LMNA and PPARG genes in Turkish patients with FPLD. Phenotypic heterogeneity is remarkable in patients with LMNA pathogenic variants related to the site of missense mutations. FPLD, caused by pathogenic variants either in LMNA or PPARG is associated with metabolic abnormalities associated with insulin resistance that lead to increased morbidity.
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Affiliation(s)
- Baris Akinci
- Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey.
| | - Huseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Tevfik Demir
- Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey
| | - Şenay Savas-Erdeve
- Division of Pediatric Endocrinology, Dr. Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Ramazan Gen
- Division of Endocrinology, Mersin University, Mersin, Turkey
| | | | - Fatma Ela Keskin
- Division of Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Ayse Kubat Uzum
- Division of Endocrinology, Capa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | - Tahir Atik
- Division of Pediatric Genetics, Ege University, Izmir, Turkey
| | - Samim Ozen
- Division of Pediatric Endocrinology, Ege University, Izmir, Turkey
| | | | - Tugce Apaydin
- Division of Endocrinology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Gulcin Akinci
- Division of Pediatric Neurology, Dr.Behcet Uz Children's Hospital, Izmir, Turkey
| | - Leyla Demir
- Department of Biochemistry, Ataturk Training Hospital, Izmir, Turkey
| | | | - Mustafa Secil
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Elif Arioglu Oral
- Division of Endocrinology and Metabolism, Brehm Center for Diabetes Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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16
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Akinci G, Topaloglu H, Demir T, Danyeli AE, Talim B, Keskin FE, Kadioglu P, Talip E, Altay C, Yaylali GF, Bilen H, Nur B, Demir L, Onay H, Akinci B. Clinical spectra of neuromuscular manifestations in patients with lipodystrophy: A multicenter study. Neuromuscul Disord 2017; 27:923-930. [PMID: 28754454 DOI: 10.1016/j.nmd.2017.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 01/14/2023]
Abstract
Lipodystrophy is a heterogeneous group of disorders characterized by loss of adipose tissue. Here, we report on clinical spectra of neuromuscular manifestations of Turkish patients with lipodystrophy. Seventy-four patients with lipodystrophy and 20 healthy controls were included. Peripheral sensorimotor neuropathy was a common finding (67.4%) in lipodystrophic patients with diabetes. Neuropathic foot ulcers were observed in 4 patients. Drop foot developed in 1 patient with congenital generalized lipodystrophy type 1. Muscle symptoms and hypertrophy were consistent findings in congenital generalized lipodystrophy (21/21) and familial partial lipodystrophy (25/34); on the other hand, overt myopathy with elevated creatine kinase activity was a distinctive characteristic of congenital generalized lipodystrophy type 4. Muscle biopsies revealed myopathic changes at different levels. Accumulation of triglycerides was observed which contributes to insulin resistance. All patients with congenital generalized lipodystrophy suffered from tight Achilles tendons at various levels. Scoliosis was observed in congenital generalized lipodystrophy type 4 (2/2) and familial partial lipodystrophy type 2 (2/17). Atlantoaxial instability was unique to congenital generalized lipodystrophy type 4 (2/2). Bone cysts were detected in congenital generalized lipodystrophy type 1 (7/10) and congenital generalized lipodystrophy type 2 (2/8). Our study suggests that lipodystrophies are associated with a wide spectrum of neuromuscular abnormalities.
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Affiliation(s)
- Gulcin Akinci
- Department of Pediatric Neurology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
| | - Haluk Topaloglu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Tevfik Demir
- Department of Internal Medicine, Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey
| | | | - Beril Talim
- Pediatric Pathology Unit, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Fatma Ela Keskin
- Department of Internal Medicine, Division of Endocrinology, Gaziosmanpasa Taksim Training Hospital, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Internal Medicine, Division of Endocrinology, Istanbul University, Istanbul, Turkey
| | - Enez Talip
- Department of Internal Medicine, Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - Guzin Fidan Yaylali
- Department of Internal Medicine, Division of Endocrinology, Pamukkale University, Denizli, Turkey
| | - Habib Bilen
- Department of Internal Medicine, Division of Endocrinology, Ataturk University, Erzurum, Turkey
| | - Banu Nur
- Department of Pediatrics, Division of Pediatric Genetics, Akdeniz University, Antalya, Turkey
| | - Leyla Demir
- Department of Biochemistry, Ataturk Training Hospital, Izmir, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Baris Akinci
- Department of Internal Medicine, Division of Endocrinology, Dokuz Eylul University, Izmir, Turkey
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17
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Apaydin T, Ozkaya HM, Keskin FE, Haliloglu OA, Karababa K, Erdem S, Kadioglu P. Daily life reflections of acromegaly guidelines. J Endocrinol Invest 2017; 40:323-330. [PMID: 27766549 DOI: 10.1007/s40618-016-0567-9] [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: 05/21/2016] [Accepted: 10/11/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the differences in acromegaly diagnosis, treatment, and follow-up among Turkish endocrinologists, and to investigate how the published guidelines are applied in clinical practice. METHODS The questionnaire was formatted as an electronic survey, conducted between November and December 2015, and sent weekly for 6 weeks via e-mail to 528 endocrinologists in Turkey. RESULTS The questionnaire was answered by 37.4 % of endocrinologists. Insulin-like growth factor-1 and nadir growth hormone level after 75 g oral glucose tolerance test (nadir GH-OGTT) were the most commonly preferred methods for the initial diagnosis. A total of 49.5 % of the participants reported using preoperative medical therapy (MT) either routinely or on a case-to-case basis. Somatostatin analogs were the most commonly used drugs, both in pre- and postoperative MT. Disease activity following surgery was assessed in the 3rd postoperative month using IGF-1 levels. Similarly, IGF-1 monitoring was preferred in the follow-up period. Monitoring nadir GH-OGTT levels was the most commonly used method in the assessment of discordant test results. The dose titration was done at month 3 after the start of MT. Resistance to SRLs was considered after using the maximal dose for at least 6 months. Pegvisomant was generally used in second- and third-line therapy. Similarly, cabergoline was not preferred in monotherapy by the majority of participants. Radiotherapy was considered in patients with incomplete response to surgery and medical treatments. CONCLUSIONS Although there were subtle differences, clinical practice guidelines were usually followed among Turkish endocrinologists.
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Affiliation(s)
- T Apaydin
- Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - H M Ozkaya
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey
| | - F E Keskin
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey
| | - O A Haliloglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey
| | - K Karababa
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey
| | - S Erdem
- Pituitary Center, University of Istanbul, Istanbul, Turkey
| | - P Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, 34303, Cerrahpasa, Istanbul, Turkey.
- Pituitary Center, University of Istanbul, Istanbul, Turkey.
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18
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Haliloglu O, Dogangun B, Ozcabi B, Kural HU, Keskin FE, Ozkaya HM, Pamukcu FC, Bektas E, Poyraz BC, Buber H, Evliyaoglu O, Kadioglu P. General health status and intelligence scores of children of mothers with acromegaly do not differ from those of healthy mothers. Pituitary 2016; 19:391-8. [PMID: 27033692 DOI: 10.1007/s11102-016-0717-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/22/2022]
Abstract
PURPOSE To determine the physical status and intelligence scores of children of acromegalic mothers and to compare them with those of children from mothers without acromegaly. METHODS Six women with acromegaly who became pregnant under follow-up between 2010 and 2014 and their 16 children (group A) were assessed and compared with 16 children of healthy women (group B) and 15 children of women with prolactinoma (group C). The physical examinations of children were performed by the department of pediatric endocrinology and intelligence quotient (IQ) testing was undertaken by adult and pediatric psychiatry departments, using appropriate scales for their ages. RESULTS Six of the 16 children (girls/boys: 7/9) were born after the diagnosis of acromegaly. Five of the 6 pregnancies occured when the patients were taking somatostatin analogs, none continued taking the drugs during pregnancy. The mean IQ of groups A, B, and C were 106.4 ± 12.5, 105.3 ± 12.5, and 103.2 ± 16.1 respectively (p > 0.05). The mean ages, birth percentiles, recent weight and height standard deviation scores were similar between groups (p > 0.05). Two siblings from group A and 1 child from group B were large for gestational age at birth. At recent follow-up, two children from group A were found tall for their age and one from group C was short for his age and was placed under the care of pediatric endocrinology clinic. CONCLUSIONS Pregnancies in acromegaly seems to be uneventful and the general health status and IQ scores of children from women with and without acromegaly were found similar.
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Affiliation(s)
- Ozlem Haliloglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burak Dogangun
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bahar Ozcabi
- Division of Endocrinology, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hanife Ugur Kural
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatma Ela Keskin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatma Colkesen Pamukcu
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Elif Bektas
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burc Cagri Poyraz
- Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hakan Buber
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Olcay Evliyaoglu
- Division of Endocrinology, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
- Pituitary Center, Istanbul University, Istanbul, Turkey.
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19
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Ozkaya HM, Comunoglu N, Keskin FE, Oz B, Haliloglu OA, Tanriover N, Gazioglu N, Kadioglu P. Locally produced estrogen through aromatization might enhance tissue expression of pituitary tumor transforming gene and fibroblast growth factor 2 in growth hormone-secreting adenomas. Endocrine 2016; 52:632-40. [PMID: 26578364 DOI: 10.1007/s12020-015-0802-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 09/27/2015] [Accepted: 11/05/2015] [Indexed: 01/05/2023]
Abstract
Aromatase, a key enzyme in local estrogen synthesis, is expressed in different pituitary tumors including growth hormone (GH)-secreting adenomas. We aimed to evaluate aromatase, estrogen receptor α (ERα), estrogen receptor β (ERβ), pituitary tumor transforming gene (PTTG), and fibroblast growth factor 2 (FGF2) expressions in GH-secreting adenomas, and investigate their correlation with clinical, pathologic, and radiologic parameters. This cross-sectional study was conducted in a tertiary center in Turkey. Protein expressions were determined via immunohistochemical staining in ex vivo tumor samples of 62 patients with acromegaly and ten normal pituitary tissues. Concordantly increased aromatase, PTTG, and FGF2 expressions were detected in the tumor samples as compared with controls (p < 0.001 for all). None of the tumors expressed ERα while ERβ was detected only in mixed somatotroph adenomas. Aromatase, ERβ, PTTG expressions were not significantly different between patients with and without remission (p > 0.05 for all). FGF2 expression was significantly higher in patients without postoperative and late remission (p = 0.002 and p = 0.012, respectively), with sphenoid bone invasion, optic chiasm compression, and somatostatin analog resistance (p = 0.005, p = 0.033, and p = 0.013, respectively). Aromatase, PTTG and FGF2 expressions were positively correlated with each other (r = 0,311, p = 0.008 for aromatase, FGF2; r = 0.380, p = 0.001 for aromatase, PTTG; r = 0.400, p = 0.001 for FGF2, PTTG). PTTG-mediated FGF2 upregulation is associated with more aggressive tumor features in patients with acromegaly. Also, locally produced estrogen through aromatization might have a role in this phenomenon.
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Affiliation(s)
- Hande Mefkure Ozkaya
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, Cerrahpasa, 34303, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Fatma Ela Keskin
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, Cerrahpasa, 34303, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Ozlem Asmaz Haliloglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, Cerrahpasa, 34303, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Nurperi Gazioglu
- Department of Neurosurgery, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, University of Istanbul, Cerrahpasa, 34303, Istanbul, Turkey.
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20
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Haliloglu O, Kuruoglu E, Ozkaya HM, Keskin FE, Gunaldi O, Oz B, Gazioglu N, Kadioglu P, Tanriover N. Multidisciplinary Approach for Acromegaly: A Single Tertiary Center's Experience. World Neurosurg 2016; 88:270-276. [PMID: 26806060 DOI: 10.1016/j.wneu.2015.12.092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/25/2015] [Accepted: 12/26/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acromegaly is a multisystemic disease that requires a multidisciplinary approach. The aim of this study was to determine early and late remissions of patients who underwent surgery at our center and to evaluate relations between pathologic and radiologic properties of adenoma and medical and radiosurgical treatments with remissions. METHODS The medical records of 103 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery in Cerrahpasa Medical Faculty, Istanbul University, between 2007 and 2014 were reviewed. Clinical, biochemical, radiologic, and pathologic properties were determined. RESULTS The total median follow-up time was 38 months [interquartile range: 24-53.5 months]. Thirty-two percent of the adenomas were microadenomas and 68% were macroadenomas The early remission rate was 51.5% and late remission was 75.2%. The sellar floor invasion was significantly lower in patients with early and late remissions (P = 0.01 and P = 0.009, respectively). The initial growth hormone (GH; P < 0.001), first-day GH (P = 0.03), 3-month GH (P = 0.001), insulin-like growth factor-1 (P = 0.004), and 6-month insulin-like growth factor-1 (P = 0.02) levels were significantly greater in patients with sellar floor invasion. The late remission rates (P = 0.004) were greter and reoperation needs (P = 0.05) were lower in patients with Ki-67 <3% than in patients with ≥3%. Seventy (68.6%) patients needed medical therapy during follow-up. CONCLUSIONS Late remission was achieved using a multidiciplinary approach in 75.2% of 103 patients with acromegaly, and young age, male sex, high Ki-67 and mitosis indices, and cavernous sinus and sellar-floor invasion had negative effects on clinical and biochemical control of the disease.
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Affiliation(s)
- Ozlem Haliloglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Enis Kuruoglu
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatma Ela Keskin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Omur Gunaldi
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nurperi Gazioglu
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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21
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Keskin FE, Yetkin DO, Ozkaya HM, Haliloglu O, Sadri S, Gazioglu N, Tanrıover N, Ak H, Hatipoglu E, Kadıoglu P. The problem of unrecognized acromegaly: surgeries patients undergo prior to diagnosis of acromegaly. J Endocrinol Invest 2015; 38:695-700. [PMID: 25716208 DOI: 10.1007/s40618-015-0245-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To reveal the variety of symptoms experienced by patients before acromegaly diagnosis and to emphasize unneeded surgeries that patients undergo related to acromegaly prior to diagnosis of the disease. METHODS In total, 490 consecutive adult patients with acromegaly who were treated at our institution between 1998 and 2014 were included in this cross-sectional study, of which 313 could be contacted. Participants were questioned about their complaints at initial consultation and at the time of diagnosis, the first medical professional who they consulted, interval between onset and diagnosis, and surgeries they had undergone. RESULTS This study included 313 participants, of whom 181 were women. The mean age was 48.8 ± 12.0 years. Patients most frequently presented with acral growth of hands and feet (32.6%) and headache (26.2%). Internists were the medical specialists who were most frequently first consulted (29.4%) then neurosurgeons (11.8%). Acromegaly was generally diagnosed by endocrinologists (55%), followed by neurosurgeons (23%). The median elapsed period prior to diagnosis was 24 months, interquartile range 6.0-48.0 months. Some 45.7% had undergone surgery; 35.2% were related to acromegaly symptoms: head and throat surgery (12.8%), nose surgery (9.3%), thyroidectomy (6.4%), carpal tunnel surgery (4.8%). The delay period for patients who had an operation prior to acromegaly diagnosis was significantly longer than for those who had no operations (p < 0.001). CONCLUSIONS Acromegaly patients mostly present to internal medicine professionals. Surgeries related to acromegaly complications and symptoms before diagnosis cause a long delay period before diagnosis. Medical staff must be more aware of the clinical aspects of acromegaly.
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Affiliation(s)
- F E Keskin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - D O Yetkin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Kolan Hospital, Istanbul, Turkey
| | - H M Ozkaya
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - O Haliloglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S Sadri
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - N Gazioglu
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - N Tanrıover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - H Ak
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - E Hatipoglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - P Kadıoglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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22
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Keskin FE, Ozyazar M, Pala AS, Elmali AD, Yilmaz B, Uygunoglu U, Bozluolcay M, Tuten A, Bingöl A, Hatipoglu E. Evaluation of cognitive functions in gestational diabetes mellitus. Exp Clin Endocrinol Diabetes 2015; 123:246-51. [PMID: 25868060 DOI: 10.1055/s-0034-1395634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the association between cognitive functions and metabolic status in cases with gestational diabetes mellitus (GDM). METHODS In this study 44 patients with GDM and 45 normal pregnant were included. Depression was evaluated with Beck's depression inventory (BDI). Cognitive functions were evaluated with Montreal cognitive assessment (MOCA), paced auditory serial addition test (PASAT), spatial recall test (SRT), symbol digit modalities (SDMT), and word list generation (WLG). RESULTS The mean gestational age, educational level and account of previous birth of the subjects in the study were not statistically different between the groups. The mean scores of BDI of the 2 groups were not statistically different. MOCA score and SDMT was significantly decreased in GDM in comparison to NP (p=0.005, p=0.04 respectively). Also, SDMT score was inversely correlated with number of pregnancies, postprandial blood glucose and HbA1c.The scores of PASAT, SRT, SPART and WLG were statistically similar between the groups. CONCLUSIONS Our findings may be a clue for early onset of impairment in cognitive functions in cases with new onset diabetes during pregnancy.
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Affiliation(s)
- F E Keskin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M Ozyazar
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A S Pala
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A D Elmali
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - B Yilmaz
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - U Uygunoglu
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M Bozluolcay
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A Tuten
- Department of Gynecology and Obstetrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A Bingöl
- Mayis Psychology Center, Istanbul, Turkey
| | - E Hatipoglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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