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Barlas T, Altinova AE, Akturk M, Toruner FB. Response to comment on "Credibility of Chat-GPT in the assessment of obesity in type 2 diabetes according to the guidelines". Int J Obes (Lond) 2024:10.1038/s41366-024-01534-2. [PMID: 38714832 DOI: 10.1038/s41366-024-01534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/10/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/10/2024]
Affiliation(s)
- Tugba Barlas
- Gazi University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.
| | - Alev Eroglu Altinova
- Gazi University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Mujde Akturk
- Gazi University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Fusun Balos Toruner
- Gazi University, Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Coskun M, Sendur HN, Babayeva A, Cerit MN, Cerit ET, Yalcin MM, Altinova AE, Akturk M, Karakoc MA, Toruner FB. Quantitative ultrasound techniques and biochemical markers to assess liver steatosis and fibrosis in newly diagnosed acromegaly. J Endocrinol Invest 2024:10.1007/s40618-024-02384-5. [PMID: 38709454 DOI: 10.1007/s40618-024-02384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The liver is known to be protected from steatosis under the influence of high GH/IGF-1. Cytokeratin 18 (CK18) and insulin-like growth factor binding protein 7 (IGFBP7) increase in liver steatosis and fibrosis. The aim of this study was to use quantitative ultrasound techniques and biochemical markers to assess liver steatosis and liver fibrosis in newly diagnosed acromegaly. METHODS This single-center, cross-sectional study included 23 patients with newly diagnosed acromegaly and 46 age, sex, body mass index (BMI) and waist circumference (WC)-matched controls. Liver steatosis was assessed using tissue attenuation imaging (TAI), and stiffness, indicative of fibrosis, was assessed by shear wave elastography (SWE). Serum IGFBP7 and CK18 were studied by ELISA. RESULTS The acromegaly group had significantly lower liver steatosis (p = 0.006) and higher liver stiffness (p = 0.004), serum IGFBP7 (p = 0.048) and CK18 (p = 0.005) levels than the control group. The presence of fibrosis (p = 0.012) was significantly higher in the acromegaly group than in the control group. Moreover, CK18 was positively correlated with liver stiffness, WC, HOMA-IR, HbA1c, and triglyceride. In the acromegaly group, liver steatosis was negatively correlated with GH level. Stepwise multiple linear regression analysis revealed that BMI (p = 0.008) and CK18 (p = 0.015) were independent risk factors for increased liver stiffness. CONCLUSION This study showed that there was an increased presence of liver fibrosis independent of liver steatosis in newly diagnosed acromegaly. Serum CK18 appears to be a potential marker of increased liver fibrosis in acromegaly.
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Affiliation(s)
- M Coskun
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - H N Sendur
- Department of Radiology, Faculty of Medicine, Gazi University, 06100, Ankara, Turkey
| | - A Babayeva
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M N Cerit
- Department of Radiology, Faculty of Medicine, Gazi University, 06100, Ankara, Turkey
| | - E T Cerit
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M M Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - A E Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M A Karakoc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - F B Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
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Barlas T, Yalcin MM, Osmanov Z, Gulbahar O, Altinova AE, Akturk M, Karakoc MA, Yetkin I, Toruner FB. Detecting the interferences in adrenocorticotropic hormone measurement - three cases reinforcing the efficiency of the complementary clinical and laboratory audit. Biochem Med (Zagreb) 2024; 34:010802. [PMID: 38125613 PMCID: PMC10731737 DOI: 10.11613/bm.2024.010802] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023] Open
Abstract
Accurate measurement of adrenocorticotropic hormone (ACTH) is crucial in the evaluation of pituitary and adrenal disorders. Although great progress has been achieved in ACTH measurement with immunometric assays, interference may occur and adversely affect the clinical management. The report contributes to compiling the evidence on the clinical challenges with the management of the interferences in the ACTH measurement by presenting three cases: two with clinically overt hypercortisolism and discrepant ACTH concentrations within the reference interval; the third case describes the falsely elevated ACTH in a patient with secondary adrenal insufficiency. In all patients, the results obtained with the two immunometric platforms, chemiluminescence (CLIA) immunoassay (Siemens, Immulite) and electrochemiluminescence (ECLIA) immunoassay (Roche, Cobas), were discordant. Serial dilution of plasma samples revealed nonlinearity. After polyethylene glycol (PEG) precipitation recoveries were less than 22%, 26%, and 3%, respectively, supporting interference. Moreover, a decrease in ACTH concentration after incubation in a heterophile antibody-blocking tube was observed in the second case. In the first case, misinterpretation of ACTH led to inferior petrosal sinus sampling (IPSS), whereas timely detection of assay interference prevented further investigations in other cases. Increasing awareness regarding ACTH interference and comprehensive approach in evaluation could allow timely detection, helping to prevent unnecessary testing and perplexing clinical outcomes.
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Affiliation(s)
- Tugba Barlas
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zakir Osmanov
- Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ozlem Gulbahar
- Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Ayhan Karakoc
- 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
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
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Barlas T, Altinova AE, Akturk M, Toruner FB. Credibility of ChatGPT in the assessment of obesity in type 2 diabetes according to the guidelines. Int J Obes (Lond) 2024; 48:271-275. [PMID: 37951982 DOI: 10.1038/s41366-023-01410-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 06/07/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The Chat Generative Pre-trained Transformer (ChatGPT) allows students, researchers, and patients in the medical field to access information easily and has gained attention nowadays. We aimed to evaluate the credibility of ChatGPT according to the guidelines for the assessment of obesity in type 2 diabetes (T2D), which is one of the major concerns of this century. MATERIALS AND METHOD In this cross-sectional non-human subject study, experienced endocrinologists posed 20 questions to ChatGPT in subsections, which were assessments and different treatment options for obesity according to the American Diabetes Association and American Association of Clinical Endocrinology guidelines. The responses of ChatGPT were classified into four categories: compatible, compatible but insufficient, partially incompatible and incompatible with the guidelines. RESULTS ChatGPT demonstrated a systematic approach to answering questions and recommended consulting a healthcare provider to receive personalized advice based on the specific health needs and circumstances of patients. The compatibility of ChatGPT with the guidelines was 100% in the assessment of obesity in type 2 diabetes; however, it was lower in the therapy sections, which included nutritional, medical, and surgical approaches to weight loss. Furthermore, ChatGPT required additional prompts for responses that were evaluated as "compatible but insufficient" to provide all the information in the guidelines. CONCLUSION The assessment and management of obesity in T2D are highly individualized. Despite ChatGPT's comprehensive and understandable responses, it should not be used as a substitute for healthcare professionals' patient-centered approach.
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Affiliation(s)
- Tugba Barlas
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
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Coskun M, Sendur HN, Cerit MN, Babayeva A, Cerit ET, Yalcin MM, Altinova AE, Akturk M, Karakoc MA, Toruner FB. Assessment of forearm muscles with ultrasound shear wave elastography in patients with acromegaly. Pituitary 2023; 26:716-724. [PMID: 37899388 DOI: 10.1007/s11102-023-01352-1] [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: 08/24/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE The effects of acromegaly on soft tissues, bones and joints are well-documented, but information on its effects on muscle mass and quality remains limited. The primary goal of this study is to assess the sonoelastographic features of forearm muscles in patients with acromegaly. METHOD Forty-five patients with acromegaly and 45 healthy controls similar in terms of gender, age, and body mass index (BMI) were included in a single-center, multidisciplinary, cross-sectional study. The body composition was analyzed using bioelectrical impedance analysis (BIA), and height-adjusted appendicular skeletal muscle index (hSMI) was calculated. The dominant hand's grip strength was also measured. Two radiologists specialized in the musculoskeletal system employed ultrasound shear wave elastography (SWE) to assess the thickness and stiffness of brachioradialis and biceps brachii muscles. RESULTS The acromegaly group had significantly higher thickness of both the biceps brachii (p = 0.034) and brachioradialis muscle (p = 0.046) than the control group. However, the stiffness of the biceps brachii (p = 0.001) and brachioradialis muscle (p = 0.001) was lower in the acromegaly group than in the control group. Disease activity has not caused a significant difference in muscle thickness and stiffness in the acromegaly group (p > 0.05). The acromegaly group had a higher hSMI (p = 0.004) than the control group. The hand grip strength was similar between the acromegaly and control group (p = 0.594). CONCLUSION The patients with acromegaly have an increased muscle thickness but decreased muscle stiffness in the forearm muscles responsible for elbow flexion. Acromegaly can lead to a permanent deterioration of the muscular structure regardless of the disease activity.
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Affiliation(s)
- Meric Coskun
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey.
| | - Halit Nahit Sendur
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, 06100, Turkey
| | - Mahi Nur Cerit
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, 06100, Turkey
| | - Afruz Babayeva
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Ethem Turgay Cerit
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Mehmet Ayhan Karakoc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
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Coskun M, Altinova AE, Babayeva A, Sel AT, Yapar D, Karaca M, Yalcin MM, Akturk M, Toruner FB, Karakoc MA, Yetkin I. Leukocyte Telomere Length and Neuregulin-4 Levels in Female Patients with Acromegaly: The Relationship between Disease Activity and Body Fat Distribution. J Clin Med 2023; 12:4108. [PMID: 37373801 DOI: 10.3390/jcm12124108] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The study aimed to examine leukocyte telomere length (LTL) and serum neuregulin-4 levels and their relationship with disease activity, co-morbidities and body fat distribution in female acromegaly patients. Forty female patients with acromegaly and thirty-nine age and body mass index (BMI) similar healthy female volunteers were included in the study. Patients were classified into two groups: active acromegaly (AA) and controlled acromegaly (CA). The quantitative polymerase chain reaction (PCR) method was used to study LTL, and T/S ratio < 1 was accepted as shortened telomere length. Neuregulin-4 was studied by ELISA. There was no difference in median LTL between acromegaly and the control group (p = 0.530). The percentage of T/S < 1 in patients with acromegaly (60.0%) was similar to that of the control group (43.6%) (p = 0.144). However, serum neuregulin-4 was significantly higher in patients with acromegaly than those in the control group (p = 0.037). There were no significant differences concerning LTL, percentage of T/S < 1 and neuregulin-4 levels between active and controlled acromegaly groups (p > 0.05). Neuregulin-4 correlated positively with fasting glucose, triglyceride (TG), triglyceride/glucose (TyG) index, and lean body mass in the acromegaly group. A negative correlation was observed between LTL and neuregulin-4 in the control group (p = 0.039). When the factors affecting neuregulin-4 were evaluated by multivariate linear regression analysis with an enter method, TG (β: 0.316, p = 0.025) was independently and positively associated with neuregulin-4. Our findings indicate that acromegaly is associated with unchanged LTL and high neuregulin-4 levels in female patients. However, the relationship between acromegaly, the aging process, and neuregulin-4 involves complex mechanisms, and further studies are needed.
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Affiliation(s)
- Meric Coskun
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Afruz Babayeva
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Aydin Tuncer Sel
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Dilek Yapar
- Department of Public Health, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Mine Karaca
- Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Mehmet Ayhan Karakoc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara 06100, Turkey
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Barlas T, Yalcin MM, Avci DE, Kaplan Y, Akturk M, Toruner FB, Karakoc A, Altinova AE. Sleep quality in patients with non-functioning pituitary adenoma: impact of replacement therapies with an emphasis on the time of hydrocortisone. Pituitary 2023:10.1007/s11102-023-01328-1. [PMID: 37261656 DOI: 10.1007/s11102-023-01328-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Sleep disturbances are widespread and associated with pituitary diseases, even those under long-term therapeutic management. The aim of this study was to investigate sleep quality in patients with non-functioning pituitary adenoma (NFPA) and determine the factors that might influence sleep quality, including the detailed features of replacement therapy. METHODS Eighty-two patients with NFPA and 82 age- and gender-matched control subjects were included. Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS) and International Physical Activity Questionnaire (IPAQ) were used. RESULTS In the NFPA group, 57.3% of patients had decreased sleep quality, compared to 35.4% in the control group (p=0.005). Although there was no relationship between the presence of hydrocortisone replacement and sleep quality (p>0.05), a strong positive correlation was observed between PSQI and morning hydrocortisone replacement time in patients with secondary adrenal insufficiency (r=0.834, p<0.001). Diabetes insipidus was found to be significantly higher in the group with decreased sleep quality (p=0.01). Moreover, there was a negative correlation between PSQI and IGF-1 in patients with NFPA (r=-0.259, p=0.01). A multivariate logistic regression model revealed that depression score and free T4 level in the upper half of the normal limit influence the sleep quality of patients with NFPA. CONCLUSION Our study indicated the presence of depression, and a free T4 level in the upper half of the normal range have an impact on the sleep quality of patients with NFPA. The time of hydrocortisone replacement might be important factor for improved sleep quality in patients with secondary adrenal insufficiency.
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Affiliation(s)
- Tugba Barlas
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Yigit Kaplan
- Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayhan Karakoc
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
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Barlas T, Yalcin MM, Ozger HS, Altinova AE, Akturk M, Toruner FB, Karakoc A, Yetkin I. Overlooked complication of Cushing's syndrome: Reactivation of hepatitis B. Clin Endocrinol (Oxf) 2023; 98:481-486. [PMID: 36443641 DOI: 10.1111/cen.14855] [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: 07/13/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Individuals infected with hepatitis B virus (HBV) are at increased risk of reactivation when they receive immunosuppressive therapies. Although exogenous corticosteroid use as immunosuppressive therapy is elaborated in current guidelines on HBV reactivation, Cushing's syndrome (CS) with endogenous hypercortisolemia is not addressed. We aimed to investigate the prevalence of HBV infection and discuss the necessity of antiviral prophylaxis in patients with CS as in other immunosuppressed patients. DESIGN AND PATIENTS We included 72 patients with CS (Adrenocorticotropic hormone (ACTH) dependent or independent) who were screened for HBV between 2016 and 2021. Patients were categorized into three groups: overt, mild autonomous cortisol secretion (MACS), and remission according to the cortisol burden. Changes in patients' HBV serology and clinical findings over time were analyzed retrospectively. RESULTS Twenty-six patients had overt hypercortisolism, 18 had mild autonomous cortisol secretion and 28 patients were in remission. Nineteen (26.3%) patients were anti-HBc IgG positive, 4 of them were chronic HBV and 15 were isolated anti-HBc IgG positive. HBsAg was positive in four (5.5%) of the patients, who were all compatible with inactive chronic HBV. While two patients developed HBV reactivation, HBV flare was observed in one patient. CONCLUSION Since it is not always possible to achieve rapid remission in CS and these patients have long-term hypercortisolemia, we suggest that consensus should be reached on HBV serological assessment, standardization of follow-up, and planning of HBV prophylaxis in required instances in patients with CS especially in regions with a high prevalence of HBV infection.
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Affiliation(s)
- Tugba Barlas
- Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey
| | | | | | | | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey
| | | | - Ayhan Karakoc
- Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey
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Barlas T, Yalcin MM, Coskun M, Demirel D, Altinova AE, Toruner FB, Karakoc MA, Yetkin I, Akturk M. Evaluation of Lipohypertrophy in Patients With Type 1 Diabetes Mellitus on Multiple Daily Insulin Injections or Continuous Subcutaneous Insulin Infusion. Endocr Pract 2023; 29:119-126. [PMID: 36423861 DOI: 10.1016/j.eprac.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine lipohypertrophy (LH) in patients with type 1 diabetes mellitus (T1DM) on multiple daily insulin injections (MDII) or continuous subcutaneous insulin infusion (CSII) and to reveal the factors associated with the development and severity of LH. METHODS Sixty-six patients with T1DM treated with MDII (n = 35, 53%) or CSII (n = 31, 47%) for at least 1 year were included. LH localizations were detected with palpation and ultrasonography (USG). RESULTS The LH detection rate with USG was significantly higher than that by palpation in the whole group (P < .001). The LH was detected with USG in 30 (85.7%) patients in the MDII group and 22 (71.0%) patients in the CSII group (P = .144). Advanced LH was detected in 13 (37.1%) of the patients treated with MDII and in 3 (9.7%) of the patients treated with CSII. LH was more severe in the MDII group than in the CSII group (P = .013). Diabetes duration and length of infusion set use were significantly longer and body mass index, hypoglycemia, and complication rates were higher in patients with LH than those in patients without LH (P < .05). A positive correlation was found between LH severity and HbA1C and insulin dose (P < .05, for both). MDII as insulin administration method, incorrect rotation, and a history of ketosis were found to be the most related factors with LH severity in a multiple linear regression analysis (P < .05). CONCLUSION USG might be an effective approach for detecting and evaluating the severity of LH. MDII might cause more severe LH than CSII in patients with T1DM. In this study, LH was found to be associated mostly with incorrect rotation technique and a history of ketosis.
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Affiliation(s)
- Tugba Barlas
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Meric Coskun
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Dilek Demirel
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Ayhan Karakoc
- 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
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
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Ozturk M, Konuk O, Tarlan B, Yalcın MM, Arıbas YK, Toruner FB, Unal M, Ayvaz G. Clinical characteristics and the treatment modalities of Graves' orbitopathy in a tertiary referral center in Turkey: changes over two decades. Int Ophthalmol 2023; 43:643-653. [PMID: 36030455 DOI: 10.1007/s10792-022-02468-2] [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: 04/09/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the changes in demographics, clinical findings, and treatment modalities in Graves' orbitopathy (GO) patients at a tertiary referral center in Turkey over the last two decades. METHODS The clinical data of 752 GO patients were evaluated retrospectively. Patients were divided into 2 groups according to the first ophthalmic examination date; Group 1(n:344) between January 1998 and December 2007 and Group 2(n:408) between January 2008 and December 2017. RESULTS The number of nonsmokers was significantly higher in Group 2 (44.0 vs. 26.5%, p < 0.001). The time from the diagnosis of thyroid dysfunction and referral to our center was 32.4 months in Group 1 and 34.8 months in Group 2, (p = 0.166). The most common treatment of hyperthyroidism was antithyroid medications. Radioiodine ablation treatment rate was significantly lower in Group 2 (14.8 vs. 9.1%, p < 0.001). The time between the diagnosis of thyroid disease and orbital involvement was 22.0 vs. 26.6 months in Groups 1 and 2, respectively (p = 0.009). The time elapsed between the diagnosis of orbital disease and referral to our clinic was 21.0 months vs. 22.4 months in Group 1 and 2, respectively (p = 0.068). Orbital disease was most commonly mild, and inactive. Mild and moderate to severe GO and the mean Clinical Activity Score significantly increased, and the rate of sight-threatening disease and orbital decompression surgery significantly decreased in Group 2 (p = 0.042; p < 0.001, respectively). CONCLUSIONS Mild and inactive orbital disease was the most common form of GO. The severity of GO is declining over the last two decades in Turkey.
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Affiliation(s)
- Mine Ozturk
- Department of Ophthalmology, Haseki Training and Research Hospital, University of Health Sciences, Millet Street, 34096, Istanbul, Turkey.
| | - Onur Konuk
- Department of Ophthalmology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bercin Tarlan
- Department of Ophthalmology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Muhittin Yalcın
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Yavuz Kemal Arıbas
- Department of Ophthalmology, Gaziantep Abdulkadir Yuksel State Hospital, Gaziantep, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Unal
- Ophthalmology, Private Practice, Ankara, Turkey
| | - Goksun Ayvaz
- Endocrinology and Metabolism, Private Practice, Ankara, Turkey
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Ozturk Gokce B, Gogus F, Bolayir B, Tecer D, Gokce O, Eroglu Altinova A, Balos Toruner F, Akturk M. The evaluation of the tendon and muscle changes of lower extremity in patients with acromegaly. Pituitary 2020; 23:338-346. [PMID: 32200458 DOI: 10.1007/s11102-020-01037-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 01/18/2023]
Abstract
PURPOSE Although it is well known that acromegaly causes enlargement in the extremities, studies investigating the effects of acromegaly on tendons, muscles and soft tissue are limited. The aims of our study were to investigate tendons, the presence of enthesitis, soft tissue, muscle groups in terms of thickness and pennation angle (PA) which is an indicator of microstructure and strength of the muscle, of the lower extremities. METHODS Thirty-nine patients with acromegaly and thirty-nine healthy control subjects similar for age, sex and body mass index were enrolled. Lower extremity tendons, skin, muscle groups were evaluated by ultrasound. RESULTS The thicknesses of heel skin, heel pad, plantar fascia and Achilles tendon were higher in acromegaly than the control group (p < 0.05). The incidence of Achilles enthesitis were increased in the acromegaly group (p < 0.05). The thicknesses of the gastrocnemius medial head, vastus medialis, lateralis muscles for both sides and the left rectus femoris muscle were found to be lower in the acromegaly patients than controls (p < 0.05). However, thicknesses of vastus intermedius, gastrocnemius lateral head and soleus were similar between the acromegaly and control groups (p > 0.05). PA values of the right and left vastus medialis and the right vastus lateralis were found to be decreased in the acromegaly group (p < 0.05). Myostatin levels were lower in acromegaly group (p < 0.05). CONCLUSIONS Acromegaly may cause to an increase in tendon and soft tissue thickness, enthesitis formation, decrease in the thickness of some muscles, and deterioration in microstructures in lower extremity.
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Affiliation(s)
- Birsen Ozturk Gokce
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Basak Bolayir
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey.
| | - Duygu Tecer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Onur Gokce
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
| | - Fusun Balos Toruner
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
| | - Mujde Akturk
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, 06560, Turkey
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12
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Kahraman S, Eroglu Altinova A, Elgun S, Yalcin MM, Aktas Yilmaz B, Ozkan C, Akturk M, Balos Toruner F. Serum activities of dipeptidyl peptidase-4 and adenosine deaminase in polycystic ovary syndrome: association with obesity. Gynecol Endocrinol 2019; 35:714-718. [PMID: 30896318 DOI: 10.1080/09513590.2019.1581165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Dipeptidyl peptidase-4 (DPP-4) plays a role in metabolic and inflammatory diseases. Increased adenosine deaminase (ADA) has been suggested to induce insulin resistance and inflammation. We measured serum DPP-4 and ADA activities. Serum ADA activity was significantly higher in PCOS group (p = .006), whereas there was no difference in serum DPP-4 activity between the groups (p > .05). When the study subjects were divided into four groups in terms of obesity; an increasing trend in serum ADA activity between the groups was observed and ADA activity was significantly higher in overweight and obese patients with PCOS than nonobese controls (p = .016), there were no significant differences between the other groups (p > .05). A positive correlation was found between ADA and BMI in the whole group (p = .022). Multivariate regression analyses revealed that significant determinants were diastolic blood pressure, ADA, and the presence of PCOS for DPP-4 (R2 = 0.344, F = 9.079, p < .001); the presence of PCOS and DPP-4 for ADA (R2 = 0.123, F = 6.302, p = .003). We demonstrated increased serum ADA activity as well as its association with obesity in PCOS, while there was no change in serum DPP-4 activity in women with PCOS.
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Affiliation(s)
- Seda Kahraman
- a Department of Internal Medicine , Faculty of Medicine, Gazi University , Ankara , Turkey
| | - Alev Eroglu Altinova
- b Department of Endocrinology and Metabolism , Faculty of Medicine, Gazi University , Ankara , Turkey
| | - Serenay Elgun
- c Department of Medical Biochemistry , Faculty of Medicine, Ankara University , Ankara , Turkey
| | - Mehmet Muhittin Yalcin
- b Department of Endocrinology and Metabolism , Faculty of Medicine, Gazi University , Ankara , Turkey
| | - Banu Aktas Yilmaz
- b Department of Endocrinology and Metabolism , Faculty of Medicine, Gazi University , Ankara , Turkey
| | - Cigdem Ozkan
- b Department of Endocrinology and Metabolism , Faculty of Medicine, Gazi University , Ankara , Turkey
| | - Mujde Akturk
- b Department of Endocrinology and Metabolism , Faculty of Medicine, Gazi University , Ankara , Turkey
| | - Fusun Balos Toruner
- b Department of Endocrinology and Metabolism , Faculty of Medicine, Gazi University , Ankara , Turkey
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13
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Kahraman S, Altinova AE, Yalcin MM, Gulbahar O, Arslan B, Akturk M, Cakir N, Toruner FB. Association of serum betatrophin with fibroblast growth factor-21 in women with polycystic ovary syndrome. J Endocrinol Invest 2018; 41:1069-1074. [PMID: 29363048 DOI: 10.1007/s40618-018-0831-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/04/2017] [Accepted: 01/10/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Betatrophin and fibroblast growth factor-21 (FGF-21), which are recently discovered members of hepatokine/adipokine family, have been proposed to be associated with some metabolic disorders in which insulin resistance plays a major role. METHODS We aimed to investigate serum betatrophin and FGF-21 concentrations in women with polycystic ovary syndrome (PCOS). In this cross-sectional study, we recruited 31 women with PCOS and 34 women as healthy controls. Serum betatrophin level and its relationship with serum FGF-21 level as well as metabolic parameters were examined. RESULTS Serum betatrophin level was significantly higher in women with PCOS than the control group [1.10 (0.20-4.20) vs 0.70 (0.20-3.50) ng/ml, p = 0.004], whereas FGF-21 did not differ between the groups [74.80 (7.80-435.90) vs 119.30 (10.50-443.40) pg/ml, p = 0.13]. Serum betatrophin correlated positively with LH levels (r = 0.26, p = 0.03). After controlling BMI, there was a significant positive correlation between betatrophin and FGF-21 (r = 0.25, p = 0.04). Multivariate regression analysis revealed that FGF-21 and presence of PCOS were the significant predictors of betatrophin concentrations (R2 = 0.22, F = 2.56, p = 0.03). CONCLUSIONS Our results indicate that betatrophin levels are increased and associated with LH and FGF-21 levels, but not with insulin resistance, in women with PCOS.
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Affiliation(s)
- S Kahraman
- Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - A E Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey.
| | - M M Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
| | - O Gulbahar
- Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - B Arslan
- Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - M Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
| | - N Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
| | - F B Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
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14
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Yalcin MM, Akturk M, Tohma Y, Cerit ET, Altinova AE, Arslan E, Yetkin I, Toruner FB. Irisin and Myostatin Levels in Patients with Graves' Disease. Arch Med Res 2017; 47:471-475. [PMID: 27986127 DOI: 10.1016/j.arcmed.2016.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/15/2016] [Accepted: 10/28/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Skeletal muscle system, which is one of the primary targets for thyroid hormones, has an important role in energy metabolism. Some myokines such as irisin and myostatin have considerable effects on energy metabolism in addition to the musculoskeletal system. Our aim was to investigate circulating irisin and myostatin levels in patients with Graves' Disease (GD). METHODS This study included 41 patients with GD who were in overt hyperthyroid status and 44 healthy subjects. RESULTS Serum irisin levels were higher in patients with hyperthyroidism than in control group (p = 0.003). However, there was no statistical difference in myostatin levels between groups (p = 0.21). Irisin levels were positively correlated with free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin receptor antibody (TRAb) (p = 0.03, p = 0.02, p = 0.02, respectively) and negatively correlated with thyroid-stimulating hormone (TSH) (p = 0.006) in both groups. In multiple regression analysis, the presence of GD was the only significant factor associated with serum irisin levels (β = 0.29, p = 0.01). Myostatin levels were positively correlated with age, body mass index (BMI), FT4, HOMA-IR (p = 0.001, p = 0.04, p = 0.003, p = 0.03, respectively) and negatively correlated with TSH (p = 0.01). Multiple regression analysis also revealed that age and FT4 were the significant factors associated with circulating myostatin levels (β = 0.27, p = 0.02; β = 0.22, p = 0.04, respectively). CONCLUSION Our results suggest that increased irisin levels might contribute to altered energy metabolism in hyperthyroidism. Further studies to determine whether myostatin is affected due to hyperthyroidism are needed.
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Affiliation(s)
- Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yusuf Tohma
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ethem Turgay Cerit
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Arslan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
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15
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Yalcin MM, Altinova AE, Cavnar B, Bolayir B, Akturk M, Arslan E, Ozkan C, Cakir N, Balos Toruner F. Is thyroid autoimmunity itself associated with psychological well-being in euthyroid Hashimoto's thyroiditis? Endocr J 2017; 64:425-429. [PMID: 28260699 DOI: 10.1507/endocrj.ej16-0418] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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] [Indexed: 11/23/2022] Open
Abstract
Recent studies imply that euthyroid Hashimoto's thyroiditis (HT) might be related with impaired HRQoL, depression and anxiety. Ninety three patients with euthyroid HT and 31 age- and gender-matched euthyroid control subjects were enrolled into this study. SF-36 questionnaire, Beck Depression Inventory and Beck Anxiety Inventory tests were used for evaluating HRQoL, depression and anxiety. Beck Depression Inventory scores were higher in patients with HT compared to control subjects (7.5 (4.0-14.75) vs. 5.0 (2.25-9.0), p=0.008). Beck Anxiety Questionnaire scores were also higher in patients with HT than controls (9.50 (5.0-17.0) vs. 5.0 (2.0-11.75), p=0.021). In SF-36 questionnaire; physical functioning (26.0 (20.0-28.0) vs. 29.0 (26.0-30.0), p=0.038), general health (16.4 (13.4-20.4) vs. 19.4 (16.3-21.2), p=0.026) and mental health (20.5 (16.0-23.0) vs. 23.0 (21.0-25.0), p=0.001) scores were lower in patients with HT than control subjects. There were no significant differences between patients with HT under levothyroxine replacement therapy compared to those without therapy in terms of depression and anxiety scores and components of SF-36 questionnaire. Beck Depression Inventory scores were positively correlated with TSH (r=0.250, p=0.01). In SF-36, role physical (r=0.192, p<0.05) and vitality (r=0.181, p<0.05) were positively correlated with fT4. Role emotional was negatively correlated with TSH (r=-0.185, p<0.05) and anti-TPO (r=-0.234, p<0.05). Mental health was negatively correlated with anti-TPO (r=-0.287, p<0.01). HRQoL is impaired and depression and anxiety scores are high in patients with euthyroid HT independent of levothyroxine replacement. Therefore, our results indicate that thyroid autoimmunity itself may have an impact on psychological well-being in euthyroid patients with HT.
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Affiliation(s)
- Mehmet Muhittin Yalcin
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Alev Eroglu Altinova
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Burcak Cavnar
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Basak Bolayir
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Mujde Akturk
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Emre Arslan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Cigdem Ozkan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Nuri Cakir
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Fusun Balos Toruner
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Çimen AR, Cerit ET, Iyidir OT, Karakus R, Uyar BB, Toruner FB, Cakir N, Arslan M. SERUM OMENTIN-1 LEVELS AND ENDOTHELIAL DYSFUNCTION IN OBESITY. Acta Endocrinol (Buchar) 2017; 13:138-143. [PMID: 31149164 DOI: 10.4183/aeb.2017.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction Our aim was to investigate the relationship between serum omentin-1 levels and endothelial dysfunction in obese patients. Material and Methods We evaluated 50 obese patients, and age/gender matched 45 healthy non-obese subjects as controls. Oral glucose tolerance test, lipid parameters, uric acid levels, homeostatic model assessment-insulin resistance (HOMA-IR) index, serum omentin-1 levels and flow mediated dilatation (FMD) % were measured in all subjects. Body compositions were analyzed with bioelectrical impedance method using a Tanita Body Composition Analyzer and ViScan. Results Serum omentin-1 levels were found significantly lower in obese population compared to the control subjects. FMD response was significantly decreased in obese population. There was a significant positive correlation between serum omentin-1 levels and FMD response (r=0.359, p<0.001). Serum omentin-1 levels were negatively correlated with body mass index (BMI), waist circumference, total fat percentage, visceral fat, fasting insulin and HOMA-IR index. Conclusion Lower serum omentin-1 levels and decreased FMD response may be an early marker of endothelial dysfunction in obese patients.
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Affiliation(s)
- A R Çimen
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - E T Cerit
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - O T Iyidir
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - R Karakus
- Gazi University Faculty of Medicine, Department of Immunology, Ankara, Turkey
| | - B B Uyar
- Gazi University Faculty of Medicine, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - F B Toruner
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - N Cakir
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - M Arslan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Altinova AE, Ozkan C, Akturk M, Gulbahar O, Yalcin M, Cakir N, Toruner FB. Vitamin D-binding protein and free vitamin D concentrations in acromegaly. Endocrine 2016; 52:374-9. [PMID: 26547217 DOI: 10.1007/s12020-015-0789-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022]
Abstract
Free 25-hydroxyvitamin D [25(OH)D] is suggested to be important in the determination of vitamin D deficiency, since vitamin D-binding protein (VDBP) may affect total 25(OH)D levels. There are no data about free 25(OH)D concentrations in acromegaly. We aimed to investigate serum VDBP and total and free 25(OH)D levels in patients with acromegaly in comparison with control subjects. We recruited 54 patients with acromegaly and 32 control subjects who were similar according to age, gender, and body mass index. Serum VDBP levels were found to be increased in patients with acromegaly compared to control subjects [90.35 (72.45-111.10) vs. 69.52 (63.89-80.13) mg/l, p = 0.001]. There was statistically no significant difference in serum total 25(OH)D levels between the patients with acromegaly and control subjects [18.63 (13.35-27.73) vs. 22.51 (19.20-28.96) ng/ml, p = 0.05]. Free 25(OH)D levels were significantly decreased in patients with acromegaly compared to control subjects [14.55 (10.45-21.45) vs. 17.75 (15.30-23.75) pg/ml, p = 0.03]. Free 25(OH)D levels correlated positively with total 25(OH)D (p = 0.0001) and HDL cholesterol (p = 0.04) and negatively with fasting blood glucose (p = 0.04). Our findings indicate that VDBP is increased and free 25(OH)D is decreased in acromegaly, while there is no significant alteration in total 25(OH)D.
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Affiliation(s)
- Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Cigdem Ozkan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey.
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Ozlem Gulbahar
- Department of Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Muhittin Yalcin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Nuri Cakir
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
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18
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Bavbek NC, Tuncer BB, Tuncer C, Gungor K, Ozkan C, Arslan E, Altinova AE, Akturk M, Toruner FB. Cephalometric assessment of soft tissue morphology of patients with acromegaly. Aust Orthod J 2016; 32:48-54. [PMID: 27468591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To assess the sagittal soft tissue morphology of patients with acromegaly in comparison with a healthy control group. METHODS Twenty-seven patients with acromegaly (11 male, 16 female; mean age 47.3 ± 11.5 years) and 30 healthy subjects (15 male, 15 female; mean age 42.2 ± 17.4 years) were included in the study. Linear and angular measurements were made on lateral cephalograms to evaluate soft tissue and skeletal characteristics. The intergroup comparisons were analysed with the Student's t-test. RESULTS Facial convexity (p < 0.01) and the nasolabial angle (p < 0.001) were reduced in patients with acromegaly, whereas nose prominence (p < 0.01), upper lip sulcus depth (p < 0.01), upper lip thickness (p < 0.01), basic upper lip thickness (p < 0.01), lower lip protrusion (p < 0.05), mentolabial sulcus depth (p < 0.05) and soft tissue chin thickness (p < 0.001) were increased. Anterior cranial base length (p < 0.05), the supraorbital ridge (p < 0.01), the length of the maxilla and mandible (p < 0.001, p < 0.01, respectively) were significantly increased, and mandibular prognathism was an acromegalic feature (p < 0.05). CONCLUSION Acromegalic coarsening and thickening of the craniofacial soft tissues was identified from lateral cephalograms, which may therefore contribute to early diagnosis when evaluated together with other changes caused by the disease.
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Konca Degertekin C, Aktas Yilmaz B, Balos Toruner F, Kalkanci A, Turhan Iyidir O, Fidan I, Yesilyurt E, Cakır N, Kustimur S, Arslan M. Circulating Th17 cytokine levels are altered in Hashimoto's thyroiditis. Cytokine 2016; 80:13-7. [PMID: 26928603 DOI: 10.1016/j.cyto.2016.02.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 11/16/2015] [Revised: 02/01/2016] [Accepted: 02/23/2016] [Indexed: 12/17/2022]
Abstract
The disrupted autoimmune response in Hashimoto's thyroiditis (HT) has long been considered to be dominantly T helper type 1 (Th1) mediated. Recent advances in the field of immunology have introduced a new class of effector T cells, named 'Th17', which plays important roles in autoimmune disorders once thought to be merely Th1 mediated. We aimed to examine the levels of major Th17 cytokines in patients with HT in this study. We studied serum interleukin 17 (IL-17) and interleukin 23 (IL-23) levels in 46 newly diagnosed, untreated patients with HT (40 women and 6 men, aged 40.0 ± 11.8 years) divided into euthyroid (n=22) and hypothyroid (n=24) groups and compared them with age and sex matched 26 healthy euthyroid controls without HT (21 women and 5 men; aged 36.0 ± 12.9 years). Serum IL-17 and IL-23 levels were significantly different among euthyroid and hypothyroid HT patients and controls, with highest levels obtained in the euthyroid HT group (p=0.041 for IL-17 and p<0.001 for IL-23). TSH was negatively and FT4 was positively correlated with IL-17 (p=0.016 for TSH and p=0.004 for FT4) and IL-23 (p<0.001 for TSH and p=0.003 for FT4) levels. There were no correlations between thyroid volumes calculated on thyroid ultrasonography and IL-17 (p=0.630) or IL-23 (p=0.321) levels. In conclusion, the levels of IL-17, one of the major effector cytokines of the Th17 system, and IL-23, which had been implicated in the generation, survival and expansion of Th17 cells, are altered in HT. How thyroid hormone status and the course of disease affect Th17 system in chronic autoimmune thyroiditis needs to be determined with further studies.
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Affiliation(s)
- Ceyla Konca Degertekin
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey.
| | - Banu Aktas Yilmaz
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Fusun Balos Toruner
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Ayse Kalkanci
- Gazi University Faculty of Medicine, Department of Microbiology, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Ozlem Turhan Iyidir
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Isıl Fidan
- Gazi University Faculty of Medicine, Department of Microbiology, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Emine Yesilyurt
- Gazi University Faculty of Medicine, Department of Microbiology, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Nuri Cakır
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Semra Kustimur
- Gazi University Faculty of Medicine, Department of Microbiology, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
| | - Metin Arslan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi Universitesi Hastanesi Endokrinoloji BD, Besevler 06100, Ankara, Turkey
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Yalcin MM, Altinova AE, Akturk M, Gulbahar O, Arslan E, Ors Sendogan D, Yetkin I, Toruner FB. GDF-15 and Hepcidin Levels in Nonanemic Patients with Impaired Glucose Tolerance. J Diabetes Res 2016; 2016:1240843. [PMID: 27642607 PMCID: PMC5014962 DOI: 10.1155/2016/1240843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/20/2016] [Accepted: 08/02/2016] [Indexed: 12/28/2022] Open
Abstract
Aims. Growth Differentiation Factor-15 (GDF-15) has been suggested as one of the regulators of hepcidin, an important regulatory peptide for iron deposition. Current data is conflicting about the relationship between hepcidin and disorders of glucose metabolism. We aimed to investigate serum hepcidin and GDF-15 concentrations and their associations with each other, in nonanemic subjects with impaired glucose tolerance (IGT) in comparison with the nonanemic subjects with normal glucose tolerance (NGT). Methods. Thirty-seven subjects with IGT and 32 control subjects with NGT, who were age-, gender-, and body mass index- (BMI-) matched, were included in the study. Results. Serum GDF-15 levels were significantly higher in IGT compared to NGT. There were no differences in hepcidin, interleukin-6, and high sensitive C-reactive protein levels between the groups. We found a positive correlation between GDF-15 and hepcidin levels. There were also positive correlations between GDF-15 and age, uric acid, creatinine, and area under the curve for glucose (AUC-G). Hepcidin was correlated positively with ferritin levels. In the multiple regression analysis, GDF-15 concentrations were independently associated with age, uric acid, and AUC-G. Conclusions. Impaired glucose tolerance is associated with increased GDF-15 levels even in the absence of anemia, but the levels of hepcidin are not significantly altered in prediabetic state.
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Affiliation(s)
- Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
- *Mehmet Muhittin Yalcin:
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
| | - Ozlem Gulbahar
- Department of Biochemistry, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
| | - Emre Arslan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
| | - Damla Ors Sendogan
- Department of Internal Medicine, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, 06560 Ankara, Turkey
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Ozkan C, Altinova AE, Cerit ET, Yayla C, Sahinarslan A, Sahin D, Dincel AS, Toruner FB, Akturk M, Arslan M. Markers of early atherosclerosis, oxidative stress and inflammation in patients with acromegaly. Pituitary 2015; 18:621-9. [PMID: 25500981 DOI: 10.1007/s11102-014-0621-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Data regarding atherosclerosis in acromegaly is controversial in literature. We aimed to investigate the markers of early atherosclerosis, oxidative stress, inflammation and their relationships with each other in acromegaly. METHODS Thirty-nine patients with acromegaly and 40 control subjects were enrolled. Patients were classified into two groups; active acromegaly (AA) and controlled acromegaly (CA). Controls were matched by age, gender, body mass index and presence of cardiovascular risk factors. Flow mediated dilatation (FMD), carotid intima media thickness (CIMT), epicardial adipose tissue thickness (EAT) were measured and serum levels of oxidative stress parameters, high mobility group box 1 protein (HMGB1) and high sensitive CRP (hs CRP) were evaluated. RESULTS Significantly decreased FMD, increased CIMT and EAT were found in patients with acromegaly compared to controls (p < 0.01, p < 0.05, p < 0.001, respectively). EAT correlated negatively with FMD (r = -0.24, p = 0.038) and positively with CIMT (r = 0.37, p < 0.01). Presence of acromegaly, hypertension and age were found to be the predictors of early atherosclerosis (p < 0.05). Hs CRP was decreased in AA compared to controls (p = 0.01). There were no significant differences for HMGB1 and oxidized LDL (ox-LDL) cholesterol levels and total antioxidant capacity (TAC) between AA, CA and controls (p > 0.05). CONCLUSION Early atherosclerosis measured with FMD, CIMT and EAT may exist in acromegaly. However, decreased hs CRP and unchanged HMGB1, ox-LDL and TAC levels suggest that inflammation and oxidative stress do not seem to contribute to the development of atherosclerosis in these patients.
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Affiliation(s)
- Cigdem Ozkan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey,
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Balos Tuncer B, Canigur Bavbek N, Ozkan C, Tuncer C, Eroglu Altinova A, Gungor K, Akturk M, Balos Toruner F. Craniofacial and pharyngeal airway morphology in patients with acromegaly. Acta Odontol Scand 2015; 73:433-40. [PMID: 25543455 DOI: 10.3109/00016357.2014.979868] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess differences in craniofacial characteristics, upper spine and pharyngeal airway morphology in patients with acromegaly compared with healthy individuals. MATERIALS AND METHODS Twenty-one patients with acromegaly were compared with 22 controls by linear and angular measurements on cephalograms. The differences between the mean values of cephalometric parameters were analyzed with Mann-Whitney U-test. RESULTS With respect to controls, anterior (p<0.05), middle (p<0.01) and posterior (p<0.05) cranial base lengths were increased, sella turcica was enlarged (p<0.001) and upper spine morphology demonstrated differences in the height of atlas (p<0.01) and axis (p<0.05) in patients with acromegaly. Craniofacial changes were predominantly found in the frontal bone (p<0.01) and the mandible (p<0.05). As for the airway, patients with acromegaly exhibited diminished dimensions at nasal (p<0.001), uvular (p<0.01), mandibular (p<0.01) pharyngeal levels and at the narrowest point of the pharyngeal airway space (p<0.001) compared to healthy controls. Soft palate width was significantly higher (p<0.001) and the hyoid bone was more vertically positioned (p<0.01) in patients with acromegaly. CONCLUSIONS Current results point to the importance of the reduced airway dimensions and that dentists and/or orthodontists should be aware of the cranial or dental abnormalities in patients with acromegaly.
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Ozkan C, Akturk M, Altinova AE, Cerit ET, Gulbahar O, Yalcin MM, Cakir N, Balos Toruner F. Proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble lectin-like oxidized LDL receptor 1 (sLOX-1) and ankle brachial index in patients with differentiated thyroid cancer. Endocr J 2015; 62:1091-9. [PMID: 26490048 DOI: 10.1507/endocrj.ej15-0308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 11/23/2022] Open
Abstract
The cardiovascular effects of short-term overt hypothyroidism are not well known. We investigated proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble lectin-like oxidized LDL receptor 1 (sLOX-1) and the ankle brachial index (ABI) in thyroid cancer patients with short-term overt hypothyroidism due to thyroid hormone withdrawal (THW). Twenty-one patients requiring radioactive iodine (RAI) ablation or scanning and 36 healthy control subjects were enrolled. Patients were evaluated in the subclinical thyrotoxic phase when they were on suppressive levothyroxine therapy and in the overt hypothyroid phase due to THW for four weeks. PCSK9, sLOX-1, lipids and ABI were measured in the patient and control groups. Total cholesterol, LDL cholesterol, triglycerides and Apo B levels were increased in short overt hypothyroidism compared with the control group (p<0.001). PCSK9 levels increased before THW and after THW in the patients compared to control group (p<0.001, p=0.004, respectively). sLOX-1 levels were not different between patients with short term overt hypothyroidism and control group (p=0.27). ABI was found to be significantly decreased in patients with thyroid cancer before and after THW compared to control group (p=0.04, p=0.002 respectively). PCSK9 levels were correlated negatively with ABI (r=-0.38, p=0.004). In conclusion; our study demonstrated that patients with differentiated thyroid cancer both before and after THW which is a short term overt hypothyroid phase, had increased PCSK9 levels and decreased ABI. Short term overt hypothyroidism also leads to increased HDL, LDL, total cholesterol, Apo A and Apo B levels.
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Affiliation(s)
- Cigdem Ozkan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Abstract
The mean platelet volume (MPV) is an indicator of the average size and activity of platelets. Elevated MPV values are associated with larger and more active platelets and perceived as a new independent cardiovascular risk factor. The aim of this study was to determine the MPV in women with gestational diabetes mellitus (GDM) and to determine the correlation of MPV with metabolic parameters in GDM. We retrospectively analyzed 30 women with GDM and 38 body mass index-matched women with healthy pregnancies as controls. MPV and platelet counts were recorded in the third trimester and at postpartum 6-12 months for GDM group and in the third trimester for control group. Third-trimester MPV was significantly higher in GDM group compared to control group (8.8 ± 1.0 versus 8.1 ± 0.7 fl, p = 0.002). In women with GDM, there was a significant decrease in MPV in the postpartum period (8.8 ± 1.0 versus 8.1 ± 0.8 fl, p < 0.001). Fasting plasma glucose levels and glucose area under the curve were positively correlated with third trimester MPV (r = 0.346, p = 0.007 and r = 0.346, p = 0.02, respectively). Our results indicate that MPV is increased in GDM. Monitoring MPV, which is widely available in clinical practice, may potentially identify women who will develop gestational diabetes during pregnancy.
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Affiliation(s)
- Ozlem Turhan Iyidir
- Faculty of Medicine, Department of Endocrinology and Metabolism, Gazi University , Beşevler, Ankara , Turkey
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Ozkan C, Altinova AE, Cerit ET, Yalcin MM, Toruner FB, Akturk M, Cakir N. Destructive thyroiditis followed by hypothyroidism associated with infliximab therapy. Endocr Pract 2014; 20:e207-10. [PMID: 25100375 DOI: 10.4158/ep14097.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To present the rare case of a patient who developed destructive thyroiditis accompanied by transient thyrotoxicosis resulting from infliximab therapy for the treatment of psoriasis. METHODS The clinical presentation and management of a case with infliximab-associated thyroiditis is described with a brief review of the literature. RESULTS A 57-year-old male who suffered from psoriasis was treated with infliximab therapy for 4 years. Thyroid function tests were normal before infliximab therapy. When the patient presented in our clinic, he had thyrotoxicosis and was using propylthiouracil. A 99m Technetiumpertechnetate thyroid scintigraphy scan showed no visualization of either thyroid lobe or decreased thyroid iodine uptake. Thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody (anti-TPO Ab) and thyroglobulin antibody (anti-Tg Ab) were negative. Thyroid ultrasonography revealed a heterogeneous thyroid gland without nodules. After stopping propylthiouracil therapy, we advised monitoring of his thyroid function tests in the following weeks, and infliximab therapy for psoriasis was continued. Four weeks later, his thyroid function tests showed an elevated TSH level with normal levels of free triiodothyronine and thyroxine (FT3 and FT4, respectively), and levothyroxine treatment was administered to the patient. Thyroid function tests normalized after levothyroxine treatment. One year later, infliximab therapy was stopped because of clinical remission. Simultaneously, levothyroxine treatment was also stopped. His thyroid function tests were normal 6 weeks after the cessation of levothyroxine treatment. CONCLUSION To our knowledge, the present report is the third infliximab-associated thyroid disorder case. Periodic follow-up of thyroid function tests is necessary during infliximab therapy.
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Affiliation(s)
- Cigdem Ozkan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ethem Turgay Cerit
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nuri Cakir
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
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Akaslan SB, Degertekin CK, Yilmaz G, Cakir N, Arslan M, Toruner FB. Effects of sitagliptin on nonalcoholic fatty liver disease in diet-induced obese rats. Metab Syndr Relat Disord 2013; 11:243-50. [PMID: 23544853 DOI: 10.1089/met.2012.0128] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Studies investigating the effects of dipeptidyl peptidase-4 inhibitors on hepatic steatosis are lacking. We aimed to determine the effects of sitagliptin on nonalcoholic fatty liver disease (NAFLD) in rats with diet-induced obesity. METHODS A total of 24 adult female Sprague-Dawley rats, which were 24 weeks old and weighed 199-240 grams, were used. The rats were randomly separated into two groups. The control group (n=6) was fed with standard rat diet; the remaining rats (n=18) were fed with a high-fat diet (HFD) to induce NAFLD. After 12 weeks, rats that were fed with a HFD were randomly separated into two groups: (1) HFD-only group (n=8) was fed with a HFD for an additional 4 weeks, (2) HFD-sitagliptin group (n=10) received sitagliptin (3 mg/kg) for 4 weeks in addition to HFD. At the end of the study (16(th) week), blood samples were drawn from all rats to determine serum glucose, triglyceride, cholesterol, alanine aminotransferase (ALT), and plasma insulin levels. Insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR) index. Histopathologic evaluation of liver samples was undertaken. RESULTS The HFD-sitagliptin group had significantly lower serum glucose (140.8±18.8 vs. 224.7±20.6 mg/dL, P<0.001), plasma insulin (15.8±4.4 vs. 28.0±5.9 μIU/L, P<0.001), HOMA-IR index (4.9±1.8 vs. 15.9±2.3, P<0.001), serum triglycerides (199.0±108.7 vs. 468.0±370.7 mg/dL, P<0.001), and cholesterol (82.0±26.7 vs. 90.5±7.0, P<0.001) values compared to the HFD-only group. Hepatic steatosis was significantly less (mean score, 1 vs. 2; P<0.001) in the HFD-sitagliptin group compared to the HFD-only group, whereas there was no difference in hepatic inflammation (P=0.057), liver weight (P=0.068), and ALT levels (P=0.232). CONCLUSION Sitagliptin may improve hepatic steatosis by increasing insulin sensitivity and improving lipid profiles in rats.
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Rizzo M, Berneis K, Altinova AE, Toruner FB, Akturk M, Ayvaz G, Rini GB, Spinas GA, Arslan M. Atherogenic lipoprotein phenotype and LDL size and subclasses in women with gestational diabetes. Diabet Med 2008; 25:1406-11. [PMID: 19046238 DOI: 10.1111/j.1464-5491.2008.02613.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [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] [Indexed: 01/08/2023]
Abstract
AIMS Women with gestational diabetes are more likely to develop Type 2 diabetes and cardiovascular disease after pregnancy; however, the exact nature of the lipid alterations present is not clear. In Mediterranean women with gestational diabetes, we measured low-density lipoprotein (LDL) size and all seven subclasses, as well as the 'atherogenic-lipoprotein phenotype'[ALP, e.g. concomitant presence of elevated triglycerides, reduced high-density lipoprotein (HDL)-cholesterol and increased small, dense LDL]. METHODS In 27 women with gestational diabetes and 23 healthy pregnant women matched for age, weeks of gestation and body mass index, we measured plasma lipids and LDL size and subclasses by gradient gel electrophoresis between 24 and 28 weeks of gestation. RESULTS Although no significant differences were found in the concentrations of any of the plasma lipids, compared with control subjects women with gestational diabetes had lower LDL size (P = 0.0007) due to reduced LDL-I (P = 0.0074) and increased LDL-IVA (P = 0.0146) and -IVB (P < 0.0001) subclasses. Correlation analysis revealed that fasting glucose, homeostasis model assessment and glycated haemoglobin were inversely correlated with LDL-I and positively with LDL-IVA and -IVB (all P < 0.05). ALP due to high HDL-cholesterol levels was not seen in either group, whereas elevated small, dense LDL were more common in women with gestational diabetes than control subjects (33% vs. 4%, P = 0.0107). CONCLUSIONS Increased levels of small, dense LDL are common in Mediterranean women with gestational diabetes. Whether these findings affect the atherogenic process and clinical end-points in these women remains to be determined by future prospective studies.
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Affiliation(s)
- M Rizzo
- Department of Clinical Medicine and Emerging Diseases, University of Palermo, Palermo, Italy.
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Yavuzer G, Yetkin I, Toruner FB, Koca N, Bolukbasi N. Gait deviations of patients with diabetes mellitus: looking beyond peripheral neuropathy. Eura Medicophys 2006; 42:127-33. [PMID: 16767059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
AIM The aim of this paper was to define the gait deviations in patients with diabetes mellitus (DM), to investigate the associations between electrophysiological findings and gait characteristics, and to interpret the findings in preventive and therapeutic rehabilitation protocols. METHODS Forty-six patients with DM and 20 healthy control subjects were enrolled into this controlled study. Electrophysiological studies and computerized gait analysis were performed. Gait deviations of DM patients with diabetic peripheral neuropathy (DPN) (n=20), without diabetic peripheral neuropathy (NDPN) (n=26) and healthy control subjects (C) (n=20) were compared, and associations between electrophysiological findings and gait characteristics were investigated. RESULTS NDPN, but not DPN, group revealed slower gait, shorter steps, limited knee and ankle mobility, lower ankle plantar flexor moment and power than C group, and the difference was statistically significant. HbA1c levels and F-wave latency were significantly correlated with ankle mobility, peak ankle plantar flexion moment and power. CONCLUSION Neuropathy may not be the only reason for gait deviations in DM patients. Considering the spectrum of hyperglycemic complications including the mechanical characteristics of bones, muscles and soft tissues, patients with DM should start mobility and strengthening exercises in early stages.
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Affiliation(s)
- G Yavuzer
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Coskun U, Günel N, Toruner FB, Sancak B, Onuk E, Bayram O, Cengiz O, Yilmaz E, Elbeg S, Ozkan S. Serum leptin, prolactin and vascular endothelial growth factor (VEGF) levels in patients with breast cancer. Neoplasma 2003; 50:41-6. [PMID: 12687277] [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: 03/01/2023]
Abstract
Angiogenesis plays an important role in tumor growth and metastasis in solid tumors. VEGF is an important regulator of tumor angiogenesis. Both leptin and prolactin have also been suggested to have roles in the regulation of angiogenic process. In our study, we measured serum leptin, prolactin and VEGF levels in 30 metastatic, 55 non-metastatic breast cancer patients and 25 control subjects. Serum leptin levels were found to be similar in non-metastatic (38.1+/-19.5 ng/ml), metastatic patients (39.6+/-16.3 ng/ml) and control subjects (35.6+/-13.9 ng/ml) (p>0.05). There was no statistically significant difference between patients with visceral metastasis (44.0+/-16.8 ng/ml) and patients with bone metastasis (35.2+/-15.0 ng/ml) (p>0.05). Serum prolactin levels were found to be similar in non-metastatic (12.2+/-10.7 ng/ml), metastatic patients (11.6+/-8.2 ng/ml) and control subjects (12.3+/-8.1 ng/ml), (p>0.05). Moreover, serum prolactin levels were not different in patients with visceral (11.4+/-8.8 ng/ml) and bone metastasis (11.8+/-8.0 ng/ml), (p>0.05). Metastatic patients had higher serum VEGF levels (249.8+/-154.9 pg/ml), when compared to the non-metastatic patients (138.7+/-59.3 pg/ml) and control subjects (108.4+/-47.7 pg/ml), (p<0.05). There was no difference in serum VEGF levels in non-metastatic patients and control subjects (p>0.05). Patients with visceral metastasis (337.0+/-168.0 pg/ml) had higher serum VEGF levels, when compared to patients with bone metastasis (162.6+71.8 pg/ml), (p<0.05). Serum VEGF activity may be used to evaluate angiogenic and metastatic activity in breast cancer patients. However, serum leptin and prolactin levels does not seem to be related with angiogenic activity and metastasis in breast cancer patients.
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Affiliation(s)
- U Coskun
- Department of Medical Oncology, Gazi University Medical School, Ankara, Turkey.
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Günel N, Coşkun U, Toruner FB, Sancak B, Yilmaz E, Cengiz O, Elbeg S, Uner A, Ozkan S. Serum leptin levels are associated with tamoxifen-induced hepatic steatosis. Curr Med Res Opin 2003; 19:47-50. [PMID: 12661780 DOI: 10.1185/030079902125001308] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/23/2022]
Abstract
PURPOSE Tamoxifen, used in breast cancer treatment, may induce hepatic steatosis. It has been suggested that leptin, which has a relationship with body fat stores, may be involved in the pathogenesis of hepatic steatosis. In this study, we compared serum leptin levels in tamoxifen-treated patients with and without hepatic steatosis. METHODS Thirty-four women with breast cancer receiving tamoxifen were included in the study. Serum samples were obtained from the patients before and 3 months after tamoxifen therapy. RESULTS Increased hepatic steatosis was detected in 15 of 34 (44%) patients after 3 months of tamoxifen therapy. Serum leptin levels were found to be significantly elevated in patients with increased hepatic steatosis (37.3 +/- 17.7 to 50.5 +/- 22.4 ng/ml, p = 0.023) compared to (48.2 +/- 20.2 to 42.6 +/- 14.9 ng/ml, p > 0.05) after tamoxifen treatment. CONCLUSION Leptin may play a role in tamoxifen-induced hepatic steatosis. The exact mechanism involved should be investigated in further studies.
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Affiliation(s)
- Nazan Günel
- Department of Medical Oncology, Gazi University Medical School, Ankara, Turkey.
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