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Sulu C, Senel GB, Koca O, Alaylioglu M, Demir AN, Durcan E, Ak DG, Dursun E, Konukoglu D, Ozkaya HM, Karadeniz D, Kadioglu P. The relations of circulating agouti-related peptide and leptin with altered sleep architecture in patients with active Cushing's disease: a pilot study. J Endocrinol Invest 2024; 47:167-178. [PMID: 37306895 DOI: 10.1007/s40618-023-02133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
AIM To evaluate sleep architecture of patients with Cushing's disease (CD) and to explore whether agouti-related peptide (AgRP) and/or leptin play a permissive role in sleep alterations in patients with active CD. METHODS We performed polysomnography on 26 patients with active CD and age 26 age- and sex-matched control subjects. Blood samples were obtained from all participants for the analyzes of AgRP and leptin. The laboratory and sleep-related parameters were compared. RESULTS The groups were similar in age, gender, and body mass index. The CD group had reduced sleep efficiency (71.6 ± 12.1% vs. 78.8 ± 12.6%, p = 0.042) and increased wake after sleep onset (WASO%) (24.7 ± 13.1% vs. 17.4 ± 11.6%, p = 0.040) as compared to control group. Seventeen patients with CD (65.4%) and 18 control subjects (69.2%) had obstructive sleep apnea. Serum AgRP (13.2 ± 7.4 pg/ml vs. 9 ± 3.1, p = 0.029), leptin (59.5 mcg/l, [IQR] 32.6-94.6 vs. 25.3 mcg/l, [IQR] 12.9-57.5, p = 0.007) were higher in CD group. AgRP and leptin correlated negatively with total sleep time, sleep efficiency, stage N2 sleep (%), and positively with WASO%. In multiple regression analyses, serum cortisol (ß = - 0.359, p = 0.042) and AgRP (ß = - 0.481, p = 0.01) were significant predictor of sleep efficiency. AgRP was also significant predictor of WASO% (ß = 0.452 and p < 0.05). CONCLUSIONS Active CD carries an increased risk of impaired sleep efficiency and continuity which may worsen health-related quality of life. Elevated circulating AgRP and, to a lesser extent, leptin may be associated with decreased sleep efficiency and continuity in patients with CD. Patients with CD who have subjective sleep symptoms should be screened with polysomnography.
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Affiliation(s)
- C Sulu
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - G B Senel
- Sleep and Disorders Unit, Department of Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - O Koca
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - M Alaylioglu
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - A N Demir
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - E Durcan
- Department of Endocrinology, Bagcilar Training Hospital, Istanbul, Turkey
| | - D G Ak
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - E Dursun
- Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - D Konukoglu
- Department of Biochemistry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - H M Ozkaya
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - D Karadeniz
- Sleep and Disorders Unit, Department of Neurology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - P Kadioglu
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey.
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Yilmaz MK, Sulu C, Ozkaya HM, Kadioglu A, Ortac M, Kadioglu P. Evaluation of sex hormone profile and semen parameters in acromegalic male patients. J Endocrinol Invest 2021; 44:2799-2808. [PMID: 34050506 DOI: 10.1007/s40618-021-01593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the changes in semen quality and bioavailable testosterone concentrations in acromegalic male patients according to their disease activity and compare them with patients with non-functional pituitary adenoma (NFA) and healthy controls (HC). METHODS Twenty-four acromegalic patients with active disease, 22 acromegalic patients in remission, 10 HCs, and 10 patients with NFA were included. RESULTS Total and calculated bioavailable testosterone concentrations were lower in patients with pituitary disease. Patients with acromegaly had more severely impaired total testosterone levels and semen parameters in comparison to HCs and patients with NFA. The degree of impairment was more prominent in acromegalic patients with active disease than acromegalic patients in remission. Acromegalic patients in remission had residual impairments in both semen quality and testosterone concentrations. Patients with NFA had the lowest concentrations of calculated bioavailable testosterone, followed by acromegalic patients with active disease and acromegalic patients in remission. Increasing growth hormone (GH) levels were found to be associated with both more severely impaired semen quality and androgen concentrations. CONCLUSION Growth hormone hypersecretion can disturb reproductive biology and thereof semen quality. The reduction in semen quality and androgen levels may not fully recover upon disease control. Clinicians should be aware of the increased risk of impaired semen parameters and reduced total/bioavailable levels in acromegalic patients, especially in the setting of active disease.
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Affiliation(s)
- M K Yilmaz
- Department of Internal Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - C Sulu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - H M Ozkaya
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - A Kadioglu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - M Ortac
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - P Kadioglu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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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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Dagistanli FK, Ozkaya HM, Kucukyoruk B, Biceroglu H, Metin D, Gazioglu N, Oz B, Kadioglu P, Ozturk M. Preoperative Somatostatin Analogue Treatment Might Trigger Apoptosis and Autophagy in Tumor Tissues of Patients with Acromegaly: A Pilot Study. Exp Clin Endocrinol Diabetes 2016; 126:168-175. [PMID: 27322826 DOI: 10.1055/s-0042-107243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effect of preoperative somatostatin analog (SRL) treatment on proteins associated with apoptosis and autophagy in patients with acromegaly and to determine factors correlating with these parameters. METHODS Ex-vivo tumor samples of 11 SRL-treated and 9 SRL-untreated patients were retrospectively included in the study. Apoptotic and autophagic proteins were determined via immunohistochemical staining and apoptosis was evaluated via in situ DNA end labeling (TUNEL). RESULTS TUNEL, caspase-3, and ATG-5 immunopositivity was significantly increased (p<0.01, p=0.01, p=0.01, respectively), survivin and beclin-1 immunopositivity was significantly decreased (p=0.03, p=0.02, respectively) in SRL-treated patients as compared with SRL-untreated controls. Ki-67 index was decreased significantly in the SRL-treated group (p=0.01). Significant positive correlations were detected between TUNEL and caspase-3 immunopositivity (r=0.577, p<0.01), and between survivin and beclin-1 immunopositivity (r=0.503, p=0.03). Age at diagnosis, preoperative GH, IGF-1 levels, tumor size, and invasion status were not found to affect TUNEL positivity nor did they correlate with caspase-3, survivin, beclin-1, ATG-5 immunopositivity (p>0.05 for all). Preoperative SRL treatment was the only factor that had a significant effect on TUNEL positivity (adjusted R2=0.39, p=0.02). Preoperative treatment duration was positively correlated with TUNEL and caspase-3 immunopositivity (r=0.526, p=0.02; r=0.475, p=0.04, respectively) and negatively correlated with survivin immunopositivity (r=-0.533, p=0.01). CONCLUSIONS Somatostatin analog treatment might induce apoptosis, increase autophagy, and decrease cell proliferation in GH-secreting adenomas. Also, proteins related to cross-talk between autophagy and apoptosis are upregulated after SRL treatment.
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Affiliation(s)
- F K Dagistanli
- Department of Medical Biology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - H M Ozkaya
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - B Kucukyoruk
- Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - H Biceroglu
- Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - D Metin
- Department of Medical Biology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - N Gazioglu
- Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.,Pituitary Center, Istanbul University, Istanbul, Turkey
| | - B Oz
- Department of Pathology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - P Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.,Pituitary Center, Istanbul University, Istanbul, Turkey
| | - M Ozturk
- Department of Medical Biology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
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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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Ozkaya A, Ozkaya HM, Alkın Z, Demirok A. Incidental 'early' diagnosis of colorectal carcinoma by way of central retinal vein occlusion. J Fr Ophtalmol 2014; 37:e73-4. [PMID: 24657217 DOI: 10.1016/j.jfo.2013.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/27/2013] [Accepted: 06/10/2013] [Indexed: 10/25/2022]
Affiliation(s)
- A Ozkaya
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey.
| | - H M Ozkaya
- Istanbul University, Faculty of Medicine of Istanbul, Internal Medicine Department, 34093 Capa, Fatih, Istanbul, Turkey
| | - Z Alkın
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
| | - A Demirok
- Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok., 34421 Beyoglu, Istanbul, Turkey
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