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Zuhur SS, Ozturk BO, Keskin U, Uysal S, Hacioglu A, Avci U, Karsli S, Andac B, Ozbay UN, Kilinc F, Erol S, Catak M, Sodan H, Pekkolay Z, Burhan S, Akbaba G, Ates C, Yorulmaz G, Tekin S, Topcu B, Tuna MM, Kadioglu P, Gonen MS, Karaca Z, Ciftci S, Celik M, Guldiken S, Tuzun D, Altuntas Y, Akturk M, Niyazoglu M, Cinar N, Gul OO, Kebapci MN, Akalin A, Bayraktaroglu T, Elbuken G. Disease-free survival and the prognostic factors affecting disease-free survival in patients with medullary thyroid carcinoma: a multicenter cohort study. Endocrine 2024:10.1007/s12020-024-03809-0. [PMID: 38570387 DOI: 10.1007/s12020-024-03809-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Despite several factors that may have been associated with poor disease-free survival (DFS) in patients with medullary thyroid carcinoma (MTC), only a few studies have evaluated the prognostic factors affecting DFS in MTC patients. Therefore, this study evaluated the prognostic factors affecting DFS, in a large number of patients with MTC. METHODS Patients treated for MTC were retrospectively analyzed. Patients were stratified as having persistent/recurrent disease and no evidence of disease (NOD) at the last follow-up. The factors affecting DFS after the initial therapy and during the follow-up period were investigated. RESULTS This study comprised 257 patients [females 160 (62.3%), hereditary disease 48 (18.7%), with a mean follow-up time of 66.8 ± 48.5 months]. Persistent/recurrent disease and NOD were observed in 131 (51%) and 126 (49%) patients, respectively. In multivariate analysis, age > 55 (HR: 1.65, p = 0.033), distant metastasis (HR: 2.41, p = 0.035), CTN doubling time (HR: 2.7, p = 0.031), and stage III vs. stage II disease (HR 3.02, p = 0.048) were independent predictors of persistent/recurrent disease. Although 9 (8%) patients with an excellent response after the initial therapy experienced a structural recurrence, the absence of an excellent response was the strongest predictor of persistent/recurrent disease (HR: 5.74, p < 0.001). CONCLUSIONS The absence of an excellent response after initial therapy is the strongest predictor of a worse DFS. However, a significant proportion of patients who achieve an excellent response could experience a structural recurrence. Therefore, careful follow-up of patients, including those achieving an excellent response is essential.
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Affiliation(s)
- Sayid Shafi Zuhur
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
| | - Beyza Olcay Ozturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Umran Keskin
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Serhat Uysal
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aysa Hacioglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ugur Avci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Seda Karsli
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Burak Andac
- Department of Endocrinology and Metabolism, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Umit Nur Ozbay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Faruk Kilinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Selvinaz Erol
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Merve Catak
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Hulyanur Sodan
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Sebnem Burhan
- Department of Endocrinology and Metabolism, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Coskun Ates
- Department of Endocrinology and Metabolism, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Goknur Yorulmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sakin Tekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Birol Topcu
- Department of Biostatistics, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mustafa Sait Gonen
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sema Ciftci
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Celik
- Department of Endocrinology and Metabolism, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Sibel Guldiken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Dilek Tuzun
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Yuksel Altuntas
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mutlu Niyazoglu
- Department of Endocrinology and Metabolism, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Nese Cinar
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Ozen Oz Gul
- Department of Endocrinology and Metabolism, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Medine Nur Kebapci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Aysen Akalin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Taner Bayraktaroglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
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Zuhur SS, Aggul H, Avci U, Erol S, Tuna MM, Uysal S, Akbaba G, Kilinc F, Catak M, Tekin S, Ozturk BO, Yavuz HC, Kadioglu P, Cinar N, Bayraktaroglu T, Topcu B, Altuntas Y, Elbuken G. The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study. Endocrine 2024; 83:700-707. [PMID: 37736822 DOI: 10.1007/s12020-023-03533-1] [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] [Received: 07/05/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Despite the presumed overdiagnosis of papillary thyroid microcarcinoma (PTMC) which has resulted in a new trend toward less-extensive surgery and a preference for active surveillance, the impact of microscopic extrathyroidal extension (mETE) on the clinical outcomes of PTMC is still controversial. This study assessed the impact of mETE on the clinical outcomes of patients with classic subtype PTMC. METHODS The data of consecutive patients who underwent thyroidectomy and were histopathologically diagnosed as classic subtype PTMC were analyzed. Cox's proportional hazards model was used to assess the impact of contributing variables on persistent/recurrent disease. Disease-free survival was estimated using the Kaplan-Meier method. RESULTS This study included 1013 patients (84% females), with a mean follow-up period of 62.5 ± 35.3 months. Patients with mETE had a significantly higher rate of locoregional persistent/recurrent disease than patients without mETE (9.8% vs 2.1%, p < 0.001). The disease-free survival rate was significantly lower in patients with mETE than in those without (90.2% vs 97%, Log-Rank p < 0.001). Furthermore, mETE and neck lymph node involvement were independent predictors of persistent/recurrent disease in multivariate analysis (HR: 2.43, 95% CI:1.02-5.81, p = 0.043; HR: 4.38, 95% CI: 1.7-11.2, p = 0.002, respectively). CONCLUSIONS In patients with the classic subtype of PTMC, mETE is an independent predictor of persistent/recurrent disease and is associated with a lower DFS rate. However, neck lymph node involvement is the strongest predictor of persistent/recurrent disease. Therefore, PTMCs with mETE and neck lymph node involvement are at a higher risk of persistent/recurrent disease than individuals lacking both characteristics.
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Affiliation(s)
- Sayid Shafi Zuhur
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
| | - Hunkar Aggul
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Ugur Avci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Selvinaz Erol
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Serhat Uysal
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Faruk Kilinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Elazig Firat University, Elazig, Turkey
| | - Merve Catak
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Sakin Tekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Beyza Olcay Ozturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Halise Cinar Yavuz
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Nese Cinar
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Taner Bayraktaroglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Birol Topcu
- Department of Biostatistics, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Yuksel Altuntas
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
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Anaforoglu I, Sancak S, Akbas EM, Oruk GG, Canat M, Tezcan KA, Uc ZA, Gorar S, Duman GC, Yaylali GF, Yılmaz M, Bilir BE, Bozoglan H, Akbaba G, Tuna MM, Akcay S, Tuzun D, Bagir GS, Haydardedeoglu FE, Elbuken G, Yorulmaz G, Celik O, Topbas M. Effects of Treatment Adherence on Quality of Life in Hypoparathyroid Patients. Exp Clin Endocrinol Diabetes 2021; 129:918-925. [PMID: 33694151 DOI: 10.1055/a-1400-2668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study aimed to evaluate the current situation of hypoparathyroid patients and to investigate the relationship between treatment adherence and quality of life. STUDY DESIGN Prospective, multicentre study. METHODS Adult patients presenting with the diagnosis of hypoparathyroidism to 20 different endocrinology clinics were included. They were receiving conventional therapies for hypoparathyroidism, using calcium, active vitamin D, and magnesium. We collected data on demographic features, disease- and treatment-related information, and results of routine laboratory tests, treatment adherence, and presence of complications. Beck Depression Inventory, Beck Anxiety Inventory, and Short Form-36 quality of life assessments were administered. RESULTS Among the 300 patients studied, 60.7% were adherent to their treatment, and 34.1% had complications. Anxiety and depression scores were significantly higher in non-adherent versus treatment-adherent patients (p<0.001 and p=0.001, respectively). Most of the domains of quality-of-life scores were also significantly lower in non-adherent patients. Both anxiety and depression scores showed significant, negative correlations with serum calcium and magnesium concentrations (r=-0.336, p<0.001 and r=-0.258, p<0.001, respectively). CONCLUSIONS Nearly 40% of the patients were non-adherent to conventional treatment for hypoparathyroidism, and such patients had higher anxiety and depression scores and poorer quality of life scores. Conventional treatment might not be sufficient to meet the needs of patients with hypoparathyroidism. In addition to seeking new therapeutic options, factors influencing quality of life should also be investigated and strategies to improve treatment adherence should be developed.
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Affiliation(s)
- Inan Anaforoglu
- Bahcesehir University, Faculty of Medicine, Department of Internal Diseases, Endocrinology Clinic, Istanbul, Turkey
| | - Seda Sancak
- University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Endocrinology and Metabolism Disorders, Department of Internal Medicine, İstanbul, Turkey
| | - Emin Murat Akbas
- Erzincan Binali Yıldırım University, Mengücek Gazi Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Erzincan, Turkey
| | - Guzide Gonca Oruk
- Izmir Katip Celebi University, Ataturk Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Izmir, Turkey
| | - Masum Canat
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Istanbul, Turkey
| | - Kadriye Aydın Tezcan
- Kartal Dr. Lütfi Kirdar City Hospital, Department of Internal Diseases, Endocrinology Clinic, Istanbul, Turkey
| | - Ziynet Alphan Uc
- Usak Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Usak, Turkey
| | - Suheyla Gorar
- Health Sciences University, Antalya Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Antalya, Turkey
| | - Gulhan Cavlak Duman
- Sivas Cumhuriyet University Health Services Practice and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Adana, Turkey
| | - Guzin Fidan Yaylali
- Pamukkale University Hospitals, Department of Internal Diseases, Endocrinology Clinic, Denizli, Turkey
| | - Merve Yılmaz
- Samsun Gazi State Hospital, Department of Internal Diseases, Endocrinology Clinic, Samsun, Turkey
| | - Betul Ekiz Bilir
- Tekirdag State Hospital, Department of Internal Diseases, Endocrinology Clinic, Tekirdag, Turkey
| | - Humeyra Bozoglan
- Giresun University Prof. Dr. A. Ilhan Ozdemir Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Giresun, Turkey
| | - Gulhan Akbaba
- Mugla Sitki Kocman University Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Mugla, Turkey
| | - Mazhar Muslum Tuna
- Umraniye Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Istanbul, Turkey
| | - Seckin Akcay
- Umraniye Training and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Istanbul, Turkey
| | - Dilek Tuzun
- Kahramanmaras Sutcu Imam University Health Practice and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Kahramanmaras, Turkey
| | - Gulay Simsek Bagir
- Baskent University Adana Dr. Turgut Noyan Practice and Research Center, Department of Internal Diseases, Endocrinology Clinic, Adana, Turkey
| | - Filiz Eksi Haydardedeoglu
- Baskent University Adana Dr. Turgut Noyan Practice and Research Center, Department of Internal Diseases, Endocrinology Clinic, Adana, Turkey
| | - Gulsah Elbuken
- Namık Kemal University, Faculty of Medicine, Department of Internal Medicine, Endocrinology Clinic
| | - Goknur Yorulmaz
- Eskisehir Osmangazi University Health, Practice and Research Hospital, Department of Internal Diseases, Endocrinology Clinic, Eskisehir, Turkey
| | - Ozlem Celik
- Mehmet Ali Aydınlar Acıbadem University, Faculty of Medicine, Department of Internal Diseases, Endocrinology Clinic, İstanbul, Turkey
| | - Murat Topbas
- Karadeniz Technical University, Faculty of Medicine, Department of Public Health, Trabzon, Turkey
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Imga NN, Elalmıs OU, Tuna MM, Dogan BA, Sahın D, Gursoy T, Yalcın Y, Berker D, Guler S. Comparison of echocardiographic findings in patients with nonfunctioning adrenal incidentalomas. Kaohsiung J Med Sci 2017; 33:295-301. [PMID: 28601234 DOI: 10.1016/j.kjms.2017.04.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/05/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022] Open
Abstract
Adrenal incidentalomas (AIs) are usually discovered incidentally after imaging unrelated to adrenal glands. We aimed to evaluate standard risk factors for systemic atherosclerosis and echocardiographic changes in patients with nonfunctioning AIs and compare them with normal subjects. We evaluated 70 patients diagnosed with AIs and 51 healthy controls. Mean levels were determined for HbA1c, LDL, uric acid, fasting plasma insulin, HOMA, and neutrophil-to-lymphocyte ratio (NLR), and these values were found to be significantly higher in the patients than the controls. The mean left atrial diameter, interventricular septum thickness, posterior wall thickness, left ventricular mass, E-wave deceleration time, isovolumetric relaxation time, and the median ratio of the early transmittal flow velocity to the early diastolic tissue velocity (E/Em) were higher in patients with AIs compared to controls. The mitral annular early diastolic velocity was lower in patients with AIs. The mean aortic diastolic diameter, stiffness index (SI), and aortic strain were higher, and aortic distensibility was lower in the patients. The mean right ventricular diameter, right atrial major-axis diameter, and right atrial minor-axis diameter were statistically higher in the patient group than the controls. A negative correlation was found between the NLR and aortic strain and aortic distensibility, while a positive correction was found between the NLR and SI. We found altered left ventricular (LV) and right ventricular (RV) echocardiographic findings in patients with AIs without known cardiovascular disease. Aortic stiffness was also increased. These changes may be related to an increase in cardiovascular risk factors in AI patients.
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Affiliation(s)
- Narin Nasıroglu Imga
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey.
| | - Ozgul Ucar Elalmıs
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Bercem Aycıcek Dogan
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Deniz Sahın
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Tugba Gursoy
- Department of Cardiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Yavuz Yalcın
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Serdar Guler
- Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Tuna MM, Kilinc F, Pekkolay Z, Soylu H, Tuzcu AK. A case of mediastinitis accompanied with hyperosmolar nonketotic coma. Turk J Emerg Med 2016; 16:75-76. [PMID: 27896327 PMCID: PMC5121274 DOI: 10.1016/j.tjem.2015.04.001] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 12/03/2022] Open
Abstract
Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling.
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Affiliation(s)
- Mazhar Muslum Tuna
- Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey
| | - Faruk Kilinc
- Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey
| | - Zafer Pekkolay
- Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey
| | - Hikmet Soylu
- Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey
| | - Alpaslan Kemal Tuzcu
- Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey
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6
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Ozkurt FE, Akdag M, Tuna MM, Yilmaz B, Sengul E, Dal MS. Hearing impairment in middle-aged patients with diabetes. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1170631] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Fazıl Emre Ozkurt
- Department of Otorhinolaryngology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mehmet Akdag
- Department of Otorhinolaryngology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mazhar Muslum Tuna
- Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Beyhan Yilmaz
- Department of Otorhinolaryngology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Engin Sengul
- Department of Otorhinolaryngology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mehmet Sinan Dal
- Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
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7
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Imga NN, Ucar Elalmis O, Muslum Tuna M, Aycıcek Dogan B, Sahin D, Berker D, Guler S. The Relationship Between Increased Epicardial Fat Thickness and Left Ventricular Hypertrophy and Carotid Intima-Media Thickness in Patients With Nonfunctional Adrenal Incidentaloma. Int J Endocrinol Metab 2016; 14:e37635. [PMID: 27942264 PMCID: PMC5138281 DOI: 10.5812/ijem.37635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/15/2016] [Accepted: 06/26/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Emerging evidences indicate that patients diagnosed with Adrenal Incidentaloma (AI) may present cardiovascular complications. Epicardial fat thickness (EFT) has recently been described as a new risk factor and an active player in metabolic syndrome and cardiovascular disease. OBJECTIVES We aimed to evaluate the relationship between EFT and left ventricular hypertrophy and carotid intima-media thickness, which are both strong predictors of cardiovascular morbity and mortality, in patients with nonfunctioning AI. PATIENTS AND METHODS We evaluated 51 patients (36 females and 15 males) diagnosed with AI and 35 (29 females, 6 males) age, gender and body mass index (BMI) matched healthy controls in terms of cardiovascular risk parameters. Epicardial fat was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. RESULTS Epicardial fat thickness was significantly higher in patients with AI when compared to the control group (0.89 ± 0.32 cm vs. 0.74 ± 0.26 cm; P = 0.023). left ventricular (LV) mass index and median carotid intima-media thickness (CIMT) were also higher in subjects with AI than in controls (99.8 g/m2 vs. 86.9 g/m2; P = 0.024 and 7.5 mm (5.5 - 11.5) vs. 6.5 mm (4.5 - 9.5); P = 0.017). There was a positive correlation between EFT, LV mass index, EFT and CIMT (r = 0.315, P = 0.004; r = 0.363, P < 0.001; respectively). CONCLUSIONS In this study we showed that EFT, measured by echocardiography is higher in subjects with AI when compared to healthy controls. epicardial fat thickness had the best independent correlation with AI in multiple logistic regression analysis. Incidentaloma is also associated with increased left ventricular mass index and CIMT. Adrenal incidentaloma patients may show early cardiac changes, such as increased left ventricular mass and increased CIMT.
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Affiliation(s)
- Nasiroglu Narin Imga
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Ankara, Turkey
- Corresponding author: Nasiroglu Narin Imga, Ankara Numune Education and Research Hospital, Department of Endocrinology, Ankara, Turkey. Tel: +90-5056492934, Fax: +90-3124263838, E-mail:
| | - Ozgul Ucar Elalmis
- Ankara Numune Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Mazhar Muslum Tuna
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Ankara, Turkey
| | - Bercem Aycıcek Dogan
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Ankara, Turkey
| | - Deniz Sahin
- Ankara Numune Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Dilek Berker
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Ankara, Turkey
| | - Serdar Guler
- Ankara Numune Education and Research Hospital, Department of Endocrinology, Ankara, Turkey
- Department of Endocrinology, Faculty of Medicine, Hitit University, Corum, Turkey
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Akbaba G, Berker D, Isık S, Tuna MM, Koparal S, Vural M, Yılmaz FM, Topcuoglu C, Guler S. Changes in the before and after thyroxine treatment levels of adipose tissue, leptin, and resistin in subclinical hypothyroid patients. Wien Klin Wochenschr 2015; 128:579-85. [PMID: 26394780 DOI: 10.1007/s00508-015-0865-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 09/01/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Subclinical hypothyroidism (SH) occurs when serum thyroid stimulating hormone (TSH) concentrations are raised and serum thyroid hormone concentrations are normal. The effect of SH on the proinflammatory adipose cytokine releasing visceral adipose tissue (VAT) is not clear. The aim of this study is to identify the difference between the pre and posttreatment levels of VAT, leptin, and resistin in SH patients. METHODS There were 51 SH patients and 43 age- and gender-matched healthy subjects included in the study. Thyroid functions, biochemical tests, leptin, resistin, and visceral and subcutaneous fat measurements were made. The measurements were repeated in the SH group in the third month following L-thyroxin treatment. RESULTS Initially, high sensitivity C-reactive protein, carotid artery intima-media thickness (mm), leptin, and resistin levels were significantly higher in the SH group compared to the controls, while the other parameters were similar. While no correlation was observed between TSH levels and adipokines, a positive correlation was detected between waist circumference and leptin levels (r = 0.549, p < 0.01). Visceral adipose tissue was positively correlated to age, waist circumference, and leptin levels, but negatively correlated to free thyroxin (T4) levels (r = 0.419, p = 0.009; r = 0.794, p < 0.01; r = 0.515, p < 0.01 and r = - 0.416, p = 0.009, respectively). A significant decrease was observed in VAT volume, leptin, and resistin levels of SH patients following levothyroxine treatment. Conclusion The reduced VAT volume, leptin, and resistin levels in SH patients following treatment may support the idea that TSH affects adipose tissue functions.
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Affiliation(s)
- Gulhan Akbaba
- Department of Internal Medicine, Endocrinology and Metabolism, Mugla Sıtkı Kocman University School of Medicine, Mugla, Turkey.
| | - Dilek Berker
- Clinics of Endocrinology and Diseases of Metabolism, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Serhat Isık
- Clinics of Endocrinology and Diseases of Metabolism, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mazhar Muslum Tuna
- Clinics of Endocrinology and Diseases of Metabolism, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Suha Koparal
- Clinics of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Murat Vural
- Clinics of Radiology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Fatma Meric Yılmaz
- Clinics of Biochemistry, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Canan Topcuoglu
- Clinics of Biochemistry, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Serdar Guler
- Clinics of Endocrinology and Diseases of Metabolism, Ankara Numune Education and Research Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Endocrinology and Diseases of Metabolism, Hitit University, Corum, Turkey
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9
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Arduc A, Dogan BA, Tuna MM, Tutuncu Y, Isik S, Berker D, Guler S. Higher body mass index and larger waist circumference may be predictors of thyroid carcinoma in patients with Hürthle-cell lesion/neoplasm fine-needle aspiration diagnosis. Clin Endocrinol (Oxf) 2015; 83:405-11. [PMID: 25296952 DOI: 10.1111/cen.12628] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/10/2014] [Accepted: 10/02/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE High body mass index (BMI) has been found to be associated with raised thyroid cancer risk, particularly in women. We examined the associations for BMI and waist circumference (WC) with thyroid cancer risk among women with Hürthle-cell lesion/neoplasm (HLN) on fine-needle aspiration biopsy (FNAB) with the hypothesis that BMI and WC could guide the management of these challenging indeterminate lesions. METHODS This cross-sectional study included 224 women with HLN who underwent thyroidectomy. In all patients, TSH and thyroid auto-antibodies were evaluated, and thyroid nodule features were recorded. Patients were grouped according to BMI (<30 or ≥30 kg/m(2)) and WC (<88 or ≥88 cm). Relationships of thyroid cancer with BMI and WC were assessed using logistic regression analysis. RESULTS Mean weight, BMI (31·26 ± 5·1 vs 26·47 ± 5·9, P < 0·001), WC (98·23 ± 7·6 vs 86·18 ± 11, P = 0·001), and proportion of patients with high BMI (≥30 kg/m(2)) (65·9 vs 33·8%, P < 0·001) or large WC (≥88 cm) (84·1 vs 47·9%, P < 0·001) were significantly higher in malignant group compared to benign group. In regression analysis, BMI and WC significantly associated with existence of malignancy. Malignancy risk was 3·819-fold higher (95% CI: 2·068-7·054) in BMI≥30 kg/m(2) group compared to BMI<30 kg/m(2), which was independent of TSH and age. Large WC was also associated with increased risk (OR = 5·593, 95% CI: 2·736-11·434). Baseline tumour characteristics were similar according to BMI and WC groups. CONCLUSIONS A great BMI and large WC were associated with higher thyroid cancer risk in patients with FNAB diagnosis of HLN. Further studies are needed to use BMI or WC in the management of patients with HLN.
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Affiliation(s)
- Ayse Arduc
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrine and Obesity Branch, Bethesda, MD, USA
| | - Bercem Aycicek Dogan
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Yasemin Tutuncu
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Serhat Isik
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Serdar Guler
- Department of Endocrinology and Metabolism, Faculty of Medicine, Hitit University, Corum, Turkey
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10
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Doğan BA, Tuna MM, Arduç A, Başaran MN, Küçükler K, Dağdelen I, Berker D, Güler S. Increased Risk of Unfavorable Metabolic Outcome in Patients with Clinically Nonfunctioning Pituitary Adenomas. Horm Metab Res 2015; 47:652-5. [PMID: 25750077 DOI: 10.1055/s-0035-1547234] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate atherosclerotic risk markers in women with clinically nonfunctioning pituitary adenomas (CNFAs). Records of 47 women with CNFAs and 73 healthy women who were treated as outpatients between January 2010 and March 2014 were evaluated retrospectively. All study data were obtained from file records. Lipid parameters, mean platelet volume (MPV), total testosterone (TT), androstenedione (AS), and dehydroepiandrostenedione sulfate (DHEAS) were recorded. Insulin resistance (IR) was calculated with homeostatic model assessment-insulin resistance (HOMA-IR). Among the atherosclerotic risk markers, the HOMA-IR and AS levels were higher in patients with CNFAs than in healthy subjects (p=0.003, p=0.021, respectively). A positive correlation between AS and insulin/HOMA-IR levels was found among the metabolic parameters in the patients with CNFAs (p=0.001, r=0.550, p=0.004, r=0.498, respectively). The data showed that patients with CNFAs had high atherosclerotic risk markers such as insulin resistance and hyperandrogenemia. Insulin resistance may also cause hyperandrogenemia in patients with CNFAs.
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Affiliation(s)
- B A Doğan
- Endocrinology and Metabolism Disease, Darıca Farabi State Hospital, Kocaeli, Turkey
| | - M M Tuna
- Endocrinology and Metabolism Disease, Dicle University, Diyarbakır, Turkey
| | - A Arduç
- Endocrine and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, National Institutes of Health, Bethesda, Maryland, USA
| | - M N Başaran
- Endocrinology and Metabolism Disease, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - K Küçükler
- Endocrinology and Metabolism Disease, Hitit University, Çorum, Turkey
| | - I Dağdelen
- Endocrinology and Metabolism Disease, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - D Berker
- Endocrinology and Metabolism Disease, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - S Güler
- Endocrinology and Metabolism Disease, Ankara Numune Training and Research Hospital, Ankara, Turkey
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11
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Basaran MN, Tuna MM, Karakılıç E, Doğan BA, İmga NN, Berker D, Güler S. Characterization of V804M-mutated RET proto-oncogene associated with familial medullary thyroid cancer, report of the largest Turkish family. J Endocrinol Invest 2015; 38:541-6. [PMID: 25501606 DOI: 10.1007/s40618-014-0224-0] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/27/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Analysis of the RET proto-oncogen is very important for diagnosis and prognosis of medullary thyroid cancer (MTC). Genotype-phenotype correlation is also well known. Here we report features of the largest known family in Turkey with the V804M-mutated RET proto-oncogene. METHODS Thirty members from three generations were evaluated. A RET proto-oncogen mutation, calcitonin (Ct) measurement and thyroid ultrasound were performed on all individuals. Seventeen members had V804M mutation. Fourteen of these patients underwent total thyroidectomy and additional central lymph node dissection for five subjects. RESULTS The mean age of patients with MTC was 46.5 (30-61) years. The mean calcitonin level of RET positive members was 13.27 pg/mL (1-49.8 pg/mL). Three had a basal Ct level above normal limits. Seven of the 14 patients were diagnosed with MTC, and two were diagnosed with papillary thyroid cancer without MTC. One patient had central neck metastasis. Hyperparathyroidism or pheochromocytoma was not detected in any case. Patients who were RET negative, had normal Ct levels and no suspected nodule on ultrasound examination. CONCLUSIONS Our study revealed a relatively good prognosis in patients with V804M mutation. Despite the surgery was performed in older age no advance disease was observed.
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Affiliation(s)
- M N Basaran
- Endocrinology and Metabolism Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - M M Tuna
- Endocrinology and Metabolism Department, Dicle University Medical Faculty, Sur, Diyarbakır, Turkey.
| | - E Karakılıç
- Endocrinology and Metabolism Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - B A Doğan
- Endocrinology and Metabolism Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - N N İmga
- Endocrinology and Metabolism Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - D Berker
- Endocrinology and Metabolism Department, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - S Güler
- Endocrinology and Metabolism Department, Hitit University Medical Faculty, Çorum, Turkey
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Abstract
The role of insulin resistance (IR) is well-documented in obese women with polycystic ovary syndrome (PCOS). Controversies exist concerning the presence of IR in idiopathic hirsutism (IH) or if it is a manifestation of high body mass index (BMI). We aimed to investigate the presence/absence of IR in lean hirsute women. One-hundred fifty-one lean women with hirsutism [96 PCOS (group 1) and 55 IH (group 2)] and 58 age-and BMI-matched healthy controls (group 3) were recruited in the study (mean age 25.21 ± 6.1 versus 26.26 ± 4.6years; BMI 21.79 ± 1.7 versus 22.02 ± 2.2 kg/m(2), respectively). Significantly higher insulin and HOMA-IR, and significantly lower fasting glucose insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), reciprocal insulin, and Raynaud index were detected in groups 1 and 2 than in group 3 (p < 0.05). These IR indices were similar between groups 1 and 2. The number of patients with IR (HOMA-IR > 2, FGIR < 7.2, or QUICKI < 0.357) was significantly higher in groups 1 and 2 than in group 3, but was similar between groups 1 and 2. A higher frequency of IR occurs in lean hirsute women regardless of they having PCOS or IH. IR may contribute to aetiopathogenesis of IH, or may cause some metabolic abnormalities in these patients.
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Affiliation(s)
- Ayse Arduc
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrine and Obesity Branch, National Institutes of Health , Bethesda, MD , USA
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Affiliation(s)
- Ayse Arduc
- National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Diabetes, Endocrine and Obesity Branch Bethesda, Maryland
| | - Yasemin Ates Tutuncu
- Department of Endocrinology and Metabolism Ministry of Health Ankara Numune Research and Training Hospital Ankara, Turkey
| | - Bercem Aycicek Dogan
- Department of Endocrinology and Metabolism Ministry of Health Ankara Numune Research and Training Hospital Ankara, Turkey
| | - Ayse Burcu Arikan Ileri
- Department of Pathology Ministry of Health Ankara Numune Research and Training Hospital Ankara, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology and Metabolism Ministry of Health Ankara Numune Research and Training Hospital Ankara, Turkey
| | - Hatice Nursun Ozcan
- Department of Radiology Ministry of Health Ankara Numune Research and Training Hospital Ankara, Turkey
| | - Serhat Isik
- Department of Endocrinology and Metabolism Ministry of Health Ankara Numune Research and Training Hospital Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism Ministry of Health Ankara Numune Research and Training Hospital Ankara, Turkey
| | - Serdar Guler
- Department of Endocrinology and Metabolism Hitit University Faculty of Medicine Corum, Turkey
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14
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Arduc A, Tutuncu YA, Dogan BA, Arikan Ileri AB, Tuna MM, Ozcan HN, Isik S, Berker D, Guler S. Parathyroid cysts. Am Surg 2015; 81:E163-E165. [PMID: 25831166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Ayse Arduc
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Endocrine and Obesity Branch, Bethesda, Maryland, USA
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15
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Arduc A, Aycicek Dogan B, Bilmez S, Imga Nasiroglu N, Tuna MM, Isik S, Berker D, Guler S. High prevalence of Hashimoto's thyroiditis in patients with polycystic ovary syndrome: does the imbalance between estradiol and progesterone play a role? Endocr Res 2015; 40:204-10. [PMID: 25822940 DOI: 10.3109/07435800.2015.1015730] [Citation(s) in RCA: 30] [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: 12/31/2022]
Abstract
OBJECTIVE Some similar factors, such as genetic susceptibility and subinflammation/autoimmunity, contribute to development of both polycystic ovary syndrome (PCOS) and Hashimoto's thyroiditis (HT), suggesting a potential pathogenic link between the two common disorders. In this study, we investigated the relationship between PCOS and HT, considering the possible effect of PCOS-related hormonal and metabolic factors on thyroid autoimmunity. METHODS Eighty-six reproductive-age women diagnosed with PCOS according to Rotterdam criteria and 60 age-BMI matched control women were included in the study. All subjects had thyroid function tests, thyroid peroxidase anti-body (anti-TPO), thyroglobulin anti-body (anti-Tg), LH, FSH, estradiol, progesterone, androgens, fasting glucose, insulin, lipid, homeostasis model assessment insulin resistance (HOMA-IR) levels, thyroid and pelvic ultrasounds. RESULTS TSH, anti-TPO (p = 0.017), anti-Tg (p = 0.014), LH, DHEAS, testosterone, and HOMA-IR levels were significantly higher and progesterone were lower in PCOS women than in controls. Free T4, free T3, FSH, estradiol levels and thyroid volume were similar between the two groups. A higher percentage of PCOS patients had elevated TSH (26.7 and 5%; p = 0.001), anti-TPO (26.7 and 6.6%; p = 0.002), and anti-Tg (16.2 and 5%; p = 0.039). HT was more common in PCOS patients compared to controls (22.1 and 5%; p = 0.004). Estradiol (p = 0.003) were higher in anti-TPO positive PCOS women than anti-TPO negative ones. Anti-TPO was correlated positively with estradiol, estradiol/progesterone ratio, and TSH. CONCLUSIONS This study demonstrated a higher prevalence of HT, elevated TSH, anti-TPO, and anti-Tg levels in PCOS patients. Increased estrogen and estrogen/progesterone ratio seem to be directly involved in high anti-TPO levels in PCOS patients.
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Affiliation(s)
- Ayse Arduc
- a Diabetes, Endocrine and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda , MD , USA
| | | | - Sevgi Bilmez
- c Department of Internal Medicine , Ministry Of Health, Ankara Numune Research and Training Hospital , Ankara , Turkey , and
| | | | | | - Serhat Isik
- b Department of Endocrinology and Metabolism
| | | | - Serdar Guler
- d Department of Endocrinology and Metabolism, Faculty of Medicine , Hitit University , Corum , Turkey
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Dogan BA, Arduc A, Tuna MM, Karakılıc E, Dagdelen I, Tutuncu Y, Berker D, Guler S. Association of mean platelet volume with androgens and insulin resistance in nonobese patients with polycystic ovary syndrome. Int J Endocrinol Metab 2014; 12:e18642. [PMID: 25745486 PMCID: PMC4338650 DOI: 10.5812/ijem.18642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/13/2014] [Accepted: 05/17/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mean platelet volume (MPV) is generally accepted as a new marker of cardiovascular disease risk in several studies. OBJECTIVES This study aimed to determine the association of MPV with androgen hormones and insulin resistance (IR) in nonobese patients with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS A total of 136 patients with newly diagnosed reproductive-age PCOS (regarding the criteria of new PCOS phenotypes, based on the Rotterdam criteria) who were nonobese with the mean age of 25 years (25.39 ± 5.51) and mean body mass index (BMI) of 21 kg/m(2) (22.07 ± 2.13) were included. In addition, 59 healthy subjects with mean age of 26 years (22.07 ± 2.13) and mean BMI of 22 kg/m(2) (21.52 ± 3.84) were recruited as control. Total blood count (including MPV), total testosterone, free testosterone, dehydroepiandrosterone-sulfate (DHEAS), and androstenedione levels were recorded. IR was calculated from blood chemistry measurements of fasting insulin and glucose according to updated homeostasis model assessment. RESULTS No differences were observed in mean MPV values between patients and control group (9.02 fL (8.5-10.1) and 8.9 fL (7.7-9.1), respectively; P = 0.777). MPV values were similar among nonobese patients with and without IR and control subjects (P > 0.05). We detected significantly lower values of MPV in patients with hyperandrogenemia in comparison to patients with normal androgen levels (8.7 and 9.5 fL, P = 0.012). There was a negative correlation between total testosterone, DHEAS, and MPV (P = 0.016, r = -0.229; and P = 0.006, r = -0.261, respectively). Multiple logistic regression analyses confirmed the independence of these associations. CONCLUSIONS Our study revealed that nonobese women with and without PCOS have similar MPV values. While IR does not have any effect on MPV, elevated androgen levels are associated with a low MPV in nonobese patients with PCOS.
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Affiliation(s)
- Bercem Aycicek Dogan
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
- Corresponding author: Bercem Aycicek Dogan, Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey. Tel: +90-3125084734, Fax: +90-3123114340, E-mail:
| | - Ayse Arduc
- National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes-Endocrine and Obesity Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Mazhar Muslum Tuna
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Ersen Karakılıc
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Iffet Dagdelen
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Yasemin Tutuncu
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Dilek Berker
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
| | - Serdar Guler
- Ankara Numune Training and Research Hospital, Endocrinology and Metabolism Disease, Ankara, Turkey
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Topaloglu O, Gokay F, Koparal SS, Akbaba G, Mete T, Arduc A, Tuna MM, Yalcin Y, Yavuz HC, Berker D, Guler S. Visceral fat measurement by ultrasound as a non-invasive method - can it be useful in evaluating subclinical atherosclerosis in male patients with hypopituitarism and growth hormone deficiency? Endokrynol Pol 2014; 65:195-202. [PMID: 24971920 DOI: 10.5603/ep.2014.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 06/27/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Growth hormone (GH) deficiency, either isolated or combined with other pituitary hormone deficiencies, is associated with increased mortality and abnormal body composition, particularly visceral adiposity. We aimed to investigate the effects of GH deficiency with or without sex steroid deficiencies on ultrasonographic visceral fat (VF) and cardiovascular risk markers in patients with hypopituitarism on conventional hormone replacement therapy. MATERIAL AND METHODS Forty hypopituitarism patients (24 women, 16 men; mean age 48 ± 16.1 years) with GH deficiency and 15 age- and sex-matched healthy controls were included in this cross-sectional study. The patients were stable on conventional hormone replacement but they were not on GH therapy. Patients who had sex steroid replacement were classified as Group 1 (n = 19), and patients who did not use sex steroids were classified as Group 2 (n = 21). Anthropometric measurements were performed. VF in three regions, subcutaneous fat, and carotid intima-media thickness (CIMT) were measured. VF volume was calculated by using a formula. RESULTS Visceral fat volume and mean CIMT were significantly higher in patients than healthy controls (p = 0.001 and 0.019 respectively). Homocysteine and hs-CRP were higher in patients (p < 0.05). In males, VF volume and VF thickness measured between abdominal muscle and splenic vein were significantly correlated with CIMT (r = 0.54, p = 0.047 and r = 0.66, p = 0.010 respectively). Furthermore, there was a strong positive correlation between VF thickness in pararenal region and homocysteine (r = 0.74, p = 0.001) in males. CONCLUSIONS VF volume evaluated by ultrasound can be accepted as a cause of subclinical atherosclerosis in GH deficient hypopituitary patients, particularly males.
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