Pub Date : 2020-01-01DOI: 10.25179/tjem.2020-77679
Priti Shahapure, Shimpa R. Sharma
Objective: Rising prevalence of non-alcoholic fatty liver disease (NAFLD), its high incidence in diabetic patients, and global diabetes prevalence, underline the need to identify comorbidities in these patients impacting their quality of life and mortality.NAFLDis associated with increased risk, prevalence, and complications of cardiovascular diseases in diabetic and non-diabetics alike. The study aimed to establish a relationship between noninvasively assessed cardiovascular morbidity and NAFLD fibrosis score (NFS) in type 2 diabetes mellitus with NAFLD. Material and Methods: After ethical approval, the study was conducted (n=100) on patients <60 years of age, havingtype 2 diabetes mellitus, and no existing cardiovascular disease. All patients underwent anthropological and routine investigations, two-dimension (2D) echocardiography, and ultrasonographic confirmation of fatty liver disease. NAFLD was ascertained based on patient history and investigations. Findings of cardiovascular evaluation on 2D-echocardiography were assessed with reference to the NFS. Results: Median age of participants was 53.5 years. Body mass index (p<0.001), right carotid intima-media thickness (p=0.0124), and left ventricular dysfunction (p=0.0024) showed a significant association with NAFLD. The presence of both left ventricular diastolic dysfunction and significant variation of carotid intima-media thickness among mild, moderate, and severe NFS groups (p=0.0049) was observed. Patients with moderate-severe NFS had 6.38 times more risk of developing cardiovascular morbidities. Conclusion: In patients with type 2 diabetes and NAFLD, the NFS helps to identify those at high risk of cardiovascular disease, and patients needing further investigation. It provides clues on how non-invasive cardiovascular markers can be used in detecting cardiovascular morbidities.
{"title":"Cardiovascular Morbidity in Diabetic Non-Alcoholic Fatty Liver Disease (NAFLD) Using NAFLD Fibrosis Score as an Early Indicator","authors":"Priti Shahapure, Shimpa R. Sharma","doi":"10.25179/tjem.2020-77679","DOIUrl":"https://doi.org/10.25179/tjem.2020-77679","url":null,"abstract":"Objective: Rising prevalence of non-alcoholic fatty liver disease (NAFLD), its high incidence in diabetic patients, and global diabetes prevalence, underline the need to identify comorbidities in these patients impacting their quality of life and mortality.NAFLDis associated with increased risk, prevalence, and complications of cardiovascular diseases in diabetic and non-diabetics alike. The study aimed to establish a relationship between noninvasively assessed cardiovascular morbidity and NAFLD fibrosis score (NFS) in type 2 diabetes mellitus with NAFLD. Material and Methods: After ethical approval, the study was conducted (n=100) on patients <60 years of age, havingtype 2 diabetes mellitus, and no existing cardiovascular disease. All patients underwent anthropological and routine investigations, two-dimension (2D) echocardiography, and ultrasonographic confirmation of fatty liver disease. NAFLD was ascertained based on patient history and investigations. Findings of cardiovascular evaluation on 2D-echocardiography were assessed with reference to the NFS. Results: Median age of participants was 53.5 years. Body mass index (p<0.001), right carotid intima-media thickness (p=0.0124), and left ventricular dysfunction (p=0.0024) showed a significant association with NAFLD. The presence of both left ventricular diastolic dysfunction and significant variation of carotid intima-media thickness among mild, moderate, and severe NFS groups (p=0.0049) was observed. Patients with moderate-severe NFS had 6.38 times more risk of developing cardiovascular morbidities. Conclusion: In patients with type 2 diabetes and NAFLD, the NFS helps to identify those at high risk of cardiovascular disease, and patients needing further investigation. It provides clues on how non-invasive cardiovascular markers can be used in detecting cardiovascular morbidities.","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"2 1","pages":"314-320"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82103998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2019-70737
A. G. Canpolat, Ş. Canlar, B. I. Aydoğan, S. Güllü, M. Erdoğan
Introduction Due to their inhibitory effect on proliferation, motility, apoptosis, and metastasis, the epidermal growth factor receptor (EGFR) inhibitor erlotinib and vascular endothelial growth factor receptor (VEGF) and EGFR inhibitor vandetanib are viable therapeutic options for the treatment of advanced non-small cell lung carcinoma (NSCLC) and thyroid cancer, respectively (1). NSCLCs and medullary or differentiated thyroid carcinomas (MTC and DTC) may show bone metastasis along with bone pain, elevated serum calcium, or elevated alkaline phosphatase levels. We present the interesting cases of two patients who were diagnosed with NSCLC and MTC with bone metastasis. Both were treated with EGFR inhibitors and presented at our outpatient clinic with hypocalcemia as a result of hypoparathyroidism.
{"title":"Development of Hypocalcemia Due to Targeted Therapies","authors":"A. G. Canpolat, Ş. Canlar, B. I. Aydoğan, S. Güllü, M. Erdoğan","doi":"10.25179/tjem.2019-70737","DOIUrl":"https://doi.org/10.25179/tjem.2019-70737","url":null,"abstract":"Introduction Due to their inhibitory effect on proliferation, motility, apoptosis, and metastasis, the epidermal growth factor receptor (EGFR) inhibitor erlotinib and vascular endothelial growth factor receptor (VEGF) and EGFR inhibitor vandetanib are viable therapeutic options for the treatment of advanced non-small cell lung carcinoma (NSCLC) and thyroid cancer, respectively (1). NSCLCs and medullary or differentiated thyroid carcinomas (MTC and DTC) may show bone metastasis along with bone pain, elevated serum calcium, or elevated alkaline phosphatase levels. We present the interesting cases of two patients who were diagnosed with NSCLC and MTC with bone metastasis. Both were treated with EGFR inhibitors and presented at our outpatient clinic with hypocalcemia as a result of hypoparathyroidism.","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"16 1","pages":"105-105"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72965431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2019-71445
E. Koca, E. Tarhan, F. Elibol, N. Çınar
Muğla Sıtkı Koçman University Faculty of Medicine, Department of Internal Medicine, Muğla, Turkey *Muğla Sıtkı Koçman University Faculty of Medicine, Department of Rheumatology, Muğla, Turkey **Muğla Sıtkı Koçman University Faculty of Medicine, Department of Radiology, Muğla, Turkey ***Muğla Sıtkı Koçman University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Muğla, Turkey
{"title":"Granulomatosis Polyangiitis Presented with Diabetes Insipidus","authors":"E. Koca, E. Tarhan, F. Elibol, N. Çınar","doi":"10.25179/tjem.2019-71445","DOIUrl":"https://doi.org/10.25179/tjem.2019-71445","url":null,"abstract":"Muğla Sıtkı Koçman University Faculty of Medicine, Department of Internal Medicine, Muğla, Turkey *Muğla Sıtkı Koçman University Faculty of Medicine, Department of Rheumatology, Muğla, Turkey **Muğla Sıtkı Koçman University Faculty of Medicine, Department of Radiology, Muğla, Turkey ***Muğla Sıtkı Koçman University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Muğla, Turkey","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"39 1","pages":"96-100"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77414109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2020-74287
M. Sencar, M. Çalapkulu, D. Sakız, S. Hepşen, P. Akhanlı, İlknur Öztürk Ünsal, E. Çakal
Objective: Although subacute thyroiditis (SAT) is not an autoimmune disease, the presence of antithyroid antibodies has been reported in this disease too. This study aims to determine the frequency of antithyroid antibodies at the time of diagnosis of SAT. Material and Methods: Quantitative measurements of antithyroid peroxidase antibody (anti-TPO), antithyroglobulin antibody (anti-Tg), and thyroid-stimulating hormone (TSH) receptor autoantibodies (TRAb) were made in 76 patients at the diagnosis of SAT. Cytopathological examination and iodine uptake test was performed to exclude Graves’ disease and Hashimoto’s disease in suspected patients. Multiple multinuclear giant cells and granulomatous formations, including epithelioid histiocytes, were the cytological findings employed to support the diagnosis of SAT in suspicious cases. Results: The median erythrocyte sedimentation rate and Creactive protein levels were found to be 49 mL/hour (21-130) and 54 mg/L (8-179), respectively. TSH, free T4, and free T3 levels were determined to be 0.01 mIU/L (0.003-5.2), 1.98 ng/dL (0.78-6.1) and 5.51 ng/L (3.07-14), respectively. During the initial presentation, 88% of the patients were hyperthyroid, and 9% of the patients were euthyroid. Anti-TPO and anti-Tg antibody levels were detected to be above the assay-specific cut-off in 11.8% and 10.5% of SAT patients, respectively, at the time of diagnosis. Elevated TRAb was detected in 6.6% of all SAT patients. The median anti-TPO, anti-Tg, and TRAb levels of antibody-positive patients were 55 IU/mL (381.078), 163 IU/mL (5.5-876), 5 IU/L (1.9-23), respectively. Conclusion: Although uncommon, antibody positivity can also be observed in SAT disease. This study has proved that the previous studies claiming the absence of thyroid antibodies in SAT are flawed. SAT must be considered while assessing the differential diagnosis of Graves’ and Hashimoto’s disease.
{"title":"Frequency of Thyroid Antibodies at the Diagnosis of Subacute Thyroiditis","authors":"M. Sencar, M. Çalapkulu, D. Sakız, S. Hepşen, P. Akhanlı, İlknur Öztürk Ünsal, E. Çakal","doi":"10.25179/tjem.2020-74287","DOIUrl":"https://doi.org/10.25179/tjem.2020-74287","url":null,"abstract":"Objective: Although subacute thyroiditis (SAT) is not an autoimmune disease, the presence of antithyroid antibodies has been reported in this disease too. This study aims to determine the frequency of antithyroid antibodies at the time of diagnosis of SAT. Material and Methods: Quantitative measurements of antithyroid peroxidase antibody (anti-TPO), antithyroglobulin antibody (anti-Tg), and thyroid-stimulating hormone (TSH) receptor autoantibodies (TRAb) were made in 76 patients at the diagnosis of SAT. Cytopathological examination and iodine uptake test was performed to exclude Graves’ disease and Hashimoto’s disease in suspected patients. Multiple multinuclear giant cells and granulomatous formations, including epithelioid histiocytes, were the cytological findings employed to support the diagnosis of SAT in suspicious cases. Results: The median erythrocyte sedimentation rate and Creactive protein levels were found to be 49 mL/hour (21-130) and 54 mg/L (8-179), respectively. TSH, free T4, and free T3 levels were determined to be 0.01 mIU/L (0.003-5.2), 1.98 ng/dL (0.78-6.1) and 5.51 ng/L (3.07-14), respectively. During the initial presentation, 88% of the patients were hyperthyroid, and 9% of the patients were euthyroid. Anti-TPO and anti-Tg antibody levels were detected to be above the assay-specific cut-off in 11.8% and 10.5% of SAT patients, respectively, at the time of diagnosis. Elevated TRAb was detected in 6.6% of all SAT patients. The median anti-TPO, anti-Tg, and TRAb levels of antibody-positive patients were 55 IU/mL (381.078), 163 IU/mL (5.5-876), 5 IU/L (1.9-23), respectively. Conclusion: Although uncommon, antibody positivity can also be observed in SAT disease. This study has proved that the previous studies claiming the absence of thyroid antibodies in SAT are flawed. SAT must be considered while assessing the differential diagnosis of Graves’ and Hashimoto’s disease.","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"27 1","pages":"144-148"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73860231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2019-71878
Ceyda Dinçer, T. Apaydın, D. Yavuz
Introduction Coffee is one of the most popular beverages consumed worldwide, thereby enhancing its market demand (1). Statistics reveal that the average consumption of coffee ranges from 2-4 cups per day in western societies. Western countries prefer to consume brewed coffee while instant coffee is popular among the North Europeans. Boiled coffee is frequently consumed by the inhabitants of the Balkan area, Ireland, North Africa, and Turkey. Scientists have extracted numerous bioactive compounds, such as chlorogenic acids (CGA), polyphenols, diterpenes, caffeine, and caffeine metabolites (1,2) from this complex beverage. Abstract Caffeine has been found to exert various biological effects including, antiangiogenic, antiproliferative, antimetastatic activity, increased fat oxidation and mobilization of glycogen in muscle, increased lipolysis, and reduction of body fat. The aim of this review is to analyze the endocrine effects of coffee consumption. A systematic literature search was conducted on PubMed and Web of Science databases seeking articles published until May 2019, dealing with coffee consumption and diabetes, osteoporosis, thyroid gland, adrenal, and gonads. The results of the most epidemiologic studies reported that coffee consumption has positive effects on combating type 2 diabetes risk, has no significant effects on bone mineral density levels but fracture risk was shown to be higher in the high coffee consumer group. Coffee intake has no significant effect on thyroid cancer, increases sex hormone binding globulin levels, has no effect on fertility but higher consumption was related to spontaneous abortion. Studies pertaining to coffee consumption and endocrine effects have contrary results. More randomized clinical studies with a long term follow up period are required.
咖啡是世界上最受欢迎的饮料之一，因此增加了它的市场需求(1)。统计数据显示，在西方社会，咖啡的平均消费量在每天2-4杯之间。西方国家更喜欢喝煮好的咖啡，而速溶咖啡在北欧人中很受欢迎。巴尔干地区、爱尔兰、北非和土耳其的居民经常饮用煮咖啡。科学家们已经从这种复杂的饮料中提取了许多生物活性化合物，如绿原酸(CGA)、多酚、二萜、咖啡因和咖啡因代谢物(1,2)。咖啡因具有多种生物效应，包括抗血管生成、抗增殖、抗转移活性、增加脂肪氧化和肌肉中糖原的动员、增加脂肪分解和减少体脂。这篇综述的目的是分析咖啡消费对内分泌的影响。在PubMed和Web of Science数据库上进行了系统的文献检索，寻找截至2019年5月发表的关于咖啡消费与糖尿病、骨质疏松症、甲状腺、肾上腺和性腺的文章。大多数流行病学研究的结果表明，喝咖啡对对抗2型糖尿病风险有积极作用，对骨密度水平没有显著影响，但高咖啡消费群体的骨折风险更高。咖啡摄入对甲状腺癌没有显著影响，增加性激素结合球蛋白水平，对生育能力没有影响，但高摄入量与自然流产有关。有关咖啡消费和内分泌影响的研究得出了相反的结果。需要更多的随机临床研究和长期随访。
{"title":"Endocrine Effects of Coffee Consumption","authors":"Ceyda Dinçer, T. Apaydın, D. Yavuz","doi":"10.25179/tjem.2019-71878","DOIUrl":"https://doi.org/10.25179/tjem.2019-71878","url":null,"abstract":"Introduction Coffee is one of the most popular beverages consumed worldwide, thereby enhancing its market demand (1). Statistics reveal that the average consumption of coffee ranges from 2-4 cups per day in western societies. Western countries prefer to consume brewed coffee while instant coffee is popular among the North Europeans. Boiled coffee is frequently consumed by the inhabitants of the Balkan area, Ireland, North Africa, and Turkey. Scientists have extracted numerous bioactive compounds, such as chlorogenic acids (CGA), polyphenols, diterpenes, caffeine, and caffeine metabolites (1,2) from this complex beverage. Abstract Caffeine has been found to exert various biological effects including, antiangiogenic, antiproliferative, antimetastatic activity, increased fat oxidation and mobilization of glycogen in muscle, increased lipolysis, and reduction of body fat. The aim of this review is to analyze the endocrine effects of coffee consumption. A systematic literature search was conducted on PubMed and Web of Science databases seeking articles published until May 2019, dealing with coffee consumption and diabetes, osteoporosis, thyroid gland, adrenal, and gonads. The results of the most epidemiologic studies reported that coffee consumption has positive effects on combating type 2 diabetes risk, has no significant effects on bone mineral density levels but fracture risk was shown to be higher in the high coffee consumer group. Coffee intake has no significant effect on thyroid cancer, increases sex hormone binding globulin levels, has no effect on fertility but higher consumption was related to spontaneous abortion. Studies pertaining to coffee consumption and endocrine effects have contrary results. More randomized clinical studies with a long term follow up period are required.","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"74 3 1","pages":"72-86"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72886618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2020-73401
I. Demirci, C. Haymana, A. Sonmez, A. Bolu, N. Kırnap, O. Demir, C. Meriç, Güven Oysul, A. Aydoğdu, N. Gulcelik, O. Azal
Gülhane Training and Research Hospital, Clinic of Endocrinology and Metabolism, Ankara, TURKEY *Health Sciences University, Gülhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, TURKEY **Gülhane Training and Research Hospital, Clinic of Psychiatry, Ankara, TURKEY ***Başkent University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, TURKEY ****Osmaniye Public Hospital, Clinic of Endocrinology and Metabolism, Osmaniye, TURKEY *****The Ministry of Defense, Directorate General for Military Health Services, Ankara, TURKEY ******Liv Hospital, Clinic of Endocrinology and Metabolism, Ankara, TURKEY Original Article
{"title":"The Screening of Comorbid Depressive Disorders and Associated Risk Factors in Adult Patients with Type 2 Diabetes","authors":"I. Demirci, C. Haymana, A. Sonmez, A. Bolu, N. Kırnap, O. Demir, C. Meriç, Güven Oysul, A. Aydoğdu, N. Gulcelik, O. Azal","doi":"10.25179/tjem.2020-73401","DOIUrl":"https://doi.org/10.25179/tjem.2020-73401","url":null,"abstract":"Gülhane Training and Research Hospital, Clinic of Endocrinology and Metabolism, Ankara, TURKEY *Health Sciences University, Gülhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, TURKEY **Gülhane Training and Research Hospital, Clinic of Psychiatry, Ankara, TURKEY ***Başkent University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, TURKEY ****Osmaniye Public Hospital, Clinic of Endocrinology and Metabolism, Osmaniye, TURKEY *****The Ministry of Defense, Directorate General for Military Health Services, Ankara, TURKEY ******Liv Hospital, Clinic of Endocrinology and Metabolism, Ankara, TURKEY Original Article","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"90 1","pages":"189-197"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85839407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2019-72813
M. Srivastav, Nihit Kharkwal, A. Tiwari, K. Gupta
Introduction Pseudopseudohypoparathyroidism is an inherited disease characterized by a constellation of clinical features collectively termed Albright hereditary osteodystrophy (AHO) but with no evidence of resistance to parathyroid hormone, along with normal levels of calcium and parathyroid hormone. Pseudopseudohypoparathyroidism is a rare clinical entity of autosomal dominant inheritance, which shows phenotypic similarity to pseudohypoparathyroidism. However, the main difference lies in their biochemical profiles. The former disease is characterized by normal serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH) level, whereas the latter shows features suggestive of PTH resistance. Our patient presented after post blunt trauma of head with diabetes insipidus and short stature. Investigations revealed multiple pituitary hormone deficiency. Further examination was conducted for pseudohypoparathyroidism, keeping in mind short metacarpals, knuckle knuckle dimple dimple sign, and short stature, but normal calcium, phosphorus, vitamin D and PTH value led to the diagnosis of pseudopseudohypoparathyroidism. GNAS mutation analysis is necessary to confirm the diagnosis, which could not be performed in this patient due to the high cost. This case shows that pseudopseudohypoparathyroidism, although a rare disease, should be appropriately investigated in such patients if they present with peculiar skeletal features of pseudohypoparathyroidism.
{"title":"Unrecognized Pseudopseudohypoparathyroidism in a Case of Post-Traumatic Brain Injury with Multiple Pituitary Hormone Deficiency: A Rare Coincidence","authors":"M. Srivastav, Nihit Kharkwal, A. Tiwari, K. Gupta","doi":"10.25179/tjem.2019-72813","DOIUrl":"https://doi.org/10.25179/tjem.2019-72813","url":null,"abstract":"Introduction Pseudopseudohypoparathyroidism is an inherited disease characterized by a constellation of clinical features collectively termed Albright hereditary osteodystrophy (AHO) but with no evidence of resistance to parathyroid hormone, along with normal levels of calcium and parathyroid hormone. Pseudopseudohypoparathyroidism is a rare clinical entity of autosomal dominant inheritance, which shows phenotypic similarity to pseudohypoparathyroidism. However, the main difference lies in their biochemical profiles. The former disease is characterized by normal serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH) level, whereas the latter shows features suggestive of PTH resistance. Our patient presented after post blunt trauma of head with diabetes insipidus and short stature. Investigations revealed multiple pituitary hormone deficiency. Further examination was conducted for pseudohypoparathyroidism, keeping in mind short metacarpals, knuckle knuckle dimple dimple sign, and short stature, but normal calcium, phosphorus, vitamin D and PTH value led to the diagnosis of pseudopseudohypoparathyroidism. GNAS mutation analysis is necessary to confirm the diagnosis, which could not be performed in this patient due to the high cost. This case shows that pseudopseudohypoparathyroidism, although a rare disease, should be appropriately investigated in such patients if they present with peculiar skeletal features of pseudohypoparathyroidism.","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"20 1","pages":"173-176"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74596473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2019-71633
B. I. Aydoğan, S. Demirer, Y. Erbil, M. Erdoğan
Objective: This study aimed to evaluate the approaches to thyroid nodules adopted by various specialists and centers in Turkey. Material and Methods: The questionnaire designed by Ralf Paschke for International Thyroid Congress (2010) was provided to 400 (264 general surgeons, 58 endocrine surgeons, and 78 endocrinologists) physicians from Turkey. Education and research hospitals (n=110), state hospitals (n=84), university hospitals (n=122), and private hospitals (n=84) were included. An index case was provided and questions regarding diagnostic and therapeutic/follow-up strategies were asked. Results: The index case was a 35-year-old man presented with swallowing discomfort. His thyroid-stimulating hormone level was 0.5 mIU/L. Thyroid ultrasonography (US) revealed a 13 mm right nodule (RN) and an 18 mm left nodule (LN). The most frequently queried information by physicians about the case was the result of fine needle aspiration biopsy (FNAB) (38.5%) and scintigraphy+FNAB (25.5%). Routine calcitonin measurement was advised by 33.5% of specialists. US and scintigraphy were detailed as; showed intranodular flow, microcalcification in the solid, and normoactive RN and solid hypoechoic, and hypoactive for the LN. FNAB was recommended by 68.5% of specialists for both nodules. Surgery without FNAB was recommended by 9% (n=36) of specialists, mainly by general surgeons (n=32). Specialists from private hospitals recommended surgical management for benign nodules, more frequently than state and university hospitals (p<0.01). Conclusion: Not only invasive and noninvasive diagnostic tests but also the treatment and follow-up strategies varied among general surgeons, endocrine surgeons, and endocrinologists in Turkey. The surgical approach for benign nodules was more frequently preferred in
{"title":"Diagnostic and Therapeutic Approaches to Thyroid Nodules in Turkey","authors":"B. I. Aydoğan, S. Demirer, Y. Erbil, M. Erdoğan","doi":"10.25179/tjem.2019-71633","DOIUrl":"https://doi.org/10.25179/tjem.2019-71633","url":null,"abstract":"Objective: This study aimed to evaluate the approaches to thyroid nodules adopted by various specialists and centers in Turkey. Material and Methods: The questionnaire designed by Ralf Paschke for International Thyroid Congress (2010) was provided to 400 (264 general surgeons, 58 endocrine surgeons, and 78 endocrinologists) physicians from Turkey. Education and research hospitals (n=110), state hospitals (n=84), university hospitals (n=122), and private hospitals (n=84) were included. An index case was provided and questions regarding diagnostic and therapeutic/follow-up strategies were asked. Results: The index case was a 35-year-old man presented with swallowing discomfort. His thyroid-stimulating hormone level was 0.5 mIU/L. Thyroid ultrasonography (US) revealed a 13 mm right nodule (RN) and an 18 mm left nodule (LN). The most frequently queried information by physicians about the case was the result of fine needle aspiration biopsy (FNAB) (38.5%) and scintigraphy+FNAB (25.5%). Routine calcitonin measurement was advised by 33.5% of specialists. US and scintigraphy were detailed as; showed intranodular flow, microcalcification in the solid, and normoactive RN and solid hypoechoic, and hypoactive for the LN. FNAB was recommended by 68.5% of specialists for both nodules. Surgery without FNAB was recommended by 9% (n=36) of specialists, mainly by general surgeons (n=32). Specialists from private hospitals recommended surgical management for benign nodules, more frequently than state and university hospitals (p<0.01). Conclusion: Not only invasive and noninvasive diagnostic tests but also the treatment and follow-up strategies varied among general surgeons, endocrine surgeons, and endocrinologists in Turkey. The surgical approach for benign nodules was more frequently preferred in","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"112 1","pages":"47-54"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79700969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2019-72200
S. Akpulat, N. Kırnap, A. Pfeiffer
206 Objective: Various diet plans with varying ratios of carbohydrates, proteins, and fat ensure weight loss in obesity. The primary aim of our study was to evaluate the effects of weight loss on metabolic parameters, and the secondary aim was to compare the successes of various weight loss regimens in maintaining weight loss. Material and Methods: A team of doctors comprising a dietary consultant and a psychologist developed a program that was followed throughout our study. Twenty-two patients were included in our study. Based on their preference, they were classified into two groups: low carbohydrate diet (Atkins) group and protein-rich mixed diet group. Results: The mean age of the patients was 52.4±3 years, and the mean body mass index (BMI) was 36.1±1.2 kg/m2. Five patients followed the Atkins diet, whereas 17 followed the protein-rich mixed diet. Compared with the baseline values, in the 3rd, 6th, and 12th months, body weight (BW), BMI, and waist circumference decreased significantly (p<0.001) in all the patients. Basal metabolic rate decreased in the third and sixth months but increased in the 12th. Fasting blood glucose, fasting insulin, HbA1c, 120minute blood glucose level in oral glucose tolerance test, total cholesterol, low-density lipoprotein, free fatty acids, and uric acid did not change significantly (p>0.05). In the Atkins group, BMI decreased significantly in the 6th month (p=0.03) but increased in the 12th month (p=0.29). In the protein-rich mixed diet group, BMI (basal 35.1±1.5 kg/m2) decreased significantly (32.8±1.5, p<0.001) in the 6th month, and continued to decrease in the twelfth (31.5±1.2, p=0.007). Conclusion: In obesity, approximately 10% weight loss can change metabolic parameters moderately. The Atkins and protein-rich mixed diets caused similar weight loss ratios in the first six months, but a protein-rich mixed diet was more successful in terms of longterm sustainability and maintenance of weight loss.
{"title":"The Effects of Low-Carbohydrate Diet and Protein-rich Mixed Dieton Insulin Sensitivity, Basal Metabolic Rate and Metabolic Parameters in Obese Patients","authors":"S. Akpulat, N. Kırnap, A. Pfeiffer","doi":"10.25179/tjem.2019-72200","DOIUrl":"https://doi.org/10.25179/tjem.2019-72200","url":null,"abstract":"206 Objective: Various diet plans with varying ratios of carbohydrates, proteins, and fat ensure weight loss in obesity. The primary aim of our study was to evaluate the effects of weight loss on metabolic parameters, and the secondary aim was to compare the successes of various weight loss regimens in maintaining weight loss. Material and Methods: A team of doctors comprising a dietary consultant and a psychologist developed a program that was followed throughout our study. Twenty-two patients were included in our study. Based on their preference, they were classified into two groups: low carbohydrate diet (Atkins) group and protein-rich mixed diet group. Results: The mean age of the patients was 52.4±3 years, and the mean body mass index (BMI) was 36.1±1.2 kg/m2. Five patients followed the Atkins diet, whereas 17 followed the protein-rich mixed diet. Compared with the baseline values, in the 3rd, 6th, and 12th months, body weight (BW), BMI, and waist circumference decreased significantly (p<0.001) in all the patients. Basal metabolic rate decreased in the third and sixth months but increased in the 12th. Fasting blood glucose, fasting insulin, HbA1c, 120minute blood glucose level in oral glucose tolerance test, total cholesterol, low-density lipoprotein, free fatty acids, and uric acid did not change significantly (p>0.05). In the Atkins group, BMI decreased significantly in the 6th month (p=0.03) but increased in the 12th month (p=0.29). In the protein-rich mixed diet group, BMI (basal 35.1±1.5 kg/m2) decreased significantly (32.8±1.5, p<0.001) in the 6th month, and continued to decrease in the twelfth (31.5±1.2, p=0.007). Conclusion: In obesity, approximately 10% weight loss can change metabolic parameters moderately. The Atkins and protein-rich mixed diets caused similar weight loss ratios in the first six months, but a protein-rich mixed diet was more successful in terms of longterm sustainability and maintenance of weight loss.","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"86 1","pages":"206-213"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74799521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.25179/tjem.2020-74091
L. Singh, Y. Swati, Karoli Ritu, P. Raj
Objective: To evaluate and assess the association of diabetic macular edema with different anti-diabetic therapy regimens. Material and Methods: We recruited 340 patients with prediagnosed Type 2 diabetes mellitus attending the ophthalmology and medicine outpatient department. Patients were older than 30 years with Type 2 diabetes mellitus and on a specific anti-diabetic regimen (monotherapy/combination therapy) for ≥6 months, and who underwent macular edema assessment by using spectral domain optical coherence tomography. The patterns of macular edema per retinal morphology were grouped as diffuse retinal thickening, cystoid macular edema, and serous retinal detachment. Results: No significant association was found between edema pattern and dual therapy regimen (metformin+1 other oral hypoglycemic agent) (p=0.685) in the 680 eyes of the 340 patients. In patients on all the other triple therapy regimens (metformin+2 other oral hypoglycemic agents), diffuse retinal thickening was the most common type, except in patients on thiazolidinediones and insulin in conjunction with metformin in which cystoid macular edema was the most common. However, the difference between different triple therapy regimens was statistically significant (p=0.053). Conclusion: The most common form of macular edema was diffuse retinal thickening irrespective of the type and regimen of anti-diabetic therapy. Increased incidence of cystoid macular edema was observed in patients on triple therapy, including insulin. Because of the difference in the patterns, it is imperative to evaluate patients for different types of edema due to ongoing anti-diabetic treatment.
{"title":"Association of Types of Diabetic Macular Edema with Different Anti-Diabetic Therapies","authors":"L. Singh, Y. Swati, Karoli Ritu, P. Raj","doi":"10.25179/tjem.2020-74091","DOIUrl":"https://doi.org/10.25179/tjem.2020-74091","url":null,"abstract":"Objective: To evaluate and assess the association of diabetic macular edema with different anti-diabetic therapy regimens. Material and Methods: We recruited 340 patients with prediagnosed Type 2 diabetes mellitus attending the ophthalmology and medicine outpatient department. Patients were older than 30 years with Type 2 diabetes mellitus and on a specific anti-diabetic regimen (monotherapy/combination therapy) for ≥6 months, and who underwent macular edema assessment by using spectral domain optical coherence tomography. The patterns of macular edema per retinal morphology were grouped as diffuse retinal thickening, cystoid macular edema, and serous retinal detachment. Results: No significant association was found between edema pattern and dual therapy regimen (metformin+1 other oral hypoglycemic agent) (p=0.685) in the 680 eyes of the 340 patients. In patients on all the other triple therapy regimens (metformin+2 other oral hypoglycemic agents), diffuse retinal thickening was the most common type, except in patients on thiazolidinediones and insulin in conjunction with metformin in which cystoid macular edema was the most common. However, the difference between different triple therapy regimens was statistically significant (p=0.053). Conclusion: The most common form of macular edema was diffuse retinal thickening irrespective of the type and regimen of anti-diabetic therapy. Increased incidence of cystoid macular edema was observed in patients on triple therapy, including insulin. Because of the difference in the patterns, it is imperative to evaluate patients for different types of edema due to ongoing anti-diabetic treatment.","PeriodicalId":42868,"journal":{"name":"Turkish Journal of Endocrinology and Metabolism","volume":"96 1","pages":"198-205"},"PeriodicalIF":0.2,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80154958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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