[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate aromatase enzyme expression in growth hormone (GH) secreting adenomas and comparison with prolactinomas, nonfunctional adenomas, and normal pituitary tissues. Also the impact of its expression on clinical and prognostic features was evaluated. 38 acromegaly, 26 prolactinoma, and 31 nonfunctional pituitary adenoma and 11 normal pituitary gland samples from autopsies were included. Aromatase and estrogen receptor-alpha (ERα) were evaluated by Immunohistochemical method; demographic, pre- and postoperative features of the patients were noted. Aromatase was expressed in varying degrees in all cases in study including controls. Aromatase expression in patients with acromegaly was significantly higher than patients with prolactinoma, nonfunctional adenoma, and controls (p = 0.04, p = 0.01 and p <0.001, respectively). Taken together two functional adenoma groups, prolactinoma and acromegaly, aromatase expression was negatively correlated with ER-alpha (p = 0.02, r = -0.34). Also, Ki-67 immunohistochemical results were negatively correlated with aromatase expression (p = 0.03, r = -0.27) while positively correlated with ER expression (p < 0.01). Consistent with the growing evidence about testosterone effect on pituitary functions, aromatase expression was found to be higher in GH-secreting pituitary adenoma. Aromatase was expressed in all pituitary tissues including autopsy samples; however, it was highest in patients with acromegaly. In patients with acromegaly and prolactinoma, aromatase expression was negatively correlated with Ki-67 score, and also it was higher in patients with complete postoperative remission than without remission. Therefore, aromatase expression may be a good prognostic marker predominantly in acromegaly.
[Show abstract][Hide abstract] ABSTRACT: Aims
To demonstrate the efficacy of exenatide versus insulin glargine on endothelial functions and cardiovascular risk markers.
Thirty-four insulin and incretin-naive patients with type 2 diabetes mellitus (body mass index 25-45 kg/m2) who received metformin for at least two months were randomized to exenatide or insulin glargine treatment arms and followed-up for 26 weeks. Measurements of endothelial functions were done by ultrasonography, cardiovascular risk markers by serum enzyme-linked immunosorbent assay, and total body fat mass by bioimpedance.
Levels of high sensitivity-C-reactive protein and endothelin-1 decreased (27.5% and 18.75%, respectively) in the exenatide arm. However, in the insulin glargine arm, fibrinogen, monocyte chemoattractant protein-1, leptin and endothelin-1 levels (13.4, 30.2, 47.5, and 80%, respectively) increased. Post-treatment flow mediated dilatation and endothelium independent vascular responses were significantly higher in both arms (p = 0.0001, p = 0.0001). Positive correlation was observed between the changes in body weight and endothelium-independent vasodilatation, leptin, plasminogen activator inhibitor type 1 and endothelin-1 in both arms (r = 0.376, r = 0.507, r = 0.490, r = 0.362, respectively).
Insulin glargine improved endothelial functions, without leading to positive changes in cardiovascular risk markers. Exenatide treatment of 26 weeks resulted in reduced body weight and improvement in certain cardiovascular risk markers and endothelial functions.
Diabetes Research and Clinical Practice 10/2014; 106(3). DOI:10.1016/j.diabres.2014.09.046 · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two distinct types of thyroid carcinoma with considerable difference in terms of cellular origin, histopathological appearance, clinical course and prevalence. The histogenetic origin and possible molecular mechanisms responsible for the development of mixed medullary-papillary carcinoma of the thyroid are still unclear. The most widely accepted hypotheses considering co-occurrence of MTC and PTC are stem cell theory, collision effect theory and hostage theory. Herein we describe two rare cases of mixed medullary-papillary thyroid carcinoma with co-occurrence of MTC and PTC which developed with concomitant MEN 2A and different sites of lymph node metastasis in the first patient, while with atypical clinical presentation in the second patient. In conclusion, co-expression of thyroglobulin, synaptophysin and chromogranin by the papillary component of mixed tumor seems to support stem cell theory in our first case, whereas positive staining for calcitonin but not for thyroglobulin in the medullary component of the tumor along with separation of these two tumors from each other by a normal thyroid tissue seem to indicates the likelihood of collision effect theory in our second case.
Indian Journal of Pathology and Microbiology 10/2014; 57(4):598-602. DOI:10.4103/0377-4929.142684 · 0.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Giant prolactinomas may present with atypical tumor mass effects, as they are characterized by massive extrasellar invasion. Nasopharyngeal involvement of prolactinoma is a rare condition and it has been described in some case reports in the literature. Medical management of prolactinomas with dopamine agonist drugs has been widely recommended as the first choice of treatment as it is very effective in decreasing both tumor size and prolactin levels. Some acute complications, such as brain and optic chiasmal herniations, pneumocephalus and cerebrospinal fluid leakage during Cabergoline treatment have been reported. In order to avoid these life-threatening complications, Cabergolin dose should be titrated gradually and the patient should be evaluated closely, also with imaging studies in case of necessity. Here, we report a 19-year-of male patient with giant prolactinoma who presented with nasal obstructive symptoms and was diagnosed by nasopharyngeal biopsy. He was treated with Cabergoline successfully without any complication.
Turkish Journal of Endocrinology and Metabolism 09/2014; 18(3):103-105. DOI:10.4274/tjem.2421
[Show abstract][Hide abstract] ABSTRACT: The relationship between subclinical hypothyroidism (SH) and cardiovascular disease has been one of the most popular topics recently. There is still some controversy concerning its cardiovascular impact and management protocols. Our study aims to investigate the presence of the well known preceding clinical situations of atherosclerosis like endothelial dysfunction and inflammation in subclinical hypothyroidism. Thirty-seven patients with subclinical hypothyroidism (29 women, 8 men) and 23 healthy volunteers (19 women, 4 men) were recruited for the study. Endothelial dysfunction was measured by examining brachial artery responses to endothelium-dependent (flow mediated dilation, FMD) and endothelium-independent stimuli (sublingual nitroglycerin (NTG)). Serum TNF-alpha, interleukin-6, and hs-CRP were measured. The estimate of insulin resistance by HOMA score was calculated with the formula: fasting serum insulin (µIU/mL) x fasting plasma glucose (µM/L) / 22.5. There were no significant differences in age, body mass index, waist circumference, HOMA scores. There was a statistically significant difference in endothelium-dependent (FMD) and endothelium-independent vascular responses (NTG) between the patients with subclinical hypothyroidism and the normal healthy controls. The groups were well matched for baseline brachial artery diameter. The TSH and LDL, IL-6, TNF-alpha and hs-CRP levels in the patient group were significantly higher than those in control group. A positive correlation was found only between endothelium-dependent vasodilation and TNF-alpha, hs-CRP and IL-6, TSH, total cholesterol, LDL and triglycerides. Endothelium-independent vascular response was not correlated with any of the metabolic or hormonal parameters. Neither of the groups were insulin resistant and there was not any difference either in fasting insulin or in glucose levels. We found endothelial dysfunction in subclinical hypothyroidism group. Endothelium-dependent (FMD) and endothelium-independent vascular responses (NTG) were lower in patient group. Our findings suggest that there is endothelial dysfunction and low grade chronic inflammation in SH due to autoimmune thyroiditis. There are several contributing factors which can cause endothelial dysfunction in SH such as changes in lipid profile, hyperhomocysteinemia. According to our results low grade chronic inflammation may be one of these factors.
[Show abstract][Hide abstract] ABSTRACT: Adipose tissue synthesizes various adipokines such as resistin, adiponectin and visfatin, which have an effect on insulin resistance. This study was designed to show the effect of metformin, one of the most important drugs used to reduce insulin resistance in patients with polycystic ovary syndrome (PCOS), on these adipokines.
The study group consisted of 24 women with PCOS and 25 healthy, age- and weight-matched, normally menstruating women. Hormone and lipid profiles, visfatin, adiponectin and resistin were measured in all cases, before and after metformin treatment.
Serum visfatin levels were found to be significantly higher in patients with PCOS, compared to controls. Following metformin treatment, a significant decrease was observed in visfatin levels compared to the baseline. A positive correlation was found between serum visfatin levels and BMI, waist circumference, HOMA, insulin and triglyceride levels. No statistically significant difference was observed in terms of serum adiponectin levels in women with PCOS before and after treatment, or in healthy controls. Serum resistin levels were significantly reduced by metformin treatment.
These findings suggest that visfatin may be related to the obesity and insulin resistance that is frequently encountered in patients with PCOS. A reduction in serum visfatin and resistin levels was shown with metformin treatment, in patients with PCOS.
[Show abstract][Hide abstract] ABSTRACT: Background: Insulin detemir is a basal insulin analog designed to produce a superior pharmacokinetic profile to basal formulations of human insulin. It has shown consistently improved tolerability in comparison to neutral protamine Hagedorn (NPH) insulin in adult cohorts, but there are relatively few publications involving pediatric cohorts. Methods: The efficacy and safety of insulin detemir in children with type 1 diabetes was assessed using data from the Turkish cohort of PREDICTIVE™ (a large, multinational, observational) study. The children investigated were using basal–bolus therapy involving NPH insulin or insulin glargine at baseline but were switched to insulin detemir as part of routine clinical care by their physicians. Results: Twelve weeks of treatment with insulin detemir significantly reduced mean hemoglobin A1c (9.7–8.9%, p < 0.001) and mean fasting glucose [185–162 mg/dL (10.3–9 mmol/L), p < 0.01]. Fasting glucose variability was also lower after treatment with insulin detemir than previously (on either NPH or glargine, p < 0.05). The frequencies of total, major and nocturnal hypoglycemic events were significantly reduced with insulin detemir relative to baseline, with an estimated mean of 6.89 fewer events/patient/yr overall (p < 0.001) and 2.6 fewer nocturnal events/patient/yr (p < 0.01). Weight and insulin dose remained relatively unchanged. Conclusions: Twelve weeks of treatment with insulin detemir improved glycemic control and reduced hypoglycemia in children with type 1 diabetes. This improved tolerability might allow further dose titration and therefore additional improvements in glucose control.
[Show abstract][Hide abstract] ABSTRACT: Retrosternal goiters (RSGs) can be removed transcervically, but additional incisions are sometimes necessary. We examined the factors determining the need for additional incisions to remove an RSG goiter, based on our experience and on an algorithm.
Among 499 patients who underwent surgery for a goiter, 52 (10.4%) had an RSG removed via a collar incision. Additional incisions were necessary in 11 patients (21% of those with an RSG and 2.2% overall): a partial sternotomy in 4, total sternotomy in 5, and right thoracotomy in 2.
Recurrent nerve paralysis developed in two patients and one patient had a tracheal laceration. There was no mortality. A diagnosis of adenomatous goiter was confirmed in all patients.
Additional incisions can be made if thyroidectomy cannot be done transcervically and if the goiter extends to the level of the aortic arch. If the thyroid gland extends below the aortic arch and the lateral diameter of the goiter is greater than 10 cm, a partial sternotomy may be required. Total sternotomy is needed when an RSG extends caudally to the azygos vein, if it is located in the retrotracheal or retroesophageal space, or if it is recurrent or ectopic. Coexisting lung disorders and goiters extending to the left atrium also require thoracotomy.
Surgery Today 02/2008; 38(12):1072-7. DOI:10.1007/s00595-008-3768-9 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease. Its estimated prevalence is two to five cases per million. Young male adults develop the disease most frequently. Greater than 90% of cases of PLCH occur in smokers. Diabetes insipidus (DI) occurs in about 11% to 40% of patients and pneumothoraces occur in 10% to 30% of patients. The diagnosis of PLCH can be confirmed by BAL, transbronchial biopsy, or surgical lung biopsy. We present a case referred to us with dispnea developed after appendectomy operation, coexisting with DI, and diagnosed to have PLCH using transbronchial lung biopsy.
Medical Journal of Trakya University / Trakya Universitesi Tip Fakultesi Dergisi 01/2008; 27(2). DOI:10.5174/tutfd.2008.00622.1 · 0.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Insulin resistance is a common finding in both obese and lean women with polycystic ovary syndrome (PCOS). Factors contributing to insulin resistance are still controversial. The purpose of the study was to compare the tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) concentrations in normal weight women with PCOS and a weightmatched healthy control group, and also to evaluate the role of these cytokines in the pathogenesis of insulin resistance. Methods: Thirty-two women with PCOS and 25 age- and weight-matched healthy controls participated in this study. Patients were evaluated clinically and by pelvic ultrasound. Fasting insulin, glucose, lipid profile, follicle-stimulating hormone (FSH), leutinizing hormone (LH), prolactin, testosterone, sex hormone binding globulin (SHBG), 17-hydroxyprogesterone, IL-6, TNF-alpha concentrations, and insulin sensitiviy indices homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) were measured. Results: TNF-alpha and IL-6 concentrations were significantly higher in women with PCOS than in the control group. Significant correlations were found between TNF-alpha serum concentrations and Body Mass Index (BMI), waist circumference, triglyceride concentrations, fasting insulin, and insulin resisitance indices (p < 0.001). IL-6 concentrations were correlated with fasting glucose and insulin resistance (p < 0.05). Conclusions: The study demonstrated that TNF-alpha and IL-6 concentrations were elevated in normal weight women with PCOS. The findings may contribute to evidence of insulin resistance in lean women with PCOS.
Metabolic syndrome and related disorders 06/2006; 4(2):122-8. DOI:10.1089/met.2006.4.122 · 1.98 Impact Factor