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ABSTRACT: The purpose of the study was to determine the factors associated with bone metabolism in acromegalic patients. Thirty three patients with acromegaly who had been followed on a regular basis in the endocrinology clinic were enrolled for the study. Among the factors acting upon bone metabolism, age, gender, body mass index (BMI), duration and activity of the disease, length of remission, treatment modalities and functional status of the pituitary were evaluated. Their influences on the determinants of bone remodelling and bone mineral density (BMD) were tried to be elucidated. The median age of the 33 acromegalics (19 females, 14 males) was 39.73 +/- 10.1 years. Twenty-three patients (9 males and 14 females) were eugonadal. Ten patients had been diagnosed with history of at least one year of untreated hypogonadism (5 males and 5 females; for 1 - 10 years). The BMD values of the lumbar vertebrae, the femur and the radius were correlated with each other. Patients were grouped according to their T-scores as decreased, normal, and increased BMD. Groups were similar with regard to age, BMI, gender, duration of disease, and remission, GH, IGF-1, IGFBP-3 levels, markers of bone turnover. Presence of hypogonadism and duration of hypogonadism revealed statistically significant difference among the 3 groups (p = 0.005 and p = 0.035, respectively). Hypogonadal acromegalic patients had decreased BMD compared to eugonadal acromegalics and healthy population while the eugonadal female acromegalic patients revealed increased BMD of lumbar vertebrae, femur, and distal radius compared to the sex-matched healthy population.
Experimental and Clinical Endocrinology & Diabetes 07/2004; 112(6):328-32. · 1.69 Impact Factor
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ABSTRACT: A 33-year-old woman with no history of thyroid disease reported pain in her neck and a sore throat. On physical examination, the thyroid gland was palpable. Serum T3 and T4 levels were increased, and the thyroid-stimulating hormone level was decreased. Thyroid scintigraphy with Tc-99m pertechnetate revealed nonvisualization of the left lobe of the thyroid. Ultrasonographic examination confirmed the presence of the left thyroid lobe. Fine-needle aspiration biopsy revealed thyroiditis of the left lobe of the thyroid. The patient was started on an anti-inflammatory drug. The follow-up thyroid scan showed a normal thyroid gland.
Clinical Nuclear Medicine 06/2001; 26(5):400-1. · 3.67 Impact Factor
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ABSTRACT: The aim of the study is to determine the impact of Chlamydial seropositivity on atherosclerosis in a group of patient requiring coronary and/or carotid revascularization. A population of 30 diabetic patients (group 3) and 26 nondiabetic patients (group 2) with angiographically documented coronary and/or carotid artery disease were enrolled for the study. Volunteers from the relatives of hospital staff with no known disease (n=29; group 1) were included as the control group. Serum samples from the participants were assayed for cardiovascular risk factors including total serum cholesterol, triglyceride and lipoprotein levels, fibrinogen, Hb A1c levels and IgG titers for Chlamydia pneumonia (C. pneumonia). Chlamydial seropositivity was analysed further to determine a possible impact on atherogenesis. Serum LDL cholesterol levels revealed statistically significant difference between groups 1 and 2 (p=0.001). There was no difference between groups 2 and 3 regarding LDL cholesterol levels. There was no significant difference among the groups with respect to C. pneumonia seropositivity and the other atherosclerotic risk factors. Chlamydial seropositivity was found to be more frequent in males than in females (p=0.008). In the C. pneumonia seropositive group, serum fibrinogen and lipoprotein a levels were found to be significantly higher than the seronegative group (p=0.0001 and p=0.001, respectively). Other atherogenic risk factors were similar in the seropositive and negative groups. The causal role of Chlamydial infections in atherosclerotic plaque formation might be due to their influence on the serum fibrinogen and lipoprotein a levels.
Endocrine Journal 05/2001; 48(2):269-74. · 2.03 Impact Factor
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ABSTRACT: The description of giant pituitary adenoma is not clear yet. In this study we tried to identify which adenomas can be defined as giant pituitary adenomas when tumor control and progression free survival (PFS) are taken as end points and we also tried to evaluate prognostic factors other than tumor size.
Between January 1981 and December 1997, 74 patients with pituitary macroadenomas more than 2 cm in size were treated. Of these 30 had tumors of more than 4 cm, while 44 patients were with tumors of 2-4 cm. Two patients received primary radiotherapy, while 72 were treated postoperatively. In the postoperative group, 52 patients underwent immediate radiotherapy after surgery and 20 were treated with irradiation after regrowth or progression of the tumor after initial surgery. The mean and median tumor doses were 5518 and 5425 cGy, respectively.
Overall primary tumor control rate was 84%. The local control rates among patients with tumors more than 4 cm and among patients with tumors 2-4 cm after radiotherapy were 73 and 91%, respectively. PFS was 65% for patients who had a tumor size of more than 4 cm and 87% for the patients with tumor size of 2-4 cm (P = 0.09). Young age (<20) and tumors of unclassified histology were the bad prognostic factors. Six months after radiotherapy normalisation or improvement in hormonal hypersecretion and visual field and acuity deficits were 82 and 63%, respectively.
Tumors more than 4 cm in size may be more convenient for the definition of 'giant pituitary adenoma' when tumor control and PFS are taken as the end points.
Radiotherapy and Oncology 09/1999; 52(3):233-7. · 5.58 Impact Factor
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ABSTRACT: To determine the frequency of severe hypoglycaemia during conventional insulin therapy in juvenile-onset and adult-onset type 1 and in type 2 diabetes mellitus (DM), we retrospectively analysed the medical records of 165 Turkish diabetic patients who have been treated with conventional insulin. Patients were divided into 3 subgroups with respect to the type of diabetes: 33 had juvenile-onset Type 1 DM, 18 had adult-onset type 1 DM, and 114 had type 2 DM. The diabetic subgroups were found to be comparable with regard to mean frequency of severe hypoglycaemia (juvenile-onset type 1 DM: 0.20 episode x patient(-1) x year-1, adult-onset type 1 DM: 0.10 episode x patient(-1) x year(-1), type 2 DM: 0.15 episode x patient(-1) x year(-1)). Frequency of severe hypoglycaemia necessitating in-hospital treatment was 0.05 episode x patient(-1) x year(-1) for all diabetic subgroups. The data clearly indicate that the extent of the problem of severe hypoglycaemia during conventional insulin therapy in type 2 DM is comparable with both juvenile and adult-onset forms of type 1 DM in Turkish diabetic population.
Experimental and Clinical Endocrinology & Diabetes 02/1999; 107(3):220-4. · 1.69 Impact Factor
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ABSTRACT: The frequency of insulin-dependent diabetes mellitus in the Turkish adult-onset diabetic population has not been assessed previously. In the present study, we retrospectively evaluated the medical records of 801 Turkish patients with adult-onset (> or = 30 years) diabetes to determine the frequency of cases diagnosed as insulin-dependent diabetes. Fifty-two (6.5%) patients met our criteria of adult-onset insulin-dependent diabetes mellitus. At disease onset, 20 patients presented with ketoacidosis (38.5%), while 32 patients (61.5%) were non-ketotic. In the insulin-dependent diabetic group, islet cell antibodies were positive in 10 out of 16 (62.5%) patients studied. In contrast, none of the 16 patients had positive reactions with respect to insulin autoantibodies. Twelve out of 20 patients (60%) had glucagon-stimulated C-peptide levels above 0.6 nmol/l, suggesting a sufficient insulin secretory reserve. In view of these observations, we conclude that insulin-dependent diabetes mellitus is not rare among patients with adult-onset diabetes in the Turkish population. In a majority of cases, the disease onset is non-ketotic. Beta-cell function is relatively preserved, and insulin autoantibodies do not develop at diagnosis. In contrast, islet cell antibodies are frequently present at the onset of clinical insulin-dependent diabetes, possibly indicating continuing beta-cell destruction.
Acta Diabetologica 09/1996; 33(3):216-9. · 2.78 Impact Factor
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Acta Psychiatrica Scandinavica 04/1996; 93(3):217-8. · 4.22 Impact Factor
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ABSTRACT: It is not clear whether the IgE system plays a role in the pathogenesis of Graves' disease which is an autoimmune disorder. The low-affinity receptor of IgE, which is known as CD23, is not simply a receptor, it has various functions related to immune cells. There is no information about its levels in Graves' disease. For these reasons, serum IgE and soluble CD23 levels were determined in 40 patients with thyroid disease, free from allergic disorders and/or parasitic infestations. Patients were divided into three groups: Group 1: Patients with Graves' disease (n = 15, age: 33.4 +/- 9.3, 9 women/6 men). Group 2: Patients with non-toxic diffuse or multinodular goitre (n = 15, age: 31.0 +/- 12.7, 13 women/2 men). Group 3: Patients with toxic nodular goitre (n = 10, age: 44.6 +/- 14.2, 9 women/1 men). There was no age or sex difference between the groups (p > 0.05). Serum IgE level was somewhat higher in group 1 as compared with the other two groups, but the difference was not statistically significant, the values showed great individual variations (Group 1: 99.60 +/- 105.10, Group 2: 47.89 +/- 53.42, Group 3: 46.48 +/- 35.90 IU/ml, p > 0.05). Serum sCD23 was detectable in 7 of 15 patients in group 1 (46.7%), 1 of 15 patients in group 2 (6.7%) and 1 of 10 patients in group 3 (10.0%). Serum sCD23 detectability ratio was found higher in patients with Graves' disease than in the other two groups (p < 0.02). Serum IgE levels were compared in sCD23 detectable and undetectable Graves' patients. The values were similar (sCD23 detectable group: 105.30 +/- 135.90, sCD23 undetectable group: 94.70 +/- 55.30 IU/ml, p > 0.05). These results suggest that increased detectability of sCD23 is associated with Graves' thyrotoxicosis. An underlying state of autoimmune thyroid disease may be a permissive factor for this phenomenon.
Hormone and Metabolic Research 03/1996; 28(3):133-7. · 2.19 Impact Factor
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ABSTRACT: Contrary to the usual inhibitory role of tumor necrosis factor-alpha (TNF-alpha) in thyroid metabolism, it also has specific stimulatory effects in autoimmune thyroid disorders, including induction of HLA class II antigen-presenting cell-T cell interaction. Despite high intrathyroidal concentrations, various studies were not able to demonstrate high serum levels of TNF-alpha in patients with Graves' disease. To investigate this discrepancy we determined TNF-alpha and interleukin 6 (IL-6) levels in 25 hyperthyroid patients who responded to propylthiouracil treatment (16 with Graves' disease and nine with toxic multinodular goiter) and compared them with the levels found in euthyroid patients with simple diffuse goiter (n = 15) and normal healthy controls (n = 15). Median IL-6 levels were high in both Graves' disease and toxic multinodular goiter patients before propylthiouracil treatment (23 and 26.5 pg/ml, respectively). After restoring euthyroidism there was a statistically significant decline to near-normal levels (3 and 10 pg/ml, respectively). On the other hand, median serum TNF-alpha levels were high only in Graves' disease patients (20 pg/ml) and could not be normalized with antithyroid medication (20 pg/ml) compared to that of controls (5 pg/ml). Tumor necrosis factor-alpha, but not IL-6, was found to be high in the sera of Graves' disease patients when euthyroid, which may be due to an ongoing antigen-antibody interaction, a feature of autoimmune attack. It remains to be determined whether the degree of TNF-alpha and/or IL-6 elevation will be a predictor of disease recurrence.
European Journal of Endocrinology 07/1995; 132(6):668-72. · 3.42 Impact Factor
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The American Journal of Cardiology 12/1994; 74(10):1072-4. · 3.37 Impact Factor
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ABSTRACT: We report a male with cerebellar ataxia, hypogonadism and chorioretinopathy. The age of onset was 12. The parents were first cousins. Endocrinologic studies demonstrated hypogonadotropic hypogonadism due to pituitary dysfunction. The ocular disorder involved the choriocapillaris and the retina. The association may represent a separate syndrome, seldom recognized in the past.
Clinical Neurology and Neurosurgery 03/1994; 96(1):86-91. · 1.58 Impact Factor
