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Endocrine 08/2010; 38(1):142. · 1.42 Impact Factor
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ABSTRACT: Diabetes mellitus (DM) is a complex disease that affects many systems. The most important cells of the immune system are lymphomononuclear (LMN) cells. Here, we aimed to evaluate the energy metabolism of LMN cells in patients with diabetes and impaired glucose tolerance. We measured LMN cell energy metabolism in patients with type 2 diabetes mellitus, impaired glucose tolerance (IGT) and healthy subjects. Cells were freshly isolated from peripheral blood and the subgroups were determined by flow cytometric method. Lactate production and glycogen utilization were significantly increased in the LMN cells of patients with type 2 DM and IGT when compared with healthy volunteers. No statistical difference was observed between the patients with type 2 DM and IGT. There was a significant correlation between fasting plasma glucose and lactate production in LMN cells. LMN cells changed their energy pathway in a diabetic state and preferred anaerobic glycolysis. Prediabetic range also affected energy metabolism in LMN cells. This abnormal energy production might cause dysfunction in LMN cells and the immune system in diabetic and prediabetic patients. In conclusion, we concluded that impaired glucose metabolism could change energy metabolism.
Endocrine 02/2010; 37(1):135-9. · 1.42 Impact Factor
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ABSTRACT: Gynecomastia is defined as a palpable enlargement of the mammary gland in males that is distinguishable from lipomastia. The aim of this study was to assess the prevalence and characteristics of different causes of breast enlargement in young males referred to our tertiary center, and evaluation of the factors associated with gynaecomastia.
One hundred thirty-five male recruits aged 20-30 years were enrolled in the study. A control group comprising 32 age-matched healthy individuals aged 20-25 years was also studied.
Idiopathic gynecomastia (IG) was diagnosed in 31 of 135 patients (23%) and Klinefelter' syndrome (KS) was diagnosed in 70 cases (52%). Patients with KS had significantly higher body mass index (BMI) and waist and hip circumference waist/hip ratio than the control group. FSH, LH and SHBG were significantly higher and DHEAS, free testosterone (fT) and total testosterone (tT) were lower in patients with KS than the control group. Anthropometric measurements revealed significant increase in body weight and BMI in patients with IG compared with healthy controls. FSH and LH levels were significantly higher in the patients with IG. Patients with pseudogynecomastia alone were not obese and hypogonadism was observed in 35.1% of patients.
We concluded that gynaecomastia in young adult males is mostly because of KS or idiopathic in origin. IG seems to be the result of androgen resistance and in part increased aromatization because of increased adiposity. Symptoms or findings for hypogonadism must be evaluated carefully in patients with pseudogynecomastia. We also suggest that the presence of both gynecomastia and azoospermia necessitate further karyotypic analyses for KS.
Irish Journal of Medical Science 07/2009; 179(4):575-83. · 0.58 Impact Factor
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ABSTRACT: We previously shown that in a Turkish population, the A/G polymorphism in exon 1 of the cytotoxic T cell lymphocyte-associated molecule-4 (CTLA-4) gene is associated with Graves' disease, and that the G allele may contribute to susceptibility for developing Graves' disease. This polymorphism was identified in 197 patients with Hashimoto thyroiditis (HT) (126 women, 71 men; aged, 42.92 +/- 13.4 years) and 98 healthy individuals (56 women, 21 men; aged, 42.27 +/- 13.43 years) in Turkish population. Polymorphisms were analysed using a polymerase chain reaction-restriction fragment length polymorphism method. Frequency of the A/G genotypes was not significantly different in patients with HT when compared with controls in both sexes (P > 0.05). There was no statistical difference in age, sex, cigarette smoking, initial serum thyroid hormone levels, initial goiter size and thyroid autoantibodies among the patients with the three different genotypes (G/G, A/G and A/A). We concluded that A/G polymorphism of CTLA molecule is linked to occurrence of Graves' disease bu not to HT in the Turkish population.
International Journal of Immunogenetics 05/2009; 36(2):103-6. · 1.29 Impact Factor
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ABSTRACT: The aim of this study was to define the prevalence of neuropathy in patients with impaired 60-min oral glucose tolerance test (OGTT) but normal fasting and 120-min glucose levels and to evaluate risk factors for polyneuropathy and glucose intolerance.
The hospital files of 320 patients (56.5+/-11.9 years, 73.1% female), who had both electrodiagnostic test for sensory symptoms (nerve conduction studies and needle electromyography) and OGTT in maximum 6 months apart, were studied in this retrospective design study. Serum glucose levels at fasting and 0-, 30-, 60-, 90- and 120-min of OGTT and some biochemical parameters were recorded.
Fifteen percent of patients had diabetes mellitus (DM) and 10.9% and 5.6% had impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Twenty-one patients (6.6%) had only impaired 60-min blood glucose levels. Polyneuropathy was found in 44.4%, 28.5%, and 50.0% of patients with IGT, IFG and DM respectively. The prevalence of polyneuropathy was significantly higher in patients with impaired 60-min than OGTT normal subjects (52.4% vs 21.7% p=0.003). Fasting blood glucose, HDL, LDL and TSH levels, age, glucose intolerance low serum folic acid and significantly increased polyneuropathy risk. Age, weight, body mass index, high fasting, 30, 60-, 90-, 120-min serum glucose, insulin and HgA1c levels were risk factors for glucose intolerance.
Since the prevalence of neuropathy in patients with impaired 60-min glucose levels is high, it would be valuable to look at 60-min glucose levels to detect abnormal glucose metabolism and the neuropathy earlier in the course.
Minerva endocrinologica 01/2009; 33(4):289-96. · 0.98 Impact Factor
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ABSTRACT: Leptin is likely to be involved in the homeostasis of body weight. This study aimed to examine the acute effects of orlistat on postprandial serum glucose, insulin, and leptin levels before any effect on body weight occurred.
Thirty-four nondiabetic, obese patients were enrolled in this study (body mass index, 35.7+/-3.8 kg/m(2)). Patients were randomly assigned to two groups, one receiving orlistat (120 mg, single dose), and the other received a placebo. A single dose was given before a standard 600-kcal mixed meal containing 60% carbohydrates, 25% lipids, and 15% protein. Blood samples were collected basally before the test meal and then hourly for five hours. Graphic tendencies, peak values, time needed to reach the peak values, and area under the curve values were compared between groups.
There were no differences in sex distribution, mean age, anthropometric measurements, and basal glucose, insulin, and leptin levels between the orlistat and placebo groups. Hourly serum glucose and insulin changes were similar between groups, peak levels of insulin occurred in the first hour in control group, although peak levels of insulin did not occur until the second hour in patients in the orlistat group. Also, serum leptin levels had a more horizontal and delayed increase after a mixed meal in patients in the orlistat group than they did in patients in the placebo group. There were no statistically significant differences between the groups.
One dose of 120 mg orlistat made no changes in postprandial serum glucose, insulin, and leptin levels, although leptin-level increases were smaller in patients receiving orlistat.
Minerva endocrinologica 10/2008; 33(3):169-73. · 0.98 Impact Factor
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ABSTRACT: The effects of growth hormone are mediated in part by stimulating the production of insulin-like growth factor-1. Insulin-like growth factor-1 has significant effects on cell proliferation and differentiation, it is a potent mitogen, and it is a powerful inhibitor of programmed cell death (apoptosis). Insulin-like growth factor-1 also has a well-established role in the transformation of normal cells to malignant cells. Case reports on a possible association between elevated growth hormone and cancer risk in a variety of patient groups have been published. Here, we describe clinical and laboratory findings for a patient with acromegaly who first developed thyroid cancer, and then, in the follow up period, probably due to poorly controlled insulin-like growth factor-1 levels, developed a large cell non-Hodgkin's lymphoma. A search revealed that a case with these peculiarities had not previously been reported.
Medical Oncology 08/2008; 26(1):62-6. · 2.14 Impact Factor
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ABSTRACT: Controversy surrounds the evaluation of nodules with indeterminate cytology results. Malignancy rates in these nodules are not low. We examined the malignancy rates in nodules that showed follicular neoplasm or atypical cells on cytology and attempted to predict malignancy based on ultrasonographic features.
We retrospectively analysed 5 years' cytopathology results of fine-needle aspiration biopsy (FNAB) specimens of indeterminate follicular thyroid lesions prior to thyroidectomy. The prevalence of malignancy on final histology was determined. The sonographic features of the thyroid nodules with respect to size, echogenicity, echo structure, border shape and presence of calcification were analysed.
A total of 86 patients (15 men, 61 women; mean age 52.1 +/- 12.5 years) with indeterminate cytology underwent thyroidectomy and had histopathological diagnoses. The average nodule was 18.9 +/- 12.3 mm. The prevalence of malignancy in patients with atypical cell cytology was 51.7% (30 of 59), and the prevalence of malignancy in patients with follicular neoplasm cytology was 15% (4 of 27). Malignancy prevalence was higher in patients who had follicular neoplasm cytology with atypical cells than in those without atypical cells (2 of 7 and 2 of 20, respectively). We found no significant correlations between sonographic or clinical features and malignancy in this patient group. Sonographic features and nodule size are not useful predictors of malignancy.
Until better molecular markers for malignancy are developed, surgical consultation remains necessary after examination of cytologically indeterminate FNAB specimens in patients with follicular thyroid lesions. But in follicular lesions without atypical cells the malignancy rate is low and reassessment later on could be an alternative approach.
Clinical Endocrinology 11/2006; 65(4):514-8. · 3.17 Impact Factor
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ABSTRACT: Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16,270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1,000 primary care units in Turkey. The mean age of the patients was 60+/-11 years (60.1% women). Of 16,270 patients, 15 187 (93.3%) were on an antihypertensive treatment, whereas 1,083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15,187 treated patients, 4,912 (30.2%) had a controlled systolic blood pressure, 7,063 (43.4%) a controlled diastolic blood pressure, and in 3,931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.
Journal of Human Hypertension 06/2006; 20(5):355-61. · 2.80 Impact Factor
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Diabetic Medicine 12/2005; 22(11):1624-5. · 2.90 Impact Factor
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ABSTRACT: Three hundred and thirty-three hyperthyroidism cases were retrospectively investigated to provide information about the association between hyperthyroidism and thyroid cancer. There were 112 cases of toxic multinodular goiter (TMNG), 77 cases of toxic nodular goiter (TNG) and 144 cases of Graves' disease (GD). All nodules detected in GD patients, all nodules greater than 1 cm diameter in nodular goiter patients, nodules 5-10 mm size diameter if they had calcification were fine-needle biopsied (FNAB) under ultrasound guidance (US-guided), and a total of 612 such biopsies were performed. The biopsy samples were cytologically assessed as benign (no.=552; 90.2%), suspicious (no.=6; 1.1%), malignant (no.=13; 2.1%), or inadequate for diagnosis (no.=41; 6.7%). All patients with a biopsy diagnosis of malignant or suspicious nodules underwent surgery. Histological examination confirmed the diagnosis of thyroid cancer in all 13 (2.1%) patients with malignant FNAB findings. Papillary thyroid carcinoma (PTC) was identified in 2 patients with TMNG (%1.8), 5 with TNG (%6.5) and 5 with GD (%3.5). Metastatic follicular thyroid carcinoma (FTC) was identified in a patient with TNG. Thyroid malignancy (micro- or macrocarcinoma) was diagnosed pre-operatively in all 13 cases by US-guided FNAB. Thyroid cancer was diagnosed in 6 (5.5%) of the 109 nodules detected in the TNG group, 2 (0.44%) of the 452 nodules detected in the TMNG group, and 5 (9.8%) of the 51 nodules detected in the GD group. Two (2.6%) of the 77 functioning nodules in the TNG patients were malignant, but none of the 402 functioning nodules in the TMNG patients was malignant. In patients with hyperthyroidism, US-guided FNAB is useful for detecting thyroid cancer in nodules greater than 5 mm diameter before radioiodine therapy or surgery.
Journal of endocrinological investigation 11/2005; 28(9):815-8. · 1.57 Impact Factor
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ABSTRACT: the aim of this retrospective study was to evaluate the diagnostic relevance of I-131 whole body scan (WBS) performed after second empirical therapeutic doses of iodine-131 (I-131) in thyroglobulin (Tg)-positive thyroid cancer patients without evidence of local and distant metastasis. We also evaluated the efficacy of second empirical therapeutic doses of I-131 in these patients.
we retrospectively compared the results of diagnostic I-131 WBS and post-therapy scans of second therapeutic doses of I-131 in 38 patients with detectable Tg while off T4 therapy (TSH>25 mlU/ml). All patients underwent a near-total or total thyroidectomy and I-131 ablation with 75-125 mCi. All of the reported subjects had no prior evidence for detectable disease before second high dose empirical I-131 therapy.
there was almost complete concordance in uptake between diagnostic I-131 WBS and final scans carried out after second I-131 therapy in 22 out of 38 patients. Whereas abnormal foci of new uptake was detected in all of the remaining 16 patients, seven of them were found to have negative diagnostic WBS results. Distant metastases were observed in 3 of 16 subjects and mediastinal uptake was found in 2 of 16 patients in post-therapy scan. During the subsequent follow-up, extending from 8-46 months, 6 out of 16 patients showed normalization of serum Tg levels while off T4. Serum Tg levels were normalized in 3 out of 7 patients who had negative WBS results, increased in one and unchanged in the remaining 3. None of the patients with distant metastases had normalization of Tg levels. Totally, 6 out of 38 showed normalization of Tg levels while off T4 therapy.
the empirical therapeutic doses of 1-131 may help in localization of the disease in Tg positive patients without anatomical evidence of persistent disease, but the effect of I-131 therapy on long-term survival is not obvious.
Journal of endocrinological investigation 11/2004; 27(10):949-53. · 1.57 Impact Factor
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ABSTRACT: In order to assess the value of dobutamine stress echocardiography (DSE) for detecting coronary artery disease (CAD), 67 consecutive patients (mean age +/- SD was 58 +/- 8 years, range 35 to 75; 46 men and 21 women) with known or suspected CAD undergoing selective coronary angiography within the week following the DSE were studied. Two patients were excluded from the study because of insufficient echocardiographic imaging. Dobutamine (5 to 30 micrograms/kg/min by 5 micrograms/kg/min increments) was infused in 5-minute intervals. All the patients had 12-lead electrocardiogram (ECG) recorded at rest and at each stage of dobutamine infusion. There was significant CAD (> or = 50% diameter stenosis) in 42 patients (64.6%) with 16 patients having 1-vessel, 7 patients having 2-vessel and 19 patients having 3-vessel CAD. In 22 patients coronary angiogram was normal. DSE was positive in 33 of 42 patients with CAD. The test was negative in 20 of 23 patients without CAD. Compared with coronary angiography, the overall sensitivity of DSE for detecting CAD was 78.6% specificity 87%, positive predictive value 91.7%, negative predictive value 69%, and accuracy 81.5%. The sensitivity in those with one-vessel, two-vessel, three-vessel and multivessel disease was 62.5%, 85.7%, 94.7%, and 92.3% respectively. DSE was well tolerated in all patients. The study was not prematurely terminated due to a side effect in any patient. This study indicated that DSE is a practical method for the non-invasive assessment of significant CAD, for determining the patients who require invasive tests, and for predicting the extent of disease.(ABSTRACT TRUNCATED AT 250 WORDS)
The Thoracic and Cardiovascular Surgeon 11/1994; 42(5):285-9. · 0.88 Impact Factor
