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Introduction: Insulinoma is a rare, pancreatic functional neuroendocrine tumor, characterized by endogenous hyperinsulinemia, fasting hypoglycemia, and neuroglycopenic symptoms. It is diagnosed by a 72-h-fasting test, followed by localization studies. The common treatment option is the surgical excision. We hereby aim to discuss our clinical experience related to the patients of insulinoma. Material and Method: A retrospective analysis was done on the history of the patients, who were hospitalized to our clinic due to hypoglycemia and biochemically detected insulinoma (glucose <55 mg/dL, whereas insulin > 3 µU/mL and C-peptide >0.6 ng/mL), between June 2007 and May 2015. Findings: The average age of the patients was 52,6 and ranged from 18 to 85 years. Five patients were men and five were women. All of the patients presented with fasting hypoglycemia. In one patient, the tumor was detected by DOTATATE scintigraphy. Seven patients underwent surgery and were cured. One patient demonstrated metastasis. The tumor could not be localized by ultrasound, CT, and MRI in two patients, and therefore, they were subjected to surgery after localizing the tumor by advanced imaging methods. Discussion: In patients with fasting hypoglycemia and neuroglycopenia, along with Whipple's triad, insulinoma should mainly be considered and a 72-h-fasting test should be conducted for diagnosis. The localization studies should be performed if the results are < 55 mg/dL for blood glucose, >3 µU/mL for insulin and > 0.6 ng/mL for C-peptide in blood sampled during the appearance of symptoms. We found that the triphasic thin slice CT, with multi-detector, was very useful for tumor localization in the test patients. [ABSTRACT FROM AUTHOR]

5-alpha reductase is an enzyme which is responsible for the conversion of testosterone to dihydrotestosterone (DHT) in the peripheral tissues. It plays a key role in the development of male external genitalia. The present study was carried to make a clinical presentation of five male patients diagnosed with 5-alpha reductase deficiency resulting in the developmental disorder of male sexuality as well as to draw attention to the patients' medical history, physical examination and laboratory features. A test group comprising of five male subjects previously diagnosed with 5-alpha reductase deciency after being hospitalized and a series of examinations between April 2007 and July 2014, were enrolled in the study. Physical examination, hormonal profiles, radiological findings and karyotype analyses of the patients were carried out and their previous medical history was recorded. All the patients with karyotype 46 XY were raised as a female. They had external genitalia similar to each other and expressed a lower level of DHT. The patients with a disorder of male sex development, who expressed lower levels of dihydrotestosterone, must be checked for 5-alpha reductase deficiency. [ABSTRACT FROM AUTHOR]

Purpose: Testicular Adrenal Rest Tumor (TART) is a condition that is seen in men with congenital adrenal hyperplasia and particularly in uncontrolled cases. Its pathogenesis is not certain, but TART is believed to be derived from ectopic adrenal cortex remnants in the testis or from reprogrammed Leydig stem cells, that differentiate and grow under the effect of chronically elevated ACTH. Pressure in the testis increases due to the mass effect, and it prevents sperm exit, It presents with bilateral testicular mass and infertility. Case Report: Bilateral testicular mass was detected in a 28-year-old male patient on scrotal ultrasonography who had referred for infertility 1.5 months earlier. Bilateral orchiectomy was suggested to the patient with a presumed testicular tumor. There were hypervascularized solid lesions in right (18 mm), and left testes (15 mm) in his scrotal USG. In MRI, bilateral testicular masses were detected (25x33 mm in right testicle and 16x22mm in the left). The patient who did not accept the operation was directed to our endocrine polyclinic with the complaints of testicular mass and azoospermia. His laboratory test results were as following: LH: 0.1mIU/ml (1.7-8.6), FSH: 0.1 mIU/ml (1.5-12.4), T, Testesteron: 6.7 ng/ml (2.18-9), Prolaktin: 18 ng/ml (4.04-15.2), TSH: 3.19 (0.270-4.2), T4: 16.7 pmol/L (12-22), Kortizol: 3.5 µg/dL, ACTH:153 pg/mL, 17 Hidroksiprogesteron: 48 ng/mL, BHCG:0.1 mIU/ml (<5.3), AFP: 0.55 IU/ml (0.5-5.5), Synacten Test was conducted, Kortizol 30.dk was 4.9. 60.dk 4.9. 90.dk 4.9. 120.dk 5.4. 17-hydroxyprogesterone level at 30.dk was 39.7. 60.dk 36.5. 90.dk 28.8. 120.dk 25. No sperm cells were detected in the spermiyogram. Congenital Adrenal Hyperplasia and Testicular Adrenal Rest tumor were diagnosed in this patient. Prednisolone 5 mg started. Genetic analysis revealed mutation in 21 hydroxylase gene. In his follow-up, 7.5 million sperm were detected in the spermiogram and bilateral masses with slight shrinkage. Conclusions: Adults with congenital adrenal hyperplasia (CAH) may refer with infertility and bilateral testicular adrenal mass. The patient should be well assessed; surgery should not be performed if not necessary. Fertility is possible by starting corticosteroid therapy and adjusting the optimal dose. [ABSTRACT FROM AUTHOR]

Aim: Pituitary apoplexy is a rare but serious condition. It is caused by infarction and/or haemorrhage of the pituitary gland. In this case report, we will present outpatient who has been suffering from lack of breastfeeding and headache at postpartum period. Case: 28-year-old female patient was applied outpatient clinic suffering from lack of breastfeeding and headache at postpartum period. On presentation, her blood pressure was normal. Patient pituitary hormones levels ACTH <5 pg/mL (0-46) kortizol: 0.08 µg/dL (morning: 6.28-18) TSH:0.42 µIU/mL (0.27-4.2) free T4:9.76 pmol/L (12-22) free T3: 6.42 pmol/L (3.1-6.8) prolactin: 2.74 ng/ml (4.79-23.3) were found. Other laboratory tests, glucose: 89 mg/dl (70- 109) urea: 18 mg/dl (10-45) creatine: 0.68 mg/dl (0.5-1.4) sodium: 137 mmol/L (135-145) potassium: 4.3 mmol/L (3.5-5.1), were normal. At first, we tought Sheehan syndrome or postpartum pituitary necrosis secondary to excessive postpartum blood losses. Because Sheehan syndrome is very common in our society. But the patient did not have much bleeding at postpartum. Magnetic resonance imaging showed a sellar heterogeneous mass with suprasellar extension and contact with the optic chiasm, compatible with adenoma apoplexy (Figure 1, 2). No evidence for pituitary apoplexy except headache and lack of breastfeeding. The patient's visual fields were normal. Oral prednisolone 5 mg/day was started. One week later, the patient felt well. Added 50 mcg/day levothyroxine. After a month's followup, re-evaluation was decided. Conclusion: Pituitary apoplexy is a life-threatening condition. Pregnancy and postpartum period are risky periods for apoplexy. Patients may have mild symptoms. Steroid therapy is life-saving. [ABSTRACT FROM AUTHOR]

Aim: Primary hyperparathyroidism (PHPT) is a prevalent mineral metabolism disorder usually caused by a single parathyroid adenoma. Although PHPT is the most frequent cause of hypercalcemia, severe hypercalcemia cases are rarely encountered. Some patients admitted because of hypercalcemia require intravenous bisphosphonate treatment. The present study aimed to investigate the efficacy of intravenous ibandronate, which is a more cheap drug than other parenteral bisphosphonates, in the preoperative treatment of symptomatic hypercalcemia in patients with PHPT. Material-Metods: The medical records of patients operated in a Dicle University Endocrinology clinic between 2010 and 2017 due to PHPT were retrospectively evaluated. Patients who were admitted because of hypercalcemia associated with parathyroid adenoma and underwent minimally invasive surgery subsequent to the lowering of calcium levels via preoperative intravenous ibandronate and zolendronate were included. Results: Totally, 24 of 167 patients received a preoperative bisphosphonate due to hypercalcemia associated with PHPT. Five female and two male patients were treated with zoledronate only. Thirteen were treated with ibandronate only. Seven of the 13 patients were female and six were male. The mean calcium level in patients before ibandronate treatment was 14.31±0.92 mg/dL, and the mean duration of calcium regulation after ibandronate treatment was 3.31±1.03 days. The mean calcium level after ibandronate treatment was 10.19±0.89 mg/dL (p=0.001). Conclusion: In Turkey, ibandronate use reduces the cost of hypercalcemia treatment by 8570%. Parenteral ibandronate for treating severe hypercalcemia associated with PHPT may thus be an effective and cheap drug. Hypocalcemic period was shorter in the ibandronate group. [ABSTRACT FROM AUTHOR]