Search

Contex. We report the use of subcutaneous somatostatin injection three times a day to decrease hypercortisolism in a patient who had Cushing's syndrome induced by bronchial carcinoid tumour progressive pneumonia due to immune suppression. Subject and Method. A 46-year-old man with 7-month history of DM type-2, hypertension and cerebrovasculardisease, vertebral compression-fracture was admitted to our clinic. Physical examination was consistent with Cushing's syndrome. Laboratory results revealed hyperglycemia (143 mg/dL; reference range, <100 mg/dL) and hypokalemia (2.29 mEq/L; reference range, 3.5-5.1 mEq/L). His morning serum cortisol was 40 μg/dL (reference range 6.7- 22.6 μg/dL), urine cortisol-excretion was 2245 μg/24 hours (reference range 58-403 μg/24 hours), after 1 mg dexamethasonesuppression test serum cortisol was 28 μg/dL (6.7-22.6 μg/dL) and ACTH 354 pg/mL (reference range 7.9-66 pg/mL). Adrenal CT and hypophyseal MRI were normal. An ectopic source was searched for Cushing's syndrome. Chest CT scan of the right lung showed 12x9 mm nodule. High fever cough occurred on the follow-up. Chest radiograph revealed diffuse pneumonic infiltration. Despite 3-drug antibiotic combination therapy, infection did not improve. Subcutaneous injection of octreotide 3x100 μ/g was initiated to decrease hypercortisolism. The infection improved rapidly after the therapy. The morning serum cortisol, urine cortisol-excretion, ACTH was at the upper normal range (77.1 pg/mL, reference range 7.9-66 pg/mL) on 10th day of treatment. The patient was a consulted for surgery and the nodule was excised. The pathology was consistent carcinoid tumor. Conclusion. Subcutaneous octreotide treatment may be helpful to gain time for exploring the focus in ectopic cushing's syndrome and to control the serious infections due to hypercortisolism. [ABSTRACT FROM AUTHOR]

Introduction: Using the Turkish and rest of world (ROW) Injection Technique Questionnaire (ITQ) data we address key insulin injection complications., Methods: Summarized in first ITQ paper., Results: Nearly one-third of Turkish insulin users described lesions consistent with lipohypertrophy (LH) at their injection sites and 27.4% were found to have LH by the examining nurse (using visual inspection and palpation). LH lesions in the abdomen and thigh of Turkish patients are slightly smaller than those measured in ROW but more than half of Turkish patients who have LH continue to inject into them at least daily. More than a quarter of Turkish patients have frequent unexplained hypoglycemia and nearly 2 out of 5 have glycemic variability, both of which have been linked to the presence of LH and the habit of injecting into it. Nearly half of Turkish injectors report having pain on injection. Of these, just over half report having painful injections only several times a month or year (i.e., not with every injection). In Turkey the diabetes nurse has by far the major role in teaching patients how to inject. Nearly 40% of Turkish injectors get their sites checked at least annually, and a larger proportion than ROW had received recent (within the last 12 months) instruction on how to inject properly., Conclusion: Turkish patients and professionals have clearly made progress in injection technique, but there are still considerable challenges ahead which the new Turkish guidelines will help address., Funding: BD Diabetes Care.

Introduction: Over 7 million people in Turkey have diabetes. Of the 1 million who inject insulin little is known of their habits and injection techniques., Methods: We conducted an Injection Technique Questionnaire (ITQ) survey throughout Turkey that involved 1376 patients from 56 centers. Turkish values were compared with those from 41 other countries participating in the ITQ, known here as Rest of World (ROW)., Results: The majority (50.4%) of Turkish insulin users give four injections/ day as opposed to ROW, where only 30.9% do. The abdomen is the most common injection site used by Turkish patients, but they also inject insulin in multiple body sites more often than do patients in ROW. Body mass index values in Turkey were 0.75 units higher than those in ROW as was the mean total daily dose (average daily dose [ADD]) of insulin (54.0 IU in Turkey vs. 47.4 IU in ROW). Mean glycated hemoglobin (HbA1c) in Turkey was 9.1%, which is higher than in ROW and possibly related to the higher BMI and ADD. Turkish patients use insulin analogs (short and long-acting) more frequently than do patients in ROW. The shortest pen needles (4 mm) are used by about one-third of patients in Turkey, but the longer ones (8 mm) are equally common. Needles are reused in Turkey at a rate of 3.4 injections/single needle. However, needle reuse, whether with pens or syringes, is lower in Turkey than ROW, as is the number of times a reused needle is used. More than 75% of used sharps in Turkey go into the rubbish, with nearly 6% having no protection of the tip., Conclusion: The continued use of 8-mm needles raises the risk of intramuscular injections in Turkish patients. Despite full reimbursement, needle reuse still remains an important issue. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulant, correct use of skin folds and safe disposal of sharps., Funding: BD Diabetes Care.

Introduction: Gestational diabetes is defined as various degrees of glucose intolerance diagnosed or detected for the first time during pregnancy and is the most common metabolic complication of pregnancy. Early diagnosis and adequate treatment are important to prevent complications. Pre-eclampsia, polyhydramnios, fetalmacrosomia, and operative delivery are some of the complications seen in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM)., Aim: The present study was designed to determine whether there was an association between Mean Platelet Volume (MPV) in predicting poor fetal outcome, insulin resistance, neonatal Apgar scores and gestational age for women with GDM., Materials and Methods: In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of 138 healthy controls. MPV, insulin and homeostatic model assessment (HOMA-IR) values were measured at 24-28 weeks of the pregnancy. An independent samples t-test was used to compare MPV values. Multivariate linear regression models were used to establish relations between MPV values, HOMA-IR, insulin levels and Apgar score., Results: There was a significant positive correlation between MPV values, HOMA-IR and Insulin levels and a negative correlation with Apgar score at 1 min and 5 min in the GDM group (r=0.227, p=0.02; r=0.206, p=0.03; r=-0.485, p<0.001; and r=-0.399, p<0.001, respectively). In the multivariate logistic regression analysis, a high MPV value was most consistently associated with a low Apgar 1 min score (β=-0.387, p=0.003) in the GDM group. An MPV of >8.0 fL had a sensitivity of 82% and a specificity of 75% for the prediction of GDM., Conclusion: We investigated the potential of MPV values in predicting low Apgar scores and insulin resistance in women with GDM.

Aim. Colonic polyps and thyroid nodules are common diseases and their frequency increases with age. In the literature, there is no study investigating the coexistence of colonic polyps and thyroid nodules. Therefore, this study was designed to investigate thyroid nodule prevalence in patients with colonic polyps. Material and Methods. Sixty-six patients with colonic polyps and 146 patients without colonic polyps enrolled into the study. Age and sex matched control group was composed from patients without colonic polyps. Colonoscopic examinations, thyroid ultrasonographies were performed in all patients, and TSH were measured. Results. Male/female ratio in polyp and control groups were 40/26 versus 68/78, respectively (P = 0.058). Mean ages were similar in both groups (53.3 ± 11.4 versus, 51.8 ± 11.4, P = 0.373). Thyroid nodule was detected in 44 (66.7%) patients with polyps and in 61 (41.8%) controls (P = 0.001). Patients with adenomatous polyps had 5 or more thyroid nodules compared to patients with hyperplastic polyps (P = 0.03). Thyroid nodules were more prevalent among patients aged 50 or older compared to 50 years or less (P = 0.023). Conclusion. Thyroid nodules were detected more common in patients with colonic polyps. Further studies are needed to clarify this coexistence.

Thyroid hormones stimulate directly or indirectly growth of erythroid colonies through erythropoietin. Anemia is often the first sign of hypothyroidism. Hypothyroidism can cause a wide variety of anemic disorders. Numerous mechanisms are involved in the pathogenesis of these anemias that can be microcytic, macrocytic and normocytic. We designed this study to investigate the anemia frequency and if present, etiology of anemia in hypothyroid patients. 100 patients with overt hypothyroid, 100 patients with subclinical hypothyroid, and 200 healthy controls were enrolled in this study. Overt hypothyroidism diagnosis is done when elevated TSH and low levels of free T4 and/or free T3 have been observed. Subclinical hypothyroidism is defined as elevated serum TSH with normal free T(4) and free T(3) levels. Peripheral smears of the anemic patients were examined. Anemia prevalence was 43% in the overt hypothyroid group, 39% in the subclinical hypothyroid group, and 26% in the control group (p=0.0003 and p=0.021 respectively related to controls). Thus, the frequency of anemia in subclinical hypothyroidism is as high as that in overt hypothyroidism. There was no difference between the hypothyroid groups in terms of anemia. Vitamin B12, Fe, and folic acid were similar between these groups. According to our findings, anemia of chronic disease is the most common type of anemia in hypothyroid patients. Suspicion of hypothyroidism should be considered in anemias with uncertain etiology.

Objective: To evaluate the plasma asymmetric dimethyl arginine (ADMA) levels and carotid intima-media thickness (IMT) in patients with polycystic ovary syndrome (PCOS)., Design: Prospective study., Setting: University medical center., Patient(s): Thirty-five patients with PCOS and 31 healthy controls., Intervention(s): Peripheral venous puncture, ultrasonography, oral glucose tolerance test (OGTT)., Main Outcome Measure(s): Plasma ADMA, serum FSH, LH, dehydroepiandrosterone sulfate (DHEAS), free T and total T, insulin, fasting plasma glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, homocysteine, fibrinogen, C-reactive protein, and carotid IMT., Result(s): The PCOS group had higher levels of androgens, triglycerides, homocysteine, insulin, and homeostasis model assessment of insulin resistance when compared with controls. There were no significant differences in ADMA levels and IMT between the two groups. The fasting plasma glucose, total cholesterol, HDL cholesterol, LDL cholesterol, fibrinogen, and C-reactive protein levels were not different among the groups. Intima-media thickness was significantly correlated with DHEAS, but there was no association between IMT and ADMA., Conclusion(s): Results of our study revealed that ADMA levels and carotid IMT in patients with PCOS are not different from healthy controls., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: We report a rare case of 49,XXXXY syndrome with autoimmune diabetes (requiring insulin therapy), bilateral cataracts and unilateral glaucoma., Clinical Presentation and Intervention: A 25-year-old man with mental retardation presented with multiple skeletal abnormalities, polyuria and polydipsia. He had high glucose concentrations, without ketonuria, and hypergonadotropic hypogonadism. Ophthalmic examination revealed a polar cataract in both eyes and increased intraocular pressure in the left eye. The anti-islet cell antibody test was positive, and anti-glutamic acid decarboxylase autoantibody levels were elevated. Karyotype analysis revealed 49,XXXXY. Intensive insulin therapy and testosterone replacements were started., Conclusion: The autoimmune nature of diabetes that we observed in our patient seems to be predisposed by hypogonadism. Cataract and glaucoma in this case seem to be the result of diabetes, and an association of these ocular manifestations with the syndrome 49,XXXXY seems unlikely., (Copyright 2009 S. Karger AG, Basel.)

Chylomicronemia syndrome is a rare disorder characterized by the presence of chylomicrons in the fasting state. An acute and potentially life-threatening complication of chyiomicronemia syndrome is severe acute pancreatitis. We report a case of a 24-year-old primigravida with severe hypertriglyceridemia-induced pancreatitis. We reviewed the clinical course and treatment of hypertriglyceridemia-induced pancreatitis. She was admitted in the 37th week of gestation with severe abdominal pain, which was radiating to the back, and having uterine contractions. Cesarean delivery was performed under spinal anesthesia, and a healthy male infant was born. Intraoperative findings included milky peritoneal fluid collection. Elevated pancreatic enzymes with significant hypertriglyceridemia (10,092 mg/dL) suggesting acute pancreatitis were also found on chemical analysis. The diagnosis of acute pancreatitis was confirmed by computed tomography scan. Treatment with continuous intravenous insulin--glucose, cessation of oral intake, and nasogastric decompression--dramatically decreased the triglyceride levels to 608 mg/dL within five days. She was discharged as symptom free with strict dietary intervention after 10 days. Intravenous insulin is a low-cost and effective alternative treatment in hypertriglyceridemia-induced pancreatitis during pregnancy. To our knowledge, such a high triglyceride level has not previously been reported in pregnancy.