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Amaç: Adrenal insidentalomalar; adrenal bezle ilişkili herhangi bir hastalık kuşkusu yokken görüntüleme yöntemleri veya abdominal laparotomide tesadüfen saptanan kitlelerdir. Abdominal görüntüleme yöntemlerinin kullanımının artması ile adrenal insidentalomaların tespit edilme sıklığı da artmıştır. Bu çalışmada nonfonksiyonel adrenal insidentalomalı (NFAI) hastaların demografik özellikleri ve insülin direncini araştırmayı amaçladık.Yöntemler: Çalışmaya 2007-2013 yılları arasında Dicle Üniversitesi Tıp Fakültesi Endokrinoloji Anabilim Dalı'nda NFAI nedeniyle takip edilen 30 hasta (20 kadın, 10 erkek) ve 66 sağlıklı birey (44 kadın, 22 erkek) dahil edildi. Hasta dosyalarından hastalara ait fizik muayene, ultrason, bilgisayarlı tomografi sonuçları kaydedildi. Tüm hastalara 1 mg deksametazon testi, idrar metanefrin ve normetanefrin, serum aldosteron ve renin düzeyi bakılmıştı. Açlık kan şekeri (AKŞ) ve insülin değerleri mevcut olan hastaların homeostatic model assessment- insulin resistance (HOMA-IR) formülüne göre insülin direnci hesaplandı, yaş ve beden kitle indeksi (BKİ) farklı olmayan kontrol grubundaki sağlıklı bireylerle karşılaştırıldı.Bulgular: Hastaların yaş ortalaması 45,9±10,9, BKİ 28,5±5,8 kg/m2 idi. Gruplar arasında yaş, cinsiyet ve BKİ açısından fark yoktu. AKŞ ve HOMA IR, NFAI grubunda kontrol grubuna göre anlamlı olarak yüksekti (sırasıyla, p= 0,022 ve p=0,005). LDL, HDL kolesterol ve trigliserid düzeyleri bakımında gruplar arasında farklılık gözlenmedi (p>0,05). Sonuç: Nonfonksiyonel adrenal insidentalomalı hastalar insulin direnci ve metabolik parametreler açısından riskli olduklarından bu açıdan değerlendirilmelidir. Objective: Adrenal incidentaloma are bulks which are stated incidentally by imagining methods or in abdominal laparotomy when there is no suspicion of any disease in adrenal gland. With increase in using abdominal ultrasonography and BT, the frequency of determining adrenal incidentaloma also increases. In this study, we aimed to examine demographical features and insulin resistance in patients with non functioning adrenal incidentaloma (NFAI). Methods: 30 (20 female-10 male) patients, who followed due to NFAI at Dicle University Medical Faculty Department of Endocrinology between years of 2007-2013, and age, BMI matched 66 healthy subjects were included in the study. Results of physical examination, USG and BT were recorded from patients' files. All patients were underwent following analyses for excluding a functioning adrenal mass, overnight dexamethasone suppression test, 24 hour urinary metanephrine and normetanephrine, plasma aldosterone/ renin activity ratio. Insulin resistance was calculated in accordance with homeostatic model assessmentinsulin resistance formula. Results: The average of age was 45.9 ± 10.9 years and body mass ındex (BMI) 28.5 ± 5.8. There were no significantly difference in terms of age, gender and BMI between groups. Fasting blood glucose and insulin resistance were significantly higher in patients with non-functional adrenal incidentaloma than control group (p=0.022, p=0.005i respectively). No significant difference was found between groups, in terms of LDL, HDL and triglyceride levels. Conclusion: patients with NFAI are more prone to have insulin resistance and hyperglycemia. Thus, clinicians should evaluate those patients with NFAI, in terms of metabolic parameters.

Adrenal incidentalomas (AIs) are adrenal lesions detected on abdominal imaging procedures or abdominal laparotomy that had been performed for unrelated reasons. AIs have become a common clinical concern as a result of widespread use of abdominal ultrasound, CT and MR imaging in clinical practice. The aim of this study was to evaluate the demographical and clinical data our patients with AI. This study included data from 78 patients (53 female – 25 male) with AI those followed at Dicle University School of Medicine, Department of Endocrinology and Metabolism, between 2007 and 2013. Data collected from the records were physical and hormonal evaluation, diameter of the lesion, and the features of the lesion on radiological imaging. Also the results of serum cortisol, aldosterone, renin and 24 hour urinary metanephrine and normetanephrine were recorded. The average age of patients were 48.6 ±14.9 years. There was no significant difference in terms of localization of adenomas. Body mass ındex of patients were 28.54 ± 5.82. Of the patients, 45 (57.7%) were diagnosed as non-functional AI, 10 (12.8%) as subclinical Cushing’s syndrome, 11 (14,1%) as pheochromocytoma, 2(2.6%) as primary hyperaldosteronism, and 3(3.8%) as adrenal carcinoma. Ganglioneuroma was stated in 2 patients (2.6%), myelolipoma was stated in 1 patient (1.3%), adrenal adenoma was stated in 1 patient, adrenal cyst was stated in 1 patient, schwannoma was stated in 1 patient and neoplasia with small circular cells was stated in 1 patients. AIs are currently more frequently detected in clinical practice due to increased use of imaging techniques. Although the vast majority of AIs are benign and non-functioning, appropriate hormonal evaluation and imaging procedures must be performed. Keywords: Adrenal incidentaloma, demographic characteristics, epidemiology ÖzetAdrenal insidentalomalar (AI); adrenal bezde herhangi bir hastalık kuşkusu yokken görüntüleme yöntemleri veya abdominal laparotomide tesadüfen saptanan kitlelerdir. Abdominal ultrasonografi, BT ve MR kullanımının artması ile adrenal insidentalomaların tespit edilme sıklığı da artmıştır. Bu çalışmamızda, AI nedeniyle takip edilen hastalarmızın demografik ve klinik verilerini sunmayı amaçladık. Bu çalışmaya 2007-2013 yılları arasında Dicle Üniversitesi Tıp Fakültesi Endokrinoloji Anabilim Dalı’na başvuran 78 hasta ( 53 kadın; 25 erkek) dahil edildi. Hasta dosyalarından hastalara ait fizik muayene, USG, BT sonuçları kaydedildi. Serum kortizolü, idrar metanefrini, idrar normetanefrini, idrar VMA, serum aldosteronu ve serum renin değerleri kaydedildi. Hastaların yaş ortalaması 48.6 ± 14.9 idi. Tespit edilen kitlelerin lokalizasyonu açısından anlamlı farklılık saptanmadı. Hastaların vücut kitle indeksi 28.54 ± 5.82 idi. 45 hastada (% 57.7) non-fonksiyonel adenom, 10 hastada (% 12.8) subklinik cushing, 11 hastada (% 14.1) feokromasitoma, 3 hastada (% 3.8) adrenal karsinom, 2 hastada (% 2.6) hiperaldosteronizm, 2 hastada (% 2.6) ganglionörom, 1 hastada (% 1.3) myelolipom, 1 hastada adrenal adenom, 1 hastada adrenal kist, 1 hastada schwannom ve 1 hastada da küçük yuvarlak hücreli tümör tespit edildi. Radyolojik görüntüleme sıklığı arttıkça adrenal insidentaloma olgularının sayısı da artmaktadır. Her adrenal insidentaloma, malign olup olmadığı ve hormonal işlevi olup olmadığı açısından değerlendirimelidir. Keywords: Adrenal insidentalom, demografik özellikler, epidemiyoloji

McCune-Albright syndrome is characterized by polyostatic fibrous dysplasia, brown spots on the skin (café au lait pigmentation) and autonomous endocrine hyperfunction. Early puberty and other endocrinological manifestations, such as acromegaly, gigantism and hypercortisolism are widely observed in the syndrome. Acromegaly is seen in 20% of patients. We report a case of acromegaly accompanied with this syndrome.Key words: McCune-Albright syndrome; acromegaly; fibrous dysplasia, McCune-Albright sendromu, poliostotik fibröz displazi, deride kahverenginde lekelenme (Cafe au lait lekeleri) ve otonomik endokrin hiperfonksiyon ile karakterize bir sendromdur. Bu sendromda yaygın olarak erken puberte ve diğer endokrinolojik manifestasyonlar örneğin akromegali, jigantizm, hiperkortizolizm görülebilir. Akromegali Mc-Cune-Albriht sendromlu hastaların % 20 sinde görülebilir. Biz bu sendroma eşlik eden bir akromegali vakasını sunduk

Background and Aim: Acute pancreatitis is an inflammatory disease of the pancreas, with variable involvement of peripancreatic tissue or remote organ systems. The etiology of the disease shows significant differences among geographic areas. In our study we aimed to enlighten the data of our region. Methods: Between January 2003 and December 2006 hospitalized patient with acute pancreatitis were retrospectively examined. Patients were evaluated according to race, age, etiology, symptomatology, data of laboratory and imagination, severity of attack, proportion of complication, proportion of mortality and treatment. Results: Of the 62 patients included into the study 33 (53.2%) were women, 29 (46.8%) were men and their mean age was consecutively 46,1 and 56,0. Etiologic dispersal was 29 (46.8%) billiary, 8 (12.9%) hypertrigliseridemia, 1 (1.6%) hypercalcemia, 1 (1.6%) alcohol, 1 (1.6%) malignancy. Twenty-two (35.5%) patients were considered to be idiopathic. Twenty-three of billiary patients (33.3%) were severe type. All of the billiary pancreatitis patients were applicated ERCP in the first 72 hours. Amilaz levels of patients with hyperlipidemia were determined lower than the other causes. Seven (31.8%) of the idiopathic patients were women and 15 (68.2%) of them were men and 31.8 % of these were severe pancreatitis type. In severe pancreatitis cases Ranson's score, CRP level, albumin level and duration of admission in the hospital were significantly different from mild acute pancreatitis. Computed tomography was taken in all the patients. While billiary pancreatit was present in two of the four patients death, two of them were idiopathic. In fine needle aspiration apllied in the six of severe patients infected necrosis was determined in four of them and they were transferred to surgary clinic. While mortality rate was 6.5% in total, in severe pancreatitis type this rate was determined as 22.2%. Mean age of the patients died was 65.5. In 16 (25.8%) patient in total pulmonary, in four of them (6.5%) multiorgans deficiency, in three of them (4.8%) local complication were determined. Conclution: In the management of acute pancreatitis it should be more conservative about computed tomography and ERCP. Idiopathic group has been determined higher compared with data. In our study our mortality rates and our general approachment algoritm has been compatible with guideline recommendation., Giriş ve Amaç: Akut pankreatit, yakın ve uzak organları değişen derecelerde etkileyebilen pankreasın akut inflamatuvar hastalığıdır. Hastalığın etiyolojik faktörleri coğrafik bölgeler arasında önemli farklılıklar göstermektedir. Çalışmamızda bölgemizdeki verilerin gün ışığına çıkarılması amaçlanmıştır. Gereç ve Yöntem: Ocak 2003 ile Aralık 2006 tarihleri arasında akut pankreatit tanısı ile izlenen hastalar retrospektif olarak incelendi. Hastalar cins, yaş, etiyoloji, belirti, laboratuvar ve görüntüleme verileri, atağın şiddeti, komplikasyon oranları, mortalite oranları ve tedavi yönünden değerlendirildi. Bulgular: Çalışmaya alınan 62 hastadan 33'ü (%53.2) kadın, 29'u (%46.8) erkek olup, yaş ortalamaları sırasıyla 46.1 ve 56,0 idi. Etiyolojik dağılım 29'unda (%46.8) biliyer, 8'inde (%12.9) hiperlipidemi, 1'inde (%1.6) hiperkalsemi, 1'inde (%1.6) alkol, 1'inde (%1.6) malignite idi. Yirmi iki (%35.5)'si idiopatik olarak kabul edildi. Biliyer pankreatitlerin 23'ü (%33.3) şiddetli tipti. Biliyer nedenlilerin hepsine ilk 72 saat içinde ERCP yapıldı. Hiperlipidemili hastaların amilaz değerleri diğer nedenlerden düşük saptandı. İdiopatik gruptakilerin 7 (%31.8)'si kadın, 15 (%68.2)'i erkekti. Bunları n %31.8'inde pankreatit şiddetli tipteydi. Şiddetli pankreatit olguları nda Ranson skoru, CRP düzeyi, albümin düzeyi ve hastane yatış süresi, hafif tipten anlamlı olarak farklı idi. Tüm hastalara bilgisayarlı tomografi çekildi. Ölen dört hastadan ikisinin etiolojisinde biliyer pankreatit mevcutken, ikisi idiopatik idi. Şiddetli pankreatitlilerin 6'sına yapılan ince iğne aspirasyonunda 4'ünde enfekte nekroz saptanarak genel cerrahi kliniğine transfer edildiler. Toplamda mortalite oranı %6.5 iken, şiddetli tipte bu oranı %22.2 saptandı. Kaybedilen hastaların yaş ortalamaları 65.5 idi. Toplam 16 (%25.8) hastada pulmoner, 4 (%.6.5) hastada multiorgan yetmezlik, 3 (%4.8) hastada lokal komplikasyonlar (apse, psödokist) tespit edildi. Sonuç: Akut pankreatit takibinde bilgisayarlı tomografi incelemesi ve ERCP konusunda daha konservatif davranılmalıdır. İdiopatik grup literatür verilerine kıyasla daha yüksek bulunmuştur. Mortalite oranları mız ve hastalara genel yaklaşım algoritmimiz kılavuzlara paralel olmuştur.

Amaç: Meme kanseri dünyada ve ülkemizde kadınlarda en sık görülen kanser türüdür. Opere edilen hastalarda ölüm nedenleri nüks ve metastazlardır. Bu hastalarda nüksü etkilediği bilinen prognostik faktörler yaş, tümör boyutu, tutulan aksiler lenf nodu sayısı, hastalık grade'i, ER, PR, HER-2 ekspresyonu, lenfatik invazyon varlığı olarak sıralanabilir. Biz de bu çalışmamızda opere meme kanserli hastalarımızda nüksü, erken-geç nüksü ve lokal ve uzak metastaz riskini belirleyen prognostik faktörleri bulmayı amaçladık.Materyal-metod: 2001-2010 yılları arasında Dicle Üniversitesi Tıp Fakültesi Tıbbi Onkoloji Bilim Dalı'na başvuran opere meme kanseri tanılı hastaların dosyaları retrospektif olarak incelendi. Takipleri sırasında nüks olan hastaların oluşturduğu grup nüks-metastaz grubu diğer hastalar remisyon grubu olarak adlandırıldı. Bu iki grup arasında yaş, cinsiyet, ikamet yeri, menapozal durum, aile öyküsü, erken menapoz, geç menapoz, gebelik sayısı, abortus sayısı, canlı doğum sayısı, BMI, oral kontraseptif kullanımı, sigara kullanma öyküsü, ilk semptom, meme lokalizasyonu, tümörün histolojisi, boyutu, lenf nodu sayısı, lenfovasküler invazyon varlığı, tümör grade'i, ER, PR, HER gibi moleküler özellikler, evreleme çalışmaları; cerrahi özellikler, cerrahi-kemoterapi ve cerrahi-radyoterapi arasındaki süre gibi zaman özellikleri; kemoterapi ve hormonal tedavi özellikleri açısından nüks-metastaz grubu ile remisyon grubu karşılaştırıldı. Daha sonra nüks eden hastalar içerisinde erken(?24 ay) ve geç(>24 ay) nüksü, lokal(lokal,aynı aksilla,kemik) ve uzak(lokal dışındaki yerler)nüksü belirleyen faktörler araştırıldı. İstatistiksel analizler için SPSS (Statistical Package for Social Sciences) 11.5 programı kullanıldı. P < 0,05 değeri anlamlı olarak kabul edildi.Bulgular: Toplam 802 hastadan 479 adet opere meme kanseri hastası çalışmaya dahil edildi. Median yaş 47 (18-79) idi. Hastalardan 136'sı nüks-metastaz grubuna dahil olurken 343 hasta remisyon grubunda yer aldı. Nüksü belirleyen faktörler tümör boyutu(tümör boyutu arttıkça nüks artıyordu p1 ay olanlarda nüks daha sıktı. p24 ay) nüksü belirleyen faktörler açısından ER pozitifliği(p1 ay olarak saptandı. Geç nüksü belirleyen faktörler ER pozitifliği ve adjuvan hormonal tedavi kullanımı olarak tespit edildi. Lokal nüks ile yetersiz evreleme ve uzak metastaz ile ?10 lenf nodu tutulumu arasında anlamlı ilişki saptandıAnahtar kelimeler: Erken evre meme kanseri, Lokal nüks, Sistemik metastaz, Prognostik faktörler Aim : Breast cancer is the most frequent kind of cancer at women in all over the world and our country. In patients that are operated the reasons of death are relapse and metastases. The prognostic factors that are known to affect relapse can be enumerated as age, tumor size, the number of axillary lymph node, degree of the illness as ER, PR, HER-2 expression, the existence of lymphatic invasion. In this study we have aimed to find out prognostic factors which determine relapse, early-late relapse and local and distant metastases risc in our patients suffering from operated breast cancer.Material-method: The files of the patients diagnosed with operated breast cancer who have consulted to Medical Oncology Field of Dicle University Medical Faculty between the years 2001-2010 were examined as retrospective. During their surveillance the group formed with the patients who have relapsed were called as relapse-metastases and the other patients were called as remission group. The molecular aspects between these two groups such as age, sex, place of residence, menopausal condition, family story, early menopause, late menopause, the number of pregnancy, the number of abortus, the number of live birth, BMI, using of oral contraceptive, the story of using cigarette, the first symptom of breast localization, the histology of tumor, its size, the number of lymph node, the existence of lymphovascular invasion, the degree of tumor, molecular aspects as ER, PR, HER, staging studies; surgical features, the time characteristics as between surgical ?chemotherapy and surgical radiotherapy; relapse-metastases group and remission group were compared in terms of chemotherapy and hormonal therapy. Then among the patients who have relapsed the factors determining early and late relapse, local and distant relapse were examined. For the statistical analysis SPSS (Statistical Package for Social Sciences) Windows 11.5 program was used. The value of P ?0,05 was accepted as meaningful.Findings: From 802 patients 479 patients suffering from operated breast cancer were included in this study. Median age was 47 (18-79). While 136 of the patients were included in relapse-metastases group 343 of them took place in remission group. The factors determining the relapse were determined as tumor size, the number of lymph node, lymphovascular invasion, grade, insufficient staging and the time passing between surgical and chemotherapy. The factors which determine early and late relapse were determined as ER pozitivity and using adjuvant hormonal therapy. Among the factors determining local and distant metastases the keeping of lymph node number and insufficient staging were found.Result: In patients suffering from operated breast cancer the factors determining the relapse were determined as tumor size, the number of lymph node that was involve, lymphovascular invasion, grade, insufficient staging and the time passing between surgical and chemotherapy. The factors defining early and late relapse were assessed as ER pozitivity and using of adjuvant hormonal therapy. Among factors defining local and distant metastases the number of lymph node involving and insufficient staging were determined.Key words: Early stage breast cancer, Local relapse, Systematic metastases, Prognostic factors 74

Amaç: Eksenatid, GLP-1 reseptörlerine yüksek afinitede bağlanmakta ve endojen GLP-1 etkisi olan glikoz bağımlı insülin sekresyonu, gastrik boşalmanın geciktirilmesi, glukagon süpresyonu, iştah baskılanması ve β-hücre kitlesini artırıcı etkilerini göstermektedir. Tip 2 diyabet tedavisinde metformin ve sulfonilüre veya her ikisinin beraber kullanılmasıyla glisemik kontrol sağlanamayan özellikle obez hastalarda kullanılmaktadır. İyi glisemik kontrol ve kilo kaybı sağlaması nedeniyle kan şekerleri yüksek seyreden oral antidiyabetik tedavinin yetersiz kaldığı vakalarda insülin tedavisine eklenmiştir. Çalışmamızda; kliniğimizde en az 4 ay ve daha fazla süreyle eksenatid tedavisi alan hastaların biyokimyasal ve klinik parametrelerini paylaşmayı planladık. Yöntemler: Çalışmaya Temmuz 2011 ile Aralık 2013 tarihleri arasında eksenatid başlanan ve en az 4 (ort: 7,3) ay takipleri tamamlanan 26 (2 erkek, 24 kadın) hasta alındı. Hastaların hepsi tedavi öncesi metformin yanında kombine oral antidiyabetik tedavi altında iken, 6 hasta metformin tedavisine ek olarak insülin tedavisi almaktaydı. Bulgular: Çalışmaya alınan hastalarda tedavi sonrası Hemoglobin A1c düzeylerinde kadınlarda %0.98, erkeklerde % 1.4, vücut ağırlığında (kg) kadınlarda % 0.64, erkeklerde % 0.57, beden kitle indeksi ölçümlerinde kadınlarda % 0.61, erkeklerde % 0.56 düşme gözlendi. Sonuç: İnsülin, metformin veya oral antidiyabetik tedaviyi kombine veya tek başına alan obez hastalarda tedaviye eksenatide eklenmesi ile hastalarda kilo kaybı ve Hemoglobin A1c düzeylerinde düşme tespit edilmiştir Objective: Exenatide has high affinity on binding GLP - 1 receptors. Endogenous GLP - 1 effects glucose -dependent insulin secretion, delayed gastric emptying, suppression of glucagon, inhibition of appetite, and shows effects of enhancing β - cell mass. It is usually use in the treatment of type 2 obese diabetic patients, whose treatment not be obtained with metformin and sulfonylurea or both. It was added to insulin therapy, because it provides better glycemic control and weight loss in cases which have high level of blood glucose with oral antidiabetic. In our study we planned to share the patients treated with exenatide in our clinic for a period of at least 4 months and discuss their biochemical and clinical parameters. Methods: In this study we evaluated 26 patients (2 males, 24 females) who admitted our clinic between July 2011 and December 2013 and who followed up at least 4 months (mean: 7.3) All of the patients were using metformin in combination with oral antidiabetic drug therapy, while 6 patients were receiving insulin therapy in addition to metformin. Results: After treatment, HemoglobineA1c decrease were found 0.98 % for women and 1.4% for men and of weight loss were found 0.64% for women and 0.57% for men, measurements of body mass index were decreased 0.61% for females and 0.56% for men. Conclusion: We determined that; addition of exenatide treatment to Insulin, metformin or oral antidiabetic therapy combination in obese patients leads to weight loss and decrease Hemoglobin A1c levels.

Allgrove syndrome is a very rare seen disorder with an autosomal recessive trait. The three characteristics of disease are alacrima, achalasia and adrenal failure. Alacrimia is the first manifestation in most cases. Achalasia and adrenal failure are seen later. Neurological involvement is rare and usually occurs in older age. A woman 22 years old admitted to our hospital with adrenal failure crisis. She had alacrimia and used teardrop for many years. Achalasia was diagnosed after evaluation of her dysphagia. Thus, diagnosis of Allgrove syndrome was done. Autonomic cardiac dysfunction and peripheral motor neuropathy were detected. In conclusion, Allgrove syndrome is rare and has life threatening potential due to adrenal failure. Early diagnosis and appropriate treatment may improve life quality and expectancy. Patients with relevant symptoms should be evaluated for autonomic neuropathy. Keywords: Allgrove; neuropathy; adrenal failure

WOS:000614161700004 Objectives. – We aimed to investigate the association between BMI and early atherosclerotic activity in cancer patients. We also compared the inflammatory and macroscopic calcification processes of atherosclerosis in the aortic segments and large arteries by 18F-FDG PET/CT of between normal and high BMI patients. Methods. – We conducted a retrospective review of cancer patients presented to our institution within the period between February and May 2018. Patients were classified according to their BMI into two groups: normal BMI group and high BMI group. Data of average SUVmax and SUVmean for four segments of the aorta, common iliac arteries, and femoral arteries were estimated and compared between both groups. Moreover, the macroscopic calcification on CT images for each vascular section was also reported. Results. – Ninety-eight patients were classified into two groups: normal BMI group (n = 52; 53.1%), and high BMI group (n = 46; 46.9%). Average SUVmax was significantly higher in obese participants in all arterial segments (P < 0.05). However, the SUVmean was significantly higher in obese patients in only three arterial segments aortic arch, left femoral artery and descending thoracic aorta (P < 0.05).Moreover, the differences between the two study groups in terms of the frequency of macroscopic calcifications were not statistically significant for all vascular segments. BMI positively correlated with SUVmax and SUVmean of the vascular segments (r value from 0,219 to 0,575/p value between 0,023 and 0,0001). Conclusions. – Fluorine-18-FDG PET/CT imaging revealed that patients with high BMI have more accelerated atherosclerotic inflammatory process in their major vessels compared to their age-matched controls with normal BMI. Future studies should assess the associated between these findings and the cardiovascular events in the long term. Objectifs. – Nous avons cherche´ a` e´tudier l’association entre l’IMC et l’activite´ athe´ roscle´ rotique pre´ coce chez les patients cance´ reux. Nous avons e´galement compare´ les processus de calcification inflammatoire et macroscopique de l’athe´ roscle´ rose dans les segments aortiques et les grandes arte` res par TEP/TDM 18F-FDG entre des patients normaux et a` IMC e´leve´. Me´thodes. – Nous avons effectue´ une revue re´trospective des patients atteints de cancer pre´ sente´ s a` notre e´tablissement entre fe´vrier et mai 2018. Les patients ont e´te´ classe´ s en fonction de leur IMC en deux groupes: groupe IMC normal et groupe IMC e´leve´. Les donne´es du SUVmax (la valeur de fixation normalise´e) et du SUVmean pour quatre segments de l’aorte, des arte` res iliaques communes et des arte` res fe´morales ont e´te´ estime´es et compare´es entre les deux groupes. De plus, la calcification macroscopique sur les images CT pour chaque coupe vasculaire a e´galement e´te´ rapporte´e. Re´sultats. – Quatre-vingt-dix-huit patients ont e´te´ classe´ s en deux groupes: groupe IMC normal (n = 52; 53,1%) et groupe IMC e´leve´ (n = 4; 46,9%). La moyenne du SUVmax e´tait significativement plus e´leve´e chez les participants obe` ses dans tous les segments arte´ riels (P < 0,05). Cependant, le SUVmean e´tait significativement plus e´leve´ chez les patients obe` ses dans seulement trois segments arte´ riels de l’arc aortique, de l’arte` re fe´morale gauche et de l’aorte thoracique descendante (P < 0,05). En outre, les diffe´ rences entre les deux groupes d’e´tude en termes de fre´quence des calcifications macroscopiques n’e´taient pas statistiquement significatives pour tous les segments vasculaires. L’IMC corre´le´ positivement avec SUVmax et SUVmean des segments vasculaires (valeur r de 0,219 a` 0,575/p valeur entre 0,023 et 0,0001). Conclusion. – L’imagerie TEP/TDM au fluor-18-FDG a re´ve´le´ que les patients avec un IMC e´leve´ ont un processus inflammatoire athe´ roscle´ rotique plus acce´le´ re´ dans leurs principaux vaisseaux par rapport a` leurs te´moins d’aˆge correspondant avec un IMC normal. Les e´tudes futures devraient e´valuer le lien entre ces re´ sultats et les e´ve´nements cardiovasculaires a` long terme.

The aim of this study was to determine whether the dopamine agonist (DA) drug cabergoline used in the treatment of prolactinoma causes autonomic dysfunction by measuring static and dynamic pupillary responses. The study included 25 eyes from 25 patients who were receiving DA for the treatment of prolactinoma and 25 eyes from 25 healthy individuals. Static and dynamic pupillary responses were measured by automatic quantitative pupillometry. The scotopic pupillary diameter was found to be significantly higher in patients receiving DA medication compared with the control group, while pupil contraction time and pupillary dilatation latency were significantly lower. DA drug use changes static and dynamic pupillary responses, probably by increasing sympathetic tone. Pupillometry can be used as a non-invasive method to provide information about changes in the autonomic nervous system in patients receiving such drug therapy.

Purpose: Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. Methods: Two hundred sixty-four patients (F/M:124/140, 45.3±13 years) who had undergone kidney transplantation between 2008 and 2018 and who were followed up at least one year in third care centers were included in this multicenter retrospective study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. Vertebral fractures were assessed semi-quantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. Results: Vertebral fractures were observed in 56.4% (n=114) of the study group. Severe vertebral fractures were observed in 30.7% (n=62) of the patients in vertebral X-ray evaluation. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). BMD levels were in the normal range in 40.3% (n=46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n=23) and the osteopenic range in 40.3% (n=46). Serum calcium, parathormone vitamin, and creatinine levels were similar between the patients with and without vertebral fractures. Femoral neck BMD was negatively correlated with age (r: −0.21, p

Objective: This study aims to investigate real-life data of patients with hypoparathyroidism. Material and Method: This retrospective case-control study was carried out in a tertiary endocrine center between 1 January 2010 and 31 December 2019. Patients with a confirmed diagnosis of persistent hypoparathyroidism and healthy controls were included. Demographic characteristics of the patients, laboratory findings, etiologies of hypoparathyroidism, treatments they received, reasons for hospitalization, and complications were investigated. Results: Sixty-five patients (mean age 42.80±13.4 years, 91% female) with hypoparathyroidism, and 54 healthy controls (mean age 33.58±11.9 years, 65% female) were included. Mean calcium level 7.95±0.92 mg/dl, and mean PTH level 9.99±6.30 pg/ml in hypoparathyroidism. Regarding the etiology of HypoPT, 51 (78%) patients had hypoPT due to surgery; 14 (22%) patients developed HypoPT due to non-surgical causes. In patients with hypoPT who underwent surgery, the mean calcium value was 8.03±0.93 mg/dl; the mean calcium value in patients with non-surgical HypoPT was 7.67±0.85 mg/dl. The mean PTH levels in non-surgical group, other group 10.16±6.21 pg/ml and 9.36±6.82 pg/ml, respectively. The most common surgery was due to multinodular goiter (72%). In 46 percent, the most common treatment was calcitriol 0.5 mcg/day and calcium 2000 mg/day. Nearly half of the patients had treatment non-compliance (46%). Eighteen percent of patients had kidney stones. Forty-three percent of the patients had been hospitalized in the last year. The most common reason for the hospitalization of patients with hypoparathyroidism was hypocalcemia, and the most common reason for this was treatment non-compliance. Conclusion: In our study, the most common cause of hypoparathyroidism is surgery due to multinodular goiter. The most common reason for hospitalization is treatment non-compliance. Up to one-fifth of patients had kidney stones.

WOS:000609589900001 PMID: 33445974 Purpose: This study aimed to evaluate the retinal blood vessel parameters and the foveal avascular zone (FAZ) area using optical coherence tomography angiography (OCTA) in patients with acromegaly in comparison with healthy controls. Methods: A total of 45 patients with acromegaly and 45 healthy controls were included in this study. In all patients, the vessel density (VD) of the deep and superficial macular vascular networks and the foveal avascular zone (FAZ) were measured using OCTA. The correlation of insulin-like growth factor 1 (IGF-1) level and disease duration with deep macular VD and FAZ values was analyzed. All parameters were registered. Results were assessed and compared between the two groups. Results: Deep macular plexus VD values were lower in patients with acromegaly compared to the control group. No significant differences in VD values in the superficial segment, except for that in the inferior parafovea (P = .01) were found between the two groups. Furthermore, patients with acromegaly showed enlargement in the superficial (P = .30) and deep FAZ areas (P < .001). IGF-1 level and disease duration showed a significant negative correlation with the deep whole image (R = -0.216, P = .041, R = -0.339, P = .001, respectively), deep parafovea (R = -0.271, P = .01; R = -0.372, P < .001, respectively), deep parafovea superior hemi (R = -0.342, P = .001; R = -0.350, P = .001, respectively), deep parafovea temporal (R = -0.224, P = .034; R = -0.234, P = .026, respectively), deep parafovea nasal (R = -0.320, P = .002; R = -0.361, P < .001, respectively), and deep parafovea superior VD values (R = -0.293, P = .005; R = -0.307, P = .003, respectively) and a significant positive correlation with the deep FAZ area values (R = 0.244, P = .02; R = 0.329, P = .002, respectively). Conclusion: VD values in the deep macular capillary plexus were lower in patients with acromegaly, and the superficial and deep FAZ area enlarged. Patients with acromegaly may have an increased risk of developing ocular vascular complications. OCTA can be used to evaluate retinal blood VD in patients with acromegaly.

PMD: 30834899 BACKGROUND: Primary hyperparathyroidism is an endocrine disease characterized by excessive secretion of parathyroid hormone and hypercalcemia. Although scintigraphy is commonly used for pre-operative localization, it does not always localize the parathyroid lesion. In such patients, ultrasonography can visualize the suspected lesion and needle washout sample for parathyroid hormone titer can be used to confirm parathyroid tissue. The aim of this study was to investigate the accuracy of the parathyroid hormone needle aspiration washout method in detecting the localization of parathyroid adenoma. MATERIAL AND METHODS: Patients with primary hyperparathyroidism who underwent surgery between 2010 and 2017 at the Dicle University Medical Faculty Hospital were retrospectively evaluated using medical records. Patients undergoing parathyroid hormone needle aspiration washout were performed in the suspected lesion were included in the study. Accompanied by ultrasonography, the suspected area was penetrated with needle, and negative aspiration was performed. Pre-operative scintigraphic data of patients were evaluated. Patients with positive scintigraphy, negative scintigraphy or patients who did not undergo scintigraphy were included in our study. Demographic data were presented as continuous data means ± standard deviation. Categorical variables were presented as frequency and percentage. RESULTS: Forty-nine patients (female/male, 40/9) who underwent parathyroid hormone needle aspiration washout were included in the study. Parathyroid hormone washout result was positive in 47 patients (47/49) and negative in 2 patients (2/49), sensitivity/positive predictive value (PPV) 95.91%. Twenty-six patients who had negative/suspicious scintigraphic results were diagnosed using the parathyroid hormone needle aspiration washout method (24/26, 92.3% accuracy). Parathyroid hormone needle aspiration washout without scintigraphy was performed in 13 patients (13/13, 100% accuracy). CONCLUSIONS: Parathyroid adenoma localization can be easily done using parathyroid hormone needle aspiration washout in centers experienced in adenoma localization in primary hyperparathyroidism cases in which scintigraphic results are negative or scintigraphy cannot be performed. We believe that primary parathyroid hormone needle aspiration washout can be a new localization method for adenoma localization.

BACKGROUND. Insulin resistance is routinely measured by homeostasis model assessment of insulin resistance (HOMA-IR).Positron emission tomography of 18F-fluorodeoxyglucose combined with computed tomography (18F-FDG PET/CT) is a valuable assessment tool for patients with cancer or staging tumors. 18F-FDG PET/CT imaging can also be utilised to detect the metabolic activity of glucose in the adipose tissue, liver and muscles. The aim of this study was to determine insulin sensitivity in the liver, muscle visceral adipose and subcutaneous adipose tissue separately via18F-FDG PET/CT. MATERIALS AND METHOD: Sixty three adult patients who underwent whole body 18F-FDG PET/CT scanning for clinical purposes (diagnosis or staging of cancer) between July and August of 2016 were included in the study. Patients were divided into two groups according to their BMI (Group 1: BMI25kg/m(2)). HOMA-IR,fasting glucose,insulin, triglycerides, total cholesterol, HDL levels were measured. We calculated SUV as the tissue activity of the ROI (MBq/g)/(injected dose [MBq]/ body weight [g]) on PET images and measured the maximum SUVs (SUVmax) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT),liver and rectus muscle ROIs (2 cm). SUV corrected by blood glucose level (SUVgluc) was calculated as SUVmax×blood glucose level/100. Student-t test, Chi-square test and Pearson correlation test were used for statistical analysis. RESULTS: Mean glucose,insulin,HOMA-IR levels of the group-2 were statistically higher than of group-1. Muscle SUVmax and liver SUVmax of group-1 were statistically higher than of group-2. Muscle SUVgluc of group-1 was statistically higher than of group-2. HOMA-IR was negatively correlated with both SUVmax(r=-0.340, p=0.01) and muscle SUVmax(r=-0.373, p=0.005) CONCLUSION: 18F-FDG PET/CT has shown that the muscle tissue maximum FDG uptake was lower in the insulin resistance group. Therefore, 18-FDG PET/CT could be a valuable tool for diagnosing insulin resistance.

Amaç: Bu çalışmada diyabetik aciller nedeniyle hastanemize başvurmuş yetişkin hastaların demografik verileri, klinik özellikleri, laboratuvar verileri, başvuru sıklıkları, diyabetik acil duruma neden olan presipitan faktörleri, takiplerinde gelişen komplikasyonları ve düzelme süreleri gibi özellikleri retrospektif olarak değerlendirmeyi amaçladık.Gereç ve Yöntem: Ocak 2010 ve Mayıs 2018 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Hastanesi acil servis veya endokrinoloji polikliniğine başvurup diyabetik ketoasidoz (DKA), hiperosmolar hiperglisemik durum (HHD) veya hipoglisemi tanısı alan 18 yaş üstü hastalar çalışmaya dahil edildi.Bulgular: Çalışma, 69'u (% 41.8) erkek ve 96'sı (% 58.2) kadın olmak üzere toplam 165 olgu ile yapıldı. Hastaların yaş ortalaması 43.8 ± 20.4 (18-88) idi. Bu hastaların % 77'sinde (n=127) DKA, % 17'sinde (n=28) HHD ve % 6'sında (n=10) hipoglisemi saptandı. Hastaların % 55.2'si (n=91) tip 1 DM, % 44.8'i (n=74) tip 2 DM idi. Diyabetik acil duruma yol açan presipitan faktörlere bakıldığında ilk iki sırada % 32.7 (n=54) ile doz atlama ve %32.1 (n=53) ile enfeksiyon yer almaktaydı. Yeni tanı DM ise hastaların % 10.9'unu (n=18) oluşturmaktaydı. DKA için bakılan düzelme süresi ortalama 12.9 ± 9.2 saat olarak bulundu. Tedavi sonrası en sık gelişen komplikasyon % 38.7 (n=60) ile hipokalemi idi; ancak hastaların büyük çoğunluğunda (% 54.8) herhangi bir komplikasyon gözlenmedi. Çalışmamızda, toplam mortalite % 1.8 iken, HHD hastalarında % 11.1 oranında idi. DKA ve hipoglisemi hastalarında ise mortalite saptanmadı.Sonuç: DM' li hastalarda DKA, diğer diyabetik acillere oranla daha fazla görülmektedir. Hastaların yaklaşık % 11' inde önceden bilinen bir diyabet tanısı bulunmamaktadır. Doz atlama ve enfeksiyon, diyabetik acil duruma yol açan en önemli presipitan faktörlerdir. Mortalite oranı, erken tanı ve doğru tedaviyle oldukça düşüktür.Anahtar kelimeler: Diyabetik aciller, diyabetik ketoasidoz, non-ketotik hiperosmolar hiperglisemik durum, hipoglisemi Purpose: In this study, we aimed to retrospectively evaluate the demographic data, clinical features, laboratory data, frequency of referral, precipitating causes of diabetic emergencies, complications in follow-up and resolution times of adult patients who applied to our hospital due to diabetic emergencies.Materials and Methods: The study included patients aged 18 years who were referred to Dicle University Medical Faculty Hospital emergency department or endocrinology policlinic between January 2010 and May 2018 with diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS) or hypoglycemia.Results: The study was carried out with 165 patients, 69 (41.8%) male and 96 (58.2%) female. The mean age of the patients was 43.8 ± 20.4 (18-88). Of these patients, 77% (n = 127) had DKA, 17% (n = 28) had HHS and 6% (n = 10) had hypoglycemia. Of the patients 55.2% (n = 91) were type 1 DM, 44.8% (n = 74) were type 2 DM. When the precipitating causes of diabetic emergencies were examined, 32.7% (n = 54) poor adherence to treatment and 32.1% (n = 53) infection of the patients were involved. The new diagnosis was DM in 10.9% of the patients (n = 18). Resolution time in diabetic ketoacidosis was found to be 12.9 ± 9.2 hours. The most common complication after treatment was hypokalemia with 38.7% (n = 60), but no complication was observed in the majority of patients (54.8%). In our study, total mortality was 1.8% and 11.1% in HHS patients. No mortality was found in DKA and hypoglycemia patients.Conclusion: Diabetic ketoacidosis is more common in DM patients than in other diabetic emergencies. Approximately 11% of patients do not have a known diagnosis of diabetes. Poor adherence to treatment and infection are the most important precipitating causes to diabetic emergency. The mortality rate is very low with early diagnosis and correct treatment.Keywords: Diabetic emergencies, diabetic ketoacidosis, non-ketotic hyperosmolar hyperglycemic state, hypoglycemia 66

Amaç: Tiroid nodüllerinin malignite potansiyelinin metabolik ve antropometrik parametrelerle ilişkisi literatürde tam olarak aydınlatılmamıştır. Bu çalışma tiroid nodüllerinin metabolik ve antropometrik parametrelerle olan ilişkisini açığa kavuşturmak için dizayn edildi. Materyal metod: 1 Ocak 2018- 31 Mayıs 2018 tarihleri arasında tiroidde nodül nedeniyle polikliniğimize başvuran, 18-65 yaş aralığında, ince iğne aspirasyon biyopsisi yapılan ve opere olan hastalar prospektif olarak çalışmaya alındı. Hastalar yaş, cinsiyet, vücut kitle indeksleri birbirine yakın olan 41 benign, 43 malign olmak üzere toplam 84 hastadan oluşan iki hasta grubuna ayrıldı. Grup 1 hastaları patoloji sonucu benign çıkan hastalar; Grup 2 hastaları patoloji sonucu malign olan hastalar oluşturdu. Her iki grupta hastaların operasyon öncesi boy, kilo, vücut kitle indeksi (VKİ), bel çevresi, boyun çevresi, kalça çevresi, kan basıncı, akantozis, skin tag, ailede DM öyküsü, ailede tiroid kanseri öyküsü, hemogram parametrelerinden lökosit, hematokrit, trombosit sayısı, nötrofil/lenfosit oranı ve MPV, biyokimyasal parametrelerden açlık kan glukozu, kreatinin, ALT, trigliserid, HDL, LDL düzeyleri, hormonal parametrelerden insülin, serbest T4, Anti-TPO ve CRP bakıldı. HOMA-IR hesaplandı. Kategorik olmayan ve normal dağılım gösteren veriler ortalama ± standart sapma (SD) ile gösterildi. Normal dağılım gösteren verilerin karşılaştırılmasında Student's t testi kullanıldı. Kategorik (nominal) verilerin karşılaştırılmasında Ki kare testi uygulandı. Korelasyon analizi için Pearson korelasyon testi yapıldı. Sonuçlar: Çalışmaya toplam 84 hasta (Kadın/Erkek: 69 (%82.1)/15 (%17.9)) alındı. Yaş ortalaması 40.13±10,81 (18-64) idi. Benign grup 41 hastadan (K/E:33/8), malign grup 43 hastadan (K/E: 36/7) oluşuyordu. Benign grubun yaş ortalaması 40,49±10,84 (18-64), malign grubun yaş ortalaması 39,79±11,23 (18-64) idi. Benign ve malign gruplar arasında kadın erkek oranı açısından bir fark yoktu (p˃ 0.05). Yaş açısından her iki hasta grubundan istatistiki farklılık yoktu (p˃ 0.05). TSH düzeyi malign grupta (5,30±1,81) benign gruptan (2,00±2,16) belirgin derecede daha yüksek idi ve istatistiksel olarak önemli anlamlılık düzeyindeydi (p< 0,0001). Açlık insülin düzeyi malign grupta (14,86±9,81) benign gruptan (10,98±5,61) belirgin derecede daha yüksek idi ve istatistiksel olarak önemli anlamlılık düzeyindeydi (p= 0,025). HOMA-IR düzeyi malign grupta (3,41±2,40) benign gruptan (2,56±1,40) belirgin derecede daha yüksek idi ve istatistiksel olarak önemli anlamlılık düzeyindeydi (p=0,031). Bel çevresi normalin (kadınlarda >88 cm, erkeklerde >102 cm) üzerinde olan hasta sayısı (39/84) malignite grubunda daha fazlaydı (23/39). Ancak istatistiksel olarak anlamlılık sınırında değildi (p=0,13). Sonuç olarak: Tiroid nodüllerinin malignite riskinin metabolik parametrelerle ilişkisi çalışmamızda; Literatüre benzer olarak TSH düzeyi, HOMA IR düzeyi ve insülin düzeyi malign hastalarda daha yüksek saptandı. Anahtar kelimeler: Tiroid nodülü, metabolik parametre, antropometrik parametre, malignite Objective: The relation of malignancy potential of thyroid nodules to metabolic and anthropometric parameters has not been fully elucidated in the literature. This study was designed to clarify the association of thyroid nodules with metabolic and anthropometric parameters.Materials and methods: Between January 1, 2018 and May 31, 2018, Prospectively, thyroid fine needle biopsy and operated patients were included in the study.A total of 84 patients were included in the study. Patients were divided into two groups: 41 benign and 43 malignant patients, whose age, sex, and body mass indexes were similar. Group 1 patients were pathologically benign patients; Group 2 patients were pathologically malignant. In both groups, preoperative height, weight, body mass index (BMI), waist circumference, neck circumference, hip circumference, blood pressure, acanthosis, skin tag, family history of diabetes mellitus, family history of thyroid cancer, leukocyte, hematocrit, thrombocyte blood glucose, creatinine, ALT, triglyceride, HDL, LDL levels, hormonal parameters, insulin, free T4, anti-TPO and CRP were measured. HOMA-IR calculated. Categorical and normal distribution was expressed as mean ± standard deviation (SD). Student's t test was used to compare normal distribution data. Chi square test was used to compare categorical (nominal) data. Pearson correlation test was performed for correlation analysis.Results: A total of 84 patients (Female / Male: 69 (82.1%) / 15 (17.9%)) were included in the study. The mean age was 40.13 ± 10,81 (18-64), the benign group consisted of 41 patients (K / E: 33/8) and the malignant group consisted of 43 patients (K / E: 36/7). There was no difference in the ratio of female to male between the benign and malignant groups (p ˃ 0.05). The mean age of the benign group was 40,49 ± 10,84 (18-64), the mean age of the malignant group was 39,79 ± 11,23 (18-64). There was no statistically significant difference in age between the two groups (p ˃ 0.05). TSH level was significantly higher in the malignant group (5,30 ± 1,81) than in the benign group (2,00 ± 2,16) and was statistically significant (p 88 cm in women,> 102 cm in men) was higher in the malignancy group (39/84) (23/39). However, it was not statistically significant (p = 0.13).In conclusion, In our study, the relationship between the risk of malignancy and thyroid nodules with metabolic parameters; similar to the literature, TSH level, HOMA IR level and insulin level were higher in malignant patients.Key words: Thyroid nodule, metabolic parameter, anthropometric parameter, malignancy 67

46 XX erkek cinsel gelişim bozukluğu çok nadir görülen bir hastalıktır. Y kromozomuna yerleşmiş olan SRY (sexdetermining region Y) geni cinsiyet belirleyen gendir. Bu gen bölgesini içeren Y kromozomunun bir parçasının X kromozomuna transloke olmasıyla hastalığın geliştiği düşünülmektedir. Otuz beş yaşında erkek hasta infertilite, cinsel istekte azalma şikayetleriyle polikliniğimize başvurdu. Fizik muayenesinde yüzde kırışıklıklar, kıllanma azlığı, kısa boy, küçük testisler mevcuttu. Hastada hipergonadotropik hipogonadizm ve azospermi saptandı. Hastanın karyotip analizi 46 XX olarak rapor edildi. SRY gen analizi pozitif bulundu. Bu hastalarda spermatogenez olmadığından testis biyopsisi ile sperm elde edilemez. Hastalığın başlıca tedavisi testosteron yerine koyma tedavisidir. İnfertilite ile başvuran primer hipogonadizmli hastaların ayırıcı tanısında bu nadir hastalık dikkate alınmalıdır. 46 XX male sexual disorder is a very rare disease. SRY (sexdetermining region Y) located in the Y chromosome is a main sex-specific gen location. It is thought that the translocation of Y chromosome part containing this gene region to the X chromosome is responsible for the disorder. A 35 year-old male patient was admitted to the outpatient clinic with complaints of infertility and decreased sexual desire. Physical examination revealed wrinkles on the face, lack of hair, short stature as well as small testicles. Hypergonadotropic hypogonadism and azoospermia were detected in the patient. The patient's karyotype analysis was reported as 46 XX. SRY gene analysis was positive. These patients do not have spermatogenesis, thus sperm can not be obtained with testis biopsy. The main treatment of the disease is testosterone replacement therapy. In the differential diagnosis of patients with primary hypogonadism presenting with infertility, this rare disease should be considered.