The amount of skeletal muscle mass is associated with arterial stiffness in hemodialysis patients.

INTRODUCTION: Sarcopenia was determined to be associated with increased arterial stiffness in the nondialysis patient population, but there is no available data on this subject in dialysis patients. METHODS: A total of 79 patients were included in the study. Sarcopenia was diagnosed according to the EWSGOP-2 criteria. Arterial stiffness was measured noninvasively with a mobile-O-Graph device. RESULTS: Skeletal muscle mass was observed to be positively correlated with weight, body mass index, creatinine, and uric acid, while negatively correlated with augmentation index. There was a correlation between augmentation index and sodium, phosphorus, systolic blood pressure, diastolic blood pressure, cardiac index, muscle percentage, fat percentage, and skeletal muscle mass. When the determinants of augmentation index in the linear regression analysis were viewed, just the systolic blood pressure and skeletal muscle mass were observed to be the determinant. CONCLUSION: Decreased skeletal muscle mass contributes to increased arterial stiffness in hemodialysis patients.

A new marker predicting gestational diabetes mellitus: First trimester neutrophil/lymphocyte ratio.

Gestational diabetes mellitus (GDM) is a condition that is very common during pregnancy and has negative consequences for both mother and fetus. Insulin resistance has been shown as an important cause in the pathogenesis of GDM and low-level inflammation is suggested to be one of the underlying causes of insulin resistance. We aimed to investigate whether the neutrophil-lymphocyte ratio (NLR), which is an indicator of systemic inflammation, is a predictor for GDM. A total of 228 pregnant women, including 128 GDM (patient group) and 100 healthy pregnant were included in the study. GDM was diagnosed with a 1-step approach between 24 and 28 weeks of pregnancy. We found a significant increase in NLR in the 1st and 3rd trimesters in the GDM group compared to healthy pregnant women, which supports that systemic inflammation starts in the early stages of pregnancy and continues throughout pregnancy. We also reported a positive correlation between NLR and fasting plasma glucose and body mass index in both trimesters. We showed that first trimester NLR independently predicted the development of GDM.

Overt hypogonadism is a cardiovascular risk factor in type 2 diabetic males: An observational study.

We aimed to evaluate the effects of hypogonadism on metabolic and chronic complications in type 2 diabetic males. 261 nonobese males with type 2 diabetes aged 18-70 were involved in the study. Hypononadal males were divided into 2 groups as overt hypogonadism (total testosterone≤230 ng/dl) and borderline hypogonadism (230-345 ng/dl). The control group involved eugonadal diabetic males. Micro-macrovascular complications were recorded. 101 patients had hypogonadism (38.7%), and 160 patients were eugonadal (61.3%). Microvascular complication rate was not different, but macrovascular complication rate was significantly higher in hypogonadal males (42.6%/31.3%, p = 0.042). Optimal glycosylated haemoglobin (HbA1c) achievement(<7%) was significantly lower in hypogonadal patients (20.8%/31.3%, p = 0.043). Poor glycaemic control (HbA1c≥7%), presence of microvascular complication and increased triglyceride levels were independent risk factors for hypogonadism (OR: 1.5, p = 0.044;OR:3.89,p = 0.025 and OR: 1.0, p = 0.016 respectively). Overt hypogonadism, hypertension, hypercholesterolaemia and severe hypoglycaemia were independent risk factors for macrovascular complications (OR: 1.0, p = 0.027; OR:2.6, p = 0.002; OR: 1.8, p = 0.047 and OR: 1.0, p = 0.007 respectively), diabetes duration (≥5 years) and poor glycaemic control for microvascular complication (OR: 1.0, p = 0.031 and OR:2.0, p = 0.028). As a result, hypogonadism is frequent among diabetic males and poor glycaemic control may be an important contributing factor. Furthermore overt hypogonadism is an important cardiovascular risk marker. Therefore, ensuring eugonadism in diabetic patients may positively affect both glycaemic control and complications.

Effectiveness of TI-RADS and ATA classifications for predicting malignancy of thyroid nodules.

BACKGROUND: Thyroid cancer is one of the most common cancers and is especially common in young patients. Therefore, effective recognition and treatment of thyroid cancer are essential for patient survival. OBJECTIVES: To compare the effectiveness of standard guidelines for predicting thyroid malignancy. To do so, thyroid nodules were classified according to the categories of the American Thyroid Association (ATA) and Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, and compared with fine-needle aspiration biopsy (FNAB) results. MATERIAL AND METHODS: The study included 1741 thyroid nodules with a final diagnosis in 1121 consecutive patients. The FNAB was recommended for all patients according to ATA guidelines and subsequently performed. The nodules were reclassified according to TI-RADS guidelines. RESULTS: Comparing nodules classified according to ATA and TI-RADS in terms of ultrasonography (US) features with the Bethesda cytological diagnosis classification System for Reporting Thyroid Cytopathology, 37.6% of the nodules classified in the high-risk category according to the ATA classification were found to be malignant cytology, 10.4% suspicious for malignancy, 4% non-diagnostic, 9.6% indeterminant cytology, and 38.4% benign. According to the TI-RADS risk category, 50% of those with high suspicion were malignant, 13.3% suspicious for malignancy cytology and 36.7% were benign. For the TI-RADS guidelines, the best cutoff value for differentiating benign and malignant nodules was found to be 4.5 (area under the curve (AUC) = 0.962, 95% CI = 0.943-0.981, p < 0.001). For the ATA guidelines, the best cutoff value for separating benign and malignant nodules was 4.5 (AUC = 0.917, 95% CI = 0.875-0.959, p < 0.001). The diagnostic performances of the TI-RADS and ATA score systems were evaluated using highly suspicious nodules. The sensitivity and specificity of highly suspicious nodules, according to both TI-RADS and ATA guidelines, were both high. Sensitivity and specificity of ATA classification were 80% and 96.3%, respectively. Sensitivity and specificity of TI-RADS classification were 76% and 97.5%, respectively, but positive predictive value was low (63.3% compared to 55.5%). CONCLUSIONS: Both, the ATA and TI-RADS classifications can effectively predict malignancy risk of thyroid nodules and may thus decrease unnecessary FNAB.

Irisin is a predictor of sarcopenic obesity in type 2 diabetes mellitus: A cross-sectional study.

ABSTRACT: We aimed to evaluate sarcopenia and sarcopenic obesity (SO) in patients with type 2 diabetes mellitus (T2DM), possible relationships with serum irisin and myostatin levels, and the effect of glycemic control on SO.Ninety T2DM patients were included in this a cross-sectional study. Sarcopenia was determined by evaluating muscle mass (bioelectrical impedance analysis), muscle strength (HGS), and gait speed (GS). Patients with muscle mass loss with functionally reduced muscle strength and/or performance were considered sarcopenic. In addition, participants were divided into 3 groups according to the FM (fat mass)/FFM (fat-free mass) ratio [group 1:5th-50th percentiles; group 2:50th-95th percentiles and group 3: ≥95 percentiles (sarcopenic obese)]. Irisin, myostatin levels and metabolic parameters were measured in all patients.The prevalence of sarcopenia and SO was 25.6% and 35.6%, respectively. Irisin levels were lower in sarcopenic patients, while glycosylated hemoglobin (A1c), body mass index (BMI), FM, and FM index were higher (P < .05). From group 1 to group 3, BMI, FM, FM index, GS, myostatin, and A1c increased, and muscle mass percentage, HGS, and irisin decreased (P < .05). A positive correlation was found between FM/FFM and myostatin and a negative correlation between FM/FFM and irisin (r = 0.303, P = .004 vs. r = -0.491, P < .001). Irisin remained an important predictor of SO, even after adjusting for confounding variables (OR:1.105; 95% CI:0.965-1.338, P = .002). The optimal cut-off value for irisin to predict SO was 9.49 ng/mL (specificity = 78.1%, sensitivity = 75.8%). In addition, A1c was an independent risk factor for SO development (OR:1.358, P = .055).This study showed that low irisin levels (<9.49ng/mL) and poor glycemic control in T2DM patients were an independent risk factor, especially for SO.

Is FGF-23 an early indicator of atherosclerosis and cardiac dysfunction in patients with gestational diabetes?

OBJECTIVE: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone and plays a role in the pathogenesis of myocardial hypertrophy. The aim of this study was to evaluate the association of FGF-23 levels with echocardiographic parameters and insulin resistance (IR) in patients with gestational diabetes. SUBJECTS AND METHODS: Fifty-four pregnant patients with gestational diabetes mellitus (GDM) (age, 31.12 ± 5.72 years) and 33 healthy pregnant women (age, 29.51 ± 4.92 years) were involved in the study. Fasting insulin, fasting plasma glucose (FPG), lipid profile, oral glucose tolerance test (OGTT), FGF23, echocardiographic parameters, and carotid artery intima-media thickness (CIMT) were evaluated in the two groups. RESULTS: The two groups were not significantly different in age, sex, body mass index, lipid profile, or blood pressure. Insulin, homeostatic model assessment-insulin resistance (HOMA-IR), FGF-23 levels, CIMT, left ventricular (LV) mass, LV mass index and myocardial performance index (MPI) were significantly higher in the GDM group. HOMA-IR was positively correlated with FGF-23, and insulin was positively correlated with FGF-23. Additionally, FGF-23 was positively correlated with CIMT, LV mass index, and MPI. CONCLUSION: Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with GDM.

Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma / Avaliação de Alterações Cardíacas Subclínicas e Atraso Eletromecânico Atrial por Ecocardiografia com Doppler Tecidual em Pacientes com Incidentaloma Adrenal Não Funcionante

Abstract Background: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. Objective: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. Methods: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. Results: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. Conclusion: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

Resumo Fundamento: A maioria das massas adrenais descobertas incidentalmente, denominadas incidentaloma adrenal (IA), são adenomas adrenais não funcionantes. O manejo adequado da IA ainda é um tema de debate, e por isso é necessário investigar suas morbidades associadas. Entretanto, dados referentes a alterações cardíacas morfológicas e funcionais são limitados nesse grupo. Objetivo: Neste estudo, objetivamos avaliar as características estruturais e funcionais cardíacas e as propriedades de condução atrial em pacientes com IA não funcionante. Métodos: Trinta pacientes com IA não funcionante e 46 controles adequadamente pareados foram incluídos no estudo. Após análise hormonal e bioquímica, todos os participantes foram submetidos a ecocardiograma transtorácico para obtenção de parâmetros sistólicos e diastólicos de ambos os ventrículos, além dos tempos de condução atrial pelo ecocardiograma com Doppler tecidual. Os dados foram analisados com o Statistical Package for the Social Sciences (SPSS, Chicago, IL, Estados Unidos), versão 17.0 para Windows. P < 0,05 foi considerado estatisticamente significativo. Resultados: O índice de massa do ventrículo esquerdo (VE) e o índice de desempenho miocárdico do VE foram significativamente aumentados no grupo IA. Entre os tempos de condução atrial, os atrasos eletromecânicos intra- e interatriais foram significativamente prolongados em pacientes com IA não funcionante. Outros achados laboratoriais e ecocardiográficos foram semelhantes entre os grupos. Conclusão: Nosso estudo revelou que os tempos de condução intra- e interatrial estavam prolongados e o índice de massa do VE estava aumentado em pacientes com IA não funcionante. Esses achados podem ser marcadores de envolvimento cardíaco subclínico e de tendência a complicações cardiovasculares. Um acompanhamento rigoroso é necessário para indivíduos com IA não funcionante, devido ao aumento do risco cardiovascular.

Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma.

BACKGROUND: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. OBJECTIVE: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. METHODS: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. RESULTS: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. CONCLUSION: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

Is FGF-23 an early indicator of atherosclerosis and cardiac dysfunction in patients with gestational diabetes?

ABSTRACT Objective: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone and plays a role in the pathogenesis of myocardial hypertrophy. The aim of this study was to evaluate the association of FGF-23 levels with echocardiographic parameters and insulin resistance (IR) in patients with gestational diabetes. Subjects and methods: Fifty-four pregnant patients with gestational diabetes mellitus (GDM) (age, 31.12 ± 5.72 years) and 33 healthy pregnant women (age, 29.51 ± 4.92 years) were involved in the study. Fasting insulin, fasting plasma glucose (FPG), lipid profile, oral glucose tolerance test (OGTT), FGF23, echocardiographic parameters, and carotid artery intima-media thickness (CIMT) were evaluated in the two groups. Results: The two groups were not significantly different in age, sex, body mass index, lipid profile, or blood pressure. Insulin, homeostatic model assessment-insulin resistance (HOMA-IR), FGF-23 levels, CIMT, left ventricular (LV) mass, LV mass index and myocardial performance index (MPI) were significantly higher in the GDM group. HOMA-IR was positively correlated with FGF-23, and insulin was positively correlated with FGF-23. Additionally, FGF-23 was positively correlated with CIMT, LV mass index, and MPI. Conclusion: Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with GDM.

Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome?

ABSTRACT Objective To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). Subjects and methods 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. Results Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). Conclusion This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome?

OBJECTIVE: To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). SUBJECTS AND METHODS: 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. RESULTS: Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). CONCLUSION: This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

Importance of ectopic thyroid tissue detected in the midline of the neck: single center experience

Objective Ectopic thyroid tissue (ETT) is a rare abnormality of the thyroid gland and the true prevalence and importance is not known. The aim of this study was to evaluate ultrasonography (US) guided fine needle aspiration biposy (FNAB) results, sonographic features, and frequency of ETT detected in the midline of the neck. Subjects and methods Five thousand five hundred and twenty outpatients who were referred to our thyroid clinic between September 2010 and April 2012 and underwent thyroid US, were retrospectively analyzed. Patients with ETT, detected in the midline of the neck in US were included in the study. Thyroid functions, sonographic features, and US guided FNAB results were evaluated. Results There were 81 (81.8%) female and 18 (18.2%) male patients with a mean age of 50.9 ± 11.7. The ETT in the midline was present in 1.79% (99/5,520) of the patients. In the majority of the patients, benign sonographic features (isoechoic, regular margin, type 1 vascularization) were detected. There were 92 (92.9%) patients with a previous history of thyroidectomy and all were histopathologically benign. In 7 (7.1%) patients, there was no history of thyroid operation. FNAB results of ETT were benign. Conclusion This study evaluated the importance of ETT detected incidentally in the midline of the neck. Especially in patients with a history of thyroidectomy, the thyroid masses in the midline of the neck can be found as incidental with imaging methods. Our results suggests that the incidence of malignancy in this group is much lower than orthotopic thyroid nodules and they are often benign.

Should human chorionic gonadotropine treatment increase thyroid volume?

Objective Our aim was to investigate the thyroid function tests and thyroid volume differences among males with isolated hypogonadotropic hypogonadism (IHH) who take androgen replacement treatment (ART). Materials and methods Forty-four male with IHH with a mean age 33.2 (18-54), diagnosed in Endocrinology and Metabolism Department between September 2013 and September 2014 and 40 healthy male control with a mean age 27.77 (18-55) were involved to study. Patient group was divided to testosterone-treated patients (n = 19) and human chorionic gonadotropine (hCG)-treated patients (n = 25). Patient group was compared in terms of total testosterone, thyroid function tests [thyroid stimulating hormone (TSH), free thyroxine (fT4)] and thyroid volume, before and 6 months after treatment. Patient group was compared with control group as well. Results When we compared the patient group with the control group, there was no significant difference for age, Body mass index, TSH, fT4 and thyroid volume between two groups before treatment. There was no difference in terms of TSH, but fT4, testosterone levels and thyroid volume were significantly higher after treatment, when the patient group was compared before and after treatment (p < 0.05). When we compared testosterone-treated patients and hCG-treated patients; thyroid volume was higher among hCG-treated patients (p = 0.001) but there was no difference for thyroid volume before and after testosterone treatment (p > 0.05). There was no statistically significant correlation between testosterone levels with TSH, fT4 and thyroid volume (r = 0.09, p = 0.32; r = 0.14, p = 0.11; r = 0.15, p = 0.09, respectively). Conclusion Our study showed that ART increases the thyroid volume especially in hCG-treated patients. Therefore, we suggest that thyroid volume changes should be followed up in hCG-treated patients.

Primary Adrenal Failure due to Antiphospholipid Syndrome.

Background. Antiphospholipid syndrome (APS) characterized by thrombosis and abortus may rarely cause primary adrenal failure. Case Presentations. A 34-year-old male presented with hypotension, hypoglycemia, hyperpigmentation on his skin and oral mucosa, scars on both legs, and loss of consciousness. In laboratory examinations, hyponatremia (135 mmol/L), hyperpotassemia (6 mmol/L), and thrombocytopenia (83 K/µL) were determined. Cortisol (1.91 µg/dL) and adrenocorticotropic (550 pg/mL) hormone levels were also evaluated. The patient was hospitalized with a diagnosis of acute adrenal crisis due to primary adrenal insufficiency. A Doppler ultrasound revealed venous thrombosis. The patient was diagnosed with antiphospholipid syndrome after the detection of venous thrombosis, thrombocytopenia, elevated aPTT, and anticardiolipin antibody levels. Anticoagulation treatment was started for antiphospholipid syndrome. The patient is now following up with hydrocortisone, fludrocortisone, and warfarin sodium. Conclusion. Antiphospholipid syndrome is a rare reason for adrenal failure. Antiphospholipid syndrome should be suspected if patients have morbidity secondary to venous-arterial thrombosis.

Importance of ectopic thyroid tissue detected in the midline of the neck: single center experience.

OBJECTIVE: Ectopic thyroid tissue (ETT) is a rare abnormality of the thyroid gland and the true prevalence and importance is not known. The aim of this study was to evaluate ultrasonography (US) guided fine needle aspiration biposy (FNAB) results, sonographic features, and frequency of ETT detected in the midline of the neck. SUBJECTS AND METHODS: Five thousand five hundred and twenty outpatients who were referred to our thyroid clinic between September 2010 and April 2012 and underwent thyroid US, were retrospectively analyzed. Patients with ETT, detected in the midline of the neck in US were included in the study. Thyroid functions, sonographic features, and US guided FNAB results were evaluated. RESULTS: There were 81 (81.8%) female and 18 (18.2%) male patients with a mean age of 50.9 ± 11.7. The ETT in the midline was present in 1.79% (99/5,520) of the patients. In the majority of the patients, benign sonographic features (isoechoic, regular margin, type 1 vascularization) were detected. There were 92 (92.9%) patients with a previous history of thyroidectomy and all were histopathologically benign. In 7 (7.1%) patients, there was no history of thyroid operation. FNAB results of ETT were benign. CONCLUSION: This study evaluated the importance of ETT detected incidentally in the midline of the neck. Especially in patients with a history of thyroidectomy, the thyroid masses in the midline of the neck can be found as incidental with imaging methods. Our results suggests that the incidence of malignancy in this group is much lower than orthotopic thyroid nodules and they are often benign.

Should human chorionic gonadotropine treatment increase thyroid volume?

OBJECTIVE: Our aim was to investigate the thyroid function tests and thyroid volume differences among males with isolated hypogonadotropic hypogonadism (IHH) who take androgen replacement treatment (ART). MATERIALS AND METHODS: Forty-four male with IHH with a mean age 33.2 (18-54), diagnosed in Endocrinology and Metabolism Department between September 2013 and September 2014 and 40 healthy male control with a mean age 27.77 (18-55) were involved to study. Patient group was divided to testosterone-treated patients (n = 19) and human chorionic gonadotropine (hCG)-treated patients (n = 25). Patient group was compared in terms of total testosterone, thyroid function tests [thyroid stimulating hormone (TSH), free thyroxine (fT4)] and thyroid volume, before and 6 months after treatment. Patient group was compared with control group as well. RESULTS: When we compared the patient group with the control group, there was no significant difference for age, Body mass index, TSH, fT4 and thyroid volume between two groups before treatment. There was no difference in terms of TSH, but fT4, testosterone levels and thyroid volume were significantly higher after treatment, when the patient group was compared before and after treatment (p < 0.05). When we compared testosterone-treated patients and hCG-treated patients; thyroid volume was higher among hCG-treated patients (p = 0.001) but there was no difference for thyroid volume before and after testosterone treatment (p > 0.05). There was no statistically significant correlation between testosterone levels with TSH, fT4 and thyroid volume (r = 0.09, p = 0.32; r = 0.14, p = 0.11; r = 0.15, p = 0.09, respectively). CONCLUSION: Our study showed that ART increases the thyroid volume especially in hCG-treated patients. Therefore, we suggest that thyroid volume changes should be followed up in hCG-treated patients.

Frequency of isolated maternal hypothyroxinemia in women with gestational diabetes mellitus in a moderately iodine-deficient area.

AIM: To investigate frequency of isolated maternal hypothyroxinemia (IMH) in women with gestational diabetes mellitus (GDM) using both the method specific trimester range (MSTR) and the standard reference range (SRR). METHODS: Our study included 50 GDM patients (case group) and 60 non-GDM pregnant (control group). Glucose, insulin, HOMA-IR, fT4 and TSH values were measured when pregnancy was confirmed in all participants. Thyroid function tests were measured in each trimester using the SRR and the MSTR. RESULTS: In the second and third trimesters, mean fT4 levels were significantly lower in the case group compared to the control group, based on the SRR (p < 0.001). Mean fT4 levels were within the normal reference range in both groups, based on the MSTR; however, the levels were significantly lower in the case group (p < 0.001). Using the SRR, IMH frequencies in the second and third trimesters, in the case group were 56 and 86%, respectively, and were 13.3 and 46.7%, respectively, in the control group (p < 0.001). Using the MSTR, the IMH frequencies in the second and third trimesters were 8 and 14%, respectively; there were no instances of IMH in the control group. CONCLUSION: This study shows that changes in glucose metabolism may affect the thyroid hormone levels (fT4). Additionally, evaluating thyroid function tests in GDM patients using the MSTR can give more accurate results.

Immunohistochemical expression of Insulin-like growth factor-1, Transforming growth factor-beta1, and Vascular endothelial growth factor in parathyroid adenoma and hyperplasia.

BACKGROUND: Insulin-like growth factor (IGF), transforming growth factor-beta1 (TGF-ß1), and vascular endothelial growth factor (VEGF) are commonly studied growth factors, but little data are available on the immunohistochemical expression of these factors in parathyroid lesions. MATERIALS AND METHODS: Tissue specimens from 36 patients with primary hyperparathyroidism (P-HPT) (26 adenomas and 10 primary hyperplasias) were examined. Normal parathyroid tissue adjacent to the adenoma or area of hyperplasia was used as control tissue. Preoperative laboratory testing [serum Ca and P, creatinine and parathormone levels (PTH)] which led to the diagnosis of P-HPT had been performed, the size and weight of the parathyroid glands measured, and postoperative serum PTH levels determined. Paraffin-embedded parathyroid tissue specimens were stained with antibodies to IGF-1, VEGF, and TGF-ß1 using standard immunohistochemical procedures. RESULTS: IGF-1 immunoreactivity was seen in 50% of hyperplasia and in 46% of adenoma samples, but in 87% of normal parathyroid tissue in the vicinity of the adenomas (P = 0.005). TGF-ß1 immunoreactivity was observed in 90% of hyperplasia, in 92% of adenoma samples, and in 95% of normal tissues around adenomas. VEGF immunoreactivity was observed in 70% of hyperplastic and 65% of adenomatous tissues, as well as in 54% of normal tissues in the vicinity of the adenoma. No significant differences in the expression of IGF-1, TGF-ß1, and VEGF were observed between primary adenomas compared to hyperplasia samples (P > 0.05). CONCLUSIONS: Parathyroid tissue is clearly a site for production of IGF-1, TGF-ß1, and VEGF. IGF-1 receptor activity was higher in normal parathyroid tissue compared to hyperplastic and adenomatous tissue.

Predictive role of acute phase reactants in the response to therapy in patients with chronic hepatitis C virus infection.

BACKGROUND/AIMS: Biochemical parameters and acute-phase proteins (APPs) may provide complementary data in patients with chronic hepatitis C (CHC). We aimed to evaluate the predictive role of APPs in the response to antiviral therapy. METHODS: Forty-five patients underwent antiviral therapy. Serum ferritin, C-reactive protein (CRP), transferrin, albumin, alpha-1 acid glycoprotein (A1AG), and alpha-2 macroglobulin (A2MG) levels were examined at the initial evaluation and at the 4th, 12th, and 48th weeks. HCV RNA levels were examined at the initial evaluation and at the 12th and 48th weeks. RESULTS: Ferritin, transferrin, A1AG, and A2MG levels were significantly higher in the patient group (p<0.05). CRP, ferritin, A1AG, and A2MG levels were significantly increased from baseline to the 4th week (p<0.05). The responders and nonresponders to antiviral therapy had insignificantly but remarkably different levels of CRP, ferritin, transferrin, A1AG, A2MG, and alanine aminotransferase (ALT) both at the initial evaluation and at the 12th week. CONCLUSIONS: Variations in ferritin, A1AG, A2MG, albumin, CRP, and transferrin levels are not alternatives to virological and biochemical parameters for predicting an early response to therapy in patients with CHC. However, the investigation of ALT levels and hepatitis C virus RNA in combination with acute-phase reactants may provide supplementary data for evaluating responses to antiviral therapy.

Prevalance of gestational diabetes mellitus in patients with gestational transient thyrotoxicosis.

OBJECTIVE: To investigate prevalence of gestational diabetes mellitus (GDM) in patients with gestational transient thyroxicosis (GTT). METHODS: Fifty two patients with GTT and 100 age matched healthy pregnant women were included. Fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), LDL-cholesterol, HDL-cholesterol, triglyceride, thyrotrophin (TSH) and thyroid hormones were measured at thyrotoxic state in GTT patients and at 6-12th weeks of pregnancy in control group. Oral glucose tolerance test (OGTT) with 100 g glucose was performed and laboratory parameters were re-evaluated at 24-28th weeks of pregnancy in all subjects. RESULTS: Mean age of patients with GTT was 28.46 ± 5.45 and control group was 27.78 ± 3.75(p = 0.085). Patients with GTT had significantly higher HbA1c, LDL-cholesterol and HDL-cholesterol at 6-12th weeks of pregnancy (p < 0.01, p < 0.01 and p = 0.034, respectively). TSH was negatively correlated with HbA1c and LDL-cholesterol in thyrotoxic state in GTT patients (r = -0.393, p < 0.001 and r = -0.293, p < 0.001, respectively). OGTT showed GDM in 7 (13.5%) GTT patients and 4 (4%) healthy pregnants (p = 0.047). HbA1c, LDL-cholesterol and HDL-cholesterol were higher in GTT patients compared to healthy pregnants also at 24-28th weeks of pregnancy (p < 0.001, p < 0.001 and p = 0.024). CONCLUSION: Although GTT is known to be a transient state that can resolve spontaneously, it might have negative effect on carbohydrate metabolism like other causes of hyperthyroidism.