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OBJECTIVE: To investigate the clinical, laboratory findings and signal intensity index (SII) on magnetic resonance imaging (MRI) of patients with bilateral and unilateral macronodular mild autonomous cortisol secretion (MACS). PATIENTS AND MEASUREMENTS: Clinical and laboratory findings of 81 patients with MACS were examined from retrospective records. SII of adenomas and internodular areas were evaluated by MRI. The unilateral group included patients with an adrenal macronodule (≥1 cm) in a single adrenal gland, while the bilateral group included patients with at least one macronodule in both adrenal glands. RESULTS: In total, 46 patients were in the unilateral (57%), while 35 (43%) patients were in the bilateral groups. The dehydroepiandrosterone sulphate (DHEA-S) level was lower in the unilateral than in the bilateral group (p < .001). The presence of type 2 diabetes mellitus (T2DM), glycosylated haemoglobin (HbA1c) and low-density lipoprotein (LDL) concentrations were higher in the bilateral group (p < .05). However, no significant difference was detected in terms of adrenocorticotropic hormone (ACTH) and overnight 1 mg dexamethasone suppression test (DST) between the two groups (p > .05). There was no difference in SII between adenomas within the same patient, as well as between the unilateral and bilateral groups (p > .05). Logistic regression analysis based on the differentiation between unilateral and bilateral macronodular MACS demonstrated that DHEA-S, HbA1c and LDL concentrations were associated factors. CONCLUSION: DHEA-S levels may not be as suppressed in patients with bilateral macronodular MACS as compared to those with unilateral adenoma. T2DM and hypercholesterolaemia have a higher frequency in bilateral patients. However, ACTH, overnight 1 mg DST and SII may not provide additional information for differentiation of bilaterality and unilaterality.
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Hidrocortisona , Imageamento por Ressonância Magnética , Humanos , Feminino , Hidrocortisona/sangue , Hidrocortisona/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto , Idoso , Sulfato de Desidroepiandrosterona/sangue , Hormônio Adrenocorticotrópico/sangue , Glândulas Suprarrenais/metabolismo , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/sangue , Neoplasias das Glândulas Suprarrenais/metabolismo , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/sangueRESUMO
OBJECTIVE: Individuals infected with hepatitis B virus (HBV) are at increased risk of reactivation when they receive immunosuppressive therapies. Although exogenous corticosteroid use as immunosuppressive therapy is elaborated in current guidelines on HBV reactivation, Cushing's syndrome (CS) with endogenous hypercortisolemia is not addressed. We aimed to investigate the prevalence of HBV infection and discuss the necessity of antiviral prophylaxis in patients with CS as in other immunosuppressed patients. DESIGN AND PATIENTS: We included 72 patients with CS (Adrenocorticotropic hormone (ACTH) dependent or independent) who were screened for HBV between 2016 and 2021. Patients were categorized into three groups: overt, mild autonomous cortisol secretion (MACS), and remission according to the cortisol burden. Changes in patients' HBV serology and clinical findings over time were analyzed retrospectively. RESULTS: Twenty-six patients had overt hypercortisolism, 18 had mild autonomous cortisol secretion and 28 patients were in remission. Nineteen (26.3%) patients were anti-HBc IgG positive, 4 of them were chronic HBV and 15 were isolated anti-HBc IgG positive. HBsAg was positive in four (5.5%) of the patients, who were all compatible with inactive chronic HBV. While two patients developed HBV reactivation, HBV flare was observed in one patient. CONCLUSION: Since it is not always possible to achieve rapid remission in CS and these patients have long-term hypercortisolemia, we suggest that consensus should be reached on HBV serological assessment, standardization of follow-up, and planning of HBV prophylaxis in required instances in patients with CS especially in regions with a high prevalence of HBV infection.
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Síndrome de Cushing , Hepatite B Crônica , Hepatite B , Humanos , Hepatite B Crônica/complicações , Hepatite B Crônica/tratamento farmacológico , Síndrome de Cushing/tratamento farmacológico , Estudos Retrospectivos , Hidrocortisona/uso terapêutico , Hepatite B/tratamento farmacológico , Hepatite B/prevenção & controle , Vírus da Hepatite B/fisiologia , Imunoglobulina G/uso terapêutico , Antivirais/uso terapêuticoRESUMO
PURPOSE: Sleep disturbances are widespread and associated with pituitary diseases, even those under long-term therapeutic management. The aim of this study was to investigate sleep quality in patients with non-functioning pituitary adenoma (NFPA) and determine the factors that might influence sleep quality, including the detailed features of replacement therapy. METHODS: Eighty-two patients with NFPA and 82 age- and gender-matched control subjects were included. Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS) and International Physical Activity Questionnaire (IPAQ) were used. RESULTS: In the NFPA group, 57.3% of patients had decreased sleep quality, compared to 35.4% in the control group (p=0.005). Although there was no relationship between the presence of hydrocortisone replacement and sleep quality (p>0.05), a strong positive correlation was observed between PSQI and morning hydrocortisone replacement time in patients with secondary adrenal insufficiency (r=0.834, p<0.001). Diabetes insipidus was found to be significantly higher in the group with decreased sleep quality (p=0.01). Moreover, there was a negative correlation between PSQI and IGF-1 in patients with NFPA (r=-0.259, p=0.01). A multivariate logistic regression model revealed that depression score and free T4 level in the upper half of the normal limit influence the sleep quality of patients with NFPA. CONCLUSION: Our study indicated the presence of depression, and a free T4 level in the upper half of the normal range have an impact on the sleep quality of patients with NFPA. The time of hydrocortisone replacement might be important factor for improved sleep quality in patients with secondary adrenal insufficiency.
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Adenoma , Insuficiência Adrenal , Neoplasias Hipofisárias , Humanos , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/tratamento farmacológico , Hidrocortisona/uso terapêutico , Adenoma/complicações , Adenoma/tratamento farmacológico , Qualidade do Sono , Insuficiência Adrenal/tratamento farmacológico , SonoRESUMO
PURPOSE: The effects of acromegaly on soft tissues, bones and joints are well-documented, but information on its effects on muscle mass and quality remains limited. The primary goal of this study is to assess the sonoelastographic features of forearm muscles in patients with acromegaly. METHOD: Forty-five patients with acromegaly and 45 healthy controls similar in terms of gender, age, and body mass index (BMI) were included in a single-center, multidisciplinary, cross-sectional study. The body composition was analyzed using bioelectrical impedance analysis (BIA), and height-adjusted appendicular skeletal muscle index (hSMI) was calculated. The dominant hand's grip strength was also measured. Two radiologists specialized in the musculoskeletal system employed ultrasound shear wave elastography (SWE) to assess the thickness and stiffness of brachioradialis and biceps brachii muscles. RESULTS: The acromegaly group had significantly higher thickness of both the biceps brachii (p = 0.034) and brachioradialis muscle (p = 0.046) than the control group. However, the stiffness of the biceps brachii (p = 0.001) and brachioradialis muscle (p = 0.001) was lower in the acromegaly group than in the control group. Disease activity has not caused a significant difference in muscle thickness and stiffness in the acromegaly group (p > 0.05). The acromegaly group had a higher hSMI (p = 0.004) than the control group. The hand grip strength was similar between the acromegaly and control group (p = 0.594). CONCLUSION: The patients with acromegaly have an increased muscle thickness but decreased muscle stiffness in the forearm muscles responsible for elbow flexion. Acromegaly can lead to a permanent deterioration of the muscular structure regardless of the disease activity.
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Acromegalia , Técnicas de Imagem por Elasticidade , Antebraço , Músculo Esquelético , Humanos , Acromegalia/diagnóstico por imagem , Estudos de Casos e Controles , Estudos Transversais , Antebraço/diagnóstico por imagem , Força da Mão , Músculo Esquelético/diagnóstico por imagemRESUMO
OBJECTIVE: To determine lipohypertrophy (LH) in patients with type 1 diabetes mellitus (T1DM) on multiple daily insulin injections (MDII) or continuous subcutaneous insulin infusion (CSII) and to reveal the factors associated with the development and severity of LH. METHODS: Sixty-six patients with T1DM treated with MDII (n = 35, 53%) or CSII (n = 31, 47%) for at least 1 year were included. LH localizations were detected with palpation and ultrasonography (USG). RESULTS: The LH detection rate with USG was significantly higher than that by palpation in the whole group (P < .001). The LH was detected with USG in 30 (85.7%) patients in the MDII group and 22 (71.0%) patients in the CSII group (P = .144). Advanced LH was detected in 13 (37.1%) of the patients treated with MDII and in 3 (9.7%) of the patients treated with CSII. LH was more severe in the MDII group than in the CSII group (P = .013). Diabetes duration and length of infusion set use were significantly longer and body mass index, hypoglycemia, and complication rates were higher in patients with LH than those in patients without LH (P < .05). A positive correlation was found between LH severity and HbA1C and insulin dose (P < .05, for both). MDII as insulin administration method, incorrect rotation, and a history of ketosis were found to be the most related factors with LH severity in a multiple linear regression analysis (P < .05). CONCLUSION: USG might be an effective approach for detecting and evaluating the severity of LH. MDII might cause more severe LH than CSII in patients with T1DM. In this study, LH was found to be associated mostly with incorrect rotation technique and a history of ketosis.
Assuntos
Diabetes Mellitus Tipo 1 , Hipoglicemia , Humanos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/complicações , Insulina/efeitos adversos , Sistemas de Infusão de Insulina/efeitos adversos , Insulina Regular Humana/uso terapêutico , Hipoglicemia/induzido quimicamente , Hipoglicemia/tratamento farmacológico , Injeções Subcutâneas , Hipoglicemiantes/efeitos adversosRESUMO
BACKGROUND: Frailty, is a geriatric syndrome that reduces the resistance to stress situations caused by activities of daily living and increases morbidity and mortality. We hypothesized that a decrease in orexigenic peptides or an increase in anorexigenic peptides might be associated with frailty. We aimed to investigate the relationship between frailty and six appetite-related peptides: ghrelin, neuropeptide Y (NPY), agouti-related peptide (AgRP), cocaine-amphetamine-associated peptide (CART), peptide YY, and alpha MSH (α-MSH). METHODS: This cross-sectional study was conducted on 85 older adults who visited the outpatient clinic. All patients underwent comprehensive geriatric assessment. Frailty status was assessed using the Fried frailty index. Plasma levels of six appetite-related peptides were studied. RESULTS: The mean age was 73.7 ± 5.4 years, 27 (31.8%) of the patients were male, and 32 of the patients (37.6%) were frail. While plasma levels of ghrelin, NPY and AgRP were significantly lower in frail patients, CART and α-MSH levels were higher compared to non-frail patients (p < .05 for all). Peptide YY was found to be higher in the frail group, however, the difference did not reach statistical significance (p = .052). In multivariate logistic regression analysis, the ghrelin, AgRP, CART, and α-MSH levels were independent predictors of frailty. Moreover, a weak correlation was found between all peptides(except NPY) and handgrip strength and Lawton-Brody score. CONCLUSION: Ghrelin, AgRP, CART, and α-MSH levels were found to be independent predictors of frailty. Our results suggest that appetite-related peptides might be playing roles in the pathogenesis of frailty. Further larger prospective studies are needed to test this hypothesis.
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Apetite , Fragilidade , Humanos , Masculino , Idoso , Feminino , Grelina , Proteína Relacionada com Agouti , alfa-MSH , Peptídeo YY , Estudos Transversais , Atividades Cotidianas , Força da Mão , Neuropeptídeo YRESUMO
PURPOSE: To evaluate the changes in demographics, clinical findings, and treatment modalities in Graves' orbitopathy (GO) patients at a tertiary referral center in Turkey over the last two decades. METHODS: The clinical data of 752 GO patients were evaluated retrospectively. Patients were divided into 2 groups according to the first ophthalmic examination date; Group 1(n:344) between January 1998 and December 2007 and Group 2(n:408) between January 2008 and December 2017. RESULTS: The number of nonsmokers was significantly higher in Group 2 (44.0 vs. 26.5%, p < 0.001). The time from the diagnosis of thyroid dysfunction and referral to our center was 32.4 months in Group 1 and 34.8 months in Group 2, (p = 0.166). The most common treatment of hyperthyroidism was antithyroid medications. Radioiodine ablation treatment rate was significantly lower in Group 2 (14.8 vs. 9.1%, p < 0.001). The time between the diagnosis of thyroid disease and orbital involvement was 22.0 vs. 26.6 months in Groups 1 and 2, respectively (p = 0.009). The time elapsed between the diagnosis of orbital disease and referral to our clinic was 21.0 months vs. 22.4 months in Group 1 and 2, respectively (p = 0.068). Orbital disease was most commonly mild, and inactive. Mild and moderate to severe GO and the mean Clinical Activity Score significantly increased, and the rate of sight-threatening disease and orbital decompression surgery significantly decreased in Group 2 (p = 0.042; p < 0.001, respectively). CONCLUSIONS: Mild and inactive orbital disease was the most common form of GO. The severity of GO is declining over the last two decades in Turkey.
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Oftalmopatia de Graves , Doenças Orbitárias , Humanos , Oftalmopatia de Graves/diagnóstico , Oftalmopatia de Graves/epidemiologia , Oftalmopatia de Graves/terapia , Centros de Atenção Terciária , Estudos Retrospectivos , Radioisótopos do Iodo , Turquia/epidemiologiaRESUMO
Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5-10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients.
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Hipocalcemia , Hipoparatireoidismo , Adulto , Cálcio , Feminino , Humanos , Hipoparatireoidismo/epidemiologia , Pessoa de Meia-Idade , Hormônio Paratireóideo , Estudos Retrospectivos , Turquia/epidemiologiaRESUMO
Dipeptidyl peptidase-4 (DPP-4) plays a role in metabolic and inflammatory diseases. Increased adenosine deaminase (ADA) has been suggested to induce insulin resistance and inflammation. We measured serum DPP-4 and ADA activities. Serum ADA activity was significantly higher in PCOS group (p = .006), whereas there was no difference in serum DPP-4 activity between the groups (p > .05). When the study subjects were divided into four groups in terms of obesity; an increasing trend in serum ADA activity between the groups was observed and ADA activity was significantly higher in overweight and obese patients with PCOS than nonobese controls (p = .016), there were no significant differences between the other groups (p > .05). A positive correlation was found between ADA and BMI in the whole group (p = .022). Multivariate regression analyses revealed that significant determinants were diastolic blood pressure, ADA, and the presence of PCOS for DPP-4 (R2 = 0.344, F = 9.079, p < .001); the presence of PCOS and DPP-4 for ADA (R2 = 0.123, F = 6.302, p = .003). We demonstrated increased serum ADA activity as well as its association with obesity in PCOS, while there was no change in serum DPP-4 activity in women with PCOS.
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Adenosina Desaminase/sangue , Dipeptidil Peptidase 4/sangue , Obesidade/sangue , Obesidade/complicações , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/complicações , Adenosina Desaminase/metabolismo , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Dipeptidil Peptidase 4/metabolismo , Feminino , Humanos , Resistência à Insulina/fisiologia , Adulto JovemRESUMO
Recent studies imply that euthyroid Hashimoto's thyroiditis (HT) might be related with impaired HRQoL, depression and anxiety. Ninety three patients with euthyroid HT and 31 age- and gender-matched euthyroid control subjects were enrolled into this study. SF-36 questionnaire, Beck Depression Inventory and Beck Anxiety Inventory tests were used for evaluating HRQoL, depression and anxiety. Beck Depression Inventory scores were higher in patients with HT compared to control subjects (7.5 (4.0-14.75) vs. 5.0 (2.25-9.0), p=0.008). Beck Anxiety Questionnaire scores were also higher in patients with HT than controls (9.50 (5.0-17.0) vs. 5.0 (2.0-11.75), p=0.021). In SF-36 questionnaire; physical functioning (26.0 (20.0-28.0) vs. 29.0 (26.0-30.0), p=0.038), general health (16.4 (13.4-20.4) vs. 19.4 (16.3-21.2), p=0.026) and mental health (20.5 (16.0-23.0) vs. 23.0 (21.0-25.0), p=0.001) scores were lower in patients with HT than control subjects. There were no significant differences between patients with HT under levothyroxine replacement therapy compared to those without therapy in terms of depression and anxiety scores and components of SF-36 questionnaire. Beck Depression Inventory scores were positively correlated with TSH (r=0.250, p=0.01). In SF-36, role physical (r=0.192, p<0.05) and vitality (r=0.181, p<0.05) were positively correlated with fT4. Role emotional was negatively correlated with TSH (r=-0.185, p<0.05) and anti-TPO (r=-0.234, p<0.05). Mental health was negatively correlated with anti-TPO (r=-0.287, p<0.01). HRQoL is impaired and depression and anxiety scores are high in patients with euthyroid HT independent of levothyroxine replacement. Therefore, our results indicate that thyroid autoimmunity itself may have an impact on psychological well-being in euthyroid patients with HT.
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Autoimunidade , Doença de Hashimoto/imunologia , Doença de Hashimoto/psicologia , Qualidade de Vida , Glândula Tireoide/imunologia , Adulto , Ansiedade/complicações , Ansiedade/imunologia , Ansiedade/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Depressão/complicações , Depressão/imunologia , Depressão/fisiopatologia , Feminino , Doença de Hashimoto/fisiopatologia , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Inquéritos e Questionários , Glândula Tireoide/fisiologiaRESUMO
Background/aim: Primary thyroid lymphoma (PTL) is a very rare thyroid malignancy. It should be diagnosed and treated immediately and accurately. Our aim was to evaluate the diagnostic methods and treatment results for patients with PTL.Materials and methods: We retrospectively evaluated the records of 11 patients with PTL from 2009 to 2015, diagnosed at our institute. Age, sex, stage, histopathologic type, presence of Hashimoto's thyroiditis, diagnostic methods, treatment types, and recurrence were examined.Results: Six patients were female, 5 were male, and the median age of the patients was 61 years (range: 15-76 years). All patients had a large palpable mass in the neck. Fine needle aspirate (FNA) biopsy was performed in all patients; however, it was useful only in the diagnosis of 7 patients. Excisional and surgical biopsy was performed in 4 patients. All patients had non-Hodgkin B-cell lymphoma, including 9 cases of diffuse large B-cell lymphoma (DLBCL), and 2 patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Recurrence was observed in one patient. Median survival was 34 months.Conclusions: The preferred option for the diagnosis of PTL should be FNA biopsy, and the treatment should be decided on according to whether the disease is limited to the thyroid gland or not, its histological type, and its stage.
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PURPOSE: Thyroglobulin (Tg) assessment in the needle washout after fine-needle aspiration biopsy (FNAB) of a suspicious neck lymph node (LN) is known to improve the diagnostic accuracy in patients with papillary thyroid cancer (PTC). However, there is still controversy on the best diagnostic cut-off levels for FNAB-Tg and whether thyroglobulin antibody (TgAb) positivity affects FNAB-Tg. The objectives of this study were to determine (i) the diagnostic power of different cut-offs for FNAB-Tg and (ii) if serum TgAb(+) negatively affects the FNAB-Tg evaluation. METHODS: This was a retrospective cohort study analyzing PTC patients with suspicious neck LNs, in a university hospital setting, from October 2009 to October 2013. In total, 103 patients with PTC (226 LNs) undergoing ultrasound-guided FNAB for LNs were included. Cytology and FNAB-Tg levels were compared in reference to LN histopathology and the effect of TgAb(+) on FNAB-Tg levels was evaluated. RESULTS: The diagnostic accuracies of FNAB-Tg cut-off of 1 and 10 ng/mL were 94.1% and 88.2%, respectively. Raising the cut-off from 1 to 10 ng/mL led to decreased sensitivity rates (91.9% vs. 83.9%). The receiver operating characteristic curve analysis demonstrated that the best FNAB-Tg cut-off was 1.2 ng/mL. There were no LNs with an FNAB-Tg ≥ 10 ng/mL that turned out to be cytologically or histopathologically benign. FNAB-Tg levels of the histopathologically malignant LNs were similar between TgAb (+) and TgAb (-) patients (p = 0.546). Serum Tg predicted FNAB-Tg levels above 1 ng/mL (p = 0.002) and FNAB-Tg predicted malignant histopathology (p = 0.004), both independently of the TgAb status of the patient. CONCLUSIONS: FNAB-Tg ≥ 1 ng/mL has a superior diagnostic power, irrespective of TgAb (+), in PTC patients with suspected LN involvement.
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Autoanticorpos/metabolismo , Biópsia por Agulha Fina/normas , Carcinoma/diagnóstico , Linfonodos/metabolismo , Neoplasias da Glândula Tireoide/diagnóstico , Adolescente , Adulto , Idoso , Carcinoma Papilar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Câncer Papilífero da Tireoide , Adulto JovemRESUMO
The cardiovascular effects of short-term overt hypothyroidism are not well known. We investigated proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble lectin-like oxidized LDL receptor 1 (sLOX-1) and the ankle brachial index (ABI) in thyroid cancer patients with short-term overt hypothyroidism due to thyroid hormone withdrawal (THW). Twenty-one patients requiring radioactive iodine (RAI) ablation or scanning and 36 healthy control subjects were enrolled. Patients were evaluated in the subclinical thyrotoxic phase when they were on suppressive levothyroxine therapy and in the overt hypothyroid phase due to THW for four weeks. PCSK9, sLOX-1, lipids and ABI were measured in the patient and control groups. Total cholesterol, LDL cholesterol, triglycerides and Apo B levels were increased in short overt hypothyroidism compared with the control group (p<0.001). PCSK9 levels increased before THW and after THW in the patients compared to control group (p<0.001, p=0.004, respectively). sLOX-1 levels were not different between patients with short term overt hypothyroidism and control group (p=0.27). ABI was found to be significantly decreased in patients with thyroid cancer before and after THW compared to control group (p=0.04, p=0.002 respectively). PCSK9 levels were correlated negatively with ABI (r=-0.38, p=0.004). In conclusion; our study demonstrated that patients with differentiated thyroid cancer both before and after THW which is a short term overt hypothyroid phase, had increased PCSK9 levels and decreased ABI. Short term overt hypothyroidism also leads to increased HDL, LDL, total cholesterol, Apo A and Apo B levels.
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Índice Tornozelo-Braço , Pró-Proteína Convertases/sangue , Receptores Depuradores Classe E/sangue , Serina Endopeptidases/sangue , Neoplasias da Glândula Tireoide/fisiopatologia , Adulto , Apolipoproteínas B/sangue , Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/fisiopatologia , Radioisótopos do Iodo/uso terapêutico , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Pró-Proteína Convertase 9 , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/radioterapia , Tiroxina/uso terapêutico , Triglicerídeos/sangueRESUMO
OBJECTIVE: To present the rare case of a patient who developed destructive thyroiditis accompanied by transient thyrotoxicosis resulting from infliximab therapy for the treatment of psoriasis. METHODS: The clinical presentation and management of a case with infliximab-associated thyroiditis is described with a brief review of the literature. RESULTS: A 57-year-old male who suffered from psoriasis was treated with infliximab therapy for 4 years. Thyroid function tests were normal before infliximab therapy. When the patient presented in our clinic, he had thyrotoxicosis and was using propylthiouracil. A 99m Technetiumpertechnetate thyroid scintigraphy scan showed no visualization of either thyroid lobe or decreased thyroid iodine uptake. Thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody (anti-TPO Ab) and thyroglobulin antibody (anti-Tg Ab) were negative. Thyroid ultrasonography revealed a heterogeneous thyroid gland without nodules. After stopping propylthiouracil therapy, we advised monitoring of his thyroid function tests in the following weeks, and infliximab therapy for psoriasis was continued. Four weeks later, his thyroid function tests showed an elevated TSH level with normal levels of free triiodothyronine and thyroxine (FT3 and FT4, respectively), and levothyroxine treatment was administered to the patient. Thyroid function tests normalized after levothyroxine treatment. One year later, infliximab therapy was stopped because of clinical remission. Simultaneously, levothyroxine treatment was also stopped. His thyroid function tests were normal 6 weeks after the cessation of levothyroxine treatment. CONCLUSION: To our knowledge, the present report is the third infliximab-associated thyroid disorder case. Periodic follow-up of thyroid function tests is necessary during infliximab therapy.
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Hipotireoidismo , Infliximab/efeitos adversos , Tireoidite , Humanos , Masculino , Pessoa de Meia-Idade , Tireoidite/induzido quimicamente , Tireotropina , Tiroxina , Tomografia Computadorizada por Raios XRESUMO
ABSTRACT: Although PSMA-targeted PET imaging is predominantly used for prostate carcinoma (PC), it has also been reported for thyroid carcinoma (TC). A 77-year-old man had a liver metastasectomy for poorly differentiated TC, which had elevated 18 F-FDG uptake. Two years later, he was diagnosed with acinar-type modified Gleason score of 7 (3 + 4) PC. Four years later, he had metastatic liver lesions that had no radioactive iodine and 18 F-FDG avidity. These lesions were 68 Ga-PSMA avid, and the biopsy confirmed TC metastasis. This case emphasizes the importance of 68 Ga-PSMA-based imaging in poorly differentiated TC and pathological confirmation for lesions that were 68 Ga-PSMA-positive.
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Neoplasias Hepáticas , Neoplasias da Próstata , Neoplasias da Glândula Tireoide , Humanos , Masculino , Idoso , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Ácido Edético/análogos & derivados , Oligopeptídeos , Radioisótopos de Gálio , Isótopos de Gálio , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Glutamato Carboxipeptidase II/metabolismo , Antígenos de Superfície/metabolismoRESUMO
Background/aim: Type 2 diabetes mellitus (T2DM) is the most common type of diabetes and occurs due to insufficient insulin secretion or inability to use existing insulin and the effects of environmental factors. Although there are many studies on the pathophysiology of T2DM, the mechanisms contributing to the pathogenesis of insulin resistance and pancreatic beta-cell dysfunction have not been completely elucidated. Some adipokines secreted from adipose tissue, which are the primary regulators of insulin resistance, affect immune and inflammatory functions. Altered adipokine profiles have been observed in obesity and T2DM, leading to severe metabolic risks and changes in insulin sensitivity. Materials and methods: This study used quantitative PCR and ELISA techniques to analyze samples from individuals without diabetes (control group) and with T2DM (macrovascular and microvascular complications and without complications) for at least 10 years. Results: The mRNA expression and protein levels of NAMPT, IL-6, and vaspin genes were determined. While there was no significant difference in NAMPT, IL-6, and vaspin mRNA expression levels between diabetic groups, there was a significant decrease between the patient and control groups (p < 0.001). For serum protein levels, NAMPT protein levels decreased significantly in the uncomplicated group, while IL-6 and vaspin protein levels increased significantly in both microvascular and macrovascular complication groups (p < 0.001). Conclusion: The correlations between gene expressions, clinical parameters, and protein levels are crucial to understanding the implications of the findings.
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OBJECTIVE: Endogenous cortisol excess is known to affect body fat distribution. Ectopic fat is the accumulation of triglycerides in non-adipose tissue regions that normally contain little fat. The aim of study was to investigate the amount of ectopic fat in aortic perivascular and renal sinus fat of patients with endogenous cortisol excess and its relationship with their comorbitidies and laboratory findings. DESIGN: A total of 119 patients, including 16 patients with pituitary Cushing's disease (CD), 21 patients with adrenal Cushing's syndrome (CS), 34 patients with mild autonomous cortisol secretion (MACS), and 48 patients with nonfunctioning adrenal adenomas were enrolled in this retrospective study. Aortic perivascular fat and renal sinus fat were evaluated with magnetic resonance imaging. RESULTS: It was determined that the amount of aortic perivascular fat was increased in patients with CD (P = 0.01). The linear regression analysis showed that the amount of perivascular fat was associated with triglyceride levels and cortisol levels after the 1 mg dexamethasone suppression test as well as with gender (P < 0.01). Renal sinus fat measurements were similar in the groups (P > 0.05). After adjusting for age, sex, and BMI, perivascular fat was found to be higher in pituitary the CD than in the MACS and the nonfunctioning adenoma groups, and renal sinus fat was seen to be higher in pituitary the CD than in the MACS groups (P < 0.05). Patients with diabetes mellitus had an increased amount of renal sinus fat (P = 0.008). CONCLUSION: The amount of perivascular and renal sinus fat may increase in patients with CD. Further studies are needed to elucidate ectopic fat distribution in patients with endogenous cortisol excess.
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CONTEXT: The impact of abnormal cortisol secretion on cognitive functions in patients with mild autonomous cortisol secretion (MACS) remains uncertain. OBJECTIVE: To assess cognitive functions, determine serum brain-derived neurotrophic factor (BDNF) concentration in patients with MACS, and investigate the association between cognitive subdomains and BDNF. METHODS: We prospectively recruited 84 participants-28 patients with MACS, 28 patients with nonfunctional adrenal adenoma (NFAA), and 28 control subjects matched for age, gender, body mass index (BMI), visceral adiposity, and educational level. The serum BDNF concentration of participants was measured. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-focused interviews and Montreal Cognitive Assessments (MoCA) were carried out by an experienced psychiatrist. RESULTS: Patients with MACS had a higher serum BDNF concentration than the NFAA (P = .001), while that of patients with NFAA was lower than the controls (P = .044). Linear regression analysis revealed BMI and morning cortisol after overnight 1 mg dexamethasone (DST) were mostly associated with BDNF (P < .05). No significant difference was found in MoCA scores between MACS and NFAA groups (P = .967), whereas those were lower than the control group (P = .004). When the cognitive subdomains were examined separately, MACS group performed higher memory score than NFAA (P = .045), but lower language scores than both the NFAA (P = .024) and control groups (P < .001). In the whole group, BDNF concentration was positively correlated with memory score (r = 0.337, P = .002), whereas DST was negatively correlated with language score (r = -0.355, P = .008). CONCLUSION: Low-grade hypercortisolism is associated with elevated BDNF concentrations, which may be a protective factor for memory function in patients with MACS relative to those with NFAA.
Assuntos
Fator Neurotrófico Derivado do Encéfalo , Cognição , Hidrocortisona , Humanos , Fator Neurotrófico Derivado do Encéfalo/sangue , Masculino , Feminino , Hidrocortisona/sangue , Pessoa de Meia-Idade , Cognição/fisiologia , Adulto , Estudos Prospectivos , Estudos de Casos e Controles , Disfunção Cognitiva/sangue , Disfunção Cognitiva/etiologia , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/complicações , IdosoRESUMO
Accurate measurement of adrenocorticotropic hormone (ACTH) is crucial in the evaluation of pituitary and adrenal disorders. Although great progress has been achieved in ACTH measurement with immunometric assays, interference may occur and adversely affect the clinical management. The report contributes to compiling the evidence on the clinical challenges with the management of the interferences in the ACTH measurement by presenting three cases: two with clinically overt hypercortisolism and discrepant ACTH concentrations within the reference interval; the third case describes the falsely elevated ACTH in a patient with secondary adrenal insufficiency. In all patients, the results obtained with the two immunometric platforms, chemiluminescence (CLIA) immunoassay (Siemens, Immulite) and electrochemiluminescence (ECLIA) immunoassay (Roche, Cobas), were discordant. Serial dilution of plasma samples revealed nonlinearity. After polyethylene glycol (PEG) precipitation recoveries were less than 22%, 26%, and 3%, respectively, supporting interference. Moreover, a decrease in ACTH concentration after incubation in a heterophile antibody-blocking tube was observed in the second case. In the first case, misinterpretation of ACTH led to inferior petrosal sinus sampling (IPSS), whereas timely detection of assay interference prevented further investigations in other cases. Increasing awareness regarding ACTH interference and comprehensive approach in evaluation could allow timely detection, helping to prevent unnecessary testing and perplexing clinical outcomes.
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Hormônio Adrenocorticotrópico , Amostragem do Seio Petroso , Humanos , Amostragem do Seio Petroso/métodos , ImunoensaioRESUMO
PURPOSE: Studies on intestinal microbiota in acromegaly are scant. This study aimed to characterize the gut microbiome in patients with acromegaly. METHOD: Stool samples were collected from 11 patients newly diagnosed with acromegaly and 12 healthy controls matched for body mass index (BMI) and age after three days on a standard diet. Clinical and gut microbial composition assessments were performed for the two participant groups using 16S rRNA gene amplicon sequencing. RESULTS: There was no difference in the alpha diversity of the microbiota between the samples from patients with acromegaly and those from the healthy controls. Based on beta diversity measurements, differences in microbial community structures were found to be significant only when compared using the Jaccard similarity index. The corresponding Firmicutes/Bacteroidota ratio tended to be higher in individuals with acromegaly than in healthy controls. The mean relative abundance of Actinobacteriota was 2.3 times higher in the acromegaly patient group than in the control group. Eggerthellaceae, Christensenellaceae, and Bacteroidaceae were among the significantly abundant bacterial families in the samples from the acromegaly patient group, while Butyricicoccaceae and Tannerellaceae were decreased. At the level of the genus, the most discriminative features were the abundance of Prevotella 7, Bacteroides, Senegalimassilia, Enterohabdus, the Family XIII AD3011 group, Howardella, and Hungatella in the samples from the acromegaly patient group. In contrast, the Butyrivibrio and the Eubacterium eligens group were the most discriminative genera for the healthy controls and were significantly less abundant in patients with acromegaly. While there were no significantly differentiated taxa between the diabetic and non-diabetic subgroups, Prevotella_7 was significantly enriched in the osteoarthritis (OA) subgroup. No significant association was found between individual genera and growth hormone (GH) levels and insulin-like growth factor-1 (IGF-1) levels as well as the upper limit of normal (ULN). CONCLUSION: Although alpha and beta diversity were mainly similar between the two groups, significant differences were observed between the acromegaly group and the control group at the family and genus levels. These results suggest that the differences between the microbial communities in patients with acromegaly and those in healthy individuals consist primarily of compositional differences independent of abundance. Prospective studies are needed to further explore the clinical implications of gut microbiome dysbiosis in patients with acromegaly.