Prevalence of gestational diabetes mellitus and associated risk factors in Turkish women: the Trabzon GDM Study.

INTRODUCTION: The aim of this study was to investigate the prevalence of gestational diabetes mellitus (GDM) in Turkish pregnant women in the Trabzon Region and further to identify population-specific risk factors for GDM. MATERIAL AND METHODS: In this prospective cross-sectional survey, universal screening for GDM was performed in 815 pregnant women. Screening was done with a 50-g oral glucose challenge test (GCT) with a 140 mg/dl cut-off point, then a diagnostic 100 g oral glucose tolerance test (OGTT) was performed according to Carpenter and Coustan (CC) criteria. RESULTS: The GCT was positive in 182 (22.3%) cases. The OGTT was performed on the 182 screen-positive pregnant women. Thirty-five were diagnosed with GDM on the basis of their results for a prevalence of 4.3% (35/815). Of the pregnancies with negative GCT but having high risk factors for GDM (n = 31), 4 were diagnosed with GDM (0.5%). Prevalence of GDM was found to be 4.8% (n = 39) for all pregnant women. Gestational diabetes mellitus was positively associated with advanced maternal age (p < 0.001), prepregnancy body mass index (p < 0.001), cessation of cigarette smoking (p < 0.001), excessive weight gain during pregnancy (p = 0.003), previous history of GDM (p < 0.001), history of selected medical conditions (p = 0.018), family history of diabetes (FHD) (p < 0.001), and existence of at least one high risk factor for GDM (p < 0.001). In multiple logistic regression analysis, independent predictors for GDM were maternal age, cessation of cigarette smoking, increasing prepregnancy body mass index, weight gain of more than 8 kg during pregnancy, GDM history in previous pregnancies and a history of diabetes in first-degree relatives of pregnant women. CONCLUSIONS: The prevalence of GDM in Trabzon province was found as moderate. Commonly recognized risk factors including older age, prepregnancy obesity, FHD and past history of GDM, are valid for our urban Turkish population. Also, excessive weight gain in pregnancy and cigarette cessation were observed to be nontradional risk factors of GDM. It was concluded that all pregnant women should be screened for GDM if prevalence was not low.

A 20-year study on 190 patients with primary hyperparathyroidism in a developing country: Turkey experience.

The aim of this study was to present our 20-year experience regarding primary hyperparathyroidism (PHPT). PHPT patients who underwent parathyroidectomy in our clinic were reviewed retrospectively. There were 190 PHPT patients, of whom 137 were asymptomatic (72%). The mean serum calcium at the time of diagnosis was 11.9 ± 2.2 mg/dL. The mean parathyroid hormone (PTH) level was 467 ± 78 pg/mL. Ultrasonography (USG) identified all abnormal glands accurately (82.6%) and Technetium-99m sestamibi scintigraphy (MIBI) was used in 89.4% of the patients and magnetic resonance imaging (MRI) in 61%. The common use of USG and MIBI detected 92% of the lesions. Bilateral neck exploration (BNE) was performed in 12.2% of the patients and focused unilateral neck exploration (FUNE) in the remaining 87.8%. Surgical intervention was unsuccessful in 1 patient (0.5%). The conversion ratio from FUNE to BNE was 5.2%. The mean operation time and mean hospital stay decreased significantly in patients with FUNE. Pathologic examination revealed single adenoma in 93% of the patients. New imaging techniques result in the conversion of surgical treatments of PHPT. FUNE in parathyroidectomy performed by an experienced surgeon may provide successful treatment rates.

Hormone-secreting large adrenal ganglioneuroma in an adult patient: a case report and review of literature.

BACKGROUND. Ganglioneuromas (GNs) are neural crest cell-derived tumors and rarely occur in the adrenal gland. They are usually asymptomatic and hormonally silent. The majority of cases are detected incidentally during work-up for unrelated conditions. Hormone-secreting pure adrenal GNs in adults are extremely rare. To date, only four cases have been reported in the English literature. CASE REPORT. We describe an adult case of endocrinologically active adrenal GN incidentally diagnosed in a 64-year-old male patient with history of uncontrolled hypertension. On physical examination, he had a blood pressure (BP) of 160/100 mmHg. Abdominal computed tomography and magnetic resonance imaging showed a large solid tumor (8.5 × 7.5 × 7 cm) in the right adrenal gland. Urinary levels of norepinephrine, normetanephrine, vanillylmandelic acid and dopamin were elevated, although urinary level of epinephrine was suppressed. Right adrenalectomy was performed for treatment purposes. The histological diagnosis of the resected tumor was adrenal GN. CONCLUSIONS. Hormone-secreting pure adrenal GN occurs very rarely in adults and preoperative diagnosis is difficult. Adrenal GN may present with hormonal activity such as increased secretion of catecholamines and their metabolites. There are no specific diagnostic signs and symptoms discriminating GN and pheochromocytoma. Therefore, histopathological examination need for a definitive diagnosis of adrenal GN. The prognosis after completed surgical resection without further therapy seems to be excellent. To our knowledge, the present case is the second report that describes hormone-secreting pure adrenal GN in an adult from Turkey in the English literature. We discuss this case and review the literature on this unusual entity.

The effects of rosiglitazone and metformin on inflammation and endothelial dysfunction in patients with type 2 diabetes mellitus.

Diabetic patients have a markedly increased risk of cardiovascular disease compared with non-diabetics. Two drug groups today target insulin resistance; biguanides and thiazolidinediones. In addition, these may have other effects on cardiovascular risk factors. The aim of this study was to evaluate the effects of metformin and rosiglitazone on non-traditional cardiovascular risk factors. Forty type 2 diabetic patients were randomized into metformin and rosiglitazone groups. After receiving the optimal doses, the patients were monitored for 12 weeks. Biochemical parameters, lipid parameters, CRP, insulin, c-peptide, and HbA1c levels were analyzed. VWF, PAI-1, ICAM-1, TNF-α, IL-6, E-selectin, and fibrinogen levels were measured in order to assess coagulation status and endothelial dysfunction. In the metformin group, body mass index, PPG, HbA1c, IL-6, ICAM-1, and TNF-α levels were significantly decreased after 12 weeks compared with the basal levels. IL-6 levels decreased from 75 pg/ml ± 20 to 42 pg/ml ± 9 (P 0.023) and TNF- α levels from 61 pg/ml ± 31 to 39 pg/ml ± 10 (P 0.018). In the rosiglitazone group, FPG, PPG, HbA1c, insulin, HOMA-IR, IL-6, and TNF-α levels decreased significantly after 12 weeks compared with the basal levels. IL-6 levels decreased from 78 pg/ml ± 21 to 41 pg/ml ± 9 (P 0.028) and TNF-α levels from 62 pg/ml ± 19 to 37 pg/ml ± 10 (P 0.012). At the end of the study, no significant differences were determined between groups. Insulin resistance and type 2 diabetes are strongly associated with low grade inflammation. Both metformin and rosiglitazone were effective in controlling inflammatory markers in addition to metabolic parameters.

Blood coagulation, fibrinolysis and lipid profile in patients with prolactinoma.

OBJECTIVE: Although the strong association between hyperprolactinaemia and platelet aggregation is well recognized, there are no studies on changes in coagulation and fibrinolytic status in patients with prolactinoma. To our knowledge, tissue plasminogen activator inhibitor-1 (PAI-1), plasma tissue factor pathway inhibitor (TFPI) and thrombin-activatable fibrinolysis inhibitor (TAFI) levels in these patients have not been investigated. Therefore, the main purpose of this study was to evaluate the markers of endogenous coagulation/fibrinolysis, including TFPI and TAFI, and to investigate the relationships between prolactin (PRL) and these haemostatic parameters and serum lipid profile in patients with prolactinoma. RESEARCH METHODS AND PROCEDURES: Twenty-two patients with untreated, newly diagnosed prolactinoma and 20 age-matched healthy controls were included in the study. Platelet count, mean platelet volume, prothrombin time, activated partial thromboplastin time, fibrinogen, factors V, VII, VIII, IX and X activities, von Willebrand factor, antithrombin III (AT-III), protein C, protein S, tissue plasminogen activator (t-PA), PAI-1, TFPI and TAFI, as well as common lipid variables, were measured. The relationships between serum PRL and these haemostatic parameters were evaluated. RESULTS: Compared with the control subjects, total cholesterol, low density lipoprotein cholesterol, apolipoprotein B, platelet count, fibrinogen, AT-III, PAI-1 and PAI-1/t-PA ratio were significantly increased in patients with prolactinoma (P < 0.0001, P < 0.001, P < 0.05, P < 0.05, P < 0.0001, P < 0.05, P < 0.0001 and P < 0.0001, respectively), whereas TFPI levels were significantly decreased (P < 0.01). Plasma TAFI Ag levels were not significantly different in patients with prolactinoma compared with the controls. In patients with prolactinoma, serum PRL was positively correlated with plasma FVII levels and apo B (r: 0.679, P < 0.05; r: 0.548, P < 0.05, respectively). CONCLUSION: We found some important differences in the haemostatic parameters between the patients with prolactinoma and healthy controls. Increased platelet count, fibrinogen, PAI-1 and decreased TFPI in patients with prolactinoma may represent a potential hypercoagulable and hypofibrinolytic state, which might augment the risk for atherosclerotic and atherothrombotic complications. Thus, disturbances of the haemostatic system and dyslipidaemia may lead to the excess mortality in patients with prolactinoma.

The prevalence of non-classic adrenal hyperplasia among Turkish women with hyperandrogenism.

The prevalence of non-classic adrenal hyperplasia (NCAH) among Turkish women with hirsutism has not been established so far. Thus, we aimed to evaluate the prevalence of 21-hydroxylase (21-OH) deficiency by ACTH stimulation test among hirsute women. The study population consisted of 285 premenopousal women, aged 16-46 years (mean: 23.2 ± 0.3). All were hirsute and hyperandrogenic. Androgen secreting tumors of the ovaries and the adrenal glands were excluded as well as thyroid dysfunction and hyperprolactinemia. All the patients were evaluated by 0.25 mg (i.v.) ACTH stimulation test and 17-OHP responses were obtained at 30 and 60 min. The diagnosis of NCAH due to 21-OH deficiency was considered in patients with the poststimulation 17-OHP level exceed 10 ng/ml. Six (2.1%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. The rest of the patients were polycystic ovary syndrome (n = 166, 58.2%) and idiopathic hyperandrogenemia (n = 113, 39.7%). There were no patients with idiopathic hirsutism because patients with normal serum androgen levels were excluded. This first and most extensive national study investigating NCAH prevalence among Turkish population showed that NCAH is not prevalent in this population.

Primary thyroid paraganglioma presenting with double thyroid nodule: a case report.

Paragangliomas (PGs) are exceptionally rare tumors. Only 24 cases have previously been reported. Both preoperative and postoperative differential diagnosis is very difficult. Due to interesting nature in diagnosis and differential diagnosis, we describe the case 58-year-old euthyroid woman with a thyroid PG. The patient had presented with euthyroid multinodular goiter to a secondary hospital. The patient was treated with right lobectomy, isthmectomy, and left partial lobectomy without any imaging procedures. No complication had been developed during and following the operation. Initial pathological examination suggested medullar thyroid carcinoma (MTC) in a nodule of 4.5 cm in diameter on right thyroid lobe and a nodule of 2.5 cm in diameter on the left thyroid lobe without amyloid stroma and referred to our third-stage hospital. Repeated pathological examination involving immunohistochemistry revealed that the tumor was stained positively to neuron-specific enolase, chromogranin A, synaptophysin, and S-100 protein. No immunoreactivity was detected against thyroglobulin, calcitonin, parathormone, carcino-embryonic antigen, thyroid transcription factor-1, and cytokeratin. A diagnosis of thyroid PG was finally made. Laboratory analyses and imaging procedures excluded any neck or extracervical tissues metastasis or multiple endocrine neoplasia. In conclusion, thyroid PG is an elusive tumor. We present this interesting nature thyroid PG case to highlight importance of careful evaluation of clinical and pathological findings to correctly identify paragangliomas which anatomically mimic MTCs. This report is the first case of thyroid PG presenting with multinodular goiter in the literature.

Adrenal ganglioneuroma: report of a new case.

Although adrenal ganglioneuroma (GN) is a rare tumor originating from the neural crest tissue of the sympathetic nervous system, detection of this tumor has increased, as imaging procedures such as ultrasonography (US) and computed tomography (CT) have become prevalent. The clinical presentation for most patients is asymptomatic, and most of those tumors are hormone silent. We describe a case of adrenal GN incidentally diagnosed in a 68-year-old female patient. Physical examination, routine laboratory studies, and hormonal tests were within normal ranges. Abdominal CT and magnetic resonance imaging showed a solid oval tumor approximately 6 x 4 cm in the left adrenal gland without remarkable signs of malignancy. Left adrenalectomy was performed for treatment purposes. Histological diagnosis of the tumor was a ganglioneuroma originating from the adrenal medulla. Adrenal GN occurs rarely in adults and preoperative diagnosis is difficult, especially in asymptomatic cases. It needs careful evaluation and surgical treatment. According to our knowledge, this is the fifth case of adrenal GN in an adult patient from Turkey in English literature.

Impairment in flow-mediated vasodilatation of the brachial artery in acromegaly.

OBJECTIVE: The aim of this study was to assess flow-mediated dilatation (FMD) of the brachial artery in patients with acromegaly. SUBJECTS AND METHODS: We prospectively evaluated 25 patients with acromegaly (14 females, 11 males; aged 42 +/- 12 years; growth hormone (GH) levels 34 +/- 14 ng/ml) and 27 control subjects (15 females, 12 males; aged 45 +/- 8 years; GH levels 3 +/- 1.5 ng/ml). The patients and controls were matched for age, gender, body mass index, cigarette smoking, blood pressure, lipid levels, diabetes mellitus, hypertension, and its duration. Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in the 2 groups. The endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery. RESULTS: The FMD was lower in patients with acromegaly (9.97 +/- 3.5%) than in controls (16.1 +/- 3.4%), and the difference was statistically significant (p = 0.0001). CONCLUSION: Endothelial dysfunction may develop in the preclinical phase of atherosclerosis in patients with acromegaly. Endothelium-dependent FMD may be impaired in acromegalic patients, and measurement of endothelial function may identify high-risk individuals earlier.

Prevalence of prehypertension and hypertension and associated risk factors among Turkish adults: Trabzon Hypertension Study.

BACKGROUND: To estimate the prevalence, awareness and control of prehypertension (preHT) and hypertension (HT) as defined by JNC-7 criteria in the Trabzon Region and its associations with demographic factors (age, sex, obesity, marital status, reproductive history in women and level of education), socioeconomic factors (household income and occupation), family history of selected medical conditions (diabetes, hypertension, obesity and cardiovascular disease), lifestyle factors (smoking habits, physical activity and alcohol consumption) in the adult population. METHODS: In this cross-sectional survey, a sample of households was systematically selected from the central province of Trabzon and its nine towns. A total of 4809 adult subjects (2601 women and 2208 men) were included in the study. Demographic and socioeconomic factors, family history of selected medical conditions, and lifestyle factors were obtained for all participants. Systolic blood pressure (BP) and diastolic BP levels were measured for all subjects. The persons included in the questionnaire were invited to the local medical centers for blood examination between 08:00-10:00 following 12 hours of fasting. The levels of serum glucose (FBG), total cholesterol (Total-C), high density cholesterol (HDL-C), low density cholesterol (LDL-C) and triglycerides were measured with autoanalyzer. Definition and classification of HT was performed according to guidelines from the US JNC-7 report. Prevalence, awareness, treatment and control of HT were assessed. RESULTS: The prevalences of HT and preHT were 44.0% (46.1% in women and 41.6% in men) and 14.5% (12.6% in women and 16.8% in men), respectively. Overall, only 41% of the hypertensive individuals had been previously diagnosed. Furthermore, 54.5% of the hypertensive subjects were being treated with antihypertensive drugs (AHD), but only 24.3% of treated subjects had their BP adequately controlled. Among all hypertensive subjects (known and newly diagnosed), only 5.43% had their BP under control. The prevalence of HT increased with age, being highest in the 60- to 69-year-old age group (84.4%) but lower again in the 70+ age group. Interestingly, the prevalence was 16.9% in the 20-to 29-year old age group. HT was associated positively with marital status, parity, cessation of cigarette smoking, and negatively with level of education, alcohol consumption, current cigarette use, and physical activity. Multinomial logistic regression analysis revealed that HT were significantly associated with age, male gender, BMI, low education level, nonsmoking, positive family history of selected medical conditions, occupation, and parity. CONCLUSIONS: The Trabzon Hypertension Study data indicated that HT is very common and is an important health problem in the adult population of Trabzon. Patients who are unaware of their status and treated uncontrolled hypertensives are at high risk of early cardiovascular morbidity and mortality. To control preHT and HT, effective public health education and urgent precautions are needed. The precautions include serious health education, a well-balanced diet and increasing physical activity.

Diagnostic value of prostate-specific antigen (PSA) and free prostate specific antigen (fPSA) in women with ovulatory and anovulatory polycystic ovary syndrome.

Diagnosis of polycystic ovary syndrome (PCOS) is very difficult in women with ovulatory cycles. We assessed the diagnostic value of prostate-specific antigen (PSA) and free prostate-specific antigen (fPSA) in women with ovulatory or anovulatory PCOS. Study group consisted of 62 women with PCOS and 35 healthy female controls. PCOS group was divided into two subgroups as anovulatory (n = 42; 68%, Group A) and ovulatory group (n = 20; 32%, Group B). A cut-off level of PSA and fPSA was established for the sensitivity, specificity, positive likelihood ratio, area under curve, diagnostic accuracy, and positive and negative predictive values of diagnosis of PCOS. In group A, a PSA level of greater than 10 pg/ml yielded a sensitivity of 73.2%, a specificity of 80%, and a diagnostic accuracy of 73%, with a positive predictive value of 88.2% and a negative predictive value of 59.3%. An fPSA level of greater than 2.1 pg/ml yielded a sensitivity of 71.2%, a specificity of 80.4%, and a diagnostic accuracy of 87%, with a positive predictive value of 87.2% and a negative predictive value of 58.4%. In group B, a PSA level of greater than 10 pg/ml yielded a sensitivity of 65%, a specificity of 80%, and a diagnostic accuracy of 73%, with a positive predictive value of 76.5% and a negative predictive value of 69.6%. An fPSA level of greater than 2.1 pg/ml yielded a sensitivity of 65.4%, a specificity of 80.4%, and a diagnostic accuracy of 87%, with a positive predictive value of 75.5% and a negative predictive value of 68.4%. Circulating androgens and hirsutism are independently associated with the degrees of PSA and fPSA in PCOS women. Increased plasma levels of PSA (>10 pg/ml) and fPSA (>2.1 pg/ml) could be helpful as a diagnostic tool for women with ovulatory or anovulatory PCOS.

Prevalence of dyslipidemia and associated risk factors among Turkish adults: Trabzon lipid study.

The objective of this study was to estimate the prevalence of dyslipidemia as defined by NCEP ATP III criteria in the Trabzon Region of Turkey and to determine its associations with cardiovascular risk factors [hypertension (HT), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and fasting serum glucose (FBG)] demographic factors (age, sex, obesity, marital status, reproductive history in women, and level of education), socioeconomic factors (household income and occupation), a family history of selected medical conditions (diabetes, HT, obesity, and cardiovascular disease), and lifestyle factors (smoking habits, physical activity, and alcohol consumption) in the adult population. In this cross-sectional survey, a sample of households was systematically selected from the central province of Trabzon city and its nine towns, namely, Akcaabat, Duzkoy, Vakfikebir, Yomra, Arakli, Of, Caykara, Surmene, and Macka. A total of 4,809 subjects (2,601 women and 2,208 men) were included in the study. Individuals older than 20 years were selected from their family health cards. Demographic and socioeconomic factors, a family history of selected medical conditions, and lifestyle factors were obtained for all participants. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels were measured for all subjects. The individuals included in the questionnaire were invited to the local medical centers for blood tests between 08:00 and 10:00 after 12 h of fasting. The levels of serum glucose (FBG), total cholesterol (TC), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), and trigylcerides were measured with autoanalyzer. Dyslipidemia was defined according to guidelines from the US NCEP ATP III diagnostic criteria. The ratio of TC to HDL-C was calculated. Definition and classification of HT were performed according to guidelines from the US JNC-7 report. The results obtained indicated that the age-adjusted mean values (mg/dl) of TC, LDL-C, HDL-C, [TC/HDL-C ratio], and TG were 190 +/- 0.6, 127.5 +/- 0.5, 50.3 +/- 0.3, 3.96 +/- 0.02, and 137.3 +/- 1.5, respectively. Overall, the mean levels of LDL-C, TG and TC/HDL-C ratio were higher in men than in women, whereas the mean level of HDL-C was higher in women than in men. The prevalences of hypercholesterolemia (> or =200 mg/dl), elevated LDL-C (> or =130 mg/dl), low HDL-C (<40 mg/dl), and hypertriglyceridemia (> or =150 mg/dl) were 37.5, 44.5, 21.1, and 30.4%, respectively. Prevalences of dyslipidemia were higher in men than in women, except for TC (P < 0.0001). The prevalences of high TC, LDL-C, TG, and TC/HDL-C ratio increased with age, with the highest prevalences in the 60-69-year-old group, and declined thereafter. The prevalences of high TC, LDL-C and TG, a high TC/HDL-C ratio and low HDL-C increased steadily in line with BP, BMI, WC, WHR, and FBG (P < 0.0001). Dyslipidemia was positively associated with marital status, parity, cessation of cigarette smoking and current cigarette use, and alcohol consumption, and negatively associated with the level of education, household income, and physical activity. Multiple logistic regression analysis revealed that dyslipidemia was significantly associated with the factors of age, male gender, BMI, WC (except for TC and LDL-C), HT (only for LDL-C and TG), FBG (only for LDL-C and TG), education level, cigarette smoking (only for HDL-C and TC/HDL-C ratio), alcohol consumption (except for HDL-C and TC/HDL-C ratio), occupation (especially housewives), marital status (widows and widowers), and a family history of selected medical conditions (for only TC). In conclusion, Trabzon Lipid Study data indicate that dyslipidemias are very common and an important health problem among the adult population of Trabzon. To control dyslipidemias, effective public health education and urgent measures are essential.

The significance of Galectin-3 expression in the immunocytochemical evaluation of thyroid fine needle aspiration cytology.

The aim of this study is to evaluate the significance of immunohistochemical expression of Galectin-3 in the differential diagnosis of benign and malignant thyroid nodules. We studied the fine needle aspiration specimens of 38 patients who had evaluated for nodular goiter and undergone a thyroid surgery between 2004-2005. Slides had been stained immunocytochemically with Galectin-3. The cytoplasmic staining of Galectin-3 was analyzed. Three cases of five follicular carcinomas had positive staining for Galectin-3, while two had not. Two cases with follicular adenomas were negative for Galectin-3. Five cases of six papillary carcinomas had positive staining for Galectin-3, while one case (the case with a papillary microcarcinoma) had not. The single cases with medullary and anaplastic carcinomas were negative for Galectin-3. None of the cases with a benign thyroid pathology had positive staining for Galectin-3. Galectin-3 immunocytochemical staining, had a sensitivity of 61.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 83.3% for thyroid malignancies. For the evaluation of follicular neoplasm, Galectin-3 immunocytochemical staining had a sensitivity of 60%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 50%. Galectin-3 expression in thyrocytes is a strong indicator of a malignant proliferative lesion especially for papillary and to an extent in follicular thyroid neoplasms. Galectin-3 could be used as a supplementary marker for cytological diagnosis.

Prevalence of metabolic syndrome and associated risk factors among Turkish adults: Trabzon MetS study.

OBJECTIVE: In order to estimate the prevalence of metabolic syndrome (MetS) as defined by NCEP Adult Treatment Panel III (ATP III) criteria in the Trabzon Region and its associations with demographic factors (age, sex, marital status, reproductive history in women, and level of education), socioeconomic factors (household income and occupation), family history of selected medical conditions (diabetes, hypertension, and obesity), lifestyle factors (smoking habits, physical activity, and alcohol consumption) in the adult population. RESEARCH METHODS AND PROCEDURES: In this cross-sectional survey, a sample of households was systematically selected from the central province of Trabzon and its nine towns. A total of 4,809 adult subjects > or = 20 years (2,601 women and 2,208 men) were included in the study. Blood pressure levels were measured for all subjects. The persons included in the questionnaire were invited to the local medical centers for blood examination between 08:00 and 10:00 following 12 h of fasting. Fasting serum glucose (FBG) levels and lipid profile were measured with autoanalyzer. MetS was defined according to guidelines from the NCEP ATP III diagnostic criteria. RESULTS: The prevalence of MetS was 26.9%: 31.3 in women and 21.7% in men. The prevalence increased with age, being highest in the 60-69-year-old age group (53.4%) but lower again in the > or = 70 age group. MetS was associated positively with marital status, parity, cessation of cigarette smoking, and negatively with the level of education, alcohol consumption, current cigarette use, household income, and physical activity. Hypertension was found as the most common MetS component in our study (57.4%). Others in decreasing order were abdominal obesity (40.9%), low high-density lipoprotein-C (HDL-C) (31.8%), hypertriglyceridemia (30.7%), and high FBG levels (9.2%). Similarly, in the subjects diagnosed with MetS, HT had the highest prevalence (91.9%). This was followed by abdominal obesity (82.3%), hypertriglyceridemia (74%), low HDL-C (68.6%), and high fasting blood glucose levels (28.6%). DISCUSSION: MetS is moderately common and an important health problem in the adult population of Trabzon. In order to control MetS and its components, effective public health education and taking urgent steps are needed. These steps include serious education, providing a well-balanced diet and increasing physical activity.

Dopamine-secreting adrenal ganglioneuroma presenting with paroxysmal hypertension attacks.

Adrenal ganglioneuromas are rare tumors originating from the neural crest tissue of the sympathetic nervous system. The clinical presentation for most patients is asymptomatic, and most of these tumors are hormone silent. We report a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient. A 46-year-old woman was admitted to our hospital with a 2-month history of right flank pain, and a 2-year history of paroxysmal hypertensive attacks associated with headaches, palpitations, nervousness, and sweating. Abdominal CT and MRI revealed a solid round tumor approximately 4 cm in diameter on the upper pole of the right kidney. Urinary levels of dopamine and homovanillic acid were slightly elevated, although urinary levels of metanephrine and normetanephrine were suppressed. The urinary levels of epinephrine, norepinephrine, and vanillylmandelic acid were within normal limits. Right adrenalectomy was performed for treatment purposes. Histological diagnosis of the tumor was a ganglioneuroma originating from the adrenal medulla. In conclusion, this is a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient.

An unusual etiology of erythropoietin resistance: hyperthyroidism.

Many possible causes of resistance to human recombinant erythropoietin (rh-EPO) have been reported in patients with renal failure. This case presents an unusual cause of erythropoietin-resistant anemia in a patient with chronic renal failure. A 61-year-old male patient who was on chronic hemodialysis program due to diabetic nephropathy for seven months developed erythropoietin resistant anemia. No iron deficiency was revealed by laboratory data, no megaloblastic anemia were found by biochemical investigation, and no inflammatory states including infection or neoplastic diseases were disclosed by abdominal ultrasonography, chest X-ray, bone marrow aspiration and biopsy, or other methods (normal C-reactive protein levels). This hemodialysis patient had epoetin-resistant anemia with primary autoimmune hyperthyroidism. The anti-thyroid therapy was effective not only against the hyperthyroidism but also against his epoetin resistant anemia.

Paragangliomas of the head and neck.

OBJECTIVES: The purpose of this study was to determine the clinical characteristics of carotid body tumors and to analyze the benefits of different treatment modalities. SUBJECTS AND METHODS: The clinical records of 13 patients with paragangliomas treated during the period of 1995-2005 were reviewed for age at diagnosis, sex, initial symptoms, duration of symptoms, evidence of secretory function, family history, radiographic studies, pre- and posttreatment cranial nerve deficits, multicentric tumors, angiography, operative procedures and findings, and complications. The diagnoses were established by computerized tomography and magnetic resonance imaging scanning. Angiography was performed on 3 patients with carotid body tumor. RESULTS: All of the patients were followed up for a duration ranging from 16 months to 9 years. The median follow-up was 5 years. Of all 18 head and neck tumors confirmed in 13 patients, 16 were in the carotid body, 1 in the vagus nerve and 1 in the middle ear cleft. Four patients had multiple paragangliomas, 2 bilateral synchronous and 1 bilateral asynchronous paragangliomas. The remaining patient had 3 asynchronous paragangliomas, i.e. left jugulotympanic, right carotid body and left vagal paraganglioma. All patients underwent successful surgical resection of the tumor after appropriate preoperative investigation. CONCLUSION: This study shows that surgical treatment is acceptably safe and effective in treating these neoplasms.

Impairment of flow mediated vasodilatation of brachial artery in patients with primary hyperparathyroidism.

BACKGROUND: Hyperparathyroid condition might influence endothelial cells. The aim of this study was to assess flow mediated dilatation (FMD) in patients with primary hyperparathyroidism (PHPT). METHODS: We prospectively evaluated 21 patients with PHPT (9 women, 12 men; aged 50 +/- 11 years, serum calcium 11.6 +/- 0.7 mg/dl, intact parathyroid hormone (iPTH) 489 +/- 495 pg/ml) and 27 healthy control subjects (13 women, 14 men; aged 49 +/- 10 years, serum calcium 9.4 +/- 0.5 mg/dl, iPTH 28 +/- 8.5 pg/ml). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. To avoid confounding factors, conditions known to affect endothelial function like diabetes mellitus, hypertension, dyslipidemia, smoking, coronary and peripheral artery disease were excluded from both groups. RESULTS: FMD was lower in patients with PHPT than that in those without (10.2 +/- 5.8 vs. 19.8 +/- 5.8, P = 0.0001). FMD negatively correlated with serum calcium (r = -0.55, P = 0.002). CONCLUSION: Endothelium-dependent FMD may impair in patients with PHPT compared to controls. Endothelial dysfunction can contribute to the deleterious cardiovascular effects of PTH excess. Therapy to reduce or retard endothelial dysfunction in patients with PHPT may lead to decreased cardiovascular morbidity and mortality.

Acromegaly presenting with diabetic ketoacidosis, associated with retinitis pigmentosa and octreotide-induced bradycardia: a case report and a review of the literature.

Carbohydrate intolerance is a common feature of acromegaly. Frank diabetes mellitus is seen in about 10-20% of patients. There is no report of acromegaly presenting with diabetic ketoacidosis (DKA), associated with retinitis pigmentosa (RP), in the literature. We report the occurrence of DKA and RP in a patient with acromegaly. A 39-year-old Turkish man was admitted to the emergency ward with a 1-mo history of thirst, polyuria, weight loss of 10 kg, and loss of consciousness for 2 d. Physical examination revealed findings suggestive of acromegaly, including coarse facial features and enlargement of his hands and feet. At ophthalmological examination, funduscopy showed RP. Laboratory studies confirmed the diagnoses of DKA and acromegaly. Magnetic resonance imaging disclosed the presence of a pituitary adenoma. During the medical treatment with octreotide, symptomatic sinusoidal bradycardia was developed (pulse rate 45 bpm, and blood pressure 70/40 mmHg). Octreotide therapy was stopped. Pituitary adenoma was removed surgically. For treatment of DKA, insulin need was very high in the first days after the onset of ketoacidosis, but decreased after initiation of treatment with octreotide and after successful operation. Insulin was stopped 7 d after surgery. Follow-up showed normalization of growth hormone levels and plasma glucose levels. Only six other cases of DKA associated with acromegaly and only three other cases of RP associated with acromegaly were found in the medical literature. In conclusion, to our knowledge, the present case is a first report of DKA and RP in patient with acromegaly.

Carotid body tumors and adrenal pheochromocytomas in siblings of a Turkish family.

OBJECTIVE: This is a report of 2 hypertensive siblings with a history of carotid body tumors and subsequent benign adrenal pheochromocytomas (pheos) in a family where the mother had died of possible adrenal carcinoma. CLINICAL PRESENTATION AND INTERVENTION: The first case was a 35-year-old woman with paroxysmal hypertensive attacks and a right adrenal mass. She had earlier undergone surgery to remove bilateral carotid body tumors. Investigation revealed excessive excretion of catecholamines and their metabolites in the urine. Abdominal MRI and (131)I-MIBG scintigraphy revealed a right adrenal tumor. Right adrenalectomy was performed. The second case, the 45-year-old brother of the first case, was found to have a left adrenal mass on abdominal MRI. Catecholamines and their metabolites in the urine were found to be increased. He had also had surgery to remove bilateral carotid body tumors of the neck. Left adrenalectomy was performed. Both siblings showed no evidence of other familial syndromes, such as multiple neoplasia type 2, von Hippel-Lindau disease or neurofibromatosis type 1. CONCLUSION: Although the combination of familial carotid body tumors and pheo is rare, a patient who remains hypertensive after removal of a carotid body tumor deserves a careful evaluation to exclude pheo. Such tumors may be extra-adrenal or multifocal.