GRANULYSIN PEPTIDE AND GENE POLYMORPHISM IN THE PATHOGENESIS OF HASHIMOTO THYROIDITIS.

Background: Hashimoto thyroiditis (HT) is an autoimmune disease and the most common cause of hypothyroidism. The widespread lymphocyte infiltration in the thyroid gland and intolerance of the body against its thyroid antigens leads to the destruction of thyroid cells and impaired thyroid function. Granulysin (GNLY) is a cytolytic antimicrobial peptide that has been associated with a wide range of diseases such as various infections, cancer, transplantation, and skin problems. However, there are a few studies investigating the relationship between HT and granulysin. Aim: Our study aims to investigate whether granulysin levels and GNLY gene polymorphism contribute to the damaged immune response leading to HT. Material and Methods: 100 unrelated patients diagnosed with HT and 140 healthy individuals were included in our study. Frequencies of GNLY rs10180391 and rs7908 gene polymorphisms were determined using PCR- RFLP method and serum granulysin levels were determined using ELISA. Results: There is no statistical significance between patient and control groups in terms of genotype and allele frequencies of GNLY gene polymorphisms and serum levels of granulysin. Conclusion: In conclusion, granulysin and GNLY gene polymorphisms do not appear to relate to HT disease.

ASSOCIATION OF PANCREAS VOLUME AND INSULIN RESISTANCE WITH ABDOMINAL FAT DISTRIBUTION IN TYPE-2 DIABETES AS EVALUATED BY COMPUTED TOMOGRAPHY.

PURPOSE: We aimed to assess the relationship between the regional body fat distribution and insulin resistance and pancreas volume (PV) in type-2 diabetes (DM) patients. METHODS: Fifty-three consecutive type-2 diabetic and 51 non-diabetic patients matched by age, gender and body mass index (BMI) were enrolled. Subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), waist circumference, and PV were measured with computed tomography. Insulin resistance was assessed by the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Patients with type-2 DM had significantly lower PV than non-diabetic individuals. HOMA-IR ranged from 0.74 to 6.24; and from 0.37 to 3.26, in type-2 DM patients and non-diabetics, respectively. VAT was positively correlated with HOMA-IR in two groups. There were inverse correlations between PV and VAT and VAT/SAT but only in diabetics. CONCLUSIONS: The VAT/SAT ratio may reflect the possible role of VAT to better understand the pathogenesis of obesity-related disorders in patients with type-2 DM.

A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review.

Thyrotropin (thyroid stimulating hormone [TSH]) secreting pituitary adenomas (TSHoma) are rare adenomas presenting with hyperthyroidism due to impaired negative feedback of thyroid hormone on the pituitary and inappropriate TSH secretion. This article presents a case of TSH-secreting macroadenoma without any clinical hyperthyroidism symptoms accompanying immunoreaction with growth hormone (GH) and prolactin. A 36-year-old female patient was admitted with complaints of irregular menses and blurred vision. On physical exam, she had bitemporal hemianopsia defect. Magnetic resonance imaging (MRI) evaluation showed suprasellar macroadenoma measuring 33 mm × 26 mm × 28 mm was detected on pituitary MRI. She had no hyperthyroidism symptoms clinically. Although free T4 and free T3 levels were elevated, TSH level was inappropriately within the upper limit of normal. Response to T3 suppression and thyrotropin releasing hormone-stimulation test was inadequate. Other pituitary hormones were normal. Transsphenoidal adenomectomy was performed due to parasellar compression findings. Immunohistochemically widespread reaction was observed with TSH, GH and prolactin in the adenoma. The patient underwent a second surgical procedure 2 months later due to macroscopic residual tumor, bitemporal hemianopsia and a suprasellar homogenous uptake with regular borders on indium-111 octreotide scintigraphy. After second surgery; due to ongoing symptoms and residual tumor, she was managed with octreotide and cabergoline treatment. On her follow-up with medical treatment, TSH and free T4 values were within normal limits. Although silent TSHomas are rare, they may arise with compression symptoms as in our case. The differential diagnosis of secondary hyperthyroidism should include TSHomas and thyroid hormone receptor resistance syndrome.

Fas ligand (FasL, Apo-1L/CD95L) expression and clinical outcome in papillary microcarcinoma and papillary thyroid carcinomas with diameter smaller than 1.5 centimeters.

CONTEXT: The presence and the importance of FasL (FasL, APO-1L/CD95L) in papillary microcarcinoma lesions which are smaller than 1.5 cm of the thyroid is unclear. OBJECTIVE: It was aimed to investigate FasL expression in papillary microcarcinoma (PMC) of the thyroid. DESIGN: FasL immunoreactivity was evaluated in PMC lesions. Paraffin sections of thyroid specimens obtained from 59 papillary thyroid carcinoma consecutive patients were stained using antibody to FasL. Fas ligand expression and the relation and comparison with clinical and pathological findings in PMC were determined. RESULTS: There were 39 females (66.1%) and 20 males (33.9%) aged 23-74 years (51.9±11.8 yrs), and 20 patients with tumor size ≤5 mm, 24 patients with 6-10 mm and 15 patients with 10-15 mm. The mean of the intensity and the percentage of FasL immunoreactivity were significantly higher in lesions of PMC than peripheral thyroid tissue (29.5±37.9% and 1.42±1.25 vs. 2.1±5.4% and 0.46±0.95, respectively; p<0.001). Fas ligand immunoreaction were not different according to tumor size, the presence of tumor capsule and tumor invasion, invasion of thyroid capsule, peripheral tissue and vascular structures and multicentricity (p>0.05). However, FasL positivity, staining and intensity were high in patients above 45 years, in oncocytic and tall cell variants, in TNM stage pT4A (p<0.05). CONCLUSIONS: This study showed that FasL expression (positivity, staining and intensity) was high and increased in PMC of the thyroid tissue, and above 45 years, in tall cell and oncocytic variants, and in advanced tumor.

Thyroid hormone receptor beta gene mutation (P453A) in a family producing resistance to thyroid hormone.

BACKGROUND: Resistance to thyroid hormone (RTH) is a dominantly inherited syndrome characterized by decreased responsiveness of target tissues to thyroid hormone. Two members of a Turkish family, a mother and son, had thyroid function tests suggestive of resistance to thyroid hormone (RTH). METHODS: The clinical presentation was, however, different. The mother (proposita) had palpitation, weakness, tiredness, nervousness, dry mouth and was misdiagnosed as having multinodular toxic goiter which was treated with antithyroid drugs and partial thyroidectomy. Her younger son had attention deficit hyperactivity disorder and primary encopresis, but normal intellectual quotient. Both had elevated serum iodothyronine levels with nonsuppressed thyrotropin. RESULTS: A mutation in one allele of the thyroid hormone receptor beta gene (P453A) was identified, providing a genetic confirmation for the diagnosis of RTH. CONCLUSION: Mutational analysis of the TRss gene allows definitive diagnosis of RTH, potentially avoiding the need for protracted and expensive pituitary function testing.

Sheehan's syndrome associated with Glanzmann's Thrombasthenia: case report and literature review.

OBJECTIVES: We aimed to present a case of Sheehan's syndrome associated with Glanzmann's thrombasthenia. CASE REPORT: A 41-year-old-woman presented with hemorrhagic diathesis needed blood transfusions occasionally during her life-time. In the course of her second delivery, four units of whole blood transfusion were required to control profuse uterine bleeding and her hemodynamic status. During postpartum period, she was not able to lactate and her menstrual periods did not return. Her hormonal profile revealed gonadotropin, TSH and prolactin deficiencies. CONCLUSION: According to our knowledge, this is the first case report of hypopituitarism developed after delivery in association with Glanzmann's thromboasthenia-induced severe uterine hemorrhage.

Static lung volumes in patients with Cushing's disease.

OBJECTIVE: Numerous clinical manifestations have been described in association with Cushing's syndrome. There are no eligible data on pulmonary function tests in Cushing's disease (CD). We aimed to asses pulmonary function tests including spirometry in a series of patients with active CD. MATERIALS AND METHODS: This cross-sectional study comprised 10 patients with Cushing's disease (F/M, 9/1). The forced expiratory volume in 1st second (FEV1), the forced vital capacity (FVC), the FEV1/FVC ratio and the forced expiratory flow over the middle half of the FVC (FEF 25-75%) values and predicted values were determined by spirometry. RESULTS: Mean age, height, weight, body mass index were 36.7+/-12.6 yrs (range 22-63 years), 156.9+/-8.4 cm, 74.1+/-10.7 kg, 29.6+/-3.8 kg/m(2), respectively. Spirometric abnormalities (impairment of FEV1, FVC, FEV1/FVC and FEF 25-75 values) were not detected, and there were no significant differences compared to reference values. Disease duration and cortisol concentrations by HDDSTs were negatively correlated with predicted FEV1/FVC values and the percentage of predicted FEV1 ratios, respectively. DISCUSSION: The lung volume and ventilatory performance by spirometry were not disturbed in patients with endogenous hypercostisolism due to Cushing's disease.

Effect of hyperthyroidism and propylthiouracil treatment on liver biochemical tests.

Liver biochemical test (LBT) changes can be commonly observed in hyperthyroid patients. Those kinds of changes could also be observed because of propylthiouracil (PTU) therapy. We prospectively evaluated LBT changes because of PTU use for 1 year in patients who had been diagnosed with hyperthyroidism first. We studied 64 patients who had been diagnosed with hyperthyroidism. These patients took at least 1-year PTU treatment. We analysed LBT at diagnosis and after 2 and 12 months of treatment with PTU. Prior to PTU treatment, 30 (46.8%) of the 64 patients had at least one LBT abnormality. We observed at least one LBT abnormality in 11 (32%) patients after 2 months and nine (26%) patients after 12 months of treatment with PTU in 34 patients whose CBT were normal before treatment. We did not observe any deterioration in clinical picture and bilirubin levels. Elevated serum LBT during the pretreatment and PTU treatment period is common and usually transient and asymptomatic. PTU could be used for long times by lowering the dose and close follow-up in patients who have elevated LBT during the pretreatment and after PTU treatment period.