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Immunological abnormalities, the resulting endocrinopathies, and their treatments may impact bone health and 25-hydroxyvitamin D (25-OHD) in patients with autoimmune polyglandular syndromes (APS). Several etiologies contribute to increased risk for low bone mineral density (BMD), including vitamin D deficiency. This study evaluated the vitamin D level and BMD of patients with APS. We performed a cross-sectional study on 44 patients with APS and 55 age and gender-matched control subjects. Among patients with APS, 14 were classified as APS-2 [Addison's disease (AD)+autoimmune thyroid disease (ATD) and/or type 1 diabetes(T1D)]. In contrast, the other 30 were APS-3 (ATD+T1D+other autoimmune diseases). Serum samples were analyzed for vitamin D levels. The lumbar spine and femoral neck BMD were measured by dual X-ray absorptiometry. Z-scores were obtained by comparison with age- and gender-matched average values (both patients and controls). The accepted normal levels were Z-score>-1 and 25-OHD>30 ng/ml. Patients with APS showed 25-OHD levels and BMD significantly lower than healthy controls (p<0.001 and p<0.05, respectively). The highest prevalence of abnormal BMD was observed in the APS-2 subgroup (13 out of 14 patients, 92.6%). Identifying and treating vitamin D deficiency and low BMD is critical in APS patients. The fact that the significant endocrine component of APS-2 is AD, and these patients receive chronic long-term glucocorticoid therapy can be shown as the reason for this result. However, more extensive prospective controlled studies are needed to confirm these findings.
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Doenças Ósseas Metabólicas , Diabetes Mellitus Tipo 1 , Deficiência de Vitamina D , Humanos , Densidade Óssea , Diabetes Mellitus Tipo 1/complicações , Estudos Transversais , Estudos Prospectivos , Centros de Atenção Terciária , Vitamina D , Absorciometria de Fóton , VitaminasRESUMO
Celiac disease (CD) accompanying autoimmune endocrine diseases (AED) is generally asymptomatic. This study aimed to evaluate the frequency of clinically overt or silent CD in patients diagnosed with autoimmune endocrinopathy and the clinical effects of silent CD in these endocrinopathies. The study included 166 patients with known or newly diagnosed mono-/polyglandular AED and 90 age- and gender-matched healthy controls. The patients were classified into four groups: type 1 diabetes mellitus (DM) (n=44), Hashimoto's thyroiditis (HT) (n=68), Addison's disease (AD) (n=17), and autoimmune polyglandular syndrome (APS) (n=37). All subjects were serologically screened for tissue transglutaminase antibody (tTG) IgA and IgG. In addition, to evaluate the possible systemic consequences of CD, serum parathormone (PTH), 25-hydroxicholecalsiferol (25-OH-Vit D), vitamin B12, folic acid, iron, iron-binding capacity (IBC), and ferritin levels were measured. In the total series, 193 (75.4%) individuals were females, and 63 (24.6%) were males. TTG IgA antibody positivity was found in 23 among 166 patients, while no positivity was encountered in the healthy control group. The highest rates of positive tTg IgA frequency were detected in AD, with 29.4% (5/17). Serum 25-OH-Vit D, vitamin B12, folic acid, iron, and ferritin levels were significantly lower in AEDs compared to controls (p<0.001), and the lowest these parameters were detected in patients with AD. The serologic CD prevalence is higher in autoimmune mono-/and polyglandular endocrine diseases than in the control group. The data support recommends regular screening for CD in all patients with AEDs.
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Doença de Addison , Doença Celíaca , Diabetes Mellitus Tipo 1 , Masculino , Feminino , Humanos , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Autoanticorpos , Imunoglobulina A , Vitamina B 12 , Ácido Fólico , Ferro , Absorção Gastrointestinal , FerritinasRESUMO
PURPOSE: The patient-reported outcome becomes important to evaluate the situation perceived by the patients and to develop new strategies. This study aims to adapt the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ), which was specially developed for patients with acromegaly, into Turkish by conducting a validity and reliability study. METHODS: After the translation and back-translation process, Acro-TSQ was filled in by face-to-face interviews with 136 patients diagnosed with acromegaly and currently receiving somatostatin analogue injection therapy. Internal consistency, content validity, construct validity, and reliability of the scale were determined. RESULTS: Acro-TSQ had a six-factor structure and explained 77.2% of the total variance in the variable. The Cronbach alpha value calculated for internal reliability showed high internal consistency (Cronbach's alpha = 0.870). Factor loads of all items were found to be between 0.567 and 0.958. As a result of EFA analysis, one item fell into a different factor in the Turkish version of the Acro-TSQ, different from its original form. CFA analysis shows that acceptable fit values are obtained for fit indices. CONCLUSION: The Acro-TSQ, a patient-reported outcome tool, shows good internal consistency, and good reliability, suggesting it is an appropriate assessment tool for patients with acromegaly in the Turkish population.
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Acromegalia , Humanos , Acromegalia/tratamento farmacológico , Reprodutibilidade dos Testes , Inquéritos e Questionários , Satisfação Pessoal , PsicometriaRESUMO
BACKGROUND: Glomerular and tubulointerstitial damage plays a role in renal function failure in diabetic patients. While both serum and urine levels of neutrophil gelatinase-associated lipocalin (NGAL) show significantly increased levels in acute renal pathologies, the NGAL increase in active phase indicates a reversible condition in chronic cases. MATERIALS AND METHODS: 52 type 1 diabetic patients and 30 healthy volunteers participated in the study. The diabetic participants were separated into two groups as follows: a normoalbuminuria group consisting of those with an albumin/creatinine ratio less than 30 mg/g and an albuminuria group consisting of those with an albumin/ creatinine ratio equal or greater than 30 mg/g. Albumin, creatinine and NGAL were measured in all participants. RESULTS: Urinary NGAL median level was 21.1 ng/mL for diabetic patients and 11.9 ng/mL for healthy controls, and the difference between the two groups was statistically significant. When diabetic patients were compared as those with and without albuminuria, the median urinary NGAL levels of normoalbuminuria and albuminuria were 24.7 and 16.1 ng/mL, respectively, but the difference was not statistically significant. Statistically similar results were obtained through evaluation of the ratio of urinary NGAL excretion to creatinine excretion. The NGAL/Cr ratio was significantly higher in diabetic patients than in healthy controls, but no statistically significant difference was found between the diabetic patients with and without albuminuria. CONCLUSIONS: Urinary NGAL excretion in type 1 diabetic patients is found to be increased over a wide range, but it does not correlate with urinary albumin excretion. In this regard, urinary NGAL excretion should not be used as an alternative to microalbuminuria in detecting diabetic nephropathy. The greater amount of NGAL excretion among diabetic patients may be due to diabetic nephropathy with possible tubulointerstitial damage pathologies.
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Diabetes Mellitus Tipo 1/complicações , Nefropatias Diabéticas , Lipocalina-2/urina , Adulto , Biomarcadores/urina , Estudos de Casos e Controles , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Adulto JovemRESUMO
Recently, studies have reported that inflammatory response and elevated platelet counts are associated with several cancers. In the present study, we aimed to evaluate hemocytometer parameters in differentiating adrenal adenoma and carcinoma, and the prognostic utility of hemocytometer parameters in adrenocortical carcinoma (ACC). We included 30 patients with nonfunctional adrenal adenoma and 13 patients with ACC having undergone surgery between 2005 and 2017 and followed up postoperatively at our centre. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV) and plateletcrit (PCT) were evaluated preoperatively in all patients included in the study. There was a significant difference between the adrenal adenoma and ACC groups in terms of neutrophil and lymphocyte counts, NLR and PLR. There was no significant difference between the two groups in terms of platelet count and MPV, but PCT levels were significantly lower in ACC group. There was no statistically significant difference between recurrent and/or metastasis positive patients and negative ones according to NLR, PLR, RDW and MPV. There was a statistically significant difference in RDW levels and tumor diameter between the groups. Our study is the first to evaluate hemocytometer parameters in differentiating adrenal adenomas and carcinomas, and also in the prognosis of ACC. The present study suggested that the hemocytometer parameters may be a marker in the differential diagnosis of adrenal adenomas and carcinomas. However, our study also showed that these parameters had no prognostic value in ACC.
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Adenoma , Neoplasias do Córtex Suprarrenal , Carcinoma Adrenocortical , Biomarcadores , Humanos , Linfócitos , Neutrófilos , Contagem de Plaquetas , PrognósticoRESUMO
CASE: A 32-year old woman was admitted to the hospital due to intractable hypothyroidism refractory to high dose of oral l-thyroxine therapy. She underwent total thyroidectomy and radioactive iodine therapy due to papillary thyroid cancer. After excluding poor adherence to therapy and malabsorption, levothyroxine absorption test was performed. No response was detected. Transient neurologic symptoms developed during the test. She developed 3 attacks consisting of neurologic symptoms during high dose administration. The patient was considered a case of isolated l-thyroxine malabsorption. She became euthyroid after intramuscular twice weekly l-thyroxine therapy. DISCUSSION: There are a few case reports regarding isolated l-thyroxine. We report successful long term results of twice weekly administered intramuscular l-thyroxine therapy. We also draw attention to neurologic side effects of high dose l-thyroxine therapy.
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Hipotireoidismo/tratamento farmacológico , Injeções Intramusculares/métodos , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Tireoidectomia/métodos , Tiroxina , Administração Oral , Adulto , Feminino , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/fisiopatologia , Absorção Intestinal , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/metabolismo , Síndromes de Malabsorção/terapia , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tiroxina/administração & dosagem , Tiroxina/efeitos adversos , Tiroxina/metabolismo , Resultado do TratamentoRESUMO
AIM: The prevalence of diabetes is increasing in elderly populations, and is thought to be an important risk factor for cognitive dysfunction in this age group. METHODS: The study included 104 patients aged over 60 years who were followed-up for type 2 diabetes for at least 6 months, in addition to 44 controls. Glycemic parameters, microangiopathic complications, microalbumin elimination, and the Standardized Mini Mental State Examination (SMMSE) scores were used as indicators of cognitive function. RESULTS: The SMMSE scores of diabetic patients were significantly lower than the control group (p < 0.05). The average SMMSE score for normoalbuminuric diabetic patients was 22.36 ± 4.66, compared with 22.61 ± 4.90 for the microalbuminuria patients (p = 0.84). A positive correlation was found between SMMSE scores and patients' hemoglobin values and education levels, whereas a negative correlation was noted between SMMSE scores and systolic and diastolic blood pressures and hemoglobin A1c levels (p < 0.05). Patients with diabetic neuropathy, a microvascular complication of diabetes, were found to have significantly lower SMMSE scores (p = 0.011). CONCLUSION: Elderly diabetic patients showed decreased cognitive function compared to volunteers. No relationship was established between microalbuminuria and cognitive functions, although diabetic neuropathy was found to be related to decreased cognitive function.
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Albuminúria/sangue , Albuminúria/complicações , Glicemia/análise , Transtornos Cognitivos/sangue , Transtornos Cognitivos/complicações , Diabetes Mellitus Tipo 2/sangue , Nefropatias Diabéticas/sangue , Idoso , Feminino , Humanos , MasculinoRESUMO
Background Thyroid cancer is one of the five most common cancers causing bone metastasis. If there is an increase in serum thyroglobulin-antithyroglobulin levels in differentiated thyroid cancer or calcitonin levels in medullary thyroid cancer, patients should be evaluated for recurrence and distant metastasis. The skeleton is the second most common site of distant metastasis in thyroid cancer after the lung. Bone metastases cause pain, fractures, and spinal cord compression, severely reducing the quality of life. They are associated with poor prognosis. Bone metastases severely reduce the quality of life. This study aimed to retrospectively evaluate the diagnosis and follow-up of patients with thyroid cancer with bone metastases diagnosed at our center. Methodology A total of 1,390 patients diagnosed with thyroid malignancy at our center between 2010 and 2023 were reviewed retrospectively. The study included 27 patients with differentiated and medullary thyroid cancer who had bone metastases. Results Of 27 patients, 19 (70.4%) had differentiated and eight (29.6%) had medullary thyroid cancer. Papillary thyroid cancer constituted 22.2% (n = 6) and follicular thyroid cancer constituted 14.8% (n = 4) of the cases. Papillary carcinoma follicular variant, oncocytic, and poorly differentiated thyroid cancer were diagnosed with similar frequency, each accounting for 11.1% (n = 3). It was found that vertebrae were most commonly involved, followed by the pelvis, sternum, costae, femur and patella, shoulder and humerus, cranium, and scapula. The five-year survival rate was 72%, and the 10-year survival rate was 53%. Conclusions The number of patients with papillary cancer was the highest, but the rate of bone metastases was the lowest in this group. The highest rate of bone metastases was found in patients with poorly differentiated, oncocytic, medullary, follicular, and papillary cancer, respectively. The results obtained in this study reveal the necessity and importance of bone metastasis evaluation in patients with thyroid cancer.
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OBJECTIVES: Central venous sampling (CVS) with corticotropin-releasing hormone (CRH) stimulation is a crucial technique in evaluating adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS). We evaluated central venous sampling (CVS) and magnetic resonance imaging (MRI) findings in predicting the localization and lateralization of pituitary microadenomas. METHODS: We analyzed 29 patients with CS who underwent CVS with CRH stimulation and examined with MRI retrospectively. Catheterization to central sinuses was successfully performed in 26 patients. Three patients with variant anatomy or inability to cannulate were diagnosed with CD after examination of pathology. RESULTS: After CVS, among 26 patients, 23 patients were determined to have CD (88.4%) and 2 (7.7%) patients were diagnosed with ectopic ACTH syndrome. One patient was diagnosed with CD postoperatively. While the sensitivity of the CVS was 95.6%, sensitivity of the preoperative pituitary MRI was lower (69.5%). Also, the negative predictive value ratio was higher in CVS than in MRI (66% versus 22%). Diagnostic accuracy in the lateralization of the tumor was high as in CVS as in MRI (76.4% versus 73.9%). CONCLUSION: Central venous sampling with higher sensitivity in the localization of pituitary microadenoma, also has approximately similar diagnostic accuracy in lateralizing the tumor with MRI.
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Síndrome de Cushing , Neoplasias Hipofisárias , Humanos , Síndrome de Cushing/diagnóstico por imagem , Síndrome de Cushing/cirurgia , Hormônio Adrenocorticotrópico , Amostragem do Seio Petroso , Estudos Retrospectivos , Neoplasias Hipofisárias/patologia , Diagnóstico Diferencial , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Hyperparathyroidism is caused by parathyroid adenoma, hyperplasia or carcinoma. Parathyroid adenomas are the most common cause of parathyroid disease (85-88%) while atypical parathyroid adenomas and carcinomas are the least frequently seen parathyroid neoplasms which cause diagnostic difficulty. This series aims to identifiy lesions of parathyroidectomy specimens in our center and draw attention to borderline cases in between parathyroid adenoma and carcinoma. METHODS: The study included 638 parathyroidectomy materials diagnosed in our center between the years 2005 and 2016 and examined retrospectively, and all were included in the study. RESULTS: In all the 638 parathyroidectomy cases evaluated, 427 were diagnosed with adenoma, 117 with hyperplasia, 54 with normal parathyroid tissue, 32 with parathyroid neoplasm with uncertain malignant potential, 7 with parathyroid carcinoma and 1 with normal thyroid tissue. CONCLUSIONS: Parathyroid neoplasm with uncertain malignant potential defines cases with suspicious histopathological features of carcinoma but doesn't meet the criteria for parathyroid carcinoma. In our series, these cases are identified as atypical parathyroid adenoma. We present clinical and morphological features of our parathyroidectomy cases in an 11-year period and aim to raise concern about borderline cases in between adenoma and carcinoma. We think that such tumors, similar to the thyroid neoplasm classification, should be defined as parathyroid neoplasms with uncertain malignant potential and should be followed closely.
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Adenoma , Carcinoma , Neoplasias das Paratireoides , Adenoma/cirurgia , Carcinoma/diagnóstico , Humanos , Hiperplasia , Neoplasias das Paratireoides/complicações , Paratireoidectomia , Estudos RetrospectivosRESUMO
Medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are two different types of thyroid carcinoma. They have different features in terms of cellular origin, histopathology, clinical features, prevalence, and prognosis. PTC originates from follicular cells, while MTC from parafollicular cells. MTC and PTC co-existence is a rare phenomenon and occurs in less than 1% of all thyroid tumors. We report three cases with coexistent MTC and PTC in the same thyroid. The papillary component was dominant in two cases and the medullary in one case. While the first case was given radioactive iodine therapy, the third was treated with vandetanib. The second case was followed up postoperatively and did not receive treatment other than levothyroxine replacement. The co-existence of these tumors requires a different clinical approach in treatment and follow-up, depending on which type is dominant. Key Words: Mixed thyroid carcinoma, Papillary thyroid carcinoma, Medullary thyroid carcinoma.
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Carcinoma Neuroendócrino , Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Neuroendócrino/patologia , Carcinoma Papilar/patologia , Humanos , Radioisótopos do Iodo , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TiroxinaRESUMO
Background: Global COVID-19 outbreak has been such a stressful experience for most of the people. Using a web-based cross-sectional study, we aimed to evaluate the acute stress response, depression, and anxiety in patients with diabetes mellitus (DM) during the COVID-19 pandemic, and to examine the effect of these psychiatric problems on diet habits and glycemic controls of patients. Methods: This web-based survey of COVID-19 was sent to the patients through the Whatsapp platform. All participants reported their demographic data, diabetes-related information, changes in self-monitoring blood glucose measurements, physical parameters, and eating habits after COVID-19, then completed Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale, Revised (IES-R) questionnaires which assessed acute stress sypmtoms, anxiety, and depression. Results: Three hundred and four patients with DM [(141 type 1 DM (T1D) and 163 type 2 (T2D)] were included in the study. In our study, female gender, higher BMI and weight, decreased in financial income after outbreak, presence of diabetic complications and comorbid diseases (i.e., retinopathy, neuropathy, diabetic foot, hypertension, dyslipidemia), worsened glycemic levels, increased carbohydrate consumption, and snacking were associated with higher anxiety and depression scores. Depression was higher in patients with T2D and duration of illness was correlated with acute stress level. Conclusions: It is important to be aware of the possibility of acute stress, depression, and anxiety after pandemic in patients with DM whose glycemic control is impaired. Psychological problems should not be ignored beyond physical inactivity and worsening eating habits.
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Parathyroid carcinoma is a rare cause of hyperparathyroidism and leads to severe hypercalcemia. The etiology is not fully known. Parathyroid cancer should be considered in the differential diagnosis, if serum calcium and parathyroid hormone levels increase, and parathyroid gland is palpable. Severe hypercalcemia is the most common cause of death in patients diagnosed with parathyroid carcinoma. Fluid replacement, diuretic therapy, bisphosphonates, and calcimimetic agents are the main treatment steps in the control of life-threatening hypercalcemia. Surgery is the primary treatment option, while denosumab is a treatment option for refractory hypercalcemia caused by parathyroid carcinoma, or for patients who are not eligible for surgery. There are few case reports in literature about denosumab treatment for parathyroid carcinoma. Herein, we report a case of a patient who presented with the complaint of leg pain and was diagnosed with parathyroid carcinoma. The elevated calcium level of the patient was controlled with denosumab. Key Words: Parathyroid carcinoma, Denosumab, Hypercalcemia, Hyperparathyroidism.
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Conservadores da Densidade Óssea , Denosumab , Hipercalcemia , Neoplasias das Paratireoides , Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Difosfonatos , Humanos , Hipercalcemia/tratamento farmacológico , Hipercalcemia/etiologia , Hormônio Paratireóideo , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/tratamento farmacológico , Neoplasias das Paratireoides/cirurgiaRESUMO
PURPOSE: Acromegaly causes multiple comorbidities, including gastrointestinal disorders. The present study evaluated the frequency of hiatal hernia and other upper gastrointestinal pathologies in patients with acromegaly, given that visceromegaly and reduced nitric oxide levels in acromegaly may impact diaphragm and lower esophageal sphincter function and thus possibly the development of hiatal hernia. METHODS: Thirty-nine acromegaly patients followed our center for the previous 6months were recruited. Upper gastrointestinal endoscopy was performed once in all patients to evaluate hiatal hernia, esophagitis, gastroduodenitis and ulcer. RESULTS: Twenty-three patients were male and 16 female. Upper gastrointestinal endoscopy found hiatal hernia, esophagitis and gastroduodenitis or gastric ulcer in 3 (7.6%), 2 (1.7%) and 31 (79.4%) patients, respectively. Pathologic examination of gastric antrum biopsy found intestinal metaplasia in 12 (30.7%) patients, and Helicobacter pylori was positive in 13 (33.3%). There were no significant correlations between age, gender, disease duration or preoperative adenoma size on the one hand and hiatal hernia or other endoscopic findings on the other. Similarly, neither surgical success nor recurrence was associated with endoscopic findings. CONCLUSIONS: The study showed that prevalence of gastritis, duodenitis, peptic ulcer and intestinal metaplasia is higher and prevalence of hiatal hernia lower in acromegaly patients than in the healthy population. Various unknown disease-related pathophysiological conditions may play a role; there is a need for further studies.
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Acromegalia/complicações , Acromegalia/epidemiologia , Gastroenteropatias/epidemiologia , Trato Gastrointestinal Superior/patologia , Acromegalia/patologia , Adulto , Endoscopia Gastrointestinal , Esofagite/complicações , Esofagite/diagnóstico , Esofagite/epidemiologia , Feminino , Gastrite/complicações , Gastrite/diagnóstico , Gastrite/epidemiologia , Gastroenteropatias/complicações , Gastroenteropatias/diagnóstico , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Úlcera Péptica/diagnóstico , Úlcera Péptica/epidemiologia , Prevalência , Trato Gastrointestinal Superior/diagnóstico por imagemRESUMO
We present a case of a 44-year-old woman with an unusual location of a brown tumor in the sacral vertebrae due to parathyroid adenoma. She was admitted to our clinic with the complaint of low-back pain and was later diagnosed to have a brown tumor. The patient underwent surgery and partial sacrectomy and iliac wing resection was performed in Orthopedic Surgery Department. Subsequently the patient underwent parathyroid adenoma excision in General Surgery Department. On her control examination at postoperative 3 months, she had no pain and was able to perform daily activities without any problem. We believe it is an interesting clinical case both because it shows a very rare localization of brown tumor and points out the importance of employing a wide clinical scope in the differential diagnosis of back pain.
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Adenoma , Dor Lombar/cirurgia , Neoplasias das Paratireoides , Sacro/patologia , Neoplasias da Coluna Vertebral , Adenoma/diagnóstico , Adenoma/patologia , Adenoma/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Radiografia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
AIM: The aim of the study was to investigate the treatment and monitoring patterns of type 2 diabetes patients in the Bursa region over the last 5 years since the implementation of family practice in Turkey in 2010. METHODS: A total of 216 volunteer family doctors working in family health centers took part in this study. The records of 44,819 diabetic patients who visited these doctors between January 1, 2010 and December 31, 2014 were inspected retrospectively. Apart from the identity of the patients, morphometric data, including the type of medication used for diabetes and the HbA1C, serum creatinine and LDL cholesterol values, were recorded. RESULTS: A total of 38.9% (17,416 patients) of the patients in the study were male and 61.1% (27,403 patients) were female. The average age was 59.7 years with a range of 13.2 years. Although the patients' average body mass index (BMI) did not change over the 5years monitoring, average blood pressure (BP), and serum creatinine and LDL cholesterol levels decreased significantly. The hemoglobin A1c levels were significantly lower after 2010 compared to the 2010 data. Upon examining the medication prescribed for the patients, we determined that the use of metformin and insulin increased, whereas the prescription of thiazolidinedione (glitazone) decreased. There was a significant increase in the amount of patient data recorded over the last 5 years. CONCLUSIONS: Despite the increased level of data entry in these patients with type 2 diabetes, the surveillance of diabetes parameters according to treatment guidelines remains suboptimal. There continues to be a need to engage family practitioners on ongoing education and practice enhancement programs.
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Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Medicina de Família e Comunidade/tendências , Hipoglicemiantes/uso terapêutico , Médicos de Família/tendências , Padrões de Prática Médica/tendências , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Hemoglobinas Glicadas/metabolismo , Fidelidade a Diretrizes/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , TurquiaRESUMO
OBJECTIVE: Adrenocortical carcinoma is an aggressive endocrine malignancy with an annual incidence of 0.5-2 cases per million. The most important factors that determine prognosis are tumor stage at the time of diagnosis and the success of surgery. However, advanced age, large tumor size, hormone secretion, high Ki-67 index (>10%), tumor necrosis and high mitotic activity are other factors associated with poor prognosis. In the present study, we aimed to evaluate the contribution of the patient and treatment- related factors to the prognosis in adrenocortical carcinoma. MATERIAL AND METHODS: We included 15 adrenocortical carcinoma patients who were followed in our center between 2005 and 2015. The effects of age, gender, tumor size, type of operation, postoperative resection status and adjuvant treatment on disease-free survival and overall survival were analyzed. RESULTS: Disease-free survival was 23.32±3.69 months and overall survival was 36.60±10.78 months. Gender, tumor size, tumor stage, type of operation, hormonal activity, presence of necrosis, recurrence and development of metastasis were not found to be associated with disease-free survival and overall survival (p>0.05). Postoperatively applied adjuvant treatments including mitotane, chemotherapy and radiotherapy did not significantly affect disease-free survival in our study, but statistically significant increase in overall survival was observed in patients getting adjuvant treatments (p=0.006). CONCLUSION: Adrenocortical carcinoma has poor prognosis and short overall survival, and in its clinical course, recurrence and development of metastasis can be commonly observed even after complete resection of the tumor. Therefore, the patients should be evaluated carefully while determining the surgical procedure during the preoperative period, and the operation and post-operative follow-up should be performed in experienced centers. However, due to the positive effects of adjuvant treatments on survival, all patients should be evaluated postoperatively for the necessity of adjuvant treatments, especially mitotane.
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SUMMARY: Langerhans cell histiocytosis (LCH) is a rare sporadic disease characterized by histiocytic neoplastic infiltration of various organ systems and a wide spectrum of clinical manifestations, ranging from benign and self-limiting to lethal. Herein, we report a rare case of adult-onset multi-systemic LCH in a 36-year-old male patient with an initial perianal presentation and incidental finding of subsequent thyroid gland involvement in the follow-up period. The patient with a history of perianal LCH treated with surgical excision and local radiotherapy was referred to our Endocrinology Department upon detection of hypermetabolic nodular lesions in the left lateral lobe of thyroid gland on positron emission tomography-computed tomography (PET/CT) scan in the nineth month of follow-up. Current evaluation revealed euthyroid status, a hypoechoic solid lesion of 13 × 9 mm in size with irregular borders in the left thyroid lobe on thyroid USG and cytologic assessment of thyroid nodule. The patient was diagnosed with suspected, oncocytic lesion, Hashimoto thyroiditis or LCH. The patient underwent total thyroidectomy and pathological assessment confirmed the diagnosis of Langerhans cell histiocytosis. Assessments in the sixth month of postoperative follow-up revealed euthyroid status with no thyroid tissue remnants or pathological lymph node on thyroid USG. In view of the multifocal lesions indicating multi-system disease, a systemic chemotherapy protocol with combination of prednisone (PRED) and vinblastine (VBL) has been planned by the hematology department. LEARNING POINTS: Langerhans cell histiocytosis (LCH) shows a wide clinical spectrum and prognosis that ranges from benign and self-limiting single-system disease (with single or multifocal lesions) to a potentially lethal multi-system disease with severe organ dysfunction and death in some cases.It has been stated that the diagnosis is often delayed in perianal LCH unless LCH is specifically considered in the etiology, despite the fact that mucosal involvement may precede systemic involvement.Our findings support the statement that most of patients with LCH were PET positive at the time of initial diagnosis, while also emphasize the inclusion of this imaging modality as a part of the diagnostic workflow as well as in the setting of treatment response evaluation among adult LCH patients.