Publications by authors named "Murat Sert"

29 Publications

  • Page 1 of 1

Outcomes of surgical and/or medical treatment in patients with prolactinomas during long-term follow-up: a retrospective single-centre study.

Horm Mol Biol Clin Investig 2020 Dec 17;42(2):153-157. Epub 2020 Dec 17.

Division of Endocrinology, Faculty of Medicine, Cukurova University, Adana, Turkey.

Objectives: Prolactinoma is the most common cause of pituitary tumours. Current medical guidelines recommend dopamine agonists (cabergoline or bromocriptine) as the initial therapy for prolactinoma. However, surgical removal can also be considered in selected cases, such as patients with macroadenomas with local complications (bleeding or optic chiasm pressure) or those not responding to medical treatment.

Methods: The present retrospective study included patients with prolactinomas (n=43; female, 24; male, 19) who were primarily managed with medical (n=32) or surgical (n=11) treatment.

Results: Macroadenoma (n=29.67%) was commonly detected in both genders (female, 54%; male, 84%). Moreover, the mean pre-treatment prolactin levels were similar in both genders (female, 683.3 ± 1347 ng/mL; male, 685.4 ± 805 ng/mL; p=0.226). Surgically treated patients had a greater reduction in tumour size (27.7 ± 17.9 mm pre-treatment vs. 8.72 ± 14.2 mm post-treatment) than non-surgically treated ones (12.5 ± 7.5 mm pre-treatment vs. 4.1 ± 4.2 mm post-treatment; p=0.00). However, the decrease in prolactin levels was similar between the two patient groups (p=0.108). During the follow-up period (10.6 ± 7.0 years), the average cabergoline dose of the patients was 1.42 ± 1.47 mcg/week.

Conclusions: Although a surgical approach was considered for selected cases of prolactinoma, the average dose used for medical treatment was highly inadequate for the patients in the present study.
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http://dx.doi.org/10.1515/hmbci-2020-0077DOI Listing
December 2020

Effect of surface treatments on wear and surface properties of different CAD-CAM materials and their enamel antagonists.

J Prosthet Dent 2021 Jul 20. Epub 2021 Jul 20.

Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio.

Statement Of Problem: Which surface treatment provides optimal surface roughness, microhardness, and wear behavior for computer-aided design and computer-aided manufacturing (CAD-CAM) materials and their enamel antagonists is unclear.

Purpose: The purpose of this in vitro study was to evaluate the effect of surface treatment on the surface roughness, microhardness, and 2-body wear of different CAD-CAM materials and their enamel antagonists.

Material And Methods: Monolithic zirconia, polymer-infiltrated ceramic network, lithium disilicate, leucite-reinforced ceramic, zirconia-reinforced lithium silicate, and feldspathic ceramic specimens were sliced into 2-mm-thick rectangular plates and divided into polished or glazed subgroups (n=6). After surface roughness and microhardness measurements, the specimens were loaded at 49 N for 250 000 cycles and simultaneously thermocycled (5 °C and 55 °C). All specimens were scanned before and after the wear test by using a scanner. The volumetric loss and wear depth of the materials and the volumetric and height loss of the enamel were calculated, and scanning electron microscope images of the specimens were made. Multiple 2-way ANOVAs and Tukey honestly significant difference tests were used to assess the effect of material and surface treatment on surface roughness, microhardness, and wear behavior of materials and enamel (α=.05).

Results: Material and surface treatment interactions affected the surface roughness (P<.001), microhardness (P<.001), volumetric loss of materials (P=.044), and height loss of enamel (P<.001).

Conclusions: Polishing resulted in higher surface roughness and microhardness than glazing. Volumetric loss depended on the material, which affected the height loss of the antagonists. Glazing and polishing had similar effects on the volumetric loss of materials and antagonists. No correlation was found between the wear of materials and the antagonists, nor between the surface roughness of materials and the volumetric loss of materials or antagonists.
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http://dx.doi.org/10.1016/j.prosdent.2021.06.023DOI Listing
July 2021

Pituitary Volume in Patients with Primary Empty Sella and Clinical Relevance to Pituitary Hormone Secretion: A Retrospective Single Center Study.

Curr Med Imaging 2021 ;17(8):1018-1024

Faculty of Medicine, Division of Endocrinology, Cukurova University, Adana, Turkey.

Background: According to neuroradiological findings, empty sella seems to be deprived of pituitary tissue in sella turcica. Changing size of the pituitary volume is closely related to the occurrence of primary empty sella. The aim of the study is to determine pituitary dysfunction in patients with partial or total primary empty sella and the significance of pituitary volume measurements in these patients.

Methods: This study was designed retrospectively. 67 patients (55 females, 12 males) diagnosed with primary empty sella syndrome between the years of 2015-2019 were included in the study. Patients were divided into two groups: partial (PES) and total (TES) empty sella by magnetic resonance imaging (MRI). Basal anterior pituitary and its hormones were assessed. We also included 26 healthy control subjects (19 females, 7 males) to compare the differences in pituitary volumes. Volumes were measured by using Osirix Dicom Viewer (Pixmeo SARL, Geneve, Swiss) in 3.0 Tesla scanner MRI.

Results: 82.1% (n=55) of all patients were PES and the others were (n=12) TES. Hypopituitarism, known as one or more pituitary hormones deficiency, was found in 12 patients (17.9%). While 9 of them had total PES, the others had partial PES. Secondary adrenal insufficiency and gonadotropin deficiency were more prevalent in patients with TES. Mean volume measurements of patients with TES, PES and healthy subjects were 0.23±0.17, 0.35±0.15, 0.54±0.17 cm3, respectively. Except for IGF1 values (p=0.026), there was not any significant correlation found between the anterior pituitary hormones and volume measurements.

Conclusion: Although volume measurement has helped in the diagnosis of pituitary empty sella (partial or total), it does not seem to have any significant correlation with pituitary secretory function.
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http://dx.doi.org/10.2174/1573405617666210525111218DOI Listing
January 2021

Clinical Relevance and Immunohistochemical Patterns of Silent Pituitary Adenomas: 10 Years of Single-centre Experience.

Curr Med Imaging 2021 ;17(2):310-317

Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey.

Background: Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production).

Introduction: The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status.

Methods: A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients' preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated.

Results: Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values.

Conclusion: Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.
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http://dx.doi.org/10.2174/1573405616666201223125642DOI Listing
January 2021

Possible role of the receptor of advanced glycation end products (RAGE) in the clinical course of prostate neoplasia in patients with and without type 2 diabetes mellitus.

Int J Clin Pract 2021 Mar 13;75(3):e13723. Epub 2020 Oct 13.

Department of Endocrinology, Cukurova University, Adana, Turkey.

Aim: The expression of the cognate receptor of advanced glycation end products (RAGE) in malignant tissues of patients with type 2 diabetes has been suggested as a co-factor determining the clinical course and prognosis. We aimed to investigate the relationship between RAGE expression and clinicopathological features of prostate neoplasia.

Methods: Tissue samples of 197 patients, 64 (24 patients with type 2 diabetes and 40 controls) with benign prostate hyperplasia (BPH) and 133 (71 patients with type 2 diabetes and 62 controls) with localised or metastatic prostate cancer (LPCa/MetPCa) were included in the study. The expression of RAGE in prostate specimens was studied immunohistochemically. RAGE scores were determined according to the extent of immunoreactivity and staining intensity.

Results: RAGE expression in BPH group (patients with type 2 diabetes and controls) was negative. Patients with both LPCa and MetPCa had significantly higher scores than those with BPH (P < .001). The mean RAGE scores of patients with type 2 diabetes LPCa and MetPCa were 4.71 ± 3.14 and 4.97 ± 3.69. The mean scores of control LPCa and MetPCa were 1.52 ± 1.87 and 1.69 ± 1.58, respectively. The scores of patients with type 2 diabetes LPCa and MetPCa were significantly higher than those of control LPCa and MetPCa (P = .01 and P < .001, respectively).

Conclusion: We found higher RAGE expression levels in malignant prostate neoplasia than in BPH. As expected, patients with diabetes had higher scores than control patients. Disease progression and survival parameters were worse in patients with high RAGE levels. RAGE expression may be a useful biomarker for the diagnosis and prognosis of prostate cancer.
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http://dx.doi.org/10.1111/ijcp.13723DOI Listing
March 2021

Hospitalization costs associated with diabetic foot ulcers treated by a multidisciplinary team in clinical practice. A retrospective study from southern Turkey.

Ann Ital Chir 2021 ;92:87-91

Purpose: Diabetic foot ulceration (DFU) is a common problem throughout the world and results in major economic consequences for the patients and country. We aim to describe the estimated cost of illness in patients with DFU in southern Turkey.

Methods: A total of 148 (F=55, M=93) patients with DFU were included in this retrospective study. Patients characteristics, duration time of hospitalisations, biochemical parameters and the presence of diabetic retinopathy, nephropathy, neuropathy, coronary artery disease and peripheral artery disease were recorded from our database. The cost of each patient was recorded from financial affairs and the billing department unit of our hospital.

Results: The average unit cost of each patient was £ 730.90±664.9. The major component in the total cost were medication (£ 258.8±360.9) and hospitalisation fees (£ 76.58±56.3). One hundred and fifteen (77.7%) of the patients had peripheral arterial diseases. While we could not determine significant correlations between the patients' demographical features (age, gender, p>0.05), biochemical parameters (plasma glucose, hemoglobin A1c % (HbA1c %)) and year of diagnoses with diabetes mellitus , the length of hospitalisation, presence of peripheral artery diseases and whether amputation (minor or major) was performed were significantly correlated with the total expenses.

Conclusion: The study revealed that the cost of DFU could show variability in relation to countries' level of development. We highlighted similar studies in other countries; the major factors of total expenses were length of hospitalisation, medication prescription and use of surgery.

Key Words: Costs, Diabetic foot, Multidisciplinary team.
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August 2021

HbA1c level decreases in iron deficiency anemia.

Wien Klin Wochenschr 2021 Feb 6;133(3-4):102-106. Epub 2020 May 6.

Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Cukurova University, Adana, Turkey.

Background: Hemoglobin A1c (HbA1c) is the major form of glycosylated hemoglobin. There are conflicting data on changes in HbA1c levels in patients with iron deficiency anemia (IDA). The present study aimed to investigate the effects of HbA1c levels in the presence of IDA, the effects of iron treatment on HbA1c levels, as well as the relationship between the severity of anemia and HbA1c levels in patients without diabetes.

Design And Methods: A total of 263 patients without diabetes mellitus (DM) who were admitted to Cukurova University, Faculty of Medicine, Department of Endocrinology and Hematology or who were followed up in this clinic and diagnosed as having IDA were included in the study. A total of 131 patients had IDA. The control group comprised 132 age-matched and sex-matched healthy individuals.

Results: The mean HbA1c level was significantly lower in the group with IDA (5.4%) than in the healthy control group (5.9%; p < 0.05). When the patients were divided into three groups according to the severity of anemia through Hb levels, HbA1c levels were observed to decrease as the severity of the anemia increased (5.5%, 5.4%, and 5%, respectively; p > 0.05). The HbA1c levels of the patients with IDA were higher after iron therapy (from 5.4 ± 0.5 to 5.5 ± 0.3; p = 0.057). The mean hemoglobin (Hb), hematocrit (Hct), mean cell volume (MCV), mean corpusculer hemoglobin (MCH), and ferritin values also increased after iron therapy (p < 0.05).

Conclusion: The study results showed that IDA was associated with low HbA1c levels, and increased after iron therapy. Based on the study findings, it is necessary to consider the possible effects of IDA on HbA1c levels.
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http://dx.doi.org/10.1007/s00508-020-01661-6DOI Listing
February 2021

Markers of Metabolic Syndrome in Patients with Pituitary Adenoma: A Case Series of 303 Patients.

Horm Metab Res 2019 Nov 4;51(11):709-713. Epub 2019 Nov 4.

Medical Faculty, Department of Internal Medicine, Division of Endocrinology, Cukurova University, Adana, Turkey.

To assess the demographic characteristics and hormonal status of patients who presented to our clinic with pituitary adenoma and to demonstrate the presence, prevalence, and relationship of metabolic syndrome parameters in these patients. The study included 303 patients with known or newly diagnosed pituitary adenoma and 52 age- and sex-matched healthy controls. The patients were classified into 3 groups; acromegaly (ACRO) (n=54),prolactinoma (PRLoma) (n=163), and non-functional adenoma (NFA) (n=86). in 55.6% (n=172) and 52% (n=163) of the patients, respectively. The waist circumference of all patients (p<0.001) and body mass index (BMI) of patients with PRLoma (p=0.03) and ACRO (p<0.001) were found to be significantly higher than in the controls. The HbA1c, insulin and HOMA-IR values were significantly higher in the ACRO and PRLoma groups, whereas the insulin and HOMA-IR values were significantly higher in the NFA group compared with the control group (p<0.001 and p<0.001, respectively). When the 3 patient groups were compared, waist circumference and BMI were significantly higher in the ACRO group than in the PRLoma group (p=0.04 and p=0.03, respectively). In patients developing pituitary failure after treatment, age, waist circumference, plasma glucose, low-density lipoproteins and triglyceride values were significantly increased when compared with those without pituitary failure after treatment (p<0.001). In our study, it was found that there was increased metabolic and cardiovascular risk in functional pituitary adenoma and NFA.
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http://dx.doi.org/10.1055/a-1020-3992DOI Listing
November 2019

Diagnostic efficacy of 18F-FDG PET/CT in patients with adrenal incidentaloma.

Endocr Connect 2019 Jul;8(7):838-845

Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey.

Background: The management of adrenal incidentaloma is still a challenge with respect to determining its functionality (hormone secretion) and malignancy. In this light, we performed 18F-FDG PET/CT scan to assess the SUVmax values in different adrenal masses including Cushing syndrome, pheochromocytoma, primary hyperaldosteronism and non-functional adrenal adenomas.

Methods: Total 109 (73 F, 36 M) patients with adrenal mass (incidentaloma), mean age of 53.3 ± 10.2 years (range, 24-70) were screened by 18F-FDG PET/CT. Data of 18F-FDG PET/CT imaging of the patients were assessed by the same specialist. Adrenal masses were identified according to the calculated standardized uptake values (SUVs). Clinical examination, 24-h urine cortisol, catecholamine metabolites, 1-mg dexamethasone suppression test, aldosterone/renin ratio and serum electrolytes were analyzed.

Results: Based on the clinical and hormonal evaluations, there were 100 patients with non-functional adrenal mass, four with cortisol-secreting, four with pheochromocytomas and one with aldosterone-secreting adenoma. Mean adrenal mass diameter of 109 patients was 2.1 ± 4.3 (range, 1-6.5 cm). The 18F-FDG PET/CT imaging of the patients revealed that lower SUVmax values were found in non-functional adrenal masses (SUVmax 3.2) when compared to the functional adrenal masses including four with cortisol-secreting adenoma (SUVmax 10.1); four with pheochromcytoma (SUVmax 8.7) and one with aldosterone-secreting adenomas (SUVmax 3.30). Cortisol-secreting (Cushing syndrome) adrenal masses showed the highest SUVmax value (10.1), and a cut-off SUVmax of 4.135 was found with an 84.6% sensitivity and 75.6% specificity cortisol-secreting adrenal adenoma.

Conclusions: Consistent with the similar studies, non-functional adrenal adenomas typically do not show increased FDG uptake and a certain form of functional adenoma could present various FDG uptake in FDG PET/CT. Especially functional adrenal adenomas (cortisol secreting was the highest) showed increased FDG uptake in comparison to the non-functional adrenal masses. Therefore, setting a specific SUVmax value in the differentiation of malignant adrenal lesion from the benign one is risky and further studies, including a high number of functional adrenal mass are needed.
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http://dx.doi.org/10.1530/EC-19-0204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599076PMC
July 2019

An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy.

Clin Rheumatol 2019 Mar 2;38(3):927-932. Epub 2019 Feb 2.

Department of Physical Medicine and Rehabilitation, Cukurova University, Faculty of Medicine, Adana, Turkey.

Objectives: The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups.

Method: The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH).

Results: Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16-9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61-9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00-1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021).

Conclusion: High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases.
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http://dx.doi.org/10.1007/s10067-019-04454-zDOI Listing
March 2019

Anemia in Patients with Diabetic Foot Ulcer: Effects on Diabetic Microvascular Complications and Related Conditions.

Endocr Metab Immune Disord Drug Targets 2019 ;19(7):985-990

Department of Internal Medicine, Cukurova University Faculty of Medicine, Division of Endocrinology, Adana, Turkey.

Objective: We aimed to investigate the etiology and prevalence of anemia in patients with diabetic foot ulcers and the relationship between both microvascular complications and related conditions and anemia.

Methods: We retrospectively collected and evaluated the data of 225 patients with diabetic foot ulcer followed at our clinic. The demographic characteristics of the patients were analyzed. Complete blood count for those with anemia, serum iron, iron-binding capacity, ferritin, transferrin saturation index, vitamin B12, folic acid and thin blood film were performed. The diabetic microvascular complications and related conditions such as osteomyelitis, peripheral artery disease, and amputations were also determined. IBM SPSS Statistics Version 20.0 package software was used for the statistical analysis of the data.

Results: Of 225 patients were 67 (29%) female and 158 (70.2%) male. The mean age of the patients was 62 ± 10.5 years (30-87). Duration of diabetes was 16.2 ± 6.7 years (2-31). Of the 225 patients, 41 had hypertension, 14 had chronic kidney failure, and 34 had coronary artery disease. Anemia was found in 192 (85.3%) of the 225 patients. Of 192, 126 (56%) had iron deficiency anemia, 50 had folate- deficiency anemia, and the remaining 16 had anemia of chronic disease. Iron deficiency anemia was significantly found to be higher in women. There was no significant difference between patients with and without anemia in terms of diabetic microvascular complications (neuropathy, retinopathy, nephropathy) and the related conditions.

Conclusion: We have found that the most common cause of anemia was iron deficiency anemia. However, in our study, the prevalences of microvascular complications did not vary between patients with and without anemia. On the other hand, since all of our patients are having DFU and the high rates of microvascular complications and correlation with the presence of anemia could not be clearly portrayed.
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http://dx.doi.org/10.2174/1871530319666190111121913DOI Listing
March 2020

Multidisciplinary approach for patients with functional and non-functional adrenal masses and review of the literature.

Health Sci Rep 2018 Mar 20;1(3):e22. Epub 2017 Dec 20.

Internal Medicine and Endocrinology, Department of Internal Medicine, Division of Endocrinology Cukurova University Medical Faculty Adana Turkey.

Background: Adrenal incidentalomas are adrenal masses that are discovered by imaging tests performed for other reasons.

Aims: In this retrospective study, we analysed 229 Turkish patients with adrenal masses and who presented with or without complaints.

Study Design: Descriptive retrospective study and review of the literature.

Methods: This study conducted a retrospective review of 229 patients with adrenal incidentalomas that were referred to Cukurova University Hospital's endocrinological department between 2009 and 2014. We reviewed detailed patient histories, physical examination findings, and symptoms and signs related to hormonal hypersecretion or malignant neoplasm and recorded clinical indications for performing diagnostic radiological imaging. The statistical analysis of data was performed using SPSS-19 software.

Results: Of the 229 patients reviewed, 195 (85.2%) had non-functional, benign adrenal adenomas, and 34 (14.8%) had functional lesions. Among those with functional lesions, 8 (3.5%) had lesions that secreted excess cortisol, 11 (4.8%) had lesions that secreted aldosterone, and 15 (6.6%) had lesions that secreted catecholamines. Eighty-four patients included in the study (36.8%) underwent adrenalectomy; in 14 of these cases, the adrenalectomy was performed before surgical treatment criteria occurred. The most frequent pathologic diagnosis was adrenal cortical neoplasia (n = 38); 32 of these patients had adenomas (Weiss <4 criteria), and 6 had carcinomas (Weiss >4 criteria). Other patient diagnoses included benign pheochromocytoma (n = 13), pseudocyst (n = 12), metastasis (n = 10), haemorrhage (n = 3), necrosis (n = 1), hyperplasia (n = 2), and other (n = 5).

Conclusions: Detailed endocrinological and radiological assessments of the mass nature and hormone status are necessary in cases of adrenal incidentaloma. Appropriate surgical treatment or periodic follow-up must be determined based on the assessment results.
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http://dx.doi.org/10.1002/hsr2.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266456PMC
March 2018

Adipocytokines in Non-functional Adrenal Incidentalomas and Relation with Insulin Resistance Parameters.

Endocr Metab Immune Disord Drug Targets 2019 ;19(3):326-332

Endocrinology Department, Cukurova University, Adana, Turkey.

Objective: Adrenal incidentalomas are diagnosed incidentally during radiological screenings and require endocrinological investigations for hormonal activity and malignancy. In certain studies, it has been reported that non-functional incidentalomas can be associated with high adipocytokines levels affecting the insulin resistance just like the adipose tissue with metabolic syndrome. Here, we studied serum adipocytokine levels including leptin, resistin, visfatin, omentin 1 and adiponectin in subjects with non-functional adrenal incidentaloma.

Methods: Seventy-seven (77) patients (Female 57; Male 20) with non-functional adrenal incidentaloma (NFAI) were enrolled in the study. All patients' past medical history, physical examination including Body Mass Index (BMI) and waist circumference were performed. The patients' demographic, radiologic, hormonal and biochemical parameters were recorded. To compare the parameters, a control group (CG) (n=30) was formed from healthy volunteers. Both groups were matched for age, gender, waist circumference and BMI. Serum adipocytokines including leptin, resistin, visfatin, omentin 1 and adiponectin were measured quantitatively by ELISA. Fasting plasma glucose, insulin, sodium, potassium, cortisol, adrenocorticotropic hormone (ACTH), lipid profiles, and dehidroepiandrostenedion sulphate (DHEAS) were measured.

Results: Mean age of the patients was 52.2±10.4 years. BMI and waist circumference of NFAI patients were 26.2±3.28 kg/m2 and 90.2 ±7.5cm, respectively. The mean age of the control group was 48.0±8.16. BMI and waist circumference values for the control group were 25.3±3.5 kg/m2 and 88.3±9.6 cm, respectively. When both groups were compared for age, gender, BMI and waist circumference were non-significant (p>0.05). Serum fasting insulin, total cholesterol, LDL, triglyceride levels of the NFAI group were significantly higher than CG (p<0.05). The insulin resistance index (HOMAIR) values of the NFAI subjects were found to be higher than CG (2.5±1.37, 1.1±0.3 p=0.00). Resistin level of NFAI group was also found to be higher than CG [286.6 ng/L vs. 197 ng/L; (P=0,00)], respectively. Leptin levels of NFAI were significantly higher than CG [441.1 ng/mL vs. 186.5 ng/mL; (P=0.00)] respectively. Adiponectin levels were significantly reduced in the NFAI group than in the CG [10.7 mg/L vs. 30.8 mg/L; (P=0.00)]. Comparision of visfatin and omentin levels was nonsignificant.

Conclusion: In this study on subjects with non-functional adrenal incidentaloma, we found not only significantly decreased serum adiponectin levels but also increased leptin, resistin levels as well as dyslipidemia, hypertension and high insulin resistance index. All of which could affect insulin resistance and cardiovascular risk factors. The underlying mechanisms of these findings are unknown, hence further studies are needed.
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http://dx.doi.org/10.2174/1871530318666181009112042DOI Listing
August 2019

Corrosion potential in artificial saliva and possible genotoxic and cytotoxic damage in buccal epithelial cells of patients who underwent Ni-Cr based porcelain-fused-to-metal fixed dental prostheses.

Mutat Res Genet Toxicol Environ Mutagen 2018 Mar 12;827:19-26. Epub 2018 Jan 12.

Department of Prosthodontics, Faculty of Dentistry, Gazi University, Emek, 06510, Ankara, Turkey.

Nickel-chromium(Ni-Cr) based alloys account for the majority of the porcelain-fused-to-metal fixed dental prostheses(PFM-FDPs) on account of their superior properties despite both nickel and chromium being known as human carcinogens. Understanding the genotoxicity and the cytotoxicity alongside the characteristics of corrosion behavior of the alloy is vital for understanding their biocompatibility. This study has evaluated whether the Ni-Cr based alloys corroded in artificial saliva by analyzing alloy decomposition at different pH levels and immersion durations(7, 14, 21, and 28 days) using inductively coupled plasma-optic emission spectrophotometry(ICP-OES). The principal aim of the study was to determine the possible genotoxicity and cytotoxicity using micronucleus(MN) and other nuclear anomaly frequencies [nuclear bud(NBUD), binucleated(BNC), condensed chromatin(CC), karyorrhectic(KhC), pyknotic(PC) and karyolytic(KC) cells] and various cytome parameters [basal cells(BC), differentiated cells(DF)] with the buccal epithelial cell(BEC) micronucleus cytome assay(BMCyt). This test was administered at 1 pre- and 3 post-treatment time points to 40 patients who underwent installation of PFM-FDPs made of Ni-Cr based alloy. Furthermore, at the final post-treatment time point, saliva cotinine levels were measured with salivary cotinine quantitative enzyme immunoassay(EIA) kit and information obtained by questionnaire prior to the first pre-treatment time point was confirmed. The highest greatest release of Ni and Cr ions were seen at pH 2.3. MN and micronucleated cell frequencies, and BNC cell frequencies were significantly elevated at post-treatment time points(p < 0.03). BC, CC, KhC, PC and KC cell frequencies however were not significantly different between pre-and post-treatment time points(p > 0.05). MN frequency was significantly lower in non-smokers than in current and former smokers(p < 0.001) at the pre-treatment time point. There was no significant correlation between the unit number of PFM-FDPs and MN frequencies. Our results revealed that Ni-Cr based alloys are prone to corrosion and that PFM-FDPs fabricated with Ni-Cr based alloys may induce genotoxic effects rather than cytotoxic effect.
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http://dx.doi.org/10.1016/j.mrgentox.2018.01.004DOI Listing
March 2018

Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional - observational study.

Pak J Med Sci 2016 Jul-Aug;32(4):891-5

Prof. Dr. Tamer Tetiker, M.D. Specialist in Internal Medicine and Endocrinology, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, 01330 Adana, Turkey.

Objective: Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer.

Methods: We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection.

Results: Native positivity between toes was higher in men compared to women (p<0.05). We obtained significant relation between HbA1c elevation and native positivity between toes (p<0.05). Fungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer (p<0.05). Moreover, native positivity in patients with diabetic foot ulcer correlated with presence of fungal infection examination findings (p<0.05).

Conclusion: Fungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers.
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http://dx.doi.org/10.12669/pjms.324.10027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017097PMC
September 2016

Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature.

World J Clin Cases 2016 Jul;4(7):181-6

Mehtap Evran, Murat Sert, Tamer Tetiker, Gamze Akkuş, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, University of Cukurova in Adana, 01330 Adana, Turkey.

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.
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http://dx.doi.org/10.12998/wjcc.v4.i7.181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945589PMC
July 2016

Impact of telephonic interviews on persistence and daily adherence to insulin treatment in insulin-naïve type 2 diabetes patients: dropout study.

Patient Prefer Adherence 2016 17;10:851-61. Epub 2016 May 17.

Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Istanbul, Turkey.

Objective: The objective of this study is to evaluate the impact of sequential telephonic interviews on treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetes patients initiated on different insulin regimens in a 3-month period.

Methods: A total of 1,456 insulin-naïve patients with type 2 diabetes (mean [standard deviation, SD] age: 56.0 [12.0] years, 49.1% were females) initiated on insulin therapy and consecutively randomized to sequential (n=733) and single (n=723) telephonic interview groups were included. Data on insulin treatment and self-reported blood glucose values were obtained via telephone interview. Logistic regression analysis was performed for factors predicting increased likelihood of persistence and skipping an injection.

Results: Overall, 76.8% patients (83.2% in sequential vs 70.3% in single interview group, (P<0.001) remained on insulin treatment at the third month. Significantly higher rate for skipping doses was noted in basal bolus than in other regimens (27.0% vs 15.0% for premixed and 15.8% basal insulin, respectively, P<0.0001). Logistic regression analysis revealed sequential telephonic interview (odds ratio [OR], 1.531; 95% confidence interval [CI], 1.093-2.143; P=0.013), higher hemoglobin A1c levels (OR, 1.090; 95% CI, 0.999-1.189; P=0.049), and less negative appraisal of insulin therapy as significant predictors of higher persistence. Basal bolus regimen (OR, 1.583; 95% CI, 1.011-2.479; P=0.045) and higher hemoglobin A1c levels (OR, 1.114; 95% CI, 1.028-1.207; P=0.008) were the significant predictors of increased likelihood of skipping an injection.

Conclusion: Our findings revealed positive influence of sequential telephonic interview, although including no intervention in treatment, on achieving better treatment persistence in type 2 diabetes patients initiating insulin.
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http://dx.doi.org/10.2147/PPA.S100626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876103PMC
June 2016

Carotid Intima-Media Thickness as the Cardiometabolic Risk Indicator in Patients with Nonfunctional Adrenal Mass and Metabolic Syndrome Screening.

Med Sci Monit 2016 Mar 26;22:991-7. Epub 2016 Mar 26.

Department of Internal Medicine, Division of Endocrinology, Cukurova University, Medical Faculty, Adana, Turkey.

Background: Our purpose was to show the association of adrenal incidentaloma and metabolic syndrome in consideration of the studies and to detect the increase in the carotid intima-media thickness which is regarded as the precessor of atherosclerosis.

Material/methods: Eighty-one patients who were diagnosed with adrenal mass were included in the study. Hormonal evaluation, insulin rezistance measurement with the HOMA-IR and 1-mg DST were performed of all patients. The patients were classified as follows: mass size <3 cm (K1) and mass size of at least 3 cm (K2). Echocardiography and carotid intima-media thickness of the patients were measured using B-mode ultrasound. Thirty-three healthy individuals were enrolled as the control group.

Results: Mass size of 64.19% K1, while mass size of the remainder (35.81%) K2 was calculated. Five of the patients with adrenal mass were detected to have subclinical Cushing syndrome. The remaining 76 patients were accepted as nonfunctional. It was seen with regard to metabolic and biochemical parameters that plasma glucose (p=0.01), insulin (p=0.00) and triglyceride (p=0.012) values of all patients were significantly high compared to those of the control group. It was detected that measured heart rate (p=0.00), end-diastolic diameter (p=0.02), end-systolic diameter (p=0.014) and carotid intima-media thickness (p=0.00) values of the patients with adrenal mass were significantly higher than those of the healthy control group.

Conclusions: We found that the increased insulin resistance, increased risk of cardiovascular disease with the increase in the thickness of carotid intima-media and diastolic disfunction parameters, although the patients with adrenal incidentaloma are nonfunctional.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811289PMC
http://dx.doi.org/10.12659/msm.897714DOI Listing
March 2016

Primary hyperparathyroidism in a patient with primary aldosteronism.

BMC Res Notes 2015 Jul 22;8:310. Epub 2015 Jul 22.

Division of Endocrinology, Department of Internal Medicine, Cukurova University Medical Faculty, 01330, Adana, Turkey.

Background: Primary hyperparathyroidism is one of the most common causes of hypercalcemia. Inherited forms of primary hyperparathyroidism like Multiple Endocrine Neoplasia Type 1, Multiple Endocrine Neoplasia Type 2a, Hyperparathyroidism-Jaw Tumor Syndrome or isolated familial tumors are not common for our population.

Results: We present a case of primary hyperparathyroidism in a 38-year-old Turkish man with hyperaldosteronism (Conn's syndrome).

Conclusion: Genetic studies could not reveal any mutation. We could not identify any inherit form of the diseases. We wanted the first-line relatives examination of the suspected gene mutation, but they refused.
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http://dx.doi.org/10.1186/s13104-015-1271-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508971PMC
July 2015

Clinical experiences and success rates of acromegaly treatment: the single center results of 62 patients.

BMC Endocr Disord 2014 Dec 16;14:97. Epub 2014 Dec 16.

Department of Internal Medicine, Division of Endocrinology, Balcali Hospital, Cukurova University Medical Faculty, 01330 Adana, Turkey.

Background: This study aimed to report the clinical and outcome data from a large cohort of patients diagnosed with acromegaly and treated at our institution over a 20-year period.

Methods: Sixty-two acromegaly patients (32 women and 30 men) treated and monitored at the endocrinology polyclinic between 1984 and 2013 were enrolled in this retrospective study. Clinical features and patients' treatment outcomes were evaluated. A level of growth hormone (GH) of <2.5 ng/ml was considered as the criterion for remission, and the normal insulin-like growth factor (IGF) range was based on gender and age.

Results: The mean age at the time of diagnosis was 38.8 ± 1.4 years, the time to diagnosis was 4.5 ± 0.3 years, and the follow-up duration was 7.3 ± 0.8 years. Among patients' symptoms, growth in hands and feet and typical facial dysmorphism were the most prominent (92%). The number of patients with diabetes mellitus, hypertension and hyperprolactinemia were 22 (35%), 13 (21%) and 13 (21%), respectively. Microadenomas and macroadenomas were found in eight and 54 patients, respectively. A significant correlation was found between the initial tumor diameters and GH levels (p = 0.002). The mean GH and IGF-1 levels were 39.18 ± 6.1 ng/ml and 993.5 ± 79 ng/ml, respectively. Visual field defect was found in 16 patients (32%). Thirty-one patients were treated by transsphenoidal surgery. Four of these were cured, 10 patients developed postoperative anterior pituitary hormone deficiency, and one patient developed diabetes insipidus. Twenty patients were treated by transcranial surgery, of which two were cured, while 17 patients developed postoperative anterior pituitary hormone deficiency. In total, five of the patients who were not cured after surgery were given conventional radiotherapy, of which two were cured. Four of 15 patients, on whom Gamma Knife radiosurgery was performed, were cured. Biochemical remission was achieved in 32 of 52 patients who received octreotide treatment, and in two of five patients who received lanreotide treatment.

Conclusions: The rate of surgical success in our patients was found to be low. This could be explained by an absence of experienced pituitary surgical centers or surgeons in our region, and the fact that most patients presented late at the macroadenoma stage.
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http://dx.doi.org/10.1186/1472-6823-14-97DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289580PMC
December 2014

A clinical prospective study on alveolar bone augmentation and dental implant success in patients with type 2 diabetes.

Clin Oral Implants Res 2015 Nov 11;26(11):1267-75. Epub 2014 Jul 11.

Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Çukurova University, Adana, Turkey.

Objectives: The objective of this prospective, controlled clinical study was to determine the outcomes of dental implant therapy with staged guided bone regeneration procedures in patients with type 2 diabetes.

Patients And Methods: Twenty-four patients were included in the study. Half of the patients were diagnosed with type 2 diabetes mellitus (group 1) while the other half (group 2) of the patients consisted of patients without diabetes. The edentulous maxillary anterior/premolar regions with sufficient vertical height but inadequate horizontal width were treated with staged guided bone regeneration technique and with one or two implant-supported fixed restorations. The patients were followed up at least for 12 months. The parameters that were evaluated were radiographic evaluations on CBCT images and periapical radiographs, histomorphometric analysis, resonance frequency analysis (RFA) and wound-healing parameters. The data were analyzed statistically.

Results: A total of 43 implants were placed in 24 patients (22 implants in group 1 and 21 implants in group 2). The survival rates of implants were 100% for both groups. The success rate of implants was 95% for group 1 and 100% for group 2. None of the parameters including CBCT findings, RFA values, success rates and wound-healing scores showed a significant difference between the two groups.

Conclusion: Staged guided bone regeneration is a feasible augmentation procedure for the treatment of horizontal bone deficiencies of the maxillary anterior/premolar regions in well-controlled type 2 diabetic patients.
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http://dx.doi.org/10.1111/clr.12450DOI Listing
November 2015

Vitamin D receptor gene BsmI, FokI, ApaI, TaqI polymorphisms and bone mineral density in a group of Turkish type 1 diabetic patients.

Acta Diabetol 2011 Dec 3;48(4):329-336. Epub 2011 May 3.

Section of Endocrinology and Metabolism, Marmara University School of Medicine, Tibbiye caddesi. No: 49 Haydarpasa, Istanbul, Turkey.

Previous studies have suggested an influence of vitamin D receptor alleles on bone metabolism and on susceptibility to type 1 diabetes mellitus in different ethnic populations. We aimed to investigate the distribution of vitamin D receptor (VDR) alleles in relation to biochemical bone turnover parameters and bone densitometry measurements in a group of Turkish type 1 diabetic patients. One hundred and seventeen patients (M/F 57/60, 27.6 ± 7.3 y duration of diabetes 8.1 ± 6.3 y) and 134 healthy controls (M/F 61/73, 26.2 ± 5.3 y) were included in the study. Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry (DEXA). The vitamin D receptor gene (VDR) polymorphisms FokI, Bsm1, Apa1, and Taq1 were examined using a PCR-based restriction analysis. Serum levels of calcium, phosphor osteocalcin, intact parathyroid hormone, and C telopeptide were measured. Vitamin D receptor Bsm1 Fok1, Apa1, and Taq1 genotype distributions were not different between patient with diabetes and control groups. BMD was 0.77 ± 0.2 g/cm(2) vs. 0.97 ± 0.2 g/cm(2) (P = 0.0001) for the femur, 1.0 ± 0.1 g/cm(2) vs. 1.13 ± 0.1 g/cm(2) (P = 0.001) for type 1 diabetic patients and controls. Bone turnover markers were significantly lower in type 1 diabetic group. BMD measurements and bone metabolic markers were not different between the genotypes in either the patient with diabetes or the controls. The VDR gene polymorphisms, Bsm1, Fok 1, Apa1, and Taq1 showed no influence on bone metabolism in our group of type 1 diabetic patients.
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http://dx.doi.org/10.1007/s00592-011-0284-yDOI Listing
December 2011

Review of Two Siblings with Werner's Syndrome: A Case Report.

Case Rep Med 2009 7;2009:138312. Epub 2010 Feb 7.

Division of Endocrinology, Department of Internal Medicine, Medical Faculty, Cukurova University, 01330 Adana, Turkey.

We report the clinical course of two siblings with Werner's syndrome (WS) who were diagnosed and followed at our clinics for 12 years. Initial diagnosis of the first sibling (sister) was at age 20, the second (brother) at 16. At the initial diagnosis, the sister had amenorrhea, muscle atrophy at arms and legs, diabetes mellitus (DM), short stature, bilateral cataracts, genital hypoplasia, osteoporosis, and gray hair. During 12 years follow-up period, high-pitched voice, hepatosteatosis, renal parenchymal disease, and urethral obstruction developed. Regarding the brother, DM, cataracts and genital hypoplasia were observed at the initial diagnosis. During the 12 years follow-up period, gray hair, high-pitched voice, steatohepatosis, and osteoporosis developed.
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http://dx.doi.org/10.1155/2009/138312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820261PMC
July 2011

Isoniazid intervention for latent tuberculosis among 86 patients with rheumatologic disease administered with anti-TNFalpha.

Clin Rheumatol 2007 Nov 27;26(11):1867-70. Epub 2007 Feb 27.

Department of Chest Disease, Cukurova University, School of Medicine, Balcali, 01330, Adana, Turkey.

In this study, we investigated the safety and toxicity of isoniazid (INH) intervention therapy to the patients with latent tuberculosis who were given tumor necrosis factor alpha (TNFalpha) for the treatment of their rheumatologic diseases. In this prospective clinical study, we enrolled 86 patients receiving anti-TNFalpha therapy for their rheumatologic diseases between April 2005 and September 2006. Of all the subjects, 45 had rheumatoid arthritis, 36 had ankylosing spondylitis, and 5 had psoriatic arthritis. In addition to anti-TNFalpha therapy, 60 of the 86 patients were given INH intervention for revealed latent tuberculosis. INH at a dosage of 300 mg daily was given for 9 months. Hepatotoxicity due to the INH therapy was considered when the serum alanine aminotransferase (ALT) and/or aspartate aminotransaminase (AST) levels showed at least threefold increase with respect to their baseline serum levels. Serum ALT and AST levels were measured by enzymatic colorimetric method in fasting peripheral blood samples at 0 (baseline), 1, 2, 3, 6, and 9 months. Of 86 patients, 47 (54.7%) were women (mean age+/-SD, 44.1 +/- 10.9 years) and 39 (45.3%) were men (38.8 +/- 10.1 years). Except five patients (8.3%), liver toxicity due to the INH therapy was not encountered among the patients, and after temporarily discontinuing the INH therapy of these five subjects, serum transaminase levels returned to the normal ranges. No hepatotoxicity was observed in the non-INH group. However, there was no statistical significance between INH-treated and non-INH-treated group (p = 0.317). In addition, none of the 86 patients developed active tuberculosis infection during the treatment period. In conclusion, for those patients who were assigned to the TNFalpha treatment for their rheumatologic disorders and carrying risk for latent tuberculosis, INH intervention therapy was found to be safe and efficacious.
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http://dx.doi.org/10.1007/s10067-007-0591-4DOI Listing
November 2007

A large family with Charcot-Marie-Tooth Type 1a and Type 2 diabetes mellitus.

Int J Neurosci 2006 Feb;116(2):103-14

Department of Neurology, Cukurova University Medical School, Adana, Turkey.

Charcot-Marie-Tooth (CMT) disease is a hereditary demyelinating peripheral neuropathy, and CMT Type 1A is the most common form. In most cases, CMT1A is usually caused by duplication at chromosome 17p11.2-12. Type 2 diabetes mellitus (Type 2 DM) is a common metabolic disorder, characterized by chronic hyperglycemia that can be associated with micro- and/or macrovascular complications. Only a few studies reported CMT1A duplication in association with Type 2 DM. This article explores the characteristics of a large family of 69 members with respect to CMT1A and Type 2 DM. CMT1A was detected in 28 of them. Molecular genetic study was performed in 22, and duplication was detected in all of them. Six of the 22 members with CMT1A also had Type 2 DM based on the American Diabetes Association diagnostic criteria. Association of these two conditions may be coincidental; however, the occurrence of these two diseases in this large family may also suggest a genetic basis. More extensive reports and further investigations of such families having this combination will certainly provide a better understanding of this link.
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http://dx.doi.org/10.1080/00207450500341431DOI Listing
February 2006

A rare case of Hurthle cell carcinoma with endobronchial metastasis.

Endocr J 2004 Apr;51(2):155-7

Department of Chest Diseases, Cukurova University, School of Medicine, Aadana, Turkey.

Endobronchial metastases (EBM) are frequently seen in breast, renal and colon carcinomas. However, to our knowledge, only one case has ever been reported as EBM secondary to Hurthle cell carcinoma (HCC) in the literature. A 57-year-old woman had a bilateral total thyroidectomy for thyroid mass in 1990 that was diagnosed as HCC. She was admitted to our outpatient clinic in August 1999, with symptoms of cough, sputum, and right-sided pleuritic pain for the last seven months. In the bronchoscopic examination, two endobronchial lesions were seen. Pathological evaluation of the bronchoscopic samples was diagnosed as "Hurthle cell carcinoma" of thyroid. We suggest that, although rare, HCC should be considered in the differential diagnosis of the endobronchial metastasis.
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http://dx.doi.org/10.1507/endocrj.51.155DOI Listing
April 2004

Delay in the diagnosis of SLE: the importance of arthritis/arthralgia as the initial symptom.

Acta Med Okayama 2003 Aug;57(4):187-90

Department of Internal Medicine, Division of Rheumatology, Cukurova University Medical Faculty, Adana, Turkey.

Despite the current diagnostic and serologic testing for SLE, the interval between the onset of symptoms and the diagnosis is still long. In this study, we aimed to show the interval between the initial symptoms and the diagnosis of SLE and to investigate the presence of any relationship between the interval and the initial symptoms. One hundred and thirty-six patients were diagnosed with SLE using the 1982 ARA criteria. The mean age of the patients at diagnosis was 29.9 +/- 10.5 years. The mean interval between the onset of symptoms and the diagnosis of SLE was 21.82 +/- 30.32 months. The subjects were evaluated twice, at intervals of < or = 3 and < or = 12 months after the onset of symptoms. Although arthritis and/or arthralgia were the most common initial symptoms (60.3%), only 26.8% of the patients with these symptoms were diagnosed earlier than 3 months after the onset. If the first initial symptoms were butterfly rash or pericarditis, pleuritis, spontaneous abortion or cognitive dysfunction, they led to early diagnosis. In conclusion, since arthritis and/or arthralgia are the most common initial symptoms of the disease, every young woman with these symptoms should be carefully evaluated for SLE.
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http://dx.doi.org/10.18926/AMO/32807DOI Listing
August 2003

Clinical report of 28 patients with Sheehan's syndrome.

Endocr J 2003 Jun;50(3):297-301

Cukurova University, Medical Faculty, Department of Internal Medicine, Endocrinology Division, Balcali Hospital, 01330 Adana, Turkey.

The aim of the present study was to determine the clinical and hormonal characteristics with Sheehan's syndrome in 28 cases that we had diagnosed and followed in the last 20 years. Twenty-eight patients with Sheehan's syndrome, diagnosed and followed at our University Endocrinology Clinic in the last 20 years were reported in the study. Medical history, physical examination, routine laboratory examinations, pituitary hormone analysis, CT and/or MRI scan of the sella of the patients were reviewed. All patients had a history of massive hemorrhage at delivery and physical signs of Sheehan's syndrome. Twenty-six of them lacked postpartum milk production, followed by failure of resumption of menses. There were 9 subjects with disturbances in consciousness associated with hyponatremia on admittance. All 28 patients had secondary hypothyroidism, adrenal cortex failure, hypogonadotrophic hypogonadism and growth hormone deficiency. Diabetes insipidus has not been found in any patient. Empty sellae were revealed in 8 patients by CT and/or MRI scan. Sheehan's syndrome is still encountered in clinical practice occasionally. If not diagnosed early, it could cause increased morbidity and mortality. The most important clues for diagnosis of Sheehan's syndrome are lack of lactation and failure of menstrual resumption after a delivery complicated with severe hemorrhage.
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http://dx.doi.org/10.1507/endocrj.50.297DOI Listing
June 2003

Comparison of the efficiency of anti-androgenic regimens consisting of spironolactone, Diane 35, and cyproterone acetate in hirsutism.

Acta Med Okayama 2003 Apr;57(2):73-6

Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical School, Adana, Turkey.

The aim of the present study was to evaluate the effects of three different anti-androgenic drug-therapy regimens, Diane 35 (cyproterone acetate (CPA) [2 mg] and ethinyl estradiol [35 microg]) plus CPA, Diane 35 plus spironolactone, and spironolactone alone, in patients with hirsutism. In this prospective, randomized clinical study, 79 subjects with idiopathic hirsutismus were studied. The patients were divided into 3 groups. Group I patients (n=32) were treated with Diane 35 plus CPA, group II patients (n=25) with Diane 35 plus spironolactone [100 mg], and group III patients (n=22) with spironolactone [100 mg] alone. Serum FSH, LH, testosterone (T), and DHEAS levels were analyzed before and after treatment at 6 and 12 months. Hirsutism scores were graded according to the Ferriman-Gallwey scoring system, and side effects were monitored. All treatment regimens were found to be efficient and well-tolerated, and none of the patients stopped therapy due to any adverse event. However, in hormone screening, only patients on the Diane 35 plus CPA regimen revealed a decrease in serum T levels after therapy. As such, treatment of each hirsute patient should be planned individually, but with regard to both cost-efficiency and potential side effects, we recommend spironolactone alone in the treatment of hirsutismus.
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http://dx.doi.org/10.18926/AMO/32820DOI Listing
April 2003
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