Elif Kilic Kan

Central retinal artery occlusion in an ANCA negative Churg-Strauss syndrome patient

PurposeTo describe a central retinal artery occlusion in a patient with antineutrophil cytoplasmic antibody (ANCA) negative Churg-Strauss syndrome.MethodsReview of clinical and laboratory findings of a 44-year-old woman with ANCA negative Churg-Strauss syndrome that developed sudden vision loss in left eye.ResultsLeft central retinal artery occlusion was diagnosed by retinal whitening, a cherry-red spot, and delayed arterial filling on fluorescein angiography. Perinuclear ANCA and cytoplasmic ANCA were negative.ConclusionCentral retinal artery occlusion can occur in ANCA negative Churg-Strauss syndrome. Patients with this diagnosis should be considered for prophylactic high dose corticosteroid, regardless of their ANCA status.

Presence of thyroid-associated ophthalmopathy in Hashimoto's thyroiditis

AIM To determine the prevalence of ophthalmopathy in Hashimotos patients and to make a comparison in subgroups of patients. METHODS The study involved 110 Hashimotos thyroiditis patients and 50 control subjects attending to the endocrinology department of the hospital. Subgroup classification of patients was made as euthyroid, subclinic and clinic in Hashimatos thyroiditis. All patients were evaluated by a single experienced ophthalmologist for the prevalence and characteristics of eye signs. RESULTS The overall prevalences of eye changes were 22.7% (25 patients) in patients and 4% (2 persons) in control subjects respectively (P=0.002). In patients the most common symptom was retrobulbar eye pain with or without any eye movement. Thirteen patients had significant upper eyelid retraction (11.8%). Six patients had eye muscle dysfunction as reduced eye movements in up gaze. In control patients one person had proptosis and another had lid retraction. The clinical activity score and classification of the ophthalmopathy did not show any significant differences among subgroups. CONCLUSION The eye signs were mostly mild (22.7%) and the most common eye sign was the presence of upper eyelid retraction (11.8%). Additionally six patients had eye muscle dysfunction as reduced eye movements in up gaze. Therefore we recommend to make a routine ophthalmic examination in Hashimotos thyroiditis patients in order not to omit the associated ophthalmopathy.

Increased Prevalence of Obstructive Sleep Apnea in Patients with Cushing's Syndrome Compared to Weight- and Age Matched Controls

OBJECTIVE Diabetes mellitus and obesity are well-known risk factors associated with obstructive sleep apnea (OSA). Cushings syndrome (CS) is also characterized by obesity and diabetes mellitus. However, the association between CS and OSA remains unclear. Therefore, we investigated the possible associations between CS and OSA in this study. PATIENTS AND METHODS Thirty female patients with newly diagnosed active CS and 30 age-, gender- and body mass index (BMI)-matched controls were included in this study. All participants were evaluated by overnight polysomnography. OSA was defined as having an apnea-hypopnea index (AHI) score of ≥5 events/h. Insulin resistance was calculated by homeostasis model assessment (HOMA) scores. Fasting serum cortisol was also determined. RESULTS The prevalence of OSA was higher (50% vs 23%, P = 0.003) in patients with CS compared with the control subjects. The mean HOMA (P = 0.046) and AHI (P = 0.028) scores were higher in patients with CS compared with the control subjects. AHI was positively correlated with the HOMA scores (r = 0.281, P = 0.046) in both groups. Linear regression analysis showed that serum cortisol remained as an independent predictor for AHI after controlling for BMI and HOMA score (P < 0.001). CONCLUSIONS The prevalence of OSA increased in patients with CS compared with control subjects with similar ages and BMI levels. Hypercortisolemia is an independent risk factor for developing OSA. The presence of OSA needs to be considered in patients with CS.

Association of Disease Activity with Serum and Tear IL-2 Levels in Behçet Disease.

Abstract Purpose: To investigate the association of Behçet disease activity with serum and tear interleukin-2 levels. Methods: The study was designed as a prospective case control study. The study population consisted of 45 patients with Behçet disease and 24 age and sex-matched healthy participants. Behçet disease patients were classified as active (24 patients) or inactive (21 patients) according to disease activity. Serum and tear interleukin-2 levels were determined using the enzyme-linked immunosorbent assay method. Results: The mean serum and tear interleukin-2 levels of the active disease, inactive disease, and control groups were 17.04 ± 5.02 and 32.61 ± 16.53 pg/mL; 15.20 ± 4.68 and 29.61 ± 8.30 pg/mL; and 14.22 ± 4.18 and 28.89 ± 8.73 pg/mL, respectively. There was no statistically significant difference between the groups with respect to all measured data. Conclusions: There was no significant difference in serum or tear IL-2 levels between Behçet patients and controls; there was no association of disease activity with serum and tear IL-2 levels.

The evaluation of central corneal thickness and intraocular pressure in conjunction with tear IGF-1 levels in patients with acromegaly.

Purpose To compare the central corneal thickness (CCT), intraocular pressure (IOP), and tear insulin-like growth factor 1 (IGF-1) levels between patients with acromegaly and a control group and to evaluate the possible effect of tear IGF-1 and duration of the disease on CCT and IOP. Methods We included 31 patients with acromegaly (study group) and 40 age- and sex-matched controls in the study. Patients with acromegaly were divided into 2 subgroups based on disease status (active/inactive). All participants underwent complete ophthalmologic evaluation including CCT and IOP values. Basal tear samples were collected from both groups and tear IGF-1 levels were measured. The CCT, IOP, and tear IGF-1 levels were compared between groups and subgroups and the association between tear IGF-I levels and ocular parameters (CCT, IOP) and disease duration were also evaluated. Results Central corneal thickness, IOP, and tear IGF-1 levels did not show a significant difference between study and control groups. We also did not find a significant difference in terms of CCT, IOP, or tear IGF-1 levels between subgroups of patients. Correlation analysis did not show an association between the duration of disease and tear IGF-1 levels with CCT or IOP. Conclusions There was no significant difference in tear IGF-1 levels between patients with acromegaly and controls. Additionally, there was no correlation between disease duration and tear IGF-1 levels with CCT or IOP levels. This lack of association may suggest that tear IGF-1 levels might not have an effect on CCT or IOP findings in patients with acromegaly.

Pegvisomant tedavisi sonuçlarımız ve literatürün gözden geçirilmesi

Akromegali, artmis buyume hormonu (BH) sekresyonu ve artmis insulin benzeri buyume hormonu-1 (IGF-1) seviyeleri ile karakterize kronik bir hastaliktir. Akromegalide tedavi secenekleri cerrahi, radyoterapi ve medikal tedavidir. Medikal tedavide somatostatin analoglari, dopamin agonistleri ve pegvisomant kullanilmaktadir. Pegvisomant, buyume hormonu reseptor antagonisti olup etkisini reseptor dimerizasyonunun engellenmesi ile birlikte IGF-1 salinimi icin gerekli intraseluler yolaklari engelleyerek gosterir. Cerrahi ve maksimum doz ve kombinasyonda medikal tedaviye ragmen biyokimyasal yanit saglanamayan hastalarda ucuncu basamak tedavide kullanilir. Bu derlemede, akromegali tedavisinde diger seceneklere gore nispeten yeni olan pegvisomant tedavisi klinigimizdeki tedavi sonuclarimiz ile birlikte guncel literatur isiginda tekrar gozden gecirilmistir.

Tiroit nodüllerine yaklaşım

Noduler tiroit hastaligi sik gorulen endokrinolojik bir hastalik olup prevalansi iyot alimina gore onemli olcude degismektedir. Her iki cinsiyette de yas ile birlikte noduler guatr prevalansinda artis saptanmistir. Tiroit nodulu ile karsilasildiginda ilk yapilmasi gereken malign-benign ayirimi, sonrasinda kompresyon belirtileri, tiroit fonksiyonlarinin degerlendirilmesi ve cerrahi gereken nodul ile medikal tedavi gereken nodul ayirimini yapmak olmalidir. Klinik degerlendirme sonrasindaki ilk degerlendirme serum TSH olcumu ve ultrasonografik inceleme olmalidir. Preopeartif olarak tiroit kanserinin teshisinde Tiroit ince igne aspirasyon biyopsisi sitolojik incelemesinin en etkili ve spesifik metod oldugu ispatlanmistir. J. Exp. Clin. Med., 2012; 29:S315-S320 Approach to thyroid nodules Nodular thyroid disease is a common endocrinopathy that prevalence varies according to the iodine uptake. Nodular goiter becomes more prevalent in both gender as the age increases. When patient with a thyroid nodule is seen compression symptoms, thyroid function and malign-benign separation are the first investigations that should be performed. The next step should be the evaluation of the nodule to decide whether surgery or medical treatment is required. After clinical evaluation of a patient with a thyroid nodule, serum TSH measurement and ultrasonographic evaluation are the first investigations that should be performed. Cytological examination of fine needle aspiration biopsy (FNAB) specimens has been proved to be the most efficient and specific method of diagnosing thyroid cancer preoperatively. J. Exp. Clin. Med., 2012; 29:S315-S320