Emrah Yerlikaya

Relation with HOMA-IR and thyroid hormones in obese Turkish women with metabolic syndrome

The aim of this study was to investigate the relationship between insulin resistance and thyroid function in obese pre- and postmenopausal women with or without metabolic syndrome (MetS). 141 obese women were divided into two groups, HOMA-IR<2.7 and HOMA-IR>2.7, to evaluate relation with HOMA-IR and fatness, hormone and blood parameters. They were then divided into four groups as pre- and postmenopausal with or without MetS. Various fatness, hormone and blood parameters were examined. Statistically significant difference was found in weight, body mass index (BMI), waist circumference, fat%, fasting insulin, TSH, FT3, FT4, FSH, Anti-microsomal antibody (ANTIM) and triglycerides levels in HOMA-IR<2.7 and HOMA-IR>2.7 obese Turkish women. This study showed that age, weight, BMI, waist circumference, fat%, fasting insulin, FT3, ANTIM, FSH, LH, total cholesterol, triglycerides, HDL, HOMA-IR, systolic and diastolic blood pressure levels were related in preand post menopausal status in obese women with or without MetS. Obesity may influence the levels of thyroid hormones and increases the risk of MetS in women. Postmenopausal status with MetS is associated with an increased TSH, FT3 and FT4 levels and HOMA-IR in obese women. Strong relation was observed with MetS and TSH and FT3 levels.

Adiponectin and Cardiac Hypertrophy in Acromegaly.

BACKGROUND Adiponectin is an adipocytes-derived hormone which has been shown to possess insulin-sensitizing, antiatherogenic, and anti-inflammatory properties. In acromegaly, the data on adiponectin is contradictory. The relationship between adiponectin levels and cardiac parameters has not been studied. OBJECTIVES The aim of this study was to find out how adiponectin levels were affected in acromegalic patients and the relationship between adiponectin levels and cardiac parameters. MATERIAL AND METHODS We included 30 subjects (15 male, 15 female), diagnosed with acromegaly and 30 healthy (10 male, 20 female) subjects. Serum glucose, insulin, GH, IGF-1 and adiponectin levels were obtained and the insulin resistance of the subjects was calculated. Echocardiographic studies of the subjects were performed. RESULTS We determined that adiponectin levels were significantly higher in the acromegalic group than the control group. In the acromegalic group, there was no statistically significant relation between serum adiponectin and growth hormone (GH), or insulin-like growth factor-1 (IGF-1) levels (p = 0.3, p = 0.1). We demonstrated that cardiac function and structure are affected by acromegaly. IVST, PWT, LVMI, E/A ratio, DT, ET, IVRT, VPR, and LVESV values were increased and the results were statistically significant. In the acromegalic group, adiponectin levels were positively related with left ventricle mass index (LVMI) but this correlation was found to be statistically weak (p = 0.03). In our study, there was a positive correlation between VAI and LVM. We also could not find any correlation between VAI and adiponectin levels. CONCLUSIONS Although insulin resistance and high insulin levels occur in active acromegaly patients, adiponectin levels were higher in our study as a consequence of GH lowering therapies. Our study showed that adiponectin levels may be an indicator of the cardiac involvement acromegaly. However, the usage of serum adiponectin levels in acromegalic patients as an indicator of cardiac involvement should be supported with other, wide, multi-centered studies.

Dehydroepiandrosterone sulfate levels in Turkish obese patients

PurposeObesity is well known to be linked to higher morbidity and mortality. Elevated plasma levels of free dehydroepiandrosterone (DHEA) are associated with reduced obesity and more limited accumulation of abdominal body fat. In contrast, the relationship between the DHEA sulfate ester (DHEAS) and adiposity is inconsistent and contradictory.MethodsThe aim of this study was to compare DHEAS levels in obese Turkish individuals, 37 men and 246 women. A variety of fatness, hormone, and blood parameters were measured.ResultsStatistically significant differences were found between male and female individuals with respect to weight, waist circumference, fat %, insulin, and DHEAS levels.ConclusionsWe found that in the Turkish population, while a correlation between obesity parameters and DHEAS levels exists in both female and male individuals, DHEAS levels are significantly higher in obese male individuals than in obese female individuals.

Resistin and Leptin Levels in Acromegaly: Lack of Correlation With Echocardiographic Findings

Purpose To find out how resistin and leptin levels were affected in patients with acromegaly and whether there is a relation between resistin levels and cardiac parameters. We also aimed to investigate whether resistin and leptin may be a link between insulin resistance and cardiac functions as well as these affected cardiac functions in the patients with acromegaly. Methods We included 30 subjects (15 men and 15 women) who had a diagnosis of acromegaly and 30 healthy (10 men and 20 women) subjects. Serum glucose, insulin, growth hormone, insulinlike growth factor 1 (IGF-1), resistin, and leptin levels were obtained, and insulin resistance of subjects were calculated. Echocardiographic studies of the subjects were performed. Results Resistin levels of the patients with acromegaly were found lower than controls. This difference was statistically significant (P = 0.001). Leptin levels were lower in the patients with acromegaly than in the controls, but this difference was not statistically significant. Resistin and leptin levels were not correlated with growth hormone, IGF-1, and with insulin-like growth factor binding protein 3 levels. Homeostasis model assessment of insulin resistance was positively correlated with resistin levels. (P = 0.03; r = 0.531) but not correlated with leptin levels. There was a positive correlation between body mass index and leptin levels in the patients with acromegaly (P = 0.007; r = 0.482). Interventricular septum thickness, posterior wall thickness, left ventricle mass index, peak early mitral inflow velocity–peak late mitral inflow velocity ratio, deceleration time, ejection time, isovolumetric relaxation time, velocity propagation, and left ventricular end-systolic volume values were significantly greater in the patients with acromegaly. Leptin levels in the acromegalic patients were not correlated with any of them. Conclusions We found biventricular hypertrophy and impairment of diastolic and systolic function in the patients with acromegaly. We conclude that changes in resistin and leptin levels are unlikely to account for the insulin resistance of acromegaly. They do not also seem to be contributing factors of cardiovascular changes in patients with acromegaly.

Misdiagnosis of hypocortisolemia based on early morning cortisol.

Evaluation of hypothalamic–pituitary–adrenal (HPA) axis after transsphenoidal surgery for GH-secreting pituitary adenomas is undertaken by measurement of early morning cortisol and insulin tolerance test (ITT). Although the ITT is the gold standard test for examining HPA axis function, the morning serum cortisol level is the most convenient test for adrenal insufficiency. It is important for clinicians to know the factors that affect basal cortisol measurement. Shift work is another factor disturbing circadian rhythm of cortisol secretion and its measurement. We present here an acromegalic patient with pseudo hypocortisolemia resulting from the disruption of the circadian rhythm of cortisol. A 37-year-old man was diagnosed with acromegaly in March 2005. He was treated with transsphenoidal tumor resection followed by monthly injections of a long-acting analog of somatostatin (SST) to keep the disease in remission. In January 2012, owing to mass effects of the residual tumor, he was operated on again with transsphenoidal resection. Evaluations for pituitary insufficiency and postoperative assessment of acromegaly remission were performed. There was no lack of pituitary hormone. Adjuvant treatment with SST analog was continued in March 2012. Postoperative 6 months later, he presented to our endocrinology clinic with continued complaints of weakness and reluctance with ill-feeling. At the time of admission, his blood pressure was 110/70 mmHg, his pulse was regular at 90 bpm, and his temperature was 37 C. Venous blood samples were taken for the determination of plasma cortisol level, glucose, thyrotrophin, free thyroxine, and electrolytes. His blood chemistry results and all pituitary hormones were normal except cortisol. His plasma cortisol concentration at 08:00 am was 2.73 lg/dL. He was thought to have hypocortisolemia. Then, he was admitted to the inpatient service for further evaluation and management of the adrenal insufficiency. Peak cortisol concentration 60 min after ACTH stimulation was 32.50 lg/dL. An ITT was also performed to measure the cortisol response to insulin-induced hypoglycemia. During the ITT, while plasma glucose was 38 mg/dL, plasma cortisol was measured as 24.52 lg/dL. Repeated early morning plasma cortisol levels were performed on the patient, and all results were lower than 3 lg/dL. After obtaining a detailed history of the patient, we learned that he was a night worker. He was staying awake all night and sleeping in the daytime. The circadian variation in plasma cortisol was studied during a 24-h period. The results of the sampling are presented in Table 1. A basal cortisol value greater than 400 nmol/L (14.5 lg/ dL) invariably indicates an intact HPA axis. Serum cortisol concentrations determined at 08:00 h of less than 3 lg/dL (80 nmol/L) are strongly suggestive of adrenal insufficiency. Ignoring the circadian rhythm of cortisol can lead to a false diagnosis of hypocortisolemia. Millions of people are shift workers. Shift work is associated with the disruption of these physiologic circadian rhythms. Hennig et al. studied the changes in biological rhythms during night-shift and its association with tolerance of the night work. A reversal of circadian function was found in 18 of 24 subjects after the fifth night, while six subjects showed no change in circadian function. They concluded that early morning cortisol concentrations become lower than evening concentrations, which may be a E. Yerlikaya F. Akin (&) Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Kınıklı Kampusü, 20070 Denizli, Turkey e-mail: fulyaendo@yahoo.com.tr

Serum leptin levels and GHR-d3/fl gene polymorphism in acromegalic patients with thyroid nodules

BACKGROUND Acromegaly is a rare and serious syndrome that is commonly associated with pituitary neoplasms. Thyroid multinodular disease is a common finding in acromegaly. Leptin is a polypeptide hormone, and studies have shown that it can increase cell proliferation and inhibit apoptosis. OBJECTIVES The aim of the study was to determine the relationship of serum leptin levels with certain blood parameters and determine if growth hormone receptor (GHR)-d3/fl gene polymorphism is associated with thyroid nodules in acromegalic patients. MATERIAL AND METHODS A total of 24 acromegalic patients with or without thyroid nodules were included in the study. Gene polymorphisms and blood parameters were examined. RESULTS A marked increase was observed in serum leptin concentration in acromegalic patients with thyroid nodules compared to patients without them (p < 0.05). GH levels were lower in patients without nodules than in patients with nodules (p < 0.05). Blood glucose levels were higher in patients with nodules compared to those without them (p < 0.05), and the presence of thyroid nodules was associated with decreased blood low-density lipoprotein (LDL) levels compared to patients without nodules (p < 0.05). A significant relationship was observed between growth hormone receptor (GHR)-d3/fl gene polymorphism and leptin levels in acromegalic patients with thyroid nodules (p < 0.001). CONCLUSIONS These data from acromegalic patients indicate that thyroid nodules are associated with increased serum leptin, GH and blood glucose levels and with decreased LDL levels. GHR-d3/fl gene polymorphism status was strongly related to higher leptin levels.

Heel Pain and Comorbid Conditions in Obese Patients

Abstract Objectives: Plantar heel pain [PHP] is one of the most common musculoskeletal disorders of the foot, yet its etiology is poorly understood. Although obesity is the most common cause of PHP, there is little information available about the prevalence and associated factors in obese patients with PHP. The aim of this study was to investigate the prevalence of obesity associated co-morbidities in people with and without PHP. Methods: Obese and overweight patients with or without PHP were sought for this study. The two groups were then compared with regard to weight, hormone, and blood parameters. Diabetes mellitus, chronic obstructive lung disease, asthma, smoking, varix, hemorrhoid, lumbago, constipation, osteoporosis, hormone replacement therapy, goiter, and gastroesophageal reflux. Findings: One hundred forty nine obese and overweight patients agreed to participate [34 with PHP and 115 without PHP]. Statistical analyses demonstrated that the PHP group had a longer duration of obesity than those without PHP. The PHP group had an increased prevalence of chronic obstructive lung disease, [p < 0.01], hemorrhoid [p < 0.01], lumbago [p < 0.01], constipation [p < 0.01], and gastroesophageal reflux [P < 0.05], By contrast, the prevalence of asthma [p < 0.05], and varix [p < 0.01] were decreased in the PHP[+] group. No statistically significant difference in group prevalence was found for diabetes mellitus, coronary heart disease, smoking, osteoporosis, hormone replacement therapy, or goiter. Conclusions: The results of this study suggest that the duration of the obesity in obese patient may be important to the development of PHP in obese patients. The longer duration of obesity in the PHP group may also help to explain its association with co-morbidities such as chronic obstructive lung disease, hemorrhoid, lumbago, constipation, and gastroesophageal reflux.

Acromegaly and Gigantism

Human growth hormone (GH), a single-chain peptide of 191 amino acids, was isolated from somatotroph cells of the anterior pituitary gland in 1956 and first used therapeutically for treatment of pituitary dwarfism in 1958 (Raben, 1958). Pituitary dwarfism is the classic form of growth hormone deficiency during childhood. Gigantism refers to any standing height more than 2 standard deviations above the mean for the persons sex, age, and Tanner stage. Abnormally high linear growth due to excessive action of insulin-like growth factor-I (IGFI)/GH causes gigantism while the epiphyseal growth plates are open during childhood, as puberty occurs it is followed by progressive acromegalic changes leading to a picture of a giant with acromegalic features acromegalic gigantism. When onset disease is after epiphyseal closure, only acromegaly results. Acromegaly, a somatic growth and proportion disorder first described by Marie in 1886 (Marie, 1886). Elevated levels of growth hormone and IGF-1 are the hallmarks of this syndrome (Melmed, et al., 1983). When Marie first desribed this syndrome at his patients, pitutiary overgrowth is the cause or reflection of the visceromegaly at these patients. In 1909, Harvey Cushing reported the remission of clinical symptoms of acromegaly after partial hypophysectomy, thus indicating the etiology of the disease and its potential treatment as well (Cushing, 1909).