Esra Hatipoglu

Corneal biomechanical properties of patients with acromegaly

Purpose Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess in acromegaly have various effects on many organs. The ophthalmologic effects of GH and IGF-1 excess have not yet been investigated in detail. The aim of the current study is to compare the corneal biomechanical properties of patients with acromegaly and those of healthy subjects. Methods 45 patients with acromegaly (F/M=27/18) and 42 age-matched and gender-matched healthy individuals (F/M=24/18) were enrolled in this cross-sectional study. Central corneal thickness (CCT), corneal resistance factor (CRF), corneal hysteresis (CH), corneal compensated intraocular pressure (IOPcc) and Goldmann correlated IOPG were measured in patients with acromegaly and in healthy individuals using the Ocular Response Analyser (ORA). GH and IGF1 values were also determined in the study group. Results The mean CH and CRF values were higher in acromegalic patients (12.1±2.2 and 12.3±2.4, respectively) than in healthy subjects (11.0±1.6 and 10.8±1.5, respectively; for CH, p=0.014; for CRF, p=0.001). Mean IOPG measurement was higher in the acromegaly group than in the control group (p=0.017). There was no statistically significant difference in measured CCT (p=0.117) and IOPcc (p=0.594) values between acromegalic patients and healthy subjects. Conclusions These findings indicate that acromegaly has target organ effects on the eye. Consequently, it can change corneal biomechanical properties such as corneal hysteresis and the CRF. Corneal biomechanical properties are known to affect the accuracy of IOP measurements. These findings should be taken into account when measuring IOP values in acromegaly patients, as IOP readings may be overestimated.

Acromegaly and aging: A comparative cross-sectional study

OBJECTIVE Cognitive and functional geriatric assessment may change in acromegaly. Herein we aimed to determine at which points geriatric assessment of the cases with acromegaly differs from that of general elderly population. DESIGN In this comparative cross-sectional study, a total of 30 cases with acromegaly (controlled n = 14, uncontrolled n = 16) and 30 gender and body-mass index-matched cases without acromegaly (control group, CG) above 60 years old were included. Cognitive functions were evaluated on the basis of the mini-mental state exam (MMSE). Affective status was determined using the geriatric depression scale. Activities of daily living (ADL) were ranked according to the Barthel index while instrumental activities of daily living (IADL) were graded on the basis of the Lawton scale. Nutritional status was evaluated using the mini-nutritional assessment (MNA). Body composition was measured through bioimpedance analysis. Functional mobility was determined using the Timed Up and Go test (TUG) and muscle strength with the handgrip strength test. RESULTS Scores on the MMSE were significantly lower in the elderly cases with acromegaly than in the cases without acromegaly (p < 0.001). Dementia was more frequent in the acromegaly group than in the CG (p = 0.04). Total MNA scores were significantly lower in cases with acromegaly than in the CG (p = 0.006). More subjects in the acromegaly group (33%) were at greater risk of malnutrition than in the CG (3%) (p = 0.003). There was greater moderate functional impairment based on Barthel ADL in the acromegaly group than in the CG (p = 0.04). CONCLUSION Acromegaly may impair cognitive functions, functional mobility and instrumental daily living activities in the geriatric population. With acromegaly, the risk of malnutrition may also increase.

Cerebrotendinous Xanthomatosis: The Effectiveness of High-Dose Piracetam for the Treatment of Cerebellar and Sensorial Ataxia

Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive metabolic disease that is based in a deficiency of sterol 27-hydroxylase, which leads to the storage of cholestanol and cholesterol in the lenses, central nervous system and tendons [1, 2]. The most common neurological manifestations of CTX include pyramidal signs, cerebellar ataxia, cognitive impairment, dysphagia, dysarthria and peripheral neuropathy [3]. Brain magnetic resonance imaging (MRI) usually reveals cerebral atrophy and T2 signal changes in the dentate nucleus and, less commonly, in the spinal cord and basal ganglia [4]. Chenodeoxycholic acid (CDCA) effectively treats the symptoms of CTX via a reduction in the synthesis and plasma levels of cholestanol [3]. Although the effects of CDCA on the progression of CTX have been explicitly described, the value of treating the ongoing symptoms of CTX using pharmacotherapies remains controversial [5–7]. For example, adult CTX patients may undergo long-term treatment with CDCA alone or in combination with inhibitors of hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase [8]. Similarly, high-dose parenteral piracetam is effective in some definite and probable cases of hereditary spinocerebellar ataxia (SCA) [9, 10]. Here, we report the effectiveness of high-dose intravenous piracetam for the treatment of ataxia in two cases of CTX. Patients and Methods

Corneal endothelial cell density and morphology in patients with acromegaly

OBJECTIVE Acromegaly has various impacts on many organs. The ophthalmologic effects of acromegaly have not yet been investigated in detail. The aim of the current study was to evaluate qualitative and quantitative changes in corneal endothelial cells and central corneal thickness (CCT) of the patients with acromegaly. DESIGN In this prospective, cross-sectional study, 128 eyes of 64 patients with acromegaly (female/male=40/24) and 208 eyes of 104 age and gender-matched healthy volunteers (female/male=69/35) were included. Endothelial cell density (ECD), cellular area (CA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and CCT were measured in patients with acromegaly and in healthy volunteers using the noncontact specular microscopy (SP-3000P: Topcon Corporation, Tokyo, Japan). RESULTS ECD and CA were lower in cases with acromegaly than in controls (ECD in acromegaly: 2615.65 cell/mm(2) and in controls: 2700.35 cell/mm(2); p=0.002. CA in acromegaly: 382.30μm(2) and in controls: 400.30μm(2); p=0.02). In the entire group with acromegaly, the time elapsed since diagnosis was positively correlated with CA and was negatively correlated with ECD (r=+0.39, p=0.001 and r=-0.42, p=0.001). CONCLUSIONS The endothelial layer of the cornea may be under risk of impairment with prolonged disease duration in acromegaly. Consistency of the corneal endothelium should be also sought during long-term follow-up of the cases with acromegaly.

Tear Osmolarity and Tear Function Changes in Patients with Acromegaly.

Abstract Purpose: Since acromegaly is a disease with various systemic complications, it may also have ophthalmologic consequences. The aim of the current study was to compare the tear osmolarity and tear function changes in patients with acromegaly with those in healthy controls. Design: Prospective, cross-sectional study. Materials and methods: Fifty-nine consecutive patients with acromegaly and 62 age and gender matched healthy volunteers were enrolled in the study. Tear osmolarity measurement with TearLab Osmolarity System (Tearlab, San Diego, CA), tear film break-up time (TBUT) assessment, and the Schirmer test without anesthesia were performed in the same order in each group. Growth hormone (GH) and insulin like growth factor-1 (IGF1) levels were also determined in the study group. Results: The mean TBUT was lower in acromegalic patients (9.1 ± 3.6 seconds) than in healthy controls (10.7 ± 2.9 s) (p = 0.009). The difference between the two groups in tear osmolarity and Schirmer test results (p = 0.08 and p = 0.9, respectively) was not statistically different. Conclusions: Acromegaly may a cause a decrease in TBUT in the affected patient. Preservation of normal tear osmolarity and normal Schirmer test results suggests that this might be due to effects on the meibomian glands.

Increased incidence of pelvic organ prolapse in women with acromegaly

OBJECTIVE To evaluate gynecological problems of female patients with acromegaly and the relationship of these problems with the activity of the disease. STUDY DESIGN Thirty-four women with acromegaly and 27 age- and body mass index-matched female healthy controls (HC) were included in the study. Demographic features, medical history, hormonal status and disease activity were obtained. A detailed gynecological examination was performed. RESULTS The incidence of pelvic organ prolapse (POP) was higher in patients with acromegaly (53%, n=18) compared to the HC (15%, n=4) (p=0.003). Limiting the analysis to only cases with previous pregnancy, POP was seen in 18 (60%) of 30 cases with acromegaly and in 4 (20%) of 20 of the HC (p=0.005). Additionally, in cases with prior vaginal delivery, POP was present in 18 (60%) of 30 cases with acromegaly and in 4 (24%) of 17 of the HC (p=0.02). The frequency of POP was similar in patients with controlled and uncontrolled acromegaly (p=0.3). CONCLUSION Acromegaly may facilitate occurrence of pelvic organ prolapse and may cause additional health issues in female cases.

Comparison of day 3 and day 5 thyroglobulin results after thyrogen injection in differentiated thyroid cancer patients

Background: It is necessary to stimulate serum thyroid-stimulating hormone (TSH) levels either endogenously by thyroid hormone withdrawal (THW) or exogenously by administration of recombinant human TSH (rhTSH) for radioactive iodine (RAI) therapy. Thyrotropin alfa (Thyrogen) has many advantages over THW. Radiation dose to laboratory staff while drawing blood for tests on the day 5 is one of the disadvantages of preferring Thyrogen. Our aim was to compare day 3 and day 5 blood test results after Thyrogen injections. Material and method: In our study, Thyrogen was preferred in 32 differentiated thyroid cancer patients with a mean age of 50.5 ± 12.3 years. Thyrogen was injected on day 1 and day 2 intramuscularly in all patients before I-131 was given on day 3. A total of 22 patients received 5 mCi RAI for ablation control scintigraphy and 10 patients received 100–250 mCi RAI for ablation or therapy (high-dose group). Blood tests were performed on day 3 and day 5 after Thyrogen injections. Results: Mean TSH level was 98.1 mg/dl for day 3 and 29.5 mg/dl for day 5. In the diagnostic group, thyroglobulin (Tg) and anti-Tg levels were nearly the same on day 3 and day 5. In the therapy group, day 5 Tg levels were higher than day 3. Conclusion: After Thyrogen injection of two consecutive days, blood sampling might be enough on day 3. Day 5 blood sampling may not be necessary routinely for radiation protection of laboratory staff. For the diagnostic group, if Tg and anti-Tg is normal then 5 mCi imaging may not be necessary.

Physical and cardiovascular performance in cases with acromegaly after regular short-term exercise

Impaired physical performance is a disturbing complication of acromegaly. We aimed to evaluate the role of regular exercise in amelioration of the impaired physical performance in acromegaly.

Comprehensive geriatric assessment of elderly cases with acromegaly

1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey 2 Division of Geriatry, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey 3 Division of Endocrinology and Metabolism, Department of Internal Medicine,Istanbul Training and Research Hospital, Istanbul, Turkey