Fahri Bayram

The effects of metformin on insulin resistance and ovarian steroidogenesis in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a form of functional ovarian hyperandrogenism and affects approximately 5‐10% of women of reproductive age. Insulin resistance and hyperinsulinaemia appear to be almost universal feature of the polycystic ovary syndrome. Abnormal regulation of cytochrome P450c17α causes the exaggerated secretion of ovarian androgens in PCOS. The aim of the present study was to determine whether reduction of insulin levels by metformin would attenuate FSH, LH, 17‐Hydroxyprogesterone (17‐OHP) and androstenedione hyperresponsiveness to buserelin testing in PCOS women.

Effects of antidepressant treatment and of gender on serum leptin levels in patients with major depression.

Leptin is a product of the obese gene and plays an important role in the regulation of body weight and food intake. Weight and appetite are frequently altered in depression. So far, inconsistent results have been reported in terms of leptin levels in depression. Therefore, the authors investigated serum leptin levels in patients with depression and in healthy controls, and whether there was any alteration throughout antidepressant treatment. Female patients showed significantly higher leptin levels than those of the control females both before and after the response to antidepressant treatment, whereas no difference was found between the male patients and the male controls. The improvement from depression with antidepressant treatment caused a further elevation on the leptin levels, in both female and male patients. These findings confirm an increase in leptin levels in depressive patients and presence of a sexual dimorphism. Moreover, clinical response to antidepressant treatment seems to have an additional increasing effect on leptin levels.

A prospective, randomized trial comparing flutamide (250 mg/d) and finasteride (5 mg/d) in the treatment of hirsutism

OBJECTIVE To compare the long-term (1 year) effects of flutamide (250 mg/d) and finasteride (5 mg/d) for the treatment of hirsutism in women. DESIGN Randomized, prospective clinical study. SETTING Departments of Gynecology and Obstetrics and Endocrinology at Erciyes University Medical Faculty, Kayseri, Turkey. PATIENT(S) Seventy patients with hirsutism were studied. INTERVENTION(S) Thirty-five patients were treated with flutamide (250 mg/d) and 35 patients with finasteride (5 mg/d) for 12 months. Hirsutism score, hormone levels, and multiscreen blood chemistry were measured at 3-month intervals. MAIN OUTCOME MEASURE(S) Reduction in hair growth. RESULT(S) The modified Ferriman-Gallwey scores for hirsutism decreased significantly at months 6 and 12 from a mean +/- SD of 17. 8 +/- 5.8 to 6.0 +/- 3.4 and 17.8 +/- 5.8 to 4.8 +/- 3.2, respectively, in group 1; and from 19.1 +/- 6.1 to 14.2 +/- 4.9 and 19.1 +/- 6.1 to 11.3 +/- 5.0 in group 2, respectively. There were no statistically significant differences in any of the hormonal indices in group 1, but in group 2, E(2) and sex hormone-binding globulin increased significantly while DHEAS decreased significantly at 12 months of therapy. CONCLUSION(S) This study shows that flutamide (250 mg/d) is more effective than finasteride (5 mg/d) in reducing hair growth. We conclude that flutamide (250 mg/d) may represent a more effective and well tolerated treatment for patients.

A comparison between two doses of flutamide (250 mg/d and 500 mg/d) in the treatment of hirsutism

OBJECTIVE To compare the effects of flutamide at 250 mg/d and 500 mg/d in the treatment of hirsutism. DESIGN Randomized, prospective clinical study. PATIENT(S) Sixty-five patients with moderate to severe hirsutism. INTERVENTION(S) Group I (n = 35) patients were treated with flutamide, 250 mg/d, and group II (n = 30) patients were treated with flutamide, 500 mg/d, for 12 months. Baseline hormone levels, body mass index, and hirsutism scores were similar between the groups. Hirsutism score, hormone levels, and multiscreen blood chemistry were measured at 3-month intervals for 12 months. RESULT(S) The modified Ferriman-Gallwey scores for hirsutism decreased significantly at months 6 and 12 from a mean +/- SEM of 17.8 +/- 0.9 to 6.0 +/- 0.6 (P < 0.001) and 17.8 +/- 0.9 to 4.8 +/- 0.7 (P < 0.001) in group I and from 17.0 +/- 0.9 to 6.6 +/- 0.7 and 17.0 +/- 0.9 to 5.2 +/- 0.7 (P < 0.001) in group II, respectively. The reductions in hirsutism scores (mean +/- SEM) were similar in group I at 6 months (64.6% +/- 2.5%) and at 12 months (71.2% +/- 2.2%) and in group II at 6 months (62.1% +/- 3.0%) and at 12 months (70.3% +/- 3.0%). The percent reductions in hirsutiam scores at 6 and at 12 months were similar within group I (64.6% +/- 2.5% and 71.2% +/- 2.2%) and group II (62.1% +/- 3.0% and 70.3% +/- 3.0%), respectively. The decreases in hirsutism scores in the first 6 months were more significant than in the last 6 months of treatment in both groups. There were no significant differences in any of the hormone levels during therapy in either group. One patient in group II was excluded from the study because of liver dysfunction. CONCLUSION(S) This study shows that two different doses of flutamide (250 mg/d and 500 mg/d) are similarly effective in reducing hair growth. Flutamide at a dose of either 250 mg/d or 500 mg/d has no further effect after 6 months. We conclude that if flutamide is administered at a dose of 250 mg/d it may represent an effective and well tolerated treatment with reduced cost for the patient.

Brown tumor of the maxilla associated with primary hyperparathyroidism

Brown tumors represent the terminal stage of the remodeling processes during primary or secondary hyperparathyroidism. During the last three decades primary hyperparathyroidism has been recognized much more commonly and the increase has generally been attributed to the routine determination of calcium by new automated methods and the advent of new and more objective parathyroid hormone radioimmunoassay techniques. Early diagnosis and successful treatment of the disease have made clinical evidence of bone disease uncommon. While, the mandible is the most frequently involved bone in the head and neck region, maxillary involvement is extremely rare. A case of brown tumor on the maxilla associated with primary hyperparathyroidism is reported. This patient presented multiple skeletal lesions, which are uncommonly seen nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiological and histopathological determinations. Excision of a parathyroid adenoma normalized the metabolic status. Excision of the maxillary mass led both histopathological confirmation of the disease and early masticator rehabilitation.

Treatment of hirsutism with lowest-dose flutamide (62.5 mg/day).

Flutamide has been used successfully in the treatment of hirsutism. However, flutamide may cause important side-effects. The aim of this study was to evaluate the clinical and hormonal effects of lowest-dose flutamide therapy. Sixty-one women with hirsutism aged 18–37 years (mean ± SD 23.4 & 5.9 years) were included in the study. Patients received 62.5 mg flutamide once per day for a period of 12 months. A hirsutism score was determined according to a modified Ferriman–Gallwey scoring system. Before therapy, multiscreen blood chemistry, hormonal analysis and complete blood counts were performed. These parameters and hirsutism scores were repeated at 3, 6, 9 and 12 months during therapy. The modified Ferriman–Gallwey scores significantly decreased from 19.1 ± 4.9 to 5.8 ± 3.3 during the study (p < 0.0001). The percentage reductions in hirsutism scores (mean ± SD) were 60.3 ± 14.4% at 6 months, and 70.3 ± 13.2% at 12 months. No significant side-effects or modifications in the menstrual cycles were observed. There were no significant differences in any of the hormone levels during therapy. In conclusion, the lowest dose of flutamide, 62.5 mg/day, is a well-tolerated therapeutic agent and can be used in the treatment of hirsutism.

Comparison of cyproterone acetate plus ethinyl estradiol and finasteride in the treatment of hirsutism

The aim of this study was to compare the clinical efficacy and safety of low dose cyproterone acetate-estrogen combination (Diane®) and the 5α-reductase inhibitor finasteride in the treatment of hirsutism. Fourty-two women with hirsutism were included in the study. Twenty-one patients treated with cyproterone acetate (CPA) 2 mg and ethinyl estradiol (E) 35 µg daily on days 5–25 of the menstrual cycle, 21 with finasteride 5 mg daily. Hirsutism score, hormone levels, multiscreen blood chemistry and side effects were evaluated at three-monthly intervals for 9 months. A significant decrease in hirsutism score as compared to baseline was observed after 9 months with either CPA+E (Diane®) (mean ± SE, 15.81±1.19 i 8.38±1.21) or finasteride treatment (17.81±1.05 vs 10.86±0.91) (p<0.0005). The reductions in hirsutism scores (mean% ± SE) were 14.23 ± 2.29 vs 19.77±2.22 (p<0.05) at 3, 40.23±4.58 vs 29.49±2.69 (p<0.02) at 6 and 50.99±4.13 vs 39.87±3.30 (p<0.02) at 9 months in CPA+E and finasteride groups, respectively. No significant changes were observed in hormone levels during finasteride treatment. Serum free testosterone significantly decreased at the third month of treatment, and remained suppressed for the duration of treatment in CPA+E group. DHEAS levels also decreased significantly after 6 and 9 months of therapy with CPA+E. SHBG significantly increased during CPA+E treatment. We conclude that both drugs are effective and well tolerated, but CPA+E appears to be more effective than 5α-reductase inhibitor finasteride in long-term treatment of hirsute women. Diane® is also a cost-effective drug.

The efficacy of 250 mg/day flutamide in the treatment of patients with hirsutism

OBJECTIVE To investigate the effects of low dose flutamide (250 mg/d) on hirsutism score and hormone levels in women with hirsutism. DESIGN Nonrandomized, prospective clinical trial. PATIENTS Forty-one patients with moderate-severe hirsutism were included in the study. INTERVENTION Hirsute patients received 250 mg/d flutamide for a period of 6 months. MAIN OUTCOME MEASURES Hirsutism score, FSH, LH, E2, total T, free T, androstenedione, DHEAS, PRL, 17-hydroxyprogesterone, and sex hormone-binding globulin levels were detected in all the patients before treatment and every 3 months during treatment. RESULTS Treatment with the antiandrogen flutamide resulted in a particularly rapid and marked decrease in the hirsutism score, which decreased from 17.48 +/- 5.35 to 5.07 +/- 2.89 after 6 months. No significant changes in the levels of hormone and no serious side effects were observed in the study. CONCLUSION The low-dose flutamide, 250 mg/d, is a cost-effective drug in the treatment of hirsutism. Low-dose flutamide may be used in place of high-dose flutamide, 500 to 750 mg/d.

Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults.

Introduction The aim of this study is to investigate the prevalence of metabolic syndrome (MS) and its components according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria and the risk factors affecting MS. Metabolic syndrome prevalence was evaluated according to certain quintet age groups, altitude, location and demographic features. Material and methods This study was a cross-sectional survey conducted in 24 provinces from the 7 regions of Turkey. A total of 4309 adults from 7 regions participated in the study (1947 males, 45.2%). Results The mean age of participants was 47 ±14 years. Metabolic syndrome prevalence was found as 36.6% according to ATP III and 44.0% according to IDF. The MS rate was found to be higher in females compared to males in both groups (p < 0.01). According to both criteria, MS prevalence was found to be higher in subjects who lived in coastal regions when evaluated according to altitude and in subjects who lived in district centers when evaluated according to location. The MS risk is 1.62-fold higher in females compared to males. Metabolic syndrome risk increases as age increases and is highest in the 61-65 age group. Metabolic syndrome risk increases 2.75-fold in the overweight compared to normal weighing subjects and 7.80-fold in the obese. Conclusions Metabolic syndrome prevalence was found to be high in Turkey according to both criteria. Metabolic syndrome prevalence increases as age and body mass index (BMI) increase. Age, female gender and obesity are independent risk factors for MS development.

Effects of Calcium Treatment on QT Interval and QT Dispersion in Hypocalcemia

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