Gokcen Unal Kocabas

A case of an ectopic prolactinoma.

A 34-year-old female presented to our clinic with a 1.5 year history of secondary amenorrhea and galactorrhea. Prolactin (PRL) level was found to be 151.89 ng/ml. Pituitary imaging was reported to be normal. An examination of the patient revealed that PRL level was still high so the dose of cabergoline was further increased and subsequently, bromocriptine was added to the treatment. There was no reduction in PRL levels in controls. A scanning was performed to look for an ectopic focus. Abdominal computerized tomography revealed a heterogenous mass lesion originating from the uterus. Octreotide scintigraphy was performed and we observed an involvement consistent with the mass in the uterus. The patient underwent abdominal total hysterectomy. PRL dropped to 0.4 ng/ml the next day after the operation. The pathology result was a low-grade malignant mesenchymal tumor. Prolactin was found to be immunohistochemically negative. However, galactorrhea disappeared postoperative and PRL levels are still low. Elevated levels of PRL, resistant to bromocriptine and cabergoline, rapidly returned to normal after hysterectomy, which obviously indicates that hyperprolactinemia was associated with the myoma of the uterus.

A novel CYP11B1 mutation in a Turkish patient with 11β-hydroxylase deficiency: An association with the severe hypokalemia leading to rhabdomyolysis

ABSTRACT Congenital adrenal hyperplasia is an autosomal recessive disorder caused by the loss of one of five steroidogenic enzymes affecting cortisol synthesis. In deficiency of 11 β- hydroxylase, 11-Deoxycortisol cannot be converted to cortisol and deoxycorticosterone cannot be converted to corticosterone. We present our 11β-hydroxylase deficiency case with hypokalemia and with a novel mutation. A 20-year-old male patient who’d been on steroid replacement treatment for adrenal insufficiency for 18 years was admitted with spasm, dyspnea and syncope attacks. On laboratory examination his potassium level was 1.4 meq/L and creatinine kinase and myoglobin levels were increased indicating rhabdomyolysis. Potassium infusion was started. 11 β- hydroxylase deficiency related congenital adrenal hyperplasia was diagnosed as the patient had adrenal insufficiency, hypertension and hypokalemia. Spironolactone treatment was started in addition to potassium infusion. Potassium levels were back to normal in the follow-up. Hypokalemia-related rhabdomyolysis regressed. In CYP11B1 whole genome sequencing analysis, p.A199P and p.R448H compound heterozygous mutation was detected. Thus, these two compound heterozygous mutations may be associated with the severity of the disease.

Circulating Lipocalin-2 Levels Are Associated With Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Levels In Type 2 Diabetic Patients

Purpose: Diabetes mellitus is associated with atherosclerotic and cardiovascular diseases. Our aim was to investigate the levels of lipocalin-2 (LCN-2) and soluble Lectin-like oxidized low-density lipoprotein receptor-1(sLOX-1) levels in both diabetics and prediabetic with comparison to non-diabetic subjects. We also examined the association of LCN-2 with sLOX-1 and albuminuria Methods: One hundred forty-two subjects with type 2 diabetes mellitus, 32 prediabetic subjects, 58 non-diabetic controls were consecutively enrolled in this study. LCN-2 and sLOX-1 levels were measured with ELISA assays. Results: LCN-2 levels didn’t show significant difference between diabetics, prediabetic and control groups (p = 0.864). sLOX-1 levels were significantly lower in diabetic group (2.53 ng/mL, median) compared with prediabetic (2.84 ng/mL, median; p = 0.041) and control groups (3.00 ng/mL, median; p = 0.001). Multiple linear regression analysis showed that urinary albumin excretion and sLOX1 were independently associated with LCN-2. When logistic regression analysis was performed LCN-2 was independent factor determining albuminuria (p = 0.021; OR, 1.001; (1.000-1.001) 95% CI). Conclusion: Our study provides the first clinical evidence demonstrating serum LCN-2 concentrations are independently associated with sLOX-1 levels which were found to be lower in type 2 diabetics unexpectedly. LCN-2 was also associated with albuminuria. Received: September 24,2018; Accepted: October 01,2018; Published: October 02,2018 *Corresponding author : Banu Sarer Yurekli, Ege University Faculty of Medicine, Department of Endocrinology, Ankara Street, Bornova, Izmir, Turkey, 35100,Tel: +90 5055250373;Fax: +902323247880;E-mail: bsareryurekli@yahoo.com