Gonca Tamer

Pituitary infiltration by non-Hodgkin's lymphoma: a case report

IntroductionPituitary adenomas represent the most frequently observed type of sellar masses; however, the presence of a rapidly growing sellar tumor, diabetes insipidus, ophthalmoplegia and headaches in an older patient strongly suggests metastasis to the pituitary. Since the anterior pituitary has a great reserve capacity, metastasis to the pituitary and pituitary involvement in lymphoma are usually asymptomatic. Whereas diabetes insipidus is the most frequent symptom, patients can present with headaches, ophthalmoplegia and bilateral hemianopsia.Case presentationA 70-year-old woman with no previous history of malignancy presented with headaches, right oculomotor nerve palsy and diabetes insipidus. As magnetic resonance imaging revealed a sellar mass involving the pituitary gland and infundibular stalk, which also extended into the right cavernous sinus and sphenoid sinus, the patient underwent an immediate transsphenoidal decompression surgery. Her prolactin was 102.4 ng/ml, whereas her gonadotropic hormone levels were low. A low level of urine osmolality after overnight water deprivation, along with normal plasma osmolality suggested diabetes insipidus. Histological examination revealed that the mass had been the infiltration of a high grade B-cell non-Hodgkins lymphoma involving respiratory system epithelial cells. Paranasal sinus computed tomography scanning and magnetic resonance imaging of the thorax and abdomen were performed. Since magnetic resonance imaging did not reveal any abnormality, after paranasal sinus computed tomography was performed, we concluded that the primary lymphoma originated from the sphenoid sinus and infiltrated the pituitary. Chemotherapy and radiotherapy to the sellar area were planned, but the patient died and her family did not permit an autopsy.ConclusionLymphoma infiltration to the pituitary is difficult to differentiate from pituitary adenoma, meningioma and other sellar lesions. To plan the treatment of lymphoma infiltration of the pituitary gland, it must be differentiated from other sellar lesions.

Pituitary Metastasis of Breast Carcinoma

Rarely, primary carcinomas can metastasize to the pituitary. Mostly the posterior lobe is affected and diabetes insipidus can develop. We report a 47-year-old woman who was on follow-up for metastatic breast carcinoma and admitted to the endocrinology unit for polyuria and polydypsia, which had worsened gradually. Her laboratory findings were compatible with diabetes insipidus. Magnetic resonance imaging revealed a huge mass involving the suprasellar cistern, surrounding the cavernous sinus and compressing the optic chiasm and infundibulum. Radiotherapy for the sellar region and chemotherapy were performed and desmopressin was started. The symptoms were controlled with desmopressin. Increased amounts of urine output and oral fluid intake in a patient with a diagnosis of carcinoma should alert the physicians of a possibility of pituitary metastasis, and the hormonal insufficiency should be corrected to increase the patient’s quality of life.

Increased fasting and stimulated c- peptide levels after the diagnosis of type 1 diabetes: a case report

Context: Recently a few studies showing α-cell ability to differentiate into insulin–producing β-cells after prolonged duration of diabetes and reconstruction of new insulin–producing cells in the absence of autoimmunity in mice with completely ablated β-cells were reported. Here, we present a patient with type 1 diabetes and increased fasting and mixed-meal stimulated C-peptide levels 10 years after the diagnosis. Case description: A female patient with type 1 diabetes for 10 years was referred to our endocrinology clinic for hypoglycemia attacks. Her fasting glucose, HbA1C, fasting and mixed-meal stimulated C-peptide levels were measured three years ago and recently. Fasting and mixed-meal stimulated C-peptide levels were found to be increased compared to the levels of three years ago (<0.01 ng/mL vs. 0.06 ng/mL and <0.01 ng/mL vs 0.28 ng/mL respectively). Conclusion: It is possible that β-cell function may increase in type 1 diabetes, a decade after the diagnosis as observed in our patient. . Germany). We performed a mixed-meal tolerance test (MMTT) to the patient after an overnight fasting of ≥ 12 hours without administering her usual morning insulin treatment. After fasting blood glucose, C-peptide, and HbA1c levels were measured, a mixed meal containing 33 g of carbohydrate, 15 g of protein, and 6 g of fat (240 kcal total) [2] was eaten in less than 10 minutes, and C-peptide level was measured 90 minutes after the mixed-meal. Parameters were confirmed with repetitive measurements. Total daily insulin dose, fasting glucose and HbA1c level of the patient was decreased and her fasting and mixed-meal stimulated C-peptide levels were increased compared to her levels 3 years ago. Her current laboratory parameters and those in 2012 are shown in Table 1. Discussion It is accepted that T1D is a disease with absolute insulin deficiency. However recent studies have shown endogen insulin secretion is still present in some patients with T1D even in patients with long disease duration [2-4]. In these studies, it was not clear whether β-cell function was ongoing since the disease begun, or if it has increased or decreased. To our knowledge this case may be the first case in literature with fasting and mixed-meal stimulated C-peptide levels increased compared to the levels three years ago. Correspondence to: Gonca Incemehmet Tamer, Istanbul Medeniyet University Goztepe Training and Research Hospital, Endocrinology and Metabolism, Fahrettin Kerim Gokay Street, Kadikoy, Turkey, Tel: +90 (216) 5709195; Fax: +90 (216) 5709191; E-mail: hgtamer@yahoo.com

Effect of vitamin D status on lipid profile in premenopausal women: a cross-sectional study

Objective High lipid levels play important roles in the pathogenesis of atherosclerosis and some authors suggest vitamin D deficiency as a risk factor for atherosclerosis. The aim of this study was to evaluate the effect of vitamin D status on lipid profile in premenopausal women. Patients and methods A total of 315 nonsmoking premenopausal female volunteers without diabetes mellitus were included in the study. Patients were divided into four subgroups. The groups were as follows: patients with less than or equal to 12 ng/ml (group 1, n=126) vitamin D levels, between 20 and 12 ng/ml (group 2, n=48), between 30 and 20 ng/ml (group 3, n=21), and at least 30 ng/ml (group 4, n=120) vitamin D levels. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and non-HDL-C levels of the four groups were compared. Results HDL-C levels of group 4 were the highest (P=0.03), and TG and non-HDL-C levels of group 1 were the highest (P=0.04, 0.016, respectively) in all groups. There was no significant difference between serum parathormone, calcium, and phosphorus levels of the four groups (P=0.778, 0.121, 0.184, respectively). In unadjusted analysis, 25-hydroxy vitamin D levels were found to be correlated negatively with BMI (P=0.0005), LDL-C (P=0.01), and non-HDL-C (P=0.003) and correlated positively with HDL-C levels (P=0.006). After adjustments for age, sex, BMI, and log parathormone levels were made, no correlation was found between 25-hydroxy vitamin D and lipid (TC, LDL-C, HDL-C, and TG) levels (P=0.91, 0.06, 0.95, 0.79, respectively). Conclusion There may be an association between vitamin D insufficiency and dyslipidemia. However, this association may depend on obesity.

Gastroesophageal reflux symptoms in Turkish people: a positive correlation with abdominal obesity in women.

OBJECTIVE: Metabolic syndrome (MetS) is increasing around the world due to abdominal obesity with altered eating habits and decreased physical activity. The aim of this study was to determine the risk factors for gastroesophagial reflux disease (GERD) symptoms and the prevalence of GERD in patients with MetS. METHODS: Five hundred patients (MetS, n=300 and the control group, n=200) were enrolled in the study. A detailed questionnaire reflux symptoms and behavioral habits was performed. RESULTS: Sixty percent of the subjects were with MetS. GERD rate was significantly higher in the group with MetS compared to subjects without MetS (50.7% vs 26%). Women were more likely to have GERD in both groups (62.6% of women and 28.6% of men ın the MetS group while corresponding rates were 37% vs 16.7% in the control group). Waist circumferences were found to be higher in female MetS patients with GERD. CONCLUSION: GERD is present approximately in every one of the two patients with MetS. Every patient who has MetS should be evaluated in terms of GERD symptoms.