Hande Peynirci

Sexual dysfunction in female patients with type 2 diabetes mellitus: a cross-sectional single-centre study among Turkish patients

Abstract The aim of the study was to assess the prevalence of female sexual function and related factors in Turkish women with type 2 diabetes mellitus (T2DM). A total of 93 female patients diagnosed with T2DM (age 48.0 ± 7.2 years (Mean ± SD) were included. Data on age, diabetes age, HbA1c level, educational level, diabetes treatment, diabetes-related complications, co-morbid disorders and concomitant medications were recorded, as were the scores obtained using a Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was noted in 55.9% of patients including problems related to desire (60.2%), arousal (52.7%), lubrication (55.9%), orgasm (51.6%) and satisfaction (58.1%) as well as pain during sexual intercourse (54.8%). Total scores were correlated negatively to age (r= −0.329, p = 0.001) and duration of diabetes (r= −0.246, p = 0.018), while significantly higher in patients with than without hypertension (19.6 vs. 22.4, p = 0.012) and with than without insulin therapy (20.0 vs. 23.7, p = 0.050). Our findings indicate the adverse effects of T2DM on sexual function in 55.9% of women in all domains of sexual response cycle, although this seems to be associated with older age, longer duration of diabetes, insulin and antidepressant therapy, presence of hypertension as well as end-organ complications of neuropathy and coronary artery disease (CAD).

ONCOCYTIC NEOPLASMS; RARE ADRENOCORTICAL TUMORS: A REPORT OF ELEVEN PATIENTS

INTRODUCTION Oncocytomas of adrenal glands are extremely rare and usually present as incidentally detected masses. We aimed to present a series of patients with adrenal oncocytomas and review the literature. MATERIAL AND METHODS Electronic database of patients with adrenal tumours, who were admitted to the internal medicine and endocrinology and metabolism outpatient clinics of Uludag University Medical Faculty between January 2005 and November 2016, were assessed retrospectively. Those who underwent surgery and pathological diagnosis of oncocytoma (n = 11) were included to the study. The demographic, clinical, pathological, radiological, and laboratory features were evaluated. RESULTS Of these 11 patients, 54.5% (n = 6) were female and 45.5% (n = 5) were male. They aged between 31 and 76 years (45.36 ± 13.68). Five (45.5%) of the masses showed endocrinological activity and were more frequent in women. The masses were 25-130 (57.63 ± 34.04) mm in width and 20-100 (47.82 ± 28.95) mm in length. Seven (63.6%) oncocytomas were classified as benign and the remainder as having uncertain malignant potential according to Lin-Weiss-Bisceglia criteria. Mean duration of follow-up were 24.8 (6-60) months and 38.2 (15-82) months, respectively. CONCLUSIONS Because there are no unique clinical and imaging characteristics differentiating adrenal oncocytomas from other types of adrenal masses, it should be kept in mind in differential diagnosis of adrenal masses, especially large ones and those suspicious for adrenocortical carcinoma.

Adrenocortical carcinoma: Single center experience

Objective Adrenocortical carcinoma is an aggressive endocrine malignancy with an annual incidence of 0.5-2 cases per million. The most important factors that determine prognosis are tumor stage at the time of diagnosis and the success of surgery. However, advanced age, large tumor size, hormone secretion, high Ki-67 index (>10%), tumor necrosis and high mitotic activity are other factors associated with poor prognosis. In the present study, we aimed to evaluate the contribution of the patient and treatment- related factors to the prognosis in adrenocortical carcinoma. Material and methods We included 15 adrenocortical carcinoma patients who were followed in our center between 2005 and 2015. The effects of age, gender, tumor size, type of operation, postoperative resection status and adjuvant treatment on disease-free survival and overall survival were analyzed. Results Disease-free survival was 23.32±3.69 months and overall survival was 36.60±10.78 months. Gender, tumor size, tumor stage, type of operation, hormonal activity, presence of necrosis, recurrence and development of metastasis were not found to be associated with disease-free survival and overall survival (p>0.05). Postoperatively applied adjuvant treatments including mitotane, chemotherapy and radiotherapy did not significantly affect disease-free survival in our study, but statistically significant increase in overall survival was observed in patients getting adjuvant treatments (p=0.006). Conclusion Adrenocortical carcinoma has poor prognosis and short overall survival, and in its clinical course, recurrence and development of metastasis can be commonly observed even after complete resection of the tumor. Therefore, the patients should be evaluated carefully while determining the surgical procedure during the preoperative period, and the operation and post-operative follow-up should be performed in experienced centers. However, due to the positive effects of adjuvant treatments on survival, all patients should be evaluated postoperatively for the necessity of adjuvant treatments, especially mitotane.

A Case of Adrenal Mass Causing Adrenal Insufficiency: Tuberculosis

Primary adrenal insufficiency (PAI) is an endocrine disease caused by bilateral adrenocortical destruction. It manifests as fatigue, loss of appetite, weight loss, nausea, vomiting, hypotension and hyperpigmentation. Clinical symptoms are observed when more than 80% of both adrenal glands are damaged. In the previous reports in the literature, tuberculosis was the main cause of adrenal insufficiency in 70-90% of cases, but, today, the leading cause of PAI is autoimmunity. However, in developing countries, tuberculosis still continues to be a common cause of PAI. Case Report

Is Parenteral Levothyroxine Therapy Safe in Intractable Hypothyroidism

CASE A 32-year old woman was admitted to the hospital due to intractable hypothyroidism refractory to high dose of oral l-thyroxine therapy. She underwent total thyroidectomy and radioactive iodine therapy due to papillary thyroid cancer. After excluding poor adherence to therapy and malabsorption, levothyroxine absorption test was performed. No response was detected. Transient neurologic symptoms developed during the test. She developed 3 attacks consisting of neurologic symptoms during high dose administration. The patient was considered a case of isolated l-thyroxine malabsorption. She became euthyroid after intramuscular twice weekly l-thyroxine therapy. DISCUSSION There are a few case reports regarding isolated l-thyroxine. We report successful long term results of twice weekly administered intramuscular l-thyroxine therapy. We also draw attention to neurologic side effects of high dose l-thyroxine therapy.

Primary squamous cell carcinoma of the thyroid: a rare type of thyroid cancer

Primary squamous cell carcinoma of the thyroid is rare but aggressive malignancy. Primary treatment is complete surgical resection of the tumor. If surgical eradication of the tumor is not successful, it has poor prognosis although multimodality treatment. We report a case with multiple thyroid nodules of which fine needle aspiration cytology was suspicious for malignancy. After total thyroidectomy, well differentiated squamous cell carcinoma was observed in histopathological examination. Postoperative investigation ruled out metastasis of the other sites and recurrence has not been observed for 25 months. Early and accurate diagnosis is crucial to achieve complete cure with surgery and long-term survival. Eur Res J 2017;3(1):94-98