Hikmet Soylu

Gestational Severe, Nonfamilial Hypertriglyceridemia, Management with İnsulin and Metformin, A Case Report

Severe hypertriglyceridemia is a rare condition in pregnancy. We report a case of gestational, nonfamilial severe hypertriglyceridemia accompanied with gestational diabetes mellitus. Despite an intensive insulin regimen and dietary fat restriction plasma triglyceride levels were remained higher. After a plasmapheresis session, triglyceride levels were reduced nearly 40%. Since plasma glucose and triglyceride levels were higher, metformin therapy was administered. After two weeks of metformin therapy, plasma glucose levels were within target range and triglyceride level was reduced below 1000 mg/dl. She delivered at 38th week of pregnancy via elective cesarean section, a healthy female baby with normal birth weight. Serum triglyceride level decreased immediately to 280 mg/dl after delivery.

İNFERTİL BİR ERKEKTE 46XX TESTİKÜLER BOZUKLUK

46 XX erkek cinsel gelisim bozuklugu cok nadir gorulen bir hastaliktir. Y kromozomuna yerlesmis olan SRY (sex-determining region Y) geni cinsiyet belirleyen gendir. Bu gen bolgesini iceren Y kromozomunun bir parcasinin X kromozomuna transloke olmasiyla hastaligin gelistigi dusunulmektedir. Otuz bes yasinda erkek hasta infertilite, cinsel istekte azalma sikayetleriyle poliklinigimize basvurdu. Fizik muayenesinde yuzde kirisikliklar, killanma azligi, kisa boy, kucuk testisler mevcuttu. Hastada hipergonadotropik hipogonadizm ve azospermi saptandi. Hastanin karyotip analizi 46 XX olarak rapor edildi. SRY gen analizi pozitif bulundu. Bu hastalarda spermatogenez olmadigindan testis biyopsisi ile sperm elde edilemez. Hastaligin baslica tedavisi testosteron yerine koyma tedavisidir. Infertilite ile basvuran primer hipogonadizmli hastalarin ayirici tanisinda bu nadir hastalik dikkate alinmalidir.

Psödohipoparatiroidi Tip 1A: Olgu Sunumu

Psodohipoparatiroidizm (PHPT); hedef organin parathormona (PTH) yanit vermedigi kalitimsal bir bozukluktur. Biyokimyasal olarak; hipokalsemi, hiperfosfatemi ve PTH yuksekligi ile karakterizedir. PTH uygulamasina verilen yanit belirgin derecede dusuktur. Tip 1A, biyokimyasal ozelliklere ek olarak Albright herediter osteodistrofisi (AHO) olarak bilinen karakteristik somatik bir fenotipe de sahiptir. Bu fenotipin, kisa boy, yuvarlak yuz, frontal bombelik, brakidaktili, obezite ozelikleri bulunmaktadir. Burada biz, hipokalsemi ve Albright herediter osteodistrofisi tanisi koydugumuz; kalsiyum, aktif D vitamini ile tedavi ettigimiz olgumuzu sunduk.

A case of mediastinitis accompanied with hyperosmolar nonketotic coma

Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patients symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling.

Clinical and Demographic Characteristics of 78 Patients with Adrenal Incidentaloma [Adrenal İnsidentalomalı 78 Hastanın Demografik ve Klinik Özellikleri]

Adrenal incidentalomas (AIs) are adrenal lesions detected on abdominal imaging procedures or abdominal laparotomy that had been performed for unrelated reasons. AIs have become a common clinical concern as a result of widespread use of abdominal ultrasound, CT and MR imaging in clinical practice. The aim of this study was to evaluate the demographical and clinical data our patients with AI. This study included data from 78 patients (53 female – 25 male) with AI those followed at Dicle University School of Medicine, Department of Endocrinology and Metabolism, between 2007 and 2013. Data collected from the records were physical and hormonal evaluation, diameter of the lesion, and the features of the lesion on radiological imaging. Also the results of serum cortisol, aldosterone, renin and 24 hour urinary metanephrine and normetanephrine were recorded. The average age of patients were 48.6 ±14.9 years. There was no significant difference in terms of localization of adenomas. Body mass index of patients were 28.54 ± 5.82. Of the patients, 45 (57.7%) were diagnosed as non-functional AI, 10 (12.8%) as subclinical Cushing’s syndrome, 11 (14,1%) as pheochromocytoma, 2(2.6%) as primary hyperaldosteronism, and 3(3.8%) as adrenal carcinoma. Ganglioneuroma was stated in 2 patients (2.6%), myelolipoma was stated in 1 patient (1.3%), adrenal adenoma was stated in 1 patient, adrenal cyst was stated in 1 patient, schwannoma was stated in 1 patient and neoplasia with small circular cells was stated in 1 patients. AIs are currently more frequently detected in clinical practice due to increased use of imaging techniques. Although the vast majority of AIs are benign and non-functioning, appropriate hormonal evaluation and imaging procedures must be performed.

A rare cause of acromegaly: McCune-Albright syndrome

McCune-Albright sendromu, poliostotik fibroz displazi, deride kahverenginde lekelenme (Cafe au lait lekeleri) ve otonomik endokrin hiperfonksiyon ile karakterize bir sendromdur. Bu sendromda yaygin olarak erken puberte ve diger endokrinolojik manifestasyonlar ornegin akromegali, jigantizm, hiperkortizolizm gorulebilir. Akromegali Mc-Cune-Albriht sendromlu hastalarin % 20 sinde gorulebilir. Biz bu sendroma eslik eden bir akromegali vakasini sunduk