Kadir Gisi

Incidental pheochromocytoma presenting with sublaboratory findings in asymptomatic surrenal masses: a case report

IntroductionAdrenal incidentaloma can be described as adrenal lesions that are incidentally diagnosed during abdominal laparotomy or any abdominal screening without prior suspicion of adrenal disease. It is important to diagnose adrenal lesions to learn if they are hormonally active or malignant. The most common clinical sign of pheochromocytoma is sustained or paroxysmal hypertension, and the most common symptoms are headache, excessive truncal sweating, and palpitation. In some cases, the clinical symptoms are not clear. Roughly 70% of adrenal incidentalomas are non-functional. A small group of 5–7% of the functional ones (30%) may exist as pheochromocytoma. Ten percent of pheochromocytoma cases are diagnosed incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) screenings for other reasons. The most frequent symptom of the pheochromocytoma is hypertension, and 90–100% of cases exhibit it. The literature indicates that incidental pheochromocytoma cases that are smaller than 1 cm have no clinical symptoms. Rarely, some large pheochromocytoma cases do not show any clinical symptoms, and it is difficult to diagnose very small ones.Case presentationA 45-year-old male patient experienced an epigastric ache and distended stomach for 7 years. The serum cortisol level was 19.2 ng/dL (normal range: 5–20 ng/dL), and urinary free cortisol excretion was 25.00 μg/24 h (normal range:10.00–100.00 μg/24 h). The serum basal level of adrenocorticotropic hormone (ACTH) was 21 pg/mL (normal range: 9 to 52 pg/mL). Plasma cortisol was under 1.00 μg/dL after low dose (1 mg) overnight dexamethasone suppression test. 24 hours urinary catecholamines level were vanil mandilic acid (VMA) 8.90 mg/day (normal range, 3 to 90 mg/day), metanefrin 330 μg/day (normal range, 52 to 341 μg/day), epinefrin 13 μg/day (normal range, 2 to 24 μg/day), norepinefrin 41 μg/day (normal range; 15 to 100 μg/day). During abdominal ultrasonography (USG), a tumor was diagnosed in the right perirenal space. A regular-shaped mass (dimension 36 × 35 × 35 mm) with a homogeneous and solid structure was diagnosed in CT. The density of the mass was 80 Hounsfield units (HU) in postcontrast CT. The patient was given a diagnosis of a non-functional adrenal incidental lesion, underwent a right adrenalectomy. Histopathological data correlated with pheochromocytoma as wellConclusionPheochromocytoma can be diagnosed by establishing an increase in catecholamines and metabolites in the plasma and urine. The level of catecholamines and metabolites in the plasma and urine provide 95% of the evidence of the disease. Because the dimensions of the lesion were large and the HU was very clear, the patient was underwent surrenalectomy. During laboratory investigation, there was no evidence of abnormality; we, therefore, think that these cases can be named sublaboratory pheochromocytoma.

Hepatitis B and C seroprevalence in patients with diabetes mellitus and its relationship with microvascular complications

Introduction Diabetic patients are susceptible to bacterial, viral and fungal infections because of various deficiencies in the immune system. Aim To investigate a possible link between hepatitis B/C prevalence and microvascular complications as well as duration of diabetes. Material and methods In total 1263 diabetic patients (1149 type 2, 114 type 1) were enrolled in the study. The control group consisted of 1482 healthy blood donors who were over 40 years old. All diabetic patients were tested for HBsAg, anti-HBs and anti-HCV beside routine laboratory tests. Diabetic patients were divided into three groups according to their diabetes duration, and all of the patients were scanned for microvascular complications. Demographic data of all patients were recorded. Results HBsAg seropositivity was 3.7% in diabetic patients and 1.08% in the control group; this difference was statistically significant (p < 0.001). HBsAg positivity rates in type 1 and type 2 diabetics were 0.8% and 4%, respectively (p = 0.09). HCV seropositivity was 2.2% for diabetics and 0.5% for the control group; this difference was statistically significant (p < 0.001). Anti-HCV seropositivity in type 1 and type 2 diabetics was 1.75% and 2.26%, respectively. There was no relationship between diabetes duration and hepatitis B-C prevalence (p > 0.05). Also, no relationship was found between microvascular complications of diabetes and hepatitis B/C seropositivity. Conclusions Hepatitis B and C seroprevalence was found to be increased in diabetes mellitus; however, there was no relationship between hepatitis seroprevalence and the duration or microvascular complications of diabetes.

Changes in Cerebral Blood Flow in Patients with Familial Mediterranean Fever

INTRODUCTION It is known that there is a relationship between systemic inflammation and atherosclerosis. Atherosclerosis is one of the best-known causes of cerebrovascular diseases. The aim of this study was to assess cerebral blood flow velocity using transcranial Doppler (TCD) ultrasonography in patients with familial Mediterranean fever (FMF). METHODS A total of 30 patients aged from 20 to 50 years with FMF were enrolled in the FMF group consecutively. The control group (non-FMF group) consisted of 30 age- and sex-matched randomly selected patients without FMF who had other diagnoses such as fibromyalgia and did not have risk factors for atherosclerosis. Bilateral peak-systolic, end-diastolic, and mean blood flow velocities in the middle cerebral artery (MCA), values of Goslings pulsatility index, and values of Pourcelots resistance index were recorded using TCD ultrasonography by a neurosonologist blinded to the FMF and control groups. RESULTS There were 30 participants in the FMF group in remission (male/female: 4/26, mean age: 34.7±5.9 years) and 30 participants in the control group (male/female: 4/26, mean age: 32.3±4.7 years). C-reactive protein levels and bilateral blood flow velocities in the MCA were significantly higher in the FMF group than in the control group. CONCLUSIONS This study suggests that persistent clinical and subclinical inflammation in patients with FMF causes an increase in cerebral blood flow velocities. Our findings provide an insight into this association between FMF and cerebrovascular diseases.

Recurrent large pericardial effusion after cardiac surgery presenting with reversible hyponatremia

Pericardial effusion is a common complication of open heart surgery and more frequently occurs after coronary artery by-pass grafting. There are classical symptoms such as chest pain, dyspnea and orthopnea. However, hyponatremia is an unusual finding on presentation, and reported only three times in the literature. In this paper, a case in which recurrent pericardial effusion developed after coronary artery by-pass grafting presented with reversible hyponatremia was described. Hyponatremia was resolved rapidly, only after removal of large pericardial effusion by a successful pericardiocentesis. The possible mechanisms of reversible hyponatremia, relationship with pericardial effusion, and discrepancies about diagnosis were discussed, briefly.

Heat Stroke caused by electric blanket: A rare surviving case

Elektrikli battaniyenin neden oldugu isi soku sendromu nadir rastlanan bir klinik durumdur. Sinirli sayida olgu bildirilmistir ve bunlarin cogu olum sonrasi bildirilerdir. Bu olgu sunumunda, elektrikli battaniyenin neden oldugu isi soku sonrasi yasamini surdurebilen 60 yasinda bir erkek hasta bildirildi. Ayrica, guncel literatur isiginda tani metotlari, klinik basvuru sekli ve hasta yonetimi tartisildi.

Fine Needle Aspiration Cytology and Ziehl-Nielsen Stain in Thyroid Nodules Associated with Active Pulmonary Tuberculosis

Tuberculosis (tbc) in thyroid nodules associated with active pulmonary tbc is reported in some endemic countries like India.1 In fact tbc of the thyroid is very rare.1-3 Tbc is also commonly seen in our region in Turkey.4 It may be seen as an isolated nodule or diffuse or multinodular goiter. Fine needle aspiration cytology (FNAC) is a rapid and minimally invasive approach to diagnosing extrapulmonary tbc and has been used successfully in thyroid malignancies.5,6 We aimed to investigate the occurrence of tbc in thyroid nodules in cases with active pulmonary tbc by using FNAC and Ziehl-Nielsen stain. It has been reported that both T3 and T4 levels were decreased in patients with pulmonary tbc.7 There are also several reports on the increased incidence of thyroid malignancy in immunosuppressive diseases.8 We also aimed to evaluate the thyroid disease prevelance in patients with newly diagnosed pulmonary tbc. This prospective study was conducted in our university between January 2006 and January 2008. Patients with active tbc were included in the study, and they had not been treated for tbc in the past. Active tbc was diagnosed by bacteriologic, clinical and roentgenographic findings. Active pulmonary tbc was defined by positive sputum culture and/or clinical and radiologic disease.9 Thyroid function tests and ultrasonography (USG) were carried out first on each patient (n = 596). USGguided FNAC was done on patients (n = 201) who had solid or dominant multinodular nodules via USG. The patients gave informed consent, and the local ethical committee approved our study. The mean age was 40.16 years, with a male to female ratio of 1:1.093. Incidence of thyroid nodules in patients with pulmonary tbc was high, 33.7%. Incidence of thyroid dysfunction was 80/596 (13.4%). Thyroid lesions were diagnosed with USG in 201 patients, including 112 with multinodular and 12 isolated cysts, and 77 patients with single nodule lesions. Findings in pathologic evaluation were: 103 of 201 cases of colloidal nodular goiter, 7 thyroiditis, 68 cystic nodules, 20 benign cytology, 1 Hurthle cell adenoma and 2 follicular neoplasia. Patients with follicular tumors underwent surgery; follicular adenoma was detected at pathology. Thyroid function test results were normal in 121 patients with thyroid nodules, 18 with hyperthyroidism, 13 with subclinical hyperthyroidism, 17 with subclinical hypothyroidism and the rest of them (32) with hypothyroidism. None of the patients were diagnosed with tbc in a thyroid nodule. Incidence of thyroid tbc in patients with pulmonary tbc was nonexistent in this population, 0% (0/596). Rate of thyroid malignancy in these patients was not increased. Thyroid disease and thyroid tbc incidences seem not to have been increased in these patients. New studies are required to determine the incidence of thyroid diseases and thyroid tbc in these patients. Discussion limitation of our study is that FNAC is useful but may be yield false negative results. Das et al2 revealed that fine needle aspirates from thyroid were found to have cytologic features consistent with tuberculous thyroiditis. We also did not have a control group in our study. This may be a limitation for comparation of thyroid disease incidence in pulmonary tbc patients. We conclude that routine acid-fast staining of all fine needle aspirates of thyroid nodules is not mandatory in patients with pulmonary tbc. Routine thyroid nodule evaluation is also suitable for patients with pulmonary tbc.