Mahmut Orhun Çamurdan

Serum ghrelin, leptin and resistin levels in adolescent girls with polycystic ovary syndrome

Aim:  The aim of the present study was to investigate the levels of leptin, resistin and ghrelin in polycystic ovary syndrome (PCOS), and to assess their possible correlations with the hormonal and metabolic features of PCOS.

l-thyroxin treatment in infants with hyperthyrotropinaemia: 4-year experience

Hyperthyrotropinaemia, in which normal levels of T4 occur in association with raised thyroid stimulating hormone (TSH), is usually picked up on neonatal screening. High TSH level can continue for a long time in some of the cases. There is no consensus concerning the follow‐up or treatment plan for hyperthyrotropinaemia. In this study, results of a 4‐year follow‐up of 36 cases who had been medically treated are discussed. Low‐dose (5 μg/kg/day) L‐thyroxin treatment was carried out in 36 cases that had 5 mU/l or higher TSH and showed exaggerated response to TRH test. Dose was decreased to 2–3 μg/kg/day in 24 of these patients during 6 months follow‐up. The drug was stopped in three cases because of the development of biochemical hyperthyroidism. Denver developmental assessment test was applied to all cases at the end of the third year. All patients showed a normal development in relation to their age. According to our results, cases with hyperthyrotropinaemia need to be followed regularly for a long time and a need for low‐dose L‐thyroxin treatment may exist at ages varying from patient to patient.

Gonadoblastoma with Dysgerminoma in a Phenotypically Turner-Like Girl with 45,X/46,XY Karyotype.

Individuals with 45,X/46,XY karyotype are at increased risk for germ cell tumor development. We report a case with a diagnosis of 45,X/46,XY gonadal dysgenesis who presented with short stature, physical stigmata of Turner syndrome. Her pubertal development was at Tanner stage 3. At follow-up, bilateral prophylactic gonadectomy was performed when considering the risk factors. Pathological assessment was consistent with gonadoblastoma in the left gonad, and dysgerminoma and gonadoblastoma in neighboring areas in the right gonad. The karyotype analysis of the right and left gonadal tissues reveled 45,X[97,3]/46,XY[2,7] and 45,X[92,7]/46,XY[4,5]/47,XYY [2,8] mosaic, respectively. The clinical management of such patient should be individualized according to the present risk factors. Additionally, signs of estrogenization like advanced breast development always suggest the possible presence of germ cell tumor.

Autoimmune Limbic Encephalitis Associated with Type 1 Diabetes Mellitus

A 16-year-old boy was admitted to our emergency department with confusion and headache. Electroencephalography revealed temporal slowing, cerebral magnetic resonance imaging demonstrated hyperintense signal of the right mesiotemporal lobe, and positron emission tomography demonstrated increased activity in the right temporal lobe. Blood glutamic acid decarboxylase antibody (anti-GAD) level was 2114 IU/mL (0–10) and the cerebrospinal fluid anti-GAD level was 4.07 nmol/L (<0.02). These findings led to a consideration of autoimmune LE as a possible diagnosis. Pulse methylprednisolone was administered over five days. After steroid treatment, symptoms improved, but hyperglycemia occurred on the third day of treatment. Glycemia level reached 502 mg/dL. Concurrent insulin level was 42 μIU/mL. Hyperglycemia improved after cessation of steroid treatment. Glycated hemoglobin was 5.6%. The possibility of a steroid-induced hyperglycemia was considered. Six months later, the patient was readmitted with dyspnea and abdominal pain. The family reported occurrence of polyuria and polydipsia during the previous two months. Blood anti-GAD level was >2000 IU/mL. The patient was diagnosed to have T1D. With treatment, the ketoacidosis improved in 10 h. After being educated for diabetes, the patient was discharged. Two months later, he presented with a headache and confusion again. Intravenous immunoglobulin (IVIG) 1 g/kg/d for two days every month was administered. Neurological symptoms improved and the daily insulin dose was decreased.

Soluble Endoglin Level Increase Occurs Prior to Development of Subclinical Structural Vascular Alterations in Diabetic Adolescents

Objective: Soluble endoglin (S-endoglin) has been implicated as a potential marker of endothelial dysfunction (ED) and was reported to be elevated in diabetic adults, correlating with the severity of diabetic vasculopathy. However, circulating S-endoglin and its association with other markers of ED have not been formerly analyzed in the first decade of diabetes onset in adolescents with type 1 diabetes mellitus (T1DM). Methods: Fifty-eight adolescents with moderately/poorly controlled T1DM were included in this study and twenty-nine healthy adolescents served as controls. The diabetic group was divided into two groups based on the presence of microalbuminuria, as the microalbuminuria group (n=15) and the normoalbuminuria group (n=43). Functional vascular alterations were evaluated by measuring serum S-endoglin and plasma nitric oxide (NO) concentrations, the flow-mediated dilatation (FMD) of the brachial artery. Carotid intima media thickness (CIMT) was measured for evaluation of structural vascular alterations. Results: The S-endoglin and NO levels of both microalbuminuria and normoalbuminuria groups were higher than those of the control group (for S-endoglin, p=0.047 and p<0.001; for NO, p=0.004 and p=0.006, respectively). The FMD percent was lower in the microalbuminuria group compared to the normoalbuminuria and control groups (p=0.036 and p=0.020, respectively). There were negative correlations between S-endoglin concentration and FMD percent (r=-0.213, p=0.051) and between serum S-endoglin concentration and albumin excretion rate (r=-0.361, p=0.005). No significant differences were found in CIMT among any of the groups (p=0.443). Conclusion: In adolescents with T1DM, S-endoglin concentrations might increase in parallel to the deterioration in endothelial function before subclinical structural vascular alterations become evident.

Extensive Middle Cranial Fossa Arachnoid Cysts and Different Clinical Presentation in Two Patients

Arachnoid cysts (ACs), particularly suprasellar cysts, cause a wide spectrum of endocrine disorders. Herein, we report two patients diagnosed with an extensive AC in the middle cranial fossa while being investigated for etiologies of precocious puberty and short stature. One of them required surgery due to his pubertal disorders associated with compression effects of cyst. After surgery, his puberty progression was regressed within one year. On the other hand, surgery was not planned for the second patient considering of his cranial imaging findings and the extremely low incidence of growth hormone (GH) deficiency caused by middle fossa AC (MFAC). We started treatment with recombinant human GH and no complication was found during treatment follow-up. Endocrine disorders associated with MFACs are extremely rare. By presenting with these two cases, we aimed to remain our fellow physcians that ACs can be possibly cause of endocrine disorders. Clinicians should be careful evaluating endocrine disorders because real cause may not be cyst itself but masked by it.