Mehtap Evran

Carotid Intima-Media Thickness as the Cardiometabolic Risk Indicator in Patients with Nonfunctional Adrenal Mass and Metabolic Syndrome Screening

Background Our purpose was to show the association of adrenal incidentaloma and metabolic syndrome in consideration of the studies and to detect the increase in the carotid intima-media thickness which is regarded as the precessor of atherosclerosis. Material/Methods Eighty-one patients who were diagnosed with adrenal mass were included in the study. Hormonal evaluation, insulin rezistance measurement with the HOMA-IR and 1-mg DST were performed of all patients. The patients were classified as follows: mass size <3 cm (K1) and mass size of at least 3 cm (K2). Echocardiography and carotid intima-media thickness of the patients were measured using B-mode ultrasound. Thirty-three healthy individuals were enrolled as the control group. Results Mass size of 64.19% K1, while mass size of the remainder (35.81%) K2 was calculated. Five of the patients with adrenal mass were detected to have subclinical Cushing syndrome. The remaining 76 patients were accepted as nonfunctional. It was seen with regard to metabolic and biochemical parameters that plasma glucose (p=0.01), insulin (p=0.00) and triglyceride (p=0.012) values of all patients were significantly high compared to those of the control group. It was detected that measured heart rate (p=0.00), end-diastolic diameter (p=0.02), end-systolic diameter (p=0.014) and carotid intima-media thickness (p=0.00) values of the patients with adrenal mass were significantly higher than those of the healthy control group. Conclusions We found that the increased insulin resistance, increased risk of cardiovascular disease with the increase in the thickness of carotid intima-media and diastolic disfunction parameters, although the patients with adrenal incidentaloma are nonfunctional.

Multidisciplinary approach for patients with functional and non‐functional adrenal masses and review of the literature

Adrenal incidentalomas are adrenal masses that are discovered by imaging tests performed for other reasons.

Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature.

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.

Polikistik over sendromunda over volümü ölçümü ve metabolik değerlendirme: kesitsel gözlemsel çalışma

Purpose: Polycystic ovary sydrome is a disease of women in reproductive period, with hirsutism or hyperandrogenic signs in laboratory evaluation, causing infertility due to dysmenorrhea and unovulation. Accompanying insulin resistance and adiposity may increase cardiometabolic risk. In our study, we planned to represent the physical examination and laboratory findings of the patients diagnosed as polycystic ovary sydrome, together with andominal ultrasonographic evaluation of the ovaries. Material-methods: Twenty-two patients who admitted the endocrinology department with the complaints of hirsutism and dysmenorrhea were included in the study. Purpose: Polycystic ovary sydrome is a disease of women in reproductive period, with hirsutism or hyperandrogenic signs in laboratory evaluation, causing infertility due to dysmenorrhea and unovulation. Accompanying insulin resistance and adiposity may increase cardiometabolic risk. In our study, we planned to represent the physical examination and laboratory findings of the patients diagnosed as polycystic ovary sydrome, together with andominal ultrasonographic evaluation of the ovaries. Material and Methods: Twenty-two patients who admitted the endocrinology department with the complaints of hirsutism and dysmenorrhea were included in the study. Their ages, family histories, polycystic ovary sydrome phenotypes, first menstrual age, length of cyclus and physical examination findings were recorded. Ferriman&Gallwey score was used for hirsutism. Insulin resistance was calculated via HOMA-IR method by making the biochemical and hormonal tests. Ovarian volumes were measured by abdominal ultrasonography. SPSS-16 was used for the statistical analysis of the findings. Results: Mean age was 21.41±0.88. Polycystic ovary sydrome phenotypes were B in 40.9%, C in 31.8% and A in 27.3%. Cyclus length was normal in 31.8% (27-34 days). Ferriman&Gallwey score was ≥7 in all of the patients. Although hirsutism rates were high, androgen levels were generally normal (testosterone 72% normal, DHEAS 82% normal). Eight (36%) patients was obese and 3 (13.6%) was overweight. Forty percent of the patients had type 2 diabetes mellitus in a first degree relative. Fasting glucose levels and glucose levels after 75 gr OGTT were normal in all patients. Insulin resistance was detected in 41% of the patients via HOMA-IR method. LDL cholesterol, trigliceryde, AST, ALT and levels were normal. HDL cholesterol level was below 50 mg/dl in 15 (68%) patients. In abdominal ultrasonography, mean ovarian volumes were 11.6±1.12ml on right, 11.5±1.01ml on left. 13 (59.1%) patients had polycystic ovary appearance. Conclusion: Hirsutism was detected in all of our patients. In most of them, polycystic ovary sydrome diagnosis was supported by cycle irregularity, increased ovarian volume and polycystic ovary appearance in ultrasonagraphy. In our polycystic ovary sydrome patients, hyperandrogenism laboratory findings, insulin resistance and obesity were seen in lower ratios.

General approach to adrenal incidentalomas with regards to a case with subclinical Cushing syndrome

Adrenal insidentalomalar baska nedenlerle yapilan goruntuleme testleri sirasinda saptanan lezyonlardir. Gunumuzde abdominal goruntuleme tekniklerinin yaygin olarak kullanilmaya baslanmasi ile birlikte adrenal insidentaloma tanisinin sikligi artmistir. Adrenal insidentalomalarin degerlendirilmesinde ilk basamak lezyonun hormonal olarak aktif olup olmadigi ya da kitlenin benign veya malign olup olmadigidir. Bu degerlendirme tedavi planlanmasi ve hastanin takibi icin onemlidir.

Primary hyperparathyroidism in a patient with primary aldosteronism

BackgroundPrimary hyperparathyroidism is one of the most common causes of hypercalcemia. Inherited forms of primary hyperparathyroidism like Multiple Endocrine Neoplasia Type 1, Multiple Endocrine Neoplasia Type 2a, Hyperparathyroidism-Jaw Tumor Syndrome or isolated familial tumors are not common for our population.ResultsWe present a case of primary hyperparathyroidism in a 38-year-old Turkish man with hyperaldosteronism (Conn’s syndrome).ConclusionGenetic studies could not reveal any mutation. We could not identify any inherit form of the diseases. We wanted the first-line relatives examination of the suspected gene mutation, but they refused.