Muhammed Kizilgul

PENTRAXIN 3 AS A NEW CARDIOVASCULAR MARKER IN ADRENAL ADENOMAS

OBJECTIVE Pentraxin 3 (PTX3) is an acute-phase glycoprotein, which is increased in patients with cardiovascular disease (CVD) and considered as a predictor of CVD in the general population. Both functional and nonfunctional adrenal tumors are associated with a higher risk of cardiovascular events and mortality. We aimed to investigate plasma PTX3 levels in patients with functioning and nonfunctioning adrenal tumors and determine its relationship with cardiovascular risk factors. METHODS Twenty-one patients with functional adrenal tumors (11 pheochromocytomas, 9 Cushing syndrome, and 1 primary hyperaldosteronism), 28 patients with nonfunctional adrenal incidentalomas, and 40 healthy controls were enrolled in the study. Serum PTX3 levels were measured using a human PTX3 enzyme-linked immunosorbent assay. RESULTS PTX3 concentrations were significantly higher in the adrenal tumor group compared with the control group (3,001.64 ± 374.64 pg/mL vs. 1,173.59 ± 168.89 pg/mL; P<.001). PTX3 concentrations were positively correlated with carotid intima media thickness (CIMT) (r2, 0.464; P<.001), high-sensitivity C-reactive protein (hsCRP) (r2, 0.551; P<.001), diastolic blood pressure (r2, 0.334; P = .003), systolic blood pressure (r2, 0.312; P = .006), and urinary metanephrine concentrations (r2, 0.320; P = .041). Serum PTX3 concentrations in patients with functional adrenal tumors and comorbidities including hypertension, diabetes mellitus, or CVD were higher than in those without comorbidities (3,654.54 ± 447 pg/mL vs. 1,026.96 ± 447.97 pg/mL; P = .008). CONCLUSION We found that serum PTX3 concentrations increased in both functional and nonfunctional adrenal tumors. PTX3 levels were correlated with cardiovascular risk factors such as CIMT, hsCRP, and blood pressure. ABBREVIATIONS BMI = body mass index; CIMT = carotid intima-media thickness; CRP = C-reactive protein; CT = computed tomography; CVD = cardiovascular disease; FGF2 = fibroblast growth factor 2; hsCRP = high-sensitivity C-reactive protein; PA = primary hyperaldosteronism; PTX3 = pentraxin 3.

Vitamin D Treatment in Patients with Hashimoto’s Thyroiditis may Decrease the Development of Hypothyroidism

The relationship between Hashimotos thyroiditis and vitamin D has been demonstrated in several studies. The aim of the present study was to evaluate vitamin D concentrations in patients with Hashimotos thyroiditis, the effect of vitamin D therapy on the course of disease, and to determine changes in thyroid autoantibody status and cardiovascular risk after vitamin D therapy. We included 75 patients with Hashimotos thyroiditis and 43 healthy individuals. Vitamin D deficiency is defined as a 25-hydroxy vitamin D (25(OH)D3) concentration less than 20ng/mL. Vitamin D deficient patients were given 50.000 units of 25(OH)D3 weekly for eight weeks in accordance with the Endocrine Society guidelines. All evaluations were repeated after 2 months of treatment. Patients with Hashimotos thyroiditis had significantly lower vitamin D concentrations compared with the controls (9.37±0.69 ng/mL vs 11.95±1.01 ng/mL, p < 0.05, respectively). Thyroid autoantibodies were significantly decreased by vitamin D replacement treatment in patients with euthyroid Hashimotos thyroiditis. Also, HDL cholesterol concentrations improved in the euthyroid Hashimoto group after treatment. The mean free thyroxine (fT4) concentrations were 0.89±0.02 ng/dL in patients with Hashimotos thyroiditis and 1.07±0.03 ng/dL in the healthy control group (p < 0.001). The mean thyroid volumes were 7.71±0.44 mL in patients with Hashimotos thyroiditis and 5.46±0.63 mL in the healthy control group (p < 0.01). Vitamin D deficiency is frequent in Hashimotos thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

Serum ghrelin levels in papillary thyroid carcinoma

OBJECTIVE Ghrelin plays a role in several processes of cancer progression, and numerous cancer types express ghrelin and its receptor. We aimed to investigate serum levels of ghrelin in patients with papillary thyroid carcinoma (PTC) and its association with the prognostic factors in PTC. MATERIALS AND METHODS We enrolled 54 patients with thyroid cancer (7 male, 47 female) and 24 healthy controls (6 male, 18 female) in the study. We compared demographic, anthropometric, and biochemical data, and serum ghrelin levels between the groups. Serum ghrelin levels were measured using as enzyme-linked immunosorbent assay. RESULTS Ghrelin levels were similar between the groups, but plasma ghrelin levels were significantly higher in tumors larger than 1 cm diameter compared with papillary microcarcinomas. Serum ghrelin levels also correlated with tumor size (r = 0.499; p < 0.001). Body mass index, thyroid-stimulating hormone, and HOMA-IR levels were similar between the groups. There were no statistically significant differences regarding average age and other prognostic parameters including lymph node invasion, capsule invasion, multifocality and surgical border invasion between patients with microcarcinoma and tumors larger than 1 cm. CONCLUSION In our study, no significant difference in serum ghrelin levels was determined between patients with papillary thyroid cancer and healthy controls however, serum ghrelin levels were higher in tumors larger than 1 cm compared to in those with thyroid papillary microcarcinoma.

Fibroblast growth factor-23 concentrations in polycystic ovary syndrome

Abstract Objective: This study was designed to compare the serum concentrations of Fibroblast growth factor 23 (FGF23) among patients with PCOS and healthy subjects and to evaluate the relation between the hormonal and metabolic parameters. Methods: Forty patients with PCOS were compared with 40 healthy individuals in a case-control study design. The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group 2003 guideline criteria were used in the diagnosis of PCOS. Serum intact FGF23 concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Results: Mean serum FGF23 concentrations were similar between PCOS group and control group (19.73±16.75 pg/mL and 17.20±9.26 pg/mL, p>0.05). Waist circumference, hip circumference, total testosterone, Ferriman-Gallwey (FG) score and hsCRP were significantly higher in the PCOS group (p<0.001). The concentrations of LH, DHEA-S, FSH, insulin, total cholesterol, triglyceride, HOMA-IR were significantly higher in the PCOS group when compared to control group (p<0.05). FGF23 concentrations did not correlate with BMI, fasting glucose and insulin, HOMA-IR and lipid parameters. Conclusions: FGF23 concentrations were similar in the PCOS group compared with the non-PCOS control group. The present findings may suggest that FGF23 is not a useful marker of metabolic disturbances including insulin resistance, dyslipidemia, and obesity in PCOS.

Vitamin D Replacement Improves Tear Osmolarity in Patients with Vitamin D Deficiency

ABSTRACT Background: Vitamin D deficiency is a common health problem worldwide. Many parts of the human eye, including the epithelium of the cornea, lens, ciliary body, and retinal pigment epithelium, as well as the corneal endothelium, ganglion cell layer, and retinal photoreceptors, contain vitamin D receptor (VDR). Dry eye is also a common health problem. An adequate tear film is required for maintaining health and function of the eye. Tear hyperosmolarity is considered to be the cause of ocular surface inflammation, symptoms, and tissue damage. It is well-documented that vitamin D has an anti-inflammatory action. We aimed to investigate the effect of vitamin D replacement on tear osmolarity in patients with vitamin D deficiency. Methods: A total of 44 patients (38 females, six males, mean age:43.5 ± 12.8 years) with vitamin D deficiency currently managed by the Endocrinology and Metabolism Department of Diskapi Training and Research Hospital in Turkey were enrolled in the study. Patients were given 50,000 units of 25(OH)D3 intramuscularly, once weekly, over a period of eight weeks. All of the patients underwent tear function osmolarity (TFO) measurement initially and eight weeks after vitamin D replacement. Demographic, anthropometric, and biochemistry data of patients were recorded. Results: The mean TFO was significantly decreased (313.7 ± 17.3 mOsm/L; 302.7 ± 14.2 mOsm/L, p<0.001) at the end of the second month; 25(OH)D3 concentrations increased from 8.3 ± 3.5 ng/mL to 68.8 ± 22.3 ng/mL (p<0.001). The mean levels of hsCRP, FPG, P were 2.5 ± 2.5 mg/L, 5.09 ± 0.48 mmol/L, 1.06 ± 0.16 mmol/L initially, and 3.8 ± 5.9 mg/L, 5.11 ± 0.68 mg/dL, 1.09 ± 0.16 mmol/L after vitamin D replacement, respectively (p>0.05). The mean Ca level was 2.37 ± 0.07 mmol/L initially and 2.35 ± 0.07 mmol/L after vitamin D replacement (p<0.05). The change of TFO was negatively correlated with the variation of 25(OH)D3 before and after replacement in patients with dry eye disease (r=–0.390, p=0.049). Conclusions: As a consequence of the presence of VDR and 1α-hydroxylase in different parts of the eye, vitamin D replacement improves tear hyperosmolarity that is considered to be induced by ocular surface inflammation.

Tear Film and Ocular Surface Evaluation in Gestational Diabetes Mellitus.

ABSTRACT Background: Dry eye syndrome is one of the complaints of diabetic patients. The aim of the present study was to evaluate the tear functions in pregnant women with gestational diabetes mellitus (GDM) using tests: Schirmer, tear break-up time (TBUT), and tear film osmolarity (TFO) tests and the Ocular Surface Disease Index score (OSDI). Methods: Pregnant women with GDM (Group 1, n=46) and healthy pregnant women (Group 2, n=36) were enrolled. Initially, all participants were asked to answer the OSDI and then they underwent a detailed ophthalmic examination including Schirmer, TBUT, and TFO tests. The individuals with ocular or systemic disorders that might affect the tear function tests and who were using topical medications were excluded. Results: The results of Schirmer, TBUT, TFO tests and OSDI scores were 11.20±4.93 mm, 5.59±2.16 sec, 309.65±14.80 mOsm/L, and 9.59 ± 9.69 in Group 1, respectively, and 12.33±5.33 mm, 5.67±2.68 sec, 308.36±16.00 mOsm/L, and 10.62±8.66 in Group 2, respectively. There was no significant difference in any of the tear function tests and OSDI scores between the study groups (p>0.05). Conclusion: GDM seems to have no negative effects on tear function tests. This may be due to a lack of duration of hyperglycemia long enough to affect the tear function tests of pregnant women.

Konkominan mediastinal paratiroid karsinom ve boyunda paratiroid adenoma: nadir tutulum

Mediastinal paratiroid karsinom nadir gorulmektedir, ancak multiglanduler paratiroid karsinom ile birlikte paratiroid adenomun gorulmesi cok daha nadirdir. Persistan primer hiperparatiroidisi (PHP) olan bir hastada, mediastende ektopik paratiroid karsinoma ile birlikte boyunda paratiroid adenoma birlikteligi olan nadir multiglanduler paratiroid neoplazi vakasini sunmaktayiz. Nefrolitiazis ve osteopenia sikayeti olan 38 yasinda kadin hastaya PHP tanisi kondu. Bilateral boyun eksplorasyonu sonrasi, boyunda sag tarafta paratiroid adenoma saptandi. Postoperatif hiperkalsemi devam etmesi nedeniyle, SPECT/CT (tek proton emisyonlu tomografi) taramasinda on mediastende tutulum gosterildi. Lezyona cerrahi uygulandi, 10x10x3 mm boyutunda paratiroid karsinom histopatolojik olarak dogrulandi. 1-yillik takip sonunda, tumor rekurensi ve hiperkalsemi gorulmedi. Persistan PHP’li hastada ektopik mediastende paratiroid karsinom ve boyunda paratiroid adenom birlikteligi olan ilk vakadir. Bu vaka paratiroid hastaliginda tani ve takipteki zorluklari gostermektedir. Persistan PHPT’li hastalarda multiple paratiroid bezleri gosterebilmek icin multiple tanisal metodlar kullanilmalidir.

Pentraxin 3 as A Cardiovascular Marker in Primary Hyperparathyroidism

Aim: Pentraxin 3 (PTX3) is an acute-phase glycoprotein, which is increased in patients with cardiovascular disease (CVD) and considered as a predictor of CVD in the general population. Accumulating evidence suggests that even mild primary hyperparathyroidism (PHPT) has an elevated risk for CVD. We aimed to investigate plasma PTX3 levels before and after parathyroidectomy in patients with primary hyperparathyroidism and determine its relationship with cardiovascular risk factors Material and Method: Twenty-nine patients with PHPT and 26 healthy controls were enrolled in the study. Anthropometric and laboratory parameters were recorded both before and 6 months after parathyroidectomy. Serum PTX3 levels were measured using a human PTX3 enzyme-linked immunosorbent assay. Results: Plasma PTX3 concentrations were similar between before and after parathyroidectomy and control group (10.97 ± 16.0, 11.97 ± 11.49, 7.88 ± 9.48, respectively, p>0.05). Systolic blood pressure, diastolic blood pressure, carotid intima-media thickness (CIMT) and calcium, parathormone, fasting plasma glucose, alkaline phosphatase concentrations were higher in the PHPT group (p<0.05). Creatinine and phosphorus concentrations were higher in the control group (p<0.05). PTX3 was not correlated with cardi-metabolic risk factors except body mass index (BMI) (r2:0.414, p:0.0253). Conclusion: Plasma PTX3 was not increased as well was not changed after parathyroidectomy in patients with PHPT. The PTX3 was correlated with BMI; however, it was not associated with other cardio-metabolic risk factors including DBP, CIMT, and CRP. These findings might support PTX3 cannot be used as a cardio-metabolic risk marker in patients with PHPT.

Effect of intrapancreatic fat on diabetes outcomes after total pancreatectomy with islet autotransplantation

Pancreatic fat may adversely affect β‐cell mass and function, possibly via local release of non‐esterified fatty acids, and proinflammatory and vasoactive factors released by adipose tissue. However, the effects of intrapancreatic fat in patients with chronic pancreatitis undergoing total pancreatectomy with islet autotransplantation (TPIAT) have not been studied. This study investigated whether pancreatic fatty infiltration has a negative effect on metabolic outcomes following TPIAT.

Cyclooxygenase-2 (COX-2) gene polymorphism in patients withdifferentiated thyroid carcinomas in the Turkish population

Background/aim: The most common thyroid malignancies are papillary and follicular thyroid carcinomas. They account for approximately 85%-90% of all thyroid cancers. Recent studies have reported the relevance of cyclooxygenase-2 (COX-2) gene polymorphism in human carcinogenesis. The aim of this study was to investigate the relationship between thyroid carcinoma and COX-2 gene polymorphism in the Turkish population.Materials and methods: We included a total of 96 differentiated thyroid cancer patients (mean age: 46.9 ± 10.3 years; 14 males, 82 females) and 83 healthy control subjects (mean age: 46.0 ± 10.6 years; 39 males, 44 females). The frequency of -765G>C, -8473T>C, and 1195A>G gene polymorphisms in the COX-2 promoter region was investigated in thyroid cancer patients and the control group using the high-resolution melting method. Results: COX-2-765G>C and COX-2-1195A>G gene polymorphisms were similar between thyroid cancer patients and the control group. There was a statistically significant difference between COX-2-8473T>C gene polymorphism in the thyroid cancer group and the control group (P = 0.012).Conclusion: The single nucleotide gene polymorphism COX-2-8473T>C might contribute to genetic susceptibility to differentiated thyroid cancer in the Turkish population.