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Öğe A Case of Pituitary Insufficiency in a Patient Presenting with Hyponatremia: Might Be Slow-Progressing Lymphocytic Hypophysitis as a Possible Cause of Empty Sella?(Nizameddin KOCA, 2020) Elbüken, Gülşah; Baydar, Ece; Kara, Sonat PınarCase: A 75-year-old female patient presented with complaints of nausea, weakness, fatigue and generalized pain all over her body. Her medical history included essential hypertension, type 2 Diabetes Mellitus, coronary artery disease and hypothyroidism. She was hospitalized due to detecting a serum sodium (Na) concentration of 123 mmol/L. Although her diuretic medications were discontinued and fluid replacement with parenteral hypertonic saline infusion was instituted for approximately 6 days, Na level did not return to normal. Secondary hypothyroidism was considered due to laboratory test results showing low fT4 level and markedly suppressed TSH value. Since further laboratory workup showed that TSH, ACTH, PRL, GH and gonadotropins were also low, the diagnosis was confirmed as “panhypopituitarism”. Her obstetric history was not suggestive of Sheehan’s Syndrome and she did not have a history of head injury or cerebrovascular disease. She was started on parenteral 100 mg hydrocortisone and hormonal replacement therapy with oral levothyroxine. The clinical picture of the patient improved dramatically with resolution of hyponatremia. Results and Discussion: Lymphocytic hypophysitis is an autoimmune disorder of the pituitary gland and it mostly affects middle-aged women. The fact that our patient was the age of 75 without having any clinical symptoms, since she had “panhypopituitarism” and a “partially empty sella” appearance in her pituitary MRI scans, “lymphocytic hypophysitis” was considered as the probably cause of pituitary insufficiency even if her age was older than the typical age of patients affected by the condition. Conclusion: It suggests that slow-progressing primary hypophysitis (probably lymphocytic hypophysitis) can lead to pituitary insufficiency at a later age.Öğe Amiodarone induced thyrotoxicosis may not respond to therapeutic plasma exchange like patients with graves' disease: A report of two cases and literature review(2019) Yıldız, İsmail; Elbüken, Gülşah; Atasever, Tugay; Gürdal, Sibel Özkan; Zuhur, Sayid ShafiThe achievement of euthyroid state has been suggested in patients with thyrotoxicosis undergoing surgery to reduce the risk of thyroid storm. However, euthyroid state could not always be achieved by antithyroid drugs. Therefore, therapeutic plasma exchange (TPE) is an option in this condition. A 58-year-old male patient with a history of type-2 diabetes using 200 mg amiodarone per day, admitted for diabetic ketoacidosis (DKA), induced by thyrotoxicosis. with palpitation, sweating, polyuria, and polydipsia. Euthyroid state could not be achieved, despite all apropriate treatments for thyrotoxicosis. Therefore, preparation with TPE followed by total thyroidectomy was planned. A 35% decrease in fT3 (free T3) and fT4 (free T4) levels were achieved, after two sessions of TPE. A 74-year-old male patient, admitted for acute anterior myocardial infarction (AMI) induced by thyrotoxicosis due to Graves’ disease. Multiple vessel disease was detected on primer percutanous coronary angiography, and an emergency coronary artery bypass grafting (CABG) was planned. Therefore, preperation with TPE was planned before surgery. A substential decrease in fT4 and fT3 levels (45% and 72%, respectively) levels were achieved, after one session of TPE. Most of the studies evaluating the efficacy of TPE in patients with thyrotoxicosis are including patients with Graves’ disease and toxic multinodular goiter, and TPE was indicated as an effective option for preparation of these patients for surgery. However, as presented in case 1, TPE may not be effective in amiodarone induced thyrotoxicosis (AIT) as in cases with thyrotoxicosis due to Graves’ disease.Öğe Assesment of attainment of recommended TSH levels and levothyroxine compliance in differentiated thyroid cancer patients(Wiley, 2022) Yavuz, Dilek Gogas; Yazan, Ceyda D.; Hekimsoy, Zeliha; Aydın, Kadriye; Gökkaya, Naile; Ersoy, Canan; Bozkur, Evin; Elbüken, GülşahObjective Thyroid-stimulating hormone (TSH) suppression treatment can induce signs and symptoms of hyperthyroidism and hypothyroidism due to inappropriate treatment or poor compliance to the treatment. The current study aimed to investigate TSH levels, frequency of being on target TSH, adherence to levothyroxine (LT4) suppression treatment in differentiated thyroid cancer (DTC) patients after surgery in a multicentric setting. Design and Patients This multicentric cross-sectional study was conducted at 21 medical centres from 12 cities in Turkey. DTC patients followed at least one year in the same center included in the study. Clinical data, serum TSH, free thyroxine (FT4), thyroglobulin (Tg) and anti-Tg levels were recorded during the most recent visit. Body mass index, systolic and diastolic blood pressures, pulse rate were measured. LT4 doses were recorded and doses per kilogram of bodyweight were calculated. Pill ingestion habits recorded and adherence to the therapy were evaluated using the Morisky Medication Adherence Scale and categorized as good, moderate or poor compliant based on their scores. Risk stratification forpredicting the disease persistance and/or reccurence was assessed using the American Joint Committee on Cancer-7th edition thyroid cancer staging calculator. TSH serum concentrations were classified as severe suppression (TSH < 0.01 mU/L), moderate suppression (TSH: 0.01-0.1 mU/L), mild suppression (TSHL 0.1-0.5 mU/L), euthyroid (TSH: 0.5-4 mU/L) and hypothyroid (TSH > 4 mU/L). TSH levels can also be classified as on being on target, under the target, or beyond over the target, according to the American Thyroid Association recommendations. Results A group of 1125 patients (F/M: 941/184, 50.7 +/- 11.7 years) were included in the study. The mean LT4 daily dosage was 132.4 +/- 39.6 mcg/day. TSH levels showed severe suppression in 99 (%8.8) patients, moderate suppression in 277 (%24.6) patients and mild suppression in 315 (%28) patients and euthyroid range in 332 (%29.5) patients and hypothyroid range in 97 (8.6%). TSH levels were in target in 29.2% of the patients 20.4% of the patients were undertreated, 50.4% overtreated. The daily LT4 dose and LT4 dose/kg were significantly higher in the severe suppression group (p < .001, p < .001). According to the Morisky scale, 564 patients (50.1%) were good compliant, 368 patients (32.7%) were moderate compliant, and 193 patients (17.1%) were noncompliant. Patients with poor compliance need a higher dose of LT4 compared to the good compliance group (p < .001). TSH levels of patients with good compliance were 0.67 +/- 1.96 mU/L and TSH with poor compliance was 2.74 +/- 7.47 mU/L (p < .001). TSH levels were similar in patients on fixed and alternating dosages. Conclusion In 29.2% of the DTC patients, serum TSH levels were at target levels. Remaining of the study group have TSH levels under or over treatment range, exposing the patient to medication side effects. Majorty of the study group 82.8% have good or moderate adherence to LT4 therapy. Reaching TSH targets requires simplified and applicable guidelines and following the guideline recommendations.Öğe Assessment of Metabolic Syndrome Components in Patients with Normocalcemic Hyperparathyroidism: A Retrospective Study(Aves, 2023) Baykut, Osman Alp; Elbüken, Gülşah; Tokuç, Burcu; Zuhur, Sayid ShafiObjective: Normocalcemic hyperparathyroidism is characterized by elevated parathormone levels persisting for 3 months or longer despite normal serum Ca levels. This study aimed to retrospectively compare the prevalence of individual metabolic syndrome components between patients with nor-mocalcemic hyperparathyroidism and an age-and sex-matched control group.Methods: Data of 82 normocalcemic hyperparathyroidism patients and 80 control subjects with nor-mal parathormone and calcium levels were reviewed retrospectively. Those meeting 3 or more of the 2001 metabolic syndrome diagnostic criteria of the US National Cholesterol Education Program Adult Treatment Panel III were considered as having metabolic syndrome. Also, Turkish waist circumfer-ence cutoff values were used to identify abdominal obesity and to estimate the metabolic syndrome frequency.Results: Considering that higher body mass index of normocalcemic patients would confound the analysis, analysis of covariance adjusted for body mass index was used to compare the groups, which showed increased waist circumference, waist/hip ratio, parathormone, 25 OH vitamin D3, fasting plasma glucose, and total cholesterol and low-density lipop rotei n-cho leste rol levels in normocal-cemic hyperparathyroidism patients than controls. The prevalence of metabolic syndrome among normocalcemic hyperparathyroidism patients was 32.9% (22.5% in controls) using the National Cholesterol Education Program Adult Treatment Panel III criteria versus 34.1% (23.8% in controls) using the Turkish waist circumference cutoff values.Conclusion: The percentage of patients meeting the metabolic syndrome criteria was higher com-pared to the control group. Even in the case of normocalcemic hyperparathyroidism, which is con-sidered to be a milder condition, the prevalence of metabolic syndrome was relatively higher than in the control group, suggesting that normocalcemic hyperparathyroidism may be a cardiovascular risk factor by predisposing to metabolic syndrome.Öğe B-mode ultrasound assessment of carotid artery structural features in patients with normocalcaemic hyperparathyroidism(Via Medica, 2023) Elbüken, Gülşah; Aydın, Cihan; Öztürk, Beyza Olcay; Aykaç, Hüseyin; Topçu, Birol; Zuhur, Sayid ShafiIntroduction: Normocalcaemic hyperparathyroidism is a condition first defined in 2008, characterized by normal se- rum calcium and high parathormone levels. Although normocalcaemic hyperparathyroidism is considered to have a milder clinical picture compared to asymptomatic primary hyperparathyroidism, recent studies have shown that it may be associated with osteoporosis, insulin resistance, metabolic syndrome, and cardiovascular risk factors. Considering that normo- calcaemic hyperparathyroidism may pose a cardiovascular risk in the setting of carotid atherosclerosis, we sought to examine the structural features of the carotid artery in patients with normocalcaemic hyperparathyroidism compared to a control group. Material and Methods: After excluding patients with hypertension, diabetes, and dyslipidaemia (other factors contributing to atheroscle- rosis), 37 (32 females, 5 males) patients with normocalcaemic hyperparathyroidism with a mean age of 51.2 +/- 8 (min: 32, max: 66) years and 40 controls (31 females, 9 males) with a mean age of 49.3 +/- 7.5 (min: 34, max: 64) years with normal serum albumin-corrected calcium and parathyroid hormone levels were included in the study. Structural features of the carotid artery including intima-media thickness (mean and maximum), lumen diameter, and the presence of plaque were assessed using B-mode ultrasound. Results: On ANCOVA analysis corrected for atherosclerotic factors (body mass index, waist circumference, fasting plasma glucose, serum cholesterol, lipid, and blood pressure), greater mean intima-media thickness was found in patients with normocalcaemic hyperparathyroidism than in controls (0.65 mm vs. 0.59 mm, respectively) (p = 0.023). Maximum ca- rotid intima-media thickness was also greater in patients with normocalcaemic hyperparathyroidism compared to controls (0.80 mm vs. 0.75 mm, respectively) (p = 0.044). The study groups did not show a significant difference in lumen diameter and the presence of carotid plaque. In addition, a negative correlation was found between parathormone (PTH) level and lumen diameter. Conclusion: The findings of this study show that as with asymptomatic primary hyperparathyroidism, normocalcaemic hyperparathy- roidism may be associated with increased cardiovascular risk by predisposing to atherosclerosis. (Endokrynol Pol 2023; 74 (1): 67-73)Öğe Denosumab Experience in a Patient with End-Stage Renal Disease and Paget’s Disease of the Bone(2022) Bilen, Ogün İrem; Elbüken, Gülşah; Ağgül, HünkarPaget’s disease of the bone (PDB) is a chronic bone disease which is characterized by accelerated bone turnover and disorganized bone remodeling. Diagnosis and treatment of PDB is particularly challenging in patients with chronic kidney disease (CKD). Denosumab administered subcutaneously at a single dose of 60 mg every 3 months reduced both serum total and bone-specific alkaline phosphatase (ALP) levels to near normal range in a 47-year-old male with CKD was suspected of having PDB due to very high serum total ALP levels and imaging findings suggestive of poliostotic involvement. Elevated serum total ALP levels detected at 3 months after denosumab suggests that serum total ALP starts to increase after 60 days of treatment but it is difficult to exactly determine the day when serum total ALP started to increase. It seems wise to administer denosumab at an interval of 60-120 days to maintain serum total ALP level within normal limits.Öğe Effects of Cigarette Smoking on Total and Salivary Cortisol Levels(Nizameddin KOCA, 2020) Elbüken, GülşahAim: Although there are some studies regarding the effects of cigarette smoking on serum total cortisol (TC) and salivary cortisol (SaC) levels, the results are still not conclusive. For this purpose, we aimed to determine the effects of cigarette smoking on TC and SaC levels in a small sample of healthy volunteers. Study design: Twenty-five (12 females and 13 males) smokers with a mean age of 42.6± 15 years and 25 (12 females and 13 males) age- and gender-matched healthy non-smokers (mean age:40.8± 14.5 years) were enrolled in the study. Hypothalamic-pituitary-adrenal (HPA) axis was evaluated by baseline TC and SaC levels, and TC and SaC responses to standard dose (250 µg) ACTH stimulation test. TC and SaC levels were obtained under baseline and stimulated conditions. Results: Although mean TC and SaC levels were higher in smokers versus non-smokers, a statistically significant difference was not found between the two groups. Conclusion: TC and SaC levels were not statistically different between smokers and non-smokers. Further studies with a larger sample size are needed to draw definitive conclusions.Öğe Evaluation of type 1 diabetic patients: A single center experience(2021) Elbüken, Gülşah; Yıldız, Resul; Yıldız, İsmail; Zuhur, Sayid ShafiWe evaluated patients diagnosed with type 1 DM who were followed at our clinic by conducting a retrospective chart review. Medical records of a total of 147 patientswith type 1 DM (70 females, 77 males) with a mean (±SD) age of 31.2±9.7 years were reviewed retrospectively. The study patients had a mean duration of follow-up of13.9±9.5 years, mean duration of follow-up of 4±2.6 years at our clinic and a mean HbA1c value of 8.3±2.1%. Microvascular complications were recorded in medicalfiles for 128 patients. There were 48 (37.5%) patients with at least one microvascular complication. Medical records showed that out of 128 patients, 23 (18%) had diabeticneuropathy alone, 4(3%) had diabetic retinopathy alone and 5 (4%) had diabetic nephropathy alone. Ten patients (8%) had both diabetic nephropathy and diabeticretinopathy and 6 (4.7%) patients had all three microvascular complications. No significant difference was observed between patients with or without microvascularcomplications in terms of HbA1c (HbA1c 8.3% versus 8.1%; p=0.85). A history of diabetic foot ulcer was present in 4 patients in the study sample (4/147=2.7% of allpatients).Twenty-two (15%) patients were on insulin pump therapy during follow-up. Insulin pump users had a significantly lower HbA1c value (7.9%) compared to thosenot using insulin pump (8.5%) (p=0.02). At our clinic, special efforts are being made to ensure type 1 diabetic individuals have regular outpatient examinations. Despiteall these measures, our patients are still far from reaching their target HbA1c values, suggesting that we have to do much more help patients achieve their glycemic goals.Öğe Expression of voltage gated potassium channel ether a go-go in pituitary adenomas of patients with acromegaly: A preliminary study(Maghira & Maas Publications, 2015) Zuhur, Sayid Shafi; Özkayalar, Hanife; Kuzu, İdris; Öztürk, Feyza Yener; Elbüken, Gülşah; Tanık, Canan; Altuntaş, YükselOBJECTIVE: To determine immunohistochemical expression of Eag1 in pituitary adenomas of patients with acromegaly and to assess the correlation between Eag1 expression with cavernous sinus invasion, tumoral Ki-67 labeling index (LI), age and gender of the patients. METHODS: The paraffin embedded pituitary adenoma tissue sections of 28 patients with acromegaly who were diagnosed as monohormonal growth hormone (GH) secreting adenomas were immunostained for Eag1 using the avidin-biotin-peroxidase complex method. Eag1 immunoreactivity was scored according to the extensity of the cytoplasm and cell membrane immunoreactivity for Eag1 (score 1 = <10%, score 2 = 10-25%, score 3 = 25-50% and score 4 = >50% of the adenoma cells showed immunoreactivity for Eag1, respectively). RESULTS: Overall, GH secreting pituitary adenomas displayed diverse levels of Eag1 immunoreactivity, however, 64% of the adenomas displayed a strong Eag1 immunoreactivity (score 3 and 4). Five of the tumors displayed Eag1 immunoreactivity score 1, 5 displayed score 2, 10 displayed score 3 and 8 displayed score 4, respectively. No correlation was found between Eag1 immunoreactivity with cavernous sinus invasion, Ki-67 LI, age and gender of the patients. CONCLUSIONS: Our results suggest Eag1 is strongly expressed in the majority of GH secreting pituitary adenomas. However, we could not find any correlation between immunoreactivity of Eag1 with cavernous sinus invasion, Ki-67 LI, age and gender of the patients. Further studies with larger sample sizes are required to demonstrate the role of Eag1 on tumorigenesis, angiogenesis, invasion and response to the treatment in GH secreting pituitary adenomas.Öğe External Validation of the GREAT Score in Turkish Patients with Graves' Hyperthyroidism Treated with the Titration Regimen Method of Antithyroid Drugs: A Multicenter Study(Georg Thieme Verlag Kg, 2019) Zuhur, Sayid Shafi; Elbüken, Gülşah; Yıldız, İsmail; Kadıoğlu, Pınar; Erol, Selvinaz; Şahin, Serdar; Altuntaş, YükselRecently, the Graves & apos; Recurrent Events After Therapy score (GREAT) was proposed as a useful tool to predict relapse before starting antithyroid drugs (ATD) in patients with Graves & apos; disease (GD). Therefore, we intended to assess the validity of the GREAT score in Turkish patients with GD, including patients who experienced a poorly controlled disease (multiple episodes of hyperthyroidism followed by euthyroidism or rarely hypothyroidism) during ATD dose titration. This is a retrospective multicenter study including 517 patients with the first episode of GD who were treated for at least 12 months. The patients were classified as relapse+poorly controlled disease (non-remission) and remission groups. During a median follow-up time of 35 months (12-144 months), 191 (37%) patients experienced a relapse, 136 (26.3%) a poorly controlled disease, and 190 (36.7%) remained in remission. Patients with non-remission disease tended to have significantly higher serum levels of TRAb, fT4, and fT3, and have larger goiter sizes on palpation at baseline, as compared with the remission group. Non-remission disease occurred in 12, 35, and, 53% of the patients falling into GREAT class I, II, and III, respectively (hazard ratio 2.56, 95% CI 2.02-3.51, p=0.012, and hazard ratio 3.54, 95% CI 2.12-5.91, p<0.001, for GREAT class II and III against class I, respectively). According to our study, the GREAT score is a useful tool to predict the risk of relapse as well as the occurrence of poorly controlled disease before starting treatment with ATDs.Öğe Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study(Springer, 2022) Konca Degertekin, C.; Göğaş Yavuz, Dilek; Pekkolay, Z.; Saygılı, E.; Ugur, K.; Or Koca, A.; Eroğlu, M.; Elbüken, GülşahHypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.Öğe Ovarian functions and polycystic ovary syndrome in adult women with type 1 diabetes mellitus in a Turkish population(Springer, 2023) Urhan, E.; Elbüken, Gülşah; Hacıoğlu, A.; Karaca, Z.; Ünlühazırcı, K.; Kelestimur, F.Purpose The effect of gonadotropin-releasing hormone agonist (GnRHa) stimulation has not been studied in adult women with type 1 diabetes mellitus (DM). We investigated the baseline and stimulated hormone levels after GnRHa and the frequency and relationship between polycystic ovary syndrome (PCOS) and type 1 DM in adult women with type 1 DM. Methods We included 55 adult women (age, 17-35 years) with type 1 DM and 15 healthy women (age, 20-29 years). Hormones including total testosterone, androstenedione, dehydroepiandrosterone sulphate (DHEAS), follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol, prolactin, and thyroid-stimulating hormone were measured in the early follicular phase of the menstrual cycle. All participants underwent GnRHa stimulation test, and FSH, LH, estradiol and 17-OHP response levels were measured every 6 h for 24 h. PCOS was diagnosed according to ESHRE/ASRM (Rotterdam) criteria. Results Between patients with type 1 DM and healthy controls, no significant differences were noted in mean age and body mass index (BMI) as well as baseline and stimulated hormone levels after buserelin stimulation, except for baseline serum 17-OHP levels, which was higher in patients with type 1 DM. Polycystic ovary morphology (PCOM) was detected in 14 (25%) patients, clinical hyperandrogenism in 16 (29%), hyperandrogenemia in 25 (45%), anovulatory cycle in 72%, and PCOS in 20 (36%). Conclusion All parameters representing androgen excess disorders, except 17-OHP level, of both groups were similar, and frequencies of PCOS and anovulatory cycle in adult women with type 1 DM were 36% and 72%, respectively.Öğe Peripheral Blood CD34+ Cell Counts in Patients With Severe Sepsis(Turkish Soc Immunology, 2016) Elbüken, Gülşah; Karaca, Züleyha; Tanriverdi, Fatih; Eser, Bülent; Ünlühızarcı, Kursad; Coşkun, Ramazan; Kelestimur, FahrettinObjectives: This study aims to determine the impact of severe sepsis (SS) on CD34(+) cell counts in the peripheral blood and to compare these counts with those of healthy subjects. Patients and methods: CD34(+) cell counts in the peripheral blood were measured in 20 patients with SS (12 males, 8 females; mean age 58.6 +/- 16.3 years; range 23 to 81 years) (group 1) and 32 healthy subjects (16 males, 16 females; mean age 51.8 +/- 8.6 years; range 36 to 64 years) (group 2). Blood samples were obtained from group 1 two times on second day (D2) within the first 24-48 hours and on seventh day (D7) after diagnosis and once from group 2 on their first day of admittance. Results: In group 1, CD34(+) cell counts on D2 were lower than those on D7, but the difference was not statistically significant. Neither on D2 nor on D7 CD34(+) cell counts of group 1 were different than those in group 2. Although CD34(+) cell counts in group 1 on D7 were higher than those of group 2, the difference was not statistically significant. CD34(+) cell counts did not differ according to the presence of adrenal insufficiency (AI) or survival status. Conclusion: Overall CD34(+) cell counts of SS patients were not different from those in healthy subjects and not affected by the presence of AI or survival in the SS group.Öğe Prevalence of Vitamin D Deficiency and Hypervitaminosis D Among Adult Patients Admitted to the Tertiary Care Hospitals in Turkey(Aves, 2022) Yavuz, Dilek Gogas; Ersoy, Reyhan; Altuntaş, Yüksel; Bilen, Habip; Pamuk, Barış; Apaydın, Tuğçe; Çetinkalp, Şevki; Elbüken, GülşahObjective: Vitamin D deficiency is a common health problem around the world. This study aimed to evaluate the nationwide prevalence of vitamin D status in tertiary care hospitals in Turkey. Methods: Retrospectively, the data on vitamin D levels from 33 tertiary care hospitals' clinical bio-chemistry laboratories around Turkey between January and December were collected. Results: In total, 706 434 serum samples from adult subjects (female/male: 469 028/237 406; 66.4%/33.6%) were included. While vitamin D levels were sufficient in 20.3% (n = 14 222), they were insufficient in 21.9% (n = 154 360) and deficient in 57.8% (n = 408 882). We observed the highest rates of deficiency in those aged between 18 and 29 years (62.9%, n = 70 235) and lowest rates between 60 and 69 years (52.3%, n = 61 121) and between 70 and 79 years (52.3%, n = 32 397). Hypervitaminosis D was detected in 5.5% of adult subjects; highest rates of hypervitaminosis D were observed in those who were over 80 years (6.6%) and 70-79 years (6.5%) and the lowest in 18-29 years (2.8%). Discussion: In this cohort, over half of the subjects admitted to the tertiary care hospitals in Turkey had vitamin D deficiency and required vitamin D supplementation. The elderly population had the lowest prevalence of vitamin D insufficiency and the highest prevalence of hypervitaminosis D.Öğe Quality of sleep in people with Type 2 diabetes(2021) Tosun, Zeynep; Akinci, Ayse Cil; Çelik, Selda; Kongur, Neşe Sönmez; Elbüken, GülşahThe aim of the study is to determine sleep quality and related factors in people with type 2 diabetes. This descriptive and cross-sectional study was conducted with 283 people with type 2 diabetes. Data were collected The Pittsburgh Sleep Quality Index (PSQI), The Epworth Sleepiness Scale (ESS), and the World Health Organization-5 Well-Being Index (WHO-5). Data was analyzed using the SPSS 15.0 software. The mean age of the people with diabetes was 60.0±10.7. Among the participants, 60.4% were female. The mean PSQI, ESS and WHO-5 scores of the participants were 6.6±3.4, 5.1±4.2 and 11.9±5.9, respectively. Among the participants, 55.8% had sleep problems. Males, those with higher education levels, employed individuals, those with moderate economic status, those who exercised, those without sleep apnea prob- lems, those without additional health problems, and those who did not have hypertension experienced sleep problems at a lesser degree (p<0.05). The waist circumference and Body Mass Index (BMI) of the participants who experienced sleep problems were higher, while their mean height was lower (p<0.05). The mean WHO-5 score of the participants who experienced sleep problems was lower, while their mean ESS score was higher (p<0.05). More than half of the people with diabetes reported to have sleep problems. Participants who experienced sleep problems had increased waist circumference, lower height and higher BMI. Participants who experienced sleep prob- lems also had higher levels of daytime sleepiness and lower quality of life. According to these findings, it is recommended to routinely assess sleep quality in people with diabetes. It is also recommended to reduce BMI and waist circumference, exercise, treat other health problems such as hypertension and OSAS for better sleep quality in individuals with diabetes.Öğe Relationship Among Pulmonary Hypertension, Autoimmunity, Thyroid Hormones and Dyspnea in Patients With Hyperthyroidism(Elsevier Science Inc, 2017) Zuhur, Sayid Shafi; Baykız, Derya; Kara, Sonat Pınar; Şahin, Ertan; Kuzu, İdris; Elbüken, GülşahObjective: Previous studies have reported conflicting results regarding the mechanisms underlying the pathophysiology of pulmonary hypertension (PHT) in patients with hyperthyroidism. Therefore, in this study, we investigated the association between PHT and thyroid-stimulating hormone (TSH) receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3, fT4 and dyspnea during daily activities in a large population of patients with hyperthyroidism. Methods: A total of 129 consecutive patients with hyperthyroidism, 37 with hypothyroidism and 38 euthyroid controls were enrolled in this study. The modified medical research council scale was used for the assessment of dyspnea in daily activities. All the patients and euthyroid controls underwent transthoracic echocardiography for the assessment of PHT. Results: Mild PHT was present in 35%, 36%, 13.5% and 5% of the patients with Graves' disease, toxic multinodular goiter, hypothyroidism and euthyroid controls, respectively. Pulmonary vascular resistance (PVR) was higher in hyperthyroid patients with PHT than in those without PHT. Moreover, a significant positive correlation was found between modified medical research council scale and pulmonary artery systolic pressure as well as PVR in patients with hyperthyroidism. No association was found between PHT and serum TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin antibody, TSH, fT3 and fT4 levels. Conclusions: Mild PHT is present in a significant proportion of patients with hyperthyroidism, regardless of etiology. PVR appears to be the main cause of PHT in patients with hyperthyroidism, and neither autoimmunity nor thyroid hormones are associated with PHT in these patients. Mild dyspnea during daily activities in patients with hyperthyroidism may be related to PHI; however, severe dyspnea requires further evaluation.Öğe The association of TSH-receptor antibody with the clinical and laboratory parameters in patients with newly diagnosed Graves' hyperthyroidism: experience from a tertiary referral center including a large number of patients with TSH-receptor antibody-negative patients with Graves' hyperthyroidism(Via Medica, 2021) Zuhur, Sayid Shafi; Bilen, Ogün; Ağgül, Hünkar; Topçu, Birol; Çelikkol, Aliye; Elbüken, GülşahIntroduction: Although the TSH-receptor antibody (TRAb) plays a central role in the pathogenesis of Graves' disease (GD), the association between TRAb at first diagnosis and clinical and laboratory parameters is not well known. On the other hand, a minority of patients with GD may be TRAb negative, and there is a lack of adequate evidence to demonstrate the clinical and laboratory characteristics of these patients. Therefore, we aimed to investigate the association of TRAb at the initial diagnosis of GD with the clinical and laboratory parameters in a large number of patients with GD and to compare the clinical and laboratory parameters between patients with high TRAb levels and TRAb-negative patients. Material and methods: This study included 440 patients [326 (74%) female, 114 (26%) male]. All patients were classified according to gender, age, smoking habit, and TRAb levels. Results: TRAb levels were significantly higher in male compared to female patients and in smokers compared to non-smokers. Smoking male patients had the highest TRAb levels. In regression analysis, goiter size, male gender, cigarette smoking, Graves' orbitopathy, fT3, and anti-TPO antibody levels were independently associated with high TRAb levels, while age at diagnosis and fT4 levels were not independently associated with high TRAb levels. TRAb-negative GD was diagnosed in 80 (18%) patients. TRA-negative patients had markedly less severe clinical and laboratory hyperthyroidism compared to patients with high TRAb levels. Moreover, the smoking habit was significantly lower in patients with TRAb-negative GD. Conclusions: According to our study results, TRAb levels at the initial diagnosis of GD are differently associated with clinical and laboratory parameters. Male patients and smoking patients with GD tended to have markedly higher TRAb levels and more severe clinical hyperthyroidism. Therefore, besides other contributing factors, male gender and smoking may affect TRAb levels and consequently the severity of hyperthyroidism in patients with GD. Furthermore, male gender and smoking may have a synergistic effect on TRAb levels and consequently on the severity of hyperthyroidism in patients with GD.Öğe The effect of gender on response to antithyroid drugs and risk of relapse after discontinuation of the antithyroid drugs in patients with Graves' hyperthyroidism: a multicentre study(Via Medica, 2020) Zuhur, Sayid Shafi; Yıldız, İsmail; Altuntaş, Yüksel; Bayraktaroğlu, Taner; Erol, Selvinaz; Şahin, Serdar; Kadıoğlu, Pınar; Elbüken, Gülşah; Topçu, BirolIntroduction: The outcome of medical treatment in patients with Graves' disease (GD) is generally difficult to predict. In this study, we examined the hypothesis that gender may affect the outcome of treatment with antithyroid drugs (ATDs). Material and methods: This is a retrospective multicentre study including 717 (514 female and 203 male) patients with the first episode of GD treated for at least 12 months. Patients were classified as relapse, poorly controlled (several episodes of hyperthyroidism followed by euthyroidism and rarely hypothyroidism, occurring after titration of ATDs), and remission. Results: During the mean follow-up time of 26.75 +/- 21.25 months (between 1 and 120 months), 269 (37.5%),176 (24.5%), and 272 (37.9%) patients experienced a relapse, a poorly controlled disease, and remained in remission, respectively. During the follow-up time, 223 (43.4%) of the female and only 49 (24%) of the male patients remained in remission. Relapse and poorly controlled disease (non-remitting GD) were more common in male compared to female patients with GD (hazard ratio 1.26, 95% CI: 1.03-133, p - 0.025). Graves' disease in male patients tended to relapse earlier, and male patients tended to have larger goiter sizes at diagnosis as well. The smoking habit was also significantly inure frequent in males compared to female patients with GD. Conclusion: Male patients with GD have a markedly higher frequency of relapse and poorly controlled disease, as compared to female patients. Larger goiter sizes and higher frequency of smoking may contribute to the higher frequency of relapse and poorly controlled disease in male patients.Öğe The frequency of Cushing's disease, ACTH-independent Cushing's syndrome and autonomous cortisol secretion among Turkish patients with obesity(Kare Publ, 2020) Atar, Resit Volkan; Yıldız, İsmail; Topçu, Birol; Elbüken, Gülşah; Zuhur, Sayid ShafiOBJECTIVE: The frequency of Cushing's disease (CD), ACTH-independent Cushing's syndrome (CS) and autonomous cortisol secretion (ACS) in patients with obesity is not well known. Therefore, in the present study, we aimed to assess the frequency of CD, CS and ACS among the patients with obesity. METHODS: This study included 813 patients (683 female, mean age 46.47 +/- 14.23 yr; mean body mass index (BMI) 37.31 +/- 6.50 kg/m(2)). Patients with obesity were classified further to stages 1, 2, and 3, according to BMI. All patients underwent a low dose dexamethasone suppression test (LDDST). The patients with CD, CS, and ACS and patients with simple obesity were compared concerning gender, age, type-2 diabetes, hypertension (HT) and hyperlipidemia (HL). RESULTS: Forty-four (5.4%) out of 813 patients were diagnosed as CD, CS or ACS. CD, CS, and ACS were diagnosed in four (0.4%), two (0.2%), and 33 (4%) patients, respectively. When patients with CD, CS and ACS were compared to the patients with simple obesity, older age at diagnosis, the presence of stage-1 obesity, the presence of HT, and uncontrolled type-2 diabetes were more frequent in patients with CD, CS and ACS (p=0.001, p=0.007, p=0.004, and p=0.0026, respectively). CONCLUSION: The frequency of CD, CS, and ACS is high among patients with obesity. Screening for CD, CS, and ACS in patients with stage-I obesity who are older than 50 years of age with uncontrolled type-2 diabetes and HT may be a reasonable approach.Öğe Üçüncü Primer Tümör Nedeniyle Gelişen, Tümör İlişkili Osteomalaziye Bağlı Bir Hipofosfatemi Olgusu.(Eskişehir Osmangazi Üniversitesi, 2022) Elbüken, Gülşah; Ağgül, Hünkar; Bilen, Ogün; Zuhur, Sayid ShafiTümörle ilişkili osteomalazi (TİO), genellikle mezenkimal kaynaklı bir tümörün sıklıkla Fibroblast Büyüme Faktörü‐23 (FGF-23) üreterek osteomalaziye neden olduğu paraneoplastik bir durumdur. FGF-23, fosfatürik etki ile hipofosfatemiye neden olur. Olgu: Altmışbeş yaşında erkek hasta, kas güçsüzlüğü, zor yürüme ve şiddetli kemik ağrıları şikayetleri ile başvurdu. Tıbbi öyküsünde: 4 cm çapta orta riskli gastrointestinal sistem stromal tümör (GİST) sebebiyle distal gastrektomi, Billroth 2 antekolik gastroenterostomi ve sonrasında Evre 1 multisentrik mikropapiller karsinom (CA) sebebiyle total tiroidektomi operasyonları mevcuttu. Kemik sintigrafisindeki yaygın lezyonları GİST’in kemik metastazı olarak kabul edilmişti. Laboratuvar tetkiklerinde: Kalsiyum (Ca):8.3 mg/dL, fosfor (P): 1.5 mg/dL, parathormon (PTH): 75 pg/mL, 25-OH vit D3: 31 ng/mL, 1-25-(OH)2 vit D3: 36 pg/mL, kreatinin: 0.75 mg/dL alkalen fosfataz (ALP: 109 IU/L, idrar fosforu: 2.54 gr/gün idi. Hastanın hipofosfatemisinin olası sebebi GIST kemik metastazlarına bağlı olarak gelişmiş TİO’ye bağlı olduğu düşünüldü. Metastazların cerrahi olarak çıkartılması mümkün olmadığından, hastaya oral fosfat ve kalsitriol tedavisi başlandı. Ancak tedavi başlandıktan sonra Ca düzeyleri düzelmesine rağmen, P düzeyleri yaklaşık 2 mg/dl düzeylerinde seyretti. Tedavi başlandıktan bir yıl sonra sağ ayak birinci parmağında ülser gelişmesi üzerine, bu lezyon eksize edildi ve patoloji sonucu “ekstraskeletal miksoid kondrosarkom” olarak raporlandı. Tümörün eksizyonu sonrasında Ca ve P değerleri tamamen normale geldi. GIST ve tiroid CA ile TİO gözlenmesi genellikle beklenilen bir durum değildir. Nitekim hipofosfatemi sebebi olarak, hastamızda üçüncü primer tümöre bağlı olarak gelişmiş bir TİO tespit edildi. Üçüncü primer tümöre bağlı olarak gelişen TİO bildiğimiz kadarıyla literatürde ilk ve tek olgudur. Eğer hastada halihazırda primer bir tümör var ve bu tümör TİO’ye sık neden olan tümörlerden değilse, başka bir primer tümör odağının olup olmadığı dikkatle araştırılmalıdır.
