JOURNALandc b es thw of j ur l wtu rkjemog MaterialDisclaimer S taem n so rpix d h uc p ub lish ednt...

JOURNAL OF THE SOCIETY OF ENDOCRINOLOGY AND METABOLISM OF TURKEYJOURNAL OF THE SOCIETY OF ENDOCRINOLOGY AND METABOLISM OF TURKEY

OWNER ON BEHALF OF THE SOCIETY OF ENDOCRINOLOGY AND METABOLISM OF TURKEYSevim Güllü, MD

MANAGING CLERICAL DIRECTORNilgün Başkal, MD

ADRESS FOR MANAGEMENTThe Society of Endocrinology and Metabolism of TurkeyMeşrutiyet Caddesi No: 29/12 Kızılay, Ankara, TURKEYPhone: +90 312 425 20 72Fax: +90 312 425 20 98web: www.turkjem.orgE-mail: [email protected]

Publication Type and PeriodsTurkish Journal of Endocrinology and Metabolism is published 4 (March, June, September and December) times a year.

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The Turkish Journal of Endocrinology and Metabolism is indexed in Emerging Sources of Citation Index (ESCI),British Library, CINAHL, Directory of Open Access Journals (DOAJ), EBSCO, EMBASE, SCOPUS,Tübitak / Ulakbim TR Index, TürkMedline, Türkiye Citation Index.

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Publishing House: Türkiye KlinikleriAddress: Nasuh Akar Mah. Türkocağı Cad. No:30 Balgat - Ankara TurkeyTelephone: +90 312 286 56 56Fax: +90 312 220 04 70E-mail: [email protected] page: www.turkiyeklinikleri.com

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Publication Date: 10.07.2018

ISSN: 1301-2193E-ISSN: 1308-9846

JOURNAL OF THE SOCIETY OF ENDOCRINOLOGY AND METABOLISM OF TURKEY

Owner on Behalf of the Society ofEndocrinology and Metabolism of TurkeySevim Güllü, Ankara, Turkey

Editor-In-ChiefNilgün Başkal, Ankara, Turkey

Deputy EditorMurat Faik Erdoğan, Ankara, Turkey

Associate EditorsHasan Ali Altunbaş, Antalya, TurkeyDilek Gogas Yavuz, İstanbul, TurkeySerkan Yener, İzmir, Turkey

Statistical ConsultantAtilla Halil Elhan, Ankara, TurkeyLevent Dönmez, Antalya, TurkeyDerya Öztuna, Ankara, TurkeyCan Ateş, Van, Turkey

Language EditorJennifer Gabriel, California, USA

Honorary BoardSema Akalın, İstanbul, TurkeyMetin Arslan, Ankara, TurkeyGürbüz Erdoğan, Ankara, TurkeyOlcay Gedik, Ankara, TurkeySadi Güngoğdu, İstanbul, Turkey

Hüsrev Hatemi, İstanbul, TurkeyŞazi İmamoğlu, Bursa, TurkeyTaylan Kabalak, İzmir, TurkeySenay Molvalılar, İstanbul, TurkeyCandeğer Yılmaz, İzmir, Turkey

Editorial BoardErsin Akarsu, Gaziantep University Faculty of Medicine, Gaziantep, TurkeyMüjde Aktürk, Gazi University Faculty of Medicine, Ankara, TurkeyFaruk Alagöl, Koç University Faculty of Medicine, İstanbul, Turkeyİnan Anaforoğlu, Medical Park International Trabzon Hospital, Trabzon, TurkeyYalçın Aral, Bozok University Institute of Health Sciences, Yozgat, TurkeyAyşegül Atmaca, Ondokuz Mayıs University Faculty of Medicine, Samsun, TurkeyGöksun Ayvaz, Liv Hospital, Ankara, TurkeyÖmer Azal, Gulhane Education and Research Hospital, Ankara, TurkeyMustafa Kemal Balcı, Akdeniz University Faculty of Medicine, Antalya, TurkeyNeslihan Başçıl Tütüncü, Başkent University Faculty of Medicine, Ankara, TurkeyDavid Baylink, Loma Linda University, California, USAFahri Bayram, Erciyes University Faculty of Medicine, Kayseri, TurkeyErol Bolu, Memorial Atasehir Hospital, İstanbul, TurkeyBekir Çakır, Yıldırım Beyazıt University Faculty of Medicine, Ankara, TurkeyMehtap Çakır, Kent Hospital, İzmir, TurkeyBerrin Çetinarslan, Kocaeli University Faculty of Medicine, Kocaeli, TurkeyAhmet Çorakçı, Ufuk University Faculty of Medicine, Ankara, TurkeyAbdurrahman Çömlekci, Dokuz Eylül University Faculty of Medicine, İzmir, TurkeySelçuk Dağdelen, Hacettepe University Faculty of Medicine, Ankara, TurkeyLeslie J. De Groot, University of Rhode Island, Kingston, USAHatice Sebila Dökmetaş, Istanbul Medipol University Faculty of Medicine, İstanbul, TurkeyBelgin Efe, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, TurkeySevinç Eraslan, Dokuz Eylul University Faculty of Medicine, İzmir, TurkeyTomris Erbaş, Hacettepe University Faculty of Medicine, Ankara, TurkeyMehmet Erdoğan, Ege University Faculty of Medicine İzmir, TurkeyEda Ertörer, Başkent University Adana Dr. Turgut Noyan Hospital, Adana, TurkeyJohn W. Funder, Monash University, Victoria, Australia

Hossein Gharib, Mayo Clinic, Minnesota, USASait Gönen, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, TurkeyNilgün Güvener, Okan University Faculty of Medicine, İstanbul, TurkeySerdar Güler, Liv Hospital, Ankara, TurkeyAlptekin Gürsoy, Ankara Güven Hospital, Ankara, TurkeyZeliha Hekimsoy, Celal Bayar University Faculty of Medicine, Manisa, TurkeyLarry Jameson, Perelman School of Medicine Univ. Of Pennsylvania, Philadelphia, USAPınar Kadıoğlu, İstanbul University Cerrahpasa Faculty of Medicine, İstanbul, TurkeyAhmet Kaya, Selcuk University Meram Faculty of Medicine, Konya, TurkeyFahrettin Keleştimur, Health Institutes of Turkey, Ankara, TurkeyMustafa Kutlu, Gulhane Education and Research Hospital, Ankara, TurkeyPierre J. Lefebvre, University of Liege Faculty of Medicine, Liege, BelgiumMesut Özkaya, Dr.Ersin Arslan Training and Research Hospital, Gaziantep, Turkeyİlhan Satman, İstanbul University İstanbul Faculty of Medicine, İstanbul, TurkeyFüsun Saygılı, Ege University Faculty of Medicine, İzmir, TurkeyAlper Sönmez, Gulhane Education and Research Hospital, Ankara, TurkeyTümay Sözen, Hacettepe University Faculty of Medicine, Ankara, Turkeyİbrahim Şahin, İnönü University Faculty of Medicine, Malatya, TurkeyMustafa Şahin, Ankara University Faculty of Medicine, Ankara, TurkeyRefik Tanakol, İstanbul University İstanbul Faculty of Medicine, İstanbul, TurkeyKubilay Ükinç, Gayrettepe Florence Nightingale Hospital, İstanbul, TurkeyBetül Uğur Altun, Başkent University İstanbul Hospital, İstanbul, TurkeyAli Rıza Uysal, Ankara University Faculty of Medicine, Ankara, TurkeyKürşad Ünlühızarcı, Erciyes University Faculty of Medicine, Kayseri, TurkeyAyşe Kubat Üzüm, İstanbul University İstanbul Faculty of Medicine, İstanbul, TurkeyAnthony Weetman, The University of Sheffield, Sheffield, UKSema Yarman, İstanbul University İstanbul Faculty of Medicine, İstanbul, TurkeyBülent Okan Yıldız, Hacettepe University Faculty of Medicine, Ankara, Turkey


AIMS AND SCOPE

The Turkish Journal of Endocrinology and Metabolism isthe peer-reviewed periodical on clinical and experimen-tal endocrinology and metabolism diseases and relatedfields. It is the official journal of the Society of Endocri-nology and Metabolism of Turkey and is published quar-terly (March, June, September and December) ashardcopy and an electronic journal at www.turkjem.org.The manuscripts are published in English language.The journal publishes original research papers, reviewsand case reports which primarily focus on clinical endoc-rinology. The journal's aim is to be the essential readingfor both endocrinologists and clinical practitioners.

Open Access PolicyThe Turkish Journal of Endocrinology and Metabolism isan open access journal. This journal provides immediateopen access to its content on the principle that makingresearch freely available to the public supports a greaterglobal exchange of knowledge.Open Access Policy is based on rules of Budapest Open Ac-cess Initiative (BOAI) http://www.budapestopenaccessini-tiative.org/.Instructions for online manuscript submission, current is-sues and archives of the journal can be found atwww.turkjem.org. Please do not send manuscripts to theeditorial office. For other related issues you may contactthe editorial office:

Subscription informationThe Turkish Journal of Endocrinology and Metabolism isdistributed free of charge to all endocrinology academici-ans and instructors serving in our country. Access to full-text articles of all issues of the journal is free at thejournal's website www.turkjem.org

Instructions for authorsInstructions for authors are published in the journal pagesand can be accessed at the web site of the journalwww.turkjem.org

Material DisclaimerStatements or opinions expressed in the manuscriptspublished in the Turkish Journal of Endocrinology and Me-tabolism reflect the views of the author(s) and are notthe opinions of the editors, the editorial board and thepublisher. The editors, editorial board and the publisherdisclaim any responsibility or liability for such materials.

The journal is printed on acid-free paper.

All rights are reserved. Rights to the use and reproduction, including in the electronic media, of all communications, papers, photographs and illustrations appea-ring in this journal belong to the Turkish Journal of Endocrinology and Metabolism. Reproduction without prior written permission of part or all of any material isforbidden. The journal complies with the Professional Principles of the Press.

The paper used the print this journal conforms to ISO 9706: 1994 standard (Requirements for Permanence). The National Library of medicine suggests that bio-medical publications be printed on acid free paper (alkaline paper).

Reviewing the articles’ conformity to the publishing standards of the Journal, typesetting, reviewing and editing and editing the manuscripts and abstracts in En-glish and publishing process are realized by Türkiye Klinikleri.

INSTRUCTIONS FOR AUTHORSTurkish Journal of Endocrinology and Metabolism issues papers on all aspectsof endocrinology. The journal is the scientific publishing organ of the Societyof Endocrinology and Metabolism of Turkey and has been published quarterly(March, June, September and December) since 1997.In addition to originalarticles, case reports, review articles, letters to the editor, educational arti-cles, sections of question and answers, abstracts from literature and an-nouncements of congresses/meetings are also published. Turkish LanguageInstitution dictionary and orthography guide should be taken as basic for lit-erary. The idioms used should be checked.The scientific and ethical liability ofthe manuscripts belongs to the authors and the copyright of the manuscriptsbelongs to the Turkish Journal of Endocrinology and Metabolism. The authorsshould submit the signed copyright transfer form together with their manu-scripts. Authors are responsible for the contents of the manuscript and accu-racy of the references.The authors should guarantee that their manuscriptshas not been published and/or is not under consideration for publication inany other periodical. This requirement does not apply to papers presented inscientific meetings and whose summaries, not exceeding 250 words, are pub-lished. In this case, however, the name, date and place of the meeting in whichthe paper was presented should be stated. The signed statement of scientificcontributions and responsibilities of all authors is required.The Turkish Journal of Endocrinology and Metabolism does not charge any ar-ticle submission or processing charges.

Peer-reviewEditorial policies of the journal are conducted according to the rules advisedby Council of Science Editors and reflected in the Uniform Requirements forManuscripts Submitted to Biomedical Journals: Writing and Editing for Bio-medical Publication (http://www.icmje.org/).Submitted manuscripts are subjected for double-blind peer-review. The sci-entific board guiding the selection of the papers to be published in the Jour-nal consists of elected experts of the Journal and if necessary, selected fromnational and international experts in the relevant field of research. All manu-scripts are reviewed by the editor, section associate editors and at least threeinternal and external expert referees. All research articles undergo review bystatistical editor as well.Submitted manuscripts are also subjected for the evaluation of plagiarism, dupli-cate publication by automatic software. Authors are obliged to acknowledge if theypublished study results in full or in part in form of abstracts.The authors of the accepted manuscripts should be in consent that the editorand associate editors could make corrections without changing the main textof the paper.Manuscript format should be in accordance with Uniform Re-quirements for Manuscripts Submitted to Biomedical Journals: Writing and Ed-iting for Biomedical Publication (http://www.icmje.org/).

General GuidelinesManuscripts can only be submitted electronically through the web site(http://www.turkjem.org) after creating an account. This system allows onlinesubmission and peer-review.The manuscripts are archived according to ICMJE-www.icmje.org, Index Medicus (Medline/PubMed) and Ulakbim-Turkish Medi-cine Index Rules. Rejected manuscripts, except artwork are not returned.For the experimental, clinical and drug human studies, approval by ethicalcommittee and statement on the adherence of the study protocol to the in-ternational agreements (Helsinki Declaration revised 2013 (www.wma.net/en/30publications/10policies/b3/) are required. In experimental animal studies,the authors should indicate that the procedures followed were in accordancewith animal rights (Guide for the care and use of laboratory animals,www.nap.edu.catalog/5140.html) and they should obtain animal ethic

committee approval. The Ethic Committee approval document should be sub-mitted to the Turkish Journal of Endocrinology and Metabolism together withthe manuscript.The approval of the ethic committee, statement on the adherence to internationalguidelines mentioned above and that the patients` informed consent is obtainedshould be indicated in the `Material and Method` section and is required for casereports whenever data/media used could reveal identity of the patient. The dec-laration of the conflict of interest between authors, institutions, acknowledge-ment of any financial or material support, aid is mandatory for authors submittingmanuscript and the statement should appear at the end of manuscript. Review-ers are required to report if any potential conflict of interest exists between re-viewer and authors, institutions.

Original ArticlesClinical research should comprise clinical observation, new techniques or labo-ratory studies. Provided that these manuscripts are written with lower-case let-ters, they should include the title in Turkish/English, the background and the keywords in Turkish/English, introduction, materials and methods, results (findings),discussion, references, tables, charts, pictures and they should be written in ac-cordance with Journal Agent rules. They should not exceed sixteen (A4) pages.It is recommended to present research articles and meta-analysis/systematic re-views article according to the guidelines on specific design of the study: random-ized studies (CONSORT), observational studies (STROBE), studies on diagnosticaccuracy (STARD), meta- analysis and systematic review (PRISMA, MOOSE) andother study designs (www.equator-network.org).

Author InformationThe name and the surname of the authors should be written without abbrevi-ation. The academic titles, the affiliations and the addresses of these affilia-tions should be clearly declared. Furthermore, the contact information of thecorresponding author should be entered to the system. Since e-mail will beused primarily for the contact with the authors, the e-mail of the correspon-ding author should be indicated. In addition the phone and the fax numbersshould be also indicated.

Title PageThis page should include the titles of the manuscript, key words and running ti-tles. In Turkish manuscripts the title in English should also take place. Likely,Turkish title should be mentioned for articles in foreign language. If the contentof the paper has been previously presented or its abstract has been published,an explanation should be made in this page about this issue. If there are anygrants and other financial supports by any institutions or firms for the study, in-formation must be provided by the authors.

AbstractTurkish and English summaries of the manuscript should take place in a man-ner that it will not exceed 250 words. The keywords should be written at theend of the summary. The references should not be cited in the summary sec-tion. As far as possible, use of abbreviations is to be avoided. If any abbrevi-ations are used, they must be taken into consideration independently of theabbreviations used in the text. The summary should be written with four run-ning titles.Purpose: The goal of the study should be clearly stated.Material and Method: The study should be defined, the standard criteria; itshould be also indicated whether the study is randomized or not, whether it isretrospective or prospective, the statistical method, if any, should be indicated.Results (Findings): The detailed result of the study should be given and thestatistical significance level should be indicated.



INSTRUCTIONS FOR AUTHORSDiscussion: It should reflect the results of the study, the favorable and un-favorable aspects should be declared.Key words: At least three and maximum eight key words. (in English and inTurkish) Do not use abbreviations in the key words. Turkish key words will beprovided by the editorial office for the authors who are not Turkish speakers. Ifyou are not a native Turkish speaker, please re-enter your English keywords to thearea provided for the Turkish keywords. English key words should be providedfrom Medical Subject Headings (http://www.nlm.nih.gov/mesh/) while Turkishkey words should be provided from http://www.bilimterimleri.com.Original researches should have the following sections;IntroductionBrief explanation about the topic should be done, the objective of the studyshould be indicated and these should be supported by the literature informa-tion.Materials and MethodsThe study design should be described, it should be indicated whetherit is interventional randomized or observational, whether it is retrospective orprospective, the number of trials, the characteristics, studied variables and spe-cific methods, the used statistical methods should be indicated. If any, it shouldbe indicated that the results should be scrutinized.Results (Findings)The results should be given, the tables and the pictures should be given innumerical order and, the results should be indicated as % and/or p-values.DiscussionThe obtained values should be discussed with its favorable and unfavorable as-pects and, they should be compared with literature.Study Limitations: Study Limitations and strengths, and directions for fur-ther research or implication must be discussed.Conclusion: The conclusion of the study should be highlighted.Authors contributions, Declaration of conflict of interest and Acknowledge-ments should appear at the end of the main text of manuscript.ReferencesAccuracy of reference data is the author’s responsibility. References shouldbe numbered according to the consecutive citation in the text. Referencesshould be indicated by parenthesis in the text. If there is Turkish Reference,attention should be paid to indicate this. Journal titles should be abbreviatedaccording to the style used in the Index Medicus. All the references, books,papers and similar articles should be cited as references should be writtenaccording to the rules of the International Committee of Medical Journal Ed-itors Uniform Requirements for Manuscripts Submitted to Biomedical Jour-nals (http://www.nlm.nih.gov/bsd/uniform_requirements.html).Journal: The surnames of the authors and the initial of authors’ names, thetitle of the paper, the title of the journal (the original abbreviation stated in thejournal), year, volume and the page numbers.Example: Collin JR, Rathbun JE. Involutional entropion: a review with evalu-ation of a procedure. Arch Ophthalmol. 1978;96:1058-1064.Book with a Single Author: The surname and the initial of the author, thetitle, chapter and section, the name of the editor, title of the book, place ofpublication, name of the printing house, year of print, page numbers.Example: Herbert L. Conjunctivitis, keratitis and infections of periorbital struc-tures. In: Armstrong D, Cohen J, eds. The Infectious Diseases (1st ed).Philadelphia; Mosby Harcourt; 1999;11;1-8.

Book Chapter: The surname and the initial of the author, chapter and section,name of the editor, title of the book, place of publication, name of the print-ing house, year of print, page numbers.Example: O’Brien TP, Green WR. Periocular Infections. In: Feigin RD, CherryJD, eds. Textbook of Pediatric Infectious Diseases (4th ed). Philadelphia; W.B.Saunders Company;1998:1273-1278.Visual Materials (Tables, Graphics, Figures, and Pictures): All tables,graphics or figures should be enumerated according to the sequence within thetext and a brief descriptive caption should be written. The abbreviations usedshould be definitely explained in the figure’s legend. Especially, the text of tablesshould be easily understandable and should not repeat the data of the main text.Illustrations that already published are acceptable if supplied by permission ofauthors for publication. The details of the pictures should be distinguishable andthey should be recorded in JPEG format and in 500 pixels per inch at least.Case ReportsIt should consist of the title, summary, key words, summary in English, key-words, introduction, case report, discussion and references, the case or thecases should be worth to be presented, it should contribute to literature, andall of them should not exceed 5 papers in (A4) sizes.ReviewIt should include new topics, the own experiences of the author, if possible,and the references also. It should consist of the title in Turkish, the summary,the keywords, the title in English, the summary in English and the keywordsin English.Letters to the EditorThey should be assays in the “review” manner in various topics or the assaysconcerning the articles published in the Turkish Journal of Endocrinology andMetabolism with the contributive content or contents as questions that do notexceed 200 words.Scientific LettersThe manuscripts should be error-free in the summaries compiled from the ar-ticles in other journals, the author names (surname, name) should be written,the journal title should be written with its original abbreviation, its year shouldbe indicated and, the name and he surname of the translator should be indi-cated under the manuscript.Open Access PolicyThis journal provides immediate open access to its content on the principlethat making research freely available to the public supports a greater globalexchange of knowledge.

CorrespondenceAll correspondences can be done to the following postal address or to the fol-lowing e-mail address, where the journal editorial resides:Address: Ankara University Faculty of Medicine, Department of Endocrinologyand Metabolism, Ankara, TurkeyPhone: +90 312 508 21 00Fax: +90 312 309 45 05E-mail: [email protected]

“This journal licenced under the terms of the Creative Commons 4.0 Interna-tional Licence (CC BY 4.0)”

CONTENTS

40th TURKISH CONGRESS OF ENDOCRINOLOGY AND METABOLIC DISEASES(9-13 May 2018, Antalya)Congress Abstract Book

1 Prevalence of Childhood Obesity and Associated Morbidities in North Cyprus

Hasan Sav, Umut Mousa

2 Dapagliflozin in Type 2 Diabetes Patients in Routine Internal Medicine and

Endocrinology Outpatient Clinical Care; A Retrospective Cohort Study from Turkey

Derun Taner Ertuğrul, Erdal Kan, Çiğdem Bahadır Tura, Hacı Bayram Tuğtekin, Hayati Ayakta,

Mehmet Çelebioğlu, Timuçin Demiralp, Onur Utebay, İlhan Yetkin

4 Screening of AIP Gene Mutations in Young Sporadic Pituitary Adenoma Patients

Feyza Nur Tuncer, Sema Çiftçi Doğanşen, Esin Serbest, Seher Tanrıkulu, Fatma Yeliz Ekici,

Bilge Bilgiç, Sema Yarman

5 Joint Involvement in Patients with Acromegaly

and the Association Between Arthropathy and Disease Remission

Özlem Haliloğlu, Merve Nur Alçiçek, Fırat Çetinkaya, Serdar Şahin, Özge Polat Korkmaz,

Serdal Uğurlu, Pınar Kadıoğlu

6 Evaluation of the Relationship Between Thyroid Nodules and Disease Activity

in Patients with Acromegaly

Gülşah Yenidünya Yalın, Sema Çiftçi Doğanşen, Artur Salmaslıoğlu, Seher Tanrıkulu, Sema Yarman

June 2018 Volume: 22 Issue: 2 Supplement


8 The Effects of Pre-operative Somatostatin Analogue Therapy on Cost of Treatment and

Also Early-late Remissions in Acromegaly

Özge Polat Korkmaz, Mert Gürcan, Özlem Haliloğlu, Hande Mefkure Özkaya, Serdar Şahin,

Fatma Eda Nuhoğlu Kantarcı, Meryem Merve Ören, Pınar Kadıoğlu

9 Effect of Sleeve Gastrectomy on Platelet Count and Mean Platelet Volume

Faruk Kutlutürk, Zeki Özsoy

11 The Compatibility of the Treatment of Chronic Kidney Disease and Diabetes

to the KDOQI-2012 Update Guideline

Zelal Adıbelli, Cevdet Duran, Hakan Demirci, Hamza Sumter

13 The Relation Between Epicardial Fat Tissue and TSH Receptor Antibody in Hyperthyroidism

Rıza Altunbaş, Mehmet Ali Eren, İbrahim Halil Altıparmak, Tevfik Sabuncu

14 DNA Breaks and Repair in Euthyroid Patients with Nodular Goiter can Predict Cancer and be a Biomarker?

Fahri Bayram, Büşra Düzgün, Zuhal Hamurcu, Kezban Korkmaz, Fatma Doğruel,

Hamiyet Dönmez-Altuntaş

15 Multiple Cardiovascular Risk Factors Management According to Guidelines

in Patients Initiating Second-Line Glucose-Lowering Treatment in Turkey:

Results from the Global DISCOVER Study

Ferit Kerim Küçükler, Yaşar Küçükardalı, Osman Başpınar, Mehmet Çalan, Çağatay Çıtırık,

Ramis Çolak, Ramazan Sarı, Mustafa Araz, Tamer Tetiker, Fahri Bayram

17 Testicular Adrenal Rest Tumor

Belma Özlem Tural Balsak, Zafer Pekkolay, Mehmet Güven, Alpaslan Kemal Tuzcu

18 A Rare Cause of Adrenal Incidentaloma: Ganglioneuroma

Seher Tanrıkulu, Kenan Çağlayan, Gizem Altınok, İdris Kuzu, Çisel Aydın, Ali Sürmelioğlu, Metin Tilki


19 Basal Cortisol Levels in the Elderly and Middle-Aged Type 2 Diabetic Patients

Zeliha Fulden Saraç, Sumru Savaş, Pelin Tütüncüoğlu

20 The Place of Interventional Blocks in the Treatment of Avascular Necrosis Developing

in Patients with Addison's Disease

Yaşar Arslan

21 Lichen Sclerosis et Atrophicus May be Associated with Prediabetes

Müge Keskin, Özlem Tekin, Arzu Or Koca, Murat Dağdeviren, Mustafa Altay, Derun Taner Ertuğrul

22 The Evaluation of Thiol/Disulfide Homeostasis in Diabetic Nephropathy

Mehmet Ali Eren, İsmail Koyuncu, Hatice İncebıyık, Hilal Karakaş, Özcan Erel, Tevfik Sabuncu

24 25-hydroxy Vitamin D Levels and Relationships Between 25-hydroxy Vitamin D and Glycemic Status

Sumru Savaş, Zeliha Fulden Saraç, Pelin Tütüncüoğlu

25 The Place of Interventional Blocks in the Treatment of Pain Associated with Lumbar Disc Herniation

in a Patient with Type 1 Diabetes Mellitus

Yaşar Arslan

26 An Acromegalic Patient with Empty Sella: Case Report

Şirin Zelal Şahin Tırnova, Elif Güneş, Soner Cander, Özen Öz Gül

27 Rapid Visual Improvement After Cabergoline Therapy in a Macroprolactinoma Case

Elif Güneş, Şirin Zelal Şahin Tırnova, Erdinç Ertürk

29 Nodular Thyroid Disease in Functional Pituitary Adenomas: Similarities and Differences

Sema Çiftçi Doğanşen, Gülşah Yenidünya Yalın, Seher Tanrıkulu, Sema Yarman

30 Postmenopausal Hook Effect

Rumeysa Çolak, Burcu Çoban, Muhammet Özer, Başak Özgen Saydam,

Erdener Özer, Nuri Karabay, A. Serkan Yener


31 The Association of Acromegaly and Visfatin

Hamide Pişkinpaşa, Yıldız Okuturlar, Sema Çiftçi Doğanşen, Yasemin Şefika Akdeniz, Ayşe Esen,

Sogol Sadri, Osman Pirhan, Mine Adaş, Sibel Ocak Serin, Asuman Gedikbaşı, Meral Mert

33 Rhinorrhea After Cabergoline Treatment for Giant Invasive Macroprolactinoma: A Case Report

Elif Güneş, Şirin Zelal Şahin Tırnova, Erdinç Ertürk

35 Characteristics of Acromegaly Patients Followed at a Single Center

Gülşah Elbüken, Orhan Yağmur, İsmail Yıldız, Tamer Tunçkale, Tezcan Çalışkan,

Numan Karaarslan, Sayid Shafi Zuhur

36 Radiotherapy in Cushing’s Disease

Hande Mefkure Özkaya, Tuğçe Apaydın, Pınar Kadıoğlu

37 Mild Symptomatic Postpartum Pituitary Apoplexy: A Case Report

Mehmet Güven, Zafer Pekkolay, Belma Özlem Tural Balsak, Hikmet Soylu, Alpaslan Kemal Tuzcu

38 Spontaneous Cervical Hematoma in a Primary Hyperparathyroidism Patient

İffet Dağdelen Duran

39 Preoperative Parenteral Ibandronate for Treating Severe Hypercalcemia Associated

with Primary Hyperparathyroidism: An Effective and Cheap Drug

Zafer Pekkolay, Faruk Kılınç, Hikmet Soylu, Belma Özlem Tural Balsak, Mehmet Güven,

Şadiye Altun Tuzcu, Alpaslan Kemal Tuzcu

40 Osteoporosis Following Antiretroviral Therapy in an HIV Positive Male Patient: A Case Report

Yılmaz Cankurtaran, Güzide Gonca Örük, Barış Önder Pamuk

41 Case Report: The Efficacy of Zolendronic Acid in Patients with Osteogenesis Imperfecta

Müge Keskin, Arzu Or Koca, Murat Dağdeviren, Derun Taner Ertuğrul, Mustafa Altay


42 Do We Neglect the Risk of Fracture?

Betül Ekiz Bilir, Bülent Bilir

43 Evaluation of Clinical and Laboratory Parameters Affecting Measurements of

Bone Mineral Densitometry in Renal Transplantation Patients

Rıfkı Üçler, Zekeriya Hannarici, Saliha Yıldız

44 Evaluation of Causes of High Parathyroid Hormone Levels in Elderly

Pelin Tütüncüoğlu, Fulden Saraç

45 Retrospective Analysis of Patients with Hypoparathyroidism

Güven Barış Cansu, Bengür Taşkıran

46 Clinical Caracteristics of Patients with Subacute Thyroiditis

Pelin Tütüncüoğlu, Fulden Saraç

47 Serum Endocan Levels in Graves' Disease

Sami Aksan, Mehmet Muhittin Yalçın, Alev Eroğlu Altınova, Müjde Aktürk, Füsun Baloş Törüner

48 Percutaneous Ethanol Injection for Benign Cystic and Mixed Thyroid Nodules

Ayşenur Özderya, Kadriye Aydın, Naile Gökkaya, Şule Temizkan

50 Simultaneous Papillary and Medullary Carcinoma in the Thyroid Gland

Rıfkı Üçler, Gülçin Miyase Sönmez, Saliha Yıldız

51 Evaluation of Choroidal Thickness Changes in Euthyroid Graves’ Ophthalmopathy

Eylem Çağıltay, Fahrettin Akay

53 Irisin Levels Increases After Treatment in Patients with Newly Diagnosed Hashimoto Thyroiditis

Ziynet Alphan Uç, Süheyla Görar, Soycan Mızrak, Sevim Güllü


55 Comparison of Serum Netrin-1, Nesfatin-1 and Adropin Levels

in Subclinical and Overt Hypothyroidism

Gülhan Akbaba, Emine Koca, Neşe Çınar, Tuba Edgünlü, Kürşad Tosun

56 The Frequency of Thyroid Diseases in Women with Breast Cancer

Mehmet Ali Eryılmaz, Cevdet Duran, Hande Köksal, Halis Elmas

58 Plasma Betotrophin Levels of Patients with Subclinical Hypothyroidism

Rıfkı Üçler, Abdurrahman Biçer, Saliha Yıldız

59 A Case Report of Metastasis to Thyroid Gland from Squamous Cell Carcinoma of Lung

Davut Sakız, M. Erkam Sencar, Murat Bayram, Cengiz Karaçin, İlknur Öztürk Ünsal,

Tuğba Taşkın Türkmenoğlu, Bekir Uçan, Mustafa Özbek, Erman Çakal

60 Frequency of Anemia and Its Association with Disease Activity in Subacute Thyroiditis

Nurdan Gül

61 The Place of Interventional Blocks in the Treatment of Pain Due to Fibromyalgia

in Hashimoto's Disease

Yaşar Arslan

62 The Relationship of Serum Osteoprotegerin Level with Hormonal and Cardiovascular Parameters

in Patients with Polycystic Ovary Syndrome

Zeynep Çetin, Dilek Berker, Berna Tekin, Muhammed Kılınçkaya, Turan Turhan, Merve Çatak

63 Association of Serum Betatrophin with Fibroblast Growth Factor-21

in Women with Polycystic Ovary Syndrome

Seda Kahraman, Alev Eroğlu Altınova, Mehmet Muhittin Yalçın, Özlem Gülbahar,

Burak Arslan, Müjde Aktürk, Nuri Çakır, Füsun Baloş Törüner


64 Vandetanib Experience in a Patient with Ectopic Cushing Syndrome

in Metastatic Medullary Thyroid Cancer

Şafak Akın, Serkan Akın, Osman Kupik

65 Tricho-Rhino-Phalangeal Syndrome is a Rare Presentation of Brachydactyly

Anara Karaca, Işılay Taşkaldıran, Tülay Omma, Neşe Ersöz Gülçelik, Murat Baştepe

66 Visceral Adiposity Index Levels in Patients with Hypothyroidism

Selma Pekgör, Cevdet Duran, Ruhuşen Kutlu, İbrahim Solak, Ahmet Pekgör, Mehmet Ali Eryılmaz


Turk J Endocrinol Metab 2018;22(Suppl):S1 S1

Introduction: Obesity is a public health problem involvingboth children and adults with an increasing prevalence inthe World and North Cyprus. In this study we aimed to de-termine the prevalence of childhood obesity in our countryand plan future studies.Subjects and Methods: In May-June 2007, we collecteddemographic, anthropometric and nutritional data of 7832students between 12-15 years of age studying in 29 diffe-rent secondary schools. We determined that the preva-lence of obesity was 13.7% (1073); overweight 18.3%(1433); low body weight 3.5% (274). We invited 274 child-ren in the obese group to our department of Endocrinologyand Metabolism for anthropometric and metabolic analy-ses.Results: Two hundred and seventy four (53.6%) were girlsand 127 (46.4%) were boys. The median age was 13.66.According to the National Cholesterol Education ProgramAdult Treatment Panel – III criteria (NCEP ATP III). 122(44.5%) were diagnosed as Metabolic Syndrome (MetS).The body mass index percentiles correlated positively with

the waist circumference, hip circumference and HOMA IRscore (r= 0.53; p<0.001; r=0.54. p<0.001; r=0.15;p<0.05 respectively). HOMA IR correlated positively withsystolic blood pressure. diastolic blood pressure. triglyceri-des. hip circumference. fasting blood glucose and waist cir-cumference (r=0.19; p<0.001; r=0.17. p<0.001; r=0.28;p<0.001; r=0.23; p<0.001; r=0.25; p<0.001; r=0.30;p<0.001 respectively). According to Receiver operated cha-racteristics (ROC) curves. a HOMA IR score of ≥2.15 pre-dicted MetS with 90% sensitivity and 20% specificity. AHOMA IR score of ≥ 5.35 predicted MetS with 90% specifi-city and 29% sensitivity (AUC 0.619. %95 CI: 0.552-0.686.p<0.001). The mean TSH level of subjects with MetS washigher than those without Mets (3.84±3.09 vs. 2.94±1.91;p=0.004). The free T4 levels were similar in both groups.The prevalence of diabetes in the family was similar in sub-jects with and without MetS [73/122 (59.8%) vs. 105/152(69.1%). p=0.127].Conclusion: The prevalence of childhood obesity and as-sociated comorbidities are similar in North Cyprus withother Mediterranean countries.

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Prevalence of Childhood Obesity andAssociated Morbidities in North Cyprus

Department of Endocrinology and Metabolism, Burhan Nalbantoglu Hospital, Lefkosa, Cyprus

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Background and Aims: The present study aimed to des-cribe characteristics of patients with type 2 diabetes (T2D)initiated on dapagliflozin in routine outpatient clinical care inTurkey, post-dapagliflozin changes in glycated hemoglobin(HbA1c), body weight and blood pressure.Materials and Methods: Descriptive retrospective obser-vational cohort study using data from Turkish patient medi-cal records from 79 different internal medicine orendocrinology clinics. Study cohort will include T2D patientswho received at least one prescription for dapagliflozin forthe first time between July 2016 and June 2017 and whohave been registered in that centre for at least 6 monthsprior to the first dapagliflozin prescription.Results: In total, 1683 patients were identified. The meanage of the patients (56.6% female) included in the analysiswas 54.9 years (Table 1). At baseline, mean HbA1c was 9.1%and the mean weight was 89.2 kg. The mean time since T2Ddiagnosis was 9.1 years and 26.4% of patients had a history

of retinopathy, 11.3% a history of neuropathy and 8.3% ahistory of nephropathy. HbA1c values were recorded in 815patients, body weight was recorded in 851 and blood pres-sure in 799 patients before the first prescription of dapaglif-lozin and during dapagliflozin treatment, 6 months afterstarting dapagliflozin. HbA1c declined by mean of -1.33%(95% CI -1.44 to -1.20, p<0.001), weight declined by meanof -4.18 kg (95% CI -4.65 to 3.71, p<0.001), and systolicand diastolic blood pressure decreased by means of -8.68(95% CI -9.53 to -7.83, p<0.001) and -4.92 (95% CI -5.54to -4.29, p<0.001) mmHg, respectively from baseline (Table2). Results were consistent across subgroups.Conclusion: This real world evidence study showed signi-ficant and clinically meaningful reductions in HbA1c, bodyweight and blood pressure after initiation of dapagliflozin inpatients with T2D in Turkey, and these results support chan-ges observed with dapagliflozin treatment in randomized cli-nical trials.Keywords: Blood pressure; body weight; HbA1c

S-13

Dapagliflozin in Type 2 Diabetes Patientsin Routine Internal Medicine and

Endocrinology Outpatient Clinical Care;A Retrospective Cohort Study from Turkey

Kecioren Training and Research Hospital, Endocrinology and Metabolic Diseases Clinic, Ankara, Turkey*Samsun Medicana Hospital, Endocrinology and Metabolic Diseases Clinic, Samsun, Turkey

**Tokat State Hospital, Endocrinology and Metabolic Diseases Clinic, Tokat, Turkey***Umraniye Training and Research Hospital, Internal Diseases Clinic, İstanbul, Turkey

****Manisa Grand Medical Hospital, Endocrinology and Metabolic Diseases Clinic, Manisa, Turkey*****Eskisehir Anadolu Hospital, Internal Diseases Clinic, Eskisehir, Turkey

******AstraZeneca Pharmaceutical Company, a subsidiary of AstraZeneca PLC, İstanbul, Turkey*******Gazi University Faculty of Medicine, Endocrinology and Metabolic Diseases Department, Ankara, Turkey

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Percentages calculated for all patients with data available; patients with missing data were excluded, BMI, body mass index; DPP-4i, dipeptidyl peptidase-4inhibitor; GLP-1A, glucagon like peptid-1 analog; HbA1c, glycated haemoglobin; SU, sulphonylurea; T2DM, type 2 diabetes melllitus; TZD, thiazolidinedione.

Data are mean (SD) or mean (95% CI), DBP, diastolic blood pressure; HbA1c, glycated haemoglobin; SBP, systolic blood pressure.

Total N=1683

Female, n (%) 952 (56.6)Age, years, mean (SD) 54.9 (9.1)BMI, kg/m2, mean (SD) 32.2 (5.8)HbA1c, %, mean (SD) 9.1 (1.7)Duration of type 2 diabetes, years, mean (SD) 9.1 (6.0)Outpatient clinic, n (%)

Internal medicine 822 (48.8)Endocrinology 861 (51.2)

History of microvascular complication, n (%)Retinopathy 444 (26.4)Neuropathy 190 (11.3)Nephropathy 140 (8.3)

Antihyperglyceamic therapy, n (%)Dapagliflozin 1683 (100.0)Metformin 1481 (88.0)SU 556 (33.0)TZD 205 (12.2)DPP-4i 876 (52.0)GLP-1A 186 (11.1)Insülin 696 (41.4)Other 160 (9.5)

Table 1. Baseline characteristics and concurrent diabetes medications.

N Baseline 6 months Change from baseline p value

HbA1c, % 815 8.97 (1.65) 7.64 (1.20) -1.33 (-1.44 to -1.20) <0.001

Body weight, kg 851 88.65 (16.31) 84.47 (15.32) -4.18(-4.65 to -3.71) <0.001

SBP, mmHg 799 132.45 (14.67) 123.77 (11.44) -8.68 (-9.53 to -7.83) <0.001

DBP, mmHg 799 81.55 (9.58) 76.63(7.65) -4.92(-5.54 to -4.29) <0.001

Table 2. Change in HbA1c, body weight and blood pressure.

Turk J Endocrinol Metab 2018;22(Suppl):S2-S3

S4

Introduction: “Aryl hydrocarbon receptor-interacting pro-tein (AIP)” gene mutations have been associated with spo-radic pituitary adenomas (PAs) in different populations witha prevalence range of 3.6-11.7%. Among mutation carri-ers, male patients were more frequent and young patients(<=30 years) with treatment resistant have been shown toexhibit AIP mutations. AIP mutation prevalence was detec-ted 1% in sporadic acromegaly patients from Anatolian partof Turkey, by another group. The aim of our study was toform a broader cohort composed of acromegaly, prolacti-noma and Cushing patients from different parts of Turkeyand screen AIP gene mutations in this group.Material and Methods: A total of 97 patients (55 soma-totrophinoma, 25 prolactinoma, 17 corticotrophinoma), whowere followed-up at our pituitary out-patient clinic and werediagnosed before 40 years old have been recruited. Previ-ously, 56 of these patients’ AIP genetic screen have beenreported. DNA was isolated from peripheral blood of the pa-tients and Sanger sequencing of AIP gene’s coding and flan-king regions were performed for point mutation screening,where mutation negative patients were subjected to MLPAmethod to detect copy number variations.

Results: The previous screen on 56 of our patients did notcarry point mutations and MLPA method did not reveal copynumber variations in these patients, too. However two ofthe additional 41 patients revealed to carry AIP c.911G>Ap.Arg304Gln (rs104894190) clinical variant. One of the pa-tients was diagnosed with acromegaly (1/55; %1.8), wherethe other was with prolactinoma (1/25; %4). Differing tre-atment models (2 operations, radiotherapy, SSA, SSA+DA)was performed on the acromegaly patient. Prolactinoma pa-tient underwent surgery due to DA intolerance (heavysymptomatic hypotension), post-operative hypopituitarismhas been developed, but tumor did not relapse. None of thepatients exhibited copy number variations.Conclusion: We detected a lower AIP gene mutation pre-valence (%2.1; 2/97) has been detected among thecohort of young sporadic pituitary adenoma with hyper-function patients in a cosmopolitan city. However, it shouldbe kept in mind that mutation carriers could be “apparentlysporadic”, thus family history should be questioned withcare.

Keywords: Sporadic pituitary adenoma,AIP gene,Arg304Gln clinical variant

S-30

Screening of AIP Gene Mutationsin Young Sporadic Pituitary Adenoma Patients

İstanbul University Aziz Sancar Institute of Experimental Medicine, Department of Genetics, İstanbul, Turkey*İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases;

Bakırköy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey**Division of Endocrinology and Metabolic Diseases, Haydarpaşa Numune Education and Research Hospital, İstanbul, Turkey

***İstanbul University, Istanbul Faculty of Medicine, Pathology Department, İstanbul, Turkey****İstanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine,

Division of Endocrinology and Metabolic Diseases, İstanbul, Turkey

Turk J Endocrinol Metab 2018;22(Suppl):S4

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Aim: To evaluate joint complaints, physical examinationsand X-rays of acromegalic patients and investigate associa-tion between arthropathy and disease remission and effectsof arthropathy on quality of life.Method: Acromegalic patients followed at Endocrinology cli-nic of Cerrahpasa Medical Faculty between 2015-2017 werescreened. Demographic and disease status, physical exami-nations and quality of life scales (Acro-QoL) were recorded.The symptoms and examination findings of patients consul-ted with Rheumatology or Physical Therapy-Rehabilitationdepartments and X-rays were evaluated, retrospectively.Results: Ninety-seven patients were assessed, 38 patients(F/M:31/7; p=0.006) had joint complaints and 59 (60.8%;F/M: 40/19; p>0.05) had pathological joint findings. Patho-logical joint signs were found in 30 patients with nosymptoms, whereas 9 out of 38 patients who declared jointsymptoms had no signs at rheumatological examination.

Patients with symptoms and signs were older (47.6±11.5vs 53.3±11.9; p=0.02 and 44.3±9.1 vs 53.4±12.3;p<0.001, respectively). When patients were evaluated ac-cording to remission status as remission with medical tre-atment (n=43), remission after surgery(n=27) and activedisease (n=18); duration of disease in active disease groupwas shorter (p=0.01). Other parameters were similar bet-ween groups. There was a significant correlation betweenAcroQoL and shoulder and AcroQoL and small hand jointsinvolvements (p=0.007, r=-0.2 vs p=0.004, r=-0.3), whe-reas no correlation was found between AcroQoL and knee orelbow involvements. No association found between diseaseduration and symptoms, examination findings, radiologicalfindings or AcroQoL.Conclusion: Joint degenerative changes detected in 60%of acromegalic patients, and affect quality of life, Regularevaluation of joint symptoms is recommended in the ma-nagement of acromegalic patients.

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Joint Involvement in Patients withAcromegaly and the Association Between

Arthropathy and Disease Remission

Department of Internal Medicine, Division of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, İstanbul University, İstanbul, Turkey*Department of Physical Therapy and Rehabilitation, Cerrahpasa Medical Faculty, İstanbul University, İstanbul, Turkey

**Colormed Imaging Center, İstanbul, Turkey***Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, İstanbul University, İstanbul, Turkey


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Introduction: Development of thyroid nodules is commonin acromegaly patients. However data related with the cli-nical course of these nodules is rare in literature. We aimedto evaluate the relationship between thyroid nodules anddisease activity in acromegaly patients.Material and Methods: Presence of nodular thyroid di-sease, papillary thyroid cancer and parameters related withnodule development were investigated in a total of 138 ac-romegaly patients (F:73, M:65). In patients who were beingfollowed up during the study period (n:56), thyroid ultraso-nography was performed by an experienced radiologist andchanges in nodule size (Group -1: decrease by >20%,Group-2: stationary with 0-20% change, Group-3 increaseby >20%) was compared with disease activity.

Results: Frequency of thyroid nodules was %69 (n=95; 20solitary nodul/75 multiple nodules), FNAB biopsy (n:55) re-vealed 66% benign, 16% suspicious, 11% malign and 7%nondiagnostic cytological results. Patients with thyroid no-dules were older (p=0.05), had higher baseline IGF-1 %ULN (upper limit of normal) levels (p=0.01) and colonpolyps were more frequent (p=0.017) (Table 1). Nodul sizewas stationary, decreased or increased in 45%, 30% and25% of the patients, respectively. Presence of disease acti-vity was significantly higher in patients with increased nodulsize (p<0.0001) (Table 2).Conclusion: Tyroid nodules are correlated with age and ba-seline IGF-1 levels in acromegaly patients. Thyroid nodulesshould be monitored regularly in patients with active acro-megaly.

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Evaluation of the Relationship BetweenThyroid Nodules and Disease Activity

in Patients with Acromegaly

İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey

p<0.05, statistically significant, Significant p values are shown in bold; FNA; fine needle aspiration, RAI; radioactive iodine therapy; *: Acromegaly & Cus-hing’s Disease; º: Acromegaly & Cushing’s Disease, acromegaly & prolactinoma

N=232 Acromegaly (n=138) Prolactinoma (n=59) Cushing’s Disease (n=35) p

Sex (Male/Female) 65/73 22/37 7/28 0.009*Age at diagnosis (years) mean±SD 42±13 36±13 36±11 <0.001ºPrevalence of nodular thyroid disease (n, %) 95 (69) 21 (36) 12 (34) <0.001º

Single nodule (n)/Multiple nodules (n) 20/75 7/14 6/6 NSDominant nodul size (mm) mean±SD 17.4±9.7 15.5±10.3 14.5±6.7 NSFNA cytology (n, % of patients with nodules) 55 (58) 10 (48) 8 (67) NS

Benign (n, %) 36 (66) 8 (80) 3 (38)Suspicious (n, %) 9 (16) 1 (10) 2 (25)Malignancy (n, %) 6 (11) - 2 (25)Nondiagnostic (n, %) 4 (7) 1 (10) 1 (12)

Surgery (n, % of patients with nodules) 27 (28) 3 (14) 5 (42) NSSuspicion of malignity 13 (48) 2 (67) 5 (100)Increased nodule size 8 (30) 1 (33) -Intrathoracic goiter 4 (15) - -Thyrotoxicosis 2 (7) - -

Prevalence of papillary thyroid carcinoma 15 (16) 2 (10) 4 (33) NS(n, % of patients with nodules)Largest tumor diameter (mm) (mean±SD) 11±9 (1-30) 26±12 (17-35) 21±9 (14-9)High risk subtype (n, %) 1 0 1RAI therapy (n, %) 9 2 4Remission rate at last visit (n, %) 14 (93) 2 (100) 4 (100)

Table 1. Comparison of functional pituitary adenomas in terms of nodulary thyroid disease and papillary thyroidcarcinoma.


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p<0.05 statistically significant, Significant p values are shown in bold; º: TSH level was assessed in patients without central hypothyroidism; *: Patientswith diabetes mellitus or prediabetes; NS, not significant; TSH, thyroid stimulating hormone; HOMA-IR, homeostasis model assessment of insulin resis-tance; IGF-1, insuline-like growth factor-1; GH, growth hormone; IGF-1 % ULN; the % increase compared with the upper limit of normal, PRL, prolac-tin; ACTH, adrenocorticotropic hormone.

Patients with nodule Patients without nodule

N=232 (n=128) (n=104) p

Sex (Male/Female) 52/76 42/62 NS

Age at diagnosis (years) mean±SD 42±13 37±13 0.01

Max. adenoma diameter (mm) mean±SD 16±10 17±12 NS

TSH levelsº (mIU/L) mean±SD 1.9±3 1.9±1.8 NS

Glucose metabolism disorders* (n, %) 92 (72) 57 (55) 0.006

Fasting plasma glucose (mg/dl) mean±SD 116±41 102±32 0.014

HbA1c (%) mean±SD 7.1±1.9 6.4±1.4 NS

HOMA-IR mean±SD 4.9±5.1 4.1±3.3 NS

Baseline IGF-1 % ULN (patients with acromegaly) mean±SD 334±149 254±82 0.01

Baseline GH levels (ng/ml) (patients with acromegaly) mean±SD 19±17 19±14 NS

Colonic polyp (n, %) (patients with acromegaly) 29 (31) 5 (12) 0.017

Baseline PRL levels (ng/ml) (patients with prolactinoma) mean±SD 1343±2902 1329±2381 NS

Baseline ACTH levels (pg/ml) (patients with Cushing’s disease) mean±SD 74±47 85±43 NS

Baseline cortisol levels (µg/dL) (patients with Cushing’s disease) mean±SD 31±11 28±10 NS

Table 2. Comparison of patients with and without nodule in terms of clinical and laboratory findings


S8

Aim: We aimed to investigate preoperative SSA treatmenteffects on the annual cost of all acromegaly treatment mo-dalities and also effects on remission rates in acromegaly.Methodology: The medical records of 135 with acromegalywho had been followed up at least 2 years after surgery inCerrahpasa Medical Faculty, Istanbul University, between2009-2016 were reviewed.Results: The median follow up time was 51 months [IQR:25-106 months]. Early remission defined according to thirdmonth values of patients who are under remission at 3thmonth after surgery. But early remission defined according tosixth month values of patients who are not under remissionat 3th month after surgery. The early and late remission ratesof all the study population were 40% and 80.7% respecti-vely. The early remission rate of the preoperative SSA-trea-ted group (%61.5) was significantly higher than SA untreatedgroup (%31.3) (p=0.002). The early remission rate of the

preoperative SSA-treated patients with macroadenomas(%52.5) was also significantly higher than SSA-untreatedgroup (%23.5) (p=0.016). There were no differences bet-ween groups in terms of late remission. The median annualcosts of all acromegaly treatment modalities in all study po-pulation was 15.684 TL (IQR: 1.307 TL-62.864 TL). The me-dian annual cost of treatment for macroadenomas wassignificantly higher than microadeadenomas (17.077 TL vs13.357 TL respectively; p=0.029). Preoperative SSA use inboth microadenomas and macroadenomas didn’t alter thecost of treatment (p=0.398; p=0.466).Conclusions: The preoperative medical treatment has noeffect on the costs of acromegaly treatment. Altough thereis a benefical effect of pre-operative SSA usage on earlyremission in acromegaly patients with macoadenomas, thiseffect didnt persist at long term.

Keywords: Acromegaly, preoperative treatment, cost

S-33

The Effects of Pre-operative SomatostatinAnalogue Therapy on Cost of Treatment and

Also Early-late Remissions in Acromegaly

Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes,Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey; Pituitary Center, Istanbul University, İstanbul, Turkey

*Cerrahpasa Faculty of Medicine, Istanbul University, İstanbul, Turkey**Department of Public Health, Istanbul University, İstanbul, Turkey


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Background: Obesity is a chronic metabolic disorder asso-ciated with cardiovascular disease, characterized by a chro-nic proinflammatory and prothrombotic state. Circulatingplatelets may differ in size and hemostatic potential. Largerplatelets contain more granules and produce greater amo-unts of vasoactive and prothrombotic factors. This studyaimed to investigate the effect of laparoscopic sleeve gas-trectomy on platelet count and mean platelet volume inmorbidly obese patients.Methods: 143 females and 62 males comprising a total of205 patients, who attended the monitoring visits starting inthe period prior to the sleeve gastrectomy till the monitoringvisit in the 6th month after the surgery, were included intothe study. The routine physical examination findings, andlaboratory parameters recorded preoperatively were com-pared with their counterparts obtained in the postoperative6th month.

Results: Prior to the sleeve gastrectomy, the mean PLTcount of the patients was 314.16±76.4 109/L; however asignificant reduction was observed in the mean PLT countduring the postoperative sixth month, which was calculatedas 263.17±65.67 109/L (p<0.001). While the MPV levelswere 10.12±0.88 fL, in the preoperative period, they weredetected to singnificantly increased to 10.41±1.23 fL,(p>0.001). Platelet counts in women were significantly hig-her preoperatively and postoperatively than in males. Theincrease in MPV levels after sleeve gastrectomy was foundboth in females and in males.Conclusions: The results of our study demonstrated thatthe levels of PLT decreased and MPV increased significantlyafter patients underwent sleeve gastrectomy and that thedecrease was independent of changes in BMI.

Keywords: Sleeve gastrectomy, platelet,mean platelet volume

S-36

Effect of Sleeve Gastrectomyon Platelet Count and Mean Platelet Volume

Department of Endocrinology and Metabolism, Gaziosmanpasa University, School of Medicine, Tokat, Turkey*Department of General Surgery, Gaziosmanpasa University, School of Medicine, Tokat, Turkey

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Platelet Count (109/L)

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Mean Platelet Volume (fL)

Figure: Effect of laparoscopic sleeve gastrectomy on platelet count and mean platelet volume.


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p: Independent Samples t test. Mean±SD *:Wilcoxon test. Median[IQR].

Preoperative Sixth Months After P value

Weight, kg 125.84 ±21.56 85.03±16.37 P<0.001

BMI, kg/m2 47.65±28.76 31.49±6.04 P<0.001

Hematolojic Parameters

Platelet (109/L) 314.16±76.40 263.17± 65.67 P<0.001

MPV (fL) 10.12±0.88 10.41±1.23 P<0.001

Leucocytes (/mm3) 9.44±2.40 7.47±2.03 P<0.001

Neutrophil (/mm3) 6.13±1.98 4.03±1.32 P<0.001

Lymphocytes (/mm3) 2.59±0.74 2.64±0.73 P=0.294

Hemoglobulin (gr/dl) 13.66±1.71 13.57±1.52 P=0.255

Metabolic and Hormonal Parameters

TSH, µIU/mL 1.95±1.6 1.91±1.58 P=0.017

Free T4, ng/dL 1.86±9.27 1.28±0.30 P=0.358

Glucose. mg/dl 111.2±37.73 97.75±62.48 P=0.019

ALT, U/L 30.74±22.07 19.85±20.53 P<0.001

AST, U/L 22.83±10.88 20.18±17.94 P=0.109

Vitamin B12, pg/ml 438.34±566.69 295.67±250.31 P=0.026

Folic acid, ng/ml 20.66±100.56 6.31±2.99 P=0.129

Calcium, mg/dl 9.40±0.47 10.28±7.14 P<0.001

Iron, µg/dl 70.45±182.51 74.24±24.56 P=0.828

Ferritin, ng/ml 91.52±182.51 84.25±96.97 P=0.687

25-hydroxyvitamin D, ng/ml 29.41±14.6 24.44±16.55 P<0.001

Table 1. Changes in metabolic parameters before and sixth months after LSG (N=205).

Pearson’s correlation coefficients were used.

Preoperative Sixth months after LSG

Preoperative BMI PLT MPV Sixth months after BMI PLT MPV

BMI r 1 .053 -.057 BMI r 1 -.027 -.029

p .448 .419 p .700 .680

PLT r 1 -.337** PLT r 1 -.313**

p .000 p .000

MPV r 1 MPV r 1

p p

Table 2. Correlation between BMI, PLT count, and MPV.


S11

Introduction: Diabetes mellitus (DM) and chronic kidneydisease (CKD) are global growing health problems that canbe controlled and avoided. Co-occurrence of DM and CKDmakes the treatment of both difficult. This study is conduc-ted to evaluate whether the treatment goals for DM andCKD patients are achieved according to KDOQI-2012 gui-deline.Materials and Methods: One-hundred sixty patients withstage 3-5 CKD and DM who had been followed in the neph-rology department for at least 3 months enrolled. From themedical records of the patients the data about the compati-bility with the treatment goals in KDOQI-2012 update guide-line for treatment of hyperglycemia (HbA1c levels).hypertension and dyslipidemia were collected, retrospectively.Results: Results are shown in Table 1 and 2. Number of pa-tients that were compatible with the treatment goal for

hyperglycemia (HbA1c level ~%7) was 94 (58.8%). No dif-ference was seen between different stages of CKD. Sixtytwo patients (46.3%) reached the treatment goal for hyper-tension. The compliance rate decreased with the progres-sion in CKD stages. It is recommended that patients withstage 3-5 CKD who are not on dialysis should take statinand the number of patients compatible with this was 54(39.9%).Conclusion: Compliance rates to the treatment goals inKDOQI-2012 guideline were still low and compliance ratesto hypertension treatment target decreased as the CKD sta-ges progressed. Worst compliance rate was observed indyslipidemia treatment and it may be because of the nega-tive perception about the dyslipidemia treatment.

Keywords: Diabetes mellitus, chronic kidney disease,KDOQI-2012

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The Compatibility of the Treatment ofChronic Kidney Disease and Diabetesto the KDOQI-2012 Update Guideline

The Department of Internal Medicine, The Division of Nephrology, The Medical School of Usak University, Uşak, Turkey*The Department of Internal Medicine, The Division of Endocrinology and Metabolism, The Medical School of Usak University, Uşak, Turkey

**The Department of Internal Medicine, The Medical School of Usak University, Uşak, Turkey


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CKD: Chronic kidney disease. DM: Diabetes mellitus. *p=0.034

Hba1c levels should Patients with diabetic kidneybe Blood pressure should be

Compliant/not compliant (n. %) ~7% disease should take statins ≤130/80 mmHg in

for cardiovascular prevention patients with hypertension

Compliant/not compliant (n. %) Compliant/not compliant (n. %)*

Stage 3a CKD patients 10/5 (66.7/33.3) 7/8 (46.7/53.3) 9/3 (75/25)

Stage 3b CKD patients 31/22 (58.5/41.5) 22/31 (41.5/58.5) 25/20 (55.6/44.4)

Stage 4 CKD patients 27/24 (52.9/47.1) 17/31 (35.4/64.6) 17/28 (37.8/62.2)

Stage 5 CKD patients 26/15 (63.4/36.6) 8/13 (38.1/61.9) 11/21 (34.4/65.6)

Total 94/66 (58.8/41.2) 54/83 (39.9/60.1) 62/72 (46.3/53.7)

Table 2. Compliance rates of patients with different stages of CKD to the KDOQI guideline.

CKD: Chronic kidney disease.

Gender (male/female) (%) 95/65 (59.4/40.6)Age (years) 67.6±10.6Body mass index (kg/m²) 29.3±5.4Systolic blood pressure (mmHg) 133±22Diastolic blood pressure (mmHg) 74±11Chronic kidney disease duration (months) 74.9±20.3Diabetes mellitus duration (year) 14.3±8.4Creatinin (mg/dL) 2.98±2LDL cholesterol (mg/dL) 105.4±35.6HbA1c (%) 7.6±1.6eGFR (CKD-EPI) (ml/min/1.73 m2) 25.5 (4-56)Patients with stage 3a CKD n (%) 15(%9.4)Patients with stage 3b CKD n (%) 53(%33.1)Patients with stage 4 CKD n (%) 51(%31.9)Patients with stage 5 CKD n (%) 41(%25.6)

Table 1. Baseline characteristics of patients.


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*: between group 1 and group 3 p=0.003+: between group 2 and group 3 p= 0.001Abbreviations: BMI: body mass index, EFT: epicardial fat tissue thickness, fT3: free triiodothyronine, fT4: free thyroxin, TRAb: TSHreceptor antibody, TSH: thyroid stimulant hormone.

Parameter Group 1 (n=26) Group 2 (n=26) Group 3 (n=26) p

Age (year) 39.1±11.4 38.7±13.9 39.1±11.4 NS

Gender (female/male) 17/9 17/9 17/9 NS

BMI (kg/m2) 25.8±4.5 26.1±4.7 25.8±4.5 NS

TSH (mIU/L) 0.007±0.004 0.01±0.007 1.7±0.9 NS

sT4 (ng/dL) 3.4±1.9 2.7±1.7 - NS

sT3 (pg/mL) 11.4±5.5 6.9 ±3.6 - <0.001

TRAb (IU/L) 9.6±6.8 0.59±0.42 - <0.001

EFT (cm) 0.38±0.15* 0.40±0.17+ 0.25±0.06 <0.001

Table 1. Comparison of clinical laboratory parameters in groups.

The pathogenesis of association between hyperthyroidismand atherosclerosis is not well known. TSH receptor anti-body (TRAb) is responsible for increased fat tissue in gravesophthalmopathy. Epicardial fat tissue thickness (EFT) hasbeen shown to increase in case of overt hyperthyroidism.In our study, we aimed to investigate the relationship bet-ween EFT and TRAb in newly diagnosed hyperthyroidism.Twenty six TRAb positive (group 1), 26 TRAb negative (dueto thyroiditis, toxic adenoma or gravese) (group 2) newlydiagnosed patients in outpatient clinic of Harran Universitywere enrolled. EFT was measured by the same cradiologistusing an echocardiography device. Serum TRAb levelsswere measured by the ‘Radio Receptor Assay’ method andlevels above 1.75 IU/L were considered as positive.There was no difference between groups in terms of age,gender and body mass index. Although there was no signi-ficant difference between group 1 and 2, mean EFT was sig-

nificantly higher in groups 1 (0.38±0.15 cm) and 2(0.4±0.17 cm) compared to group 3 (0.25±0.06 cm)(p=0.003 between group 1 and 3. p=0.001 between group2 and 3). Furthermore. there was no significant correlationbetween TRAb levels and EFT.Several studies showed that hyperthyroidism has been as-sociated with cardiovascular disease and mortality. Also theEFT has been found to be related with cardiovascular di-sease and mortality. TSH receptors and proteins have de-tected in orbital fibroblasts and adipose tissues and TSHreceptors have been found to be associated with adipoge-nesis in Graves ophthalmopathy. Stimulation of endogenousadipogenesis in orbital preadipocytes with dealing of TRAbhas been showed. The results of our study suggest that in-crease in EFT independent the presence of TRAb, it directlydepends on the cardiovascular effects of hyperthyroidism.The change EFT with the correction of hyperthyroidism bytreatment mus t be investigated.

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The Relation Between Epicardial Fat Tissue andTSH Receptor Antibody in Hyperthyroidism

Harran University Faculty of Medicine, Department of Internal Medicine, Şanlıurfa, Turkey*Harran University Faculty of Medicine, Division of Endocrinology and Metabolism, Şanlıurfa, Turkey

**Harran University Faculty of Medicine, Department of Cardiology, Şanlıurfa, Turkey


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*(p<0.05).

Patients Controls P value (Mann-Whitney U test)

The number of γ-H2AX foci 0.62±0.89 0.25±0.35 0.046*

γ-H2AX positive cell ratio (%) 19.14±21.62 7.99±9.43 0.039*

The number of 53BP1 foci 10.47±10.09 13.54±17.30 0.308

53BP1 positive cell ratio (%) 19.21±13.27 15.22±15.85 0.030*

Table 1. The number of γ-H2AX and 53BP1 foci per cell and γ-H2AX and 53BP1 positive cell ratio in euthyroidpatients with nodular goiter and control subjects (mean±SD).

Aim: Although the majority of thyroid nodules commonlyseen in most of people are benign, thyroid cancer accountsfor a small proportion of thyroid nodules. In recent years,the combined assay of the histone subunit H2AX phosp-horylated (γ-H2AX) and 53BP1 was used to determine DNAdamage such as DNA double-strand breaks (DSBs) and theDNA repair protein of p53 binding protein 1 (53BP1), as abiomarker for the response of cellular stress. The purpose ofpresent study was to evaluate DNA damage and DNA repaircapacities of peripheral mononuclear cells from whole bloodin euthyroid patients with nodular goiter by using combinedγ-H2AX and 53BP1 assay and a fully automatic imageanalysis system.Methods: Peripheral blood samples of euthyroidpatients with nodular goiter untreated and new diagnosed(n=33) and healthy control subjects (n=52) were pre-pared according to combined γ-H2AX and 53BP1 assay.The foci of γ-H2AX for DNA damage and 53BP1 forDNA repair was analysed using an automated reading sys-tem.

Results: In our study, the number of γ-H2AX foci per cell,γ-H2AX positive cell ratio and 53BP1 positive cell ratio ofeuthyroid patients with nodular goiter was found to behigher than in those of control subjects (p<0.05).Conclusion: In this study, we showed that DNA damage(DNA DSBs) and DNA repair capacities were increased inblood samples of euthyroid patients with nodular goiter usingγ-H2AX and 53BP1 foci analysis. Increased genome damageis events that can be seen in the early stages of carcinogen-esis. This increase in DNA damage of euthyroid patients withnodular goiter is indicated increased genome damage inthese patients and may be associated with possible futurecancer risk. Our results clearly demonstrated the importanceof long-term follow-up of euthyroid patients with nodular goi-ter in order to the increased malignancy risk.Acknowledgements: This work was supported by ErciyesUniversity Scientific Research Projects Units (Project no.:TYL-2015-5980).

Keywords: Genome damage; γ-H2AX assay; 53BP1;euthyroid; nodular goiter

S-46

DNA Breaks and Repair in Euthyroid Patients withNodular Goiter can Predict Cancer and be

a Biomarker?

Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey*Erciyes University, Faculty of Medicine, Department of Medical Biology, Kayseri, Turkey

**Erciyes University, Kayseri, Genom and Stem Cell Center, Kayseri, Turkey***Erciyes University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kayseri, Turkey


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Multiple Cardiovascular Risk FactorsManagement According to Guidelines in

Patients Initiating Second-Line Glucose-LoweringTreatment in Turkey: Results from the

Global DISCOVER Study

Hitit University Faculty of Medicine, Endocrinology and Metabolic Diseases Department, Çorum, Turkey*Yeditepe University Faculty of Medicine, Internal Diseases Department, İstanbul, Turkey

**Kayseri Training and Research Hospital, Internal Diseases Clinic, Kayseri, Turkey***Izmir Bozyaka Training and Research Hospital, Endocrinology Clinic, İzmir, Turkey

****AstraZeneca Pharmaceutical Company, a subsidiary of AstraZeneca PLC, İstanbul, Turkey*****Ondokuz Mayis University Faculty of Medicine, Endocrinology and Metabolic Diseases Department, Samsun, Turkey

******Akdeniz University Faculty of Medicine, Internal Diseases Clinic, Antalya, Turkey*******Gaziantep University Faculty of Medicine, Endocrinology and Metabolic Diseases Department, Gaziantep, Turkey

********Cukurova University Faculty of Medicine, Endocrinology and Metabolic Diseases Department, Adana, Turkey*********Erciyes University Faculty of Medicine, Endocrinology and Metabolic Diseases Department, Kayseri, Turkey

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Background and Aims: Numerous studies have shown theefficacy of controlling individual cardiovascular risk factorsin preventing or slowing atherosclerotic cardiovascular di-sease in people with diabetes. Furthermore. large benefitsare seen when multiple cardiovascular risk factors are add-ressed simultaneously. Here. we report glycated haemoglo-bin (HbA1c). low-density lipoprotein cholesterol (LDL-C).and systolic blood pressure (SBP) management at baseline(initiation of second-line treatment) among Turkish patientsparticipating in the DISCOVER study together with the com-parison versus the overall DISCOVER cohort.Materials and Methods: DISCOVER is a 3-year. non-in-terventional. prospective study assessing treatment and cli-nical outcomes in patients with T2DM initiating second-linetreatment across 37 countries. Consecutive patients withT2DM (aged ≥18 years) were invited to participate in thestudy if they were scheduled to initiate second-line glucose-lowering treatment (add-on or switch) following oral mo-notherapy. dual therapy or triple therapy in first-line setting.

Results: Mean HbA1c. LDL-C and SBP were 8.8%. 131.4mg/dL and 131.6 mmHg among the Turkish cohort compa-red to 8.4%. 108.1 mg/dL and 132.3 mmHg in the overallstudy population. respectively (Table 1). In total. 11.7% ofpatients had HbA1c <7% compared to 17.6% of the overallcohort. SBP <140 mmHg was observed in 62.5% of the pa-tients compared to 67.7% of the study population. While21.2% of patients had LDL-C levels <100 mg/dL in the re-sults from Turkey. this proportion was 43.5% in the overallcohort (Figure 1).Conclusion: Although poor glyceamic control is an expec-ted finding in patients initiating second-line treatment.fewer subjects were observed to achieve HbA1c and LDL-Ctargets in Turkey. Therefore. cardiovascular risk factors sho-uld be systematically assessed regularly in all patients withdiabetes. Modifiable abnormal risk factors such as hyper-tension and dyslipidemia should be treated as recommen-ded by guidelines.

Keywords: HbA1c; LDL-C; systolic blood pressure


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All Countries N=14178 Europe N=3492 Turkey N=536

Gender, male, n, % 7541 (53.2) 1864 53.4) 269 (50.2)

Age, years, mean (SD) 56.6 (11.7) 61.9 (10.9) 55.1 (10.0)

BMI, kg/m2, mean (SD) 29.6 (6.0) 31.9 (6.2) 31.7 (6.4)

Diabetes duration since diagnosis, years, median (IQR) 4.1 (2.0-7.8) 5.4 (2.7-9.1) 5.9 (2.9-9.2)

HbA1c, %, mean (SD) 8.4 (1.7) 8.1 (1.6) 8.8 (1.8)

LDL-C, mg/dL, mean (SD) 108.1 (39.6) 112.1 (42.4) 131.4 (44.5)

SBP, mmHg, mean (SD) 132.3 (16.9) 136.0 (17.9) 131.6 (15.9)

Table 1. Demographics and treatment characteristics of DISCOVER participants at the start of second-linetreatment.

Percentages were calculated for all patients with available data; missing data were excluded, BMI, body mass index; HbA1c, glyca-ted haemoglobin; LDL-C, low-density lipoprotein cholesterol; IQR, interquartile range; SBP, systolic blood pressure; SD, standarddeviation.

5 �5 .5 ,5 (5 /5 05 )5 *5

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+��

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<�� ?)#52 <�� 67<?�(5��

<�� ?�55��9��

Figure 1: Proportions of DISCOVER patients meeting the HbA1c, LDL-C and SBP targets at the start of second-linetreatment: overall, by region and by country.Note: Patient numbers vary across the groups owing to differences in availability of data for individual variables among countries.


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Purpose: Testicular Adrenal Rest Tumor (TART) is a condi-tion that is seen in men with congenital adrenal hyperplasiaand particularly in uncontrolled cases. Its pathogenesis isnot certain, but TART is believed to be derived from ectopicadrenal cortex remnants in the testis or from reprogrammedLeydig stem cells, that differentiate and grow under the ef-fect of chronically elevated ACTH. Pressure in the testis in-creases due to the mass effect, and it prevents sperm exit,It presents with bilateral testicular mass and infertility.Case Report: Bilateral testicular mass was detected in a28-year-old male patient on scrotal ultrasonography whohad referred for infertility 1.5 months earlier. Bilateral or-chiectomy was suggested to the patient with a presumedtesticular tumor. There were hypervascularized solid le-sions in right (18 mm), and left testes (15 mm) in his scro-tal USG. In MRI, bilateral testicular masses were detected(25x33 mm in right testicle and 16x22mm in the left). Thepatient who did not accept the operation was directed toour endocrine polyclinic with the complaints of testicularmass and azoospermia. His laboratory test results were as

following: LH: 0.1mIU/ml (1.7-8.6), FSH: 0.1 mIU/ml(1.5-12.4), T, Testesteron: 6.7 ng/ml (2.18-9), Prolaktin:18 ng/ml (4.04-15.2), TSH: 3.19 (0.270-4.2), T4: 16.7pmol/L (12-22), Kortizol: 3.5 µg/dL, ACTH:153 pg/mL, 17Hidroksiprogesteron: 48 ng/mL, BHCG:0.1 mIU/ml (<5.3),AFP: 0.55 IU/ml (0.5-5.5), Synacten Test was conducted,Kortizol 30.dk was 4.9. 60.dk 4.9. 90.dk 4.9. 120.dk 5.4.17-hydroxyprogesterone level at 30.dk was 39.7. 60.dk36.5. 90.dk 28.8. 120.dk 25. No sperm cells were detectedin the spermiyogram. Congenital Adrenal Hyperplasia andTesticular Adrenal Rest tumor were diagnosed in this pa-tient. Prednisolone 5 mg started. Genetic analysis revealedmutation in 21 hydroxylase gene. In his follow-up, 7.5 mil-lion sperm were detected in the spermiogram and bilateralmasses with slight shrinkage.Conclusions: Adults with congenital adrenal hyperplasia(CAH) may refer with infertility and bilateral testicular ad-renal mass. The patient should be well assessed; surgeryshould not be performed if not necessary. Fertility is possi-ble by starting corticosteroid therapy and adjusting the op-timal dose.

P-001

Testicular Adrenal Rest Tumor

Dicle Universty School of Medicine, Adult Endocrinology Department, Diyarbakır, Turkey


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Ganglioneuromas arise from sympathetic ganglion cells and,like paragangliomas and pheochromocytomas, have the ca-pacity to synthesize and secrete catecholamines (%30).They can be seen anywhere throughout the sympatheticnervous system but most commonly located in the posteriormediastinum and retroperitoneum. They usually hormon-ally inactive and detected incidentally. We report a case ofa female patient with incidentally detected adrenal gan-glioneuroma.Case: Eighteen-year old female patient was admitted to hos-pital with abdominal pain. Physical examination was insignif-icant except right lower quadrant pain. Laboratory tests werenormal with no significant past medical history. She was pre-diagnosed as appendicitis and abdominal ultrasonographywas performed which revealed 95x52 mm well-defined right

adrenal mass lesion. Patient was referred to endocrinologydepartment for futher evaluation. Abdominal MRI showed asolid mass measuring 65x72x91 mm arising from right ad-renal gland. Tumor was hypointense on T1A and T2A-weighted images, with no significant washout. Endocrinologicevaluation of urinary catecholamines, cortisol, calsitonin werenormal. One mg overnight dexamethasone suppression testwas suppressed. Although catecholamine levels were normal,we could not exclude pheochromocytoma so alpha blockertreatment was initiated preoperatively. Right adrenalectomywas performed without any complications. Pathology resultwas compatible with ganglioneuroma.As no sign and symptoms are pathognomonic for adrenalganglioneuromas differential diagnosis is often challenging.Adrenalectomy is the gold standard for the diagnosis andtreatment. Overall prognosis is generally good.

P-003

A Rare Cause of Adrenal Incidentaloma:Ganglioneuroma

Haydarpasa Numune Education and Research Hospital, Department of Endocrinology and Metabolism, İstanbul, Turkey*Haydarpasa Numune Education and Research Hospital, Department of Pathology, İstanbul, Turkey

**Haydarpasa Numune Education and Research Hospital, Department of General Surgery, İstanbul, Turkey


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Objective: Cortisol and ACTH levels increase by age.Causes of cortisol increase are increased secretion and de-creased catabolism. Aim of this study was; 1. To comparebasal cortisol levels in elderly and middle-aged type 2 dia-betic patients. 2. To determine the factors affecting plasmacortisol levels.Material and Methods: Fourty diabetic patients ≥65 yearsof age, and 50 middle-aged diabetic patients were enrolledin the study. Patients receiving oral, parenteral or inhaledcorticosteroid therapy were excluded. Biochemical testswere evaluated retrospectively.Results: Mean cortisol level was 10.1±4.9 µg/dL in theelderly, and 11.3±5.0 µg/dL in the controls (P>0.05)(mean age= 75.8±11.8 years; 54.2±6.0 years, respec-

tively). Mean cortisol level in older women were higherthan in men (12.1±7.6 and 9.9±6.1. P<0.001). Mean cor-tisol level correlated positively with fasting blood glucose(FBG) (r=0.344, P=0.001) and HbA1c (r=0.230,P=0.005), negatively with uric acid level (r=-0.110,P=0.01) in the elderly. In the controls; mean cortisol levelpositively correlated with FBG (r=0.400. P=0.0001), postprandial BG (r=0.700, P=0.001) and HbA1c (r=0.170,P=0.01).Conclusion: In elderly and middle-aged diabetic patients,mean basal cortisol level was similar. Older women hadhigher cortisol levels than men. In all diabetics; there wasa positive correlation between cortisol and FBG. There wasa negative correlation with cortisol and uric acid in the eld-erly.

P-011

Basal Cortisol Levels in the Elderly andMiddle-Aged Type 2 Diabetic Patients

Geriatrics Section, Internal Medicine Department, Ege University, School of Medicine, İzmir, Turkey*İzmir Katip Celebi University, Atatürk Education and Research Hospital, Endocrinology and Metabolism Department, İzmir, Turkey


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Introduction: Primary adrenal insufficiency (addison'sdisease) is associated with glucocorticoid deficiency.Weight loss, orthostatic hypotension due to dehydration,hyponatremia, hyperkalemia, blood count disorders andhypoglycaemia are seen. The appropriate dose of gluco-corticoid and minerocorticoid replacement should be ap-plied in the treatment. Many risk factors, such as steroidtherapy, are responsible for avascular necrosis in patientswith Addison's disease. Here, we are presenting a case re-lated to interventional blocks in the treatment of avascu-lar necrosis which develops during Addison's diseasetreatment.Case: 63 years old female patient. She has been monitoredas an Addison's disease patient for 10 years and has a painthat is spreading downwards from the left hip for 5 years.She was using deltacortil 5 mg tb 1X1 for this Addison's dis-ease. For the pain, she was admitted to various clinics for 5years and lumbar disc herniation was diagnosed in the lum-bar MR imaging, and operation for pregabalin 75 mg tb 2X1-

initiated LDH was proposed, but as it was not accepted shewas admitted to algology polyclinic. VAS was 9-10 when shecame here. We told the patient to continue with previoustreatments and suggested to apply an interventional block.First, caudal epidural block was applied, and she was told tocome back 15 days later with hip MR imaging results. VASwas 6-7 in the control and avascular necrosis was found tobe present in the left hip MR. After that, caudal epiduralblock + left femoral intraarticular injection was applied, and15 days later caudal epidural block + left femoral intraar-ticular injection + left lumbar vertebral facet joint block wasapplied; and VAS was 1-2 in the control performed 15 dayslater. Then the previous 3 blocks were repeated, and treat-ment was ended with control to be performed 3 monthslater.Conclusion: With the application of interventional block,sympathetic block, parasympathetic activity and vasodi-latation develops here and oxygen increases in the dam-aged area. We think that the treatment here is associatedwith this mechanism.

P-019

The Place of Interventional Blocksin the Treatment of Avascular Necrosis Developing

in Patients with Addison's Disease

Department of Anesthesiology and Reanimation, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey


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Objective: In obese young patients with prediabetes, in-tramyocellular and intraabdominal lipid accumulation isclosely linked to the development of severe peripheral in-sulin resistance. Skin diseases have been associated withinsulin resistance such as acanthosis nigricans, skin tags,acne, psoriasis, hidradenitis suppurativa, androgeneticalopecia and hirsutism. Hyperinsulinemia activates insulingrowth factor-1 (IGF-1) receptors located in fibroblastsand keratinocytes and thereby stimulating their prolifera-tion.Case: 19 year old male patient was referred to endocrinol-ogy department for violaceus striae. On physical examina-tion there were linear strias (for 2 years) localized onabdominal area, and brown patches and depigmented mac-ulas on lateral trunk and neck areas (for 12 years). BMI was30 kg/m2. There was no history of any medication includingsteroids. Laboratory findings: fasting blood glucose: 89

mg/dl (70-99), creatinine: 0.77 mg/dl (0.72-1.25), ALT: 47(0-54), insulin: 15.7 µIU/ml (0-29), morning cortisol: 13.2µg/dl (4.3-22.4), ACTH: 24.7 pg/ml (0-46), and cortisolafter 1 mg dexamethasone suppression test: 0.7 µg/dl,OGTT 0. hour: 101 mg/dl, 2. hour: 165 mg/dl, HOMA-IR:3.45. HbA1c: 6. Punch biopsy specimen (0.2 cm) was takenfrom lesions and he was diagnosed with lichen sclerosis etatrophicus.Conclusion: Skin is the largest organ of human body, andendocrinological disorders may present with skin lesions be-fore the disease itself becomes more obvious for diagnosis,We diagnosed both IFG and IGT in a patient presenting witha combination of three unusual skin lesions, vitiligo, striaeand lichen sclerosis et atrophicus. These skin lesions shouldbe evaluated for diabetes in clinical practice.

Keywords: Lichen sclerosis et atrophicus,prediabetes, obesity

P-021

Lichen Sclerosis et Atrophicus May be Associatedwith Prediabetes

Department of Endocrinology and Metabolism, Kecioren Education and Research Hospital, Ankara, Turkey*Department of Dermatology, Kecioren Education and Research Hospital, Ankara, Turkey


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a: p=0.003 between Group 1 and Group 2; b: p<0.001 between Group 1 and Group 3; c: p<0.001 between Group 1 and Group 4;d: p=0.007 between Group 2 and Group 3 a; e: p=0.014 between Group 2 and Group 4; f: p=0.001between Group 2 and Group 4;g: p=0.002between Grup 3 and Grup 4; h: p<0.001between Grup 2 and Grup 4; i: p=0.001 between Grup 3 and Grup 4; j: p=0.006between Grup 1 and Grup 4; k: p=0.002between Grup 1 and Grup 3; l: p=0.001between Grup 1 and Grup 3.

Parameters Group 1 (n=26) Group 2 (n=17) Group 3 (n=24) Group 4 (n=20) p

Gender (female/male) 13/13 7/10 15/9 9/11 NS

Age (year) 48.7±10.4 50.7±10.1 54.6±9.0 53.4±9.1 NS

Glucose (mg/dL) 90.4±8.8a.b.c 155.9±37.0d 216.0±98.4 198.0±89.0 <0.001

A1c (%) - 7.9±2.1e 8.7±1.6 9.5±2.3 0.046

Urea (mg/dL) 31.1±9.9c 30.0±5.5f 33.3±15.3g 50.6±30.0 0.001

Creatinine (mg/dL) 0.8±0.1c 0.8±0.1h 0.9±0.2i 1.1±0.5 <0.001

GFR (mL/dk) 87.2±6.8j 98.1±14.6h 90.5±16.3i 72.5±27.8 <0.001

Total cholesterol (mg/dL) 169.9±37.4 176.1±43.8 189.0±49.3 189.3±40.9 NS

Triglyceride (mg/dL) 138.9±55.4k 189.4±88.9 237.7±176.0 189.3±77.7 0.025

HDLC (mg/dL) 46.2±9.5l 40.9±9.7 37.2±10.5 41.5±8.5 0.015

LDLC (mg/dL) 97.8±33.3 97.4±39.1 109.7±28.7 109.9±32.5 NS

Table 1. Clinical and laboratory parameters between groups.

Thiol/disulfide homeostasis plays a critical role in antioxi-dant defense, detoxification, apoptosis, enzyme activities,transcription and cellular signal transduction. It is knownthat thiol levels decrease due to thiol oxidation, disulfidelevels increase and thiol/disulfide ratio increase in diabetics.However, it is not known that how diabetic thiol/disulfidebalance changes in diabetic nephropathy. Therefore, weaimed to investigate thiol/disulfide balance in diabetic pa-tients with nephropathy.61 patients with type 2 diabetes and 26 healthy volunteerswere included. Proteinuria was tested by measuring mi-croalbumin/creatinine ratio in spot urine. The groups namedas follows: healthy volunteer group 1, normal albuminuricgroup 2 (n=17), middle albuminuric group 3 (n=24) andsevere proteinuric group 4 (n=20). Thiol/disulphide home-ostasis concentrations were measured using method devel-oped by Erel et al.

Mean blood urea and creatinine levels were found to be sig-nificantly higher and GFR level was found to be significantlylower in group 4 than in the other 3 groups. Native thiol lev-els are significantly lower in diabetic groups than in healthycontrols and in diabetic subjects with moderate and severeproteinuria, compared to healthy and diabetics with normalproteinuria. Total thiol level was significantly lower in groups2 and 3 than group 1 and 2. Disulfide/native thiol and disul-fide/total thiol ratios were significantly higher in the diabeticgroups than in the healthy control group and in the group 4than in the group 2.In our study, it was determined that the level of native andtotal thiols decreased significantly in diabetic patients withnephropathy and the balance was disrupted in favor ofdisulfide. We conclude that the reduction in thiol levels as-sociated with increased oxidative stress may be one of theimportant factors in the development and progression of di-abetic nephropathy.

P-032

The Evaluation of Thiol/Disulfide Homeostasisin Diabetic Nephropathy

Harran University Faculty of Medicine, Division of Endocrinology and Metabolism, Şanlıurfa, Turkey*Harran University Faculty of Medicine, Department of Medical Biochemistry, Şanlıurfa, Turkey

**Harran University Faculty of Medicine, Department of Internal Medicine, Şanlıurfa, Turkey***Yıldırım Beyazıt University, Department of Medical Biochemistry, Ankara, Turkey


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a: p=0.013 between Group 1 and Group 2; b: p<0.001 between Group 1 and Group 3; c: p<0.001 between Group 1 and Group 4;d: p=0.001 between Group 2 and Group 3; e: p=0.001 between Group 2 and Group 4; f: p=0.002 between Group 2 and Group 3;g: p=0.004 between Group 2 and Group 4; h: p=0.019 between Group 1 ile Group 2; i: p=0.018 between Group 2 ile Group 4;j: p=0.007 between Group 1 ile Group 2; k: p=0.028 between Group 2 ile Group 4.

Parameters Group 1 (n=26) Group 2 (n=17) Group 3 (n=24) Group 4 (n=20) p

Native thiol (µmol/L) 426.4±44.3a.b.c 386.2±35.3d.e 329.1±63.3 318.2±53.3 <0.001

Total thiol (µmol/L) 468.4±52.4b.c 448.7±51.6f.g 388.9±62.6 390.3±71.8 <0.001

Disülfide (µmol/L) 20.5±7.9a.b.c 31.2±11.8 29.9±12.0 36.1±18.9 0.002

Disülfide/ native thiol (%) 4.9±1.8h.b.c 8.0±2.7i 9.6±4.8 11.4±6.2 <0.001

Disülfide/ Total thiol (%) 4.4±1.5j.b.c 6.8±2.0k 7.8±3.3 8.9±7.8 <0.001

Table 2. Comparison of thiol and disulfide parameters between groups.


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Objective: It was found that vitamin D has effect on insulinsecretion and insulin sensitivity as well as bone health. Theaim of the study; 1. to determine the 25-hydroxy vitamin D(25-OH D) levels in elderly with type 2 diabetes. 2. to as-sess the relationships between 25-OH D levels and fastingblood glucose (FBG) and postprandial blood glucose (PBG)and HbA1c levels.Material and Methods: One houndred fifty five diabeticpatients ≥65 years of age (mean age= 72.4±6.2 years (127female, 28 male), were enrolled in the study. Demographiccaracteristics, 25-OH D, biochemical tests were evaluatedretrospectively.Results: Mean level of 25-OH D was found to be 37.9±5.1ng/mL. 25-OH D levels were <30 ng/mL in twenty sevenpercent of these patients. Mean levels of FBG and PBG and

HbA1c were 149.5±14.5 mg/dL, 227.0±23.9 mg/dL and8.2±1.8%, respectively. There was a negative correlationbetween 25-OH D levels and PBG (r=-0.200, p=0.02) in pa-tients. In patients who had 25-OH D levels below 30 ng/mL,mean levels of 25-OH D correlated negativelly with FBG(r= -0.700, p=0.0001) and with PBG (r=-0.200, p=0.02)and with HbA1c (r=-0.450,p=0.001). In diabetic elderlywho had 25-OH D levels ≥30 ng/mL; there were no corre-lations between 25-OH D levels with FBG and PBG and-HbA1c.Conclusion: Mean levels of 25-OH D were 37.9±5.1ng/mL in the elderly with type 2 diabetes. There werenegative correlations between mean levels of 25-OH Dand fasting blood glucose and postprandial glucose andHbA1c in diabetic elderly who had 25-OH D levels below30 ng/mL.

P-035

25-hydroxy Vitamin D Levels andRelationships Between 25-hydroxy Vitamin D and

Glycemic Status

Geriatrics Section, Internal Medicine Department, Ege University, School of Medicine, İzmir, Turkey*İzmir Katip Celebi University, Atatürk Education and Research Hospital, Endocrinology and Metabolism Department, İzmir, Turkey


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Introduction: Type 1 diabetes is the most commonchronic disease of childhood. It is characterized by the de-ficiency of the insulin amount produced the beta cells ofpancreas, resulting in insufficiency of complete insulin di-agnosis. Treatment of type 1 diabetes is the injection ofsynthetic insulin into the body, even at the beginning ofthe disease. Here we are presenting a case of interven-tional block application in treatment of pain caused bylumbar disc herniation in a patient with type 1 diabetesmellitus.Case: 22 years old male patient. The patient who has beenfollowed up for 8 years for type 1 diabetes mellitus has beensuffering from lumbar pain due to lumbar disc herniation forthe last 2 years. Pregabalin 75mgX2 is administered in thebeginning here. Surgical operation was proposed after noresponse to treatment. The patient did not accept the sur-gical operation and applied to the algology polyclinic. VASdue to lumber pain was 8-9 when he came to us, FBG was

315, and HbA1C was 11. The dose of insulin he used was12U. We told him to continue his previous treatment forlumbar pain and planned an interventional block. We firstapplied caudal epidural block, and 15 days later we appliedcaudal epidural block + lumbal paravertebral block, and 15days later we applied caudal epidural block + lumbal par-avertebral block + lumbal facet joint block. He was called forcontrol after 15 days, VAS was 1-2 in the control. After that,the previous 3 blocks were repeated and he was asked tocome to control 1.5 months later. In the control VAS was todecreased 0-1, FBG to 130, HbA1C to 9, and insulin dose to6U. After that he was asked to come to control 3 monthslater.Conclusion: With the application of these interventionalblocks, sympathetic block, parasympathetic activity and va-sodilatation and accordingly oxygen increases in the dam-aged area. We think that the decrease in lumbar disc pain,FBG and HbA1C values as well as in the required insulinvalue is due to this mechanism.

P-048

The Place of Interventional Blocksin the Treatment of Pain Associated

with Lumbar Disc Herniation in a Patient withType 1 Diabetes Mellitus

Department of Anesthesiology and Reanimation, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey


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P-053

An Acromegalic Patient with Empty Sella:Case Report

Uludağ University Facutly, Department of Internal Medicine, Bursa, Turkey*Uludağ University Facutly, Department of Internal Medicine, Division of Endocrinology and Metabolism Bursa, Turkey

S26

Introduction: Empty sella (ES) means an enlarged sellaturcica that is not completely filled with pituitary tissue. Oc-casionally patients may have ES with the tumor situatedwithin the normal pituitary tissue. In this paper we describean ES case which presented with acromegaly clinical find-ings.Case Report: 52-year-old woman presented with enlarg-ing of her hands and feet. Physical examination revealedtypical acromegalic features and no visual field defects.Laboratory data showed elevated serum growth hormone[GH: 1.83 ng/ml. NR (0.06-5)] and insulin-like growth fac-tor-1 [IGF-1: 661ng/ml, NR (55-248)]. An oral glucose-tolerance test(OGTT) showed no suppression of GH values.The other pituitary hormone profile was in normal range.Magnetic resonance imaging(MRI) revealed an empty sellaand no sellar mass (Figure 1). We considered this situa-

tion as MRI-occult adenoma. Somatostatin 30 mg/day wasstarted and cabergolin 0.5 mg/week was added. There areno complications of acromegaly and the laboratory is sta-ble (GH <1 ng/mL, IGF-1 normal) at the 5-years follow-up.Discussion: The acromegalic patients who present withempty sella are more likely to have small-sized tumors thatare not detected on the MRI. Even though the most widelyaccepted recommendation in these patients is surgery asthe primary treatment regardless of tumor size. it’s reportedthat intraoperative cerebrospinal fluid leakage and noncu-rative resection is higher in these patients. At our case, asthe patient didn’t have hypopituitarism, we followed the pa-tient with medical treatment and there was no mass growthor clinical deterioration. As our opinion, follow-up can be achoice at these patients to protect the patient from worseendocrinologic outcomes.

Figure 1


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P-054

Rapid Visual Improvement AfterCabergoline Therapy in a Macroprolactinoma Case

Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism Bursa, Turkey*Uludağ University Faculty of Medicine, Department of Internal Medicine, Bursa, Turkey

Introduction: Medical therapy with dopamin agonists(DAs) is the first treatment of choice for prolactinomas. nomatter how large or how severe the neurologic sequelaeand cabergoline (CAB) is the best initial choice (1). We pres-ent a giant prolactinoma case with visual loss that showeda significant improvement after CAB therapy.Case Report: A 45-year-old male patient was admittedto hospital due to bilateral impaired vision. Magnetic res-onance imaging (Figure 1) revealed a pituitary giant ade-noma of 6x5cm in diameter invading the bilateralcavernous sinuses and extending into the suprasellar re-gion. and compressing the optic chiasm. Visual field test(VFT) revealed bilateral near-total visual field deficit. Thepituitary profile (Table 1) was remarkable for centralhipothyroidism and hypogonadotropic hypogonadism butthere was no secondary adrenal failure and the prolactin

(PRL) level was 19216 ng/mL. Cabergoline treatment wasstarted with dose of 1mg/week. Fifteen days later. VFTshowed a significant improvement both at the left andright eye (Figure 2) when compared with pre-treatmentand PRL levels were normalised. At the 2-month follow-up. the patient is stable.Discussion: Macroprolactinomas may manifest by visualdisturbance due to mass effect especially at men (2). CABis currently the cornerstone of medical therapy as it is ef-fective in controlling clinical symptoms. reducing PRL levelsand shrinking tumor size (1). Severe bilateral visual im-pairment may be a mind-boggling condition but as in ourcase. CAB is effective in the management of neuro-oph-thalmic complications. Also. to protect the hypophysial func-tions and avoid the postoperative complications. CAB shouldbe considered as first choice therapy instead of surgery inthese tumors.

Figure 1: Sella MR.

Biomarker Value Normal references

Prolactin 19216 ng/mL 3-19GH 0.08 ng/mL 0.06-5.00IGF-1 44.9 ng/mL 81.0-225.0ACTH 14.1 pg/mL 5-46FSH 0.4 mIU/mL 0.95-11.95LH 0.26 mIU/mL 0.57-12.07Serum cortisol (AM) 7 µg/dL 3.7-19.4Total serum testosterone 0.14 ng/mL 2.2-7.15TSH 1.77 µlU/mL 0.350-4.940Free T4 0.4 ng/dL 0.70-1.48

Table 1


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Figure 1: Visual field test. Comparison between initial visual field testing and post-treatment visual field testing. (a)Initial visual field test showing bilateral total visual field deficit. (b) the visual field of the right eye was completely nor-malized. and deficits remained only in the temporal part of the left eye.

References1. Melmed S. Casanueva FF. Hoffman AR et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical prac-

tice guideline. J Clin Endocrinol Metab. 2011;96(2):273.2. Carter JN. Tyson JE. Tolis G et al. Prolactin-screening tumors and hypogonadism in 22 men. N Engl J Med. 1978;299(16):847.


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P-056

Nodular Thyroid Diseasein Functional Pituitary Adenomas:

Similarities and Differences

İstanbul University İstanbul Faculty of Medicine, Department of Endocrinology and Metabolism, İstanbul, Turkey

Purpose: Increased frequency of nodular thyroid disease(NTD) is reported in acromegalic patients. Recent studiesalso demonstrated an increased coexistence of NTD withCushing’s disease (CD) and prolactinoma. In this study, weevaluated the frequency and outcomes of NTD in functionalpituitary adenoma (FPA) patients.Material and Methods: A total of 232 (138 F/94 M) pa-tients with a diagnosis of acromegaly (n=138), prolactin-oma (n=59) and CD (n=35) were included in thisretrospective observational study. Frequency of NTD, fine-needle aspiration (FNA) results, frequency of papillary thy-roid carcinoma (PTC) are compared in each group. Factorsrelated with NTD development are evaluated in FPA patientswith and without nodule.Results: NTD frequency was higher in acromegaly (69%)compared to prolactinoma (36%) and CD (34%) (p<0.001).FNA results and PTC frequencies were similar between

groups. In comparison to patients without nodule (n=104),patients with nodules (n=128) were older (p=0.01) and glu-cose metabolism disorders were more common (p=0.006).IGF-1 levels were higher in acromegalic patients with NTD(p=0.01). There was no relationship between nodule for-mation and baseline prolactin, cortisol/ACTH levels in pro-lactinomas and CD, respectively.Conclusion: NTD was more common in acromegalic pa-tients, however in both frequencies of prolactinoma and CDwere higher than previously reported in our country (24%for <65 years). Most important factors playing role in nod-ule formation were glucose metabolism disorders and age inall FPA patients. Although frequency of increased PTC inacromegalic patients has been reported, the frequency ofPTC in our series was similar for each FPA with nodule.

Keywords: Acromegaly, prolactinoma, Cushing’s disease,thyroid nodule, papillary thyroid carcinoma


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P-059

Postmenopausal Hook Effect

Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, İzmir, Turkey*Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, İzmir, Turkey

**Dokuz Eylül University Faculty of Medicine, Department of Medical Patology, İzmir, Turkey***Dokuz Eylül University Faculty of Medicine, Department of Radiology, İzmir, Turkey

Introduction: Prolactinoma is the most common functionalpituitary adenoma. The degree of serum prolactin (PRL) is cor-related with the size of adenoma and the PRL level is usually>250 ng/dL in macroprolactinomas. In non-functional pituitaryadenomas, moderate PRL elevation due to compression effectcan be seen, but in patients with prolactinoma, false - PRL maybe lower in serum bound to Hook Effect. The differential diag-nosis of non-functional adenomas and prolactinomas is impor-tant because of the different treatment options (1,2). Here wepresent a patient with Postmenopausal prolactinoma, identi-fied with Hook Effect, whom we confessed by dilution.Case: At the age of 61, a postmenopausal female patient withno additional comorbid syndrome was diagnosed as a pitu-itary mass in the cranial MR due to headache, and we were di-rected to make hormonal examinations. No acromegaly orcushingoid appearance on the physical examination of the pa-tient who did not show visual disturbance or galactorrhea, nosignificant neurological deficit was detected. In the hormonepanel; Prolactin (PRL): 202 ng/mL (3.8-26.7), Cortisol 10.6mg/dL (6.7-23), ACTH 18.9 pg/mL (0-46), FSH 3.66 (16.7-113) mIU/mL LH: 0.14 mIU/mL (14.2-52), IGF1: 110 ng/mL,TSH: 0.79 mIU/mL (0.38-5.33) and T4: 0.72 ng/dL (0.5-1.51). There was no narrative of drug use that could lead tohyperprolactinaemia in the interrogation. In the pituitary MR,a mass lesion of 20x20x28 mm in size, filling the sella cavity,compressing right optic nerve and right cavernous sinus wasdetected. Because of the advanced age and postmenopausalfeatures in the patient with macroadenomas and moderatehyperprolactinemia, an elevation of the prolactin in the ante-rior infundibulum was noted. However, in order to exclude thepossible Hook Phenomenon, the PRL was 3100 ng/mL, whichwe looked at using the 1/100 dilution method. The patientwas then evaluated as Prolactinoma and Cabergoline startedat 1 mg/week. After 3 weeks, the patient who came to thecontrol came to PRL 656 ng/mL. A narrowing of the visual fieldexamination of the patient with the findings of the nerve com-pression was found. It was reevaluated by Neurosurgery anddecision of operation was taken. Postopathology was compat-ible with prolactin-producing adenoma. Carbergolin continued

to be treated at 1.5 mg/week and was regressed to PRL 123ng/mL. The patient's polyclinic is continuing its follow-up interms of diabetes insipitus and central hypothyroidism.Discussion: Pituitary adenomas are the most common causesof sellar masses and constitute about one third of all intracra-nial tumors. It is classified using hormone producing cell type(determined by immunohistochemistry method) or clinicallyfunctional/non-functional. Among the functional pituitary ade-nomas, prolactinomas are the most common pituitary adeno-mas (approximately 50%). In literature, 83.3% of cases withmacroprolactinomas are male, mean age is 38.5 years (5). Ourcase is 61 years old and differs because it is postmenopausal.Direct prolactin measurement is important for the differentialdiagnosis of hypophylic tumors. In non-functioning tumors withneurological deficit, the first treatment option is surgical,whereas the medical treatment is prophylactic in proluxed pa-tients. Despite the presence of prolactinoma in our case, med-ical treatment as well as surgical treatment have beenapproved due to the presence of visual deficiency,PRL measurements are stimulant in the sense of 'hook effect',which has normal or normal light measurements despite thepresence of macroadenomas (3) and the incidence of this phe-nomenon in patients with macroadenomas is %5-8 (4). Hookeffect is an artifact encountered in immunoradiometric (ECLIA,ICMA, IRMA vb) measures and results in very high prolactinlevels. In this case, the serum sample should be diluted to1/100 and prolactin measurement should be repeated. Alter-natively, the first antibody should be rinsed to remove excessprolactin that has not been ligated before the second antibodyis added after the prolactin has been attached. The presenceof non-functional macroadenoma sap in the presence of an el-evated PRL height (<200 ng/mL) should be suspected and isdifficult to distinguish from macroprolactin (1).Results: The distinction is important because non-func-tional adenomas and prolactinomas have different first-linetreatment options. In cases of macroadenoma and moder-ate PRL elevation. Hook effect should come to mind as wellas stem pressure. Hook effect is a rare entity in post-menopausal older women. In suspected cases, this effectcan be avoided by using serial dilution methods.

References1. Yener S. Comlekci A. Arda N. Men S. Yesil S. Misdiagnosisduetothehookeffect in prolactinassay. MedPrincPract. 2008;17:429–31.2. Al Sifri S. Raef H: Thehookeffect in prolactinimmunoassays.SaudiMed J 25(5): 656–659. 2004.3. Schofl C. Schofl-Siegert B. KarstensJH.Bremer M. Lenarz T. Cuarezma JS. SamiiM.vonzurMuhlen A. Brabant G: Falselylow serum

prolactin in twocases of invasivemacroprolactinoma. Pituitary 2002; 5: 261–265.4. St-Jean E. Blain F. Comtois R. High prolactinlevelsmaybemissedbyimmunoradiometricassay in patientswithmacroprolactinomas.

ClinEndocrinol (Oxf) 1996; 44:305-309.5. Casanueva FF. Molitch ME. Schlechte JA. Abs R. Bonert V. Bronstein MD. Brue T. Cappabianca P. Colao A. Fahlbusch R. Fide-

leffH.Hadani M. Kelly P. Kleinberg D. LawsE.Marek J. Scanlon M. Sobrinho LG. WassJA.Giustina A: Guidelines of thePituitarySo-cietyforthediagnosisandmanagement of prolactinomas. ClinEndocrinol (Oxf) 2006; 65: 265–273.


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P-064

The Association of Acromegaly and Visfatin

Department of Endocrinology and Metabolism, Bakırköy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey*Department of Internal Medicine, Bakırköy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey

**Department of Cardiology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey***Department of Internal Medicine, Okmeydani Education and Research Hospital, İstanbul, Turkey****Department of Internal Medicine, Umraniye Education and Research Hospital, İstanbul, Turkey

*****Department of Biochemistry, Bakırköy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey

Introduction: Acromegaly is a systemic disease that causesmultiple metabolic disorders caused by an excess of growthhormone. The excess of growth hormone affects the secretionof adipokines in fat tissue, leading to metabolic disorders. Vis-fatin is also an adipokine synthesized in visceral fat tissue,andplays a role in systemic inflammation. In this study, we eval-uated the effect of acromegaly on serum visfatin levels andthe parameters that may be associated with it.Method: 53 acromegaly patients (37 females/16 males) inacromaegaly gruop and 34 patient (22 females/12 males) inthe control group with normal IGF1 and BH with similar ageand body mass index (BMI) were included in our study. Thewaist and hip circumference, fasting blood glucose, insulin,HbA1c, lipid profile, BH, IGF1 and visfatin levels were com-pared among the groups. Epicardial fat tissue was examined

by echocardiography. Serum visfatin levels were measuredby micro ELISA. Correlation analysis was performed.Result: The visfatin levels in the acromegaly group weresignificantly higher than the control group (p<0.001).In ad-dition, HbA1c values were higher in the acromegaly group(p=0.007), while other parameters were similar betweenthe groups (Table 1). In the correlation analysis of allgroups, there was a significant positive correlation betweenvisfatin levels and HbA1c, IGF1 and BH levels (p=0.02,p=0.03, p=0.02, respectively).Conclusion: In acromegalic patients, visfatin levels in-crease with IGF1 and GH levels. In addition, glucose me-tabolism impairment also increases visfatin levels. Thisadipokine may also be effective in systemic inflammation inacromegaly. The results of our studies with more patientsshould be verified.

Akromegali grubu (n=34) Kontrol grubu (n=53) p

Age (years) 44.8±12.8 46.87±13.39 NSGender(F / M) 22/12 37/16 NSVisfatin (ng/ml) 4.66±3.61 7.41±2.52 <0.01

Glucose (mg/dl) 104.21±32.13 108.88±34.1 NSTotal cholesterol (mg/dl) 213±49.90 194.25±41.11 NSLDL cholesterol (mg/dl) 125.22±44.02 109.96±36.01 NSTriglycerides (mg/dl) 154.41±69.93 141.71±77.39 NSHDL cholesterol (mg/dl) 59.21±14.64 55.92±14.69 NSInsulin (µU/ml) 13.85±8.76 14.13±11.19 NSHOMAIR 3.67±2.74 3.85±3.54 NSHbA1c % 5.84±1.18 6.14±0.94 0.007

IGF1 (ng/ml) 135.47±46.25 287.49±169.07 <0.01

gH (ng/ml) 0.97±1.80 7.65±1.67 <0.01

BMI (kg/m2) 29.25±5.31 30.64±6.02 NSEpicardial fat tissue 0.40±0.10 0.42±0.10 NSWaist circumference (cm) 98.77±12.88 94.57±13.39 NSHip circumference (cm) 110.71±11.02 108.37±10.69 NS

Table 1. Data of the working group.

The data are presented as mean±standard deviation, P<0.05 was considered statistically significant.


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Acromegaly + Control group

Visfatin N=87 r value p value

Age (years) 0.110 0.310Waist circumference (cm) 0.095 0.394Hip circumference (cm) 0.008 0.946BMI 0.090 0.411Glucose (mg/dl) 0.143 0.189Insulin (µU/ml) 0.066 0.551HOMA 0.090 0.410Hb A1c % 0.245 * 0.024

Total cholesterol(mg/dl) 0.055 0.615Triglycerides (mg/dl) 0.056 0.613HDL cholesterol (mg/dl) 0.025 0.824LDL cholesterol (mg/dl) 0.053 0.634GH (ng/ml) 0.259 * 0.017

IGF1 (ng/ml) 0.235 * 0.029

Epicardial fat tissue 0.083 0.541

Table 2. Correlation analysis between visfatin and other parameters.


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P-065

Rhinorrhea After Cabergoline Treatment forGiant Invasive Macroprolactinoma: A Case Report

Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism Bursa, Turkey*Uludağ University Faculty of Medicine, Department of Internal Medicine, Bursa, Turkey

Introduction: Rhinorrhea may be seen at giant invasivemacroprolactinomas due to dural injury or after medicaltreatment with dopamine agonists and it may lead tomeningitis, intracranial abscess and pneumocephaly (1). Wereport a case of macroprolactinoma that develops rhinor-rhea after cabergoline (CAB) treatment.Case Report: A 56-year-old male patient was admitted toendocrinology department due to a massive sellar massafter ventriculoperitoneal-shunt insertion at the neuro-surgery department due to hydrocephalus. Magnetic reso-nance imaging (Figure 1) showed an expansive sellar massmeasuring 5.7x3.6 cm, eroding the cavernous and sphenoidsinuses and compressing the third ventricle and chiasma.The pituitary profile is seen at Table 1. A diagnosis of giantinvasive macroprolactinoma was made and treatment initi-ated with 0.25 mg of oral cabergoline twice weekly. Patient

was readmitted 2 weeks later with rhinorrhea. CT scanshowed no evidence of pneumocephaly or shunt dysfunc-tion (Figure 2). As the risk of tumor re-expansion in case ofdiscontinuation of CAB was high and the leakage was mini-mal, we decided to continue CAB and follow the patientclosely. The rhinorrhea was stopped at the 4th week and did-n’t occur again.Discussion: Rhinorrhea is a potential complication of man-agement of invasive prolactinomas (2). Although the stan-dard management is surgical repair in 71% of cases,spontaneous resolution following medical treatment havealso been reported (3). In our case, multidisciplinary follow-up was done without surgical intervention and the rhinor-rhea was stopped and PRL levels were normalised. Inconclusion, when the postoperative panhypopituitarism andother comorbidities due to surgery are considered, follow-up may be an option in these cases.

Figure 1. On the left. pre-treatment sella MR and on the right. 3 months after the treatment sella MR image is seen.


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Figure 2

Biomarker Value Normal references

Prolaktin 27846 ng/mL 3-19GH <0.05 ng/mL 0.06-5.00IGF-1 44.9 ng/mL 81.0-225.0ACTH 17.5 pg/mL 5-46FSH 0.89 mIU/mL 0.95-11.95LH 0.8 mIU/mL 0.57-12.07Serum kortizol (AM) 8 µg/dL 3.7-19.4Total serum testosterone 0.86 ng/mL 2.2-7.15TSH 1.237 µlU/mL 0.350-4.940Serbest T4 1.33 ng/dL 0.70-1.48

Table 1


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P-066

Characteristics of Acromegaly Patients Followedat a Single Center

Namık Kemal University Medical Faculty, Department of Endocrinology and Metabolism, Tekirdağ, Turkey*Namık Kemal University Medical Faculty, Department of Internal Medicine, Tekirdağ, Turkey

**Namık Kemal University Medical Faculty, Department of Neurosurgery, Tekirdağ, Turkey

Introduction: Acromegaly is a chronic condition with athree to four fold higher rate of mortality than general pop-ulation. if remain untreated. Acromegaly has an estimatedprevalence of 40 cases per million population and an an-nual incidence of three to seven cases per million popula-tion. Early diagnosis and treatment of this disease is ofgreat importance since it affects many organs and systems.So. we retrospectively investigated the characteristics ofacromegaly patients to assess their clinical and follow-upstatus.Patients and Methods: Clinical and laboratory records of32 acromegaly patients (mean age = 53.8±10.5 SD; 19 fe-male. 13 male) were analysed. The mean follow-up periodof the patients was 39±25 months. Only 6 of the patientshad transsphenoidal (TS) pituitary surgery in our center.The mean IGF-1 values before and after pituiary surgerywere 745±302 and 284±177 ng/mL. respectively. Four pa-tients were treated with long acting somatostatin analogs(SS-RA) as primary therapy while the remaining patients

underwent pituitary surgery. Six patients were cured afterfirst surgery and 16 were treated with SS-RA. Five patientslost to follow-up after surgery and 5 patients continued theirtreatment in other centers. Cure was achieved in 3 patientswho were operated in our center and 3 patients receivedSS-RA therapy. Among 16 patients who were treated withSS-RA's. pegvisomant was added to 2 patients. due to thelack of response to SS-RA's.Conclusion: The treatment and follow-up of patients withacromegaly should be carried out in centers consisted of ateam of experienced neurosergeons and endocrinologistsregarding the the treatment of acromegaly. Although ouruniversity and medical faculty are newly established. thenumber of patients with acromaly is increased day by dayand tough the neurosergeons in our center are trained inpitutary surgery. the number of surgeries carried out in ourcenter are not enough to boost their experience. Therefore.the team of neurosurgeons in our center are constantly in-volved in various educational events. in order to improvetheir experience in pituitary surgery.


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P-072

Radiotherapy in Cushing’s Disease

Department of Endocrinology and Metabolism, Okmeydani Training and Research Hospital, İstanbul, Turkey*Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, İstanbul, Turkey

**Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University, İstanbul, Turkey***Pituitary Center, Istanbul University, İstanbul, Turkey

Objectives: To assess tumor growth control, biochemicalresponse, factors affecting remission, and to identify possi-ble complications in Cushing’s Disease (CD) treated with ra-diotherapy (RT).Methods: Forty-two patients who had undergone RT due toCD between 1996 and 2017 were included in the study.Hormonal remission after RT has been defined according tothe clinical characteristics of the patients and results of the24-hour urinary cortisol and 1 mg dexamethasone sup-pression tests. Tumor size control was defined as a stableor diminished tumor size in magnetic resonance imaging(MRI) during the follow-up. The statistical package for so-cial sciences version 22.0 (SPSS 22.0) was used for statis-tical analyses.Results: The median follow-up time after RT was 54.5months. Gamma-knife, Cyberknife, conventional RT wereperformed in 73.8%; 16.7%; 9.5% of the patients, respec-tively. The mean RT dose was 25.7 Gy for Gamma-knife; 28

Gy for Cyberknife; 45 Gy for conventional RT. Hormonal re-mission rate was 54.8% and occured at a median of 13(IQR: 3.7-27.7) months after RT. Tumor size control was ob-tained in all patients. Patients with high preoperative 24-hour urinary cortisol and 1 mg DST had biochemicalremission in a longer time. Similarly, the remission rate waslower in those with high 24-hour urinary cortisol postoper-atively, In 33,3% of the patients, a new hypophyseal defi-ciency developed within 10.5 (IQR: 3.0-19.7) months of RT.Meningioma was detected in one patient and cerebrovascu-lar disease in 5 patients during the follow-up. None of thepatients had cranial or optic nerve neuropathy.Conclusion: Radiotherapy or radiosurgery is effective inmaintaining tumor size and biochemical remission in CD.Delayed hypopituitarism is the most common complication.Long-term follow-up is necessary for both recurrence andpossible complications.

Keywords: Cushing's disease, radiotherapy, radiosurgery


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P-076

Mild Symptomatic Postpartum Pituitary Apoplexy:A Case Report

Dicle University Faculty of Medicine, Department of Endocrinology and Metabolism, Diyarbakır, Turkey*Ahi Evran Training and Research Hospital, Department of Endocrinology and Metabolism, Kırşehir, Turkey

Aim: Pituitary apoplexy is a rare but serious condition . Itis caused by infarction and/or haemorrhage of the pituitarygland. In this case report, we will present outpatient whohas been suffering from lack of breastfeeding and headacheat postpartum period.Case: 28-year-old female patient was applied outpatientclinic suffering from lack of breastfeeding and headache atpostpartum period. On presentation, her blood pressure wasnormal. Patient pituitary hormones levels ACTH <5 pg/mL(0-46) kortizol: 0.08 µg/dL (morning: 6.28-18) TSH:0.42µIU/mL (0.27-4.2) free T4:9.76 pmol/L (12-22) free T3:6.42 pmol/L (3.1-6.8) prolactin: 2.74 ng/ml (4.79-23.3)were found. Other laboratory tests , glucose: 89 mg/dl (70-109) urea: 18 mg/dl (10-45) creatine: 0.68 mg/dl (0.5-1.4)sodium: 137 mmol/L (135-145) potassium: 4.3 mmol/L(3.5-5.1), were normal. At first, we tought Sheehan syn-drome or postpartum pituitary necrosis secondary to ex-

cessive postpartum blood losses. Because Sheehan syn-drome is very common in our society. But the patient didnot have much bleeding at postpartum. Magnetic resonanceimaging showed a sellar heterogeneous mass with suprasel-lar extension and contact with the optic chiasm, compatiblewith adenoma apoplexy (Figure 1, 2). No evidence for pitu-itary apoplexy except headache and lack of breastfeeding.The patient's visual fields were normal. Oral prednisolone 5mg/day was started. One week later, the patient felt well.Added 50 mcg/day levothyroxine. After a month's follow-up, re-evaluation was decided.Conclusion: Pituitary apoplexy is a life-threatening condi-tion. Pregnancy and postpartum period are risky periods forapoplexy. Patients may have mild symptoms. Steroid ther-apy is life-saving.

Keywords: Pituitary apoplexy, postpartum,mild symptoms

Figure 1: Contrast-enhanced Mr imaging (coronal sec-tion): bleeding into pituitary adenoma.

Figure 2: Contrast-enhanced Mr imaging (sagittal sec-tion): bleeding into pituitary adenoma.


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P-086

Spontaneous Cervical Hematomain a Primary Hyperparathyroidism Patient

Kırıkkale Yüksek İhtisas Hospital, Department of Endocrinology and Metabolic Diseases, Kırıkkale, Turkey

Introduction: Thoracocervical ecchymosis can be pro-duced by trauma, dissecting aortic aneurysm and compli-cations due to medical procedures and hemorrhage ofparathyroid adenoma. Extracapsular hemorrhage is a rareinterpretation of a parathyroid adenoma (1). We presentedour case with spontaneous thoracocervical ecchymosis whowas on follow-up for parathyroid adenoma.Case: 64 year old man arrived our clinic with complaint ofpainful discoloration on his neck and chest which appearedone day ago spontaneously. The area of ecchymoses was lo-cated centrally through neck extanding to thorax (Figure 1).Before the admission, he had been followed up by our insti-tution for primary hyperparathyroidism and primary hy-pothyroidism. In his medical history there was also Behcet’sdisease and he was on colchicine, levothyroxine 50 mcg/dayused regularly and acetyl salicylic acid which he used sel-domly. His vital signs were absolutely normal just like his co-agulation studies and hemoglobin level. He was hospitalizedregarding complicational risks due to hematoma’s localiza-tion. In his latest follow-up before hematoma formation, inthyroid ultrasonography (USG) there was moderate hetero-geneity, a 2x3x4 mm hypoechoic nodule in left upper pole anda 9x11x17 mm hypoechoic lesion compatible with parathy-roid adenoma in left thyroid lobe inferoposterior region. Tc 99m parathyroid scintigraphy revealed a hyperactive lesion inthe same localization with the susceptible parathyroid lesionin USG. After the formation of ecchymoses the novel ultra-sonographic investigation revealed a heterogenic area sur-rounding the left thyroid lobe, extanding to common carotidartery laterally. Due to this heterogeneity the former parathy-

roid lesion in USG could not be visualized. Priorly, the adjustedcalcium (Ca) levels could not ever be dropped below 10.5mg/dl with medication. The results were as follows: Ca: 11.1mg/dl, albumin (alb): 4.7 g/dl, phosphorus (P): 2.6 mg/dl,magnesium (mg): 1.8 mg/dl, creatinine (cre): 1.0 mg/dl,parathormone (PTH): 92 pg/ml, 25-hydroxyvitamin-D3(25-OH-vitD3): 15 ng/ml, thyrotropin (TSH): 2.5 IU/ml. After aperiod of vitD3 administration and following ecchymoses for-mation, Ca: 9.5 mg/dl, P: 2.3 mg/dl, mg: 1.9 mg/dl, cre: 1.1mg/dl, PTH: 34.5 pg/ml, 25-OH-vitD3: 38.5 pg/ml werefound. Even though he used acetylsalicylic acid very seldomly,it was absolutely given up and he was given symptomatictreatment for the pain. After two days the ultrasonographicinvestigation revealed partial resolution of hematoma withmaintenance in laboratory findings. He was discharged andinvited for control regarding suspicion of parathyroid infarct.Conclusion: Thoracocervical ecchymosis would occur due tohematoma from a parathyroid adenoma. Hypercalcemia dueto release of PTH from damaged gland, hypocalcemia associ-ated with extensive parathyroid destruction (1) or normocal-cemia just like in our case are possible laboratory resultsfollowing hematoma. Anticoagulation and hemorrhagic diathe-sis may be a predisposing factor in neck hematomas (2).Hemorrhage into thyroid cysts are more common, howeverthey are usually intracapsular depending on thyroid gland’sthicker capsule while hematomas associated with parathyroidadenomas are usually extracapsular and may invade adja-cent tissues including even mediastinum.Potential seriouscomplications are rapidly progressive airway and esophagealobstruction. When the patient is stable, conservative man-agement is preferred followed by elective parathyroid surgery.

Figure 1

References1. Rehman HU et al.Spontaneous cervical hematoma associated with parathyroid adenoma. CMAJ. 2010 Sep 21;182(13):E6322. Shinomiya H et al. Parathyroid adenoma causing spontaneous cervical hematoma: two case reports.BMC Res Notes 2015 Nov 26;8:726


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P-087

Preoperative Parenteral Ibandronate forTreating Severe Hypercalcemia Associated with

Primary Hyperparathyroidism:An Effective and Cheap Drug

Dicle Universty School of Medicine Adult Endocrinology Deparment, Diyarbakır, Turkey*Fırat Universty School of Medicine Adult Endocrinology Deparment, Elazığ, Turkey

**Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey

Aim: Primary hyperparathyroidism (PHPT) is a prevalentmineral metabolism disorder usually caused by a singleparathyroid adenoma. Although PHPT is the most frequentcause of hypercalcemia, severe hypercalcemia cases arerarely encountered. Some patients admitted because of hy-percalcemia require intravenous bisphosphonate treatment.The present study aimed to investigate the efficacy of intra-venous ibandronate, which is a more cheap drug than otherparenteral bisphosphonates, in the preoperative treatmentof symptomatic hypercalcemia in patients with PHPT.Material-Metods: The medical records of patients oper-ated in a Dicle University Endocrinology clinic between 2010and 2017 due to PHPT were retrospectively evaluated. Pa-tients who were admitted because of hypercalcemia associ-ated with parathyroid adenoma and underwent minimallyinvasive surgery subsequent to the lowering of calcium lev-els via preoperative intravenous ibandronate and zolen-dronate were included.

Results:Totally, 24 of 167 patients received a preopera-tive bisphosphonate due to hypercalcemia associated withPHPT. Five female and two male patients were treatedwith zoledronate only. Thirteen were treated with iban-dronate only. Seven of the 13 patients were female andsix were male. The mean calcium level in patients beforeibandronate treatment was 14.31±0.92 mg/dL, and themean duration of calcium regulation after ibandronatetreatment was 3.31±1.03 days. The mean calcium levelafter ibandronate treatment was 10.19±0.89 mg/dL(p=0.001).Conclusion: In Turkey, ibandronate use reduces the costof hypercalcemia treatment by 8570%. Parenteral iban-dronate for treating severe hypercalcemia associated withPHPT may thus be an effective and cheap drug. Hypocal-cemic period was shorter in the ibandronate group.

Keywords: Hyperparathyroidism, hypercalcemia,ibandronate

Characteristic of patients groups (N.S: non-significant).

Ibandronate group n =13 Zoledronate group n=7 P value

Age (year) 62±19 57±17 N.S.

Sex (female/male) 7/6 5/2 N.S.

Calcium (mg/dl) before treatment 14.3±0.92 14.6±0.96 N.S.

Calcium (mg/dl) after treatment 10.19±0.89 11.02±1.18 N.S.

PTH (pg/ml)before treatment 585±398.95 1351±580 N.S.

PTH (pg/ml)after treatment 44±43.15 28.86±1.58 N.S.

Post-bisphosphonate hypocalcemia (yes/n) 3/13 5/7

Drug cost (USD) 22 84

Table 1. Characteristic of patients groups.


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Figure 1. DEXA:L1-L4 vertebral. Figure 2. Thoracolumbar graphy.

P-88

Osteoporosis Following Antiretroviral Therapyin an HIV Positive Male Patient:

A Case Report

İzmir Katip Çelebi University Atatürk Training and Research Hospital, Department of Internal Medicine, İzmir, Turkey*İzmir Katip Çelebi University Atatürk Training and Research Hospital, Department of Endocrinology, İzmir, Turkey

Introduction: Osteoporosis frequency in HIV-positive pa-tients receiving antiretroviral therapy (ART) is three timeshigher compared to HIV-negative patients. At bone mineraldensity during the first 2 years with ART onset, a reductionof 2% to 6% is shown. In this case, we presented osteo-porosis following ART HIV-positive young male patient with-out additional risk factor.Case Presentation: A 35-year-old male with a history ofheterosexual risky sexual intercourse, identified as HIV-pos-itive in 2009 was started tenofovir/emtricitabine andlopinavir/ritonavir treatment. He applied to the clinic withblunt pain of waist, hip and both feet. There was no addi-tional feature other than a low-energy right hand fifthmetacarpal bone fracture history. At the time of admissioncalcium: 8.9 mg/dL, phosphorus: 1.3 mg/dl, 24 hour uri-nary calcium level: 728 mg/day, 24 hour urinary phos-phorus level: 26 mg/day, vitamin D: 44.5 ng/ml, ALP: 270

ul, PTH: 53 pg/ml, DXA: femur neck T score:-2.7, ZScore: -2.3, L1-L4 T score: -4.5, Z score: -4.5 (Figure 1).Thoracolumbar graphy was consistent with osteoporoticthe view. There was no apparent compression fracture(Figure 2). The patient was treated with alendronatesodium 70 mg/week, calcium 1000 mg + 880 IU vitamind3, sodium phosphate. Tenofovir/emtricitabine andlopinavir/ritonavir treatment was discontinued and aba-cavir/dolutegravir/lamividune therapy was started.Conclusion: HIV infection and ART are important in the de-velopment of osteoporosis. Especially tenofovir causes kid-ney failure or tubulary dysfunction. If hypophosphotemiadepending on tenofovir is present. ART regime changeshould be considered, phosphorus deficiency treatmentshould also be applied to the patient along with osteoporo-sis treatment. Biphosphonate, vitamin D, calcium, andphosphorus treatment are potent in the treatment of os-teopenia/osteoporosis associated with HIV infection.


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P-89

Case Report: The Efficacy of Zolendronic Acidin Patients with Osteogenesis Imperfecta

Department of Endocrinology and Metabolism, Keçiören Education and Research Hospital, Ankara, Turkey

Introduction: Osteogenesis imperfecta (OI) or “brittlebone disease’’ is a clinically heterogeneous inherited con-nective tissue disorder. OI is characterized by low bone den-sity. increased bone fragility. bone deformities. OI isclassified as five types and among them. type III is the mostsevere form with progressive bone deformity. Bisphospho-nates are known to increase bone density. to correct verte-bral size and shape. and to decrease fracture risk due toosteoporosis.Case: A thirty year old male was treated for osteoporosis inour institution for four years. Physical examination; height:155 cm. weight: 55 kg. kyphoscoliosis. On laboratory eval-uation; PTH: 62.9 pg/ml (15-65). calcium: 10.2mg/dl (8.4-10.2). albumin: 4.9 g/dl (3.4-5). 25(OH) VitD3: 37.3 ng/ml(25-80). phosphate: 4.1 mg/dl (2.5-4.9). alkaline phos-phatase: 61U/l (45-129). magnesium: 1.9 mg/dl (1.8-2.4).glucose: 88 mg/dl(70-99). creatinine: 0.65 mg/dl (0.72-

1.25). ALT: 14u/l (0-49). TSH: 2.05 µIU/ml (0.55-4.78).BMD before zolendronic acid treatment was L1-L4 total (Zscore): -6.2 and after 3 dose every year zolendronic acidand vitamin D. calcium treatment. BMD was significantly im-proved; L1-L4 total (Z score): -0.7 (Table 1). We did notobserve fractures and any other unexpected complicationsduring this treatment period.Conclusions: Bisphosphonate treatment has been widelyused in patients with OI over the past decade. It can bestarted even at an early age. Treatment should be deter-mined according to disease type and severity. In this case.we prefered zolendronic acid because of its potency andhigh bioavailability due to intravenous use. As oral bispho-sphonates have very low bioavailability. they may not be asuitable alternative for OI.

Keywords: Bone mineral density. osteogenesis imperfecta.zolendronic acid

L1-L4 total L1-L4 total Left femur Left femur BMD (g/cm2) BMD (g/cm2)T score Z score T score Z score L1-L4 Left femur

2013 -6.2 -6.2 - - 0.411 -2014 -5.4 -5.4 -3.4 -3.4 0.501 0.4612015 -4.5 -4.5 -1.8 -1.8 0.598 0.9002016 -3.7 -3.7 -3.7 -3.7 0.721 0.5902017 -0.7 -0.7 -2.9 -2.7 1.015 0.643

Table 1. BMD measurements (DEXA).

Figure 1 Figure 2


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P-098

Do We Neglect the Risk of Fracture?

Republic of Turkey, Ministry of Health, Tekirdag State Hospital, Department of Endocrinology and Metabolism Diseases, Tekirdağ, Turkey*Namık Kemal University, Faculty of Medicine, Department of Internal Medicine, Tekirdağ, Turkey

Objective: Osteoporosis is a common metabolic bone dis-ease. All women over the age of 65, all men over the age of70 and the younger cases having some other risk factorsare recommended to be screened for osteoporosis. In thisstudy, we tried to show how much of the cases that wererecommended to be screened had already been evaluatedby DEXA.Methods: The age, height, weight and osteoporosis riskfactors data of 125 cases, who admitted to our endocrinol-ogy out-patient clinics between October 2017 and February2018 and must already been screened, were recorded. Thecases were questioned whether their bone mineral densitywas assessed with DEXA previously. Fracture risk situationswere analyzed by means of Fracture Risk Assessment Tool(FRAX) adapted for Turkey. The mean calculated risk of hipand major osteoporotic fractures and the frequency of eachrisk factor were assessed using the SPSS-21 statistical soft-ware program.Results: A total of 125 cases (106 female and 19 male) agedbetween 47 and 85 were evaluated with a mean age of 68.The means of weight and height were 76.08 kg and 155.2 cmrespectively, 92% of the patients were non-smokers and any

of the cases did not use alcohol regularly. Four cases were onglucocorticoid treatment and six cases were diagnosed withrheumatoid arthritis, 59.2% of cases had a secondary cause(8 cases were on aromatase inhibitor therapy for breast can-cer, 1 had hypoparathyroidism, 4 had primary hyperparathy-roidism, 15 had premature ovarian failure, 14 cases werethyrotoxic that 5 of them were iatrogenic thyrotoxicosis be-cause of differentiated thyroid carcinoma treatment). Whilethere was a personal history of fractures in 27.2% of cases,the parental fracture history was present in 8% of cases.While the mean 10-year-major osteoporotic fracture risk cal-culated by the FRAX scoring system was 6.05% (2.5-49), themean risk of hip fracture was 1.6% (0.2-40). The percentageof those evaluated with DEXA previously despite the currentindication for osteoporosis screening was only 55.5%. Ac-cording to the FRAX calculation system, 24.8% of our caseswere in high risk group for fracture, but only 48.4% of thesecases were evaluated with DEXA.Conclusion: In our outpatient clinics, we neglect evaluat-ing the risk of fracture which has so severe economical andemotional burden after it develops.

Keywords: Fracture, FRAX risk scoring system, DEXA


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P-110

Evaluation of Clinical and Laboratory ParametersAffecting Measurements of Bone Mineral

Densitometry in Renal Transplantation Patients

Department of Endocrinology and Metabolism, Yuzuncu Yıl University, Faculty of Medicine, Van, Turkey*Department of Internal Medicine, Yuzuncu Yıl University, Faculty of Medicine, Van, Turkey

Introduction: Histological evidences of osteodystrophyand osteopenia in the majority of successful kidney transp-lant patients are frequently detected. In this study weaimed to evaluate the bone mass values in patients withkidney transplantation and to investigate the factors affec-ting these values.Materials and Methods: In the study, 83 male (mean age40.42±11.64), and 35 woman (mean age 39.8±12.4) atotal of 118 kidney transplant patients over 18 years of agewere included. The patiens's laboratory and clinical infor-mations was reviewed retrospectively via electronic hospi-tal registry system.Results: Patients had values of BMD that 28 normal(%23.7), 57 osteopenic (%48.3), 33 osteoporotic (%28).Significant positive correlations were found between weightand body mass index (BMİ) values and BMD measurements(gr/cm2 and T score). BMD measurement values (gr/cm2)were significantly lower in the group that receiving bothhemodialysis and peritoneal hemodialysis treatments(p=0.040). T score values were significantly lower in the HDgroup (p=0.017), also osteopenic and osteoporotic valueswere significantly higher in HD group (p=0.046). Normal T

score values were significantly higher in the transplantationcenter which is Antalya group (p=0.030). There was a sig-nificant negative correlation between T score and PTH(p=0.012; r=-0.237) and 25(OH)vitD (p=0.041; r=-0.272)values. In our study osteopenic values were found to be sig-nificantly higher in patients group that does not receivemTOR inh (p=0.002).Conclusions: We have found that the value of BMI, pre-vious renal replacement therapy modality, transplantationcenter, mamalian target of rapamycin (mTOR) inh's treat-ment, serum PTH levels has an effect on BMD measuredvalues In renal transplant patients. We believe that; in thepre-transplantation period making follow-ups of the pati-ents in terms of bone metabolism, to give appropriate os-teoporosis treatment, doing the strict follow-ups of patientsat the their transplantation centers and, in terms of post-op complications being in coordination with related branc-hes, has an important place in the preservation andtreatment of bone dansities in patients with renal transp-lantation as well.

Keywords: Renal transplantation,bone mineral densitometry, osteoporosis


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P-111

Evaluation of Causesof High Parathyroid Hormone Levels in Elderly

Atatürk Training and Research Hospital, Department of Endocrinology and Metabolism, İzmir, Turkey*Ege University Medical Faculty, Department of Geriatric Medicine, İzmir, Turkey

Primary hyperparathyroidism (PHPT) predominantly affectsthe elderly, with a peak incidence between ages 55 and 70.Parathyroid adenoma is the principal cause, representing80-85% of all cases. The aim of the study to determine thefrequency of parathyroid adenoma in elderly with highparathyroid hormone levels.Subjects and Methods: We performed a retrospectiveanalysis of 31 (30 female, 1 male) elderly wih high parathy-roid hormone levels. The demographic caracteristics, bio-chemical tests and imaging features such as neckultrasound and parathyroid scintigraphy were evaluated,retrospectively.Results: The patients had a mean age of 67±8.1 years,serum Ca of 10.9±0.5 mg/dL, serum PTH of 110.6±15.2pg/mL, serum 25-hydroxy-vitamin D (25-OH D) of

22.9±1.1 nmol/l. Two female patients 2/31) had a parathy-roid adenoma shown on a sestamibi scan and neck ultra-sound. The frequency of parathyroid adenoma was found tobe 6.4%. These patients were underwent parathyroidec-tomy for primary hyperparathyroidism, 1 patient presentedwith severe abdominal pain diagnosed as parathyroid ade-noma. Surgery was successful in all patients with no post-operative mortality. 12 patients had low serum 25- OH D(17.3±3.9 nmol/l). Frequency of deficiency of vitamin D was38.7%. And also, they treated with D vitamin and decreasedtheir PTH levels. No cause was found related hyperparathy-roidism with normal 25- OH D using imaging in the rest ofthem.Conclusion: High PTH levels due to deficiency of Dvitamin levels were higher than parathyroid adenoma inelderly.


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P-113

Retrospective Analysis of Patientswith Hypoparathyroidism

Yunus Emre State Hospital, Eskişehir, Turkey

Aim: Hypoparathyrodism is characterized by absence or in-appropriately low level of parathyroid hormone (PTH). Themost common cause is surgical removal or damage ofparathyroid glands. Other causes are autoimmune and in-filtrative disorders. We present data of our patients diag-nosed with hypoparathyroidism.Methods: The clinical and laboratory data of patients withhypoparathyroidism during years between 2013-2018 wereretrospectively evaluated.Results: Data of 84 female (82.4%) and 16 male (17.6%)patients were analyzed. The cause of hypoparathyroidismwas surgery for multinodular goiter in 72, surgery for thy-roid cancer including lymph node dissection in 16, surgeryfor PHPT in 7 cases and idiopathic in 7 cases. Mean PTHlevel was 6.18±5.14 pg/ml, lowest level of calcium cor-rected for serum albumin 6.4±0.9 mg/dl, mean phosphorus

level measured at the same time was 5.3±1.0 mg/dl. Dailyneed of elementary calcium was 1512±1115 mg and chole-calciferol was 0.68±0.32 mcg. There was no difference be-tween female and male patients regarding etiology, age,PTH level, and daily dosage of elemenatry calcium andcholecalciferol, while serum calcium and phosphorus levelsdiffered significantly (p<0.01 and p=0.014. respectively).PTH was negatively correlated (p=0.019, r=-0.233), withdaily elementary calcium need and positively with(p=0.026, r=0.225) daily cholecalciferol need.Conclusion: The most common cause of hypoparathy-roidism was surgery in accordance with the literature. Dailycalcium and cholecalciferol need was also similar to thepresent knowledge. Since most of the data in the literaturecome from developed countries, we need larger scale stud-ies to evaluate causes and treatment approaches of hy-poparathyroidism in Turkey.


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P-118

Clinical Caracteristics of Patientswith Subacute Thyroiditis

Atatürk Training and Research Hospital, Department of Endocrinology and Metabolism, İzmir, Turkey*Ege University Medical Faculty, Department of Geriatric Medicine, İzmir, Turkey

Objective: Subacute thyroiditis is a self-limited, inflamma-tory viral thyroid disease which presents with neck pain,usually accompanied by systemic symptoms. The aim of thestudy was to evaluate the clinical characteristics of patientswith SAT.Method: Fourty-two patients ≥35 years of age (mean age=42.4±5.9 years (40 female, 2 male), were enrolled in thestudy. Demographic caracteristics, thyroid functon testssuch as Thyroid Stimulating Hormone (TSH). Free TriiodoThyronine (FT3), and Free Thyroxine (FT4) and other bioc-hemical tests were evaluated retrospectively.Results: Clinical symptoms of patients such as palpitation(and tachycardia), neck pain, fever, tenderness, weight lossand tremor were found in 47.6%, in 90.4%, in 66.6%, in92.8%, in 11.9%, and in 16.6%, respectively.

Mean levels of TSH, FT3, FT4, and erythrocyte sedimenta-tion rate were found to be 0.03±0.01 µIU/mL (normalrange: 0.35-5.5 µIU/mL), 3.7±0.2 pg/mL (normal range:2.3-4.2 pg/mL); 1.4±0.1 ng/dL (normal range: 0.93-1.7ng/dL) and 62.5±13.0 mm/hour, respectively. Thyroid sin-tigraphy was performed in 41 patients and showed low up-take in all patients. Ultrasound, performed in all patients,showed dishomogeneous and bilateral patchy in 28 patientsand thyroid nodules in 14 patients. Two patients receivedno treatment, and 40 received either non-steroidal anti-in-flamatory drugs (NSAID) (no.=10) or glucocorticoids(no.=30).Conclusion: The most common symptoms such as neckpain, tenderness and fever were seen in patients. And also,supressed TSH and increased sedimentation rate werefound in all patients.


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P-119

Serum Endocan Levels in Graves' Disease

Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey*Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Ankara, Turkey

Objective: It has been reported that endothelial dys-function may occur in Graves' disease. Endocan and vas-cular endothelial growth factor (VEGF) are thought toexhibit endothelial dysfunction. The increase in carotid in-tima media thickness (CIMT) is known to be the earliestchange in endothelial dysfunction. In our study, it wasaimed to investigate the levels of serum endocan andVEGF in Graves' disease, to perform PMSC measurementsand to examine the relationship between these parame-ters.Method: 31 healthy volunteers with 31 known Graves' dis-ease and age, gender, who had no other known disease,newly diagnosed and had no anti-thyroid therapy, werestudied as a control group. Serve endocan and VEGF levelswere measured in the Graves group after both treatmentand euthyroidism, and these values were compared with thecontrol group.

Findings: Serum endocan levels were higher in the hyper-thyroid Graves group than in the control group (0.68 (0.18-1.21) vs 0.49 (0.11-1.88) pg/ml, p=0.002). There was nosignificant difference between control group and controlgroup (p>0.05). Serum VEGF levels were not significantlydifferent between Graves and control group (p>0.05). ThePFT measurement was higher in the hyperthyroid Gravesgroup than in the control group (0.68±0.07 vs 0.47±0.06mm, p<0.001). Graves group, which became euthyroidafter antithyroid therapy, showed a decrease in CIMT com-pared to the control group (0.59±0.05 vs 0.47±0.06,p<0.001). There was a positive correlation between serumendocan levels and TSH (p<0.01), sT3, sT4, Anti-Tg andAnti-TPO (p<0.01, p<0.05, p<0.001). In multiple linear re-gression analysis, sT3 was found to be the most effectiveparameter on endocan (F=5.664, R2=0.106, p<0.05).Conclusion: Our findings suggest that serum levels of en-docan are increased and related to sT3 in Graves' disease.


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P-124

Percutaneous Ethanol Injection forBenign Cystic and Mixed Thyroid Nodules

Department of Endocrinology and Metabolism, Kartal Dr. Lutfi Kirdar Research and Training Hospital, İstanbul, Turkey

Background/Aim: We aimed to determine the effect ofpercutaneous ethanol injection (PEI) on volume of cysticand mixt thyroid nodules, thyroid function tests (TFTs), an-tibody titers and cytological changes for 1 year.Methods: Fifty-five nodules of 53 patients with cystic andmixt properties treated with PEI were included. Nodule vol-umes. TFTs, thyroid autoantibodies were analyzed at base-line, 6th and 12th months. Fine needle aspiration biopsy(FNAB) was performed to PEI applied nodules in the 12th

month. Thyroid nodules were grouped into three by struc-tural properties (pure cystic, predominant cystic, predomi-nant solid).Results: PEI caused a volume reduction of 80.7% at 6th

month and 82.1% at 12th month without any serious com-

plication. PEI was repeated 1.4±0.4 times with a meantotal ethanol amount of 3.6±3.1 mL. Volume reduction inthe pure cystic nodules at 6th and 12th months after PEIwas greater than the volume reductions in predominantcystic and predominant solid nodules. We detected thatsmaller nodules have greater volume reductions after PEIat 12th month. During the study, patients remained eu-thyroid. Anti-thyroglobulin levels were decreased at 12th

months. None of the FNAB results was compatible with amalignant or suspicious for malignancy cytology at 12th

month.Conclusion: PEI is an effective way of treatment for benigncystic and mixt thyroid nodules without any serious side ef-fects. We can also assume that PEI is not a trigger for au-toimmunity and carcinogenesis for short term.

Gender (M/F) (n=53) 13/40

Age (years) (n=53) 44.6±13.9

Mean basal nodule volume (cm3) (n=55) 13.9±12.9

Mean aspirated cyst fluid volume (mL) (n=55) 11.6±10.7

Mean total ethanol (mL) (n=55) 3.6±3.1

Nodule characteristics

Pure cystic (n=12) (%) 21.8

Predominant cystic (n=30) (%) 54.6

Predominant solid (n=13) ( %) 23.6

Table 1. Clinical characteristics of study population/


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Pa for assessment of basal and sixth month; Pb for assessment of basal and tweltfh monthAbbreviations: TSH: thyroid stimulating hormone, fT3: free triiodothyronine, fT4: free thyroxine , A-TPO: antithyroid peroxidase antibody, A-TG: an-tithyroglobulin antibody.

Table 2. Thyroid function tests. thyroid autoantibodies and nodule volumes during the study

Basal 6th month 12th month Pa (basal- Pb (basal-

n=55 n=55 n=48 6th month) 12th month)

TSH 1.51±1.39 1.42±0.76 1.45±0.87 0.268 0.128fT3 4.80±0.67 5.11±0.97 5.28±0.814 0.158 0.008fT4 11.82±2.17 10.88 ±1.89 11.02±1.85 0.003 0.036Total nodule volume (mL) 9.0 (4.4-20.90) 1.2 (0.3-4.1) 0.9 (0.2-4.0) <0.001 <0.001Percent decrease in nodule volume (%) 80.7±15.9 82.1±12.2A-TPO 0.4 (0-2.5) 1.4 (0-3.8) 0 (0-3.07) 0.357 0.822A-TG 0.1 (0-1.62) 0 (0-1.10) 0 (0-0) 0.398 0.033

Figure 1: A-B. Left lobe inferiorde before PEE 3.86x2.72x3.89 cm (21.24 mL) clear cystic nodule. C. The cystic no-dule in the left lobe inferior was completely ablated, one year after PEI (Volume decline rate= 100%).


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P-128

Simultaneous Papillary and Medullary Carcinomain the Thyroid Gland


Introduction: The most common type of thyroid cancers ispapillary thyroid carcinoma originating from follicular cells.Medullar thyroid cancer (MTK), a neuroendocrine tumor, isderived from thyroid parafollicular (C cells) cells. These twocarcinomas, which incidences, origins of cells, histopatholo-gical features and prognosis are completely different, arerarely found together in the thyroid gland.Case Report: A 55-year-old male patient without a knowndisease other than COPD, had no history of prior radiationto the head or neck and no known family history of any en-docrine disease whose on The pathology of the specimendetected a papillary carcinoma oncocytic variant with atumor size of 7x5.5x5 cm in the left lobe and a medullarymicrocarcinoma with a tumor diameter of 2 mm in the rightlobe. In immunohistochemical studies; CEA, calcitonin,chromogranin, synaptophysin were positivite and cytokera-tin 19 was focal positive. Vascular invasion, perineural in-vasion, penetration into the thyroid and invasion of softtissue outside the thyroid were not observed in the patho-logical examination of both tumors. Postoperative RAI tre-

atment and TSH suppressive treatment were performed onpatient. In the scan after RAI treatment, no metastaseswere detected. Urine vanillyl mandelic acid, 5 hydroxy in-dole acetic acid and catecholamine levels were normal. Mu-tation was not detected in the selected exon sequenceanalysis of RET-protooncogen.Discussion: There is a case report in the literature aboutthe existence of RET and BRAF gene mutations in thesesimultaneous malignancies. RET proto-oncogen mutationdetected in hereditary medullary carcinoma cases has alsobeen reported in some papillary carcinoma cases. There-fore, the appearance of these two tumors at the sametime suggests that is linked to RET proto-oncogen muta-tion. Additional studies are necessary to describe the cli-nical and pathologic characteristics of these patients andto clarify potential biologic relationship between concur-rent medullary thyroid carcinoma and papillary thyroidcarcinoma.

Keywords: Papillary thyroid cancer,medullary thyroid cancer


DOI:10.25179/tjem.20182202-P128

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P-129

Evaluation of Choroidal Thickness Changesin Euthyroid Graves’ Ophthalmopathy

Medical Sciences University. Sultan Abdulhamid Han Education and Research Hospital, İstanbul, TurkeyDepartment of Endocrinology and Metabolic Diseases. İstanbul, Turkey

*Katip Celebi University. Ataturk Education and Research Hospital. Department of Opthalmology. İzmir, Turkey

Objective: Clinical manifestations of GO are caused by theover compression of orbital tissues within the restricted or-bital bone cavity. Impaired ocular blood flow may disruptthe retinal microstructure and functions.. In this study weaimed to investigate the macular and choroidal thicknesschanges in GO compared with healthy subjects.Materials and Methods: The study group comprised 50adult patients with previously diagnosed Graves’ Disease withophthalmopathy who were on anti-thyroid treatment. For theassessment of GO activity. VISA (vision. inflammation. stra-bismus. and appearance) inflammatory score was used.When euthryoidism was achieved without side effects. the pa-tients were referred to the ophthalmology clinic for Spectral-domain optical coherence tomography (SD-OCT) evaluation.

Results: Subfoveal. mean and temporal choroidal thick-nesses were increased significantly in study group accord-ing to the controls. The mean choroidal thickness waselevated.Conclusions: This elevation is because of the retroorbitalinflammation even in this non-severe GO group. Choroidalthickness might be affected from the venous obstructionand congestion in patients with GO. The elevation of thechoroidal thickness might be an early sign of venous con-gestion that occurs before the elevation of intraocular pres-sure.

Keywords: Graves’ ophthalmopathy.spectral-domain optical coherence tomography.choroidal thickness

Clinical findings Score

Orbital pain (none. at rest. with gaze) 0-2

Chemosis 0-2

Eyelid oedema 0-2

Conjunctival injection 0-1

Eyelid injection 0-1

Total 0-8

Table 1. VISA inflammatory scale.

BCVA = best- corrected visual acuity. logMAR= logarithm of the minimum angle of resolution. IOP= intraocular pressure. BMI= Body mass index. MBP =mean blood pressure. N/A= not applicable. VISA= vision. inflammation. strabismus. and appearance.*Mann-Whitney U test. **Independent samples t-test.

Characteristics Study group n= 50 Control group n= 50 P value

Age, years 36.2±5.3 35.4±6.0 0.50*Males, n (%) 39/11 43/7 0.30*BCVA, logMAR -0.006±0.02 -0.008±0.02 0.69*IOP, mmHg 16.1±2.2 15.9±1.9 0.86**Axial length, mm 22.4±0.7 22.7±0.6 0.20**Spherical equivalent, dioptres -0.35±0.89 -0.33±0.63 0.52*Exophthalmometry, mm 18.7±2.2 17.4±0.9 0.002*BMI 24.2±1.9 24.3±1.6 0.69**MBP, mmHg 88.9±4.3 88.3±4.7 0.53**Disease duration, years 3.1±1.7 N/A -VISA score 4.7±1.3 N/A -

Table 2. Characteristics of the patient and control groups.


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*Independent samples t-test.

Choroidal thickness measurement location Study group n= 50 Control group n= 50 P value*

Subfoveal 307.1±30.2 275.5±34.2 p<0.001

Temporal, 500 µm 314.3±31.6 274.2±34.9 p<0.001

Temporal, 1.000 µm 312.2±31.3 272.9±33.2 p<0.001

Temporal, 1.500 µm 303.9±28.3 267.6±31.8 p<0.001

Nasal, 500 µm 296.4±28.9 270.8±34.7 p<0.001

Nasal, 1.000 µm 278.5±30.4 263.5±34.1 p=0.023

Nasal, 1.500 µm 261.8±32.9 253.1±34.7 p=0.20

Mean 296.3±28.1 268.2±33.1 p<0.001

Table 3. Choroidal thickness: differences between groups.

Figure 1: Representative choroidal thickness (CT) in Graves’ ophthalmopathy (GO).

Figure 2: Correlation plot showing a positive relation-ship between the mean CT and the vision. inflamma-tion. strabismus. and appearance (VISA) inflammatoryscores of patients with GO (R2=0.531; P=0.001).


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P-133

Irisin Levels Increases After Treatmentin Patients with Newly Diagnosed

Hashimoto Thyroiditis

Department of Endocrinology, Usak University School of Medicine, Uşak, Turkey*Department of Endocrinology, Antalya Training and Research Hospital, Antalya, Turkey

**Department of Biochemistry, Usak University School of Medicine, Uşak, Turkey***Department of Endocrinology, Ankara University School of Medicine, Ankara, Turkey

Background and Aim: Irisin is a newly identified myokinesecreted by skeletal muscle and has significant effects onbody metabolism. Thyroidal functional state has a profoundinfluence on the metabolism of human body. Therefore. theaim of this study was to investigate the possible changes inserum irisin concentrations before and after treatment inhypothyroid subjects.Methods: The study included 26 patients with overt hy-pothyroidism due to Hashimoto thyroiditis and 19 healthysubjects. Baseline serum thyroid function tests. presence ofthyroid autoantibodies and levels of creatine kinase (CK)and irisin were measured in both groups. All measurementsin the hypothyroid group were repeated after euthyroidismwas achieved.Results: Serum irisin levels were significantly lower in thehypothyroid groups than the control group (p<0.001).Negative correlation between irisin and TSH and CK levels(r=-0.623. p<0.001. r:-0.389. p:0.008. respectively) anda positive correlation between irisin and fT4 levels (r:0.570.

p<0.001) was found. Serum CK levels decreased signifi-cantly after treatment(p<0.001).Serum irisin levels signifi-cantly increased (from 57.4 U/L to 99.8U/L. p<0.001) whenthe hypothyroid patients were treated to achieve euthy-roidism.Conclusions: To the best of our knowledge this is the firststudy providing insight that low serum irisin levels signifi-cantly increased following treatment to euthyroid state inovert hypothyroid patients with Hashimoto thyroiditis. Thenegative correlation between CK and irisin levels found inour study might underline a possible relation between irisinlevel and muscle damage in patients with hypothyroidismdue to Hashimoto’s thyroiditis. The increase in irisin levelsand the decrease in CK levels after treatment may indicatemyopathy due to hypothyroidism. Larger scale studies areneeded to confirm these results and to ensure irisin as apossible biomarker of Hashimoto’s thyroiditis.

Keywords: Irisin. Hashimoto thyroiditis.overt hypothyroidism


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Anti-TPO. anti-thyroid peroxidase; anti-TG. anti-thyroglobulin; BMI. body mass index; CK. creatine kinase; fT3. free triiodothyro-nine; fT4. free thyroxine; TSH. thyrotropin.

Control group Hypothyroid group

(n=19) (n=26) P value

Gender Male n (%) 5 (26.3) 2 (7.7) 0.198

Female n (%) 14 (73.7) 24 (92.3)

Age, years Mean±SD 31.7±4.1 34±8.9 0.262

BMI, kg/m2 Mean±SD 24.6±3.25 26.8±4.1 0.060

TSH, µIU/mL Median (min-max) 2.1 (1.1-3.8) 12.6 (8.3-100.9) <0.001

fT4, ng/dL Median (min-max) 1.2 (1-1.57) 0.7 (0.4-0.8) <0.001

fT3, pg/mL Mean±SD 3.29±0.1 2.85±0.4 0.001

AntiTPO, U/mL Median (min-max) 28 (25-48) 1300 (122.6-1300) <0.001

AntiTG, U/mL Median (min-max) 15.3 (15-34.3) 219 (15-500) <0.001

Irisin, ng/ml Mean±SD 80.1±12.1 58.8±13.8 <0.001

CK, U/L Mean±SD 54.4±24.5 103.6±38.7 <0.001

Table 1. Demographical characteristics and laboratory findings of hypothyroid and control groups.

Anti-TPO, anti-thyroid peroxidase; anti-TG, anti-thyroglobulin; BMI, body mass index; CK, creatine kinase; fT4, free thyroxine; fT3,free triiodothyronine; TSH, thyrotropin.

Parameters Before treatment (n=26) After treatment (n=26) P value

BMI (kg/m2) Mean±SD 26.8±4.1 27.05±4.4 0.295

TSH (µIU/mL) Median (min-max) 12.6 (8.3-100.9) 2.4(0.78-3.9) <0.001

fT4 (ng/dL) Median (min-max) 0.7 (0.4-0.8) 1.06 (0.9-1.6) <0.001

fT3 (pg/mL) Mean±SD 2.85±0.4 3.1±0.3 0.012

Anti-TPO (U/mL) Median (min-max) 1300 (122.6-1300) 1182 (82.6-1300) 0.003

Anti-Tg (U/mL) Median (min-max) 219 (15-500) 164.2 (15-500) 0.019

Irisin (ng/ml) Median (min-max) 57.4 (30.2-91.8) 99.75 (56.6-290.1) <0.001

CK (U/L) Mean±SD 103.6 (45-194) 63 (30-114) <0.001

Table 2. Comparison of thyroid functions and irisin levels before and after treatment in the hypothyroid group.


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P-146

Comparison of Serum Netrin-1, Nesfatin-1 andAdropin Levels in Subclinical and

Overt Hypothyroidism

Muğla Sıtkı Koçman University Faculty of Medicine, Department of Internal Medicine,Department of Endocrinology and Metabolism Diseases, Muğla, Turkey

*Muğla Sıtkı Koçman University Faculty of Medicine, Department of Internal Medicine, Muğla, Turkey**Muğla Sıtkı Koçman University Faculty of Medicine, Department of Medical Biology, Muğla, Turkey

***Muğla Sıtkı Koçman University Faculty of Medicine, Department of Biostatistics, Muğla, Turkey

Introduction: Overt and subclinical hypothyroidism (OH.SH) are diseases characterized by the activation of inflam-matory pathways. In particular, OH is associated with in-creased mortality and morbidity. Netrin-1, nesfatin-1 andadropin are linked to numerous physiological processes.but their effects of hypothyroidism are not clear. In ourstudy. we aimed to investigate serum levels of these threemolecules in OH and SH and their relations with the dis-ease.Method: This monocentric cross-sectional study was con-ducted prospectively between August 2016 and October2017 in patients who applied to the Endocrinology Clinic ofMugla Sitki Kocman University. Patients were divided intothree groups, namely, OH, SH and control (C).Results: A total of 83 people were included in the study.27 of them with OH. 29 with SH. and 27 in C. Adropin lev-els in the group OH and SH were lower than those in groupC (150.0. 156.3. 180.4. p=0.085. p=0.230. respectively)while nesfatin-1 levels were higher (14.2. 14.8. 10.9.

p=0.168. p=0.191. respectively). but the differences werenot statistically significant. Netrin-1 levels were lower ingroup OH and SH than in group C. and only the differencebetween SH and C groups was statistically significant(379.5. 361.7. 417.3. p=0.129. p=0.011. respectively).Conclusion: In our study, netrin-1 levels were lower ingroups OH and SH than in group C. and only the differencebetween SH and C groups was statistically significant(p=0.011). We also found higher levels of nesfatin-1 andadropin levels in group OH and SH than group C. but thedifferences were not statistically significant. Previous stud-ies have shown that circulating netrin-1 suppresses inflam-mation; more recent studies emphasize its proinflammatoryfunction in the tissue. Low circulating levels of netrin-1 ob-served in hypothyroidism which is characterized by antiin-flammatory properties. are compatible with the literatureand may be a cause of increased inflammation in SH. Com-prehensive studies with these molecules may play a role inelucidating inflammatory processes in patients with OH andSH.

C vs OH C vs SH OH vs SH

OH SH C p values p values p values

Netrin-1 (pg/ml) median 379.5 361.7 417.3 0.129 0.011 0.484min-max 251.6-1138.3 248.9-1889.0 272.1-808.7

Nesfatin-1 (ng/ml) median 14.2 14.8 10.9 0.168 0.191 0.897min-max 4.1-54.0 4.0-52.7 4.2-53.6

Adropin (ng/L) median 150.0 156.3 180.4 0.085 0.230 0.588min-max 11.7-472.7 18.7-349.4 45.5-374.4

Table 1. Comparison of anthropometric measurements and blood parameters in OH. SH and C groups.


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P-148

The Frequency of Thyroid Diseasesin Women with Breast Cancer

The Department of General Surgery, Konya Health Application and Research Center, University of Health Sciences, Konya, Turkey*The Department of Internal Medicine, The Division of Endocrinology and Metabolism, The Medical School of Usak University, Uşak, Turkey

**The Department of Internal Medicine, Konya Health Application and Research Center, University of Health Sciences, Konya, Turkey

Introduction: Breast cancer and thyroid disorders are bothimportant health problems that are common in women. Therelationship between both diseases is not fully known. Inthis study, the frequency of thyroid diseases was investi-gated in patients with breast cancer.Materials and Methods: Eighty women with breast cancerand age-matched 63 women without cancer, as the controlgroup, were included into the study. Thyroid stimulatinghormone (TSH), free T4, Anti-TPO, Anti-Tg, glucose and in-sülin levels were measured and all cases underwent thyroidultrasonography (USG). Patients who had undergone thy-roid surgery and who used drugs that affect glucose me-tabolism were excluded.Results: The results are given in Table 1 and Table 2. Waistand hip circumferences, glucose, insulin and HOMA-IR lev-els were higher in patients with breast cancer. Waist hip

ratio, body mass index (BMI), TSH, free T4, anti-TPO andanti-thyroglobulin levels and thyroid volumes were similar inboth groups. Rates of autoantibody positivity, the presenceof nodules and thyroiditis in USG were similar in bothgroups. The frequency of hypothyroidism was similar in bothgroups. Thyrotoxicosis was not detected in the breast can-cer group, whereas in the control group, thyrotoxicosis wasdetected in 4(6.3%) patients (p= 0.022).Discussion: Thyrotoxicosis was found to be less frequent inpatients with breast cancer, although nodular goiter, au-toimmune thyroid disease, and hypothyroidism frequencieswere similar. We believe that prospective studies involvingmore cases should be appropriate to remove the suspicionof the relationship between breast cancer and thyroid dis-eases.

Keywords: Breast cancer, nodular goiter, thyroiditis


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HOMA-IR: Homeostasis model assessment-insülin resistance. TPO: Thyroid peroxidase.

Patient Group (n:80) Control group (n:63) p values

Age (year) 49 (25-65) 48 (18-65) 0.104

Height (cm) 160.9±0.67 160.9±0.76 0.934

Weight (Kg) 72.5 (50-116) 72 (46-105) 0.855

Body Mass Index (kg/m²) 28.8±0.6 28.3±0.6 0.536

Waist circumference (cm) 90.7±1.4 83.7±1.7 0.001

Hip Circumference (cm) 104.8±1.4 97.9±1.9 0.003

Waist/Hip Ratio 0.87±0.01 0.86±0.01 0.285

Systolic Blood Pressure (mmHg) 120 (90-180) 120 (85-160) 0.473

Diastolic Blood Pressure (mmHg) 72.5 (50-100) 74 (60-95) 0.683

Glucose (mg/dL) 97.5 (73-161) 91.0 (71-191) 0.008

Insulin (µIU/mL) 12.3 (2-82) 8.7 (2-38) 0.018

HOMA-IR 2.9 (0.4-22.8) 1.9 (0.4-9.7) 0.007

Thyroid stimulating hormone (µU/mL) 1.8 (0-6) 1.7 (0.2-11.2) 0.649

Free T4 (ng/dL) 1.2 (0.7-2.9) 1.2 (0.8-1.9) 0.812

Anti TPO (IU/mL) 10 (10-1000) 10 (10-579) 0.110

Anti-thyroglobulin (IU/mL) 20 (20-3000) 20 (10-3000) 0.223

Thyroid volume(cm³) 13.4 (3.6-28) 14.2 (2.7-27.3) 0.669

Table 1. Some clinical and laboratory characteristics of the cases.

USG: Ultrasonography.

Patient Group (n:80) Control group (n:63) p values

Number of cases with nodules (%) 55 (68.8) 38 (60.3) 0.294

Number of cases with antibody positive (%) 12 (15) 11 (17.5) 0.691

Number of cases with thyroiditis in USG (%) 44 (55) 32 (50.8) 0.617

Number of cases with hypothyroidism (%) 1 (1.3) 4 (6.3) 0.099

Number of cases with thyrotoxicosis (%) 0 (0) 4 (6.3) 0.022

Table 2. Some clinical features of the cases.


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P-150

Plasma Betotrophin Levels of Patientswith Subclinical Hypothyroidism


Introduction: Since betatrophin has an effect on both lipidand glucose homeostasis, its thought to be valuable for fur-ther researches as a promising metabolic regulator. Thereare well-defined associations between metabolic spells andthyroid dysfunction, but so far the potential relationship be-tween betatrophin disturbances and thyroid dysfunction hasbeen examined in a single clinical trial. In this study, weaimed to evaluate serum betatrophine levels in patientswith subclinical hypothyroidism.Materials and Methods: In case group (n=44); Patientswith subclinical hypothyroidism were included. In controlgroup (n=44); age, sex, and body mass index were selectedfrom healthy volunteers. Serum betatrophine, TSH, sT4, sT3,Anti-TPO and Anti-Tg analyzes were performed in both groups.Results: There were no significant differences in age, gen-der, weight, height, BMI, diastolic blood pressures and sT3between groups (p=0.082, 0.622, 0.648, 0.226, 0.802,

0.053 and 0.989, respectively). Systolic blood pressure,TSH, anti-TPO and anti-Tg measurements were found sig-nificantly higher in the case group than in the control group(p=0.001, ≤0.001, ≤0.001, 0.002 respectively). Serum be-tatrophine and sT4 levels were statistically significantlylower in the case group than in the control group (p=0.036and 0.007, respectively).Conclusions: In patients with subclinical hypothyroidism,we found that circulating betatrophin levels were reduced.This finding suggests that thyroid failure may be effective atthe level of serum betatrofine. We are encouraged to takethyroid hormones into consideration when evaluating beta-trofine because of the increasing interest in the study of be-tatrophin. However, further work is needed to clarify thecausal relationship between hypothyroidism and betat-rophin.

Keywords: Betatrophin, thyroid, hipothyroidism


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P-153

A Case Report of Metastasis to Thyroid Gland fromSquamous Cell Carcinoma of Lung

Department of Endocrinology and Metabolism, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey*Department of Medical Oncology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey

**Department of Pathology, Diskapi Training and Research Hospital, University of Health Sciences, Ankara, Turkey

Introduction: Although the high vascularity of the thyroidgland. metastatic lesions from other regions are rare. Thereare reports that metastasis to thyroid gland is associatedwith poor prognosis of primary condition .Case: A 51-year-old male who had chemo-radiotherapyafter lobectomy due to squamous cell lung carcinoma ap-plied to our clinic for swelling on his neck. Hyperthyroidismsymptoms and signs were present at the time of admis-sion. Laboratory evaluation was consistent with obvioushyperthyroidism. AntiTPO and TRAb tests were negative.AntiTg antibody was positive. Thyroid ultrasonographyperformed in our clinic and detected increased thyroidgland size.Thyroid gland had multinoduler appereance.and biggest nodule had irreguler margins and 24x26x48mm in size .take place the left lobe of thyroid. There weremultipl lymphadenopaties. the biggest one was 8x15x22

mm in size. in left second servikal compartment. Onscintigraphy. there were thyroid gland hyperplasia and hy-poactive multinodular appearance. Hyperthyroidism wasattributed to previous iodinated contrast medium expo-sure. Thyroid fine needle aspiration cytomorphology andimmunohistochemical findings were reported consistentwith "squamous cell carcinoma". The patient was diag-nosed with lung squamous cell carcinoma metastasis andreevaluated with medical oncology. No other metastasiswas detected. Surgical decision was taken on the oncologycouncil.Result: Thyroid gland metastases are usually in advancedstages of primary disease. In our case. known organ metas-tasis was not known. Patients with newly diagnosed or pro-gressed thyroid nodules with history of malignancy shouldbe assessed for metastatic lesions even if remission hasbeen provided for primary disease.


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P-0154

Frequency of Anemia and Its Associationwith Disease Activity in Subacute Thyroiditis

Istanbul University. Istanbul Faculty of Medicine. Department of Internal Medicine. Division of Endocrinology and Metabolism. İstanbul. Turkey

Objective: To investigate the frequency of anemia and itsassociation with inflammation in patients with subacute thy-roiditis (ST) at the time of diagnosis and after resolution ofclinical findings and acute phase response.Materials and Methods: Charts of patients with con-firmed diagnosis of ST and followed at the Endocrinologyand Metabolism Outpatient Clinic of Istanbul Faculty ofMedicine were retrospectively reviewed, and those withacute phase response and hemogram results at the time ofdiagnosis and after the resolution of clinical and inflamma-tion findings comprised the study group. Hemoglobin levelsbelow 12g/dl for females and 13 g/dl for males were de-fined as anemia.Results: Anemia was detected in 37 out of 60 ST patients(65%) studied at the time of diagnosis, and its frequencywas reduced to 28.3% following the resolution of clinical

and laboratory findings without additional treatment. A sig-nificant increase was observed both in hemoglobin(1.08±0.98 g/dl) and hematocrit (3.45±2.9) levels, but nochange was detected in MCV values. Hemoglobin andhematocrit values of 20 patients (33.3%) who developedpermanent hypothyroidism after the resolution of clinicalfindings were significantly lower than those of remainingpatients both at the diagnosis and after the clinical im-provement.Conclusion: Anemia can develop in 65% of patients withST, and a significant improvement can be observed in par-allel with resolution of clinical and laboratory findings.Therefore, further investigations for the causes of anemiashould be avoided in ST patients until the improvement ofclinical findings and acute phase response.

Keywords: Subacute thyroiditis, anemia, inflammation


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P-164

The Place of Interventional Blocksin the Treatment of Pain Due to Fibromyalgia in

Hashimoto's Disease

Department of Anesthesiology and Reanimation. Afyon Kocatepe University Faculty of Medicine. Afyonkarahisar, Turkey

Introduction: The exact cause of the hashimoto thyroid isunknown. The most important cause of the thyroid glanddeficiency (hypothyroid) is the Hashimoto type thyroidgland inflammation. While there is a slight goiter and an an-tiTPO elevation at baseline. TSH. T3 and T4 are normal.Thyroid growth usually occurs silently without complaints.These patients are usually referred to the doctor for com-plaints such as exhaustion. prostration. swelling of thehands and face. hoarsening of the voice caused by goitre orthyroid hormone deficiency. There is no treatment methodin the disease. Here. we are presenting a case of the use ofinterventional blocks in the treatment of pain due to fi-bromyalgia in a patient with Hashimato's disease.Case: 25 years old female patient. She is being monitoredfor Hashimato's disease for 2 years. There was painspreading in the back and sleep disturbance for 5 yearsdue to fibromyalgia. In this case. for Hashimoto. TSH. T3.T4 was normal and anti-TPO was 100. She was not usingany medication for this. She was just being controlled in

three-month periods. She was using pregabalin 75 mgX2for fibromyalgia. VAS was 8-9 when she came to us. Wetold her to continue the previous treatment and plannedfor the application of interventional blocks. We applied bi-lateral suprascapular block. and bilateral suprascapularblock + paraservical block 15 days later. and we addedtrigger point injections to 2 blocks 15 days later. In thecontrol after 15 days. VAS was 1-2. We applied the previ-ous 3 blocks after this and we asked her to come to con-trol 1 month later. VAS was 0-1 in the control; anti TPOvalue was 5; and TSH. T3. T4 values were normal. Afterthat. we ended the treatment with control to be performed3 months later.Conclusion: Interventional blocks have an important role inthe treatment of pain due to fibromyalgia. With the appli-cation of interventional block. sympathetic block. parasym-pathetic activity. vasodilatation and oxygen increases in thedamaged area. We think that the decrease in the pain of fi-bromyalgia and the low anti-TPO in Hashimoto's thyroiditisare due to this.


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Objective: Osteoprotogerin (OPG), in addition to its effectson bone metabolism, is a molecule which has also differenteffects on cardivascular system. Despite the fact that it wasalleged that there is cardiovascular protection in animalstudies, there are contradictory results in human studies.The aim of this study is to detect the role of osteoprotegerinin diagnosis and determining cardiovascular risk of patientswith polycystic ovary syndrome (PCOS) which is a diseasewith multisystem effects.Methods: The study has been on 28 premenopausalhealthy women and 57 patients with polycystic ovarysendrome who have applied to Ankara Numune Training andResearch Hospital, Clinical of Endocrinology, between 1 June2017 and 1 September 2017. On every participants, histo-ries were received, body mass indexes were calculated, thetests and suprapubic ovary ultrasonographies for PCOS di-agnosis and definitive diagnosis have been made, serumOPG level has been studied by enzyme-linked immunosor-bent assay. Statistics have been analyzed in IBM SPSS forWindows Version 22.0 programme.Results: Serum OPG levels were similar in PCOS and con-trol group and there was no statistically significant differ-

ence (p=0.815). In correlation analysis, we detected liminalpositive correlation between OPG and LH levels in all par-ticipants and PCOS group (p=0.057 and 0.058), positivecorrelation between OPG and total testosterone levels(p=0.045). While liminal possitive correlation between OPGand insulin and HOMA-IR (p=0.063 and 0.059, respec-tively). liminal negative correlation with TSH (p=0.06) weredetected in all participants, these correlations were not ob-served in PCOS group.Conclusion: Despite the fact that there is not a significantdifference in OPG levels between patient group and thehealthy control group, a positive correlation between OPGand total testosterone, and liminal possitive correlation withLH was indicated that OPG may be a contributory factor inPCOS pathogenesis. Of the cardiovascular risk markers,positive correlation was observed between only HOMA-IR,fasting insulin and OPG in all subjects, but a significant as-sociation was not observed in patients with PCOS. All in all,these results suggest that OPG is not a contributory factorin determining cardiovascular risk in PCOS.

Keywords: Cardiovascular, osteoprotogerin,polycystic ovary syndrome

P-169

The Relationship of Serum Osteoprotegerin Levelwith Hormonal and Cardiovascular Parameters

in Patients with Polycystic Ovary Syndrome

Amasya University, Sabuncuoğlu Şerefeddin Training and Research Hospital, Clinical of Endocrinology and Metabolic Diseases, Amasya, Turkey*University of Health Sciences, Ankara Numune Training and Research Hospital, Clinical of Endocrinology and Metabolic Diseases, Ankara, Turkey

**University of Health Sciences, Ankara Numune Training and Research Hospital, Clinical of Nuclear Medicine, Ankara, Turkey***University of Health Sciences, Ankara Numune Training and Research Hospital, Clinical of Biochemistry, Ankara, Turkey


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Betatrophin and fibroblast growth factor-21 (FGF-21), asrecently discovered members of hepatokine/adipokine fa-mily, have been proposed to be associated with some me-tabolic disorders in which insulin resistance plays a majorrole. We aimed to investigate serum betatrophin and FGF-21 concentrations in women with polycystic ovary syndrome(PCOS).In this cross-sectional study, we recruited 34 women withPCOS and 31 women as healthy controls. Serum betatrop-hin level and its relationship with serum FGF-21 level as wellas other metabolic parameters were examined.Serum betatrophin level was significantly higher in womenwith PCOS than the control group (1.10 (0.20-4.20) vs 0.70(0.20-3.50) ng/ml, p=0.004), whereas, FGF-21 did not dif-

fer between the groups (74.80 (7.80-435.90) vs 119.30(10.50-443.40) pg/ml, p=0.13). Serum betatrophin corre-lated positively with LH levels (r=0.26, p=0.03). After con-trolling BMI, there was a significant positive correlationbetween betatrophin and FGF-21 (r=0.25, p=0.04). Multi-variate regression analysis revealed that FGF-21 and pre-sence of PCOS were the significant predictors of betatrophinconcentrations (R2=0.22, F=2.56, p=0.03).Our results indicate that betatrophin levels are increasedand associated with LH and FGF-21 levels, not insulin resis-tance, in women with PCOS.

Keywords: Betatrophin, body mass index,fibroblast growth factor-21,luteinizing hormone, polycystic ovary syndrome

P-171

Association of Serum Betatrophinwith Fibroblast Growth Factor-21 in Women

with Polycystic Ovary Syndrome

Gazi University Facutly of Medicine, Department of Internal Medicine, Ankara, Turkey*Gazi University Facutly of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Ankara, Turkey

**Gazi University Facutly of Medicine, Department of Medical Biochemistry, Ankara, Turkey


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ALT: 42 U/L ACTH: 118-121 pg/mL

AST: 16 U/L Cortisol: 23.7 µg/dL

Urea: 23 mg/dL Urinary cortisol: >1196 µg/gün

Creatinine: 0.62 mg/dL 2 days 2 mg DST cortisol: 22 µg/dL

FPG: 78 mg/dL 2 days 8 mg DST cortisol: 31.3 µg/dL

HbA1c: %5.2 Calcitonin: 8242 pg/mL

Na: 142 mmol/L CEA: 606.5 U/mL

K: 2.8 - 3.56 mmol/L

Table 1. Laboratory results.

Figure

Aim: Medullary thyroid cancer (MTC) constitutes 1-2% ofall thyroid cancers. Ectopic Cushing's syndrome (ECS) de-velops in 0.6% of MTC cases. We wanted to present a casewith metastatic MTC and ectopic Cushing's syndrome.Case: A thirty-seven-year-old male patient was performedbilateral total thyroidectomy and left neck dissection in 2011.Histopathological findings revealed a metastatic MTC. He hada lung and neck lymph node metastases at the time of di-agnosis. He received conventional chemotherapy and suni-tinib treatment. He was a stable disease without treatmentfor the past two years. He had cushingoid appearance in Oc-tober 2016. Laboratory results are shown in Table 1. RETmutation was negative. Bilateral adrenal glands and pitu-itary were normal. The colonoscopic examination detectedofthe diverticulas. We diagnosed ECS due to metastatic MTC.

Bilateral adrenalectomy was considered. However anesthe-sia was seen as high risk due to multiple rib fractures andoperation could not be performed. Ketocanazole was givenfor ECS. Twenty days after treatment with ketoconazole,vandetanib treatment started. Urinary cortisol level was de-creased to 14 mcg/day in the 6th months after vandetanibtreatment. Potassium level was normal after 2 weeks oftreatment. In the first year of vandetanib treatment, a newmetastatic lesion in the liver was detected with PET-CT. Thepatient is still under vandetanib treatment.Conclusion: Ectopic Cushing syndrome due to metastaticMTC is very rare. In the literature, there are some dataabout the efficiacy of vandetanib treatment in metastaticMTC and ECS. In our case. progression with vandetanibtreatment can be explained that it can not be used effectivedose and time due to the side effects.

P-188

Vandetanib Experience in a Patientwith Ectopic Cushing Syndrome

in Metastatic Medullary Thyroid Cancer

Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Endocrinology and Metabolism, Rize, Turkey*Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Medical Oncology, Rize, Turkey*Recep Tayyip Erdoğan University, Faculty of Medicine, Department of Nuclear Medicine, Rize, Turkey


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Mutations of TRPS1 cause tricho-rhino-phalangeal syndrome(TRPS), characterized by brachydactyly, sparse hair, and spe-cific facial dysmorphism including a bulbous nose. Lab findingsregarding parathormone, calcium and phosphate are normal.Thus, TRPS is usually mistaken for acrodysostosis types. Theseverity of brachidactyly is various, one or more metacarpalscan be affected. Herein we report a Turkish female with phe-

notype consistent with TRPS. In this patient with severebrachydactyly and short stature, we identified a novel het-erozygous missense mutation in exon 6 (c.2782T<G.p.Tyr928Asp). located within the GATA DNA-binding domain.These patients usually refer to dermatologist due to sparsehair. Brachydactyly is less noticed feature for patients. Ourfindings emphasize that physician should think all syn-dromes that can cause brachydactyly.

P-204

Tricho-Rhino-Phalangeal Syndromeis a Rare Presentation of Brachydactyly

Harvard University Faculty of Medicine, Massachusetts General Hospital, Endocrine Unit, Boston, USA*University of Health Sciences, Ankara Training and Research Hospital, Clinic of Endocrinology, Ankara, Turkey

**University of Health Sciences, Gülhane Training and Research Hospital, Clinic of Endocrinology, Ankara, Turkey


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P-205

Visceral Adiposity Index Levels in Patientswith Hypothyroidism

The Department of Family Medicine, Konya Health Application and Research Center, University of Health Sciences, Konya, Turkey*The Department of Internal Medicine, The Division of Endocrinology and Metabolism, The Medical School of Usak University, Uşak, Turkey

**The Department of Family Medicine, Meram Medical School of Necmettin Erbakan University, Konya, Turkey***The Department of Statistics, Necmettin Erbakan University, Faculty of Science, Konya, Turkey

****The Department of General Surgery, Konya Health Application and Research Center, University of Health Sciences, Konya, Turkey

Objective: To assess visceral adiposity index (VAI) as asign of cardio-vascular diseases (CVD) in patients with overtor subclinical hypothyroidism.Materials and Methods: Sixty-eight patients with hypothy-roidism (29 with overt and 39 with subclinical hypothy-roidism) and 33 age- and gender-matched control patientswere included. VAI levels were calculated with the followingformula: (waist circumference (WC)/[36.58+(1.89xbodymass index (BMI))])x[(triglyceride (TG) (mmol/L)/0.81)x(1.52xhigh-density lipoprotein cholesterol (HDL-cholesterol)(mmol/L))] and (WC/[39.68+(1.88xBMI)])x[(TG (mmol/L)/1.03)x(1.31xHDL-cholesterol (mmol/L))], respectively.Results: While body weight (p<0.01), BMI (p<0.01), TGand VAI levels (p<0.01) were higher in patients with hy-pothyroidism than controls. HDL-cholesterol levels werelower (p=0.02) (Table 1). When patients were divided togroups as subclinical (n=39) and overt hypothyroidism(n=29) and compared with each other and controls (n=33)

(Table 2), body weight (p=0.02 and p=0.02, respectively),BMI (p=0.01 and p<0.01, respectively) and TG (p<0.01and p=0.03, respectively) were higher in overt and subclin-ical hypothyroidism groups than controls. HDL-cholesterolwas lower only in the group with overt hypothyroidism thancontrols (p=0.01). Although found similar to each other inovert and subclinical hypothyroidism groups. VAI levelswere observed to be higher in both groups than controls(p<0.01 and p=0.02, respectively). In correlation analysis,a positive correlation was determined between thyroid stim-ulating hormone (TSH), BMI and VAI levels (p=0.03 andp<0.01, respectively).Conclusions: Due to the association between increasedVAI levels and CVDs, we consider that several measuresshould be promptly taken to decrease these risk factors inpatients with hypothyroidism.

Keywords: Hypothyroidism, visceral adiposity index,cardiovascular risk


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BP: Blood pressure. HDL-cholesterol: High density lipoprotein cholesterol. TSH: Thyroid stimulating hormon. VAI: Visceral adipo-sity index. WC: Waist circumference. Results are given as mean±standard deviation

Controls (n=33) Patients with hypothyroidism (n=68) p

Age (year) 36.73±2.39 40.31±1.54 0.20

Height (cm) 162.0±1.37 162.15±0.96 0.93

Weight (kg) 69.30±3.05 81.04±2.39 0.02

WC (cm) 93.09±4.18 100.54±1.86 0.06

Systolic BP (mmHg) 110.67±5.05 118.36±2.77 0.34

Diastolic BP (mmHg) 71.67±2.50 76.64±1.79 0.11

TSH (µIU/mL) 1.87±0.14 15.61±2.60 <0.01

Free thyroxine (ng/mL) 1.2±0.0 0.9±0.0 <0.01

Total cholesterol (mg/dL) 200.68±9.68 216.15±6.95 0.14

HDL-cholesterol (mg/dL) 67.29±8.95 51.86±2.98 0.02

Triglyceride (mg/dL) 93.74±7.69 145.12±16.36 <0.01

Body mass index (kg/m2) 26.44±1.15 30.76±0.82 <0.01

VAI 3.37±0.43 6.03±0.76 <0.01

Table 1. The comparison of study parameters in patients with hypothyroidism and controls.

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BP: Blood pressure, HDL-cholesterol: High density lipoprotein cholesterol, TSH: Thyroid stimulating hormon, VAI: Visceral adiposity index, WC: Waist cir-cumference. Results are given as mean±standard deviation.1: Controls, 2: Subclinical hypothyroidism, 3: Overt hypothyroidism.

Controls1 Subclinical Hypothyroidism2 Overt Hypothyroidism3

(n=33) (n=39) (n=29) p p1 vs 2 p1 vs 3 p2 vs 3

Age (year) 36.73±2.39 40.36±1.94 40.24±2.54 0.37

Height (cm) 162.0±1.37 162.41±1.31 161.79±1.42 0.78

Weight (kg) 69.30±3.05 82.15±2.87 79.55±4.09 0.02 0.02 0.02 0.93

WC (cm) 93.09±4.18 101.53±2.10 99.26±3.34 0.16

Systolic BP (mmHg) 110.67±5.05 119.05±3.70 117.41±4.26 0.63

Diastolic BP (mmHg) 71.67±2.50 75.27±2.19 78.52±3.01 0.20

TSH (µIU/mL) 1.87±0.14 6.71±0.22 27.58±5.39 <0.01 <0.01 <0.01 <0.01

Free thyroxine (ng/mL) 1.2±0.0 1.0±0.0 0.8±0.0 <0.01 <0.01 <0.01 <0.01

Total cholesterol (mg/dL) 200.68±9.68 211.42±7.19 222.34±13.09 0.35

HDL-cholesterol (mg/dL) 67.29±8.95 55.18±4.83 47.39±2.47 0.03 0.11 0.01 0.12

Triglyceride (mg/dL) 93.74±7.69 124.45±11.76 172.21±34.23 0.01 0.03 <0.01 0.25

BMI (kg/m2) 26.44±1.15 31.06±0.95 30.35±1.46 <0.01 0.01 0.04 0.67

VAI 3.37±0.43 4.98±0.63 7.36±1.51 <0.01 0.02 <0.01 0.08

Table 2. The comparison of demographic and laboratory parameters, and VAI levels in patients with overt andsubclinical hypothyroidism and controls.


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