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  • Küçük Resim
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    Acromegaly and pregnancy: Five new cases
    (Turkiye Klinikleri, 2017) Önder, Elif; Aydın, Yusuf; Soysal, Tuba; Tuna, Mazhar; Güngör, Adem
    Pregnancy is a rare occurrence in acromegalic patients because of impaired fertility due to the disease. There are limited data available regarding pregnancy in acromegalic patients; although, it appears that the patients are usually able to carry their pregnancies to full term. In addition, certain metabolic effects of acromegaly need to be considered as they can be harmful to both mother and fetus. The discontinuation of the medical treatment is usually recommended as the effects of medical treatment are unclear. Herein, we report five new cases of pregnancies in acromegalic patients who had undergone surgery and medical treatment for macroadenoma, before the onset of pregnancy, from different centers. Two of them had received radiotherapy after the surgery. None of the patients in our study were treated for pregnancy; however, two of them were receiving octreotide when the diagnosis of pregnancy was established. The medical treatment of these two patients was discontinued at the beginning of pregnancy. Four patients delivered healthy babies, and therapeutic abortion was performed at the sixth week of pregnancy to one of the patients who was being treated with octreotide before the pregnancy. Out of the five patients in our study, two had pregestational diabetes and one had hypertension. As a conclusion, it can be said that pregnancy in acromegalic patients is usually uneventful without any treatment throughout the pregnancy.
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    The experience from ten insulinoma cases
    (Türkiye Klinikleri, 2017) Pekkolay, Zafer; Kılıç, Faruk; Tuna, Mazhar; Soylu, Hikmet
    Introduction: Insulinoma is a rare, pancreatic functional neuroendocrine tumor, characterized by endogenous hyperinsulinemia, fasting hypoglycemia, and neuroglycopenic symptoms. It is diagnosed by a 72-h-fasting test, followed by localization studies. The common treatment option is the surgical excision. We hereby aim to discuss our clinical experience related to the patients of insulinoma. Material and Method: A retrospective analysis was done on the history of the patients, who were hospitalized to our clinic due to hypoglycemia and biochemically detected insulinoma (glucose [removed] 3 μU/mL and C-peptide >0.6 ng/mL), between June 2007 and May 2015. Findings: The average age of the patients was 52,6 and ranged from 18 to 85 years. Five patients were men and five were women. All of the patients presented with fasting hypoglycemia. In one patient, the tumor was detected by DOTATATE scintigraphy. Seven patients underwent surgery and were cured. One patient demonstrated metastasis. The tumor could not be localized by ultrasound, CT, and MRI in two patients, and therefore, they were subjected to surgery after localizing the tumor by advanced imaging methods. Discussion: In patients with fasting hypoglycemia and neuroglycopenia, along with Whipple’s triad, insulinoma should mainly be considered and a 72-h-fasting test should be conducted for diagnosis. The localization studies should be performed if the results are < 55 mg/dL for blood glucose, >3 μU/mL for insulin and > 0.6 ng/mL for C-peptide in blood sampled during the appearance of symptoms. We found that the triphasic thin slice CT, with multi-detector, was very useful for tumor localization in the test patients.