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    Are there any causes for increased thyroid volume in women with prolactinoma?
    (Masson Editeur, 2015) Dogan, Bercem Aycicek; Tasci, Tugba; Arduc, Ayse; Tuna, Mazhar Muslum; Berker, Dilek; Guler, Serdar
    Purpose. - The aim of this study was to evaluate thyroid volume in women with prolactinoma and investigate the relationship between anabolic hormones [insulin, insulin like growth factor (IGF-1), estrogen] and thyroid volume in the patients. Material-method. - Sixty-three euthyroid women with prolactinoma and 60 healthy euthyroid women were included. Serum prolactin (PRL), thyroid-stimulating hormone (TSH), thyroxine (free T4), free tri-iodothyronine (free T3), insulin resistance (IR) which was estimated by the homeostasis model assessment, thyroidal microsome (anti-TPO), antithyroglobulin antibodies (TgAb), estradiol (E2), and insulin like growth factor (IGF-1) were evaluated, and thyroid volume was calculated by B-mode doppler USG. Results. - The mean thyroid volume was significantly higher in women with prolactinoma (82.5 +/- 15.1 mL) than in healthy women (76 +/- 15.1 mL)(P = 0.014), but no correlation was found between thyroid volume and serum PRL levels (P = 0.967). There were also no differences between thyroid volume, anabolic hormones (E2, IGF-1), and insulin resistance in women with prolactinoma (P = 0.776, P = 0.786, P = 0.647, respectively). Conclusions. - Our study did not show an association between anabolic hormones and increased thyroid volume in women with prolactinoma. (C) 2015 Elsevier Masson SAS. All rights reserved.
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    Autoimmune Fibrotic Adverse Reactions in One-Year Treatment with Cabergoline for Women with Prolactinoma
    (Bentham Science Publ Ltd, 2016) Dogan, Bercem Aycicek; Arduc, Ayse; Tuna, Mazhar Muslum; Berker, Dilek; Demirci, Nilgun; Demirtas, Semra; Cicekcioglu, Hulya
    Aim: Cabergoline is related to an elevated risk of fibrotic adverse reactions including cardiac valvular and pleuropulmonary fibrosis. We investigated pulmonary and cardiac valve fibrosis and immunological markers before and after 3 and 12 months of treatment with cabergoline in women with prolactinoma. Material-Methods: The study included thirty-two women with newly diagnosed prolactinoma and 28 healthy women. CAB cumulative dose was 7.8 +/- 5.5 mg after 3-month therapy, and 31 +/- 22 mg after 12-month follow-up. The risk of autoimmune adverse fibrotic reactions related to CAB treatment including cardiac valvulopathy and pulmonary fibrosis were assessed by a transthoracic echocardiography and pulmonary function tests, respectively. Immunological markers including Antistreptolysin O, Rheumatoid factor, Immunglobuline E, Antinuchlear antibody were also evaluated. Results: Before the start of CAB therapy, the total prevalence of trace grade of mitral, aortic, pulmonic, and tricuspid valve regurgitations were found as 34%, 3%, 6.3%, and 39 % respectively in women with prolactinoma. After improving of prolactin levels with CAB treatment, no change was found in the prevalence of the all valve regurgitations. There was no deterioration in pulmonary function tests. Rheumatoid factor was found higher in newly diagnosed women with prolactinoma than in healthy women (p=0.01), and this was improved by CAB therapy (p=0.005). Conclusion: The prospective study indicated that sufficient cabergoline doses for a period of one year treatment of prolactinoma were not found to be related to fibrotic adverse reactions including cardiac valvular and pulmonary fibrosis or increased levels of immunological marker, apart from rheumatoid factor. For the first time Rf was found higher in newly diagnosed women with prolactinoma and was improved after cabergoline therapy.
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    A case of mediastinitis accompanied with hyperosmolar nonketotic coma
    (Kare Publ, 2016) Tuna, Mazhar Muslum; Kilinc, Faruk; Pekkolay, Zafer; Soylu, Hikmet; Tuzcu, Alpaslan Kemal
    Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner.
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    Effect of androgen replacement therapy on atherosclerotic risk markers in young-to-middle-aged men with idiopathic hypogonadotropic hypogonadism
    (Wiley, 2015) Dogan, Bercem Aycicek; Karakilic, Ersen; Tuna, Mazhar Muslum; Arduc, Ayse; Berker, Dilek; Gueler, Serdar
    ObjectiveIdiopathic hypogonadotropic hypogonadism is a rare disorder. This study evaluated the effect of androgen replacement therapy on atherosclerotic risk markers in young-to-middle-aged men with this disorder. Design and methodsForty-three male patients aged 30 (range: 24-39years) who were newly diagnosed with idiopathic hypogonadotropic hypogonadism and 20 age-, sex- and weight-matched controls (range: 26-39years) were included in the study. Androgen replacement therapy was given according to the Algorithm of Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes (2010; Journal of Clinical Endocrinology and Metabolism, 95, 2536). The patients were assessed at a pretreatment visit and 3 and 6months after the treatment. Inflammatory markers and lipid parameters were evaluated. Endothelial function was assessed with brachial flow-mediated dilation of a brachial artery and high-resolution ultrasonography of the carotid intima-media thickness. ResultsThe carotid intima-media thickness (P<0001) was higher and the brachial flow-mediated diameter (P=0002) was lower in patients with idiopathic hypogonadotropic hypogonadism compared to the control subjects at the pretreatment visit. There was a negative correlation between the total testosterone level and carotid intima-media thickness (r=-0556, P=<0001). The carotid intima-media thickness and per cent flow-mediated diameter were significantly improved in the patient group 6months after the androgen replacement therapy (P=0002 and 0026, respectively). ConclusionsThis study indicated that low total testosterone levels can be considered a significant marker of atherosclerosis in patients with idiopathic hypogonadotropic hypogonadism and that androgen replacement therapy significantly reduces atherosclerotic risk markers in these patients after 6months.
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    Elevated neutrophil-to-lymphocyte ratio in the diagnosis of subacute thyroiditis
    (Mattioli 1885, 2018) Kilinc, Faruk; Ergun, Yakup; Pekkolay, Zafer; Tuzcu, Sadiye Altun; Gozel, Nevzat; Tuna, Mazhar Muslum; Tuzcu, Alpaslan Kemal
    Subacute thyroiditis (SAT) is a self-limiting inflammatory condition of the thyroid gland in which multinucleated giant cells constitute a key histological finding. The neutrophil-lymphocyte ratio (NLR), determined from peripheral blood, is accepted as an available and practical indicator of the systemic inflammation. The purpose of this study was to determine the neutrophil-to-lymphocyte ratio (NLR), a novel marker of inflammation, in patients with SAT and to compare these values with those from healthy subjects. A total of 150 participants were included in the study, 75 SAT patients and 75 healthy volunteers. Retrospectively, demographic and laboratory data of the subjects were obtained from our institution's database. Patients with active infection, diabetes mellitus, malignancy, other chronic inflammatory diseases and hematologic disorders were excluded from the study. Values for complete blood count (CBC) and serum laboratory parameters of SAT patients were the baseline values obtained at the time of SAT diagnosis. Control subjects consisted of healthy volunteers who visited our institution for a routine check-up. A total of 75 subacute thyroiditis patients 54 (72%) were female and 21 (28%) were males and 50 (66.6%) were female and 25 (33.3%) were male and 75 were healthy adults were included. The mean age was 39.95 +/- 14.2, years for patients with SAT and 37.53 +/- 13.45 years for the control group. There was no significant difference between the age for groups (P = 0.13). NLR levels were found to be 3,56 +/- 2,64 in patients with SAT; NLR levels were found to be 1.41 +/- 0.9 in the control group. NLR levels were significantly higher in patients with SAT compared to the control group. Our study showed that increased NLR may be useful as an indicator of the presence of SAT, especially in complicated cases. The assessment of neutrophil-lymphocyte ratio in conjunction with radiological and clinical findings will assist in the achievement of an accurate diagnosis. Larger, prospective studies are required to determine its usefulness in assessing diagnostic potential and treatment outcomes in SAT patients.
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    Evaluation of adipocytokine levels and vascular functions in young aged to middle aged men with idiopathic hypogonadotrophic hypogonadism
    (Maghira & Maas Publications, 2014) Tuna, Mazhar Muslum; Dogan, Berem Ayiek; Karakilic, Ersen; Arduc, Ayse; Isik, Serhat; Yilmaz, Fatma Meric; Topcuoglu, Canan
    OBJECTIVE: Hypogonadism has major effects on the urogenital system, in addition to other systems, the cardiovascular system in particular. There have been few studies conducted on markers of atherosclerosis, such as flow mediated dilatation (% FMD), carotid intima-media thickness (CIMT) and adipocytokine levels in idiopatic hypogonadotropic hypogonadal (IHH) males mostly in adult patients. The aim of this study was to evaluate the relationship between androgens and adipocytokines and parameters of vascular functions in hypogonadal men. MATERIALS AND METHODS: The study population consisted of 11 treatment naive IHH patients (group 1) and 15 age-matched healthy control males (group 2). A fasting blood sample was obtained for leptin, adiponectin and resistin. The endothelial functions were evaluated by studying % FMD and CIMT by high resolution B-mode ultrasound. RESULTS: No significant differences in age, body mass index, systolic and diastolic blood pressure were recorded between the two groups. The leptin level was significantly higher in group 1, whereas adiponectin and resistin levels were same between two groups. There was a negative correlation between total testosterone and carotid intima-media thickness (r=-0.656, p=0.008), and a negative correlation between total testosterone and leptin level (r=-0.794, p<0.001). No correlation was found between leptin and CIMT (p=0.184). CONCLUSION: Testosterone deficiency in hypogonadal men is associated with vascular parameters of atherosclerosis. The findings may establish indications for testosterone replacement therapy in hypogonadal men.
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    Non-functioning adrenal incidentalomas are associated with higher hypertension prevalence and higher risk of atherosclerosis
    (Springer, 2014) Tuna, Mazhar Muslum; Imga, Narin Nasiroglu; Dogan, Bercem Aycicek; Yilmaz, Fatma Meric; Topcuoglu, Canan; Akbaba, Gulhan; Berker, Dilek
    Introduction Adrenal incidentalomas (AIs) have been associated with an increased incidence of several cardiovascular risk factors. The aim of this study was to investigate plasma adiponectin, leptin, resistin, homocysteine, high sensitive C-reactive protein levels, and carotid intima media thickness (CIMT) in patients with non-functioning AI (NFAI). Materials and methods This study included data from 28 patients with NFAI (Group 1) and 41 controls (Group 2). Of the patients, 50 were female and 19 were male, and the mean age was 46.7 (range 37-65) years. Results There were no significant differences between Group 1 and 2 in terms of age, sex, or BMI. Hypertension prevalence was significantly higher in the NFAI group than in the control group (p = 0.01). Both groups had similar lipid, blood glucose, homocysteine, uric acid, high-sensitivity CRP levels. Adiponectin, leptin, and resistin levels were similar in both groups. CIMTs were significantly higher in the NFAI group. Conclusion There is increasing evidence that several cardiometabolic risk factors occur with higher prevalence in non-functioning adrenal incidentaloma patients compared to age-matched healthy subjects. In our study, hypertension prevalence and CIMT were higher in the NFAI group. Serum adipokine levels were similar for both groups.
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    Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism
    (Springer Japan Kk, 2016) Tuna, Mazhar Muslum; Caliskan, Mustafa; Unal, Mustafa; Demirci, Taner; Dogan, Bercem Aycicek; Kucukler, Kerim; Ozbek, Mustafa
    Normocalcemic primary hyperparathyroidism (NC-PHPT) is a variant of hyperparathyroidism, characterized by normal serum calcium levels, high parathyroid hormone (PTH) and normal 25-OH vitamin D status. The present study aimed to compare complications related to hyperparathyroidism in patients with NC-PHPT and hypercalcemic PHPT (HC-PHPT). We retrospectively evaluated the records of 307 PHPT patients between January 2010 and March 2013. We excluded patients with impaired renal function and liver failure. All patients underwent a biochemical and hormonal examination including serum glucose, albumin, total calcium, phosphorus, creatinine, lipoproteins, PTH and 25-OH vitamin D. Nephrolithiasis and bone mineral density were documented based on a review of the medical records. The study population consisted of 36 (12 %) males and 271 (88 %) females with a mean age of 53.3 +/- A 9.5 years (29-70 years). Twenty-three of the patients were diagnosed with NC-PHPT (group 1) and 284 were diagnosed with HC-PHPT (group 2). There were no significant differences in terms of age, gender, prevalence of hypertension, low bone mineral density and kidney stones between the groups. The mean thyroid-stimulating hormone (TSH) and low-density lipoprotein (LDL) levels were significantly higher in group 1 than in group 2. Our study found that patients with NC-PHPT have similar several complications as patients with HC-PHPT. NC-PHPT patients have higher TSH levels despite being within the normal range, and higher LDL-C levels than patients with HC-PHPT. However, this relationship needs to be clarified in future studies with larger cohorts.