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    5-Alpha Reductase Deficiency: A Review of Five Cases Diagnosed with Ambiguous Genitalia
    (Galenos Yayincilik, 2017) Pekkolay, Zafer; Kilinc, Faruk; Tuzcu, Sadiye Altun; Soylu, Hikmet; Tuzcu, Alpaslan Kemal
    5-alpha reductase is an enzyme which is responsible for the conversion of testosterone to dihydrotestosterone (DHT) in the peripheral tissues. It plays a key role in the development of male external genitalia. The present study was carried to make a clinical presentation of five male patients diagnosed with 5-alpha reductase deficiency resulting in the developmental disorder of male sexuality as well as to draw attention to the patients' medical history, physical examination and laboratory features. A test group comprising of five male subjects previously diagnosed with 5-alpha reductase deciency after being hospitalized and a series of examinations between April 2007 and July 2014, were enrolled in the study. Physical examination, hormonal profiles, radiological findings and karyotype analyses of the patients were carried out and their previous medical history was recorded. All the patients with karyotype 46 XY were raised as a female. They had external genitalia similar to each other and expressed a lower level of DHT. The patients with a disorder of male sex development, who expressed lower levels of dihydrotestosterone, must be checked for 5-alpha reductase deficiency.c
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    68Ga-DOTATATE PET/CT Can Be an Alternative Imaging Method in Insulinoma Patients
    (Soc Nuclear Medicine Inc, 2017) Tuzcu, Sadiye Altun; Pekkolay, Zafer; Kilinc, Faruk; Tuzcu, Alpaslan Kemal
    Insulinomas are the most common cause of hypoglycemia, resulting from endogenous hyperinsulinism. The diagnosis of insulinoma is established by demonstrating inappropriately high serum insulin concentrations during a spontaneous or induced episode of hypoglycemia. Most insulinomas are islet-cell tumors. They are often small (<2 cm), benign, and difficult to localize with current imaging techniques. Insulinomas can be detected using either noninvasive procedures (e.g., transabdominal ultrasonography, spiral CT, MRI, In-111-pentetreotide imaging, and F-18-L-dihydroxyphenylalanine PET) or invasive procedures (e.g., endoscopic ultrasonography) or a selective arterial calcium stimulation test with hepatic venous sampling. Methods: We performed Ga-68-DOTATATE PET/CT on 3 patients with insulinoma. Results: All patients' insulinomas were shown clearly with Ga-68-DOTATATE PET/CT. Conclusion: Ga-68-DOTATATE PET/CT imaging may be a useful noninvasive imaging technique to localize insulinomas preoperatively.
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    Alternative treatment of resistant hypoparathyroidism by intermittent infusion of teriparatide using an insulin pump: A case report
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Pekkolay, Zafer; Kilinc, Faruk; Soylu, Hikmet; Balsak, Belma; Guven, Mehmet; Tuzcu, Sadiye Altun; Kara, Ali Veysel
    Hypoparathyroidism usually responds to oral active vitamin D and calcium, but, although rare, some patients do not respond to this treatment. A 47-year-old Caucasian female presented to our medical unit with classical oral treatment-resistant hypocalcemia after thyroidectomy. Teriparatide was infused through the insulin pump with dosage set to 1 unit which equals to 2.5 mu g of teriparatide. In conclusion, intermittent subcutaneous infusion of teriparatide using an insulin pump is a safe and effective treatment modality to ensure normocalcemic conditions in patients with classical treatment-resistant hypoparathyroidism.
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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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    Exploring 18 F-FDG uptake patterns in liver, spleen, and bone marrow: Implications for inflammatory and infectious conditions
    (Hellenic Soc Nuclear Medicine, 2024) Tuzcu, Sadiye Altun; Cetinkaya, Erdal; Guzel, Fatih; Cetin, lbey Erkin; Mete, Umit; Argin, Esref; Tasdemir, Bekir
    Objective: This study aimed to explore the relationship between fluorine-18-fluorodeoxyglucose (F-18-FDG) uptake in the liver, spleen, and bone marrow and inflammatory markers such as c-reactive protein (CRP), albumin, and erythrocyte sedimentation rate (ESR) in patients undergoing positron emission tomography/computed tomography (PET/CT) imaging for cancer diagnosis. Subjects and methods: This retrospective cross-sectional study included a total of 708 patients with a diagnosis of malignancy. Fluorine-18-FDG PET/CT images acquired between January 2021 and December 2022. Exclusion criteria comprised prior chemotherapy, radiotherapy, hematological malignancies, or liver/spleen tumors. Statistical analysis included correlation analysis, univariate, and multivariate regression analysis. Results: C-reactive protein levels demonstrated a significant positive correlation with F-18-FDG uptake in the spleen (r=0.104, P=0.006) and bone marrow (r=0.112, P=0.003). Albumin showed a negative correlation with liver F-18-FDG uptake (r=-0.220, P<0.001). Regression analysis revealed ESR's impact on spleen-to-liver (P=0.023) and bone marrow-to-liver (P=0.012) F-18-FDG uptake. Conclusion: This study demonstrates the association between inflammatory markers and F-18-FDG uptake in liver, spleen and bone marrow. C-reactive protein and ESR showing significant correlations with spleen and bone marrow F-18-FDG uptake, and albumin correlated with liver F-18-FDG uptake negatively. Erythrocyte sedimentation rate had significant impact on spleen and bone marrow F-18-FDG uptakes. These findings suggest the potential of F-18-FDG PET/CT in diagnosing inflammatory conditions, warranting further investigation into its clinical implications.
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    Local imaging to interpret tumor size in F18 fluorodeoxyglucose positron emission tomography/CT in lung cancers
    (Assoc Medica Brasileira, 2024) Tuzcu, Sadiye Altun; Kaplan, Ihsan; Ibiloglu, Ibrahim; Uyar, Ali; Guzel, Fatih; Guzel, Yunus; Tasdemir, Bekir
    OBJECTIVE: This study aimed to determine the thoracic and extra-thoracic extension of the disease in patients diagnosed with lung cancer and who had whole-body F18-fluorodeoxyglucose positron emission tomography/CT imaging and to investigate whether there is a relationship between tumor size and extrathoracic spread. METHODS: A total of 308 patients diagnosed with lung cancer were included in this study. These 308 patients were first classified as group 1 (SPN 30 mm>longest lesion diameter >= 10 mm) and group 2 (lung mass (longest lesion diameter >= 30 mm), and then the same patients were classified as group 3 (nodular diameter of <= 20 mm) and group 4 (nodular size of >20 mm). Group 1 was compared with group 2 in terms of extrathoracic metastases. Similarly, group 3 was compared with group 4 in terms of frequency of extrathoracic metastases. F18 fluorodeoxyglucose positron emission tomography/CT examination was used to detect liver, adrenal, bone, and supraclavicular lymph node metastasis, besides extrathoracic metastasis. RESULTS: Liver, bone, and extrathoracic metastasis in group 1 was statistically lower than in group 2 (p<0.001, p<0.01, and p=0.03, respectively). Liver, extrathoracic, adrenal, and bone metastasis in group 3 was statistically lower than that in group 4 (p<0.001, p=0.01, and p=0.04, p<0.01, respectively). The extrathoracic extension was observed in only one patient in group 3. In addition, liver, adrenal, and bone metastases were not observed in group 3 patients. CONCLUSION: Positron emission tomography/CT may be more appropriate for cases with a nodule diameter of <= 20 mm. Performing local imaging in patients with a nodule diameter of <= 20 mm could reduce radiation exposure and save radiopharmaceuticals used in positron emission tomography/CT imaging.
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    Multiple endocrine neoplasia type 2A syndrome (MEN2A) and usefulness of 68Ga-DOTATATE PET/CT in this syndrome
    (Edizioni Luigi Pozzi, 2019) Tuzcu, Sadiye Altun; Pekkolay, Zafer
    The aim of this study was to evaluate a new imaging method 68Ga-DOTATATE PET/CT as an alternative method to diagnose evidence of neuroendocrine tumors or their metastasis (if any) in patient with MEN 2A. METHODS: Three patients( 2F, 1M; age 28,46 and 50 years) with MEN 2A syndrome who underwent 68Ga-DOTATATE PET/CT scan were prospectively evaluated. PET/CT images were analyzed with measurement of maximum standardized uptake value (SUVmax). RESULTS: All patients had adrenal masses with increased uptake of 68Ga-DOTATATE (first case adrenal mass SUVmax: 9,1, second case adrenal mass SUVmax: 32,4(right) 30,3 (left ) and third case SUVmax:12,4). All of the patients had medulla?), thyroid carcinoma with increased uptake - of 68Ga-DOTATATE (first case SUVmax: 3,3 second case SUVmax:7,7 and third case SUVmax: left thyroid nodule: 19,4, right thyroid nodule: 21,2). Third case has a parathyroid adenoma with SUVmax: 2,8. CONCLUSIONS: New imaging method 68Ga-DOTATATE PET/CT may be an alternative method to diagnose MEN 2A patients. 68Ga-DOTATATE PET/CT can give a great opportunity to detecting the multiple neoplasia like MEN 2A with only one session.
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    Preoperative intravenous ibandronate for treating severe hypercalcemia associated with primary hyperparathyroidism: an effective and low cost
    (Mattioli 1885, 2018) Pekkolay, Zafer; Kilinc, Faruk; Soylu, Hikmet; Balsak, Belma; Guven, Mehmet; Tuzcu, Sadiye Altun; Tuzcu, Alpaslan Kemal
    Primary hyperparathyroidism (PHPT) is a prevalent mineral metabolism disorder usually caused by a single parathyroid adenoma. Although PHPT is the most frequent cause of hypercalcemia, severe hypercalcemia cases are rarely encountered. Severe hypercalcemia results in fatal complications unless immediately treated; moreover, it causes delays in surgery for PHPT, the primary treatment. Some patients admitted because of hypercalcemia require intravenous bisphosphonate treatment. Aimed to investigate the efficacy of intravenous ibandronate, which is a relatively cheap drug than other intravenous bisphosphonates, in the preoperative treatment of symptomatic hypercalcemia in patients with PHPT. Also, there are some difference in the total cost of treatment for patients treated with ibandronate and zolendronate. The medical records of patients operated at Dicle University Department of General Surgery between 2010 and 2017 due to PHPT were retrospectively evaluated. Patients who were admitted because of hypercalcemia associated with parathyroid adenoma and underwent minimally invasive surgery subsequent to the lowering of calcium levels via preoperative intravenous ibandronate and zolendronate were included. Totally, 20 of 167 patients received a preoperative bisphosphonate due to hypercalcemia associated with PHPT. Seven patients treated with zoledronate only. Thirteen were treated with ibandronate only. There was no difference in hypercalcemia correction between the groups. Percentage of patients with hypocalcemia was less in the ibandronate group. The hypocalcaemic period was shorter in patients receiving ibandronate. Cost of hospital stay in patients receiving ibandronate is cheaper than zolendronate (780 +/- 462 USD versus 1765 +/- 1537 USD). Ibandronate use reduces the cost of hypercalcemia treatment by 55% in comparison with zolendronic acid. Intravenous ibandronate for treating severe hypercalcemia associated with PHPT is an effective and relatively cheap drug.