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Papers by Selcuk Dagdelen

Research paper thumbnail of Higher rate of COVID-19 mortality in patients with type 1 than type 2 diabetes: a nationwide study

Endokrynologia Polska, 2022

Introduction: COVID-19 disease has a worse prognosis in patients with diabetes, but comparative d... more Introduction: COVID-19 disease has a worse prognosis in patients with diabetes, but comparative data about the course of COVID-19 in patients with type 1 (T1DM) and type 2 diabetes (T2DM) are lacking. The purpose of this study was to find out the relative clinical severity and mortality of COVID-19 patients with T1DM and T2DM. Material and methods: A nationwide retrospective cohort of patients with confirmed (PCR positive) COVID-19 infection (n = 149,671) was investigated. After exclusion of individuals with unspecified diabetes status, the adverse outcomes between patients with T1DM (n = 163), T2DM (n = 33,478) and those without diabetes (n = 115,108) were compared by using the propensity score matching method. The outcomes were hospitalization, the composite of intensive care unit (ICU) admission and/or mechanical ventilation, and mortality. Results: The patients with T1DM had higher mortality than the age-and gender-matched patients with T2DM (n = 489) and those without diabetes (n = 489) (p < 0.001). After further adjustment for the HbA 1c , and microvascular and macrovascular complications, the odds of mortality (OR: 3.35, 95% CI: 1.41-7.96, p = 0.006) and ICU admission and/or mechanical ventilation (OR: 2.95, 95% CI: 1.28-6.77, p = 0.011) were significantly higher in patients with T1DM compared to those with T2DM. Older age (OR: 1.06, 95% CI: 1.01-1.12, p = 0.028) and lymphopaenia (OR: 5.13, 95% CI: 1.04-25.5, p = 0.045) were independently associated with mortality in patients with T1DM. Conclusions: Patients with T1DM had worse prognosis of COVID-19 compared to T2DM patients or those without diabetes. These cases should be cared for diligently until more data become available about the causes of increased COVID-19 mortality in T1DM.

Research paper thumbnail of The Value of 4D Speckle-Tracking Strain Echocardiography in Evaluating the Relationship Between Asprosin and Growth Differentiation Factor-15 Levels and Subclinical Systolic Dysfunction in Patients With Acromegaly and Prolactinoma

Journal of the Endocrine Society, 2021

Introduction: In patients with acromegaly and prolactinoma, the long-term presence of elevated GH... more Introduction: In patients with acromegaly and prolactinoma, the long-term presence of elevated GH and PRL levels is associated with an unfavorable cardiovascular risk profile. Early recognition of dysfunctions related to cardiovascular complications, which can be a significant contributor to mortality, is important. The aim of this study was to assess the relationship of four-dimensional speckle-tracking strain echocardiographic (4DSTE) measurements with asprosin, GDF-15 levels, and the Framingham cardiovascular risk score (FRS) in patients with acromegaly and prolactinoma. Methods: The study included 41 acromegaly [20F/21M, age: 49 (41-57)], 29 prolactinoma patients [18F/11M, age: 40 (28-48)] and 33 healthy control subjects [15F/18M, age: 48 (37-54)]. Data are presented as median with interquartile ranges (IQR). Anthropometric, biochemical and echocardiographic measurements were performed. Asprosin and GDF-15 levels were measured by ELISA. Results: Plasma asprosin concentration in ...

Research paper thumbnail of Detection of Sex Steroid Expressions in Benign Versus Malignant Adrenal Tumor Tissue Homogenates With Western Blot Analysis

Journal of the Endocrine Society, 2021

Background: Adrenocortical cancer (ACC) is a rare tumor with poor prognosis. The prognostic value... more Background: Adrenocortical cancer (ACC) is a rare tumor with poor prognosis. The prognostic value of sex steroid expressions in ACC, was firstly shown by our group with immunohistochemistry staining in paraffin embedded blocks (1). Aim: To detect the presence of sex steroid expressions in different types of adrenal fresh tissue samples by Western Blot method. Method: Adrenal fresh tissue samples were isolated from benign (patient 1: adrenal hemangioma, n: 1 intratumoral + 1 extratumoral tissue samples) and malignant tumors (patient 2: ACC, n: 4 intratumoral tissue samples). Expressions of estrogen receptor alpha (Erα), progesterone receptor A (PR), androgen receptor (AR) and aromatase proteins were investigated using Western Blot method in the tissue lysates obtained. Monoclonal antibodies that recognize a single determinant of the obtained denatured proteins with high affinity and specificity were used. GAPDH was used as control protein. After the primary antibody incubation, the i...

Research paper thumbnail of Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study

Diabetes Therapy, 2021

Introduction: To investigate the effect of preexisting treatment with dipeptidyl peptidase-4 inhi... more Introduction: To investigate the effect of preexisting treatment with dipeptidyl peptidase-4 inhibitors (DPP-4is) on COVID-19-related hospitalization and mortality in patients with type 2 diabetes mellitus (T2DM). Methods: A multicenter, retrospective cohort study was conducted using patient data extracted from the Turkish National Electronic Data

Research paper thumbnail of MON-303 Giant Growth Hormone Secreting Pituitary Adenomas: A Single Institution Case Series

Journal of the Endocrine Society, 2020

The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituita... more The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituitary adenomas. Giant GH-secreting pituitary adenomas (≥ 4 cm) are rare tumors, and its prevalence of among acromegalic patients is <5%. This is a retrospective cohort study including patients with giant GH-secreting pituitary adenomas. The study population consisted of 10 patients (5 M/5 F). The mean age at diagnosis was 33.0±12.9 yrs (11-55 yrs). The mean delay between first symptom onset and diagnosis was 2.9 years. The most frequent symptoms were acral enlargement and facial changes (80%), followed by headache (70%) and visual deterioration (50%). One patient had epilepsy. Amenorrhea was presented in three females but obvious galactorrhea in two. The mean adenoma diameter was 42.6±4.7 mm (40-51 mm) at diagnosis. The vast majority of adenomas presented suprasellar extension (100%) or cavernous sinus invasion (80%). Cystic adenomas accounted for 50%. At presentation, mean GH and IGF-1 ...

Research paper thumbnail of Clinical Characteristics, Management, and Treatment Outcomes of Primary Hypophysitis: A Monocentric Cohort

Hormone and Metabolic Research, 2020

Primary hypophysitis (PH) is a rare autoimmune inflammatory disease of the pituitary gland. The a... more Primary hypophysitis (PH) is a rare autoimmune inflammatory disease of the pituitary gland. The aim of the study was to evaluate clinical characteristics, disease management, and outcomes of cases with PH. Medical records of PH patients admitted to Hacettepe University Hospital between 1999 and 2017 were analyzed retrospectively. Paraffin-embedded pathology blocks were obtained for both re-examination and IgG4 immunostaining. Twenty PH patients (15 females, 5 males) were evaluated. Mean age at diagnosis was 41.5±13.4 years. Some form of hormonal disorder was present in 63.2% of cases, hypogonadism (66.6%) being the most common. Panhypopituitarism was present in 36.8%. All patients had pituitary gland enlargement on magnetic resonance imaging; stalk thickening and loss of neurohypophyseal bright spot were present in 17.6 and 23.5%, respectively. Lymphocytic hypophysitis was the most common histopathological subtype (50%). Among pathology specimens available for IgG and IgG4 immunosta...

Research paper thumbnail of Rosiglitazone-induced anasarca without heart failure: capillary leakage?

Hormones, 2008

severity of thiazolidinedione (rosiglitazone)-induced fluid retention is linked almost exclusivel... more severity of thiazolidinedione (rosiglitazone)-induced fluid retention is linked almost exclusively to cardiac decompensation. We here report a 68-year old female with type 2 diabetes mellitus, in whom a life-threatening (anasarca type) acute pulmonary edema, induced by rosiglitazone plus insulin therapy, occurred without any evidence of left ventricular systolic or diastolic dysfunction. It seems that thiazolidinedione-induced severe edema does not have to be the result of acute congestive heart failure. these agents have been shown to increase vascular permeability in experimental models. thus, the recommendation of only cardiac monitoring in pulmonary edema, associated with thiazolidinediones, should be reconsidered.

Research paper thumbnail of Subclinical Inflammation is Associated with Reductions in Muscle Oxygenation, Exercise Capacity, and Quality of Life in Adults with Type 2 Diabetes

Canadian Journal of Diabetes, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Electron Microscopic Findings of Insulin-Induced Local Amyloidosis

Diabetes, 2018

Introduction: Insulin-induced local amyloidosis (ILA) was firstly described in 1983, but still un... more Introduction: Insulin-induced local amyloidosis (ILA) was firstly described in 1983, but still underdiagnosed. Here we describe clinicopathological and electron microscopic findings of a case with ILA. Case: A 52-year-old male with type 2 diabetes mellitus for 14 years, on basal-bolus insulin (i.e., insulin lispro and glargine), had noticed 2x2 cm mass at injection site. MRI showed a fibrous mass at the subcutaneous tissue. Punch biopsy of the lesion revealed amyloid deposition surrounded by giant cells. Immunohistochemistry studies proved that amyloid material is insulin. Electron microscopic evaluation (EM) revealed both extra-, and intracellular amyloid fibrils (Figure 1A,B). Discussion: Local amyloid deposition due to insulin injection could be seen in both types of diabetes. Despite earlier reports were associated with porcine insulin, subsequent publications linked also with human insulin and recombinant insulin analogues. High doses of insulin and inappropriate insulin inject...

Research paper thumbnail of A case of atypical macroprolactinoma presenting with pituitary apoplexy during pregnancy and review of the literature

Gynecological Endocrinology, 2019

Pituitary apoplexy (PA) during pregnancy is a rare acute clinical situation which could have life... more Pituitary apoplexy (PA) during pregnancy is a rare acute clinical situation which could have life-threatening consequences. Here we reported a case of 26-year-old nulliparous woman presenting with PA at the second trimester of her pregnancy. We also have reviewed reported cases of PA during pregnancy and conducted a detailed discussion on presenting symptoms, underlying pituitary pathology, management of apoplexy during pregnancy and outcomes.

Research paper thumbnail of Spontaneous Remission of Acromegaly after Infarctive Apoplexy with a Possible Relation to MRI and Diabetes Mellitus

The Endocrine Society's 92nd Annual Meeting, June 19–22, 2010 - San Diego, 2010

OBJECTIVES: Pituitary apoplexy is a rare clinical syndrome associated with rapid enlargement of a... more OBJECTIVES: Pituitary apoplexy is a rare clinical syndrome associated with rapid enlargement of a pituitary mass. We report the initial presentation, subsequent course and outcome of an acromegalic patient who developed spontaneous remission following pituitary apoplexy with pathologic findings of tumor infarction. CLINICAL PRESENTATION: A 38 year-old man with typical acromegalic features was referred to our hospital. He had been diabetic and hypertensive. His basal GH and IGF-1 levels were high (80 μg/L and 747 ng/mL respectively). Sella MRI showed a macroadenoma about 19×20 mm in size. He admitted to emergency department with complains of severe frontal headache accompanied by nausea and vomiting two days after MRI was taken. His neurological examination and visual field test were normal. Emergent MRI of the sella disclosed an enhancing intrasellar mass of 24×23 mm compressing the optic chiasm. The patient underwent transsphenoidal decompression of the lesion. Histological examination revealed an adenomatous tissue showing nonhemorrhagic coagulation necrosis. Before surgery, his GH levels declined to 2.72 μg/L spontaneously and after surgery he was in remission even leading to a state of growth hormone deficiency. CONCLUSION: When apoplexy occurs in functionning adenomas, it may cause spontaneous remission. However pituitary apoplexy due to tumor infarction is very rare. Various precipitating factors have been reported in 25-30% of pituitary apoplexy patients. Diabetes mellitus and diabetic ketoacidosis are one of these. The presence of contrast media induced endothelial swelling with the result of hypoperfusion and diabetes mellitus associated vasculopathy might be a precipitating factor in this patient.

Research paper thumbnail of Recurrent parathyroid carcinoma with spinal metastases unresponsive to cinacalcet therapy

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

Research paper thumbnail of Hepatosteatosis with hypobetalipoproteinemia

Journal of the National Medical Association, 2007

Nonalcoholic fatty liver disease is increasingly recognized as a condition that may progress to c... more Nonalcoholic fatty liver disease is increasingly recognized as a condition that may progress to chronic liver disease. Most cases of fatty liver are asymptomatic and often are detected during routine medical or laboratory examinations. There also are some rare genetic diseases such as abetalipoproteinemia and familial hypobetalipoproteinemia that may cause fatty liver disease. Both are inherited disorders of lipoprotein metabolism. Although abetalipoproteinemia and homozygous familial hypobetalipoproteinemia patients present with severe manifestations, heterozygotes are usually asymptomatic. In the last several years, case reports or studies indicating a relationship between hepatosteatosis and familial heterozygote hypobetalipoproteinemia (FHBL) have been reported. Here, we report three cases of FHBL with characteristic lipid profile, mildly elevated liver enzymes and hepatosteatosis confirmed by ultrasonography.

Research paper thumbnail of The clinical and cardiometabolic effects of d3-growth hormone receptor polymorphism in acromegaly

Pituitary, 2014

Exon 3-deleted GH receptor variant (d3-GHR) is associated with increased responsiveness to exogen... more Exon 3-deleted GH receptor variant (d3-GHR) is associated with increased responsiveness to exogenous GH. The aim of this study was to determine the effect of d3-GHR polymorphism on the GH/IGF-1 relationship, clinical parameters, and comorbidity in acromegalic patients. The study included 118 acromegalic patients (61 female and 57 male; mean age: 50.3 ± 12.2 years) and 108 healthy controls (94 female and 14 male: mean age: 41.1 ± 11.1 years). The prevalence of GHR genotypes was evaluated via PCR. In all, 71 (60.2%) patients had the fl/fl-GHR genotype, 40 (33.9%) were heterozygous for the fl/d3-GHR genotype, and 7 (5.9%) were homozygous for the d3/d3-GHR genotype. The prevalence of fl/fl-GHR, fl/d3-GHR, and d3/d3-GHR genotypes in the control group was 57.4, 29.6, and 13.0%, respectively-similar prevalences as in the patient group. Patients that were heterozygous and homozygous for the d3 allele were subgrouped (d3-GHR subgroup), and were compared to those with the fl/fl-GHR genotype (fl/fl-GHR subgroup). Anthropometric measures, features of pituitary adenoma, and baseline GH and IGF-1 levels were similar in both subgroups. The prevalence of coronary artery disease, hypertension, hyperlipidemia, type 2 diabetes mellitus, and multinodular goiter did not differ between patient subgroups. In total, 24 (20.3%) of the patients had cancer and the prevalence of cancer was similar in the d3-GHR (14.9%) and fl/fl-GHR (23.9%) subgroups (P = 0.23). More of the acromegalic patients that were d3 carriers had discordant GH and IGF-1 levels at baseline and post surgery, but the difference was not significant. A significant correlation between basal GH and IGF-1 levels was observed only in the patients with the fl/fl-GHR genotype (R(2) = 0.227, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The d3-GHR variant genotype did not have an effect on clinical features or comorbidity in acromegalic patients, but it might play a role in GH/IGF-1 level discordance in acromegaly.

Research paper thumbnail of Metastatic adrenocortical carcinoma presenting with concomitant secretion of glucocorticoid, mineralocorticoid, androgen, and catecholamines: a case report

Endocrine Abstracts, 2013

Research paper thumbnail of Hypotension, Syncope, and Fever in Systemic Mastocytosis without Skin Infiltration and Rapid Response to Corticosteroid and Cyclosporin: A Case Report

Case Reports in Medicine, 2010

Mast cell disorders are defined by an abnormal accumulation of tissue mast cells in one or more o... more Mast cell disorders are defined by an abnormal accumulation of tissue mast cells in one or more organ systems. In systemic mastocytosis, at least one extracutaneous organ is involved by definition. Although, systemic mastocytosis usually represents with skin lesion called urticaria pigmentosa, in a small proportion, there is extracutaneous involvement without skin infiltration. Other manifestations are flushing, tachycardia, dyspepsia, diarrhea, hypotension, syncope, and rarely fever. Various medications have been used but there is not a definite cure for systemic mastocytosis. The principles of treatment include control of symptoms with measures aimed to decrease mast cell activation. We describe a case of systemic mastocytosis presenting with hypotension, syncope attacks, fever, and local flushing. In bone marrow biopsy, increased mast cell infiltration was demonstrated. She had no skin infiltration. A good clinicopathological response was obtained acutely with combination therapy...

Research paper thumbnail of Retrospective analysis of adrenal incidentalomas: a single center experience

Endocrine Abstracts, 2014

Research paper thumbnail of Increased thyroid cancer risk in acromegaly

Endocrine Abstracts, 2013

Acromegaly increases cancer risk. We aimed to determine the prevalence and the predictors of tumo... more Acromegaly increases cancer risk. We aimed to determine the prevalence and the predictors of tumors in acromegalic patients treated at our department. We retrospectively evaluated 160 acromegalic patients [79 female (mean age 52.0 ± 10.4 years) and 81 male (mean age 49.1 ± 12.4 years)] between 1990 and 2012, with a mean follow up period of 7.1 ± 5.7 years. The patients were screened with colonoscopy, mammography, thyroid and prostate ultrasonography. Malignancy was found in 34 (21.3 %) patients. No significant difference was observed in the distribution of malignancy among sexes (20.3 % in F vs. 22.2 % in M). Thyroid cancer was the most frequent (n = 17, 10.6 %) followed by the breast cancer (n = 4, 2.5 %) and colorectal cancer (n = 3, 1.8 %). Renal cell cancer in two patients, bladder cancer in two patients, periampullary tumor, rectal carcinoid tumor, malignant melanoma, prostate cancer, lung cancer, parotid mucoepidermoid carcinoma and malignant mesenchymal tumor in brain in one patient were detected. One patient had both thyroid and renal cell cancer. Age of patients at diagnosis of acromegaly was significantly higher in patients with cancer (45.8 ± 9.9 vs. 40.9 ± 11.3 years, p \ 0.05). No significant difference was found in duration of the disease, initial GH levels and IGF-1 % upper limit of normal values, the prevalence of diabetes, hypertension, coronary heart disease, hyperlipidemia and treatment modalities between the patients with/without cancer. In logistic regression analysis, older age at diagnosis was associated with malignancy risk. The risk of cancer in acromegaly especially the thyroid cancer risk seems to be more increased than known in the literature. Therefore, acromegaly patients should be screened routinely for cancer, especially for thyroid cancer due to it being up to four times higher prevalence than breast and colorectal cancer.

Research paper thumbnail of Symptomatic Treatment of Graves Hyperthyroidism With Lithium in States of Thionamide Adverse Reactions

The Endocrinologist, 2004

In this retrospective study, we evaluate the efficacy and safety of lithium as a second-line trea... more In this retrospective study, we evaluate the efficacy and safety of lithium as a second-line treatment of hyperthyroidism. The data were retrieved from the hospital recordings of 12 patients with a mean age of 42 years. All patients had Graves disease, and they had initially been treated with propylthiouracil. Indications for the change of treatment to lithium were elevation of transaminases (n ϭ 5), agranulocytosis (n ϭ 2), allergic reaction (n ϭ 1), elevation of transaminases and allergy (n ϭ 2), dyspepsia (n ϭ 1), and resistance to propylthiouracil therapy (n ϭ 1). A total of 900 mg lithium daily was given in 3 divided doses. One patient experienced an allergic reaction to lithium with a severe urticarial rash after the second dose. The mean follow up with lithium therapy in the remaining 11 patients was 36 days. Euthyroidism was achieved in 2 patients after 45 and 120 days of lithium treatment. In 9 patients who received lithium, the thyroid hormone levels tended to decline. Nine patients received radioactive iodine (RAI) therapy and 2 thyroid surgery as definitive treatment. The lithium therapy was generally well tolerated except in 1 patient with a high serum lithium level, nausea, and vomiting. Our results suggest that lithium has a weak antithyroid effect and can restore euthyroidism in a small number of patients. It can be tried as a second-line, symptomatic treatment when adverse reaction or resistance to thionamides occurs.

Research paper thumbnail of Thrombin-activatable fibrinolysis inhibitor activity and global fibrinolytic capacity in Type 1 diabetes

Journal of Diabetes and its Complications, 2006

Hypofibrinolysis is a state that is commonly observed in type 2 diabetic patients, a finding also... more Hypofibrinolysis is a state that is commonly observed in type 2 diabetic patients, a finding also possibly related to obesity and insulin resistance. There is little information, however, regarding the status of fibrinolytic system in Type 1 diabetes, in particular as reflected by thrombin-activatable fibrinolysis inhibitor (TAFI) activity and global fibrinolytic capacity (GFC). To provide information in this respect, 30 Type 1 diabetic patients (median age=16) and 28 healthy controls (median age=14) were enrolled in this study. The median duration of diabetes was 7 years, and median HbA 1c was 8.85% (range: 5.5-11.9%) in the diabetic group. None of the patients had macrovascular complications. Microvascular complications were present in a total of eight patients (nephropathy: n=5; retinopathy: n=3). A comparison of the TAFI activity between the patient (median 84.9, range: 71.5-103.3%) and the control groups (median=83.3, range: 63.7-97.4%) yielded no statistically significant difference (P=.950). Similarly, GFC was comparable between the two groups (median=8.22, range: 0.72-22.38 Ag/ml, and median=13.32, range: 3.0-23.22 Ag/ml, respectively, in the diabetic and control groups, P=.086). TAFI activity did not significantly correlate with age, albumin excretion, fasting plasma glucose, HbA 1c , D-dimer, and fibrinogen by Spearman rank correlation test. There was as a significant inverse correlation between GFC and TAFI activity (r=À.414, P=.006). Contrary to the previous observations in Type 2 diabetes, our data suggest that fibrinolytic activity is not adversely affected by Type 1 diabetes, and it has no relationship with the degree of metabolic control.

Research paper thumbnail of Higher rate of COVID-19 mortality in patients with type 1 than type 2 diabetes: a nationwide study

Endokrynologia Polska, 2022

Introduction: COVID-19 disease has a worse prognosis in patients with diabetes, but comparative d... more Introduction: COVID-19 disease has a worse prognosis in patients with diabetes, but comparative data about the course of COVID-19 in patients with type 1 (T1DM) and type 2 diabetes (T2DM) are lacking. The purpose of this study was to find out the relative clinical severity and mortality of COVID-19 patients with T1DM and T2DM. Material and methods: A nationwide retrospective cohort of patients with confirmed (PCR positive) COVID-19 infection (n = 149,671) was investigated. After exclusion of individuals with unspecified diabetes status, the adverse outcomes between patients with T1DM (n = 163), T2DM (n = 33,478) and those without diabetes (n = 115,108) were compared by using the propensity score matching method. The outcomes were hospitalization, the composite of intensive care unit (ICU) admission and/or mechanical ventilation, and mortality. Results: The patients with T1DM had higher mortality than the age-and gender-matched patients with T2DM (n = 489) and those without diabetes (n = 489) (p < 0.001). After further adjustment for the HbA 1c , and microvascular and macrovascular complications, the odds of mortality (OR: 3.35, 95% CI: 1.41-7.96, p = 0.006) and ICU admission and/or mechanical ventilation (OR: 2.95, 95% CI: 1.28-6.77, p = 0.011) were significantly higher in patients with T1DM compared to those with T2DM. Older age (OR: 1.06, 95% CI: 1.01-1.12, p = 0.028) and lymphopaenia (OR: 5.13, 95% CI: 1.04-25.5, p = 0.045) were independently associated with mortality in patients with T1DM. Conclusions: Patients with T1DM had worse prognosis of COVID-19 compared to T2DM patients or those without diabetes. These cases should be cared for diligently until more data become available about the causes of increased COVID-19 mortality in T1DM.

Research paper thumbnail of The Value of 4D Speckle-Tracking Strain Echocardiography in Evaluating the Relationship Between Asprosin and Growth Differentiation Factor-15 Levels and Subclinical Systolic Dysfunction in Patients With Acromegaly and Prolactinoma

Journal of the Endocrine Society, 2021

Introduction: In patients with acromegaly and prolactinoma, the long-term presence of elevated GH... more Introduction: In patients with acromegaly and prolactinoma, the long-term presence of elevated GH and PRL levels is associated with an unfavorable cardiovascular risk profile. Early recognition of dysfunctions related to cardiovascular complications, which can be a significant contributor to mortality, is important. The aim of this study was to assess the relationship of four-dimensional speckle-tracking strain echocardiographic (4DSTE) measurements with asprosin, GDF-15 levels, and the Framingham cardiovascular risk score (FRS) in patients with acromegaly and prolactinoma. Methods: The study included 41 acromegaly [20F/21M, age: 49 (41-57)], 29 prolactinoma patients [18F/11M, age: 40 (28-48)] and 33 healthy control subjects [15F/18M, age: 48 (37-54)]. Data are presented as median with interquartile ranges (IQR). Anthropometric, biochemical and echocardiographic measurements were performed. Asprosin and GDF-15 levels were measured by ELISA. Results: Plasma asprosin concentration in ...

Research paper thumbnail of Detection of Sex Steroid Expressions in Benign Versus Malignant Adrenal Tumor Tissue Homogenates With Western Blot Analysis

Journal of the Endocrine Society, 2021

Background: Adrenocortical cancer (ACC) is a rare tumor with poor prognosis. The prognostic value... more Background: Adrenocortical cancer (ACC) is a rare tumor with poor prognosis. The prognostic value of sex steroid expressions in ACC, was firstly shown by our group with immunohistochemistry staining in paraffin embedded blocks (1). Aim: To detect the presence of sex steroid expressions in different types of adrenal fresh tissue samples by Western Blot method. Method: Adrenal fresh tissue samples were isolated from benign (patient 1: adrenal hemangioma, n: 1 intratumoral + 1 extratumoral tissue samples) and malignant tumors (patient 2: ACC, n: 4 intratumoral tissue samples). Expressions of estrogen receptor alpha (Erα), progesterone receptor A (PR), androgen receptor (AR) and aromatase proteins were investigated using Western Blot method in the tissue lysates obtained. Monoclonal antibodies that recognize a single determinant of the obtained denatured proteins with high affinity and specificity were used. GAPDH was used as control protein. After the primary antibody incubation, the i...

Research paper thumbnail of Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study

Diabetes Therapy, 2021

Introduction: To investigate the effect of preexisting treatment with dipeptidyl peptidase-4 inhi... more Introduction: To investigate the effect of preexisting treatment with dipeptidyl peptidase-4 inhibitors (DPP-4is) on COVID-19-related hospitalization and mortality in patients with type 2 diabetes mellitus (T2DM). Methods: A multicenter, retrospective cohort study was conducted using patient data extracted from the Turkish National Electronic Data

Research paper thumbnail of MON-303 Giant Growth Hormone Secreting Pituitary Adenomas: A Single Institution Case Series

Journal of the Endocrine Society, 2020

The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituita... more The prevalence of growth hormone (GH)-secreting pituitary adenoma is around 11-13% of all pituitary adenomas. Giant GH-secreting pituitary adenomas (≥ 4 cm) are rare tumors, and its prevalence of among acromegalic patients is <5%. This is a retrospective cohort study including patients with giant GH-secreting pituitary adenomas. The study population consisted of 10 patients (5 M/5 F). The mean age at diagnosis was 33.0±12.9 yrs (11-55 yrs). The mean delay between first symptom onset and diagnosis was 2.9 years. The most frequent symptoms were acral enlargement and facial changes (80%), followed by headache (70%) and visual deterioration (50%). One patient had epilepsy. Amenorrhea was presented in three females but obvious galactorrhea in two. The mean adenoma diameter was 42.6±4.7 mm (40-51 mm) at diagnosis. The vast majority of adenomas presented suprasellar extension (100%) or cavernous sinus invasion (80%). Cystic adenomas accounted for 50%. At presentation, mean GH and IGF-1 ...

Research paper thumbnail of Clinical Characteristics, Management, and Treatment Outcomes of Primary Hypophysitis: A Monocentric Cohort

Hormone and Metabolic Research, 2020

Primary hypophysitis (PH) is a rare autoimmune inflammatory disease of the pituitary gland. The a... more Primary hypophysitis (PH) is a rare autoimmune inflammatory disease of the pituitary gland. The aim of the study was to evaluate clinical characteristics, disease management, and outcomes of cases with PH. Medical records of PH patients admitted to Hacettepe University Hospital between 1999 and 2017 were analyzed retrospectively. Paraffin-embedded pathology blocks were obtained for both re-examination and IgG4 immunostaining. Twenty PH patients (15 females, 5 males) were evaluated. Mean age at diagnosis was 41.5±13.4 years. Some form of hormonal disorder was present in 63.2% of cases, hypogonadism (66.6%) being the most common. Panhypopituitarism was present in 36.8%. All patients had pituitary gland enlargement on magnetic resonance imaging; stalk thickening and loss of neurohypophyseal bright spot were present in 17.6 and 23.5%, respectively. Lymphocytic hypophysitis was the most common histopathological subtype (50%). Among pathology specimens available for IgG and IgG4 immunosta...

Research paper thumbnail of Rosiglitazone-induced anasarca without heart failure: capillary leakage?

Hormones, 2008

severity of thiazolidinedione (rosiglitazone)-induced fluid retention is linked almost exclusivel... more severity of thiazolidinedione (rosiglitazone)-induced fluid retention is linked almost exclusively to cardiac decompensation. We here report a 68-year old female with type 2 diabetes mellitus, in whom a life-threatening (anasarca type) acute pulmonary edema, induced by rosiglitazone plus insulin therapy, occurred without any evidence of left ventricular systolic or diastolic dysfunction. It seems that thiazolidinedione-induced severe edema does not have to be the result of acute congestive heart failure. these agents have been shown to increase vascular permeability in experimental models. thus, the recommendation of only cardiac monitoring in pulmonary edema, associated with thiazolidinediones, should be reconsidered.

Research paper thumbnail of Subclinical Inflammation is Associated with Reductions in Muscle Oxygenation, Exercise Capacity, and Quality of Life in Adults with Type 2 Diabetes

Canadian Journal of Diabetes, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Electron Microscopic Findings of Insulin-Induced Local Amyloidosis

Diabetes, 2018

Introduction: Insulin-induced local amyloidosis (ILA) was firstly described in 1983, but still un... more Introduction: Insulin-induced local amyloidosis (ILA) was firstly described in 1983, but still underdiagnosed. Here we describe clinicopathological and electron microscopic findings of a case with ILA. Case: A 52-year-old male with type 2 diabetes mellitus for 14 years, on basal-bolus insulin (i.e., insulin lispro and glargine), had noticed 2x2 cm mass at injection site. MRI showed a fibrous mass at the subcutaneous tissue. Punch biopsy of the lesion revealed amyloid deposition surrounded by giant cells. Immunohistochemistry studies proved that amyloid material is insulin. Electron microscopic evaluation (EM) revealed both extra-, and intracellular amyloid fibrils (Figure 1A,B). Discussion: Local amyloid deposition due to insulin injection could be seen in both types of diabetes. Despite earlier reports were associated with porcine insulin, subsequent publications linked also with human insulin and recombinant insulin analogues. High doses of insulin and inappropriate insulin inject...

Research paper thumbnail of A case of atypical macroprolactinoma presenting with pituitary apoplexy during pregnancy and review of the literature

Gynecological Endocrinology, 2019

Pituitary apoplexy (PA) during pregnancy is a rare acute clinical situation which could have life... more Pituitary apoplexy (PA) during pregnancy is a rare acute clinical situation which could have life-threatening consequences. Here we reported a case of 26-year-old nulliparous woman presenting with PA at the second trimester of her pregnancy. We also have reviewed reported cases of PA during pregnancy and conducted a detailed discussion on presenting symptoms, underlying pituitary pathology, management of apoplexy during pregnancy and outcomes.

Research paper thumbnail of Spontaneous Remission of Acromegaly after Infarctive Apoplexy with a Possible Relation to MRI and Diabetes Mellitus

The Endocrine Society's 92nd Annual Meeting, June 19–22, 2010 - San Diego, 2010

OBJECTIVES: Pituitary apoplexy is a rare clinical syndrome associated with rapid enlargement of a... more OBJECTIVES: Pituitary apoplexy is a rare clinical syndrome associated with rapid enlargement of a pituitary mass. We report the initial presentation, subsequent course and outcome of an acromegalic patient who developed spontaneous remission following pituitary apoplexy with pathologic findings of tumor infarction. CLINICAL PRESENTATION: A 38 year-old man with typical acromegalic features was referred to our hospital. He had been diabetic and hypertensive. His basal GH and IGF-1 levels were high (80 μg/L and 747 ng/mL respectively). Sella MRI showed a macroadenoma about 19×20 mm in size. He admitted to emergency department with complains of severe frontal headache accompanied by nausea and vomiting two days after MRI was taken. His neurological examination and visual field test were normal. Emergent MRI of the sella disclosed an enhancing intrasellar mass of 24×23 mm compressing the optic chiasm. The patient underwent transsphenoidal decompression of the lesion. Histological examination revealed an adenomatous tissue showing nonhemorrhagic coagulation necrosis. Before surgery, his GH levels declined to 2.72 μg/L spontaneously and after surgery he was in remission even leading to a state of growth hormone deficiency. CONCLUSION: When apoplexy occurs in functionning adenomas, it may cause spontaneous remission. However pituitary apoplexy due to tumor infarction is very rare. Various precipitating factors have been reported in 25-30% of pituitary apoplexy patients. Diabetes mellitus and diabetic ketoacidosis are one of these. The presence of contrast media induced endothelial swelling with the result of hypoperfusion and diabetes mellitus associated vasculopathy might be a precipitating factor in this patient.

Research paper thumbnail of Recurrent parathyroid carcinoma with spinal metastases unresponsive to cinacalcet therapy

Journal of B.U.ON. : official journal of the Balkan Union of Oncology

Research paper thumbnail of Hepatosteatosis with hypobetalipoproteinemia

Journal of the National Medical Association, 2007

Nonalcoholic fatty liver disease is increasingly recognized as a condition that may progress to c... more Nonalcoholic fatty liver disease is increasingly recognized as a condition that may progress to chronic liver disease. Most cases of fatty liver are asymptomatic and often are detected during routine medical or laboratory examinations. There also are some rare genetic diseases such as abetalipoproteinemia and familial hypobetalipoproteinemia that may cause fatty liver disease. Both are inherited disorders of lipoprotein metabolism. Although abetalipoproteinemia and homozygous familial hypobetalipoproteinemia patients present with severe manifestations, heterozygotes are usually asymptomatic. In the last several years, case reports or studies indicating a relationship between hepatosteatosis and familial heterozygote hypobetalipoproteinemia (FHBL) have been reported. Here, we report three cases of FHBL with characteristic lipid profile, mildly elevated liver enzymes and hepatosteatosis confirmed by ultrasonography.

Research paper thumbnail of The clinical and cardiometabolic effects of d3-growth hormone receptor polymorphism in acromegaly

Pituitary, 2014

Exon 3-deleted GH receptor variant (d3-GHR) is associated with increased responsiveness to exogen... more Exon 3-deleted GH receptor variant (d3-GHR) is associated with increased responsiveness to exogenous GH. The aim of this study was to determine the effect of d3-GHR polymorphism on the GH/IGF-1 relationship, clinical parameters, and comorbidity in acromegalic patients. The study included 118 acromegalic patients (61 female and 57 male; mean age: 50.3 ± 12.2 years) and 108 healthy controls (94 female and 14 male: mean age: 41.1 ± 11.1 years). The prevalence of GHR genotypes was evaluated via PCR. In all, 71 (60.2%) patients had the fl/fl-GHR genotype, 40 (33.9%) were heterozygous for the fl/d3-GHR genotype, and 7 (5.9%) were homozygous for the d3/d3-GHR genotype. The prevalence of fl/fl-GHR, fl/d3-GHR, and d3/d3-GHR genotypes in the control group was 57.4, 29.6, and 13.0%, respectively-similar prevalences as in the patient group. Patients that were heterozygous and homozygous for the d3 allele were subgrouped (d3-GHR subgroup), and were compared to those with the fl/fl-GHR genotype (fl/fl-GHR subgroup). Anthropometric measures, features of pituitary adenoma, and baseline GH and IGF-1 levels were similar in both subgroups. The prevalence of coronary artery disease, hypertension, hyperlipidemia, type 2 diabetes mellitus, and multinodular goiter did not differ between patient subgroups. In total, 24 (20.3%) of the patients had cancer and the prevalence of cancer was similar in the d3-GHR (14.9%) and fl/fl-GHR (23.9%) subgroups (P = 0.23). More of the acromegalic patients that were d3 carriers had discordant GH and IGF-1 levels at baseline and post surgery, but the difference was not significant. A significant correlation between basal GH and IGF-1 levels was observed only in the patients with the fl/fl-GHR genotype (R(2) = 0.227, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The d3-GHR variant genotype did not have an effect on clinical features or comorbidity in acromegalic patients, but it might play a role in GH/IGF-1 level discordance in acromegaly.

Research paper thumbnail of Metastatic adrenocortical carcinoma presenting with concomitant secretion of glucocorticoid, mineralocorticoid, androgen, and catecholamines: a case report

Endocrine Abstracts, 2013

Research paper thumbnail of Hypotension, Syncope, and Fever in Systemic Mastocytosis without Skin Infiltration and Rapid Response to Corticosteroid and Cyclosporin: A Case Report

Case Reports in Medicine, 2010

Mast cell disorders are defined by an abnormal accumulation of tissue mast cells in one or more o... more Mast cell disorders are defined by an abnormal accumulation of tissue mast cells in one or more organ systems. In systemic mastocytosis, at least one extracutaneous organ is involved by definition. Although, systemic mastocytosis usually represents with skin lesion called urticaria pigmentosa, in a small proportion, there is extracutaneous involvement without skin infiltration. Other manifestations are flushing, tachycardia, dyspepsia, diarrhea, hypotension, syncope, and rarely fever. Various medications have been used but there is not a definite cure for systemic mastocytosis. The principles of treatment include control of symptoms with measures aimed to decrease mast cell activation. We describe a case of systemic mastocytosis presenting with hypotension, syncope attacks, fever, and local flushing. In bone marrow biopsy, increased mast cell infiltration was demonstrated. She had no skin infiltration. A good clinicopathological response was obtained acutely with combination therapy...

Research paper thumbnail of Retrospective analysis of adrenal incidentalomas: a single center experience

Endocrine Abstracts, 2014

Research paper thumbnail of Increased thyroid cancer risk in acromegaly

Endocrine Abstracts, 2013

Acromegaly increases cancer risk. We aimed to determine the prevalence and the predictors of tumo... more Acromegaly increases cancer risk. We aimed to determine the prevalence and the predictors of tumors in acromegalic patients treated at our department. We retrospectively evaluated 160 acromegalic patients [79 female (mean age 52.0 ± 10.4 years) and 81 male (mean age 49.1 ± 12.4 years)] between 1990 and 2012, with a mean follow up period of 7.1 ± 5.7 years. The patients were screened with colonoscopy, mammography, thyroid and prostate ultrasonography. Malignancy was found in 34 (21.3 %) patients. No significant difference was observed in the distribution of malignancy among sexes (20.3 % in F vs. 22.2 % in M). Thyroid cancer was the most frequent (n = 17, 10.6 %) followed by the breast cancer (n = 4, 2.5 %) and colorectal cancer (n = 3, 1.8 %). Renal cell cancer in two patients, bladder cancer in two patients, periampullary tumor, rectal carcinoid tumor, malignant melanoma, prostate cancer, lung cancer, parotid mucoepidermoid carcinoma and malignant mesenchymal tumor in brain in one patient were detected. One patient had both thyroid and renal cell cancer. Age of patients at diagnosis of acromegaly was significantly higher in patients with cancer (45.8 ± 9.9 vs. 40.9 ± 11.3 years, p \ 0.05). No significant difference was found in duration of the disease, initial GH levels and IGF-1 % upper limit of normal values, the prevalence of diabetes, hypertension, coronary heart disease, hyperlipidemia and treatment modalities between the patients with/without cancer. In logistic regression analysis, older age at diagnosis was associated with malignancy risk. The risk of cancer in acromegaly especially the thyroid cancer risk seems to be more increased than known in the literature. Therefore, acromegaly patients should be screened routinely for cancer, especially for thyroid cancer due to it being up to four times higher prevalence than breast and colorectal cancer.

Research paper thumbnail of Symptomatic Treatment of Graves Hyperthyroidism With Lithium in States of Thionamide Adverse Reactions

The Endocrinologist, 2004

In this retrospective study, we evaluate the efficacy and safety of lithium as a second-line trea... more In this retrospective study, we evaluate the efficacy and safety of lithium as a second-line treatment of hyperthyroidism. The data were retrieved from the hospital recordings of 12 patients with a mean age of 42 years. All patients had Graves disease, and they had initially been treated with propylthiouracil. Indications for the change of treatment to lithium were elevation of transaminases (n ϭ 5), agranulocytosis (n ϭ 2), allergic reaction (n ϭ 1), elevation of transaminases and allergy (n ϭ 2), dyspepsia (n ϭ 1), and resistance to propylthiouracil therapy (n ϭ 1). A total of 900 mg lithium daily was given in 3 divided doses. One patient experienced an allergic reaction to lithium with a severe urticarial rash after the second dose. The mean follow up with lithium therapy in the remaining 11 patients was 36 days. Euthyroidism was achieved in 2 patients after 45 and 120 days of lithium treatment. In 9 patients who received lithium, the thyroid hormone levels tended to decline. Nine patients received radioactive iodine (RAI) therapy and 2 thyroid surgery as definitive treatment. The lithium therapy was generally well tolerated except in 1 patient with a high serum lithium level, nausea, and vomiting. Our results suggest that lithium has a weak antithyroid effect and can restore euthyroidism in a small number of patients. It can be tried as a second-line, symptomatic treatment when adverse reaction or resistance to thionamides occurs.

Research paper thumbnail of Thrombin-activatable fibrinolysis inhibitor activity and global fibrinolytic capacity in Type 1 diabetes

Journal of Diabetes and its Complications, 2006

Hypofibrinolysis is a state that is commonly observed in type 2 diabetic patients, a finding also... more Hypofibrinolysis is a state that is commonly observed in type 2 diabetic patients, a finding also possibly related to obesity and insulin resistance. There is little information, however, regarding the status of fibrinolytic system in Type 1 diabetes, in particular as reflected by thrombin-activatable fibrinolysis inhibitor (TAFI) activity and global fibrinolytic capacity (GFC). To provide information in this respect, 30 Type 1 diabetic patients (median age=16) and 28 healthy controls (median age=14) were enrolled in this study. The median duration of diabetes was 7 years, and median HbA 1c was 8.85% (range: 5.5-11.9%) in the diabetic group. None of the patients had macrovascular complications. Microvascular complications were present in a total of eight patients (nephropathy: n=5; retinopathy: n=3). A comparison of the TAFI activity between the patient (median 84.9, range: 71.5-103.3%) and the control groups (median=83.3, range: 63.7-97.4%) yielded no statistically significant difference (P=.950). Similarly, GFC was comparable between the two groups (median=8.22, range: 0.72-22.38 Ag/ml, and median=13.32, range: 3.0-23.22 Ag/ml, respectively, in the diabetic and control groups, P=.086). TAFI activity did not significantly correlate with age, albumin excretion, fasting plasma glucose, HbA 1c , D-dimer, and fibrinogen by Spearman rank correlation test. There was as a significant inverse correlation between GFC and TAFI activity (r=À.414, P=.006). Contrary to the previous observations in Type 2 diabetes, our data suggest that fibrinolytic activity is not adversely affected by Type 1 diabetes, and it has no relationship with the degree of metabolic control.