Halit Diri - Academia.edu (original) (raw)

Papers by Halit Diri

Turkish Journal of Endocrinology and Metabolism, 2014

ABSTRACT 17-alpha hydroxylase deficiency (17OHD) is an uncommon cause of congenital adrenal hyper... more ABSTRACT 17-alpha hydroxylase deficiency (17OHD) is an uncommon cause of congenital adrenal hyperplasia (CAH) resulting from mutation in the CYP17 gene. It is an autosomal recessive disease leading to the deficiency of enzyme activity which results in impaired synthesis of cortisol, androgen and sex steroids. A 35-year-old woman was admitted to the hospital with hypokalemia, weakness, and fatigue. Medical history revealed two attempts of in vitro fertilization (IVF) without achieving pregnancy. Laboratory evaluation showed hypokalemia, hypocortisolemia, hypergonadotropic hypogonadism and increased levels of 11-deoxycorticosterone. Her karyotype was 46XX. The patient had no history of menarche. She had Tanner stage 2 breast development. Genotyping showed homozygous mutation located in exon 7 which abolishes both 17-alpha hydroxylase and 17,20 lyase activities of the CYP17A1 protein. After starting dexamethasone 0.5 mg/day, her potassium level was normalized, and blood pressure improved. In conclusion, a comprehensive evaluation should be performed before using assisted reproductive techniques, such as in vitro fertilization in hypertensive women with sexual infantilism, primary amenorrhea, and hypokalemia.

Endocrine, 2015

Sheehan's syndrome (SS) is a parturition-related pituitary disease resulting from severe post... more Sheehan's syndrome (SS) is a parturition-related pituitary disease resulting from severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. Pathological and clinical findings of SS were first described by Harold L. Sheehan in the previous century. Although his definitions are still valid, various studies and reports including new data have subsequently been published. Additionally, the diagnosis of SS has often been overlooked and thus delayed for long years due to its nonspecific signs and symptoms. Therefore, a large number of patients may be remained undiagnosed and untreated. SS is not as rare as assumed in developed countries, probably due to migrant women and unawareness of physicians regarding the syndrome. In this review, we provide a detailed review of the epidemiology, etiopathogenesis, clinical, laboratory and radiological features, new diagnostic criteria, differential diagnosis, and treatment of SS.

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, Jan 15, 2015

The aim of this study was to evaluate and compare the effects of spironolactone and spironolacton... more The aim of this study was to evaluate and compare the effects of spironolactone and spironolactone plus metformin treatments on body mass index (BMI), hirsutism score, hormone levels, and insulin resistance in women with polycystic ovary syndrome (PCOS). Thirty-seven patients with PCOS were randomly assigned to receive spironolactone 100 mg/d (spironolactone group, 18 patients) or spironolactone 100 mg/d plus metformin 2000 mg/d (combination group, 19 patients) for 12 months. BMI, modified Ferriman-Gallway score (FGS), serum levels of regarding hormones, and homeostasis model assessment of insulin resistance (HOMA-IR) index were assessed before and after the treatments. Six patients in the spironolactone group and four patients in the combination group reported inter-menstrual vaginal bleeding during treatments. In hirsutism scores, the spironolactone therapy resulted in 25.2% reduction, while combination therapy resulted in 28.3% reduction (p > 0.05, between groups). When the gr...

Pituitary, 2015

The aim of this study was to assess diagnostic values of insulin tolerance test (ITT), glucagon s... more The aim of this study was to assess diagnostic values of insulin tolerance test (ITT), glucagon stimulation test (GST), and insulin like growth factor-I (IGF-I) level, to find optimal GH cut-off values for GST, and to evaluate efficiencies of patient age, gender, body-mass index (BMI), and additional pituitary hormone deficiencies (PHDs) in the diagnosis of growth hormone deficiency (GHD). This retrospective study involved 216 patients with a pituitary disease and 26 healthy controls. Age, gender, BMI, medical histories, and hormonal data including baseline and stimulated hormone values were evaluated. Three cut-off values for peak GH responses to stimulation tests were evaluated: (a) 3.00 µg/L on ITT, (b) 3.00 µg/L on GST, and (c) 1.07 µg/L on GST. According to the ITT, GST with 3.00 µg/L cut-off, and GST with 1.07 µg/L cut-off, GHD was present in 86.1, 74.5, and 54.2 % patients, respectively. Patient age, BMI, and number of PHDs, but not gender, were found to be correlated with IGF-I and peak GH concentrations. All patients with an IGF-I concentration ≤95 ng/ml or ≥3 PHD had GHD. None of the patients with adequate GH response to the GST with 1.07 µg/L cut-off, but blunted responses to ITT and GST with 3.00 µg/L cut-off, had ≥3 PHDs. 12 out of 26 (46.2 %) healthy subjects failed the GST with 3.00 µg/L cut-off, but not with 1.07 µg/L cut-off. Patient age, IGF-I, BMI, and number of PHDs are efficient factors associated with the diagnosis of GHD. A 4 h GST with a diagnostic GH threshold of 1.07 µg/L seems to be a good diagnostic method for GHD.

Case Reports in Endocrinology, 2015

Adrenal incidentalomas are found incidentally during a radiologic examination performed for indic... more Adrenal incidentalomas are found incidentally during a radiologic examination performed for indications other than an adrenal disease, and 15% of them are bilateral adrenal masses. This study describes a 51-year-old male smoker patient admitted with diabetes mellitus. An abdominal ultrasonography performed due to his anemia revealed bilateral adrenal masses. His chest X-ray showed abnormal 10 cm opacity at the right upper lung, and brain, thorax, and abdomen CT scans showed multiple lesions compatible with lung cancer metastases. The pathological examination of the transthoracic lung biopsy specimen was consistent with lung adenocarcinoma. Findings in this patient indicate that, in middle aged patients with bilateral adrenal mass and a history or finding of any malignancy, the first diagnosis which should be considered is adrenal metastasis, and confirming the diagnosis by adrenal biopsy may be useless. Furthermore, screening all smoking patients by chest X-ray or thoracic CT for lung cancer may not be accepted as a routine procedure, but in smokers admitted to a hospital due to signs and symptoms attributed to a pulmonary disease, at least a chest X-ray should be requested.

Journal of endocrinological investigation, Jan 9, 2014

Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (... more Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (CVD) are identified as risk factors for hypopituitarism. Pituitary dysfunction after TBI, SAH, and CVD may present in the acute phase or later in the course of the event. Chronic hypopituitarism, particularly growth hormone (GH) deficiency is related to the increased cardiovascular morbidity and mortality. In patients with serious ventricular arrhythmias, who need cardiopulmonary resuscitation, brain tissue is exposed to short-term severe ischemia and hypoxia. However, there are no data in the literature regarding pituitary dysfunction after ventricular arrhythmias. Forty-four patients with ventricular arrhythmias [ventricular tachycardia (VT), ventricular fibrillation (VF)] (mean age, 55.6 ± 1.8 years; 37 men, 7 women) were included in the study. The patients were evaluated after mean period of 21.2 ± 0.8 months from VT-VF. Basal hormone levels, including serum free triiodothyronine (fT...

Turkish Neurosurgery, 2015

International Journal of Endocrinology, 2014

Turkish Neurosurgery, 2014

Pituitary adenomas do not have a single factor of aggressive behavior or recurrence. The objectiv... more Pituitary adenomas do not have a single factor of aggressive behavior or recurrence. The objective of this study was to determine factors influencing the prognosis in pituitary adenomas. 243 patients who were operated between January 2000 and June 2012 were included in this retrospective study. Demographic data, age at diagnosis, date of diagnosis, date of operation, type of operation, post-operative medications, pre- and postoperative hormone levels, and MRI findings were evaluated in each patient. The rate of total resection of sellar tumors was less than 50% in our patient population. The prognosis was better in cases with total resection. Tumor size was a poor prognostic factor in sellar tumors. Female sex was a poor prognostic factor in acromegaly and male sex in prolactinoma. The prognosis was worse in patients with cavernous sinus invasion. In acromegaly, pre-operative level of 850 ng/ml for IGF-1 was noted as a possible prognostic cut-off value. Long-term follow-up results of our study suggest that factors common to all sellar tumors including tumor type, tumor size, total resection, and cavernous sinus invasion and tumor type-specific factors including sex and hormone levels play important roles in the prognosis.

Endocrine Abstracts, 2013

Mutation Research/Genetic Toxicology and Environmental Mutagenesis, 2014

Over-weight and obesity are serious problems that increase the risk not only for chronic diseases... more Over-weight and obesity are serious problems that increase the risk not only for chronic diseases like diabetes and heart disease but also of various types of cancer. This study was conducted to evaluate cytokinesis-block micronucleus cytome (CBMN-cyt) assay parameters and plasma concentrations of 8-hydroxy-2 -deoxyguanosine (8-OHdG), and their relationship with age, body-mass index (BMI) and waist-to-hip ratio (WHR) in 83 obese, 21 over-weight and 21 normal-weight subjects. Frequencies of micronuclei (MN), nucleoplasmic bridges (NPB), nuclear buds (NBUD), and apoptotic and necrotic cells in lymphocytes of obese subjects were found to be significantly higher than those found in normalweight and over-weight subjects (p < 0.01 and p < 0.05), whereas plasma concentrations of 8-OHdG in obese subjects were lower than those observed in normal-weight and over-weight subjects (p < 0.05 and p < 0.01, respectively). There was a negative correlation between age and frequency of necrotic cells and NDI (p < 0.05), whereas there was no correlation between BMI, WHR, CBMN cyt assay parameters and plasma 8-OHdG in normal-weight subjects. In over-weight subjects, a negative correlation was observed between age and NDI (p < 0.01) and a positive correlation between age and frequency of NPB (p < 0.01) and between BMI and frequency of NBUD (p < 0.05). In obese subjects, a negative correlation was observed between age and NDI (p < 0.01) and between BMI and NDI (p < 0.05), whereas no correlation was observed between WHR and CBMN-cyt assay parameters and plasma 8-OHdG. However, frequencies of MN, NPB, NBUD, apoptotic and necrotic cells in total over-weight/obese (p < 0.01/p < 0.05) and all subjects (p < 0.01) increased with increasing BMI. The increase in genomic damage (MN, NPB and NBUD) in obese subjects and the positive correlation between genomic damage and BMI in total over-weight/obese subjects indicate that obesity increases genomic damage and may be associated with an increased risk of cancer, because an increase in MN frequency is a predictor of cancer risk. .tr (H. Donmez-Altuntas). accumulation may impair health 2]. Being obese and over-weight poses a major risk for development of chronic diseases, including diabetes, cardiovascular diseases, hypertension and stroke, and certain forms of cancer. Over-weight and obesity are linked to more deaths worldwide than being under-weight [1]. At least 2.8 million adults die each year as a result of being over-weight or obese, the fifth leading cause of death globally. In addition, 44% of the diabetes burden, 23% of the ischaemic heart-disease burden and between 7% and 41% of certain cancer burdens are attributable to being over-weight or obese [2].

Case Reports in Endocrinology, 2014

Cushing's syndrome (CS) may lead to severe maternal and fetal morbidities and even mortalities in... more Cushing's syndrome (CS) may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertensioninduced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone-(ACTH-) independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

Gynecological Endocrinology, 2014

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, which is considered not only a repr... more Polycystic ovary syndrome (PCOS) is a heterogeneous disorder, which is considered not only a reproductive disease but also a metabolic disorder associated with long-term health risks. The aim of this study was to assess the effects of metformin on insulin resistance, oxidant-antioxidant status, endothelial dysfunction, lipid metabolism and their contribution to the risks of cardiovascular disease in women with PCOS. Fifteen women with PCOS and 17 healthy women were included in this case-control study. Nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA), Apo A1, Apo B, small, dense LDL cholesterol (sdLDL-C), lipid levels and paraoxonase 1 (PON1) activity were measured in serum/plasma obtained from study groups. Insulin resistance (HOMA index -Homeostasis Model Assessment) and serum sex hormone profiles were also evaluated. Significantly decreased NO levels and PON1 activities, but increased MDA, ET-1 and sdLDL-C were found in PCOS patients compared to those of controls. Serum MDA, ET-1, HOMA and sdLDL-C levels decreased and PON1 activity and NO levels increased significantly after the metformin treatment. There was a positive correlation between MDA and free testosterone (fT), ET-1 and fT; and a negative correlation between PON1 activity and fT. Insulin resistance, dyslipidemia, endothelial dysfunction and oxidative stress might contribute to the excess risk of cardiovascular disease reported in PCOS. Metformin seemed to decrease oxidative stress and improve insulin resistance, dyslipidemia and endothelial dysfunction in PCOS patients.

Endocrine, 2014

The presence of comorbid disruptive behavior disorder (oppositional defiant disorder [ODD] or con... more The presence of comorbid disruptive behavior disorder (oppositional defiant disorder [ODD] or conduct dis order [CD]) within children with attention-deficit hyperactivity disorder (ADHD) has been well estab lished for several decades (e.g., see Bird et al., 1990 Hinshaw, 1987. Only in the past decade has it become apparent that internalizing disorders (both anxiety and depressive disorders) also commonly co-occur with ADHD. Thus, both clinical and epidemiological studie have consistently shown that as many as one third o children with ADHD have co-occurring anxiety dis ABSTRACT Objectives: Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes. Method: Drawing upon cross-sectional and longitudinal information from 579 children (aged 7-9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD. Results: Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and

European journal of endocrinology / European Federation of Endocrine Societies, 2014

Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pi... more Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients. A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations. The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whos...