Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
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Item Severe chronic periodontitis is not common in Acromegaly: Potential protective role of gingival BMP-2(2021) Bascil, Sibel; Turhan Iyidir, Ozlem; Bayraktar, Nilufer; Ertorer, Melek Eda; Bascil Tutuncu, Neslihan; 0000-0002-0225-2477; 0000-0001-5305-6807; 0000-0002-7886-3688; 0000-0001-7357-8709; 0000-0002-1816-3903; 33421969; K-7904-2019; Y-8758-2018; ABI-3705-2020; ABG-5027-2020Background/aim : Advanced chronic periodontitis is observed rarely in acromegaly. Periodontal tissue including the alveolar bone is seemed to be spared from the systemic metabolic derangements of bone in this patient population. Chronic elevation of growth hormone, IGF-1, and bone morphogenetic proteins may play a role in periodontal tissue regeneration in acromegalics. In this study, we aimed to evaluate the potential roles of local gingival bone morphogenetic proteins (BMP) in periodontal tissue pathology in acromegaly. Materials and methods: Thirty-five patients with acromegaly and 22 healthy subjects were recruited. All the participants were examined by the same periodontologist for the diagnosis of periodontal diseases. BMP-2 and-4 were studied in gingival crevicular fluid. Results: Gingival BMP-2 and BMP-4 levels were similar in acromegaly and control groups in general, with and without chronic periodontitis. For all the participants, gingival BMP-2 levels were statistically lower in those participants with chronic periodontitis then those without periodontitis (29.4 +/- 11.2 vs. 41.2 +/- 23.2, respectively, p = 0.027). Causal relation between the gingival BMP levels and periodontal tissue health status was tested with one way ANOVA which revealed a significant difference between gingival BMP-2 levels in those with different degrees of periodontal tissue pathology (p = 0.025). When analyzed separately, gingival BMP-2 levels revealed a causal relation with the degree of periodontal pathology with borderline significance only in patients with acromegaly (p = 0.057). Conclusion: Acromegaly is a disease with an unexpectedly low frequency of advanced periodontitis, irrespective of the long disease duration and pathognomonic oral manifestations. BMP-2 might have a protective role against chronic advanced periodontitis in these patients.Item Higher mean platelet volume is accompanied with hyperthyroidism in patients with Graves' disease(2020) Bagir, Gulay Simsek; Ertorer, Melek Eda; 0000-0001-7357-8709; ABI-3705-2020Purpose: Graves' disease (GD) is an autoimmune disease that is the most common cause of thyrotoxicosis. Thyrotoxicosis can cause a decrease in platelet survival time. Inflammation is an important stimulus for platelets and mean platelet volume (MPV) could be used a diagnostic marker which is an important determinant of platelet activity. In this study we aimed to evaluate whether MPV would be a useful inflammatory marker for evaluation of disease activity in patients with Graves' disease. Materials and Methods: Two hundred twenty-nine patients (GD patients (Group 1); n=102 and patients with euthyroid nodular goiter (Group 2); n=127) were included in this retrospective study. Serum TSH, fT3, fT4 and MPV levels were recorded at presentation and at first euthyroid period under ATD treatment in GD patients and at presentation in patients with euthyroid nodular goiter. Results: The mean age was 40.3 +/- 13.5 in Group 1 and 50.2 +/- 11.6 in Group 2. Mean initial MPV level did not differ between groups; 8.3 +/- 1.2 fL and 8.3 +/- 1.1 fL, respectively (p=0.9). We found that mean initial MPV was higher than the first euthyroid period MPV in Group 1; Graves' group (8.3 +/- 1.2 fL vs 8.0 +/- 1.3 fL, p=0.02). Conclusion: Higher initial MPV levels in Graves patients and significant drop following the restoration of hyperthyroidism may be due to hypermetabolism of hyperthyroidism.Item The acromegaly registry of ten different centers in Turkey(2020) Keskin, Caglar; Demir, Ozgur; Karci, Alper Cagri; Berker, Dilek; Canturk, Zeynep; Yaylali, Guzin Fidan; Topsakal, Senay; Ersoy, Reyhan; Bayram, Fahri; Ertorer, Melek Eda; Bozkirli, Emre; Haydardedeoglu, Filiz; Dilekci, Esra Nur Ademoglu; Ay, Seyid Ahmet; Cansu, Guven Baris; Sahin, Mustafa; Emral, Rifat; Corapcioglu, Demet; 0000-0002-0179-9673; 0000-0001-7357-8709; 32417639; AAK-5003-2021; ABI-3705-2020; ABI-3393-2020Objectives: To describe biochemical and clinical features, and therapeutic outcomes of acromegaly patients in Turkey. Methods: Retrospective multicenter epidemiological study of 547 patients followed in 10 centers of the Turkish Acromegaly registry. Results: A total of 547 acromegaly patients (55% female) with a median age of 41 was included in this study. Majority of patients had a macroadenoma (78%). Transsphenoidal surgery was performed as primary treatment in 92% of the patients (n = 503). Surgical remission rate was 39% (197/503) in all operated patients. Overall disease control was achieved in 70% of patients. Remission group were significantly older than non-remission group (p = .002). Patients with microadenomas had significantly higher remission rates than patients with macroadenomas (p < .001). Patients with microadenomas were significantly older at the time of diagnosis when compared to patients with macroadenomas (p < .001). Preoperative growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were significantly lower in the remission group (p < .001). Initial IGF-1 and GH levels were significantly higher in macroadenomas compared to microadenomas (p < .001). Medical treatment was administered as a second-line treatment (97%) in almost all patients without remission. Radiotherapy was preferred in 21% of the patients mostly as a third line treatment. Conclusions: This is one of the largest real life studies evaluating the epidemiological characteristics and treatment outcomes of patients with acromegaly who were followed in different centers in Turkey. Transsphenoidal surgery in the treatment of acromegaly still remains the most valid method. Medical treatment options may improve long-term disease outcomes in patients who cannot be controlled with surgical treatment (up to 70%).Item Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization(2020) Bagir, Gulay Simsek; Gunesli, Aylin; Haydardedeoglu, Filiz Eksi; Bakiner, Okan Sefa; Alkan, Ozlem; Ertorer, Melek Eda; 0000-0001-7357-8709; ABI-3705-2020Objective: Despite serum prolactin normalization and tumor shrinkage being obtained using dopamine agonist treatment, hypogonadism may persist in several men with prolactinomas. In this study, we evaluated the effects of tumor magnetic resonance imaging features on the persistence of hypogonadism among normoprolactinemic men with prolactinomas objectively using Knosp and Hardy grading systems. Material and Methods: The patients with prolactinomas who achieved serum prolactin normalization using cabergoline therapy were evaluated, respectively. The extent of tumor growth was evaluated on the basis of Knosp and Hardy grading systems both at diagnosis and six months of medical therapy with serum prolactin normalization. Results: A total of 28 cases (18 macro- and 10 microprolactinomas) were included. After six months of treatment with cabergoline, all microprolactinoma patients with hypogonadism at baseline showed recovery (3, 100%). Moreover, nine of 14 macroprolactinoma patients with hypogonadism at inclusion recovered at the end (group 1), and five did not (group 2). Baseline Knosp grades and Hardy numbers did not differ between groups. However, higher Knosp grades and Hardy numbers were observed in patients who consistently had low serum testosterone in the sixth month (group 2) (p=0.01, p=0.02, respectively). All patients in group 2 had invasive tumors (Hardy number III-IV) both at inclusion and the sixth month according to this classification. Conclusion: We demonstrated that macroprolactinomas with persistent hypogonadism despite serum prolactin normalization more commonly showed cavernous sinus invasion and sellar destruction. We proposed that Knosp and Hardy grading systems are useful in predicting the persistence of male hypogonadism in prolactinomas following prolactin normalization.Item Low Prevalence of Periodontitis in Acromegaly: Growth Hormone May Exert a Protective Effect(2015) Serinoz, Hulya; Ertorer, Melek Eda; Bascil, Sibel; Bakiner, Okan; Bozkirli, Emre; Tutuncu, Neslihan B.Purpose: To evaluate bone mineral density (BMD) measurements and the presence of periodontitis in patients with acromegaly, as well as to inquire the impact of interfering factors. Material and Method: Forty-seven acromegalic patients with any accompanying condition known to affect calcium-bone metabolism and 60 age-matched healthy controls were included. Age, gender, duration and activity of acromegaly, past-present therapy options, pituitary hormone profiles, replacement therapies, and the results of periodontal analysis were recorded. Results: Eighteen patients were male (38.3%), 29 were female (61.7%). The mean age of the patients was 46.6 +/- 11.5 years, twenty-five (53.1%) had active, 22 (46.8%) had inactive acromegaly. The latter were older and had longer disease duration (p=0.04, p=0.003, respectively). Serum calcium and phosphorus levels, 24-hour urinary calcium excretion and BMD at the lumbar spine and femur neck insignificantly associated with disease activity (p>0.05). Osteoporosis was detected in 6 patients (12.76%). Periodontitis and advanced periodontitis were more common in control group (66.7% vs. 44.7%), (43.3% vs. 12.8%) (p=0.022, p=0.0001, respectively). There was no difference in chronic periodontitis and severity between active and inactive groups (48% vs. 40.9%; p=0.279). No difference was noted in other study parameters, as well. Repeated measures analysis of variance demonstrated statistically insignificant distribution between GH change in time and periodontitis subgroups. Discussion: We demonstrated that acromegaly exerted no clear negative impact on vertebral BMD in the absence of overt hypogonadism. Regardless of disease activity, acromegaly cases exhibited lower rates of periodontitis with less severity which remained unchanged in the presence of accompanying metabolic disorders known to have negative impact on periodontal tissue. Chronic exposure to excess GH may have a protective role against periodontitis.Item Postprandial Hypoglycemia: An Unusual Presentation for Insulinoma(2016) Haydardedeoglu, Filiz Eksi; Torun, Ayse Nur Izol; Andic, Cagatay; Bakiner, Okan; Bozkirli, Emre; kayaselcuk, Fazilet; Ertorer, Melek EdaInsulinoma is the most common type of islet cell tumor of the pancreas and its incidence is estimated at four per one million persons per year. Although fasting hypoglycemia is the typical presentation, cases with postprandial hypoglycemia have rarely been reported. A 48-year-old woman was admitted to our department for evaluation of hypoglycemia. Laboratory data suggested a state of postprandial endogenous hyperinsulinemic hypoglycemia. Abdominal computed tomography revealed a mass lesion measuring 20 mm at the distal pancreas. A decision was made to perform an arterial calcium-stimulated venous sampling for excluding nesidioblastosis coexisting with a pancreatic incidental mass. After that the patient was referred to surgery. Pathological examination revealed a low-grade well-differentiated neuroendocrine tumor with regional lymph node metastasis. Herein, we report a case of malignant insulinoma presenting with postprandial hypoglycemia and discuss the differential diagnosis and possible mechanisms of postprandial hypoglycemia in insulinoma cases.Item Hyperglycemia in Hospital: Diagnosis, Classification, Clinical Implications and Treatment(2017) Bagir, Gulay Simsek; Ertorer, Melek Eda; 0000-0001-7357-8709; ABI-3705-2020Hyperglycemia is a well-recognized risk factor for hospital-related complications, prolonged stay in the hospital and even mortality. The patients with in-hospital hyperglycemia may be categorized into three groups: i) Patients who have been diagnosed as having diabetes mellitus (DM) before admission; ii) Patients with newly diagnosed DM; and iii) Patients with stress hyperglycemia. The release of stress hormones, such as cortisol, catecholamines, glucagon, growth hormone and the related acceleration in gluconeogenesis and glycogenolysis, medications used for the treatment of primary diseases, such as glucocorticoids and vasopressors, are all claimed to be responsible for the development of in-hospital hyperglycemia. Glucose normalization with insulin therapy has been demonstrated to significantly decrease the morbidity and mortality in all the three groups. Therefore, it is recommended to monitor blood glucose levels for all hospitalized patients irrespective of the accompanying DM diagnosis.Item Mean platelet volume in Graves' disease: A sign of hypermetabolism rather than autoimmunity?(2017) Bagir, Gulay Simsek; Haydardedeoglu, Filiz Eksi; Bakiner, Okan Sefa; Bozkirli, Emre; Ertorer, Melek Eda; 0000-0002-1644-6790; 0000-0002-0179-9673; 0000-0001-7357-8709; 29067056; AAK-5525-2021; E-9887-2014; AAK-5003-2021; ABI-3705-2020Objective: To evaluate the impact of mean platelet volume (MPV) on predicting disease course among patients with Graves' disease (GD). Methods: This retrospective study was performed between 2013-2016 at the Outpatient Endocrinology Clinic of Baskent University Faculty of Medicine, Adana hospital on 65 patients with GD. Among participants, 30 cases experienced thyrotoxicosis again during the first six months after discontinuing anti-thyroid drug (ATD) sessions that had been carried out for at least 12 months prior to stopping (Relapse group). We also observed 35 patients who exhibited normal thyroid functions within six months following ATD withdrawal (Remission group). MPV levels and thyroid function tests were recorded and total duration of ATD therapy was calculated for all participants. Results: The mean MPV level that was measured at the time of drug withdrawal did not differ between groups, being 8.0 +/- 1.2 fL in the Relapse group vs. 8.0 +/- 1.0 fL in the Remission group (p=0.81). However, we found that the relapse MPV was higher than the withdrawal MPV in the Relapse group (9.2 +/- 1.3 fL) than it was in the Remission group (8.0 +/- 1.2 fL, p=0.00). Conclusions: Higher relapse MPV in Relapse group but similar MPV levels in both groups at ATD withdrawal may be attributed to hypermetabolism or hyperthyroidism rather than autoimmunity of GD.Item Hounsfield unit value has null effect on thyroid nodules at F-18-FDG PET/CT scans(2018) Haydedeoglu, Filiz Eksi; Bagir, Gulay Simsek; Torun, Nese; Kocer, Emra H.; Reyhan, Mehmet; Ertorer, Melek Eda; 30304111Objective: Detection rate of thyroid nodules is increasing with the use of new imaging modalities, especially in screening for malignancies. Positron emission tomography/computed tomography (PET/CT)-positive thyroid nodules should be differentiated for malignancy to avoid unnecessary operations and further follow-up. Most trials evaluate the role of SUVmax, but there is no definitive information about the utility of Hounsfield unit (HU) values for prediction of malignancy. This study aimed to evaluate the HU values beside SUVmax for detecting malignancy risk of PET/CT-positive thyroid nodules. Subjects and methods: Results of 98 cancer patients who had fine needle aspiration biopsy (FNAB) for thyroid nodules detected on PET/CT between January 2011 and December 2015 were assessed. The FNABs and surgical pathological results were recorded. Results: FNABs revealed benign results in 32 patients (32.7%), malignant in 18 (18.4%), non-diagnostic in 20 (20.4%), and indeterminate in 28 (28.5%). Twenty-four patients underwent thyroidectomy. The mean HU values were not significantly different in benign and malignant nodules (p = 0.73). However, the mean SUVmax was significantly higher (p < 0.001) in malignant ones. Area under curve (AUC) was 0.824 for SUVmax; the cut-off value was over 5.55 (p < 0.001), with 80% sensitivity, 84.5% specificity. Conclusions: Our current study demonstrated that HU value does not add any additional valuable information for discriminating between malignant and benign thyroid nodules. We also defined a SUVmax cut-off value of 5.55 for malignant potential of thyroid nodules detected on PET/CT.