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Öğe Adult Nesidioblastosis With Hypoglycemia Mimicking an Insulinoma: A Challenging Case(Int College Of Surgeons, 2017) Yurekli, Banu Sarer; Kutbay, Nilufer Ozdemir; Altun, Ilker; Cetinkalp, Sevki; Nart, Deniz; Coker, Ahmet; Ozgen, GokhanIntroduction: Nesidioblastosis is the primary cause of persistent hyperinsulinemic hypoglycemia in infants but it is a rare entity for the adults. Nesidioblastosis is defined as an increase of pancreatic beta cells in number and in size. Case Presentation: We describe a rare case of nesidioblastosis with positive endoscopic ultrasonography result mimicking an insulinoma. A 35-year-old female patient had hypoglycemic episodes with high insulin level. Her investigation revealed low venous plasma glucose, high insulin and C-peptide level with positive 72-hour fasting test suggestive of hyperinsulinemic hypoglycemia. Abdominal computed tomography did not show any mass lesion. Endoscopic ultrasonography revealed a mass lesion sized as 1 cm in diameter in the pancreas. But, insulinoma like lesion couldn't be found intra-operatively. It was decided to perform distal pancreatectomy. After distal pancreatectomy, nesidioblastosis was diagnosed histopathologically. The patient was free from her symptoms after surgery. Conclusion: This case illustrates difficulties and limitations of imaging modalities and false positive result of EUS in a case of nesidioblastosis. When there is no insulinoma like lesion during operation, operation should be performed as gradient guided pancreatectomy by the way of selective arterial calcium injection test.Öğe Osteoprotegerin Levels in Acromegaly(Endocrine Soc, 2014) Kocabas, Gokcen; Simsir, Ilgin; Yurekli, Banu Pinar; Kutbay, Nilufer; Baykan, Emine Kartal; Altun, Ilker; Aksit, Murat; Bozkaya, Giray; Saygili, FusunÖğe Preoperative and Postoperative (1st and 3rd Month) Metabolic Data of Patients Who Underwent Bariatric Surgery(Galenos Yayincilik, 2015) Kutbay, Nilufer Ozdemir; Yurekli, Banu Sarer; Ozisik, Hatice; Altun, Ilker; Suner, Asli; Simsir, Ilgin Yildirim; Firat, Ozgur; Erdogan, Mehmet; Cetinkalp, Sevki; Ozgen, Gokhan; Saygili, FusunPurpose: The growing prevalence of obesity has become a major concern. The efficacy of medical treatment, diet and behavior therapy in morbidly obese patients is limited. Obesity surgery is a treatment option for selected morbidly obese patients. Material and Method: Data of 47 patients (n=39 women, 8 men) who underwent bariatric surgery were investigated. Results: Out of 47 patients, 20 underwent Roux-en-Y gastric bypass (RYGB) (43%) and 27 had sleeve gastrectomy (SG) (57%). The mean age of the patients was 37+/-9.5 (19-59) years. 17% of patients were men and 83% were women. In the analysis of data on weight that could be found for 31 out of 47 patients, we detected preoperative and postoperative (1st and 3rd month) mean weight values as 125.4+/-15.9 kg, 112.7+/-13.2 kg (p<0.001) and 100.9+/-17.5 kg (p<0.001), respectively. In addition, the analysis of the data on mean fasting plasma glucose (FPG) levels which could be found for 23 out of 47 patients, showed us that preoperative and postoperative (1st and 3rd month) FPG levels were 100.9+/-17.5 mg/dL, 91.6+/-10.9 mg/dL (p=0.03) and 87.3+/-2.0 mg/dL, respectively. Only 1 patient had diabetes before the surgery. In the RYGB group, the mean change in weight was 12.4+/-5.5 kg in the 1st month and 22.2+/-8.6 kg in the 3rd month (compared to the weights in the preoperative period). Moreover, in the SG group, the mean change in weight was 13.7+/-4.5 kg in the 1st month and 23.4+/-5.8 kg in the 3rd month. No statistically significant difference was found between the weight changes in the 1st and the 3rd month as for surgery types. Discussion: After bariatric surgery, significant loss in weight and reduction in FPG occurred in short-term.Öğe Preoperative and Postoperative (1st and 3rd Month) Metabolic Data of Patients Who Underwent Bariatric Surgery(Galenos Yayincilik, 2015) Kutbay, Nilufer Ozdemir; Yurekli, Banu Sarer; Ozisik, Hatice; Altun, Ilker; Suner, Asli; Simsir, Ilgin Yildirim; Firat, Ozgur; Erdogan, Mehmet; Cetinkalp, Sevki; Ozgen, Gokhan; Saygili, FusunPurpose: The growing prevalence of obesity has become a major concern. The efficacy of medical treatment, diet and behavior therapy in morbidly obese patients is limited. Obesity surgery is a treatment option for selected morbidly obese patients. Material and Method: Data of 47 patients (n=39 women, 8 men) who underwent bariatric surgery were investigated. Results: Out of 47 patients, 20 underwent Roux-en-Y gastric bypass (RYGB) (43%) and 27 had sleeve gastrectomy (SG) (57%). The mean age of the patients was 37+/-9.5 (19-59) years. 17% of patients were men and 83% were women. In the analysis of data on weight that could be found for 31 out of 47 patients, we detected preoperative and postoperative (1st and 3rd month) mean weight values as 125.4+/-15.9 kg, 112.7+/-13.2 kg (p<0.001) and 100.9+/-17.5 kg (p<0.001), respectively. In addition, the analysis of the data on mean fasting plasma glucose (FPG) levels which could be found for 23 out of 47 patients, showed us that preoperative and postoperative (1st and 3rd month) FPG levels were 100.9+/-17.5 mg/dL, 91.6+/-10.9 mg/dL (p=0.03) and 87.3+/-2.0 mg/dL, respectively. Only 1 patient had diabetes before the surgery. In the RYGB group, the mean change in weight was 12.4+/-5.5 kg in the 1st month and 22.2+/-8.6 kg in the 3rd month (compared to the weights in the preoperative period). Moreover, in the SG group, the mean change in weight was 13.7+/-4.5 kg in the 1st month and 23.4+/-5.8 kg in the 3rd month. No statistically significant difference was found between the weight changes in the 1st and the 3rd month as for surgery types. Discussion: After bariatric surgery, significant loss in weight and reduction in FPG occurred in short-term.Öğe Preoperative and Postoperative (1st and 3rd Month) Metabolic Data of Patients Who Underwent Bariatric Surgery(Galenos Yayincilik, 2015) Kutbay, Nilufer Ozdemir; Yurekli, Banu Sarer; Ozisik, Hatice; Altun, Ilker; Suner, Asli; Simsir, Ilgin Yildirim; Firat, Ozgur; Erdogan, Mehmet; Cetinkalp, Sevki; Ozgen, Gokhan; Saygili, FusunPurpose: The growing prevalence of obesity has become a major concern. The efficacy of medical treatment, diet and behavior therapy in morbidly obese patients is limited. Obesity surgery is a treatment option for selected morbidly obese patients. Material and Method: Data of 47 patients (n=39 women, 8 men) who underwent bariatric surgery were investigated. Results: Out of 47 patients, 20 underwent Roux-en-Y gastric bypass (RYGB) (43%) and 27 had sleeve gastrectomy (SG) (57%). The mean age of the patients was 37+/-9.5 (19-59) years. 17% of patients were men and 83% were women. In the analysis of data on weight that could be found for 31 out of 47 patients, we detected preoperative and postoperative (1st and 3rd month) mean weight values as 125.4+/-15.9 kg, 112.7+/-13.2 kg (p<0.001) and 100.9+/-17.5 kg (p<0.001), respectively. In addition, the analysis of the data on mean fasting plasma glucose (FPG) levels which could be found for 23 out of 47 patients, showed us that preoperative and postoperative (1st and 3rd month) FPG levels were 100.9+/-17.5 mg/dL, 91.6+/-10.9 mg/dL (p=0.03) and 87.3+/-2.0 mg/dL, respectively. Only 1 patient had diabetes before the surgery. In the RYGB group, the mean change in weight was 12.4+/-5.5 kg in the 1st month and 22.2+/-8.6 kg in the 3rd month (compared to the weights in the preoperative period). Moreover, in the SG group, the mean change in weight was 13.7+/-4.5 kg in the 1st month and 23.4+/-5.8 kg in the 3rd month. No statistically significant difference was found between the weight changes in the 1st and the 3rd month as for surgery types. Discussion: After bariatric surgery, significant loss in weight and reduction in FPG occurred in short-term.Öğe Testicular Adrenal Rest Tumor (TART) in congenital adrenal hyperplasia(Elsevier Science Bv, 2017) Ozisik, Hatice; Yurekli, Banu Sarer; Simsir, Ilgin Yildirim; Altun, Ilker; Soyaltin, Utku; Guler, Ezgi; Onay, Huseyin; Sarsik, Banu; Saygili, FusunCongenital adrenal hyperplasia is one of the most common autosomal recessive genetic disorders. Testicular adrenal tumors are significant complications of congenital adrenal hyperplasia. We would like to present two patients of testicular adrenal rest tumors. Patient 1 24 year-old male, he was diagnosed with congenital adrenal hyperplasia at the age of 8 due to precocious puberty. He received hydrocortisone treatment until the age of 18. Testicular mass had been detected and right radical orchiectomy had been applied 6 months ago and reported as testicular adrenal rest tumor. In scrotal ultrasound, a mixed type mass lesion (6 x 4x3 cm) covering a large part of left testis was observed. The imaging findings were consistent with adrenal rest tumor. The patient took adrenocorticotropic hormone supressive therapy with dexamethasone 0.75 mg once a day. Patient 2, 38 year-old male, he had been followed-up as adrenal insufficiency for 35 years. He underwent right orchiectomy operation due to the testicular mass in 2010 and the pathological examination revealed Leydig cell tumor. In scrotal ultrasound, small multifocal lesions were detected on the left testis and resection was done. It was reported as testicular adrenal rest tumor. He is being followed-up with glucocorticoid treatment according to androgen and adrenocorticotropic hormone levels. Early diagnosis of testicular adrenal rest tumor is significant in preventing irreversible testicular damage and infertility. In the differential diagnosis, we should keep in mind that testicular adrenal rest tumor can mimic other testicular tumors such as primary germ cell tumors. (C) 2017 Elsevier Masson SAS. All rights reserved.