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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 Assessment of insulin resistance in the idiopathic hirsutism(Karger, 2007) Sarac, Fulden; Saygili, Fusun; Ozgen, Gokhan; Tuzun, Mehmet; Yilmaz, Candeger; Kabalak, TaylanBackground: Idiopathic hirsutism (IH) is the second most common cause of hirsutism, after polycystic ovary syndrome and occurs in about 15% of hirsute women. There are not many studies showing whether patients with IH also have insulin resistance. In the present study, we aimed to investigate the insulin sensivity in IH with non-obese and changing hormone levels during the hyperinsulinemic- euglycemic clamp. Methods: Twenty ( 20) non-obese women with IH ( Group I) ranging in age from 20 to 30 ( mean 25 8 5) years were studied. Hirsutism in women with normal testosterone ( T) levels and regular menstrual cycles is as defined IH. Twenty ( 20) healthy women (mean age 23 +/- 2 years) (Group II) were included in this study as the control group. Insulin sensitivity was assessed with modified euglycemic insulin clamp technique. Samples of prolactin, luteinizing hormone (LH), follicle-stimulating hormone, adrenocorticotropic hormone ( ACTH), dehydroepiandrosterone sulfate, cortisol, estradiol, progesterone, 17-OH progesterone (17-OHP), total T, and free T ( FT) were obtained at baseline and at 2nd hour during clamp. Results: Steady-state ( 120 min) glucose disposal rates were higher in Group II than Group I ( 7.51 +/- 0.83 vs. 5.76 +/- 1.89 mg/kg/min). Mean FT, ACTH, cortisol, LH, prolactin and 17-OHP levels were found to have decreased statistically significantly (p < 0.05) in Group I. Mean FT, ACTH, and prolactin levels were found to have decreased statistically significantly (p < 0.05) in Group II during the clamp. Mean baseline levels of FT, LH and prolactin were greater in women with hirsutism than in the control subjects ( p < 0.05). Insulin mediated glucose disposal was lower in the normal weight women with IH than in those without hirsutism. Conclusions: Mean FT, 17-OHP and dehydroepiandrosterone sulfate levels decreased during euglcemic-hyperinsulinemic clamp in IH. Copyright +/- 2007 S. Karger AG, Basel.Öğe A Case of Thyroid Hemiagenesis: An Exceptional Case(Galenos Yayincilik, 2018) Yurekli, Banu Sarer; Kutbay, Nilufer Ozdemir; Erdogan, Mehmet; Makey, Ozer; Icoz, Gokhan; Ozgen, GokhanThyroid hemiagenesis is a rare congenital anomaly in which one thyroid lobe fails to develop. We recently observed a case of thyroid hemiagenesis accompanied by parathyroid adenoma and papillary thyroid microcarcinoma in a 51-years-old woman. The patient's serum calcium level was 10.9 mg/dL and that of intact parathyroid hormone was 218 pg/mL. Although she had a history of thyroid hemiagenesis, the patient was in a euthyroid state without thyroxine replacement. Thyroid ultrasonography detected no right lobe and four nodules of varying sizes in the left thyroid lobe. Tc-99m scintigraphy also demonstrated the absence of the right thyroid lobe. In addition, MIBI-parathyroid scintigraphy showed a parathyroid adenoma at the lower pole of the right cervical region. Based on the diagnosis, parathyroid adenoma excision and thyroidectomy were performed. Postoperative pathological diagnosis revealed parathyroid adenoma and papillary thyroid microcarcinoma in the form of a 0.4 cm sized tumor in the left thyroid lobe. The coexistence of thyroid hemiagenesis, primary hyperparathyroidism, and papillary thyroid microcarcinoma is truly exceptional and has never been reported in the literature before.Öğe The Effects of Rosiglitazone, Metformin, and Estradiol-Cyproterone Acetate on Lean Patients With Polycystic Ovary Syndrome(Lippincott Williams & Wilkins, 2009) Cetinkalp, Sevki; Karadeniz, Muammer; Erdogan, Mehmet; Ozgen, Gokhan; Saygili, Fuesun; Yilmaz, CandegerBackground: Polycystic ovary syndrome (PCOS) is characterized by anovulation, infertility, and hyperandrogenism. The present study aims to compare the clinical, biochemical, and hormonal changes in PCOS patients taking estradiol-cyproterone acetate (ECA), metformin (MET), and rosiglitazone (ROSI). Methods: Ninety-four patients with PCOS were randomized according to the therapy they received as follows: MET 2 g/d group (n = 47), ROSI 4 mg/d group (n = 14). and 35 mu g ethinyl estradiol-2 mg cyproterone acetate group (ECA) (n = 33). Complete hormonal assays, lipid profile, glucose, and insulin levels were studied over a 4-months period. Results: Patients randomized to the MET group lost more weight and had a greater reduction in BMI compared with baseline (P = 0.006 and P = 0.004). The reduction in triglyceride levels and high-sensitivity C-reactive protein (hs-CRP) were statistically significant in the MET group while no changes were observed in the other groups. Regarding HDL levels, did not change in MET and ECA groups, but there was a significant increase compared with baseline in the ROSI group (P = 0.04). Mann-Whitney U test showed that the change (a tendency of reduction) was more significant in PCOS patients on MET for both total cholesterol and LDL-cholesterol (P < 0.001). The rate of improvement in oligomenorrhea was similar in all 3 treatments (P = 0.202). Conclusion: Our data show that in women with PCOS, ECA is more effective than insulin-sensitizing drugs such as rosiglitazone and metformin in improving menstrual pattern and reducing serum free-testosterone levels. MET, an insulin-sensitizing drug, is more effective in reducing fasting insulin levels than the ECA.Öğe Evaluation of IL-10, MCP-1, IFN gamma, and protectin D1 levels in patients with Hashimoto's thyroiditis(Springer London Ltd, 2022) Ozisik, Hatice; Cekin, Ayse; Suner, Asli; Durmaz, Burak; Ozel, Buket; Gunel, Nur Selvi; Ozgen, GokhanPurpose Hashimoto's thyroiditis (HT) is one of the most prevalent autoimmune endocrine diseases and caused by the loss of immune tolerance for the thyroid gland. Many pathophysiological mechanisms were speculated about the development of HT. In our study, we aimed to reveal the relationship between HT and IL-10, MCP-1, IFN gamma, and PD1 levels and compare them with control subjects. Methods We collected 37 patients with HT and 25 controls referred to our outpatient clinic. The diagnosis of HT was based on the detection of circulating antibodies to thyroid antigens and decreasing echogenicity on thyroid USG in patients with appropriate clinical characteristics. Serum IL-10, MCP-1, IFN gamma, and PD1 levels were detected using an ELISA KIT (96 T) method according to the manufacturer's instructions. Results All subjects were euthyroid (median TSH level was 1.68 mU/L in HT vs 1.83 mU/L in the controls, p = 0.672). Twenty-three of 37 patients with HT were taking L-thyroxin replacement. Levels of serum IL-10, IFN gamma, and PD1 in patients with HT were higher than the controls, but the differences were not statistically significant (p = 0.393, p = 0.495, and p = 0.052 respectively). The serum levels of MCP-1 in HT patients were statistically different and higher than the controls (p = 0.018). Correlation analysis displayed significant associations between IL-10, MCP-1, IFN gamma, and PD1 levels. Conclusion Our study demonstrated that serum MCP-1 levels in HT patients were significantly increased; on the other hand, significant difference was not found between HT patients and the controls in terms of serum IL-10, IFN gamma, and PD1 levels.Öğe The Interaction of Oxidative Stress Response with Cytokines in the Thyrotoxic Rat: Is There a Link?(Hindawi Publishing Corporation, 2009) Makay, Balahan; Makay, Ozer; Yenisey, Cigdem; Icoz, Gokhan; Ozgen, Gokhan; Unsal, Erbil; Akyildiz, Mahir; Yetkin, EnisOxidative stress is regarded as a pathogenic factor in hyperthyroidism. Our purpose was to determine the relationship between the oxidative stress and the inflammatory cytokines and to investigate how melatonin affects oxidative damage and cytokine response in thyrotoxic rats. Twenty-one rats were divided into three groups. Group A served as negative controls. Group B had untreated thyrotoxicosis, and Group C received melatonin. Serum malondialdehyde (MDA), glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx), and nitric oxide derivates (NO(center dot)x), and plasma IL-6, IL-10, and TNF-alpha were measured. MDA, GSH, NO(center dot)x, IL-10, and TNF-alpha levels increased after L-thyroxine induction. An inhibition of triiodothyronine and thyroxine was detected, as a result of melatonin administration. MDA, GSH, and NO(center dot)x levels were also affected by melatonin. Lowest TNFalpha levels were observed in Group C. This study demonstrates that oxidative stress is related to cytokine response in the thyrotoxic rat. Melatonin treatment suppresses the hyperthyroidism-induced oxidative damage as well as TNF-alpha response. Copyright (C) 2009 Balahan Makay et al.Öğe A novel CYP11B1 mutation in a Turkish patient with 11 beta-hydroxylase deficiency: An association with the severe hypokalemia leading to rhabdomyolysis(Hellenic Endocrine Soc, 2016) Yurekli, Banu Sarer; Kutbay, Nilufer Ozdemir; Onay, Huseyin; Simsir, Ilgin Yildirim; Kocabas, Gokcen Unal; Erdogan, Mehmet; Cetinkalp, Sevki; Ozgen, Gokhan; 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 Thyroid Diseases, Metformin and the AMP Kinase Pathway(Turkiye Klinikleri, 2021) Soyaltin, Utku; Ozgen, Gokhan; Kabalak, TaylanAn increase in the adenosine monophosphate (AMP)/adenosine triphosphate ratio activates AMP-activated protein kinase (AMPK), leading to inhibition of the mammalian target of rapamycin signaling pathway that is associated with autophagy, mitochondriogenesis, glucose uptake, mRNA stabilization, and cell cycle regulation. Metformin activates AMPK and inhibits mitochondria! oxidative phosphorylation. Currently, there is an increasing interest in investigating the effects of metformin on thyroid diseases. Recent data show an association between metformin treatment and lower incidence of thyroid cancer, better survival of patients with thyroid cancer, and lower thyroid volume and nodule size. Insulin-like growth factor receptor and AKT pathways are the AMPK-independent mechanisms through which metformin acts on thyroid diseases. Although metformin has a promising role in adjuvant therapy for thyroid cancers, well-designed prospective trials are required before reaching a final decision.Öğe Thyrotoxic autoimmune encephalopathy in a female patient: Only partial response to typical immunosuppressant treatment and remission after thyroidectomy(Elsevier Science Bv, 2007) Yuceyar, Nur; Karadeniz, Muarnmer; Erdogan, Mehmet; Copur, Asli; Akgun, Aysegul; Kumral, Emre; Ozgen, GokhanHashimoto's encephalopathy (HE) is a rare immune-mediated encephalopathy developing in patients with high serum concentrations of anti-thyroid antibodies usually in an euthyroid or hypothyroid state. We report a 31-year-old female patient with thyrotoxic HE whose daughter has been followed up with the same diagnosis. Suboptimal response was observed with intravenous methylprednisolone (IVMP), intravenous immunoglobulin (IVIG) and plasmapheresis. Reduction of the anti-thyroid auto-antibody concentrations marked the patient's improvement in each episode. She relapsed under oral immunosuppressive therapy. After removing the thyroid tissue, full recovery has been achieved for the last 18 months. These data may contribute to clarification of the pathogenetic role of anti-thyroid antibodies in HE. Thyroidectomy can be considered as one of the treatment options especially in thyrotoxic HE patients with uncontrolled relapses. Our patient is the first reported HE case with a family history. Genetic background can underlie the etiopathogenesis of HE as is the case in other autoimmune disorders. (C) 2007 Elsevier B.V All rights reserved.Öğe Two Siblings with Triple-A Syndrome: Endocrinologic and Neurologic Features(Galenos Yayincilik, 2018) Ozdemir Kutbay, Nilufer; Keklik, Fatma; Sarer Yurekli, Banu; Kavasoglu, Gokce; Oruc, Nevin; Erdogan, Mehmet; Cetinkalp, Sevki; Ozgen, Gokhan; Saygili, FusunTriple-A syndrome is a rare, multi-systemic disease and is characterized by adrenal insufficiency, achalasia, or alacrima. The symptoms may also involve neurologic manifestations, including pyramidal findings and peripheral motor neuropathy. Other findings include autonomic dysfunction and cerebellar ataxia. In the present study, we present the case of two siblings with triple-A syndrome with neurologic manifestations. The neurologic abnormalities can lead to misdiagnosis owing to resemblance to the manifestations of other neurologic disorders. Therefore, the cases with triple-A syndrome should be carefully evaluated and examined for clinical and neurophysiologic signs.Öğe Vitamin D deficiency in the absence of enteropathy in three cases with common variable immunodeficiency(Karger, 2008) Ardeniz, Omur; Avci, Cigir Biray; Sin, Aytul; Ozgen, Gokhan; Gunsar, Fulya; Mete, Nihal; Gulbahar, Okan; Kokuludag, AliBackground: Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and a defect in antibody production. Herein we describe 3 patients diagnosed with CVID in whom vitamin D deficiency was detected in the absence of enteropathy. Methods: Biochemical and immunological analysis, serum osteocalcin, parathyroid hormone, 25-OH vitamin D, 1,25(OH) 2 vitamin D, vitamin A, vitamin E, urinary calcium, and deoxypyridinoline measurements were carried out. Vitamin D receptor (VDR) expression was examined in the peripheral blood mononuclear cells and hair follicles by reverse transcriptase polymerase chain reaction. VDR gene polymorphism was evaluated by high-performance liquid chromatography. Results: None of the patients presented nutrient deficiencies other than vitamin D. Two of them were free of osteomalacia-related symptoms. VDR expression was found to be lower in the peripheral blood mononuclear cells and hair follicles when compared to the control group. Conclusions: Patients with CVID may present asymptomatic vitamin D deficiency. Vitamin D and VDRs play an important role in the innate immune system and modulate Toll-like receptor-related responses. Delay in diagnosis may predispose these patients not only to irreparable bone loss but also to infections, and autoimmune and malignant disorders, thus emphasizing the importance of prompt intervention. Copyright (C) 2008 S. Karger AG, Basel.
