Hiperprolaktinemik olgularda prolaktin-makroprolaktin ve ADP ile indüklenmiş trombosit aktivasyonu ilişkisi

Trombositlerin ADP ile stimülasyonunun, serum PRL düzeyleri ile pozitif korelasyon gösterdiği ve hiperprolaktineminin, trombosit agregasyonu için bir risk faktörü olabileceği son zamanlarda bildirilmiştir. Prolaktin yüksekliği olan hastalarda yapılan çalışmalar, hiperprolaktineminin, trombosit aktivasyonu için uygun bir ortam oluşturduğu bilinen ateroskleroz ve insülin direnci ile de bağlantılı olduğunu düşündürmektedir. Bu çalışmada, hiperprolaktinemi ile trombosit aktivasyonuna bağlı Pselektin ekspresyonu arasındaki ilişki, hastaların metabolik durumları da göz önünde bulundurularak irdelendi. Trombosit fonksiyonlarını etkilediği bilinen tüm faktörler dışlandıktan sonra, premenopozal dönemde bulunan ve hiç tedavi almamış olan hiperprolaktinemik kadın olgular (n=32), yaş ve vücut kitle indeksleri benzer normoprolaktinemik olgular (n=33) ile karşılaştırıldı; yaş; 30,6±8 karşı 29,8±7,7 yıl, vücut kitle indeksi; 26,8±5,4 karşı 24,8±5,2 kg/m2, prolaktin 1889,8±886 karşı 335,9±117,9 mU/lt. Gruplar arasında HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) formülü ile hesaplanan insülin duyarlılığı, bel çevresi, kan basıncı, açlık plazma glukozu, insülini ve lipidler bakımından anlamlı fark olmaması şartı arandı. Trombositlerin ADP bağımlı P selektin ekspresyonunu göstermek için flovsitometri yöntemi kullanıldı. Hiperprolaktinemik grupta serum prolaktin düzeyleri polietilen glikolle (PEG) muamele edilmeden ve edildikten sonra ölçüldü. PEG ile muameleden sonra %40’ın üzerinde çökme olması durumu, makroprolaktin pozitifliği olarak kabul edildi. Trombositlerin ADP ile indüklenmiş P-selektin ekspresyonu hiperprolaktinemik grupta daha fazlaydı; [%14,2±15,5 karşı %6,7±5,2, (p=0.01) ]. Makroprolaktinemi sıklığı %29 bulundu. Prolaktin düzeyleri ve ADP ile indüklenmiş P selektin ekspresyonları arasında anlamlı korelasyon vardı (r=0,3, p<0,02). P selektin ekspresyonu makroprolaktin negatif (gerçek hiperprolaktinemi) (n=21) ve makroprolaktin pozitif (n=11) grupta benzerdi; %13,6±16,4 karşı %15,3±14,4 (p=0,7). P selektin ekspresyonunun, her iki alt-grupta kontrol grubundan yüksek olduğu izlendi; 513,6±16,4 (p=0,03) ve %15,3±14,4, (p=0,005), sırası ile. Trombosit aktivasyonu, insülin direnci ile ilişkili olarak aterosklerotik hastalıkların patogenezinde rol alır. Bu çalışmada, insülin duyarlılığı belirteçleri bakımından tamamen benzer olan iki grupta, hiperprolaktineminin kendisinin trombosit aktivasyonu için bir risk faktörü olduğu ortaya konuldu. Aynı zamanda, makroprolaktineminin de, tıpkı gerçek hiperprolaktinemik hastalarda olduğu gibi, artmış trombosit aktivasyonu ile ilişkili olduğu gösterildi

Acute Adrenal Insufficiency Associated with Tuberculous Vertebral Osteomyelitis and Lymphadenopathy: Case Report

A 51-year-old man developed anorexia, dizziness, nausea, vomiting, and weight loss. He had orthostatic hypotension, hyponatremia, hyperkalemia, and hypocortisolemia, and the diagnosis of adrenal insufficiency was made. Magnetic resonance imaging (MRI) showed asymmetrically enlarged adrenal glands. Biopsy of a hypoechoic, enlarged, inguinal lymph node showed caseating granulomas. Lumbar MRI showed vertebral body height loss and abnormal signal in L1 and L2; vertebral biopsy showed chronic, necrotic, caseating granulomatous inflammation consistent with tuberculous osteomyelitis. Clinical improvement occurred with isoniazid, rifampicin, pyrazinamide, and corticosteroids. The differential diagnosis of adrenal insufficiency should include tuberculosis, especially in geographic regions where tuberculosis is endemic

Distribution of RET mutations and evaluation of treatment approaches in hereditary medullary thyroid carcinoma in Turkey

Objective: This retrospective multicenter study, centrally conducted and supported by the Society of Endocrinology and Metabolism of Turkey, aimed to evaluate the impact of free RET proto-oncogene testing in medullary thyroid carcinoma (MTC) patients. Surgical timing, adequacy of the treatment, and frequency of prophylactic thyroidectomy (PTx) in mutation carriers were also assessed. Methods: Genetic testing for MTC and pheochromocytoma was conducted between July 2008 and January 2012 in 512 patients. Application forms and RET mutation analyses of these patients whose blood samples were sent from various centers around Turkey were assessed retrospectively. An evaluation form was sent to the physicians of the eligible 319 patients who had confirmed sporadic MTC, familial MTC (FMTC), multiple endocrine neoplasia type 2 (MEN2), or who were mutation carriers. Physicians were asked to give information about the surgical history, latest calcitonin levels, morbidity, mortality, genetic screening, and PTx among family members. Twenty-five centers responded by filling in the forms of 192 patients. Results: Among the 319 patients, RET mutation was detected in 71 (22.3%). Cys634Arg mutation was the most prevalent mutation (43.7%), followed by Val804Met in 18 patients (25.4%), and Cys634Tyr in 6 patients (8.5%). Among 192 MTC patients, the diagnosis was sporadic MTC in 146 (76.4%), FMTC in 14 (7.3%), MEN2A in 15 patients (7.9%), and MEN2B in one patient. The number of mutation carriers among 154 apparently sporadic MTC patients was 8 (5.2%). Ten patients were submitted to PTx out of twenty-four mutation carriers at a mean age of 35 +/- 19 years. Conclusion: Turkish people have a similar RET proto-oncogene mutation distribution when compared to other Mediterranean countries. Despite free RET gene testing, the number of the PTx in Turkey is limited and relatively late in the life span of the carriers. This is mainly due to patient and family incompliance and incomplete family counselling.SEM

Effects of Treatment Adherence on Quality of Life in Hypoparathyroid Patients

Objectives This study aimed to evaluate the current situation of hypoparathyroid patients and to investigate the relationship between treatment adherence and quality of life. Study design Prospective, multicentre study. Methods Adult patients presenting with the diagnosis of hypoparathyroidism to 20 different endocrinology clinics were included. They were receiving conventional therapies for hypoparathyroidism, using calcium, active vitamin D, and magnesium. We collected data on demographic features, disease- and treatment-related information, and results of routine laboratory tests, treatment adherence, and presence of complications. Beck Depression Inventory, Beck Anxiety Inventory, and Short Form-36 quality of life assessments were administered. Results Among the 300 patients studied, 60.7 % were adherent to their treatment, and 34.1 % had complications. Anxiety and depression scores were significantly higher in non-adherent versus treatment-adherent patients (p ? 0.001 and p = 0.001, respectively). Most of the domains of quality-of-life scores were also significantly lower in non-adherent patients. Both anxiety and depression scores showed significant, negative correlations with serum calcium and magnesium concentrations (r = -0.336, p ? 0.001 and r = -0.258, p ? 0.001, respectively). Conclusions Nearly 40 % of the patients were non-adherent to conventional treatment for hypoparathyroidism, and such patients had higher anxiety and depression scores and poorer quality of life scores. Conventional treatment might not be sufficient to meet the needs of patients with hypoparathyroidism. In addition to seeking new therapeutic options, factors influencing quality of life should also be investigated and strategies to improve treatment adherence should be developed. © 2021 Georg Thieme Verlag. All rights reserved