Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity

Hipofiz sapı kesinti sendromunda manyetik rezonans görüntülemenin önemi

Objective: To evaluate the importance of magnetic resonance imaging in the treatment and follow-up of patients with pituitary stalk interruption syndrome. Material and Methods: The study included patients who were admitted to the Endocrinology and Metabolism Clinic of our hospital from 2009 to 2013. Pituitary functions, growth and development curves, and magnetic resonance imaging findings of the patients were evaluated during the follow-up period. Results: The study included three men and two women. Four patients had multiple pituitary hormone deficiency. All cases were diagnosed with short stature with respect to their chronological age. Four patients were diagnosed with pituitary stalk interruption syndrome in their childhood. Isolated growth hormone deficiency was observed only in one patient. Conclusion: Pituitary insufficiency should be considered when evaluating pituitary stalk interruption syndrome. The presence of pituitary stalk and the change in the size of the anterior pituitary gland are crucial magnetic resonance imaging findings in monitoring pituitary functions. In addition, evaluating the size of the pituitary gland may allow early detection of pituitary insufficiency in adult patients with pituitary stalk interruption syndromeAmaç: Hipofiz sapı kesinti sendromu hastalarının takip ve tedavisinde manyetik rezonans görüntülemenin önemini değerlendirmektir. Gereç ve Yöntemler: Çalışma grubumuz, 2009-2013 yılları arasında endokrinoloji ve metabolizma hastalıkları polikliniğimize başvuran hastalardan oluşmaktadır. Hasta takibinde hipofiz fonksiyonları, büyüme ve gelişme eğrileri ve manyetik rezonans görüntüleme bulguları değerlendirmeye alındı. Bulgular: Çalışma grubumuz üç erkek ve iki kadın hastadan oluşmaktadır. Dört hastamızda çoklu hipofizer hormon yetmezliği saptandı. Hastalarımızın hepsi kronolojik yaşlarına göre kısa boylu olmaları nedeni ile değerlendirilirken tanı konuldu. Dört hastamıza çocuk yaş grubunda tanı konulmuştu. Sadece bir hastada izole büyüme hormon eksikliği mevcuttu. Sonuç: Hipofiz sapı kesinti sendromlu olguları değerlendirirken hipofiz yetmezliği dikkate alınmalıdır. Manyetik rezonans görüntülemede hipofiz sapının varlığı ve ön hipofiz bezinin büyüklüğünün zaman içinde değişimi, hipofiz bezinin fonksiyonlarının takibinde önemlidir. Ayrıca, hipofiz sapı kesinti sendromlu erişkin yaştaki hastalarda, hipofiz bezinin büyüklüğünün değerlendirilmesi, hipofiz yetmezliğinin erken tanısına olanak sağlayabilmektedir

COVID-19 mRNA vaccine may trigger subacute thyroiditis

Subacute thyroiditis is the most common cause of painful thyroiditis, which usually occurs after an acute viral upper respiratory tract infection. Rare cases of subacute thyroiditis have been reported after administration of viral vaccines. Here, we report four cases of subacute thyroiditis after administration of the COVID-19 mRNA vaccine (Pfizer/BioNTech®). We describe the clinical, laboratory and imaging features of five cases of subacute thyroiditis after COVID-19 mRNA vaccine (Pfizer/BioNTech®). COVID-19 mRNA vaccine (Pfizer/BioNTech®)-associated subacute thyroiditis may present with clinical findings typical of classic subacute thyroiditis such as fever, neck pain, weakness, and tremor within a few days following vaccination. Subacute thyroiditis may be focal or may progress with diffuse bilateral involvement. Depending on the extent of subacute thyroiditis involvement, significant increases in acute-phase reactants can be observed. COVID-19 mRNA vaccine (Pfizer/BioNTech®) associated subacute thyroiditis responds quite well to non-steroidal anti-inflammatory therapy. Clinicians should be aware of the risk of developing subacute thyroiditis after vaccination