Denosumab Experience in a Patient with End-Stage Renal Disease and Paget’s Disease of the Bone

Paget’s disease of the bone (PDB) is a chronic bone disease which is characterized by accelerated bone turnover and disorganized bone remodeling. Diagnosis and treatment of PDB is particularly challenging in patients with chronic kidney disease (CKD). Denosumab administered subcutaneously at a single dose of 60 mg every 3 months reduced both serum total and bone-specific alkaline phosphatase (ALP) levels to near normal range in a 47-year-old male with CKD was suspected of having PDB due to very high serum total ALP levels and imaging findings suggestive of poliostotic involvement. Elevated serum total ALP levels detected at 3 months after denosumab suggests that serum total ALP starts to increase after 60 days of treatment but it is difficult to exactly determine the day when serum total ALP started to increase. It seems wise to administer denosumab at an interval of 60-120 days to maintain serum total ALP level within normal limits

The association of TSH-receptor antibody with the clinical and laboratory parameters in patients with newly diagnosed Graves' hyperthyroidism: experience from a tertiary referral center including a large number of patients with TSH-receptor antibody-negative patients with Graves' hyperthyroidism

Introduction: Although the TSH-receptor antibody (TRAb) plays a central role in the pathogenesis of Graves' disease (GD), the association between TRAb at first diagnosis and clinical and laboratory parameters is not well known. On the other hand, a minority of patients with GD may be TRAb negative, and there is a lack of adequate evidence to demonstrate the clinical and laboratory characteristics of these patients. Therefore, we aimed to investigate the association of TRAb at the initial diagnosis of GD with the clinical and laboratory parameters in a large number of patients with GD and to compare the clinical and laboratory parameters between patients with high TRAb levels and TRAb-negative patients. Material and methods: This study included 440 patients [326 (74%) female, 114 (26%) male]. All patients were classified according to gender, age, smoking habit, and TRAb levels. Results: TRAb levels were significantly higher in male compared to female patients and in smokers compared to non-smokers. Smoking male patients had the highest TRAb levels. In regression analysis, goiter size, male gender, cigarette smoking, Graves' orbitopathy, fT3, and anti-TPO antibody levels were independently associated with high TRAb levels, while age at diagnosis and fT4 levels were not independently associated with high TRAb levels. TRAb-negative GD was diagnosed in 80 (18%) patients. TRA-negative patients had markedly less severe clinical and laboratory hyperthyroidism compared to patients with high TRAb levels. Moreover, the smoking habit was significantly lower in patients with TRAb-negative GD. Conclusions: According to our study results, TRAb levels at the initial diagnosis of GD are differently associated with clinical and laboratory parameters. Male patients and smoking patients with GD tended to have markedly higher TRAb levels and more severe clinical hyperthyroidism. Therefore, besides other contributing factors, male gender and smoking may affect TRAb levels and consequently the severity of hyperthyroidism in patients with GD. Furthermore, male gender and smoking may have a synergistic effect on TRAb levels and consequently on the severity of hyperthyroidism in patients with GD

B-mode ultrasound assessment of carotid artery structural features in patients with normocalcaemic hyperparathyroidism

Introduction: Normocalcaemic hyperparathyroidism is a condition first defined in 2008, characterized by normal se- rum calcium and high parathormone levels. Although normocalcaemic hyperparathyroidism is considered to have a milder clinical picture compared to asymptomatic primary hyperparathyroidism, recent studies have shown that it may be associated with osteoporosis, insulin resistance, metabolic syndrome, and cardiovascular risk factors. Considering that normo- calcaemic hyperparathyroidism may pose a cardiovascular risk in the setting of carotid atherosclerosis, we sought to examine the structural features of the carotid artery in patients with normocalcaemic hyperparathyroidism compared to a control group. Material and Methods: After excluding patients with hypertension, diabetes, and dyslipidaemia (other factors contributing to atheroscle- rosis), 37 (32 females, 5 males) patients with normocalcaemic hyperparathyroidism with a mean age of 51.2 +/- 8 (min: 32, max: 66) years and 40 controls (31 females, 9 males) with a mean age of 49.3 +/- 7.5 (min: 34, max: 64) years with normal serum albumin-corrected calcium and parathyroid hormone levels were included in the study. Structural features of the carotid artery including intima-media thickness (mean and maximum), lumen diameter, and the presence of plaque were assessed using B-mode ultrasound. Results: On ANCOVA analysis corrected for atherosclerotic factors (body mass index, waist circumference, fasting plasma glucose, serum cholesterol, lipid, and blood pressure), greater mean intima-media thickness was found in patients with normocalcaemic hyperparathyroidism than in controls (0.65 mm vs. 0.59 mm, respectively) (p = 0.023). Maximum ca- rotid intima-media thickness was also greater in patients with normocalcaemic hyperparathyroidism compared to controls (0.80 mm vs. 0.75 mm, respectively) (p = 0.044). The study groups did not show a significant difference in lumen diameter and the presence of carotid plaque. In addition, a negative correlation was found between parathormone (PTH) level and lumen diameter. Conclusion: The findings of this study show that as with asymptomatic primary hyperparathyroidism, normocalcaemic hyperparathy- roidism may be associated with increased cardiovascular risk by predisposing to atherosclerosis. (Endokrynol Pol 2023; 74 (1): 67-73

Pneumocystis jiroveci infection and lung involvement

Pneumocystis jiroveci, bağışıklık sistemi baskılanmış hastalarda özellikle akciğer tutulumu ile seyreden fırsatçı bir patojendir. Pneumocystis jiroveci pnömonisinde klinik bulgular dispne, taşipne, nonprodüktif öksürük, ateş ve siyanozdur. Radyolojik olarak interstisyel pnömoni görünümü saptanır. Kültürde üretilemediğinden tanı klinik bulgular ile birlikte akciğer sekresyonunda organizmanın morfolojik olarak gösterilmesi veya fluoresan antikor ve moleküler yöntemler gibi daha duyarlı yöntemler ile saptanması ile konulabilmektedir. Diğer ilaç alternatifleri bulunmakla birlikte trimetoprim-sulfametaksazol profilaksi ve tedavide ilk seçenek olarak önerilmektedir.Pneumocystis jiroveci is an oppurtunistic pathogen especially affecting lungs in immune-suppressed patients. The clinical findings in Pneumocystis jiroveci pneumonia are dyspnea, tachypnea, nonproductive cough, fever and cyanosis. Interstitial pneumonia is demonstrated radiologically. As it can not be cultured, the diagnosis is made with the presence of clinical findings and the morphological demonstration of the organism in the secreation of lung or detection with more sensitive methods like fluorescence antibody and molecular methods. Although other drug alternatives exist, trimethoprime-sulphamethaxasole is offered as the first option in the prophylaxis and treatment

Evaluation of type 1 diabetic patients: A single center experience

We evaluated patients diagnosed with type 1 DM who were followed at our clinic by conducting a retrospective chart review. Medical records of a total of 147 patientswith type 1 DM (70 females, 77 males) with a mean (±SD) age of 31.2±9.7 years were reviewed retrospectively. The study patients had a mean duration of follow-up of13.9±9.5 years, mean duration of follow-up of 4±2.6 years at our clinic and a mean HbA1c value of 8.3±2.1%. Microvascular complications were recorded in medicalfiles for 128 patients. There were 48 (37.5%) patients with at least one microvascular complication. Medical records showed that out of 128 patients, 23 (18%) had diabeticneuropathy alone, 4(3%) had diabetic retinopathy alone and 5 (4%) had diabetic nephropathy alone. Ten patients (8%) had both diabetic nephropathy and diabeticretinopathy and 6 (4.7%) patients had all three microvascular complications. No significant difference was observed between patients with or without microvascularcomplications in terms of HbA1c (HbA1c 8.3% versus 8.1%; p=0.85). A history of diabetic foot ulcer was present in 4 patients in the study sample (4/147=2.7% of allpatients).Twenty-two (15%) patients were on insulin pump therapy during follow-up. Insulin pump users had a significantly lower HbA1c value (7.9%) compared to thosenot using insulin pump (8.5%) (p=0.02). At our clinic, special efforts are being made to ensure type 1 diabetic individuals have regular outpatient examinations. Despiteall these measures, our patients are still far from reaching their target HbA1c values, suggesting that we have to do much more help patients achieve their glycemic goals

Assessment of Metabolic Syndrome Components in Patients with Normocalcemic Hyperparathyroidism: A Retrospective Study

Objective: Normocalcemic hyperparathyroidism is characterized by elevated parathormone levels persisting for 3 months or longer despite normal serum Ca levels. This study aimed to retrospectively compare the prevalence of individual metabolic syndrome components between patients with nor-mocalcemic hyperparathyroidism and an age-and sex-matched control group.Methods: Data of 82 normocalcemic hyperparathyroidism patients and 80 control subjects with nor-mal parathormone and calcium levels were reviewed retrospectively. Those meeting 3 or more of the 2001 metabolic syndrome diagnostic criteria of the US National Cholesterol Education Program Adult Treatment Panel III were considered as having metabolic syndrome. Also, Turkish waist circumfer-ence cutoff values were used to identify abdominal obesity and to estimate the metabolic syndrome frequency.Results: Considering that higher body mass index of normocalcemic patients would confound the analysis, analysis of covariance adjusted for body mass index was used to compare the groups, which showed increased waist circumference, waist/hip ratio, parathormone, 25 OH vitamin D3, fasting plasma glucose, and total cholesterol and low-density lipop rotei n-cho leste rol levels in normocal-cemic hyperparathyroidism patients than controls. The prevalence of metabolic syndrome among normocalcemic hyperparathyroidism patients was 32.9% (22.5% in controls) using the National Cholesterol Education Program Adult Treatment Panel III criteria versus 34.1% (23.8% in controls) using the Turkish waist circumference cutoff values.Conclusion: The percentage of patients meeting the metabolic syndrome criteria was higher com-pared to the control group. Even in the case of normocalcemic hyperparathyroidism, which is con-sidered to be a milder condition, the prevalence of metabolic syndrome was relatively higher than in the control group, suggesting that normocalcemic hyperparathyroidism may be a cardiovascular risk factor by predisposing to metabolic syndrome.[2021.69.03.09]Ethics Committee Approval: The study was approved by the Local Ethics Committee of Tekirda? Nam?k Kemal University, Faculty of Medicine (date: March 30, 2021, no: 2021.69.03.09)

The frequency of Cushing's disease, ACTH-independent Cushing's syndrome and autonomous cortisol secretion among Turkish patients with obesity

OBJECTIVE: The frequency of Cushing's disease (CD), ACTH-independent Cushing's syndrome (CS) and autonomous cortisol secretion (ACS) in patients with obesity is not well known. Therefore, in the present study, we aimed to assess the frequency of CD, CS and ACS among the patients with obesity. METHODS: This study included 813 patients (683 female, mean age 46.47 +/- 14.23 yr; mean body mass index (BMI) 37.31 +/- 6.50 kg/m(2)). Patients with obesity were classified further to stages 1, 2, and 3, according to BMI. All patients underwent a low dose dexamethasone suppression test (LDDST). The patients with CD, CS, and ACS and patients with simple obesity were compared concerning gender, age, type-2 diabetes, hypertension (HT) and hyperlipidemia (HL). RESULTS: Forty-four (5.4%) out of 813 patients were diagnosed as CD, CS or ACS. CD, CS, and ACS were diagnosed in four (0.4%), two (0.2%), and 33 (4%) patients, respectively. When patients with CD, CS and ACS were compared to the patients with simple obesity, older age at diagnosis, the presence of stage-1 obesity, the presence of HT, and uncontrolled type-2 diabetes were more frequent in patients with CD, CS and ACS (p=0.001, p=0.007, p=0.004, and p=0.0026, respectively). CONCLUSION: The frequency of CD, CS, and ACS is high among patients with obesity. Screening for CD, CS, and ACS in patients with stage-I obesity who are older than 50 years of age with uncontrolled type-2 diabetes and HT may be a reasonable approach