Immunosuppressive treatment for immune thrombocytopenia which masked Graves′ disease

A 71-year-old female patient followed primary immune thrombocytopenia (ITP) was admitted to endocrinology unit with excessive sweating. We started methimazole for Graves′ disease. Without any additional immunosuppressive treatment, at week 12 of methimazole therapy, thyroid stimulating hormone (TSH) levels returned to normal, and platelet counts rose to tolerable levels. When her hospital records were analyzed, they revealed that a year ago, when she had been diagnosed with ITP, her TSH values had been suppressed. After immunosuppressive therapy, her platelet values were maintained at normal levels, and during her control visits, her TSH levels were measured twice and were within normal limits. We think that immunosuppressive therapy for ITP without considering thyroid function tests may result in a transient euthyroid state, which potentially masks Graves′ disease accompanying immunosuppressive therapy and associated recurrent ITP attacks

Relationship Between Insulin Resistance and Mean Platelet Volume in Gestational Diabetes Mellitus

Objectives: A few studies have investigated the relationship between mean platelet volume (MPV) and gestational diabetes mellitus (GDM), and in these studies the relationship between MPV and insulin resistance has not been analyzed. Our aim in this study was to compare MPV values of the pregnant women with or without GDM and evaluate the relationship between MPV and homeostasis model assessment insulin resistance index (HOMA-IR) in pregnant women. Materials and Methods: One hundred and fourteen with GDM measurements being obtained before any dietary advice or therapy with insulin or hypoglycemic agents were given, and 76 with healthy pregnant women were included the study. Results: In the group with GDM, MPV value was found to be significantly higher than that of the control group (10.2 fl [8.0–12.2] vs. 9.9 fl [5.81–10.9], P = 0.004). HOMA-IR value was detected to be significantly higher in the group with GDM (2.46 [1.5–5.88] vs. 1.30 [0.17–2.92], P < 0.001). A positive correlation between MPV and HOMA-IR was found (r = 0.30, P = 0.002). Conclusion: We have shown that MPV was significantly elevated in GDM patients when compared to healthy pregnant women. Furthermore, we found that there was a positive correlation between MPV and HOMA-IR

Genetic Risk Analysis of Gestational Diabetes Mellitus in a Turkish Population

Background: Gestational diabetes mellitus (GDM) is a type of clinical diabetes characterized by insulin resistance and impaired insulin secretion because of environmental and genetic factors. The high risk of developing type 2 diabetes (T2D) in women with GDM and the high risk of developing GDM in women with a family history of T2D suggests that both diseases may have the same genetic basis. Therefore, genes and risk variants associated with the genetic architecture of T2D are being investigated for their effects on the development of GDM. In this study, we aim to investigate ABCC8, TCF7L2, Adiponectin, IRS1, and PPARG genes, which are known as T2D risk genes, to understand the genetic basis of GDM in a Turkish population. Materials and Methods: In our study, 74 pregnant women diagnosed with GDM according to the American Diabetes Association criteria and 49 healthy pregnant women were included. DNA isolations were made from peripheral blood cells collected from pregnant women and regions of targeted genes were scanned by the Polimerase Chain Reaction-Restriction fragment length polymorphism (PCR-RFLP) technique. The homeostatic model assessment for insulin resistance (HOMA-IR), which is an indicator of insulin resistance, was calculated for each individual in the biochemical examinations. The associations of genotypes detected in the target gene regions with the disease and their effects on the biochemical phenotypes were analyzed by establishing the dominant, recessive, and additive models along with calculating odd ratios. The P<0.05 was considered statistically significant in all analyses. Results: A statistically significant association was found between R1273R substitution in the ABCC8 gene and GDM under dominant and additive models. No statistically significant correlation was found between the A1369S and e16/-3t→c variants in the ABCC8 gene and the screened variants in other genes and GDM. When the genotype-phenotype association data was evaluated, no association was detected between all the scanned variants and fasting blood sugar while a weak correlation was found between e16/-3t→c in the ABCC8 gene and fasting insulin (P=0.075) and HOMA-IR (P=0.067). Conclusion: ABCC8 (R1273R and e16/-3t→c) gene variants may be a risk factor for the development of GDM in the Turkish population

108-110Diagnosis of the Combination of Immune Thrombocytopenia and Woodhouse-Sakati Syndrome

Abstract Woodhouse-Sakati Syndrome (WSS) is a rare autosomal recessive syndrome characterized by sensorineural hearing loss, ECG ST-T changes, partial alopecia, hypogonadism, diabetes, and moderate mental retardation. A 23-year-old male patient was admitted to our hospital with complaints of purpura and petechial rashes. His platelet count was 3.04 x 10 9 /L and the peripheral blood smear was compatible with this count. No atypical cell was observed. He had mild mental retardation. He had hearing loss since childhood. Physical examination showed widespread petechiae and purpura on bilateral lower extremities. Significant growth retardation was detected and male pattern hair growth was less. In genital examination, bilateral testicles were small; penis length was 1 cm and it was 4 cm when elongated. T negativity was present in precordial derivations of ECG. He was diagnosed Immune thrombocytopenic purpura (ITP) and WSS according to these findings. In addition to ITP treatment with steroids, the combination of testosterone propionate and testosterone phenyl propionatewas also administered to him. Upon we observed that there was an increase in his platelet number, he was discharged from the hospital. WSS is a very rare disease. Different components of the syndrome have been reported in different patients.It is the first time in the literature that ITP is observedtogether with WSS in a male patient

Changes in Serum Levels of ADMA, SDMA and L-NMMA with Helicobacter Pylori Eradication

WOS: 000419258100007Objective: Increased asymmetric dimethylarginine (ADMA) levels are associated with reduced nitric oxide (NO) levels in many systems, particularly the cardiovascular system, and cause adverse effects. The objective of this study is to evaluate the effect of eradication therapy in patients infected with Helicobacter pylori (H. pylori) on the serum level of ADMA and other metabolic products of methylarginine. Methods: Patients who were found positive both in urea breath tests and stool antigen tests were considered to have H. pylori infection. These patients received eradication therapy for 14 days (twice daily pantoprazole 40 mg, twice daily amoxicillin 1000 mg, and twice daily clarithromycin 500 mg). Blood samples were taken to measure serum ADMA, symmetric dimethylarginine (SDMA), and N-monomethyl-Larginine (L-NMMA) levels before eradication therapy and 3 months after the therapy for patients for whom eradication was achieved. Results: A total of 23 of the 45 patients included in the study were female, whereas 22 were male. The mean age of the patients was 32.4 +/- 8 years. Significant reductions in the serum ADMA, SDMA, and L-NMMA levels of the patients were observed post-eradication therapy versus pre-eradication therapy. Conclusion: This study demonstrated significant reductions in serum ADMA, SDMA, and L-NMMA levels with H. pylori eradication. Further extensive long-term studies are needed to evaluate the positive effects that reduced serum ADMA, SDMA, and L-NMMA levels after H. pylori eradication can have on all systems, particularly the cardiovascular system

Letrozole Induced Hypercalcemia in a Patient with Breast Cancer

Hypersecretion of PTHrP is a relatively common cause of malignancy-related hypercalcemia. However, there is only one case report of letrozole induced hypercalcemia. A 52-year-old female patient was referred to our clinic because of the recent discovery of hypercalcemia (11.0 mg/dL). The patient had a history of left breast carcinoma. She had started a course of letrozole (aromatase inhibitor; 2.5 mg dose/day) ten months earlier. Patient’s parathyroid hormone-related protein levels were normal and a bone scintigram revealed no evidence of skeletal metastasis. Other potential causes of high calcium levels were ruled out. We recognized that, when letrozole was taken at one dose daily (2.5 mg), she had recurrent hypercalcemia. Our experience suggests that letrozole may precipitate hypercalcemia in a patient with breast cancer

PIK3R1 gene polymorphisms are associated with type 2 diabetes and related features in the Turkish population

WOS: 000440357400009PubMed ID: 29893513Background. The phosphatidylinositol 3-kinase p85 alpha regulator subunit 1 gene (PIK3R1) encodes the PIK3R1 protein, which plays a direct role in insulin signaling. PIK3R1 (p85 regulatory subunit) connects firmly with the p110 catalytic subunit, and together these proteins form the phosphatidylinositol 3-kinase (PI3K) protein. PI3K is a key protein in the Akt signaling pathway, which regulates cell survival, growth, differentiation, glucose trafficking, and utilization. Defects in the insulin signaling cascade play an important role in the development of insulin resistance, which shares a common genetic basis for metabolic diseases such as type 2 diabetes (T2D), obesity and cardiovascular diseases. Objectives. In our study, we investigated the effect of single nucleotide polymorphisms (SNPs) rs3756668 in 3'UTR region, rs706713 and rs3730089 in exons 1 and 6, respectively, rs7713645 and rs7709243 in intron 1, and rs1550805 in intron 6 of PIK3R1 gene on T2D. Material and methods. This study enrolled a total of 840 individuals, including 427 diabetic individuals (206 obese and 221 non-obese) and 413 nondiabetic individuals (138 obese and 275 non-obese). The target SNPs were analyzed using real-time polymerase chain reaction (RT-PCR). Statistical analysis was performed using SPSS18.0 (IBM Corp., Armonk, USA). The p-values >= 0.05 were consideied statistically significant. Results. The SNPs rs706713 (Tyr73Tyr) and rs3730089 (Met326lle) located in exons, and rS7713645, rs7709243 and rs1550805 located in introns were determined to be significantly associated with T2D and phenotypic features such as obesity, insulin resistance and the lipid parameters. The association with SNP rs3756668, which is located in the 3'UTR, was not significant. Conclusions. Our study supports the role of PIK3R1, an important candidate gene due to its critical role in insulin signal transduction, in T2D development.Selcuk University Research FoundationSelcuk University [13202033]This study was supported by the Selcuk University Research Foundation (13202033)

Comparison of Salivary Cortisol, Serum Cortisol, Plasma ACTH and Urinary Free Cortisol Levels in Thyrotoxic and Hypothyroid Patients

Objective: Hypothalamo-pituitary-adrenal (HPA) axis is affected by thyroid hormones. The present study was designed to compare the level of salivary cortisol, serum cortisol, plasma adrenocorticotropic hormone (ACTH) and urinary free cortisol (UFC) levels in patients with subclinical and overt thyrotoxicosis and hypothyroidism. Material and Methods: We analyzed the salivary cortisol, serum cortisol, plasma ACTH and UFC levels in 123 patients with thyroid dysfunction. The patients were classified into four groups; overt thyrotoxicosis (n=32), subclinical thyrotoxicosis (n=29), overt hypothyroidism (n=28) and subclinical hypothyroidism (n=34). Results: There were no significant differences in terms of salivary cortisol, serum cortisol, plasma ACTH and UFC levels in patients with subclinical and overt thyrotcodcosis (p>0.05). Similarly, no significant differences could be detected in terms of salivary cortisol, serum cortisol, plasma ACTH and UFC levels in patients with subclinical and overt hypothyroidism (p>0.05). The comparison of patients with hypothyroidism and thyrotoxicosis also did not yield any significant difference in terms of salivary cortisol, serum conisol, plasma ACTH and UFC levels (p>0.05). Conclusion: Similar salivary cortisol, serum cortisol, plasma ACTH and UFC levels were detected in patients with hypothyroidism and thyrotoxicosis. Thus, we may suggest that thyroid hormone status does not play a role in the HPA axis. The major limitation of this study was the absence of a healthy control group. Further studies with large numbers of patients are required to clarify the association between thyroid hormone dysfunction and glucocorticoid levels

Do We Need to Replace GH to Correct Anemia in Hypopituitarism?

WOS: 000209805102094