Subklinik hipotiroidili hastalarda metabolik ve kardiyolojik değişiklikler ; L-tiroksin dedavisinin değerlendirilmesi

TEZ7658Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2009.Kaynakça (s62-67 ) var.ix, 68 s. ; 29 cm.Amaç: Subklinik hipotiroidizm, serum fT4 (serbest T4) ve fT3 (serbest T3) düzeyleri referans aralıkta iken serum TSH (tiroid stimulan hormon) düzeylerinde hafif düzeyde artış ile tanımlanır. Bu hastalarda temel sorun tedavi alıp almayacaklarıdır. Birçok çalışmada, levotiroksin tedavisinin hipotiroidizm semptomları, serum lipid düzeyleri ve kardiyak fonksiyonlar üzerine olumlu etkileri gösterilmiştir. Biz prospektif klinik çalışmamızda, daha önce tanı almamış subklinik hipotiroidili hastalardaki metabolik değişiklikleri ve bunlara tiroksin tedavisinin etkilerini incelemeyi amaçladık. Gereç ve Yöntem: Çalışma grubunu yeni tanı konulan ve daha önce herhangi bir tedavi almamış subklinik hipotiroidili 53 hasta oluşturdu. Rastgele seçilen 29 hastaya tedavi verilirken, 24 hasta kontrol grubu olarak tedavisiz izlendi. Hastaların başlangıçta ve 6 ay sonra semptomları sorgulanıp, fizik muayeneleri yapıldı. Başlangıçta ve 6. ayda tedavi verilen ve tedavi verilmeyen hastaların tiroid fonksiyon testleri, lipid parametreleri, holter EKG ve EKO'ları karşılaştırıldı...Objectives: Subclinical hypothyroidism is defined as a mild elevation in serum TSH (thyroid stimulating hormone) level while serum fT4 (free T4) and fT3 (free T3) levels are in reference range. Main problem with these patients is whether they will receive therapy or not. In many studies, positive effects of levothyroxine treatment on hypothyroidism symptoms, serum lipid levels and cardiac functions were shown. In this prospective clinical study, we aimed to evaluate the metabolic changes in the newly diagnosed patients with subclinical hypothyroidism and the effects of thyroxine treatment in these patients. Material and Methods: Fifty-three newly diagnosed patients with subclinical hypothyroidism who did not receive any therapy before were included in the study group. Randomly choosen 29 patients received therapy while the remaining 24 patients formed the control group and followed without any treatment. Patients were asked for symptoms and examined physically at the beginning of the study and at the end of sixth month. Thyroid function tests, lipid parameters, holter ECG and ECO at the beginning of the study and at the end of sixth month were compared between the 2 groups...Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No

Optik sinir kılıflarında ödem saptanan bir sheehan sendromu olgusu

Sheehan sendromu postpartum kanama ve hipovolemiye sekonder olarak ortaya çıkan hipofiz nekrozuna bağlı parsiyel veya tam hipofiz yetmezliğidir. Klinik bulgular laktasyonun kesilmesi, sekonder amenore, libido kaybı ve hipofiz rezerv kaybı ile ilişkili bulgular ile karakterizedir. Tedavide hormon replasmanı kullanılır. 44 yaşındaki kadın sürekli uyuma isteği, halsizlik, vücutta şişlik ve görme bulanıklığı yakınması ile kliniğe kabul edildi. Fizik muayenede hipotansiyon ve ödem saptandı. Özgeçmişinde 11 yıl önce doğum yaptığı, aşırı kanamasının olduğu, kan transfüzyonu yapıldığı ve sonrasında bebeğini emziremediği bildirildi. Hali hazırda amenoresi olduğu belirlendi. Sheehan sendromu olarak değerlendirilen olguya glukokortikoid ve levotiroksin replasmanı başlandı. Hipofiz magnetic rezonans görüntülemede empty sella, orbital magnetik rezonans görüntülemede ise bilateral optik sinir kılıflarında ödem saptandı. Empty sella subaraknoid mesafede basınç artışına yol açarak optik sinir kılıfında ödeme neden olabilir. Bu olgu nedeniyle klinik pratiğimizde ender görülen bu birlikteliğe dikkat çekilmek istenmiştir.Sheehan syndrome is partial or complete hypophyseal insufficiency due to hypophyseal necrosis secondary to postpartum hemorrhage and hypovolemia. Clinical findings are cessation of lactation, secondary amenorrhea, loss of libido and hypophyseal reserve loss. Treatment is hormone replacement. Forty-four years old women admitted with somnolence, malaise, edema and blurred vision. Physical examination revealed edema and hypotension. She had massive bleeding during her birth 11 years ago; therefore she had received blood transfusion and could not breast-feed then. She had amenorrhea when she was admitted. She was diagnosed with Sheehan syndrome when glucocorticoid and levothyroxine replacement therapy was started. Hypophyseal and orbital magnetic resonance imaging revealed empty sella and edema in bilateral optical neural sheaths, respectively. Empty sella may cause edema in optical neural sheaths by increasing pressure in subarachnoidal space. We present this case to point out this coincidence

Cushing sendromlu olgu bağlamında adrenal

Adrenal insidentalomalar başka nedenlerle yapılan görüntüleme testleri sırasında saptanan lezyonlardır. Günümüzde abdominal görüntüleme tekniklerinin yaygın olarak kullanılmaya başlanması ile birlikte adrenal insidentaloma tanısının sıklığı artmıştır. Adrenal insidentalomaların değerlendirilmesinde ilk basamak lezyonun hormonal olarak aktif olup olmadığı ya da kitlenin benign veya malign olup olmadığıdır. Bu değerlendirme tedavi planlanması ve hastanın takibi için önemlidir.Adrenal incidentalomas are masses that are discovered by imaging tests performed for other reasons. Today, in line with the increased use of imaging methods as computerized tomography and magnetic resonance imaging, the prevalence of diagnosis of adrenal incidentaloma has increased. The first stage that must be assessed after diagnosing adrenal incidentaloma is the examination of the mass in terms of hormonal status and malignancy. This evaluation is important for follow-up of the patients and for treatment planning

Clinical experiences and success rates of acromegaly treatment: the single center results of 62 patients

PubMedID: 25511633Background: This study aimed to report the clinical and outcome data from a large cohort of patients diagnosed with acromegaly and treated at our institution over a 20-year period. Methods: Sixty-two acromegaly patients (32 women and 30 men) treated and monitored at the endocrinology polyclinic between 1984 and 2013 were enrolled in this retrospective study. Clinical features and patients' treatment outcomes were evaluated. A level of growth hormone (GH) of < 2.5 ng/ml was considered as the criterion for remission, and the normal insulin-like growth factor (IGF) range was based on gender and age. Results: The mean age at the time of diagnosis was 38.8 ± 1.4 years, the time to diagnosis was 4.5 ± 0.3 years, and the follow-up duration was 7.3 ± 0.8 years. Among patients' symptoms, growth in hands and feet and typical facial dysmorphism were the most prominent (92%). The number of patients with diabetes mellitus, hypertension and hyperprolactinemia were 22 (35%), 13 (21%) and 13 (21%), respectively. Microadenomas and macroadenomas were found in eight and 54 patients, respectively. A significant correlation was found between the initial tumor diameters and GH levels (p = 0.002). The mean GH and IGF-1 levels were 39.18 ± 6.1 ng/ml and 993.5 ± 79 ng/ml, respectively. Visual field defect was found in 16 patients (32%). Thirty-one patients were treated by transsphenoidal surgery. Four of these were cured, 10 patients developed postoperative anterior pituitary hormone deficiency, and one patient developed diabetes insipidus. Twenty patients were treated by transcranial surgery, of which two were cured, while 17 patients developed postoperative anterior pituitary hormone deficiency. In total, five of the patients who were not cured after surgery were given conventional radiotherapy, of which two were cured. Four of 15 patients, on whom Gamma Knife radiosurgery was performed, were cured. Biochemical remission was achieved in 32 of 52 patients who received octreotide treatment, and in two of five patients who received lanreotide treatment. Conclusions: The rate of surgical success in our patients was found to be low. This could be explained by an absence of experienced pituitary surgical centers or surgeons in our region, and the fact that most patients presented late at the macroadenoma stage. © 2014 Evran et al

General approach to adrenal incidentalomas with regards to a case with subclinical Cushing syndrome

Adrenal incidentalomas are masses that are discovered by imaging tests performed for other reasons. Today, in line with the increased use of imaging methods as computerized tomography and magnetic resonance imaging, the prevalence of diagnosis of adrenal incidentaloma has increased. The first stage that must be assessed after diagnosing adrenal incidentaloma is the examination of the mass in terms of hormonal status and malignancy. This evaluation is important for follow-up of the patients and for treatment planning. [Cukurova Med J 2016; 41(2.000): 363-369

Idiopathic Hypoparathyroidism associated Fahr's Disease: Two Case Reports and Review of the Literature

Bilateral Striopallidodentat Kalsinozis olarak da isimlendirilen Fahr Hastalığı (FH); bazal ganglion, talamus, serebellar dentat nükleus ve serebral beyaz cevherde simetrik kalsifikasyonlar ile karakterize bir hastalıktır. Kalsifikasyonlar genellikle başka nedenlerle çekilen serebral görüntülemelerde dikkati çekmektedir. Hastalık klinik olarak değişken nörolojik veya nöro-psikiyatrik bulgularla seyredebilmektedir. Fahr hastalığının anoksi, radyasyon, sistemik hastalıklar, toksinler, kalsiyum metabolizma bozuklukları ve ensefalitler ile bağlantılı olduğu düşünülmektedir. Biz de burada primer hipoparatiroidizm tanısı olan ve nörolojik problemlerle başvuran, görüntüleme yöntemleriyle serebral ve serebellar kalsifikasyonlar saptanan iki olguyu sundukBilateral Striopallidodentat Calcinosis also called Fahr's disease (FH); basal ganglia, thalamus, and cerebellar dentate nucleus is a disease characterized by symmetric calcifications in the cerebral white matter. Calcifications are often drawn attention in brain imaging for other reasons. The disease can progress with clinically variable neurological or neuro-psychiatric symptoms. Fahr's disease are believed to be associated with anoxia, radiation, systemic diseases, toxins calcium metabolism disorders, and encephalitis. We presented two cases with primary hypoparathyroidism were diagnosed and detected of neurological problems, cerebral and cerebellar calcifications on imagin

A Rare Case Presenting with Symptoms of Familial Pheochromacytoma

Pheochromocytoma is a rare tumor in which seen an incidence of 1 per 100.000 in the general population. Pheochromocytoma is a catecholamine producing neuroendocrine tumor arising from adrenal medulla. A 46-year-old man experienced headache, sweating and palpitation referred to our hospital. Familial pheocromocytoma was detected. We presented this case as whole family members had suffered from morbidities and deaths due to this disorder. [Cukurova Med J 2015; 40(3.000): 593-596

Familyal Feokromasitoma Semptomlarıyla Başvuran Nadir Bir Olgu

Feokromasitoma 100.000 kişide bir görülebilen nadir tümörlerden birisidir. Genel olarak adrenal medulladan katekolamin salınımı ile karakterizedir. Kırk altı yaşında erkek hasta baş ağrısı, terleme, çarpıntı şikayeti ile kliniğimize başvurdu. Hastaya feokromasitoma tanısı konuldu. Bu yazıda ailesinde feokromasitomaya bağlı morbidite ve ölüm öyküsü olan bir hasta aktarılmıştır.Pheochromocytoma is a rare tumor in which seen an incidence of 1 per 100.000 in the general population. Pheochromocytoma is a catecholamine producing neuroendocrine tumor arising from adrenal medulla. A 46-year-old man experienced headache, sweating and palpitation referred to our hospital. Familial pheocromocytoma was detected. We presented this case as whole family members had suffered from morbidities and deaths due to this disorder