Medical Nutrition Therapy for Special Groups with Diabetes Mellitus

The prevalence of diabetes mellitus (DM) is increasing worldwide. Medical nutrition therapy increases the success of diabetes treatment and provides an appropriate glycemic control that decreases diabetes complications. The requirement of energy and nutritional elements may differ according to specific conditions including age, the presence of pregnancy, or comorbidities. Therefore, these specific conditions should be taken into account in the planning of medical nutrition therapy. Ensuring continuity of children and young growth and development, providing requirements based on comorbidities and physiological alterations in older adults, and protection of fetal development and maternal glycemic and nutrient balance in pregnancy should be aimed in the determination of energy and nutritional elements requirements. Here, we will discuss the medical nutrition therapy in special groups with diabetes mellitus

The value of routine measurement of serum calcitonin on insufficient, indeterminate, and suspicious thyroid nodule cytology

Routine calcitonin measurement in patients with nodular thyroid disease is rather controversial. The aim of this study was to evaluate the contribution of serum calcitonin measurement in the diagnostic evaluation of thyroid nodules with insufficient, indeterminate, or suspicious cytology. Out of 1668 patients who underwent thyroidectomy with the diagnosis of nodular thyroid disease and were screened, 873 patients with insufficient, indeterminate, or suspicious fine needle aspiration biopsy results were included in the study. From the total number of patients in this study, 10 (1.1%) were diagnosed as medullary thyroid cancer (MTC) using histopathology. The calcitonin level was detected to be above the assay-specific cut-off in 23 (2.6%) patients ranging between 6.5 - 4450 pg/mL. While hypercalcitoninemia was detected in all 10 MTC patients, a false positive elevation of serum calcitonin was detected in 13 patients (1.5%). Of the MTC group, 7 patients had cytology results that were suspicious for malignancy (Bethesda V), one patient’s cytology showed atypia of undetermined significance (Bethesda III) and two patient’s cytology results were suspicious for follicular neoplasm (Bethesda IV). Among the cases with non-diagnostic cytology (Bethesda I), none of the patients were diagnosed with MTC. In conclusion, routine serum calcitonin measurement can be performed in selected cases rather than in all nodular thyroid patients. While it is reasonable to perform routine calcitonin measurement in patients with Bethesda IV and Bethesda V, this measurement was not useful in Bethesda I patients. In Bethesda III patients, patient-based decisions can be made according to their calcitonin measurement.

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs)

The gut is similar to an endocrine organ, and produces several hormones and substances with endocrine, paracrine, autocrine and neurocrine effects. Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are tumors derived from neuroendocrine cells, and they can occur anywhere along the gut. In the GEP-NETs, normal physiological regulations of hormones are lost, and hormones are released autonomously. Although the majority of GEP-NETs are sporadic, they can also be part of familial syndromes such as multiple endocrine neoplasia type 1 (MEN1) syndrome, von-Hippel-Lindau disease, tuberous sclerosis and neurofibromatosis type 1. GEP-NETs are rare, with an incidence of 2.55 cases per 100,000. Due to increased availability of advanced endoscopic and radiological imaging, the diagnosis of benign and incidentally identified lesions has also increased over the past decades. Except for nonfunctioning GEP-NETs, the extensive release of hormones by the tumor into the circulation leads to diverse clinical manifestations. Hormones and peptides [chromogranin, neurotensin, pancreatic polypeptide (PP), or neuron-specific enolase] are frequently ectopically released by nonfunctional GEP-NETs but these peptides do not cause distinct clinical syndromes. In recent years, there have been significant advances in the treatment of these tumors. In this review, the clinical features of the different types of GEP-NETs, as well as different aspects of their diagnosis and medical management will be discussed