Mogu li hemocitometrijski parametri poslužiti kao biološki biljezi u razlikovanju adrenalnih adenoma i karcinoma te u prognozi adrenokortikalnih karcinoma?

Recently, studies have reported that inflammatory response and elevated platelet counts are associated with several cancers. In the present study, we aimed to evaluate hemocytometer parameters in differentiating adrenal adenoma and carcinoma, and the prognostic utility of hemocytometer parameters in adrenocortical carcinoma (ACC). We included 30 patients with nonfunctional adrenal adenoma and 13 patients with ACC having undergone surgery between 2005 and 2017 and followed up postoperatively at our centre. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV) and plateletcrit (PCT) were evaluated preoperatively in all patients included in the study. There was a significant difference between the adrenal adenoma and ACC groups in terms of neutrophil and lymphocyte counts, NLR and PLR. There was no significant difference between the two groups in terms of platelet count and MPV, but PCT levels were significantly lower in ACC group. There was no statistically significant difference between recurrent and/or metastasis positive patients and negative ones according to NLR, PLR, RDW and MPV. There was a statistically significant difference in RDW levels and tumor diameter between the groups. Our study is the first to evaluate hemocytometer parameters in differentiating adrenal adenomas and carcinomas, and also in the prognosis of ACC. The present study suggested that the hemocytometer parameters may be a marker in the differential diagnosis of adrenal adenomas and carcinomas. However, our study also showed that these parameters had no prognostic value in ACC.Nedavna istraživanja pokazuju da su upalni odgovor i povišeni trombociti udruženi s nekim vrstama karcinoma. Cilj našega istraživanja bio je procijeniti hemocitometrijske parametre u razlikovanju adrenalnog adenoma i karcinoma, kao i prognostičku vrijednost hemocitometrijskih parametara u adrenokortikalnom karcinomu (adrenocortical carcinoma, ACC). U istraživanje smo uključili 30 bolesnika s nefunkcionalnim adrenalnim adenomom i 13 bolesnika s ACC operiranih između 2005. i 2017. godine i poslije operacije praćene u našoj ustanovi. Kod svih bolesnika uključenih u studiju prijeoperacijski su izmjereni sljedeći parametri: omjer neutrofila i limfocita (neutrophil/lymphocyte ratio, NLR), omjer trombocita i limfocita (platelet/lymphocyte ratio, PLR ), širina distribucije eritrocita (red blood cell distribution width, RDW ), srednji volumen trombocita (mean platelet volume, MPV) i pleteletkrit (PCT). Utvrđena je statistički značajna razlika između skupina bolesnika s adrenalnim adenomom i onih s ACC u broju neutrofila i limfocita, NLR i PLR. Nije bilo značajne razlike među skupinama u broju trombocita i MPV, ali su razine PCT bile značajno niže u skupini s ACC. Nije bilo statistički značajne razlike u NLR, PLR, RDW i MPV između bolesnika s opetovanim ACC i/ili metastazama i onih bez tih stanja. Statistički značajna razlika između skupina nađena je za razine RDW i promjer tumora. Naše istraživanje je prvo te vrste u kojem su se procjenjivali hemocitometrijski parametri u razlikovanju adrenalnih adenoma i karcinoma te u prognozi ACC. Rezultati studije ukazuju na to da bi se hemocitometrijski parametri mogli primijeniti kao biljezi u diferencijalnoj dijagnostici adrenalnih adenoma i karcinoma. Međutim, naše je istraživanje pokazalo kako ovi parametri nemaju prognostičku vrijednost kod ACC

Atypical Thyroid Function Tests, Thyroid Hormone Resistance [Atipik Tiroid Fonksiyon Testleri: Tiroid Hormon Direnci]

The assessment of thyroid function tests for to the diagnose hyperthyroidism (thyrotoxicosis) or hypothyroidism does not constitute a nuisance when the clinical suspicion is strong. However, substantial proportion of discordant results with clinical findings or atypical results possible to come across in the thyroid function tests. In such cases, accurate diagnosis is very important for appropriate management to the patient, prevention of unnecessary tests and cost increases. For accurate diagnosis in these patients, a detailed clinical evaluation with specific laboratory studies are needed. Atypical hyperthyroxinemia (high thyroid hormone levels are incompatible with TSH) is an atypical thyroid function test pattern can be seen in the rare cases of thyrotropin releasing pituitary adenoma or thyroid hormone resistance syndrome. However, in this case, assay interferences and euthyroid situations such as thyroxin replacement therapy with poor-compliance, euthyroid sick syndrome including acute psychiatric disorders, hyperthyroxinemia due to drugs like heparin, disorders with protein binding abnormalities (familial dysalbuminemic hyperthyroxinemia, transthyretin related hyperthyroxinemia) which are seen more common, should be excluded primarily. Then should be consulted further examinations for the differential diagnosis of thyrotropin-secreting pituitary adenomas and thyroid hormone resistance syndrome. The Refetoff Syndrome is developing due to a defect in the beta-receptor and is most common in thyroid hormone resistance syndromes. It includes a combination of findings of hyperthyroidism and hypothyroidism and suggests an autosomal dominant inheritance feature. Therefore, family screening should be done in patients diagnosed. Mostly, beta blockers is sufficient in the treatment. Other rare syndromes of thyroid hormone resistance that occurs due to alpha-receptor defects, thyroid hormones membrane transport defect and thyroid hormone metabolism defect related with deficiency of deiodinases. The clinical pictures of this rare syndromes are more severe compared to classic syndrome and often the choice of treatment is only supportive therapy. [Med-Science 2014; 3(3.000): 1545-70

Curative Result with Primary Medical Therapy in an Elderly Acromegaly Patient

In acromegaly, transsphenoidal hypophysectomy is the primary treatment of choice. Medical treatment is performed on patients uncontrollable with surgery. Indications for primary medical treatment or medical treatment prior to surgery are limited to patients with macroadenoma with high risk for surgery due to cardiac and respiratory problems. Medical treatment is not applied on patients with microadenoma due to the high chance of cure with surgical option. Seventy-five years-old female patient was admitted in our clinic with complaints of drowsiness, fatigue and growth in hands and feet. Patients IGF1level was measured 516 ng/ml (64-118 ng/ml normal range for age and gender) and in the magnetic resonance imaging of the pituitary; an adenoma, 2x2 mm in size, was detected. Octreotide LAR therapy was begun 10 mg per month considering the age of the patient. IGF1 level was measured as 129ng/ml and growth hormone (GH) as 0.65ng/ml (0.06-5 ng/ml normal range) at the end of the third month of treatment. On the MRI carried out in the 9th month of treatment, it was observed that the pituitary was compatible with partial empty sella and no adenoma was determined. In our case of acromegaly with microadenoma, taking into account the age and medical condition of the patient, primary medical therapy was required. Although a low dose of octreotide LAR was implemented, primary medical therapy has been effective in controlling biochemical parameters. Moreover, it was observed that the tumor completely disappeared and is considered a curative result. Therefore, primary medical treatment of acromegaly should be among the options in selected patients with microadenomas. [Med-Science 2014; 3(4.000): 1697-707

Cytokine signal suppressor (SOCS) 1-1478 CA/del gene polymorphism in Turkish patients with polycystic ovary syndrome

Eighty-four subjects, premenopausal female patients (n = 42, mean (SD) age: 26.4 (4.2) years) diagnosed with polycystic ovary syndrome (PCOS) and age-matched healthy volunteers (n = 42, mean (SD) age: 27.6(3.4) years), were included in this study. Data on physical examination, anthropometric measurements and blood biochemistry analysis were recorded for each subject along with analysis for SOCS1-1478 CA/del polymorphism by polymerase chain reaction-restriction fragment length polymorphism. The relation of SOCS1-1478 CA/del polymorphism to PCOS status and insulin resistance was analysed via logistic regression analysis. Mean (SD) levels for BMI (28.5(6.5) vs.22.5 (4.9) kg/m2, p < .001), HOMA-IR (3.1(1.8) vs.1.5 (1.0), p < .001), LDL-cholesterol (115.9(32.7) vs.100.7 (27.3)mg/dL, p = .03) and triglyceride (113.8(64.9) vs.83.3(36.3)mg/dL, p = .017) were significantly higher in patients. Groups were similar in terms of SOCS1-1478 CA/del polymorphism. No significant relation of this polymorphism was noted to PCOS and HOMA-IR. Our findings revealed no difference between groups in terms of the rate of SOCS1-1478 CA/del polymorphism, and no significant relation of this polymorphism to insulin resistance and PCOS status.Impact statement Polycystic ovary syndrome (PCOS), the most common cause of anovulation and the most commonly encountered form of female endocrine disease. SOCS proteins have been suggested to play a fundamental role in the negative feedback regulation of the JAK-STAT pathway, which is the major signalling pathway involved in a wide range of physiologic and pathologic processes, including inflammatory diseases, malignancies and immune disorders. Pathways involving the induction of suppression of SOCS proteins were also shown likely to be involved in mediating cytokine-induced insulin resistance. The present study was designed to determine the frequency of SOCS1-1478 CA/del gene polymorphism in patients with PCOS in relation to healthy controls and insulin resistance. Our findings revealed significantly higher rates of insulin resistance, obesity and dyslipidaemia in Turkish patients with PCOS compared with age-matched healthy controls, while no difference between study groups in terms of the rate of SOCS1-1478 CA/del polymorphism along with no significant relation of SOCS1-1478 CA/del polymorphism to insulin resistance and PCOS status. Future larger scale studies with the application of standardised diagnostic methods and criteria, and of state-of-the-art modern techniques including genomics, proteomics and pharmacogenetics would provide better understanding of the association between PCOS and genomic variants

Medicine Science 2014;3(4):1697-707 Primary Medical Therapy and Acromegaly Case Report Curative Result with Primary Medical Therapy in an Elderly Acromegaly Patient

Abstrac

Effect of Rosiglitazone and Insulin Combination Therapy on Inflammation Parameters and Adipocytokine Levels in Patients with Type 1 DM

Aim. To investigate the efficacy of combined therapy of insulin and rosiglitazone on metabolic and inflammatory parameters, insulin sensitivity, and adipocytokine levels in patients with type 1 diabetes mellitus (type 1 DM). Material and Methods. A total of 61 adults with type 1 DM were randomly and prospectively assigned in open-label fashion to take insulin and rosiglitazone 4 mg/day (n=30) or insulin alone (n=31) for a period of 18 weeks while undergoing insulin therapy without acute metabolic complications. Results. Combination therapy did not significantly improve metabolic and inflammatory parameters, insulin sensitivity, and adiponectin levels. While leptin and resistin levels decreased in both groups (group 1: resistin 6.96 ± 3.06 to 4.99 ± 2.64, P=0.006; leptin 25.8 ± 17.6 to 20.1 ± 12.55, P=0.006; group 2: resistin 7.16 ± 2.30 to 5.57±2.48, P=0.031; leptin 16.72 ± 16.1 to 14.0 ± 13.4, P=0.007) Hgb and fibrinogen levels decreased only in group 1 (Hgb 13.72 ± 1.98 to 13.16 ± 1.98, P=0.015, and fibrinogen 4.00 ± 1.08 to 3.46 ± 0.90, P=0.002). Patients in both groups showed weight gain and the incidence of hypoglycemia was not lower. Discussion. The diverse favorable effects of TZDs were not fully experienced in patients with type 1 DM. These results are suggesting that insulin sensitizing and anti-inflammatory characteristics of TZDs were likely to be more pronounced in patients who were not totally devoid of endogenous insulin secretion

Investigation the Relationship of Lower Urinary Tract Symptoms whit Vascular Risk Factors; Our Preliminary Results

Our aim was to investigate the relationship between lower urinary tract symptoms (LUTS) in terms of vascular risk factors include diabetes. In a prospective study, a total of 116 men aged 40 years or more who presented to the outpatient clinics of urology or endocrinology between January 2012 and April 2013 were included. After receiving a detailed medical history, fasting blood glucose, serum lipids including total cholesterol, HDL and triglyceride, HbA1c, creatinine, total testosterone and total prostate-specific antigen were measured. Urinalysis and uroflowmetry were done. Postvoiding residual urine and prostate volume were measured by suprapubic ultrasonography. International Prostate Symptom Score (IPSS) of the patients were determined. Existence of vascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease and obesity as well as age, body mass index (BMI), weight, waist circumference and body fat percentage values were recorded. Of the patients, 41 (35.3%) had hypertension, 54 (46.6%) dyslipidemia, 68 (58.6%) diabetes mellitus, 34 (29.3%) coronary artery disease and 39 (33.6%) obesity. When the patients were grouped according to the presence of the risk factors (no risk [14 patients], mild to moderate [1-2 risk factor] [65 patients] and severe [3 or more risk factors] [37 patients]), there was no a significant difference among the groups in terms of IPSS (p = 0.76) The results of this prospective study show that vascular risk factors and diabetes may not be related to LUTS [Med-Science 2015; 4(1.000): 1826-35

An unusual case of adult-onset multi-systemic Langerhans cell histiocytosis with perianal and incident thyroid involvement

Langerhans cell histiocytosis (LCH) is a rare sporadic disease characterized by histiocytic neoplastic infiltration of various organ systems and a wide spectrum of clinical manifestations, ranging from benign and self-limiting to lethal. Herein, we report a rare case of adult-onset multi-systemic LCH in a 36-year-old male patient with an initial perianal presentation and incidental finding of subsequent thyroid gland involvement in the follow-up period. The patient with a history of perianal LCH treated with surgical excision and local radiotherapy was referred to our Endocrinology Department upon detection of hypermetabolic nodular lesions in the left lateral lobe of thyroid gland on positron emission tomography–computed tomography (PET/CT) scan in the nineth month of follow-up. Current evaluation revealed euthyroid status, a hypoechoic solid lesion of 13 × 9 mm in size with irregular borders in the left thyroid lobe on thyroid USG and cytologic assessment of thyroid nodule. The patient was diagnosed with suspected, oncocytic lesion, Hashimoto thyroiditis or LCH. The patient underwent total thyroidectomy and pathological assessment confirmed the diagnosis of Langerhans cell histiocytosis. Assessments in the sixth month of postoperative follow-up revealed euthyroid status with no thyroid tissue remnants or pathological lymph node on thyroid USG. In view of the multifocal lesions indicating multi-system disease, a systemic chemotherapy protocol with combination of prednisone (PRED) and vinblastine (VBL) has been planned by the hematology department