Massive bilateral adrenal mass with adrenal insufficiency: a case report of primary adrenal lymphoma

Primary Adrenal Lymphoma (PAL) is extremely rare and usually occurs in men in the 6th-7th decade as bilateral, diffuse large B-cell lymphoma (DLBCL). Here, an 80-year-old patient admitted to the urology outpatient clinic with flank pain and bilateral adrenal mass detected on ultrasound is presented. Positron Emission TomographyComputed Tomography (PET-CT) was planned for the patient who was referred to the endocrine outpatient clinic. The PET-CT scan revealed lobulated-contoured masses containing necrotic areas with a size of 7.4×5.5×9.8 cm, 19 Hounsfield Unit (HU), and SUVmax value of 23.9 the right adrenal, and with the size of 8.4×8.7×10.8 cm, 28 HU, SUVmax value of 27.3 in the left adrenal. These masses were reported to be not compatible with metastasis and suggested a tumor of the adrenal origin or bilateral adrenocortical carcinoma. In laboratory tests, since Adrenocorticotropic hormone level 291-592 pg/mL (high) and Cortisol level was 7.5- 9.5 mcg/dL (low), bilateral adrenalectomy was performed considering adrenocortical cancer primarily. Diffuse large B cell lymphoma was determined as the result of the pathology. Postoperative hydrocortisone and fludrocortisone treatment was initiated for the patient immediately. The patient was transferred to the hematology inpatient clinic to receive Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone chemotherapy. In this case report, we aimed to emphasize that the differential diagnosis should be made well in massive bilateral adrenal masses. Although the diagnosis is challenging, clinicians should be alert in diagnosing lymphoma in bilateral, massive adrenal masses with adrenal insufficiency. Since this disease's prognosis is poor and aggressive, a histopathological diagnosis should be obtained, and treatment should be initiated as soon as possible

Effects of chronic suppression or oversuppression of thyroid-stimulating hormone on psychological symptoms and sleep quality in patients with differentiated thyroid cancer

In differentiated thyroid cancer (DTC), the standard treatment includes total thyroidectomy and lifetime levothyroxine (LT4) replacement. However, long-term exogenous LT4 has become controversial due to the adverse effects of oversuppression. The study included 191 patients (aged 18-76 years) with a prospective diagnosis of non-metastatic DTC and 79 healthy individuals. The patients with DTC were stratified into three groups according to their TSH levels: suppressed thyrotropin if TSH was below 0.1 mu IU/ml, mildly suppressed thyrotropin if TSH was between 0.11 and 0.49 mu IU/ml, and low-normal thyrotropin if THS was between 0.5 and 2 mu IU/ml. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Short Symptom Inventory (SSI), and Pittsburgh Sleep Quality Index (PSQI) were administered to all participants. It was found that the BDI, BAI, SSI and PSQI scores were worse in patients with DTC (p=0.024, p=0.014, p=0.012, and p=0.001, respectively). According to theTSH levels, the mean ASI was found to be higher in the suppressed and mildly suppressed thyrotropin groups (19 +/- 14.4 vs. 10.6 +/- 11.1; 16.4 +/- 14.9 vs. 10.6 +/- 11.1, p=0.024, respectively), the mean SSI was found higher in the suppressed group (61.0 +/- 55.5 vs. 35.1 +/- 37.0, p=0.046), and the mean PSQI was higher in all three groups (7.94 +/- 3.97 vs. 5.35 +/- 4.13; 7.21 +/- 4.59 vs. 5.35 +/- 4.13; 7.13 +/- 4.62 vs. 5.35 +/- 4.13, p=0.006) when compared with the controls. No significant difference was found between the groups. A positive correlation was detected in the duration of LT4 use and BDI and SSI, and a weak, negative correlation was detected between TSH levels and ASI and PSQI. Based on our study, it was found that depression, anxiety disorders, and sleep problems were more prevalent in patients with DTC, being more prominent in the suppressed TSH group. These results were inversely correlated with TSH values and positively correlated with the duration of LT4 use. Unnecessary LT4 oversuppression should be avoided in patients with DTC

Changes in HbA1c values of patients with type 2 diabetes mellitus during the pandemic period and their relationship to food literacy

Background Diabetes Mellitus is recognized as one of the most prevalent chronic diseases worldwide. The disruptions encountered in healthcare services during the pandemic period have significantly impacted the treatment and monitoring of these patients. While the concept of food literacy is relatively new, its potential impact on nutrition-related chronic diseases remains to be fully demonstrated.Objective This study aimed to determine glycemic control of DM patients without physician supervision was affected by treatment adherence and food literacy during COVID-19.MethodsThis was a cross-sectional study. A face-to-face survey was conducted among the patients who were admitted to the Internal Medicine outpatient clinic between April 2021 and October 2021 who had been ill with type 2 DM for more than one year, and whose medical follow-up was delayed by at least one year due to the pandemic.ResultsA total of 154 patients 90 (58.4%) of whom were women, participated in our study. HbA1c in patients in 2020 ranged from 5.2 to 14.0 with a mean of 8.36 & PLUSMN; 2.00, whereas HbA1c in 2021 ranged from 5.6 to 14.3 with a mean of 8.38 & PLUSMN; 1.86. Minimal increase in HbA1c was observed in patients last year without a physician's check-ups, the difference was not significant. While the rate of change of HbA1c group in the good direction was higher in subjects with good food literacy (p = 0.011). The food literacy scores of patients whose HbA1c changed in the good direction (35.4 & PLUSMN; 4.3) were higher. Food literacy scores of patients with decreased HbA1c were significantly higher (33.0 & PLUSMN; 6.6).ConclusionWhile the rate of change in the good direction in the HbA1c group was higher among participants with good food literacy, the rate of change in the poor direction in the HbA1c group was higher among participants with poor food literacy

Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX survey

A Summary Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. Purpose We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. Methods An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL. Results A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 +/- 15.6 years). The average serum 25(OH)D level was 119.9 +/- 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 +/- 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 +/- 64 ng/mL vs. 117.7 +/- 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH) D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)]. Conclusions High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency

Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)

Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus