ACTA ENDOCRINOLOGICA (BUC)

Background. Diabetes mellitus has been associated with many different musculoskeletal system problems. Objective. This study aims to show the prevalence of musculoskeletal disorders in patients with diabetes and to reveal their relationship to the metabolic parameters and microvascular complications. Methods. Seven hundred two diabetic patients who consecutively applied to our clinic between March 2017 and February 2018 were included in this prospective crosssectional study. The relationship of the musculoskeletal disorders including carpal tunnel syndrome, Dupuytren’s contracture, adhesive capsulitis, flexor tenosynovitis, limited joint mobility syndrome, Charcot arthropathy, diabetic foot and gout to the patients’ age, gender, type of diabetes, duration of diabetes, metabolic parameters, and microvascular complications were evaluated. Results. Musculoskeletal system disorders were detected in 45.9% (n = 322) of the 702 diabetic patients evaluated in our study. The most common disorders were carpal tunnel syndrome 17.7% (n = 124), Dupuytren’s contracture 14.4% (n = 101), and adhesive capsulitis 13.8% (n = 97). A statistically significant relationship of the HbA1c level with Dupuytren’s contracture, carpal tunnel syndrome, and adhesive capsulitis was detected (p<0.05). Conclusions. Patients’ age, duration of diabetes, HbA1c level, and presence of microvascular complications are associated with musculoskeletal disorders in this population.

Background. Composite adrenal pheochromocytoma-ganglioneuromas (PHEO-GNs) are well-defined neoplasms of the adrenal medulla, consisting of both endocrine and neural components. They are extremely rare. To date, only 46 cases have been reported in the English literature. Case report. We describe an adult case of endocrinologically active adrenal composite PHEO-GN diagnosed in a 62-year-old male patient with history of dizziness, headache, nausea, vomiting, and uncontrolled hypertension including intermittant hypertension attacks. On physical examination, he had a blood pressure (BP) of 170/110 mmHg. 18-fluorodeoxyglucose positron emission tomography-computed tomography showed a right adrenal tumor with increased metabolic activity. Urinary levels of catecholamines and their metabolites were prominently elevated. Right adrenalectomy was performed for treatment purposes. The histological diagnosis of the resected tumor was composite adrenal PHEO-GN. Conclusions. Composite adrenal PHEO-GN is a rare entity and preoperative diagnosis is difficult. Its hormonal activity and imaging characteristics are frequently very similar to those of other adrenal tumors, especially pure PHEO and adrenal carcinoma. Therefore, careful evaluation by endocrine tests and multiple imaging procedures are needed for providing a differential diagnosis. However, definitive diagnosis composite adrenal PHEO-GN is established by histological and immunochemical studies. To our knowledge, the present case is the first report that describes composite adrenal PHEO-GN in a patient from Turkey. We discuss this case and review the literature on this unusual entity.

Purpose. To determine the effectiveness of the basal calcitonin (CTb) determination in the early postoperative period to predict the possible recurrence (persistence) of medullary thyroid cancer (MTC). Material and Methods. A retrospective study of the treatment results in 194 patients with MTC (148 (76.3%) primary – group 1 and 46 (23.8%) recurrent – group 2) according to the levels of CTb in the first week after surgery and one year later. All groups were analyzed by staging, the level of preoperative and postoperative basal calcitonin 5 days and 1 year after the primary surgery. Findings. Among all patients, women prevailed – 144 (74.2%), the average age was (48.7±15.2), the average follow-up period was 67.5 months. Basal calcitonin was studied in patients of all groups in the preoperative and serially in the postoperative periods: 5 days and 1 year after the most radical surgical volumes. To test the hypothesis about the possibility of using CTb indicators in the early postoperative period, the degree of compliance with normal calcitonin indicators (≤18 pg/mL) was assessed by observation groups 5 days and 1 year after surgery. Conclusions. 1. The CTb value 5 days after surgery is no less a reliable marker of the result of surgical treatment of MTC than the currently recommended CTb measurement 2-3 months after surgery. 2. The technique is applicable for both primary and reoperations used for recurrent forms of medullary thyroid cancer.

Context. Visceral adipose tissue (VAT) is a strong predictor of carbohydrate metabolism disorders. Abdominal bioelectrical impedance analysis (A-BIA) is a simple method for the measurement of VAT and is a promising tool in screening and follow-up of abdominal obesity. However the role of A-BIA in dieting individuals has not been evaluated adequately in longitudinal followup studies. Objective. The aim of this study is to determine the role of A-BIA in identifying the changes in metabolic predictors after diet and/or exercise therapy. Design. All patients who sought weight loss treatment underwent baseline assessment and were prescribed a program of diet. After a mean follow-up of 3.2 months, data were analyzed. Subjects and Methods. Ultimately, 103 participants who reported adhering to the diet, enrolled to the study. We tested associations between changes in body composition measures and changes in laboratory measures using correlations and multivariate linear regression analysis. Results. Mean loss of body weight was 3.4±2.8 kg. All but waist-to-hip ratio, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels changed significantly (p<0.001). Decreases in body weight, body mass index (BMI), and VAT level significantly correlated with decreases in fasting blood glucose, fasting insulin level, and HOMA-IR score (r=0.230–0.371). In multiple linear regression analysis changes in BMI and VAT significantly correlated with change in HOMA-IR score (F(7.93)=2.283, p=0.034, R2=0.147). Conclusion. Decreases in BMI and VAT, as determined by A-BIA, were predictors of changes in metabolic laboratory measures. A-BIA is useful for followup of patients receiving diet therapy for weight loss.

Background. Warthin-like tumor of the thyroid (WALTT) is a very rare variant of papillary thyroid cancer.We want to draw attention to this rare condition by reporting two cases. Patient reports. Patient 1 was a 24 year-old woman presented with 14×12 mm solid nodule on the left lobe of the thyroid gland. Fine needle aspiration biopsy of the nodule was reported as suspicious for papillary thyroid carcinoma. Patient 2 was a 40 year-old woman who had multinodular thyroid gland with a 31×26 mm major nodule on the left lobe. On fine neddle aspiration, cytologic findings were consistent with papillary thyroid carcinoma. Both underwent total thyroidectomy and histological examination of the cases revealed Warthin-like tumor of the thyroid. Summary and conclusion. We report two patients with WALTT. This rare variant of papillary thyroid cancinoma has four main histologic criteria: papillary architecture, oxyphilic cytoplasmic changes, papillary nuclear features and dense lymphoid infiltrate. WALTT can be distinguished from other aggressive variants with these distinct histological features. Since variants show different clinical behaviour, classification of these might be helpful to predict patient prognosis.

The aim of this study is to investigate the possible association between hormonal status and adipose tissue characteristics in obese and non-obese subjects. Fourteen obese and 15 nonobese premenopausal female patients were enrolled in the study. Stromal vascular cells were isolated and cultured using modified procedures described by Entenmann and Hauner. In the non-obese group, omental SVCs seeded at a density of 4.12?1.1x103/cm2 in 25-cm2 in culture flasks for measuring cell proliferation and subcutaneus SVCs seeded at a density of 2.05?0.76x103/cm2 in 25-cm2 at culture flasks. In the obese group, omental SVCs seeded at a density of 6.11?1.98x103/cm2 in 25-cm2 at culture flasks for measuring cell proliferation and subcutaneous SVCs seeded at a density of 2.94?0.75x103/cm2 in 25-cm2 in culture flasks. Mean GPDH activity levels were significantly higher in SVCs from the omentum in obese compared to those from the omentum in nonobese (651.9?65.7 vs 405.1?60.1 mU/mg protein). However, GPDH activities were similar in SVCs from the subcutaneous SVCs in obese subjects, compared to those from the subcutaneous SVCs in non-obese subjects (303.5?63.2 vs 367.4?73.7 mU/mg protein). In obese group, omental SVCs number was positively correlated with plasma estradiol (E2) (r=0.604, p=0.017), and fasting insulin levels (r=0.843, p=0.01). It was negatively correlated with plasma progesterone (r=-0.793, p=0.006), prolactin (r=-0.655, p=0.008) and free T3 (FT3) levels(r=-0.630, p=0.01). These findings suggest that there are differences in adipose tissue proliferation capacity and metabolic activity between obese and non-obese subjects. In obese group, the number of omental stromal vascular cells was positively correlated with plasma estradiol and insulin levels.

Objective. The aim of this study was to investigate the relationship of Claudin-5, Apelin, Tumor Necrosis Factor Alpha (TNF-α) expression, and body mass index (BMI) of cholecystectomies. Materials and methods. Sixty-eight paraffin embedded cholecystectomy specimens diagnosed as chronic cholecystitis were collected in the Pathology Department of the Training and Research Hospital between 2015-2017. The samples were stained with Apelin, Claudin-5 and TNF-α. The immunohistochemical study was carried out using the system in an automatic staining machine. Results. There was a significant positive correlation between BMI and TNF-α staining (p=0.010). This result indicated that the degree of staining increased together with BMI. When age, BMI, and the other biochemical parameters were evaluated, a significant correlation was found between BMI and blood glucose only (p=0.029); correlations of BMI with the other parameters were not statistically significant. Conclusion. Although there is no relationship between inflammation and BMI with Claudin-5 and Apelin in this study, there is a significant relationship between BMI and TNF-α.

Background. Pomegranate is a rich source of many polyphenolic compounds including ellagitannins (punicalagin, punicalin and others). Aim. The effects of punicalagin and punicalin on adipogenesis were investigated in this study. Materials and Methods. To examine the effect of punicalagin and punicalin on adipocyte differentiation, various concentrations of punicalagin and punicalin (2- 10 μM) were applied to differentiated 3T3-L1 cells. Glyceraldehyde-3-phosphate dehydrogenase (GPDH) activity, Oil red O staining, intracellular triglyceride levels, and gene expressions of transcription factors (Peroxisome proliferator-activated receptor-γ (PPARγ), CCAATenhancer- binding proteins-α (C/EBPα), Sterol regulatory element-binding protein 1c (SREBP-1c)) and lipolysisassociated genes (hormone-sensitive lipase (HSL), Perilipin A, tumor necrosis factor-α (TNF-α)) were examined in order to investigate the effects of punicalagin and punicalin on adipocyte differentiation. Results. Punicalagin and punicalin applications caused a continuous decrease in cell size and intracellular triglyceride accumulation. GPDH activity and transcription gene expressions decreased significantly in groups that were applicated punicalagin and punicalin at high concentrations. Punicalagin, but not punicalin, down-regulated the expression of HSL and perilipin A and up-regulated the expression of TNF-α in a dose-dependent manner. In conclusion, both punicalagin and punicalin were able to inhibit the adipocyte differentiation.

Objective. We aimed to investigate the potential relationship between plasma alarin levels and type 2 diabetes mellitus (T2DM). Patients and Method. We included 154 participants, divided into four groups in a cross-sectional study design. The first group includes patients with T2DM without complications (n=30), the second group patients with T2DM with microvascular complications (T2DMnoC n=32), the third group patients with T2DM with macrovascular complications, T2DM-MV (n=32) and the last group is the healthy control group (n=60). Results. In our study 94 patients were diabetic; 47 females and 47 males. The control group consists of 60 people, 30 women and 30 men. It was found that these had a significant (p>0.05) variation in serum alarin levels among the T2DM (T2DM-noC=3.1±0.7 ng/mL T2DMmV=2.8±0.4 ng/mL, T2DM-MV= 3.6±0.4 ng/mL) versus control group (15.6±2.6). We failed to find a significant variation of serum alarin levels (p>0.05) between T2DM subgroups. Serum alarin levels were significantly higher among control patients (p<0.05). There was no difference between diabetic sub-groups. Conclusion. We concluded that serum alarin levels in patients with T2DM are lower than in normal people. Further studies are needed to investigate the possible prognostic value of alarin in clinical practice in T2DM.

Abstract Context. The inhibition of adipocyte differentiation has a significant role on the prevention of obesity and obesity-associated complications. Objective. In this study, we aimed to detect whether hyperoside is able to inhibit the conversion of pre-adiposits into mature adiposits. Design and Methods. 3T3-L1 pre-adipocytes were stimulated so as to differentiate into mature adipocytes. Hyperoside in non-cytotoxic concentrations (1, 2, 5, and 10 μM) were separately applied to differentiated 3T3-L1 cells. Oil red O staining was performed and triacylglycerol contents were measured. Furthermore, gene and protein expressions of transcription factors, adipogenic genes and adipokines were examined in order to investigate the effect of hyperoside on adipocyte differentiation. Results. Hyperoside in high concentrations significantly suppressed the adipogenic process by inhibiting the expression of transcription factors and adipogenic genes and reducing lipid accumulation in adipocytes (p<0.05). Low doses of hyperoside are able to inhibit adipogenesis, but higher doses are needed to reduce fat accumulation in mature adipocytes. In the case of maturing preadipocytes, 5 μ M of hyperoside exerts its antiadipogenic effect at the early stages of adipogenesis, whereas 10 μ M of hyperoside acts at the later stages (p<0.05). Conclusion. These results suggest that hyperoside has a beneficial effect on the prevention and treatment of obesity.