ACTA ENDOCRINOLOGICA (BUC)

Background. We know that mortality had increased in diabetic patients with COVID-19 pneumonia. The aim of this study was to compare the mortality and inflammation parameters difference in critically ill COVID-19 patients according to their admission HbA1c levels and diabetes mellitus status. Secondary aim was to evaluate the effect of the first week hyperglycemic episode frequency on mortality. Methods. Critically ill COVID-19 patients who were tested for HbA1c levels on ICU admission were analyzed retrospectively. Results. Of 218 COVID PCR(+) patients, 139 met the inclusion criteria in study period. The median age was 67[57-76] years and 55(40%) of them were female. Seventy-six (55%) of the patients required invasive mechanical ventilation (IMV). The IMV requirement was higher in diabetic patients (p=0.01). When the groups were compared in terms of inflammatory parameters no significant difference was found except for admission and first week’s highest fibrinogen levels (p=0.02 and p=0.03, respectively). In multivariate analysis, fibrinogen levels were not determined as a risk factor for mortality. Overall ICU mortality was 43% (60/139). In group-1 23(37%), in group-2 27(57%), and in group-3 10(34%) patients had died. There was no statistically significant difference between groups in terms of mortality (p=0.05). Records of 96(69%) patients revealed there were more than five glucose readings over 180mg/dL during the first week. Mortality was higher in patients with more frequently hyperglycemic recordings (p=0.03). Conclusions. There was no significant mortality and inflammatory parameters difference in patients with and without diabetes. However, more than five glucose readings over 180mg/dL during the first week were found with increased mortality.

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.

Background. Abnormal thyroid function is accepted to be associated with disordered production of hormones released by adipose tissue. Objective. We aimed to investigate the relationship between thyroid functions and adipocytokines as leptin and visfatin and Angiopoietin-like Protein 3 (ANGPTL), a secretory protein that affects adipocity in patients with thyroid dysfunction. Methods. Twenty-seven patients with hyperthyroidism, 27 patients with hypothyroidism and 31 euthyroid subjects as control group were selected. Serum TSH, fT3, fT4, fasting glucose, lipid profile, ANGPTL, visfatin, leptin, insulin levels were determined. Results. ANGPTL and visfatin were significiantly different in hypothyroid group when compared to other groups. (p<0.0167) ANGPTL was positively correlated with TSH and leptin. Leptin was correlated with insulin and ANGPTL positively. Visfatin, positively correlated with TSH, total cholesterol, LDL-C and negatively correlated with fT3 and fT4. Conclusion. Serum ANGPTL may be increased because of lipid abnormalities in hypothyroid patients. Visfatin is thought as a partly mediator to the effect of hyper/ hypothyroidism on several metabolic parameters. We suggest that the release of Visfatin is regulated by thyroid hormones. The effect of thyroid dysfunction on production and release of adipocytokine is not yet clarified.

Background. Adrenocortical oncocytoma (ACO) is exceedingly rare. To date, only 81 cases are reported in the English literature. Most of ACOs are nonfunctioning and benign.\r\nCase report. We describe a case of ACO incidentally diagnosed in a 54-yearold male patient. Physical examination, routine laboratory studies and hormonal tests were within normal ranges. Abdominal computed tomography (CT) and magnetic resonance imaging showed a large and\r\nheterogeneous tumor (9x7x6 cm) in the left adrenal gland with borderline malignant characteristics. Left adrenalectomy was performed for treatment purposes. The cut\r\nsurface of the resected tumor was heterogeneous with tan brown color with areas of extensive hemorrhage and necrosis.\r\nMicroscopically, the tumor consisted predominantly of large polygonal cells containing eosinophilic granular cytoplasm\r\narranged in a solid pattern with abundant hemorrhage and necrosis. The tumor showed a compressed remnant of adrenal\r\ncortex in the outer the capsule of the mass. No vascular and capsular invasion was noted, and mitotic figures were not\r\nconspicuous. Immunohistochemically, the tumor cells were diffusely and strongly positive for melan-A, vimentin, alphainhibin, weakly positive for synaptophysin and calretinin. The tumor was focal and erratively positive for pancytokeratin. No immunoreactivity was observed form\r\nchromogranin-A, CD10 or p53. The histological diagnosis was ACO with uncertain malignant potential.\r\nConclusions. ACO occurs rarely in adults and preoperative diagnosis is difficult, especially in asymptomatic cases.\r\nIt needs careful evaluation and surgical treatment. According to our knowledge, this is the 2th case of ACO in an adult patient from Turkey in English literature. We\r\ndiscuss this case and review the literature on this unusual entity.

Objective. Ectopic posterior pituitary gland (EPP) is usually characterized by an abnormal pituitary stalk and hypoplasia of the anterior hypophysis. The genetic mechanisms involved in the development of EPP remain uncertain. The aim of this study is to determine whether mutations in the three genes, PROP-1, LHX2, and POU1F1, are associated with the risk for and the characteristics of EPP. Methods. In the Endocrinology Outpatient Clinic of “Dr. Behcet Uz” Children’s Hospital, 27 patients with EPP were submitted to sequencing analyses of the PROP-1, LHX2, and POU1F1 genes. Results. Growth hormone, thyrotropin, corticotropin, gonadotropin, and vasopressin deficiency were observed in 22 (81.5%), 23 (85.2%), 17 (63%), 14 (51.9%), and two (7.4%) patients. Thirteen patients (48.1%) presented with hyperprolactinemia. Fourteen patients (51%) had a history of birth dystocia, and 12 cases (42.1%) had a history of breech presentation. Central nervous system abnormalities included five cases with corpus callosum agenesis, one case with schizencephaly, and one case with Chiari type 1 malformation. We identified a homozygous p.S109* mutation in exon 2 in one male patient with EPP and two different PROP1 gene polymorphisms (A142T or c.109+3 G>A polymorphism) in thirteen patients. Conclusions. Our results suggest that PROP1 gene abnormalities might explain the genetic mechanisms involved in the development of EPP.

Aim. Is to evaluate the influence of glucovance therapy on biomechanical properties of bone in streptozotocin - induced diabetes mellitus (DM) in rats. Materials and Methods. A total of 28 male Wistar- Albino rats (12-week-old; 210-300 g) were divided into 4 groups including control (C; no treatment; n=7), sham [Sh; distilled water (gavage, for 8 weeks); n=7], diabetes [DM; streptozotocin (45 mg/kg, single i.p injection); n=7] and diabetes+ Glucovance treatment [DM+G; streptozotocin (45 mg/kg, single i.p injection) + Glucovance (Glucovance, 500/5 mg/kg/day/rat, gavage, for 8 weeks); n=7] groups. Body weight, blood glucose levels (BGLs), bone mineral density (BMD) and geometric/mechanical properties of bone tissue were evaluated. BGLs in diabetic rats were significantly increased compared to non-diabetic rats, while the body weights were decreased (p<0.05). Results. A significant difference was not detected between groups with regard to cross-sectional area of diaphyseal femur (p>0.05). Maximum load, energy absorption capacity, ultimate stress, ultimate strain, toughness and displacement were shown to decrease and stiffness was shown to increase in DM rats (p<0.05). Ultimate stress and maximum load were significantly increased in DM+G groups compared to DM groups (p<0.05). Conclusion. Glucovance treatment seems to be effective in restoration of biomechanical deterioration of bone specific to STZ-induced DM.

Context. Fetuin-A is a multifunctional protein and is known to be related to metabolic syndrome, vascular calcification, and inflammation. Objective. The purpose of this study was to determine the effects of serum fetuin-A levels on autoimmune thyroiditis without thyroid dysfunction. Subjects and Methods. This prospective casecontrol study was performed at the pediatric endocrinology outpatient clinic of a tertiary health institution in Istanbul, Turkey between July 2022 and October 2022. Serum fetuin-A levels were assessed using a human fetuin-A enzyme-linked immunosorbent assay (ELISA) kit (Elabscience Biotechnology, Houston, TX, USA). Results. The study included 86 participants, of which 42 were patients with Hashimoto’s thyroiditis (HT) and 44 were controls. Autoimmune thyroiditis without thyroid dysfunction was found to be related to lower plasma fetuin-A levels. There were no statistically significant differences in the neutrophil-to-lymphocyte ratio, fasting blood glucose level, insulin level, or HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) value between the groups. A fetuin-A level of ≤162.22 μg/mL (80.95% sensitivity and 70.45% specificity) was found to support the identification of autoimmune thyroiditis. Conclusions. The findings of our study suggest that autoimmune thyroiditis without thyroid dysfunction is related to lower fetuin-A levels. Low fetuin-A levels are known to be associated with an increased risk of cardiovascular disease, suggesting that careful monitoring is required in patients with low fetuin-A levels.

Context. 18F-fluorocholine (FCH) has been used as a positron emission tomography (PET) tracer in the localization of hyper-functioning parathyroid glands (HPGs). Objective. We performed this methodological study to evaluate the diagnostic performance of 18F-FCH PET/computerized tomography (CT) and repeated ultrasonography (USG) in detecting unidentified lesions in patients with primary hyperparathyroidism (PHPT). Design. In this retrospective methodological study, we studied the diagnostic performance of 18F-FCH PET/CT and a repeated USG in detecting unidentified parathyroid lesions. Subjects and Methods. Twenty-eight patients who were diagnosed with PHPT, had an indication for surgery following the current guidelines and had no identified lesion on 99mTc-MIBI SPECT/CT, USG, or other imaging methods than 18F-FCH PET/CT, included in the study. Results. While lesions were detected in 26 patients via 18F-FCH PET/CT among 28 patients [92.9% (95% CI: 76.6%-99.1%)], the lesion detection rate was 95.7% (95% CI: 78.1%-99.9%) in 23 patients who underwent a repeated USG. The sensitivity and the accuracy of both 18F-FCH PET/CT and repeated USG were 95.2% (95% CI: 76.2%- 99.9%) and 95.0 (95% CI: 75.1%-99.9%), respectively. Conclusions. This study supports that the combination of 18F-FCH PET/CT and repeated USG has promising potential for being an imaging technique for early detection and localization of HPGs.

Objective. This study aims to investigate the factors affecting development of acute kidney injury (AKI) in patients with severe hypothyroidism. Methods. This retrospective observational study involved patients with primary hypothyroidism and thyroid stimulating hormone (TSH) levels of more than 50 mIU/L at their review in the endocrinology outpatient clinic, between January 2015 and April 2021. Factors affecting the development of AKI were examined by logistic regression analysis. Results. A total of 100 patients, 20 (11 male (M), 9 female (F)) in the AKI (case) group and 80 (23 M, 57 F) patients in control group, were included in our study. The median age of the case group (56 years, interquartile range (IQR) 44.3–68.5) was significantly higher than the control group (49 years, IQR 32.3–60; p = 0.027), and the ratio of males to females was significantly higher in the case group (p = 0.001). Multivariate logistic regression analyses showed that hypothyroidism diagnosed after the age of 60 years (odds ratio (OR) 59.674, 95% confidence intervals (CI) 5.955–598.031; p = 0.001), free triiodothyronine (FT3) < 1.3 pg/mL (OR 17.151, 95% CI 2.491–118.089; p = 0.004) and creatine kinase (CK) > 1000 U/L (OR 1.522, 95% CI 1.602– 82.848; p = 0.015) were predictors for the development of AKI in patients with severe hypothyroidism. Conclusion. We recommend close follow-up and monitoring of patients with AKI caused by severe hypothyroidism if patients who are diagnosed at age > 60 years, CK > 1000 U/L or FT3 < 1.3 pg/mL.