Introduction and aims: Poor sleep and urinary incontinence (UI) negatively affect health related quality of life (HRQoL). The aim of the study was to investigate the associatons between sleep, UI and HRQoL in type-2 diabetic women.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Background: This study was designed in order to evaluate bone and mineral metabolism in type 2 diabetic patients and its relationship with bone mineral density and diabetic microvascular complications. Methods: Forty two type 2 diabetic patients and 23 healthy cases were included in the study. Serum osteocalcin, procollagen type 1 – C peptide (PICP), total and bone specific alkaline phosphatase (bone ALP), urinary deoxypyridinoline (free DPD), parathormone (PTH), serum and urinary calcium and phosphorus levels were measured. Bone mineral densities of all subjects were studied in lumbar vertebra and femur region using dual X-ray absorptiometry (DXA). Results: Serum osteocalcin and bone ALP levels of the diabetics were found to be significantly lower and total alkaline phosphatase and calcium levels were higher in diabetic patients compared to healthy controls, but PICP and free DPD levels were not different between these two groups. There was a positive correlation between PTH levels and urinary DPD excretion. Among diabetics, serum osteocalcin levels increased with the impairment of renal functions. Bone mineral densities were lower in diabetics with worse renal functions. Conclusion: Bone turnover is slow in type 2 diabetes and there is no prominent bone loss related to this condition. PTH is an important factor determining the rate of bone resorption in diabetics. Renal functional impairment is the most important factor affecting the bone mass in type 2 diabetic patients.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

ABSTRACT To determine the effects of sibutramine in combination with hypocaloric diet and exercise on body composition, metabolic parameters and insulin resistance. 11 female, 1 male (aged 18-60 year) patients were enrolled. Sibutramine (10 mg/day), hypocaloric mixed diet and exercise were given. Analysis of antropometric measurements and bioimpedance measurements for estimating body composition, metabolic (uric acid, cholesterol, triglyceride, HDL-cholestrol) and hormonal (total and free testosterone, DHEAS, cortisol, growth hormone, prolactin) measurements and the determination of insulin resistance by euglycemic hyperinsulinemic clamp technique were done before and after the patients lost 10 % of their initial body weight. After weight loss, decrease in body weight (from 102,0±4,9 to 89,8±4,4 p<0,001), waist circumference (from 110,0±2,7 to 97,9±3,6 p>0,001) WHR (from 0,85±0,02 to 0,79±0,02 p<0,05) were significant. In impedance measurements, decrease of body fat mass (from 48±2,2 % to 41,1±2,2 % p<0,001) increase of lean body mass (from 51,9±2,2 % to 58,6±2,1 % p<0,001) and decrease of level of uric acid (from 5,3±0,4 to 4,8±0,3 p<0,05), triglyceride (from 126,2±23,7 to 98,0±17,2 p<0,01), cortisol (from 18,9±1,9 to 11,6±1,0 p<0,05), C-peptide (4,7±1,0 to 2,6±2,6 p<0,05) and 120 min glucose concentration (from 107,5±3,5 to 9,1±6,3 p<0,05) were significant. In euglycemic hyperinsulinemic clamp study, whole body glucose disposal (M value) increased significantly (from 2,87±0,27 to 4,26±0,41 p<0,01). Although the patients didn’t reached ideal body weight, sibutramine assisted weight reduction of %10 caused meaningful reductions in BMI, WHR, triglyceride, fasting Cpeptide, cortisol level and significant improvement in insulin resistance.

ABSTRACT In order to evaluate the prevalence of hepatitis C virus (HCV) infection in diabetic patients, 13 type 1 and 106 type 2, a total of 119 diabetic patients were examined. Patients were analyzed for sex, type of diabetes, diabetes duration, treatment of diabetes, diabetic complications and HbA1c and their history about previous hospitalization, major surgical procedure and blood transfusion was recorded. Liver function tests were studied and elevations were categorized as hepatocellular, cholestatic or both. Serologic testing for anti-HCV was done using a third generation commercial enzyme-linked immunosorbent assay (ELISA) and also hepatitis B virus markers were studied. When diabetic patients were compared with 3000 healthy blood donors, the prevalence of HCV infection was found to be significantly higher in diabetic patients (10.92% vs. 1.2%, p<0.001). Antİ HCV positive diabetic patients were compared with the anti HCV negative diabetic patients for epidemiological and clinical variables and there was found no correlation between them. Abnormal liver function tests were observed in 61.4% of anti HCV positive diabetic patients compared with 23.5% of anti HCV negative diabetics (p<0.05). While hepatocellular and cholestatic enzyme elevations of the two groups were not markedly different, mixed cholestatic+hepatocellular enzyme abnormalities were significantly higher in anti HCV positive patients (53.8% vs. 5.6%,p<0.001). In five of the 13 HCV(+) diabetic patients percutaneous liver biopsies were performed and 4 patients were found to have chronic active hepatitis and one precirrhosis. Because HCV infection prevalence is extremely high in the diabetic population, diabetic patients that have liver enzyme abnormalities should be evaluated strictly and HCV infection be ruled out.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

ABSTRACT A fifty-eight- year old woman with a history of subtotal thyroidectomy 20 years before was admitted to the hospital because of back ache. Chest computed tomography revealed a mass lesion destroying the ribs and multiple metastatic lesions scattered bilaterally in the lungs. Transthoraclc blopsy was performed and blopsy findings were consistent with follicular thyrold cancer metastasis. 131I whole body scan showed uptake in mulilple sites of the lungs and in the thyroid as well. The patient was euthyroid. A renal mass, observed on ultrasound examination was Investigated by blopsy and pathological examination showed metastatic follicular carcinoma. Subsequently, the patient underwent total thyroldectomy. Pathological examination of the thyroid revealed no remarkable abnormality and malignancy could not be detected. A therapeutlc dose of 160 mCI 131I was given, on the posttreatment scan the activities on the lungs and kidneys persisted. After the treatment period, TSH became suppressed and free T4 and T3 levels rose above the normal range without L-thyroxin being given. Thyroid hormones persisted in the thyrotoxlc range throughout the 2 month period though clinically silent. Then TSH rose to the normal range and a TSH- suppressive dose of L-T was administered.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Amaç: Gerçek hayatta yeni nesil insülin glarjin u-300'ün açlık kan şekeri, HbA1c, LDL ve trigliserit düzeylerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Eskişehir Osmangazi Üniversitesi Endokrinoloji ve Metabolizma polikliniğine 2019 yılında başvuran, eski nesil bazal insülin yerine glargine u-300 kullanılan ve antilipidemik tedavisi değişmeyen hastaları geriye dönük olarak inceledik. Başlangıçta ve 3 ay sonra açlık kan şekeri(mg/dl), HbA1c(%), LDL(mg/dl) ve trigliserit(mg/dl) değerlerini karşılaştırdık. Biz de bu verileri cinsiyetlere continayırarak değerlendirdik. Sürekli değişkenler için Shapiro-Wilk normallik testi yapıldı. Normal dağılım gösteren değişkenler için paired sample t testi, normal dağılım göstermeyen değişkenler için Wilcoxon Signed Ranks testi uygulandı. Bulgular: 109 hasta ile ilgili veriler analiz edildi. Açlık kan şekeri ortalaması ve medyan değeri kontrolde glarjin u-300'e başladıktan sonra azaldı. Ancak istatistiksel olarak farklı değildi(p=0,06). HbA1c kontrol değeri (%8,8) başlangıç değerine (%9,61) göre istatistiksel olarak anlamlı derecede azaldı (p

ABSTRACT This study was performed to compare the changes in anthropometric measurements, muscle strength, flexibility, energy consumption and pulmonary function before the treatment of hyperthyroidism and in euthyroid status after antithyroid treatment in previously hyperthyroid patients. Eight (5 female, 3 male) hyperthyroid patients (mean age: 43.38±13.51 years) participated in the study. The anthropometric measurements, manual muscle test, hand grip strength test with a Jamar dynamometer, the test for 1 maximum repetition of the Quadriceps femoris muscle (1 max of QF) and flexibility tests were done both prior to the antithyroid treatment and after the patients returned to euthyroid status. Energy consumption was measured using the "physiological cost index", also pulmonary functions (VC, FVC, FE V1) were tested using a spirometer. When the results obtained before the treatment and in euthyroid status after antithyroid treatment were compared, increases in the muscle strengths in the neck, trunk, scapula (p<0.05), upper, lower extremities (p<0.001) and the flexibilities of Quadriceps femoris (QF) and trunk extension (p<0.001) were statistically significant in the euthyroid status. The increases in the hand grip strength and the 1 max of QF (p<0.001) were also significant. The body weight increased (p<0.05) but, there were no statistically significant differences in the other anthropometric measurements or pulmonary function. The energy consumption decreased in euthyroid status (p<0.01). The present study demonstrated that the medical treatment of hyperthyroid patients resulted in a mark ed increase in muscle strength and a decrease in energy consumption while there were no statistical significant differences in the anthropometric measurements, except body weight, before and after treatment.

ABSTRACT A variety of thyroid abnormalities may co-exist and interact with diabetes mellitus. in this study, we aimed to examine the frequency of thyroid disease in patients with diabetes mellitus and the relation between goiter and antidiabetic treatment. 820 patients with diabetes mellitus (507 females and 313 males, age 54,3 ± 0,4 years) were evaluated retrospectively. Age, sex, duration of diabetes mellitus, type of treatment, duration of treatment with oral antidiabetic drugs, thyroid morphology, thyroid function, duration of thyroid disease and their relations were examined. Thyroid dysfunction was found in 20 patients of whom 11 were hyperthyroid (1,3 %) and 9 hypothyroid (1,1 %). Also, thyroid morphology was found abnormal in 120 patients of whom 37 had diffuse goiter (4,5 %), 24 solitary nodule (2,9 %), 47 multinodular goiter (5,7 %) and 12 patients had thyroidectomy (1,4 %). There was no difference in thyroid function and morphology between groups that were treated with diet only, oral antidiabetic drugs and insulin. When compared with epidemiological studies, the results were similar. So, it was thought that there is no increase in goiter prevalence in diabetes mellitus.

ABSTRACT Between the years 1990 and 1996, 802 patients with Diabetes Mellitus (DM) were scanned for hypertension prevalence and the effect of hypertension on diabetic complications. Over 6 years, 103 patients with IDDM and 699 patients with NIDDM were examined and it was found that the prevalence of hypertension was 45.53% and 71% of them were female. The percentage of hypertension in patients with IDDM was 17% and 45.77% in NIDDM patients. it was found that diabetes was prior to hyper tension in 68.4% of the cases and in 8.4% of the cases the onset of hypertension ac companied the onset of diabetes. While the duration of diabetes is important in the existence of hypertension in IDDM, age is not a significant factor. it has been ob served that a family history of hypertension and atherosclerotic heart disease is not frequent in hypertensive IDDM patients. in IDDM, hypertension significantly coexists with nephropathy. in NIDDM both the age of the patient and the duration of diabetes affect the existence of hypertension. Hypertension is more prevalent in female and obese NIDDM patients. A family history of hypertension and atherosclerotic hearth disease is more frequent in hypertensive NIDDM patients than normotensive ones. When the hypertensive diabetics that had the same glycemic control as normotensives and normotensive diabetics were compared prior to the onset of anti hypertensive therapy, it was observed that diabetic complications such as re tinopathy, neuropathy and renal damage, which were determined by proteinuria and Creatinin Clearance (CCr), were found to be more prominent in hypertensives than in normotensives in the initial examination. it was observed that the difference between the normotensives and the hypertensives receiving antihypertensive and lipid lowering drugs became insignificant w it h time. Both normotensives and hypertensives' albuminuria stage distribution changed with time. While normoalbuminuric patients decreased, microalbuminuric patients increased. Although the distribution of al buminuria stages in hypertensive diabetics receiving antihypertensive medication and in normotensive patients look similar, in detailed examination the decrease in mean CCr levels and increase on mean proteinuria levels were found to be more prominent in hypertensives. Atherosclerotic ECG changes were observed in increasing frequency with time in both groups, being more prominent in the hypertensive group. Triglyceride and total cholesterol levels that were higher before the onset of antihypertensive and lipid lowering therapy in hypertensives vvere lovvered to as levels similar to normotensives with time. Even the hypertensives that had the same glycemic control as normotensives and received lipid lowering and antihyper tensive therapy were more prone to develop renal damage and macrovascular complications compared to normotensives. In the existence of hypertension which accelerates nephropathy and macrovascular complications, being the most important factors in the survival of diabetic patients, it is very important to begin antihypertensive treatment at an early stage. in hypertensive diabetics progress of renal damage and atherosclerotic complications açcelerated by hypertension can not be completely prevented but can be slowed down with antihypertensive therapy.

ABSTRACT Diabetes Mellitus is associated with disturbances of the hemostatic system, which might contribute to the development of diabetic vascular disease. The purpose of this study was to clarify whether the levels of natural anticoagulants are changed in diabetics and whether biochemical changes, especially hyperlipidemia and hyperglycemia could affect the levels of the natural anticoagulants. We investigated also the effect of the therapy type; smoking, hypertension, ischemiac ECG findings, BMI status, retinopathy, neuropathy and nephropathy status on the natural anticoagulants. These parameters were studied in 84 type 2 and 18 type 1 diabetic patients and compared with 15 healthy control subjects for type 2 patients and 11 healthy control subjects for type 1 patients matched for age, sex and BMI. The natural anticoagulants protein C, protein S and antithrombin III were correlated to triglyceride and the protein C was correlated with total cholesterol in type 2 patients. The protein C and protein S levels were correlated to prothrombin time and activated partial thromboplastin time in type 1 diabetics. Protein C levels were correlated to fibrinogen levels in type 1 patients. Antithrombin III levels were also correlated to HbA1C, fasting glucose and triglyceride levels in type I diabetics. The levels of protein S were found to be lower in type 1 patients in comparison to type 2 patients. The levels of protein C were found to be lower in type 2 patients when compared with the control group. The type 2 patients had significantly higher fibrinogen levels than the control group. From these results, we have concluded that there is a thrombotic tendency or at least an imbalance between the hemostatic and thrombosis protecting system in type 2 diabetic patients, especially in patients with hyperlipidemia; hyperglycemia and hyperfibrinogenemia.

ABSTRACT Alpha-tocopherol (A-T) ,ascorbic acid (AA),malondialdehide (MDA) concentrations, superoxide dismutase (SOD) and glutathione peroxidase (GPX) activities were measured before and after a 60 day period to define the basal oxidative status in type 2 diabetic patients and to assess the effects of A-T and AA supplementation as an anti-oxidative therapy. The results were compared to those of 10 healthy volunteers. Type 2 diabetic patients were followed up for 60 days in four main groups. Glubornuride or insuline was given to all the patients. Group 1: No additional vitamin was given. Group 2: AA (1 g/day) was given. Group 3: A-T (600 mg/day) was given. Group 4: Both AA (1 g/day) and A-T (600 mg/day) were given. At the end of 60 days normoglycaemic (HbA 1c < 8%) and hyperglycaemic (HbA 1c > 8%) groups of patients were formed. Initial A-T and AA concentrations of patients were statistically lower, MDA concentration, MDA/SOD and MDA/GPX ratios were statistically higher than in the control group. SOD and GPX activities were similar to the control group. At the end of 60 days, normoglycaemic patients had significant increments in A-T and AA levels without any vitamin supplementation. Supplementation of A-T in combination in AA besides normoglycaemia restoration resulted in the highest significant increments in A-T and AA and the highest significant reduction in MDA levels. In conclusion: anti-oxidative therapy with A-T and AA may be beneficial in addition to glycaemia regulation. Abbreviations: A-T, alpha tocopherol; AA, ascorbic acid; MDA, malon-dialdehide; SOD, superoxide dismutase; GPX, glutathione peroxidase; DM, diabetes mellitus.

Background/aim:Hyperparathyroidism is an endocrine disorder characterized by hypercalcemia. Because of calcium’s effects on parathyroid glands, bone, intestines, and kidneys, it has an important place in homeostasis. The results of studies regarding hyperparathyroidism hemostasis are conflicting. Thromboelastography helps to evaluate all steps of hemostatic system. Our aim in this study was to investigate the possible role of hemostatic mechanisms in the development of thrombosis in hyperparathyroid patients with the modified rotation thromboelastogram (ROTEM).Materials and methods:Twenty-two patients with primary hyperparathyroidism (PHPT) and 20 healthy controls were involved. This study was conducted in Eskisehir Osmangazi University Faculty of Medicine, Endocrinology and Hematology clinics for 2 years. The complete blood count, fibrinogen, D-dimer levels, prothrombin time, activated prothrombin time, and ROTEM parameters [clot formation time (CFT), clotting time (CT), and maximum clot formation (MCF)] were determined by two activated tests, INTEM and EXTEM analyses. A thromboelastographic evaluation was performed in the preoperative and postoperative (3 months after surgery) periods.Results:In INTEM assay, the CT (p = 0.012) and CFT (p = 0.07) values were increased in preoperative PHPT patients compared with the control group. Although there was a decrease in the postoperative CT and CFT values, no statistical difference was found.Conclusion:The prolongation of the CT and CFT values were consistent with a hypocoagulable state in patients with PHPT. Hyperparathyroidism causes a hypocoagulable state that can be successfully assessed by ROTEM. Hemostatic changes, do not seem to have an effect on increased cardiovascular mortality.

Type of funding sources: None. Diabetes mellitus is a risk factor for cardiovascular disease. In women, one of the strongest and most consistent estimators of cardiac prognosis is functional capacity which is an important component affecting the predictive value of exercise testing. The Duke Activity Status Index (DASI) is a questionnaire and it correlates with a woman’s capabilities to perform adequate levels of exercise stress testing and predicts prognosis to a similar degre. The every unit increase in the DASI MET subsets (4.8-7-4, 7.5-9.9 and >9.9 METs) related to Bruce protocol, were associated with a 25% decrease in adverse cardiac events. To appreciate the physical function and health related quality of life according to the likelihood of adverse cardiac events using estimeted function capasity in type 2 diabetic women Forty nine type 2 diabetic women (mean age: 61.48 ± 8.42 years) completed the DASI questionnaire for the functional capacity and SF-36 for health related quality of life. They also underwent two minute walk test, Up and Go test and one leg standing test. The women were divided into two groups according to functional capacity by their estimated MET capacity at < 7.5 (group 1 who had higher risk for adverse cardiac events) and ≥7.5 (group 2, who had lower adverse cardiac events risk) using DASI. The age, BMI, diabetes duration, HgA1c and SF-36 mental health weren’t different between the groups (p>.05). The education duration (p=.031), comorbidity number ((p=.035), the scores of two minute walk test (p=.000), Up and Go test (p=.000), one leg standing test (p=.001) and vitality (p=.002), physical functioning (p=.000), bodily pain (p=.040), physical role functioning (p=.003), emotional role functioning (p=.040) domains of SF-36 were greater in Group 2. In the type 2 diabetic womens who had higher risk for adverse cardiac events, physical function was lower and quality of life was worse than those in the womens who had lower adverse cardiac events risk. The physical activity as a contributing factor to reduce the likelihood of adverse cardiac events and to increase the health related quality of life, should be improved.

Background/aim It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients. Materials and methods In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained. Results In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003). LAD [36.0 (34.0–38.0) vs. 38.0 (35.0–41.0) mm, p < 0.001], LVM [155.27 ± 27.00 vs. 173.0 (153.0–235.0) g, p < 0.001], LVMi [83.12 ± 13.19 vs. 92.0 (83.0–118.0) g/m², p < 0.001] and RWT [0.39 ± 0.03 vs. 0.43 (0.41–0.45), p = 0.001] were significantly higher in patients with acromegaly. Disease duration was significantly higher (11.59 ± 1.3 vs. 8.2 ± 1.8 years, p < 0.001) in the fQRS (+) group. LAD [41.0 (39.0–42.5) vs. 37.0 (34.7–38.0) mm, p < 0.001], LVM [219.0 (160.5–254.5) vs. 164.0 (153.0–188.0) g, p = 0.017], LVMi [117.0 (92.5–128.5) vs. 86.0 (82.0–100.2) g/m², p = 0.013] and RWT [0.44 (0.42–0.49) vs. 0.43 (0.40–0.44), p = 0.037] were significantly higher in fQSR (+) acromegaly patients. In multivariate logistic regression analysis, disease duration (odds ratio: 10.05, 95% CI: 1.099–92.012, p = 0.041) and LAD (odds ratio: 2.19, 95% CI: 1.030–4.660, p = 0.042) were found to be the independent predictors of fQRS formation. Conclusion The results of our study revealed that fQRS (+) acromegaly patients had increased LVH parameters compared to fQRS (-) patients.