Background and Objectives: Pediatric-onset metabolic bone diseases, including osteogenesis imperfecta (OI), hypophosphatemic rickets (XLH), hypoparathyroidism, and McCune–Albright syndrome (MAS), require lifelong follow-up because of persistent skeletal fragility, biochemical abnormalities, and functional morbidity extending into adulthood. However, evidence regarding structured transition from pediatric to adult care in these rare disorders remains limited. This study evaluated one-year outcomes of a multidisciplinary transition program for adolescents and young adults with rare metabolic bone diseases. Materials and Methods: This retrospective cohort study included 20 patients aged ≥17 years who underwent evaluation through a structured transition pathway consisting of multidisciplinary team meetings, a joint pediatric–adult transition clinic, and subsequent follow-up in adult endocrinology. Demographic, clinical, treatment, and transition-related data were extracted from medical records. The primary outcome was successful transition, defined as at least one adult endocrinology visit within 12 months. Secondary outcomes included attendance at the transition clinic, follow-up continuity, and treatment modifications. Results: All patients underwent multidisciplinary evaluation, and 85% attended the joint transition clinic. Successful transfer to adult endocrinology was achieved in 90% (18/20), while regular follow-up during the first year was maintained in 75%. Retention was highest in patients with OI, MAS, XLH, vitamin D-dependent rickets, and DiGeorge syndrome (100%). Greater variability was observed in postoperative and primary hypoparathyroidism. Treatment adjustments were required in 40% of patients, including optimization of phosphate/calcitriol replacement and reassessment of bisphosphonate or burosumab therapy. Three patients were lost to follow-up. No acute transition-related complications were observed. Conclusions: In this small exploratory cohort, implementation of a structured multidisciplinary transition pathway was feasible and was accompanied by high transfer and one-year retention rates. Observed differences across diagnostic subgroups should be interpreted cautiously, and larger multicenter comparative studies are needed to evaluate the effectiveness of structured transition frameworks.

Objective: This study aimed to compare body composition measurements between patients with nonfunctional adrenal incidentalomas (NFAI) and mild autonomous cortisol secretion (MACS) using bioelectrical impedance analysis (BIA) and anthropometric methods. Subjects and methods: This cross-sectional study included patients diagnosed with MACS or NFAI. Body composition was assessed using BIA, anthropometric measurements, and the Durnin and Womersley (DW) method. Correlation and Bland-Altman analyses were performed to assess the relationship and agreement between the DW method and BIA. Results: Fiftyseven patients (32 with MACS and 25 with NFAI) were included; those with MACS were older (p = 0.004). Post-dexamethasone suppression test cortisol levels (p < 0.001) and the incidence of bilateral tumors (p = 0.017) were higher in MACS patients. No significant differences in body composition parameters were observed between the MACS and NFAI groups. A strong correlation was observed between BIA-and DW-derived fat mass in MACS patients (r = 0.890, p < 0.001). Bland-Altman analysis revealed a slight mean bias for body fat mass of-0.4 kg (limits of agreement: -9.14-8.34 kg) and for body fat percentage of-0.83% (limits of agreement: -11.32-9.66%) between methods. Conclusion: A robust correlation and acceptable agreement was demonstrated between the DW method and BIAfor estimating bodyfat. The DW equation may provide a practical and low-cost alternative for assessing body composition in MACS and NFAI cohorts. Limitations include the lack of a healthy control group and the inability to validate BIA and anthropometric estimates against gold-standard imaging techniques, potentially introducing accuracy bias.

Objective: Differentiated thyroid cancer (DTC) generally has a favorable prognosis; however, resistance to radioactive iodine therapy (RAI) markedly worsens outcomes. Sorafenib is among the standard treatment options for RAI-refractory DTC. This study aimed to present our single-center experience with sorafenib therapy. Methods: The medical records of patients diagnosed with RAI-refractory DTC who were followed in the endocrinology and oncology outpatient clinics of Bursa Uludağ University Faculty of Medicine Hospital between 2010 and 2022 and treated with sorafenib were retrospectively reviewed. Progression-free survival (PFS), overall survival (OS), response rates, and adverse events profiles were analyzed. Results: Of the 19 patients included, 68.4% had papillary thyroid carcinoma and 31.6% had follicular variants. Median PFS was 16.1 months, and median OS was 36.2 months. The overall response rate was modest, while sorafenib-related adverse events occurred in 63% of patients, most commonly hand–foot syndrome (31%). Conclusion: Our single-center data suggest that sorafenib is a generally tolerable and effective therapeutic option in patients with RAI-refractory DTC, with median PFS exceeding 1 year despite frequent adverse events.

This retrospective study evaluates the impact of the transition council on clinic attendance, glycaemic control and complications in type 1 diabetes. Since 2015, monthly multidisciplinary transition meetings (transition councils) have been held involving paediatric and adult endocrinology departments at Bursa Uludag University Hospital, Turkey. The study retrospectively compared outcomes of type 1 diabetes patients who transitioned to adult care via the council versus standard transition. A total of 180 patients (90 in each group) aged at transition 18–21 years (58.9% male) were included. Within 6 months post-transition, 84.9% of council patients (exposed group) and 54.1% of the standard care group attended at least one visit ( p  < 0.001). Regular follow-up during the first year was significantly higher in the exposed group (58.1% vs. 29.7%, p  < 0.001); rates were similar between groups in subsequent years. HbA1c levels increased significantly 1 year after transition in the standard care group ( p  = 0.025), while the exposed group remained stable ( p  = 0.719). No significant differences were observed in hospitalisation or diabetic ketoacidosis. This transition model may improve regular follow-up rates during the challenging first year of transition and help prevent additional deterioration in glycaemic control compared to standard care. Prospective randomised trials could strengthen these findings.

Background/Objectives: Diabetic foot (DF) is among the leading causes of diabetes-related disability. It is important to maintain regular follow-up and patient education in the prevention and treatment of DF ulcers. In extraordinary situations such as a pandemic, there are disruptions in regular clinical follow-up and patient education, and the effects of this disruption need to be investigated. The aim of this study was to investigate the impact of the pandemic on the clinical condition of patients hospitalised for DF. Methods: Patients were divided into two groups according to the date of admission to the clinic: the pre-pandemic (1 January 2019–11 March 2020) and the pandemic period (12 March 2020–1 June 2021). Comparisons were made between the two groups in terms of DF data and clinical parameters. Data were analysed with SPSS using chi-square, Student’s t-test and Mann–Whitney U analysis. Results: As a result of the screening, data from 125 DF patients (45 pre-pandemic and 80 pandemic) were collected. The DF stage, according to the Wagner classification, was significantly more advanced in patients during the pandemic period (p = 0.015). However, the time between the onset of symptoms and hospitalisation was longer for patients during the pandemic period (p = 0.035). When analysing treatment outcomes, the rate of wound healing was found to be lower (62.2% vs. 30%), and the rate of transtibial amputation was higher (11.2% vs. 20%) during the pandemic period (p = 0.002). Conclusions: This study found that the number of patients hospitalised for DF increased during the pandemic period, as did the severity of the wound, length of admission and radical treatment interventions.

AIM:This retrospective study evaluates the impact of the transition council on clinic attendance, glycaemic control and complications in type 1 diabetes. METHODS:Since 2015, monthly multidisciplinary transition meetings (transition councils) have been held involving paediatric and adult endocrinology departments at Bursa Uludag University Hospital, Turkey. The study retrospectively compared outcomes of type 1 diabetes patients who transitioned to adult care via the council versus standard transition. A total of 180 patients (90 in each group) aged at transition 18-21 years (58.9% male) were included. RESULTS:Within 6 months post-transition, 84.9% of council patients (exposed group) and 54.1% of the standard care group attended at least one visit (p < 0.001). Regular follow-up during the first year was significantly higher in the exposed group (58.1% vs. 29.7%, p < 0.001); rates were similar between groups in subsequent years. HbA1c levels increased significantly 1 year after transition in the standard care group (p = 0.025), while the exposed group remained stable (p = 0.719). No significant differences were observed in hospitalisation or diabetic ketoacidosis. CONCLUSION:This transition model may improve regular follow-up rates during the challenging first year of transition and help prevent additional deterioration in glycaemic control compared to standard care. Prospective randomised trials could strengthen these findings.

Background:Transition describes preparing children with chronic illnesses for adult healthcare and gradually transferring their care, starting late adolescence. Joint meetings and visits are recommended during this process. This study examines an 8-year transition experience in our clinic, focusing on the differences between adult and pediatric endocrinology practices and the rates of loss to follow-up in specific disease groups. Methods:Three hundred thirty-five patients evaluated in transition meetings were included. The frequency of visits 1 year before transition, during the first and second years after transition, the number of patients lost to follow-up and disease groups were analyzed. Results:Among the patients discussed in the transition meetings, 56.3% participated in joint visits. Post-transition, 82.5% of patients continued their follow-up care, while 17.5% were lost to follow-up. There was a statistically significant difference in the number of visits before and after the first year of transition (P = 0.000). Conclusion:To increase adaptation during the transition, informing patients and families about the process at every visit after late adolescence is beneficial. Moreover, scheduling joint visits on flexible dates and increasing the number of joint visits per patient could substantially enhance patient participation and follow-up rates. We observed that patient follow-up frequency was higher in pediatric endocrinology due to differences in pediatric and internal medicine practices.

Tip 2 diyabet hastalarında kardiyovasküler hastalıklar diyabeti olmayanlara göre daha yüksektir. SGLT-2 inhibitörlerinin (empagliflozin, dapagliflozin vb.) ve GLP-1 analoglarının (exenatid vb.) kardiyak etkilerine ilişkin olumlu sonuçlar veren geniş çaplı çalışmalar mevcuttur. Bu çalışmayla empagliflozin, dapagliflozin veya eksenatid kullanan hastalarda kardiyovasküler sonuçları değerlendirmek ve karşılaştırmak amaçlanmıştır. Kontrol grubu olarak kardiyak açıdan nötr olduğu bilinen DPP-4 inhibitörü (linagliptin) kullanan hastalar seçilmiştir. Bu çalışma her tedavi grubundan (linagliptin, eksenatid, dapagliflozin, empagliflozin) en az on iki aydır tedavi gören 100 hasta olmak üzere toplam 400 hasta ile gerçekleştirilmiştir. Miyokard enfarktüsü (MI), serebrovasküler olay (SVO), kardiyak nedenlere bağlı ölüm, majör kardiyovasküler olay (MACE: MI, SVO ve kardiyak ölüm), kalp yetmezliği nedeniyle hastaneye yatış, kararsız angina/akut koroner sendrom (AKS), periferik arter hastalığı ve tüm nedenlere bağlı ölümler değerlendirilmiştir. Tüm kardiyovasküler patolojilerin toplam oranları incelendiğinde linagliptin grubunda %10, eksenatid grubunda %6, dapagliflozin grubunda %4 ve empagliflozin grubunda %6 olarak tespit edilmiştir. Kardiyak hastalık öyküsü olmayan hastalar karşılaştırıldığında eksenatid, dapagliflozin ve empagliflozin grubunda toplam kardiyovasküler patoloji oranlarının linagliptin grubuna göre istatistiksel olarak anlamlı derecede azaldığı saptanmıştır. Kardiyak öyküsü olan hastalarda ise dapagliflozin ve empagliflozin grubunda angina/AKS tablosunun anlamlı derecede azaldığı ortaya konmuştur. Bu sonuçlar diyabet hastalarının kardiyak patolojilerden birincil korunmasında eksenatid, dapagliflozin ve empagliflozin moleküllerinin faydalı olduğunu göstermektedir. Dapagliflozin ve empagliflozin molekülleirinin hastaların kardiyovasküler patolojilerden sekonder korunmasında da tekili olabileceğini düşündürmektedir.

BACKGROUND Dipeptidyl peptidase-4 (DPP-4) and neprilysin (NEP) regulate glucose metabolism through incretin activity. While DPP-4 inhibitors have established benefits in glycemic control, the precise role of NEP in metabolic regulation remains unclear. This study assessed the effect of sitagliptin therapy on serum neprilysin levels and its association with glycemic and metabolic parameters in patients with newly diagnosed type 2 diabetes. MATERIAL AND METHODS Thirty-five patients with newly diagnosed type 2 diabetes were included in this prospective study. Sitagliptin (100 mg/day) was administered for 3 months. Serum neprilysin levels, body mass index (BMI), waist circumference, and glycemic parameters were measured at baseline and after 3 months. A multivariable regression analysis was conducted to assess the relationship between neprilysin levels and metabolic parameters. RESULTS Serum neprilysin levels remained unchanged after sitagliptin therapy (p=0.789). However, neprilysin changes were significantly associated with BMI change (ß=-0.0003, p=0.001), while no significant relationship was found with waist circumference (p=0.464) or homeostasis model assessment (HOMA) levels (p=0.383). CONCLUSIONS Sitagliptin therapy significantly improves glycemic control and promotes weight loss without affecting serum neprilysin levels. The significant association between neprilysin changes and BMI suggests that neprilysin may have a more direct role in body composition rather than glucose homeostasis.

Tyrosine kinase inhibitors (TKIs) are crucial for improving the survival rates of individuals with metastatic thyroid cancer. Moreover, systemic inflammation and malnutrition are known to negatively affect metastatic thyroid cancer prognosis. Evaluating nutritional status at the start of treatment can improve survival rates. Purpose: This study investigated the correlation between the hemoglobin, albumin, lymphocyte count, and platelet (HALP) score and prognosis of patients with metastatic thyroid cancer undergoing first-line TKI therapy. Methods: We retrospectively analyzed data from 44 patients between January 2010 and June 2024. The primary outcomes evaluated in the study were time to treatment failure (TTF) and overall survival (OS); HALP scores were categorized as low (≤29.21) and high (>29.21) based on receiver operating characteristic analysis. Results: The 1-year survival rate was significantly lower in the low HALP score group compared to the high HALP score group (50% vs. 96.3%). Multivariate Cox regression analysis revealed that low HALP scores, elevated leukocyte counts, and lymphopenia were independent predictors of shorter TTF (HR = 0.272, p = 0.011) and OS (HR = 0.208, p = 0.028). Conclusions: The results obtained in the present study demonstrate that the HALP score has prognostic significance for patients with metastatic thyroid cancer who are undergoing first-line TKI treatment. In metastatic thyroid cancer patients, interventions focused on improving nutritional status at the start, during initiation, and throughout the TKI treatment may enhance treatment effectiveness. However, further prospective studies involving larger patient cohorts are necessary to validate our results.

In this single-center retrospective study, we aimed to evaluate the results of medical therapy as primary or secondary treatment following surgery and compare follow-up outcomes between the two approaches. Patients were grouped as medical therapy alone (Group M) and surgery plus medical therapy (Group S+M). Patients' demographics, such as age and gender, and age at the diagnosis were recorded. Differences between the pre-and post-treatment tumor size, prolactin (PRL) levels, Knosp grades, tumor response to treatment, improvement in hypofunctions, visual field, and biochemical control were recorded and compared between the two groups. A total of 41 patients diagnosed with giant prolactinomas were included in the study. Hypopituitarism was found in 82.93%, hypogonadism in 80.59%, GH deficiency in 51.22%, ACTH deficiency in 36.59%, and TSH deficiency in 41.46% of the patients. Visual field defects were found by 60.53%. Tumor volume at diagnosis was significantly higher in Group M (p 0.05). This study's results demonstrate no statistically significant difference between medical therapy alone and surgery plus medical therapy regarding the reduction of tumor volume and normalization of PRL values in patients with giant prolactinomas. Surgery should be reserved for severe compression conditions, and potentially unnecessary surgical approaches should be avoided.

Multiple Sclerosis (MS) is a T-cell-mediated autoimmune disease with distinct clinical and pathologic phenotypes. Thyroid disorders play an essential role in studies evaluating the coexistence of both autoimmune and nonautoimmune diseases in MS patients. This study aimed to elucidate the characteristics of RRMS patients with thyroid pathologies and to determine the impact of the coexistence of both diseases on clinical or radiologic outcomes. Demographic, clinical, laboratory, and radiological data of patients with thyroid pathology (RRMS and thyroid pathology) who were followed up in our center for at least 12 months were retrospectively evaluated from patient files. Thyroid pathology was present in 34 patients with RRMS, 29 females and five males. Hashimoto's disease was the most common pathology. There was no significant difference between the presence or absence of thyroid pathologies in patients with RRMS in terms of clinical, radiologic, and laboratory characteristics. Thyroid pathologies, especially Hashimoto's disease, are among the most common autoimmune disorders in MS. This condition does not adversely affect the course of MS. On the other hand, no significant difference is expected in the hormonal follow-up of patients with Hashimoto's disease accompanying MS. Correction of thyroid pathology and hormone replacement therapy may be necessary for the course of MS. Further studies evaluating prospective standardized replacement therapies are needed.

Background/aim:There is increasing interest in endocrine disrupting chemicals because of the potential effects on neurological health. These chemicals are widely found in various consumer products and industrial processes, and can lead to serious disorders of the endocrine system by disrupting hormone synthesis, expression, and function. The aim of this review was to examine epidemiological and experimental findings by investigating the link between exposure to endocrine disrupting chemicals and adverse neurological outcomes. Materials and methods:In the preparation of this review, a PubMed literature search was conducted using the words "endocrine disruptors," "neuroendocrine effects," "neurobehavioral effects," and "neurodevelopmental effects" and articles containing relevant studies were examined. Results:Recent studies have shown a strong correlation between exposure to endocrine disrupting chemicals and the development of neurodegenerative diseases such as Alzheimer's and Parkinson's disease, and neurodevelopmental diseases such as autism spectrum disorder and attention deficit hyperactivity disorder. The effects of common pollutants such as pesticides, bisphenol A, polychlorinated biphenyls, and heavy metals on the endocrine system have been especially emphasized. Conclusion:In conclusion, understanding the role played by endocrine disrupting chemicals in the development of neurological diseases will be of critical importance in the development of new strategies to prevent these diseases.

This study aimed to determine the effect of adrenal mass functionality and different hormone subtypes synthesized by the adrenal masses on laparoscopic adrenalectomy (LA) outcomes. The study included 298 patients, 154 of whom were diagnosed with nonfunctional masses. In the functional group, 33, 62, and 59 patients had Conn syndrome, Cushing’s syndrome, and pheochromocytoma, respectively. The variables were analyzed between the functional and nonfunctional groups and then compared among functional masses through subgroup analysis. The incidence of diabetes mellitus, hypertension, and obesity, blood loss, and length of hospital stay (LOH) were significantly higher in the functional group than in the nonfunctional group. In the subgroup analysis, patients with pheochromocytoma had significantly lower body mass index but significantly higher mass size, blood loss, and LOH than the other two groups. A positive correlation was found between mass size and blood loss in patients with pheochromocytoma (p ≤ 0.001, r = 0.761). However, no significant difference in complications was found among the groups. In this study, patients with functional adrenal masses had higher comorbidity rates and American Society of Anesthesiologists scores. Moreover, blood loss and LOH were longer on patients with functional adrenal masses who underwent LA. Mass size, blood loss, and LOH in patients with pheochromocytoma were significantly longer than those in patients with other functional adrenal masses. Thus, mass functionality did not increase the complications.

Background Thyroid cancer is one of the five most common cancers causing bone metastasis. If there is an increase in serum thyroglobulin-antithyroglobulin levels in differentiated thyroid cancer or calcitonin levels in medullary thyroid cancer, patients should be evaluated for recurrence and distant metastasis. The skeleton is the second most common site of distant metastasis in thyroid cancer after the lung. Bone metastases cause pain, fractures, and spinal cord compression, severely reducing the quality of life. They are associated with poor prognosis. Bone metastases severely reduce the quality of life. This study aimed to retrospectively evaluate the diagnosis and follow-up of patients with thyroid cancer with bone metastases diagnosed at our center. Methodology A total of 1,390 patients diagnosed with thyroid malignancy at our center between 2010 and 2023 were reviewed retrospectively. The study included 27 patients with differentiated and medullary thyroid cancer who had bone metastases. Results Of 27 patients, 19 (70.4%) had differentiated and eight (29.6%) had medullary thyroid cancer. Papillary thyroid cancer constituted 22.2% (n = 6) and follicular thyroid cancer constituted 14.8% (n = 4) of the cases. Papillary carcinoma follicular variant, oncocytic, and poorly differentiated thyroid cancer were diagnosed with similar frequency, each accounting for 11.1% (n = 3). It was found that vertebrae were most commonly involved, followed by the pelvis, sternum, costae, femur and patella, shoulder and humerus, cranium, and scapula. The five-year survival rate was 72%, and the 10-year survival rate was 53%. Conclusions The number of patients with papillary cancer was the highest, but the rate of bone metastases was the lowest in this group. The highest rate of bone metastases was found in patients with poorly differentiated, oncocytic, medullary, follicular, and papillary cancer, respectively. The results obtained in this study reveal the necessity and importance of bone metastasis evaluation in patients with thyroid cancer.

Objective: The novel coronavirus caused a disease that mainly affected the respiratory system. The effect of severe acute respiratory syndrome coronavirus 2 on the hypothalamic–pituitary–adrenal axis is unknown. This study assesses the prognostic accuracy of serum cortisol levels and prediction tools in predicting mortality rates in patients with coronavirus disease 2019 (COVID-19). Methods: We prospectively analyzed 106 inpatients (53 COVID-19 positive, 53 non-COVID-19; mean 59.9 ± 17.3years; 38 males and 68 females) with serum cortisol and adrenocorticotropic hormone levels compared with prognostic scores. Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores determined the disease’s severity. The predictive value of serum cortisol, APACHE, and SOFA on mortality was assessed using receiver operating characteristic curve analysis and the area under the curve (AUC). Results: No significant age or sex differences were found between groups. Serum cortisol levels were similar. The APACHE-II scores in the COVID-19 group were higher than in the other group, while SOFA scores showed no significant difference. The AUC for the APACHE-II score in predicting mortality was 0.765 (95% CI 0.672-0.842), with an optimal cutoff (>9) demonstrating 62.5% sensitivity and 86.7% specificity for overall participants. No correlation was found between serum cortisol levels and prediction tools such as APACHE-II and SOFA. Conclusion: The measurement of serum cortisol did not provide additional prognostic information beyond that established by the APACH-II score. This study highlights the significance of assessing novel prognostic tools for predicting outcomes in hospitalized patients with COVID-19. Cite this article as: Aydemir E, Ünsal Y, Ateş C, Refik Göktuğ M, Öz Gül Ö, Cander S. Assessment of serum cortisol levels in coronavirus disease 2019 inpatients and investigation of the potential impact of alterations in serum cortisol levels on prognosis. Endocrinol Res Pract. 2024;28(2):94-99.

The increasing incidence of obesity and type 2 diabetes mellitus (T2DM) is a global problem. Although the obesity epidemic is mostly associated with a lack of physical activity and diet, several chemicals have been demonstrated to have a potential role in its pathophysiological mechanisms. An accumulating volume of evidence indicates that a subclass of endocrine-disrupting chemicals (EDCs) can impair hormonally regulated metabolic processes, particularly in the case of exposure early in life when the defense mechanisms of the human body are yet to be fully developed. These chemicals are called "obesogenic EDCs" and might cause some people to gain weight despite their attempts to increase physical activity and limit calorie intake. Similarly, background exposure to some environmental EDCs has been associated with diabetes and impaired glucose metabolism. Certain widespread EDCs, including pesticides, dioxins, and bisphenol A, in animal models may change beta function and insulin resistance. These EDCs, which may accumulate in adipose tissue and cause a pro-inflammatory response, can also be found at measurable levels in human blood and can either imitate or block some hormonal reactions. In this review, we evaluate EDCs in relation to obesity and T2DM in light of the current literature.

Atypical parathyroid tumor is a rare disease that can be challenging to distinguish from parathyroid adenoma. Atypical parathyroid tumor shows some laboratory and histopathological features with parathyroid cancer. This study attempts to compare clinical, laboratory, radiologic, and histopathological characteristics in atypical parathyroid tumor and parathyroid adenoma. This was a retrospective study based on the database of eighty-two subjects who underwent surgery for primary hyperparathyroidism at a tertiary referral center between 2010 and 2021. Forty-one patients with atypical parathyroid tumor were matched by age and gender to controls with parathyroid adenoma. Clinical, laboratory, radiologic, and characteristics were obtained from the hospital database. Forty-five (54.8

We examined the patients with hyperinsulinemic hypoglycemia who were performed non-invasive imaging techniques with doubtful or failed results. We compared the performances of the Selective Arterial Calcium Stimulation Test (SACST) and non-invasive imaging techniques. Eight patients with hyperinsulinemic hypoglycemia, performed SACST after evaluating with imaging modalities were examined retrospectively. Three patients were diagnosed with Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS), 4 with insulinoma, and 1 with autoimmune hypoglycemia after SACST. While the concordance between the SACST and surgery-proven pathology for insulinoma was 50% (2/4), the accuracy in the localization of insulinoma was 25%. Although SACST does not have high concordance with surgery-proven pathology and accuracy in the localization of insulinoma, it may be preferred in the differential diagnosis of hyperinsulinemic hypoglycemia in medical centers where other imaging techniques are not available, or in cases where other imaging methods obtain suspicious/inadequate diagnosis.