Background: This study investigated the effects of kefir consumption on lipopolysaccharides (LPS), LPS-binding protein (LBP), and miRNA-155 expression in obesity. Methods: Thirty-two obese women and 22 normal-weight controls were included. Obese participants on a calorie-restricted diet were assigned to a kefir group (250 ml twice daily for 4 weeks) or a non-kefir group. LPS, LBP, and miRNA-155 were measured. Results: Reductions in BMI, body circumferences, and body fat were similar in both obese groups. Fasting plasma glucose decreased significantly only in the kefir group. Baseline LPS levels were similar. After 4 weeks, LPS decreased in both obese groups compared with controls (p = 0.002), with a significant reduction observed only in the kefir group (p = 0.049). LBP remained unchanged (p > 0.05). miRNA-155 expression was elevated in obese participants at baseline (p = 0.01), similar between kefir and non-kefir subgroups (p > 0.05), and decreased significantly only in the kefir group at follow-up (p = 0.005). Conclusions: Kefir may serve as a complementary beverage in obesity management although it does not promote weight loss. Larger and longer-term studies are needed.

Introduction: Large adrenal tumors (≥8 cm) are associated with a high risk of malignancy, although their pathological distribution varies across institutions. Clarifying their clinical and biochemical features is essential for appropriate surgical decision-making. This study aimed to evaluate the clinical presentation, hormonal activity, surgical management, and histopathological outcomes of adrenal tumors ≥8 cm. Methods: This retrospective study included patients who underwent adrenalectomy at a tertiary endocrine center and had a tumor size ≥8 cm on histopathology. Demographic data, hormonal evaluation, radiological findings, and follow-up outcomes were analyzed. Results: Twenty-six patients (mean age 50.85 ± 13.04 years; 57.7% women) were included. Tumors were incidentally detected in 46.2% of cases. Hormonal hypersecretion was present in 46.2% of patients, most commonly catecholamine excess (34.6%). Pheochromocytoma was the most frequent diagnosis (38.5%), followed by adrenocortical carcinoma (15.4%). Overall, 46.2% of masses were malignant. Malignant tumors were significantly larger than benign ones (p = 0.041). Laparoscopic adrenalectomy was performed for smaller lesions than those treated by open surgery (p = 0.003). During follow-up, 58.3% of malignant cases developed metastases; two patients achieved remission. CONCLUSION: Adrenal tumors ≥8 cm demonstrate marked clinical and pathological heterogeneity. Although tumor size is associated with malignancy, the high prevalence of pheochromocytoma in referral centers highlights the importance of comprehensive biochemical evaluation. Management should be individualized using a multidisciplinary approach rather than relying solely on tumor size.

Fear of cancer recurrence (FCR) is a common concern among papillary thyroid cancer (PTC) survivors and may not reflect actual recurrence risk. This study aimed to assess FCR in low-risk PTC patients compared to intermediate- and high-risk groups and to identify factors influencing FCR. A total of 240 patients were included in this cross-sectional study. Patients were classified into low, intermediate, and high risk, according to the American Thyroid Association (ATA) 2015 risk stratification system. All participants completed the Fear of Cancer Recurrence Inventory (FCRI) and the Beck Anxiety Inventory (BAI) questionnaires. Among 240 patients, 132 (55

Although most patients with thyroid eye disease (TED) present with hyperthyroidism, some remain euthyroid or hypothyroid throughout long-term follow-up. We aimed to evaluate TED using MRI-based orbital measurements and investigate the influence of thyroid function on proptosis, extraocular muscles (EOM) and retrobulbar fat edema. Patients with TED who underwent orbital MRI were included. Patients were categorized as hyperthyroid or euthyroid/hypothyroid based on thyroid function. The total EOM thickness was calculated as the sum of the diameters of the EOMs. Proptosis was evaluated by measuring the distance between the anterior globe and the interzygomatic line. T2 signal intensity and retrobulbar fat edema were assessed, with edema graded on a 0–3 scale. Seventy-four patients were included: 59(79.7

Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly recognized; however, its relevance in individuals with type 1 diabetes mellitus (T1DM) remains unclear. This study aimed to investigate MASLD and its associated determinants in patients with T1DM using multiparametric liver ultrasonography and noninvasive scoring indices. This study included 43 patients with T1DM and 43 age-, gender-, and BMI-matched controls. Noninvasive steatosis and fibrosis indices were calculated. Multiparametric liver US, including liver stiffness, attenuation imaging, texture, and hepatorenal index, was used to evaluate steatosis and fibrosis. Steatosis prevalence did not differ between patients with T1DM and controls; however, both FIB-4 index and liver stiffness measurement (LSM) defined risk of liver fibrosis were significantly higher in the T1DM group (11.6

The relationship between quality of life (QoL) and thyroid stimulating hormone (TSH) levels in patients receiving levothyroxine (LT4) therapy is unclear. Our aim was to determine the efficacy of replacement therapy and the relationship between TSH concentration and QoL in patients diagnosed with primary hypothyroidism and receiving LT4 replacement therapy. This is a national retrospective cross-sectional study. Demographic information, a questionnaire for diagnosis and management of thyroid diseases and Thyroid related Patient Reported Outcome (ThyPRO ) and EQ-5D questionnaires to assess quality of life were used to collect data. The study included retrospective 3 year follow up data. Our study included 1750 patients (90.3

OBJECTIVE:Acromegaly may impair balance and increase fall risk. We aimed to evaluate postural stability, fall risk, and vestibulo-ocular reflex function in patients with acromegaly and to assess the effects of a balance-oriented exercise program. DESIGN:Single-center, prospective case-control study with an exercise intervention. METHODS:Thirty-two patients with acromegaly (15 active, 17 inactive) and 32 age-, sex-, and body mass index-matched sedentary healthy controls were enrolled. Balance was assessed using computerized dynamic posturography along the anterior-posterior (AP) and medial-lateral (ML) axes. Vestibulo-ocular reflex function was evaluated with the video head impulse test. Clinical assessments included the Berg Balance Scale, International Falls Efficacy Scale, and Dizziness Handicap Inventory-Short Form. Fifteen patients with balance impairment completed an 8-week home-based exercise program, with outcomes reassessed afterward. RESULTS:Patients had lower preference AP, visual ML, vestibular ML, and global AP/ML scores than controls (P < .01). Berg Balance Scale scores were lower, whereas fall risk, fear-of-falling, and dizziness scores were higher in patients (P < .05). Fourier analysis demonstrated increased sway amplitudes with low-frequency dominance under static and dynamic conditions (P < .05). Global AP/ML scores were lower in active than inactive patients (P < .05). Vestibulo-ocular reflex gains were similar between groups (P > .05). Exercise significantly improved balance and clinical scale scores (P < .05). CONCLUSIONS:Balance impairment and increased fall risk may occur in acromegaly, likely due to deficits in central sensory integration. Balance-oriented rehabilitation may improve postural control and reduce fall risk in this population.

Purpose Primary hyperparathyroidism (PHPT) is a common endocrine disorder that affects bone structure. Several methods are available to evaluate bone microarchitecture, and among these, the Trabecular Bone Score (TBS) provides an indirect assessment through textural analysis of lumbar spine Dual-energy X-ray absorptiometry (DXA) images. Our study aimed to assess the effects of PHPT on bone in postmenopausal women using bone mineral density (BMD) and TBS, and to evaluate the relationship between TBS, BMD, clinical characteristics, and biochemical parameters. Method The clinical characteristics, laboratory findings, and DXA imaging results of 118 postmenopausal women with PHPT were retrospectively analyzed, and TBS analyses were performed. Results A total of 118 patients were included in this study. Among them, 92 (77.9%) had TBS≤1.35, with a mean TBS value of 1.23±0.12, indicating an impaired bone microarchitecture. Additionally, 55 patients (46.6%) met the diagnostic criteria for osteoporosis, and 77.1% of the overall cohort were asymptomatic at presentation. Patients with TBS≤1.35 had lower BMD at the lumbar spine, femur, and radius and were more frequently diagnosed with osteoporosis (p<0.05). A positive correlation was observed between TBS and BMD in all measured skeletal areas (p<0.05). BMD values were significantly lower in symptomatic patients than in asymptomatic patients (p<0.05), whereas no statistically significant difference was found in TBS between the two groups (p>0.05). TBS values were also significantly lower in patients recommended for surgical treatment than in those under follow-up (p=0.005). Conclusion Bone microarchitecture is affected in patients with asymptomatic PHPT. To accurately assess the effects of PHPT on bone, bone microarchitecture should also be evaluated.

Abstract Background Obesity and periodontitis are chronic inflammatory conditions linked by shared immunometabolic pathways. Although asprosin has been implicated in metabolic regulation and systemic inflammation, its role in the immunometabolic interaction between obesity and periodontal inflammation remains unclear. This study evaluated local and systemic levels of asprosin, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in obese and normal-weight individuals with and without periodontitis. Materials and methods This cross-sectional study included 60 individuals aged 18–65 years, categorized by body mass index (BMI) as normal weight (18.5–24.9 kg/m²) or obese (≥ 30 kg/m²). Participants were further classified as periodontally healthy or with periodontitis, forming four groups: normal-weight periodontally healthy (NH), obese periodontally healthy (OH), normal-weight periodontitis (NP), and obese periodontitis (OP) (n = 15 each). Plaque index, gingival index, probing pocket depth, clinical attachment level, and bleeding on probing were recorded. Gingival crevicular fluid (GCF) and serum samples were analyzed for asprosin, TNF-α, and IL-6 using an enzyme-linked immunosorbent assay. Intergroup comparisons were performed using a rank-based general linear model adjusted for age and sex. Results Serum asprosin levels were lower in the NH group than in the NP (p = 0.025), OH (p < 0.001), and OP (p < 0.001) groups and were also lower in the NP group than in the OH (p = 0.006) and OP (p = 0.021) groups. GCF asprosin levels were lower in the NH group compared with the OH (p < 0.001) and OP (p = 0.017) groups, and were also lower in the NP group than in the OH (p = 0.042) and OP (p = 0.022) groups. IL-6 levels were higher in the OH group than in the NH group (p = 0.050), whereas serum TNF-α did not differ significantly among groups (p = 0.078). Although overall group differences were observed for GCF IL-6 (p = 0.014) and TNF-α (p = 0.008), overlap in interquartile ranges limited consistent pairwise comparisons. Conclusion GCF and serum asprosin levels were higher in obese individuals than in normal-weight participants, while serum asprosin levels were higher in normal-weight individuals with periodontitis than in normal-weight periodontally healthy individuals. These findings are consistent with an association between asprosin levels, obesity, and periodontal status, indicating that obesity status should be considered when interpreting asprosin levels in periodontal conditions. Trial registration The study was retrospectively registered on ClinicalTrials.gov on March 17, 2025 (Identifier: NCT06879951).

Background/aim:To describe Graves' Disease (GD) associated with COVID-19 infection (COVID) or its vaccines (VAC) and to compare the clinical presentations, laboratory parameters, and short-term clinical course of the disease among different etiology groups (COVID, VAC, and GD control). Materials and methods:Included in this multicenter matched case-control, retrospective cohort study were 239 patients with newly diagnosed (n = 196) or recurrent GD (n = 43) associated with COVID (n = 79) or VAC (n = 160). Each case was matched (1:1) with a control who had been diagnosed with GD prior to COVID. Results:The median age of the entire group was 42 years (female:male = 137:102). Both the COVID (4.6-fold) and VAC (4.1-fold) groups demonstrated higher TSH receptor antibody (TRAb) titers (p < 0.001) compared with the control group (3.5-fold), as well as a higher proportion of recurrent cases. At baseline, the COVID group had higher free triiodothyronine (fT3) levels than the other groups. Graves orbitopathy (GO) was observed in 60 patients (12.6%), with a higher frequency in classical GD (18.4%). At baseline, the variables associated with thyrotoxicosis severity (defined as fT3 levels) were younger age, higher thyroid gland volume (TGV), and etiology, with the COVID and, to a lesser extent, VAC groups presenting with higher fT3 levels. The variables associated with GO were higher TGV, TRAb titers, and smoking, while no association with etiology was identified. Conclusion:The clinical course was similar in all groups other than in some laboratory findings. Although the frequency of GO associated with COVID and VAC was lower, the proportion of cases with a Clinical Activity Score of ≥3 was higher compared to GD. This pattern suggests a potentially stronger immunologic trigger in these cases.

Abstract Introduction X-linked adrenoleukodystrophy (X-ALD; OMIM:300100) is a progressive neurodegenerative disorder resulting from a congenital defect in the ABCD1 gene, which encodes the adrenoleukodystrophy protein (ALDP). Deficiency of ALDP leads to impaired peroxisomal β-oxidation of very long chain fatty acids (VLCFAs), causing their accumulation in the nervous system, testes, and adrenal cortex. Clinical Case A 20-year-old male patient was referred to the neurology clinic with a progressive speech disorder, impaired coordination while eating, incoherent speech, prolonged periods of dissociation, and cognitive disability for 6 months. Also clumsiness, unintentional falls, and involuntary arm movements were observed. In fact, when a more detailed history was obtained from the family, they mentioned that the patient had shown signs of clumsiness over the past three years. The patient was born healthy with no underlying health conditions, had an average academic record, and no history of illicit drug use. His neurologic examination did not reveal motor deficits, and the patient was attentive and oriented to person, place, time and situation. However, spasticity was observed in both lower extremities, and it was noted that the patient exhibited difficulty in following commands and doing some movements. His brain MRI revealed bilateral frontoparietal white matter patterns consistent with X-ALD. After that he was referred to our clinic. Adrenal insufficiency was detected, and he was started on hydrocortisone therapy. Elevated very long-chain fatty acid levels were also found. Genetic testing revealed a novel mutation (NM_000033.4 c.778dup p.(Ala260GlyfsTer41) in the ABCD1 gene, which was also detected in the patient’s female sibling. Subsequently, he developed gait disturbances, paraparesis, and sphincter dysfunction. The patient exhibited rapid progression and is currently bedridden, being fed through a percutaneous enteral gastrostomy (PEG) in a three months. According to the evaluation of the patient, it was determined that he was not suitable for gene therapy or stem cell transplant due to the high Loes score (19), rapid progression, and his age. Conclusion X-ALD is a rare disease with significant morbidity and a high mortality rate. Typically, affected boys present between four and eight years of age. Our case involves late-onset and rapid progression with a novel mutation.

Aim: We aimed to evaluate clinical and laboratory parameters that may predict relapse in patients who have received adequate antithyroid drug (ATD) therapy for Graves’ disease (GD). Material and Methods: We included patients with GD who received ATD therapy for at least 12 months and were followed for at least 12 months after treatment. Patients were classified into relapse and non-relapse groups, and their demographical, laboratory, imaging findings, and follow-up information were recorded retrospectively. Results: Eighty-three patients were included, with a median treatment duration of 18 (13-24) month. Graves' orbitopathy (GO) was present in 58 (69.9%) of patients, and 17 (20.5%) received steroid therapy for GO. Relapse occurred in 27 (32.5%) of patients, with a median time to relapse of 22 (6-60) months, and 11 (40.7%) relapsed within the first 12 months. No association was found between TRAb positivity at diagnosis and relapse (p=0.542), but higher TRAb levels at ATD discontinuation (p=0.026), larger thyroid volumes (p=0.043), and lower TSH levels at diagnosis (p=0.027) were related with increased relapse risk. In the whole patient group, GH relapse was lower in those treated with corticosteroids as GO therapy (p=0.030). The regression model identified thyroid volume (p=0.044) and corticosteroid usage for GO (p=0.042) as predictors of relapse. Conclusion: Our findings suggest that while GH relapse might be more frequent in patients with larger thyroid volumes, corticosteroid therapy administered for GO may serve as a protective factor for GH relaps. The real-world data from our tertiary referral center may contribute to studies on GD relapse development, especially when considering sociodemographical differences.

Adults with type 1 diabetes (T1D) are reported to be at higher risk for clinical eating disorders (ED) and other disordered eating behaviors (DEB) than their peers without diabetes. On the other hand, there is insufficient data on DEB in adults with type 2 diabetes (T2D). Our study aimed to investigate the prevalence of DEB in patients with T1D and T2D on intensive insulin therapy followed in our outpatient clinic. Diabetes Eating Problem Survey-Revised (DEPS-R), electronically delivered to the patients with T1D and T2D who were on an intensive insulin regimen followed up in the diabetes outpatient clinic in our center for the evaluation of DEB. A total of 120 participants, 80 patients with T1D and 40 patients with T2D, were included in the study. DEB was defined as a DEPS-R score ≥ 20 according to the answers given to the questionnaire. Risk of DEB was observed in 35

Aberrant expression of glucose-dependent insulinotropic peptide receptors (GIPR) might regulate increased steroidogenesis in patients with ACTH-independent cortisol hypersecretion. This study investigated the presence of aberrant GIPR expression in patients with ACTH-independent cortisol hypersecretion and bilateral adrenal adenomas.Patients with bilateral adrenal adenomas, ACTH-independent CS and aberrant GIPR screened via mixed meal test were included. Patients' demographic features and laboratory and imaging findings were obtained retrospectively.Twenty-one patients were included. Overt CS findings were present in 14.3% of the patients. One patient (4.7%) had a complete positive response (537% increase) and one patient (4.7%) had a partial response (41% increase) to the mixed meal test. In the remaining 19 patients, a mean change of -10.1% (range: -56.5% to+24.7%) in cortisol levels was observed at 120 min compared to baseline. The patient with a complete positive response was confirmed using 100 µg of IV octreotide. The patient underwent unilateral adrenalectomy after an inadequate long-term response to octreotide LAR therapy. The histopathology revealed bilateral macronodular adrenal cortical disease. We identified a germline heterozygous frameshift variant in the KDM1A gene in the patient's blood sample and a recurrent deletion of the p arm of chromosome 1 harboring the KDM1A locus in the adrenal sample.These results may provide useful insights into the screening of aberrant GIPR expression in patients with ACTH-independent hypercortisolism. It is essential to further investigate which patients require screening. Moreover, a significant cortisol peak observed during the mixed meal test in the presence of these receptors has drawn attention.

Purpose Hyperglycemia in Type 1 diabetes mellitus (T1DM) leads to endothelial and vascular dysfunction, affecting various bodily functions, including psychological well-being, exercise capacity, and pulmonary function. This study investigates the impact of T1DM on quality of life, physical activity, exercise capacity, chronotropic response, pulmonary function, muscle strength, endurance, fatigue, and dyspnea. Methods In a cross-sectional study, 27 patients with T1DM and 26 healthy controls were compared. Quality of life World Health Organization (WHO) index, physical activity (metabolic holter), maximal exercise capacity (incremental shuttle walking test (ISWT)), chronotropic incompetence, pulmonary function (spirometer), muscle strength (dynamometer), respiratory muscle strength (mouth pressure device) and endurance (threshold loading test), fatigue (Fatigue Severity scale (FSS)), dyspnea (modified Medical Research Council scale (MMRC)) were evaluated. Results WHO index, physical activity levels, chronotropic index, pulmonary function, MIP, MEP, respiratory muscle endurance, FSS, and MMRC scores were similar between groups (p > 0.05). ISWT distance was clinically decreased in patients (p > 0.05). Quadriceps femoris muscle strength was reduced in patients (p < 0.05). 76 % of T1DM patients were inactive based on step counts, and 100 % were less active according to MET values. Also, 11.53 % exhibited chronotropic incompetence, 61.53 % reported severe fatigue, and 15.38 % experienced dyspnea. Conclusion Maximal exercise capacity decreased clinically in patients with T1DM, while respiratory muscle strength, endurance, and quality of life remain preserved. Muscle strength declines, with 28 % showing restrictive pulmonary function abnormalities. Thus, directing T1DM patients to exercise training and providing physical activity counseling are recommended. Clinical trials number NCT04819815, 2022-03-22.

PURPOSE:It can be challenging to localize the lesions in certain cases of primary hyperparathyroidism. Recently, it has been proposed that assessing the localization of parathyroid lesions with dynamic images enhances the diagnostic power of standard MRI (magnetic resonance imaging) due to the hypervascular structure of these lesions. In this study, we aimed to evaluate the success of four-dimensional dynamic perfusion MRI (4D MRI) in localizing parathyroid lesions. METHODS:Thirty patients who underwent 4-dimensional dynamic MRI diagnosed with primary hyperparathyroidism and indications for surgery, whose USG (ultrasonography) and/or Tc 99m sestamibi SPECT scan were negative or discordant, were included. The sensitivity and positive predictive values (PPV) were calculated for each imaging modality. RESULTS:Of the 30 patients, 29 had parathyroid adenoma, and one had parathyroid hyperplasia in histopathologic examination. 4D MRI accurately identified the location of parathyroid lesions in 25 of 30 patients (sensitivity 83.3%, PPV 96.1%), whereas USG successfully identified the lesion location in 21 patients (sensitivity 70%, PPV 91.3%) and Tc 99m sestamibi SPECT scan in 17 patients (sensitivity 56.7%, PPV 94.4%). The sensitivity of the combination of three imaging modalities was found to be 96.7%. CONCLUSION:4D MRI can be utilized as a complementary imaging modality to localize parathyroid lesions, offering the advantage of no ionizing radiation, especially when USG and/or Tc 99m sestamibi SPECT scans cannot reliably identify them.