Background/aim:This study aimed to evaluate the demographic, clinical, and hormonal characteristics; comorbidities; surgical pathology; treatment modalities; and long-term clinical outcomes of patients diagnosed with and managed for acromegaly at our tertiary referral center over a 15-year period. Materials and methods:Between 2010 and 2024, 247 patients with acromegaly were evaluated. Diagnosis and biochemical remission were determined according to the 2024 Acromegaly Consensus Criteria. Results:The median follow-up duration was 8 years (IQR: 3-14). At the time of diagnosis, the most frequent pituitary hormone deficiency was secondary adrenal insufficiency, present in 17.8% of patients. The most common comorbidities were hypertension (HT, 42.1%) and diabetes mellitus (DM, 30.8%). At the time of diagnosis, macroadenomas were present in 153 of 193 patients (79.3%), and, according to the Knosp classification, 28.6% of tumors were grade 4. A total of 218 patients underwent surgical intervention; 86 (39.4%) achieved postoperative cure without the need for adjuvant medical therapy or radiotherapy. Postoperatively, one or more anterior pituitary hormone deficiencies were found in 34 patients (22.8%), with central hypothyroidism being the most common (52.9%). Patients who achieved biochemical remission were significantly older (p = 0.003), had a higher prevalence of HT and DM (both p < 0.05), and were more likely to exhibit positive growth hormone (GH) immunostaining (p = 0.017). In contrast, those who did not achieve remission were more likely to have higher Knosp grades (3-4) (p = 0.002). Conclusions:In this study, a favorable prognosis was associated with older age at diagnosis, lower baseline GH levels, positive GH immunostaining, smaller tumor size, and lower Knosp grade, underscoring the prognostic value of both biochemical and anatomical parameters. Further studies are warranted to refine prognostic markers and establish standardized treatment algorithms to improve long-term outcomes in acromegaly.

ABSTRACT Purpose Acromegaly is commonly associated with diabetes mellitus (DM), and its prevalence may be higher among individuals with type 2 DM than in the general population. This study aimed to assess the frequency of acromegaly in patients with poorly controlled type 2 DM. Methods This cross‐sectional study included 504 patients (mean age: 57.7 ± 10.8 years) with uncontrolled type 2 DM (HbA1c > 8%) despite at least 1 year of insulin treatment (insulin alone or oral anti‐diabetic drugs together with insulin). Serum insulin‐like growth factor 1 (IGF‐1) levels were measured for screening. In patients with elevated IGF‐1, growth hormone (GH) levels were assessed by oral glucose tolerance test (OGTT). Pituitary magnetic resonance imaging (MRI) was performed in cases with persistently elevated IGF‐1 and inadequate GH suppression or discordant post‐glucose GH levels. Results The median duration of DM was 9 (3–15) years, and the mean HbA1c was 11.12% ± 2.30%. Elevated serum IGF‐1 levels were found in 2 of the 504 patients (0.39%). Both underwent OGTT for GH evaluation. One patient showed appropriate GH suppression, and the other demonstrated borderline GH suppression (a nadir GH of 0.88 ng/mL) with a 4 × 3 mm cystic pituitary lesion on MRI. However, given the absence of acromegalic clinical features and lack of biochemical confirmation, acromegaly was not diagnosed in either case. Conclusion Routine IGF‐1 screening in all patients with poorly controlled type 2 DM has limited diagnostic yield. IGF‐1 testing should be reserved for patients exhibiting clinical features or phenotypic suspicion of acromegaly.

The factors predicting the long-term response to cabergoline are not well known, particularly in more invasive prolactinomas. This study aimed to evaluate the rate of good response (GR) (normoprolactinemia and ≥ 50

Background The risk of death is increased in acromegaly patients compared to the general population, and cardiovascular system-related complications are among the risk factors decreasing life expectancy. The Tp-e interval, which is the distance between the point where the T-wave peaks and ends on electrocardiography (ECG), shows ventricular rapolarization and, together with the Tp-e/QT and Tp-e/QTc ratios, these are relatively new tools that predict ventricular arrhythmia. We aimed to evaluate the ECG of acromegaly patients at the time of diagnosis and compare the results with current ECG findings. Material and Methods The study included 103 acromegaly patients and 81 control subjects. Of the 103 patients, 41 patients had only baseline ECG, 23 patients had only current ECG and 39 patients had both baseline and current ECGs. Heart rate, QT interval and corrected QT (QTc) interval, Tp-e, Tp-e/QT, Tp-e/QTc values on the ECGs were measured by a cardiologist. Results In the acromegaly patients with both baseline and current ECGs, heart rate, QRS duration, Tp-e, and Tp-e/QTc ratio were decreased. The decrease in these arrhythmia parameters was similar in active and remission patients. Compared to the control group, in acromegaly patients with only baseline ECG, heart rate, QTc interval, Tp-e, Tp-e/QT, and Tp-e/QTc were decreased. Conclusion Ventricular arrhythmia parameters improve with treatment in patients with acromegaly. The decrease in ventricular arrhythmia parameters was similar in active and remission patients, which can be explained by the significant decrease in IGF-1 levels compared to the time of diagnosis, even in patients with active disease.

Objectives: This study aims to investigate whether the middle ear resonance frequency (RF) is affected in acromegaly, which causes growth in the skull bone. Methods: Thirty acromegaly patients and 38 volunteers were included in the study. Pure tone average scores and middle ear RF values of the groups that underwent pure tone audiometry, tympanometry, and multifrequency tympanometry tests were compared. Results: The pure tone mean was 14.95 +/- 12.13 in acromegaly patients and 5.70 +/- 8.52 in the control group (p:0.18). Sensorineural hearing loss(SNHL) was observed in 16.6% of the patients. The average middle ear RF was calculated as 815 +/- 179.05 Hz in patients with acromegaly and 773 +/- 127.15 in the control group. ( p = 0.0001). Conclusion: This study is the first to evaluate middle -ear RF in acromegaly patients. Acromegaly-induced changes in soft tissues and bone structures impact middle ear functions. In this patient group, we found an increase in middle ear RF without conductive -type hearing loss and a 16.6% rate of SNHL.

Objective: It was previously shown that the levels of several biomarkers increase due to acromegaly disease-related inflammation, and some markers are parallel to the disease's activity. The current study compared the possible relationship of growth differentiation factor-15 (GDF-15) with acromegaly disease activity in healthy subjects. Methods: This case-control study was conducted in a single center. It included 40 acromegaly patients (25 active/15 controlled) (47.7 +/- 9.4 years, 20 female/20 male) and 24 healthy individuals (49.9 +/- 10.1 years, 13 female/11 male) with age-sex-body mass index similar to the patient group. Demographic data, metabolic and hormonal parameters, and GDF-15 levels of the study population were studied. Results: The median GDF-15 levels were significantly higher in patients with acromegaly compared to healthy subjects (HS) (280.4 (Q1-Q3: 197.0-553.2) vs. 213.3 (Q1-Q3: 179.9-297.2) ng/L, P = .01). Serum GDF-15 levels of active and controlled acromegaly patients were comparable (P = .39). Interestingly, compared to HS, GDF-15 levels were significantly higher in controlled disease (P = .013), whereas GDF-15 levels tended to be higher in active disease but did not reach statistical significance (P = .06). Growth differentiation factor-15 levels were positively correlated with fasting plasma glucose (r = 0.304, P = .01) and HbA1c (r = 0.292, P = .02). When evaluated across the entire cohort, GDF15 levels were found to be higher in diabetic patients compared to non-diabetic individuals (P = .04). Conclusion: Plasma GDF-15 levels were increased in the patients with acromegaly compared to healthy subjects. This increment may be due to accompanying diseases such as diabetes rather than a disease-specific effect.

Aims: We aimed to investigate the changes in glycemic status and beta cell function in type 2 diabetes mellitus (T2DM) patients with poor glycemic control despite receiving basal/bolus insulin therapy when switched from insulin therapy to combination therapy [exenatide/pioglitazone/sodium glucose cotransporter 2 inhibitor (SGLT-2i)]. Methods: A retrospective examination was made of the data of 64 patients, aged >18 years, diagnosed with T2DM, who were being followed up in the endocrinology outpatient clinic and were switched from basal/bolus insulin therapy to triple combination therapy. At the time of the patients changing to combination therapy, the glycosylated hemoglobin (HbA1c) value was ≥8.5% and fasting c peptide value was within the normal reference range. The anthropometric data of the patients, and glycemic and biochemistry values with modified homeostastis model assessment β (HOMA-β) levels were compared before the combination therapy and at 6 months after. Results: Compared to the baseline values, a decrease was seen after 6 months in the values of body weight (89.6±5.8 vs. 83.8±3.6, p=0.015), body mass index (BMI) (38.3±2.7 vs. 33.5±1.9, p=0.011), and waist circumference (105.6±8.8 vs. 99.7±6, p=0.027). A decrease was determined in fasting blood glucose (FBG) (197±27.3 vs. 129±13.1, p

OBJECTIVE:Despite improvements in diagnostic methods, acromegaly is still a late-diagnosed disease. In this study, it was aimed to automatically recognize acromegaly disease from facial images by using deep learning methods and to facilitate the detection of the disease.DESIGN:Cross-sectional, single-centre study.METHODS:The study included 77 acromegaly (52.56 ± 11.74, 34 males/43 females) patients and 71 healthy controls (48.47 ± 8.91, 39 males/32 females), considering gender and age compatibility. At the time of the photography, 56/77 (73%) of the acromegaly patients were in remission. Normalized images were obtained by scaling, aligning, and cropping video frames. Three architectures named ResNet50, DenseNet121, and InceptionV3 were used for the transfer learning-based convolutional neural network (CNN) model developed to classify face images as "Healthy" or "Acromegaly". Additionally, we trained and integrated these CNN machine learning methods to create an Ensemble Method (EM) for facial detection of acromegaly.RESULTS:The positive predictive values obtained for acromegaly with the ResNet50, DenseNet121, InceptionV3, and EM were calculated as 0.958, 0.965, 0.962, and 0.997, respectively. The average sensitivity, specificity, precision, and correlation coefficient values calculated for each of the ResNet50, DenseNet121, and InceptionV3 models are quite close. On the other hand, EM outperformed these three CNN architectures and provided the best overall performance in terms of sensitivity, specificity, accuracy, and precision as 0.997, 0.997, 0.997, and 0.998, respectively.CONCLUSIONS:The present study provided evidence that the proposed AcroEnsemble Model might detect acromegaly from facial images with high performance. This highlights that artificial intelligence programs are promising methods for detecting acromegaly in the future.

Aim: We consider mean platelet volume (MPV), a pointer of platelet activity related to type 2 diabetes mellitus (T2DM) and vascular complications, may have a role in patients using Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i). Therefore, we aimed to evaluate the MPV change after SGLT2i use in diabetic patients.Matherial and Method: Hemogram parameters such as hemoglobin, hematocrit, and MPV in the 0th and 24th weeks of 102 patients with T2DM that received SGLT2i treatment added to their existing medications and of the control group in which participants are compatible in terms of age and gender factor were compared.Results: A significant increase was observed in the values of MPV and hemoglobin in the 0th and 24th weeks (9.3 (8.2-10.3) to 10.1±1.3, p<0.001, 13.9±1.42 to 14.4±1.5 p<0.001, respectively). Similarly, the hematocrit value increased (42±3.7 to 44.2±3.8, p<0.001). There was also a significant increase in both red blood cell (RBC) and platelet counts (5±0.42 to 5.2±0.47, p<0.001, 252,000 (209,000-304,000) to 262,000 (221,000-322,000), p=0.007, respectively). No correlation was identified in patients with T2DM between MPV and age and gender factors, diabetes duration, body mass index (BMI), fasting and postprandial blood glucose, and insulin use.Conclusion: Contrary to the studies analyzing the relation between MPV and T2DM and its complications, we detected that a 24-week SGLT2i treatment led to an increase in MPV value.

AIM:The levels of serum phosphorus (P) are low or low-normal in primary hyperparathyroidism (PHPT), and there is an inverse relationship between the levels of parathormone (PTH) and P. However, when considering the diagnostic and surgical indication criteria of PHPT, serum P levels are generally ignored. The aim of this study was to retrospectively evaluate the association of serum P levels with the clinical outcomes of PHPT. MATERIALS AND METHODS:A retrospective evaluation was made of the data of 424 consecutive patients (370 females, 54 males) with PHPT who presented at our centre. RESULTS:The mean age of the study population was 57 ± 11.68 years. The mean P was 2.57 ± 0.53 mg/dl. Asymptomatic disease was determined in 199 (47%) patients. Male patients had significantly lower levels of P. Symptomatic patients and patients with renal stones, vitamin D < 20 µg/l, calcium level ≥ 11.2 mg/dl, 24 h urinary calcium > 400 mg/day, or hypomagnesemia, were seen to have significantly lower levels of P (p < 0.05). Hypophosphatemia (hypoP) was found in 202 of 424 patients (47%), and these patients had a higher rate of symptomatic disease (63% to 44%, p < .0001). Of the 61 (88%) patients with moderate hypoP, 54 (88%) had at least one of the surgical criteria. A statistically significant increase in the incidence of hypoP was determined in symptomatic and male patients. In the patients with hypoP, serum PTH and urine calcium levels were found to be higher, and lumbar T-scores and serum vitamin D levels were lower. The patients with hypoP had higher rates of renal stones and osteoporosis (p < 0.05). CONCLUSIONS:The current study results show that hypoP is associated with a higher risk of osteoporosis and renal stones in PHPT patients. Even if patients are asymptomatic, moderate hypoP may be associated with poor outcomes of PHPT. Therefore, moderate hypoP may be a new criterion for parathyroidectomy, regardless of hypercalcemia level.

The aim of this study was to investigate the prevalence of simple renal cysts (SRCs) and kidney stone disease (KSD) together with laboratory data in patients with acromegaly through comparisons with healthy subjects, and to examine the possible risk factors associated with these abnormalities in acromegaly. This retrospective, single-center study included 125 acromegaly patients (46.4 ± 11.6 years, 68 females/57 males) and 114 age-sex matched healthy individuals (45.3 ± 12.4 years, 59 females/55 males). Demographic data, clinical history, biochemical and abdominal/urinary system ultrasonographic data of the patients were reviewed. The SRC prevalence (28.8

Magnesium (Mg) homeostasis is closely related to calcium (Ca) metabolism. Hypercalcemia inhibits the reabsorption of Mg from the kidneys, leading to hypomagnesemia. Therefore, patients with primary hyperparathyroidism (PHPT) are predisposed to hypomagnesemia. However, there are few studies on the clinical significance of hypomagnesemia in PHPT. The aim of this study was to retrospectively evaluate the association of hypomagnesemia with the clinical outcomes of PHPT. A retrospective evaluation was made of the data of 538 consecutive patients (478 females, 60 males) diagnosed with PHPT in our center. The mean age of the study population was 56.5 ± 11.66 years. The mean serum Mg level was 2 ± 0.26 mg/dl. Asymptomatic disease was present in 241 (44

Background/aim: To reveal the impacts of dapagliflozin, a sodium glucose transporter-2 inhibitor (SGLT-2i), on body weight and body composition, cardiovascular risk indices, and carotid intima-media thickness (CIMT). Materials and methods: The data of patients with type-2 diabetes mellitus (T2DM) who applied to Department of Endocrinology and Metabolic Disorders between September 2019 and 2020, and had started dapagliflozin treatment along with their current medications were recorded retrospectively. Body weights, body compositions measured through bioelectrical impedance, and CIMT with T2DM receiving SGLT-2i treatment and medication were measured at weeks 1, 12, and 24 of 42. The visceral adiposity index (VAI), lipid accumulation product (LAP), and atherogenic index of plasma (AIP) were used to determine the lipid measurements and anthropometric values. Results: The mean change in the total body weight and total fat mass was ?2.96 and ?1.97 kg, respectively (p < 0.001). There was a reduction in total fat mass of 1.23 kg (from 31.4 to 29.3 kg, p < 0.001) and in body fat percentage of 2.5% (from 35.8% to 34.4%, p < 0.001) in the first 12 weeks. A mild increase was observed in both the total fat mass and body fat percentage between weeks 12 and 24, which was not statistically significant (p = 0.783 and p = 0.925, respectively), whereas there was a statistically significant reduction in high-sensitive C-reactive protein (hsCRP), AIP, and CIMT values (p = 0.006, p = 0.035, and p = 0.007, respectively). No changes were observed in the VAI and LAP values (p = 0.985 and p = 0.636, respectively). Conclusion: It was observed that dapagliflozin not only contributes to weight and fat loss but also has positive impacts on cardiovascular and atherosclerotic indicators.

In this article, we present a case of diffuse follicular variant papillary thyroid carcinoma with pituitary metastasis, which is a rare cause of pituitary metastasis.The follicular variant of papillary thyroid carcinoma is an uncommon variant of papillary carcinoma.A 74-year-old male was presented with weakness, fatigue, and a decreased appetite.The patient was diagnosed with secondary adrenal and thyroid insufficiencies.Imaging revealed a pituitary mass with suprasellar extension, right cavernous sinus invasion, and optic chiasm compression.Thyroid ultrasonography revealed a nodule with a maximum size of 7.2cm in the right lobe.Cytological examination via fine-needle aspiration suggested papillary thyroid cancer.Total thyroidectomy with central and right lateral neck dissection confirmed the diagnosis of diffuse follicular variant of papillary thyroid carcinoma.Owing to visual field defects, the patient underwent transsphenoidal surgery.Histological and immunohistochemical evaluations confirmed pituitary metastasis from the papillary thyroid cancer.Radioactive iodine treatment and gamma knife radiotherapy of the pituitary gland were performed.The initiation of sorafenib treatment was deemed appropriate during the follow-up.A significant decrease in the thyroglobulin levels was observed after sorafenib treatment.Pituitary metastasis should be considered in patients diagnosed with hypopituitarism and pituitary lesions at initial evaluation.The presence of visual field defects may be an indication for neurosurgical intervention and guide both diagnosis and treatment.The management of papillary thyroid cancer and the role of treatment modalities in prognosis depend on the biological behavior of the tumor.Early diagnosis and multidisciplinary management are crucial for the treatment of these patients.

BACKGROUND:Nodular thyroid disease is a frequent finding seen in patients with acromegaly. Ultrasound-elastography (US-E) appears to be a helpful tool for the diagnosis of thyroid cancer. The aims of this study were to evaluate thyroid nodules in acromegaly and to assess the diagnostic accuracy of US-E in detecting thyroid cancer in this population. METHODS:US-E was applied to 166 nodules detected in 102 acromegalic patients and to 105 nodules found in 95 nonacromegalic subjects. The lesions were classified according to the elasticity scores (ES) as soft (ES 1-2) or hard (ES 3-4). RESULTS:: Mean age was 55.1 ± 12.47 years [59 (58%) women]. The prevalence of hard nodules (ES 3 and 4) was significantly higher in the group of acromegalic patients than in control subjects (48% to 20%, p < 0.001). Mean ES was higher in patients with acromegaly (2.45 to 2.22, p: 0.001), however, the mean strain index (SI) was similar between groups (1.53 to 1.65, p: 0.204). DISCUSSION:Thyroid nodules in acromegaly patients have a higher elasto score and the prevalence of hard nodules is higher in active disease. However, increased stiffness of nodules by US-E in patients with acromegaly does not seem to estimate the malignancy of the nodules.

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

Böbrek nakli sonrası erken dönem hasta ve graft sağkalımı, birbiriyle ilişkili birçok karmaşık faktöre bağlıdır. Bu çalışmada; canlı ve kadaverik vericiden böbrek nakli yapılan hastalarda intra- ve post-operatif gelişen medikal ve cerrahi komplikasyonların sıklığı ve bu komplikasyonların erken dönemde hasta ve graft sağkalımı üzerine olan etkileri araştırıldı. Tek merkezde on yıllık dönemde böbrek nakli yapılan 498 hasta verileri retrospektif olarak incelendi. Alıcıların demografik, diyaliz ve nakil bilgileriyle, intra- ve post-operatif komplikasyonlar tıbbi kayıtlardan elde edildi. Komplikasyon gelişimi ile hasta ve graft sağkalımını etkileyen risk faktörler değerlendirildi. Çalışmamızda, canlı vericili nakillerde intra-operatif cerrahi komplikasyon, kadaverik vericili nakillerde post-operatif medikal ile post-operatif medikal ve cerrahi komplikasyon sıklığı anlamlı olarak yüksek saptandı. Gündüz çalışma saatleri dışında yapılan operasyonlarda post-operatif medikal komplikasyonlar daha sık görüldü. Post-operatif cerrahi komplikasyon ile post-operatif medikal ve cerrahi komplikasyon görülmesi ise istatistiksel olarak graft sağkalım süresini ve hasta sağkalım süresini anlamlı olarak kısalttı. İntra-operatif medikal ve cerrahi komplikasyon gelişiminde; verici yaşındaki 1 birimlik artış komplikasyon riskini 1.027 kat arttırdı. Nakil öncesi diyaliz modalitesinin hemodiyaliz olması, periton diyalizi olmasına kıyasla intraoperatif medikal ve cerrahi komplikasyon gelişme riskini 3.816 kat arttırdı. Sonuç olarak, gözlemlerimiz erken dönemde medikal ve cerrahi komplikasyonların sık görüldüğünü ve bu komplikasyonların hasta ve graft sağkalımını etkileyebileceğini düşündürmektedir.

Although many studies have shown the relationship between type 1 diabetes mellitus (T1DM) and autoimmune thyroid diseases, few studies have conducted a morphological evaluation of the thyroid gland in T1DM without thyroid disease. This study aimed to compare thyroid ultrasonography findings of the healthy control group with the T1DM group without thyroid disease and examine the relationship between β-cell autoantibodies and the presence of thyroid nodules. This cross-sectional study included 119 patients with T1DM and 105 healthy controls. Thyroid function tests, thyroid volume, and presence of thyroid nodules were compared between the two groups. Patients with T1DM were divided into two groups according to the presence of thyroid nodules, and risk factors that may affect the development of thyroid nodules were tried to be determined. No significant difference was found between the control group and the T1DM group in terms of thyroid function tests, thyroid volume, and presence of thyroid nodules. In the T1DM group, the number of female patients and the islet cell antibody (ICA) positivity rate were higher in the presence of thyroid nodules. As a result of regression analysis, ICA positivity in the T1DM group increased threefold the risk of having thyroid nodules. A relationship was observed between ICA positivity and thyroid nodules in T1DM. Thus, cases with ICA positivity may have a higher probability of nodules in the thyroid gland, and neck examinations should be performed more frequently.

Background: The nadir growth hormone (nGH) during the oral glucose tolerance test (OGTT) is the gold standard method for diagnosing acromegaly. A paradoxical growth hormone (GH) response to oral glucose (OG) in acromegaly can be observed. The role of the paradoxical GH response on how the patients with acromegaly respond to the treatment has been addressed in few studies. The aim of this study was to investigate the asso-ciation between glucose-dependent growth hormone results and and the responses of acromegalic patients to surgical and/or medical therapy following surgery.Material and methods: This retrospective cohort study included patients with acromegaly who underwent surgery (n = 189) or received primary medical treatment (n = 9). The mean age was 50.44 +/- 12.81 years (M/F: 84/114). The patients were grouped into paradoxical (GH-P) and non-paradoxical (GH-nP) according to GH response to OG and were compared in terms of clinical and pathological features, pituitary tumor size, invasiveness, biochemical profiles, and how they responded to the treatment.Results: The mean age, gender distribution, and basal tumor diameter were all similar in both groups (p > 0.05). The GH-P group had a higher remission rate in response to medical therapy followed by surgery (83% vs. 55%; p = 0.026). Although a higher surgical remission rate in favor of GH-P was observed, it did not reach statistical significance (63% vs. 48%; p = 0.059). Overall treatment response rates were also higher in the GH-P group compared to the GH-nP group (89% vs. 71%; p = 0.005).Conclusion: A paradoxical GH response to OG load may help to predict the response to medical treatment in patients with acromegaly.