INTRODUCTION:Constitutional thinness (CT) is an uncommon condition, allegedly non-pathological, defined by a persistently low body mass index (BMI <18 kg/m2) enduring from childhood through to later stages of life, without underlying chronic illnesses or hormonal abnormalities. Although CT is not associated with poor health outcomes, its long-term cardiovascular and metabolic implications remain unclear. Given that patients with CT often aim to achieve weight gain, and considering the lack of studies examining the outcomes of high-calorie dietary interventions in this population, we aimed to evaluate vascular and metabolic risk factors associated with atherosclerosis in CT individuals. METHODS:This prospective before-and-after study involved 60 nonsmoking, normotensive, normoglycemic participants with CT, all exhibiting normal lipid profiles (HDL: 55.8 ± 16 mg/dL; LDL: 66 ± 19.9 mg/dL). Changes in carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), fasting, and postprandial blood glucose levels before (T0) and after (T1) a 3-month high-calorie diet intervention was assessed using paired Student's t test. In addition, postprandial insulin levels were evaluated to capture potential metabolic adaptations. RESULTS:No significant changes were observed in CIMT (p = 0.54), FMD% (p = 0.423), BMI (p = 0.978), fasting (p = 0.297) or postprandial (p = 0.511) glucose levels, or lipid profiles (total cholesterol p = 0.138, HDL p = 0.858, LDL p = 0.66) after the 3-month high-calorie diet intervention. Both CIMT and FMD% remained within normal ranges at baseline and follow-up, suggesting that in the short term, individuals with CT do not experience substantial alterations in vascular or metabolic parameters despite increased caloric intake. A post hoc power analysis based on postprandial insulin (p = 0.007) showed a large effect size (Cohen's d = 0.71), with a power of 82% using G*Power software. CONCLUSIONS:Short-term high-calorie dietary intervention does not lead to significant cardiovascular or metabolic changes in individuals with CT. However, these findings should be interpreted with caution due to the small sample size and short duration. Further studies with longer follow-up and larger sample sizes, or different dietary compositions, may be necessary to evaluate long-term effects.

Aim: Obesity is a key risk factor for cardiovascular diseases, contributing to endothelial dysfunction and atherosclerosis. Pericardial fat, a visceral fat depot surrounding the heart, has emerged as an important cardiovascular risk factor. Its proximity to coronary vessels and its role in inflammatory processes suggest its potential impact on vascular health. This study investigates the effects of a probiotic-focused diet on cardiovascular risk markers, including carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and pericardial fat thickness in obese individuals. Methods: This was a 12-week prospective dietary intervention study designed to evaluate the effects of a probiotic-rich diet in 100 obese participants. The participants followed a probiotic-focused diet, and cardiovascular risk markers-including CIMT, FMD, and pericardial fat thickness-were measured before and after the intervention. Metabolic markers such as body weight, insulin levels, and high-sensitivity C-reactive protein (hsCRP) were also evaluated. Results: The probiotic group showed significant improvements in body weight, body mass index, insulin sensitivity, and hsCRP levels. However, no significant differences were observed in CIMT, FMD, or pericardial fat thickness between the two groups. Pericardial fat thickness showed a slight reduction in the probiotic group, but this change was not statistically significant. Conclusion: A probiotic-rich diet significantly improves metabolic health but does not result in significant changes in cardiovascular markers such as CIMT, FMD, or pericardial fat thickness in obese individuals over a 12-week period. Further research with longer intervention periods is necessary to explore the impact of probiotics on vascular health and pericardial fat accumulation in obesity.

This study aimed to investigate whether 25 µg/day dose of triiodothyronine (T3) can also suppress thyroid stimulating hormone (TSH) level, as well as the routine dose of 50–100 µg/day in T3 suppression test, which is used to the distinguish between resistance to thyroid hormone (RTH) and TSH secreting pituitary adenoma. In this prospective study, 26 patients with genetically proven RTH were randomly divided into two groups: Group 1 comprised 13 patients who were administered 50–100 µg/day T3 for 3–9 days, while Group 2 also comprised 13 patients who were administered 25 µg/day T3 for 7 days for T3 suppression test. The two groups’ responses to T3 suppression tests were compared. The comparison of the mean percentage changes in TSH values by the T3 suppression tests showed no significant differences between the groups, and a ≥80

BACKGROUND:This study compared the outcomes between intensive and nonintensive insulin regimens and assessed the predictive factors for failing to achieve the glycated hemoglobin (A1C) goals in type-2-diabetes-mellitus (T2DM) patients requiring insulin therapy.METHODS:A single-center, retrospective assessment of the medical records of 125 T2DM patients undergoing intensive (46 patients) and nonintensive insulin therapy (79 patients) were conducted.RESULTS:No significant differences were found when the intensive and nonintensive insulin therapy groups were compared in terms of the percentage decreases of glucose and A1C levels. The mean A1C levels of the nonintensive and intensive groups declined from 11.15% and 11.30% to 7.97% and 8.06%, respectively.CONCLUSIONS:Both intensive and nonintensive insulin therapies improved the baseline glycemic parameters but being overweight or obese and/or being reluctant to dietary recommendations led to treatment failures regardless of the insulin regimen.

Background:This case report provides detailed experiences of a patient with Multiple Endocrine Neoplasia type 2A (MEN-2A) who underwent surgery for pheochromocytoma and medullary thyroid cancer (MTC). Case Report: A 58-year-old male patient with resistant hypertension, despite triple anti-hypertensive drug therapy, was diagnosed with pheochromocytoma after investigation into the underlying etiology. Although the adrenalectomy performed was unilateral rather than bilateral, and there were no signs of Cushing's syndrome or adrenal insufficiency before the operation, temporary adrenal insufficiency developed after the excision of the large adrenal mass. Additionally, the biochemical diagnosis of MTC was primarily established using a calcium stimulation test (CST) rather than basal calcitonin levels. Conclusion: In cases where unilateral adrenalectomy is performed for a large adrenal mass, postoperative hypotension resistant to conservative therapy should raise suspicion of adrenal insufficiency. Furthermore, when basal calcitonin levels fall within the gray zone, a CST may be necessary for the diagnosis of MTC.

Background To investigate the topographic measurements and densitometry of corneas in Wilson’s disease (WD) patients with or without a Kayser-Fleischer ring (KF-r) compared to healthy individuals. Methods This cross-sectional study included 20 WD patients without a KF-r (group I), 18 WD patients with a KF-r (group II), and 20 age-matched controls (group III). The Pentacam high resolution imaging system is used to determine corneal topographic measurements and densitometry. Results Mean age for groups I, II and III was 25.40 ± 6.43 years (14–36 years), 25.38 ± 6.96 years (16–39 years), 23.60 ± 6.56 years (17–35 years), respectively ( P = 0.623). There was no significant difference between the groups in terms of the anterior corneal densitometry values ( P > 0.05), while the 6–10 mm and 10–12 mm mid stroma and the 2–6 mm, 6–10 mm, and 10–12 mm posterior corneal densitometry values in group II were significantly higher than those in groups I and III (for all values, P < 0.05). However, the 10–12 mm posterior corneal densitometry values in group I were also significantly higher than those in group III ( P = 0.038). The central corneal thickness (CCT), thinnest corneal thickness (tCT), and corneal volume (CV) values in groups I and II were significantly lower than those in group III (for CCT values, P = 0.011 and P = 0.009; for tCT values, P = 0.010 and P = 0.005; for CV values, P = 0.043 and P = 0.029). Conclusion In WD patients with a KF-r, corneal transparency decreased in the peripheral posterior and mid stromal corneal layers; for these patients, corneal transparency may be impaired not only in the peripheral cornea but also in the paracentral cornea.

PURPOSE:The aim of this study was to research the relationship between types of birth and congenital nasolacrimal duct obstruction.METHOD:The study enrolled 665 infantile patients with prediagnosis of congenital nasolacrimal duct obstruction due to associated ophthalmic symptoms. Age, gender, family history, delivery type, and patient medical records were investigated. Patients were grouped and compared according to their birth type and whether it was the first birth.RESULTS:The number of the infants with and without congenital nasolacrimal duct obstruction was 227 (34.1%) and 438 (65.9%), respectively. Comparison of the congenital nasolacrimal duct obstruction and non-congenital nasolacrimal duct obstruction groups according to the first births showed that ratio of cesarean section was significantly higher in the congenital nasolacrimal duct obstruction group than the non- congenital nasolacrimal duct obstruction group (58.7% and 20.7%, respectively). Number with positive family history also was significantly higher in the congenital nasolacrimal duct obstruction group.CONCLUSION:Cesarean section in first birth and positive family history of congenital nasolacrimal duct obstruction appear to be important risk factors in the etiopathogenesis of congenital nasolacrimal duct obstruction.

ABSTRACT Objective The insulin tolerance test (ITT) has been accepted as the gold standard test for assessing the integrity of the growth hormone (GH) – insulin-like growth factor (IGF-1) axis and the hypothalamic-pituitary-adrenal (HPA) axis. The goal of the test is to achieve clinical and biochemical hypoglycemia at a blood glucose level ≤ 40 mg/dL to effectively and correctly assess the HPA and GH-IGF-1 axes. In this study, the GH and cortisol responses of patients who achieved and failed to achieve biochemical hypoglycemia during an ITT were compared. Subjects and methods One hundred thirty-five patients with pituitary disorders were included in the study. Samples for blood glucose levels were obtained after clear symptoms of clinical hypoglycemia developed. The patients were enrolled in the hypoglycemic and nonhypoglycemic groups according to whether their plasma glucose level ≤ 40 mg/dL or > 40 mg/dL during an ITT, and the groups were compared in terms of their GH and cortisol responses. Results The mean age, body mass index and waist circumference of the two patient groups were found to be similar. The mean blood glucose level was significantly lower in the hypoglycemic group than in the nonhypoglycemic group (19.3 and 52.0 mg/dL, respectively). When the two groups were compared in terms of peak cortisol and GH responses, no statistically significant differences were found. Conclusion The data presented suggest that clinically symptomatic hypoglycemia is as effective as biochemically confirmed hypoglycemia during an ITT. Arch Endocrinol Metab. 2020;64(1):82-8

AIM:The aim of this study was to clarify the prognostic values of various preoperative factors, including the surgeon's ability as well as the patient's age, gender, tumor size, cavernous sinus invasion, compression of the optic chiasm, hypopituitarism, immunohistochemical (IHC) staining pattern of the adenoma, and insulin-like growth factor-1 (IGF-1) level, in acromegalic patients who had undergone pituitary surgery. STUDY DESIGN:This single-center, retrospective study assessed the medical records of 108 patients who had undergone pituitary surgery with the same neurosurgical team. RESULTS:The mean total follow-up period after surgery was 44.8 (min: 24, max: 59) months. Remission was reported in 67 (62.0%) patients, and 57 (52.8%) patients did not experience recurrence. Initial tumor volume, IGF-1 level, and optic chiasm compression, but not patients' age, gender, cavernous sinus invasion, and IHC staining patterns of the adenoma, were prognostic of either remission or recurrence. An IGF-1 level of 860 ng/mLwas found to be a convenient cut-off point for determining remission. CONCLUSIONS:The experience of the surgical team suggests that the initial tumor volume, IGF-1 level, and optic chiasm compression have high prognostic values in relation to pituitary surgery for patients with acromegaly.

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)

AIM The aim of this study was to assess the relationships among immunohistochemical staining patterns and prognostic factors in patients with non-functioning pituitary adenoma (NFPA). MATERIAL AND METHODS The study included 103 patients who had undergone pituitary surgery for NFPAs. The prognostic factors evaluated were initial tumor size, cavernous sinus invasion, compression of the optic chiasm, recurrence, residual tissue, reoperation, and hypopituitarism. RESULTS Recurrence rates were higher for NFPAs with large initial tumor volume and preoperative cavernous sinus invasion. Tumor recurrence rates were higher for NPFAs positive (55.6%) than negative (10.3%) for luteinizing hormone (LH). Reoperation rate, but not recurrence rate, was higher in patients with tumors positive than negative for follicle-stimulating hormone (FSH) group. Recurrence and reoperation rates were lowest in patients with null-cell adenomas. CONCLUSION In contrast to previous studies, we observed a higher recurrence rate in LH-positive than in LH-negative adenomas. To our knowledge, this is the first study showing an association between LH positivity and poorer prognosis; and in addition, optimal outcomes in patients with null-cell adenomas. Thus, additional studies are required to assess the relationship between LH positivity and poor prognosis in patients with NFPAs.

BACKGROUND/AIMThis study compared the genotypes and virulence factors of Candida species isolated from oral cavities of healthy individuals and patients with diabetes mellitus (DM).MATERIALS AND METHODSA total of 142 healthy individuals and 73 diabetic patients participated in this study. Study populations were classified into 4 groups as follows: Group I - Healthy, without caries; Group II - Healthy, with caries; Group III - DM, with caries; Group IV - DM, without caries. Diabetic patients' blood glucose and hemoglobin A1c concentrations were determined. Identification of Candida species was performed with conventional methods. Biofilm production, proteinase, phospholipase, and esterase were analyzed. The genetic diversity of Candida species was established using rep-PCR.RESULTSThe most isolated species was Candida albicans. There were statistical differences in terms of isolated Candida frequency between healthy subjects and diabetic patients. There was no statistical difference between the virulence factors of groups. Twelve genotypes were determined. While there were statistical differences in aerobe biofilm production, proteinase, and phospholipase activity between genotypes, there were no statistical differences in anaerobe biofilm production and esterase activity between genotypes.CONCLUSIONDiabetes has no effect on the activities of virulence factors of Candida species. Different genotypes of Candida albicans exhibited different virulence activities.

AIM:Total surgical resection of pituitary macroadenomas is difficult due to the location of the adenoma and the propensity to invade surrounding tissues. The purpose of this study was to evaluate the risk factors for invasive and aggressive pituitary macroadenomas using radiological, hormonal, clinical, and immunohistochemical markers.MATERIAL AND METHODS:Seventy cases of pituitary macroadenoma were examined. Age, gender, symptoms, the presence of fibrosis within the adenoma, hormonal levels, radiological findings, pathological results and immunohistochemical staining of the patients were evaluated using statistical methods.RESULTS:We observed that the patients with macroadenomas in our study most frequently presented during their 5th decade. The most frequent pituitary adenomas were non-functional, GH-secreting and PRL-secreting macroadenomas. The most frequent complaint was vision loss, headache and acral growth. Based on Magnetic Resonance Imaging (MRI) results, it was observed that the degree of invasion into surrounding tissues increased as the size of the macroadenoma increased. Macroadenomas that had invaded into the cavernous sinus invasion or that had a fibrotic tumor structure had a low probability of being resectable. There were no significant relationships between invasive behavior and p53, telomerase, ghrelin and CD46.CONCLUSION:It is not possible to identify only one factor that affects the prognosis of patients with pituitary macroadenomas. The contribution of the experience of surgeon to the treatment is surely beyond dispute. Fibrotic tumor structure, the surgical technique, the type of hormone, and cavernous sinus invasion affect the ability to perform a total resection and the overall prognosis.

Sheehan’s syndrome (SS) is a parturition-related pituitary disease resulting from severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. Pathological and clinical findings of SS were first described by Harold L. Sheehan in the previous century. Although his definitions are still valid, various studies and reports including new data have subsequently been published. Additionally, the diagnosis of SS has often been overlooked and thus delayed for long years due to its nonspecific signs and symptoms. Therefore, a large number of patients may be remained undiagnosed and untreated. SS is not as rare as assumed in developed countries, probably due to migrant women and unawareness of physicians regarding the syndrome. In this review, we provide a detailed review of the epidemiology, etiopathogenesis, clinical, laboratory and radiological features, new diagnostic criteria, differential diagnosis, and treatment of SS.

PURPOSE:The aim of this study was to evaluate the roles of factors associated with coagulation in the etiology and pathogenesis of Sheehan's syndrome (SS) which is a frequent cause of hypopituitarism in underdeveloped and developing regions of the world.METHODS:Mean prothrombin time (PT), activated partial thromboplastin time (APTT) and expression levels of genes, which included methylenetetrahydrofolate reductase (MTHFR), angiotensin I converting enzyme (ACE), coagulation factor V (FV), FVII, FVIII and FIX in 44 patients with SS were compared with 43 healthy subjects.RESULTS:The mean expression level of the ACE gene was significantly lower, while that of the FV gene was significantly higher in the patients with SS. No significant difference was found between the patients with SS and the healthy subjects in the comparisons of the remaining gene expression values, as well as in the PT and APTT values.CONCLUSION:An increased expression of the FV gene may be a contributing factor for the development of SS in some patients. Further studies are required to clarify the roles of coagulation disorders in the development of SS.

Thyrotropinomas are rare pituitary tumors that are difficult to diagnose due to their variety of clinical presentations. We describe three patients with thyrotropinoma and review the management of this disease based on current literature. Patient 1 had a typical acromegalic phenotype with a pituitary adenoma that secreted both growth hormone (GH) and thyroid-stimulating hormone (TSH). Patient 2 underwent pituitary surgery without antithyroid treatment; this tumor was also positive for both TSH and GH on pathological examination, and the patient experienced transient central hypothyroidism postoperatively. Patient 3, who had both a thyrotropinoma and autoimmune thyroiditis, underwent surgery after one year of treatment with lanreotide; the removed pituitary adenoma was positive only for TSH. To our knowledge, concomitant Graves' disease and thyrotropinoma is very rare, with only two patients previously reported. In conclusion, thyrotropinomas are increasingly being encountered when they are smaller, which has improved patient prognosis. Nevertheless, the diagnosis and perioperative management of thyrotropinomas remain challenging, which suggests that patients with such tumors should be managed by endocrinologists.