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

Metabolic syndrome (MS) may reduce circulating testosterone and, at the same time, low testosterone levels may lead to MS. Thus, identifying problems regarding sex hormones and examining their effects on the pathogenesis of MS is important to prevent serious complications of the condition, such as diabetes or cardiovascular diseases. This study aimed to investigate the correlations between MS-related parameters and androgen levels. A total of 108 males [median age 48.5 years (min/max = 21/77 years)] were included in the study. Blood pressure and anthropometric measurements (body mass index, waist circumference, hip circumference, thigh circumference, neck circumference, and length of index and ring finger) were performed. Biochemical analysis was assessed. Additionally, total testosterone, free testosterone, and sex hormone binding globulin levels were investigated. Weak negative correlations were observed between testosterone levels and several anthropometric measures/glucose metabolisms (p < 0.05). The highest correlation was between total testosterone levels and body mass index (rho= −0.390, p < 0.001) According to our results, controlling weight, one of the preventable risk factors, can have a positive effect on testosterone levels and, therefore, on the cardiovascular system through different mechanisms.

ABSTRACT Werner's syndrome is a rare disorder resembling premature aging. This autosomal recessive disorder is frequently associated with endocrinological problems, particularly diabetes mellitus and hypogonadism. Although the diagnosis is not difficult when it is kept in mind it may be so because of its rarity. In this report we present a case of Werner's syndrome who was hospitalized in our clinic because of diabetic foot. Detailed physical and laboratory examinations revealed that this 53-year-old male patient also had hypergonadotropic hypogonadism, gynecomastia and mental deficiency. Details of the syndrome with regard to clinical characteristics, diagnosis and therapeutic modalities are discussed.

ABSTRACT Werner's syndrome is a rare disorder resembling premature aging. This autosomal recessive disorder is frequently associated with endocrinological problems, particularly diabetes mellitus and hypogonadism. Although the diagnosis is not difficult when it is kept in mind it may be so because of its rarity. In this report we present a case of Werner's syndrome who was hospitalized in our clinic because of diabetic foot. Detailed physical and laboratory examinations revealed that this 53-year-old male patient also had hypergonadotropic hypogonadism, gynecomastia and mental deficiency. Details of the syndrome with regard to clinical characteristics, diagnosis and therapeutic modalities are discussed.

Amaç: Aşırı yeme bozuklukları olarak tanımlanan, duygusal, dışsal ve kısıtlayıcı yeme bozuklukları ile metabolik sendrom ve metabolik sendrom parametreleri arasındaki ilişkiyi saptamak. Gereç ve Yöntemler: İç Hastalıkları Polikliniğine ardışık olarak başvuran 169’u kadın, 58 i erkek, toplam 227 hasta alındı. Okuma yazma bilmeyen, mental geriliği olan, malignitesi bulunan ve herni, assit, karın içi kitle veya gebelik gibi bel çevresi ölçümünü etkileyebilecek faktörleri olan hastalar ile ortopedik anormallikleri olanlar çalışmaya alınmadı. Yeme bozukluklarının değerlendirilmesinde, “Hollanda Yeme Davranışı Anketi” Türkçe geçerlilik ve güvenilirlik çalışması yapılarak kullanıldı. Metabolik Sendrom tanısı için National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) kriterleri baz alındı. Bulgular: Duygusal ve dışsal yeme bozuklukları açısından, MS olan ve olmayan kadın ve erkekler arasında istatistiksel olarak anlamlı bir fark saptanmamıştır (p>0.05). Aynı durum, hastalar obez olanlar ve olmayanlar olarak ayrıldıklarında da benzerdir. Buna karşın; kadınlarda kısıtlayıcı yeme bozukluğu skorları gerek obez, gerekse MS olanlarda olmayanlara göre istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur.(p<0.05). Sonuç: Kısıtlayıcı yeme bozukluğu kadınlarda Metabolik Sendrom gelişimi ile ilişkilidir. Obezite ve komplikasyonlarının önlenmesinde karşılaşılan güçlükler, uygulanan benzer tipteki diyet programlarının hastalar tarafından idame ettirilememesi, hastaların aşırı yemeye neden olan yeme bozuklukları açısından değerlendirilmesinin ve öncelikle mevcut yeme bozukluğunun giderilmeye çalışılmasının önemini ortaya koymaktadır. Purpose: The objective of this study was to evaluate the association between excessive eating behaviours such as emotional, external and restrained eating with the development of metabolic syndrome. Methods: Study group consisted of 227 individuals consecutively examined at the outpatient clinic of Internal Medicine. Patients with illiteracy, mental retardation, malignancy, factors that may affect waist circumference measurement such as hernia, ascites, intra-abdominal mass or pregnancy, and those with orthopedic abnormalities were excluded from the study. To determine the eating behaviours, Turkish version of Dutch Eating Behaviour Questionnaire (DEBQ) were used after the validity and reliability of the test have been verified. National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) was used to diagnose metabolic syndrome. Results: No statistically significant difference was found between men and women with and without MS in terms of emotional and exogenous eating disorders (p> 0.05). The same results were obtained when patients were divided into obese and non-obese patients. However, restrictive eating disorder scores were significantly higher in women with metabolic syndrome or obesity than those who non-obese or did not have metabolic syndrome (p <0.05). Conclusion: In women, restrained eating disorder is associated with the development of metabolic syndrome. The difficulties encountered in the prevention of obesity, metabolic syndrome and its complications as well as the inability of the maintenance of similar diet programs by the patients reveals the importance of the evaluation and elimination of eating disorders that may cause these disorders. Key words: metabolic syndrome, eating disorders, restrained eating

The coexistence of different types of thyroid carcinomas is rather unusual. It has been considered coincidental and linked to the growing incidence of papillary thyroid carcinoma (PTC). This paper presents a case of multifocal PTC and coexistent medullary thyroid carcinoma (MTC) distinct from each other, along with PTC lymph node metastasis. The 44-year-old female patient underwent subtotal thyroidectomy with a pre-operative diagnosis of multinodular goiter. Histological reports revealed PTC in the right lobe and PTC beside a tumoral area morphologically suspicious for MTC in the left thyroid lobe. Immunohistochemistry confirmed the diagnosis of MTC. Post-operative ultrasound and subsequent fine needle aspiration biopsy revealed lymph node metastases of PTC in the right anterior cervical area. Complementary thyroidectomy, central neck dissection, and right modified neck dissection were carried out with subsequent I-131 ablation therapy. In conclusion, the biological behaviors and prognoses of MTC and PTC are different. Therefore, the entity demands a different clinical approach in treatment and follow-up.

Objective: In this study we evaluated the usefulness of 2nd to 4th (2nd:4th) digit length difference and ratio in determining hyperandrogenism in females and the relationship with metabolic syndrome.Methods: We designed a cross-sectional clinical study and examined 150 females who visited our clinic; 137 completed the study. We measured blood pressure and anthropometric values. Biochemical parameters associated with metabolic syndrome were also measured.Results: The mean age of our patient is 46.1 yrs. The 2nd:4th digit length difference and ratio were correlated slightly with total testosterone levels and positively with free testosterone levels (p=0.028, p=0.016, p=0.003, p=0.016). Sex hormone-binding globulin levels and 2nd:4th digit length difference and ratio were mildly negatively correlated (p=0.011, p=0.016). No statistically significant differences were found between 2nd:4th digit length difference and ratio, and metabolic syndrome parameters. Thus, the 2nd:4th digit length difference and ratio are significantly correlated with androgens.Conclusion: The 2nd:4th digit length difference and ratio, which are easily measurable values, can be used as an important predictor of hyperandrogenism in females. In the present study, 2nd:4th digit length difference and ratio were not statistically significantly correlated with metabolic syndrome; however, additional studies with a larger group of patients are necessary.

Disorders of sexual differentiation may be classified into two categories; 1-disorders of gonadal differentiation; and 2-disorders of genital development. Here we present a case with complete 46, XY gonadal dysgenesis (Swyer’s syndrome) which is one of the female phenotype sexual differentiation disorders resulting from abnormal gonadal differentiation. It is well known that the risk of gonadal neoplasia is increased in gonadal dysgenesis. Swyer’s syndrome should be differentiated from syndrome of complete androgen insensitivity (Testicular feminization) and from Leydig cell agenesis. In the latter two disorders phenotype is female, karyotype 46, XY, the gonads are testes, while uterus and tubes are absent. On the contrary, the patients with Swyer’s syndrome have uterus and cervix which are hypoplastic.

Background. The prevalence of gestational diabetes mellitus (GDM) continues to increase worldwide and women with a history of GDM are at high risk for type 2 diabetes. The role of adiponectin in GDM has not been clearly defined,Objective. Our objective was to investigate the relationship between adiponectin levels in women with GDM, and insulin resistance and glucose and lipid metabolism.Methods. Twenty-four women with GDIVI were compared with 20 women with normal glucose tolerance (NOT). Scrum adiponectin level, the homeostasis model assessment of insulin resistance (HOMA-IR), and metabolic variables related to glucose and lipid metabolism were measured in the third trimester of pregnancy and 3 months after delivery.Results. Adiponectin level was significantly lower in pregnant women with GDM than in those with NGT during pregnancy [6.5 (1-24) vs. 12.5 (5-18) mu g/mL; p < 0.001] and at 3 months postpartum [7.0 (1-21) vs. 12.5 (4-19) mu g/mL; p < 0.001]. HOMA-IR was higher in women with GDM during pregnancy (p = 0.001) and postpartum (p = 0.012).Insulin resistance, pre-pregnancy BMI (pr BMI), age, HDL-cholesterol during pregnancy, 2-h postprandial glucose level, insulin resistance, age and postpartum BMI during postpartum period were independently correlated with adiponectin level. Adiponectin level during pregnancy and postpartum was negatively correlated with pr BMI.Conclusion. Gestational diabetes is associated with hypoadiponectinemia during pregnancy and postpartum.Hypoadiponectinemia during pregnancy may contribute to the pathogenesis of GDM

This study reports a literature review aimed to analyse various studies related to the use of phytotherapy in diabetes mellitus in Turkey in order to provide additional information for healthcare professionals. The incidence of Diabetes Mellitus is rising and many of the diabetics frequently use herbal treatments along with modern medical treatment for glycaemic control and/or improve their well-being. Several electronic databases (such as Medline and Pubmed) were searched for 1990-2010 period (till May, 2010) and 33 related articles were analysed. Many studies--mostly animal trials- have been conducted in this field. Among the herbs most-commonly used along with modern medical therapies and also in folkloric medicine, we searched for bitter melon, cinnamon, fenugreek, olive leaf, black seed and white mulberry. Studies conducted in this field have produced conflicting results and, the necessity to conduct randomized, placebo-controlled clinical human studies to develop new drugs from herbs, as in the case of metformin, still remains important. Besides, further studies are required to address the issues of standardization and quality control of existing preparations. More importantly, healthcare professionals caring for diabetic patients need to be aware of phytotherapy to incorporate phytomedicine into their practices and should undertake more responsibility in relation to these kind of therapies that are commonly-used throughout the world.

Aim. This study was designed to measure serum fibroblast growth factor 21 (FGF21) levels in patients with polycystic ovary syndrome (PCOS) and healthy subjects.Methods. A total of 37 women were evaluated. Serum levels FGF21, glucose, lipid profile, hormones (follicle-stimulating hormone, luteinising hormone, oestradiol, testosterone, thyroid stimulating hormone, prolactin and insulin) were determined in 24 PCOS (15 subjects of PCOS BMI < 25 kg/m(2), 9 subjects of PCOS BMI >= 25 kg/m(2)) and 13 control group (BMI < 25 kg/m(2)).Results. Serum FGF21 levels were higher in the PCOS group [99.5 (173.7) pg/ml] than in the control group [52.0 (88.0) pg/ml]. LH and T are significantly higher in PCOS cases (respectively; p < 0.05, p < 0.01). A positive correlation was found between FGF21 and luteinising hormone and testosterone (respectively; r = 0.43 p = 0.007, r = 0.38, p = 0.02). Multivariate discriminant analysis showed that BMI, triglyceride, HOMA-IR, fasting glucose with rise of FGF21 were found significant in PCOS.Conclusion. Our study indicates that FGF21 in cases with PCOS exhibit an increase along with the increase of BMI and also has a positive correlation with LH and T. Further studies are required to clarify the aetiology and effects of FGF21 in women with PCOS.

Fever of unknown origin (FUO) was described in 1961 by Petersdorf and Beeson as a fever above 38.3°C that lasts more than three weeks and cannot be diagnosed despite a one-week hospitalized examination. In 1991, Durack and Street made a different FUO description for patients with nosocomial infections, human immunodeficiency virus (HIV) and neutropenia. Along with this reconsideration, the investigation period was limited to one week of investigation, three days of hospitalization or three clinical visits. In the literature, the most frequent cause of FUO is infections followed by neoplasms and connective vascular diseases, respectively. The etiology in 5-15% of patients can not be diagnosed despite detailed examination. Here, we present a 75-year-old patient admitted to the hospital with a two-week history of fever, fatigue and lack of appetite. He had been examined in the infection and lung diseases clinics over a three–month period without diagnosis. In our internal medicine clinic, we diagnosed the patient as Wegener granulomatosis and a satisfactory response to the therapy was observed. (Turk J Rheumatol 2010; 25: 159-61)

Abstract Objective: Visfatin is a adipocytokine suggested to play a role in glucose homeostasis. The aim of this study is to investigate the relationship of simple anthropometric measures of obesity and metabolic syndrome with visfatin. Materials and Methods: Eighty-eight obese females were evaluated in our study. We used anthropometric measures to determine obesity and NCEP-ATPIII criteria, which best predict the metabolic syndrome. Visfatin concentrations were compared between the groups after categorizing the subjects according to obesity degree and presence or absence of metabolic syndrome. Results: Visfatin levels were not statistically significant between overweight/obese and morbidly obese groups, but it was observed that visfatin levels rose as BMI increased. However, visfatin levels did not differ between the subjects with or without metabolic syndrome. Conclusion: Our results suggested that increased concentrations of visfatin may be associated with obesity but not with metabolic syndrome. Further studies may lead to new insights into physiological role of visfatin in glucose homeostasis and metabolic diseases.

BACKGROUND:In hypothyroid patients, the risk for cardiovascular disease is higher and ultrasonography (US) demonstrates that the carotid intima-media thickness (CIMT) is significantly increased. We hypothesized that L-thyroxine replacement therapy might be able to reverse the process associated with increase in CIMT in patients with primary hypothyroidism.PATIENTS:In this study, a total of 43 females with primary hypothyroidism and 21 euthyroid females as control group were included. In hypothyroid patients, CIMT was measured using US and the measurement was repeated 6 months after euthyroidism was achieved with L-thyroxine replacement therapy. Biochemically, lipid profile, high sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitory-1 (PAI-1) and fibrinogen levels were measured.RESULTS:It was found that in hypothyroid patients the value of CIMT was significantly higher than those in control group (0.534+/-0.08 mm vs. 0.443+/-0.05 mm, respectively; p<0.001). However, the value of CIMT decreased significantly in all but two patients after euthyroidism was achieved with L-thyroxine replacement therapy (0.534+/-0.08 mm and 0.465+/-0.06 mm, respectively; p<0.001). Moreover, there was a positive correlation between the CIMT value and all other parameters except patient age, including total cholesterol (r=0.437, p=0.003), low density lipoprotein (LDL) cholesterol (r=0.415, p=0.006), total cholesterol/high density lipoprotein (HDL) cholesterol ratio (r=0.391, p=0.01) basal levels.CONCLUSION:This report demonstrates that in patients with primary hypothyroidism, in addition to values of total cholesterol, LDL cholesterol, and total cholesterol/HDL cholesterol ratio, the CIMT value was higher compared to healthy controls. Importantly, the value of CIMT, as well as the levels of lipid parameters, decreased to normal level after L-thyroxine replacement therapy. Furthermore, significant correlations were detected between the changes of CIMT and the changes of total cholesterol and LDL cholesterol respectively. Thus, it is suggested that an increased CIMT value may be an objective sign of accelerated atherosclerosis in patients with primary hypothroidism.

ditary, multisystemic disorder. The most common extrarenal feature of ADPKD is liver cysts originating from biliary ductal microhamartomas. Usually, there are no symptoms related to liver cysts and no treatment is required. Symptoms, when they occur, are caused by the mass effect of the cysts. They include abdominal distention and pain, dyspnea, low back pain, and those caused by the development of complications such us cyst infection, hemorrhage, rupture, extrinsic compression of the portal vein and intrahepatic radicles, inferior vena cava, hepatic veins, or bile ducts.

Introduction: Hirsutism is commonly a consequence of ovarian androgen over-production. Polycystic ovary syndrome (PCOS) or peripheral hypersensitivity to normal androgen circulating levels (idiopathic hirsutism) can be the underlying cause. Several drugs with anti-androgenic properties, such as cyproterone acetate (CPA), spironolactone and flutamide have been used to treat hirsutism, but the efficacy of these drugs has yet to be fully elucidated. The objective of this study was to compare the effectiveness of flutamide, and spironolactone plus a combination tablet of 2 mg CPA/35 μg ethinyloestradiol (EE) in the treatment of hirsutism.