To investigate the alterations in the diffusion tensor imaging (DTI) parameters measured in the hunger and satiety centers of the brain before and after bariatric surgery (BS) in morbidly obese patients. Fourty morbidly obese patients were evaluated before and after BS. Mean diffusivity (MD) and fractional anisotropy (FA) values were calculated from 14 related brain locations, and the DTI parameters were analyzed. After the BS, the mean BMI of the patients decreased from 47.53 ± 5.21 to 31.48 ± 4.21. The MD and FA values in the all of the hunger and satiety centers was found statistically significant different in the pre-surgery period compared to the post-surgery period (for each; p-value < 0.001). The FA and MD changes after BS may be attributed to reversible neuroinflammatory alterations in the hunger and satiety centers. Decreased MD and FA values after BS may be explained by the neuroplastic structural recovery in the related brain locations.

This study was aimed to investigate the effect of weight loss by bariatric surgery on the level of anti-Mullerian hormone (AMH) in morbidly obese female patients with or without polycystic ovary syndrome (PCOS). This prospective study includes 70 females, obese, and fertile patients of reproductive age. All patients were evaluated to determine the changes in weight, body mass index (BMI), serum AMH, and other biochemical parameters at the end of six months. The mean levels of the preop and postop AMH were 1.66±0.87 ng/ml and 5.99±1.39 ng/ml in the PCOS group; 1.35±0.76 ng/ml and 6.23±1.47 ng/ml in the non-PCOS group, respectively. The postop AMH levels were significantly higher than the preop levels for both groups (p<0.001). There were significant differences in the level of glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, total cholesterol, hemoglobin A1c, HOMA-IR, insulin between preop and postop 6th month. A negative correlation was found between postop AMH and body weight in all patients (r=-0.337, p=0.031). Postop AMH levels were negatively correlated with postop BMI levels in the non-PCOS patient group (r=-0.408, p=0.043). No significant difference was observed between the PCOS and non-PCOS groups in terms of all the parameters examined. In conclusion, our study suggests that the significantly increased AMH levels by losing weight with bariatric surgery in patients with morbid obesity with and without PCOS may indicate the improvement of fertilization potential. It could be considered when evaluating fertility in patients with morbid obesity.

Objevtive: Acromegaly is a rare disease characterized by growth hormone hypersecretion generally arising from pituitary adenomas. Survivin, an apoptosis inhibitor protein, plays an important role in cell cycle regulation and possibly involves hypophysis gland proliferation mechanisms. However, the underlying causes of somatotroph adenomas with different behaviors and useful prognostic markers are still not fully understood. We investigated possible associations between survivin gene promoter -31 G\C genotypes and serum survivin level and clinical prognostic factors in acromegaly. Material and Methods: Sixty-eight acromegaly patients and 171 age-sex matched control subjects were enrolled in the study. Survivin -31 G\C polymorphism was performed by using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Blood GH and IGF1 levels were assayed using a chemiluminescence immunometric assay. Serum survivin levels were determined by ELISA. Results: Acromegaly patients had significantly higher serum survivin levels than controls (p=0.001). We found no significant association between acromegaly patients and controls in terms of survivin gene promoter -31 G\C genotype distribution and allele frequencies. No correlation was found between disease characteristics and survivin gene polymorphisms. Conclusion: Our study suggests that serum survivin levels might be associated with acromegaly, but survivin -31 G\C polymorphisms do not modify individual susceptibility to acromegaly in the Turkish population.

ABSTRACT BACKGROUND AND PURPOSE Hashimoto's thyroiditis (HT) is a type of autoimmune thyroid disease. Diffusion tensor imaging (DTI) can evaluate microstructural brain involvement in various diseases. We aimed to investigate whether there were any DTI differences in patients with HT, and the relationship between DTI values and disease duration time and thyroid peroxidase antibodies (TPOAb) levels. METHODS We prospectively included 36 patients with HT (mean age 41.6 ± 13.8 years, range 18‐64 years) and 18 age and sex‐matched healthy control subjects (mean age 41.6 ± 13.1 years, range 18‐63 years). All patients were euthyroid at the time of imaging. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values of 15 distinct neuroanatomical locations were measured and compared. RESULTS FA values of the patients with HT were lower in cingulum, globus pallidus (GP), cerebellar white matter (CWM) than the control ( P = .019, .002, and <.001, respectively). MD values of the CWM in patients were higher than the control ( P = .008). AD values of patients with HT were lower in the cingulum, posterior limbs of the internal capsule, GP, and putamen ( P = .038, .038, .030, and .045, respectively). RD values of cingulum and CWM in HT were higher than controls ( P <.001 and P = .011, respectively). There was a negative relationship between the FA values of PLIC and a positive relationship between the MD values of the corona radiata and TPOAb levels were detected. CONCLUSIONS The current DTI study presented microstructural changes in the neurocognitive‐related areas that may be related to accompanying neurological findings in HT.

INTRODUCTION: In the pathogenesis of Graves' disease (GD), which is the most common cause of hyperthyroidism, cellular and humoral immune systems are thought to play a role together. TNF-alpha, fibronectin and galectin-3 known to play an active role in inflammatory processes. The aim of this study was to investigate the relationship between galectin-3, fibronectin and TNF-alpha molecules with hyperthyroidism and GD. METHODS: The study included 108 volunteers, 50 Graves, 19 non-Graves hyperthyroid patients and 39 healthy controls. Galectin-3, fibronectin and TNF-alpha levels measured by enzyme-linked immunosorbent assay (ELISA). In the Graves group (Group 1) 32 women, 18 men; in the non-Graves hyperthyroidism group (Group 2) 13 women, 6 men; and there were age- and sex-matched 26 females and 13 males in the control group (Group 3). RESULTS: TNF-alpha levels were 22.7 ± 1.97 pg / ml in Group 1, 19.8 ± 2.56 pg / ml in Group 2, and 16.6 ± 2.29 pg / ml in the control group. TNF-alpha levels were significantly higher in GD group compared to healthy controls (p <0.009). There was no significant difference between the three groups in terms of galectin-3 and fibronectin levels. DISCUSSION AND CONCLUSION: In this study, the relationship between GD and galectin-3 investigated for the first time in the literature and TNF-alpha levels shown in addition to the inflammatory markers known in GD. This finding supports the previous studies and shows the presence of the inflammatory process in GD. Unlike the other causes of hyperthyroidism, the lightening of this inflammatory process in GD, with inflammatory comorbidities such as ophthalmopathy, orbitopathy and dermopathy, will contribute to the development of new treatment options both for the disease itself and for these comorbidities.

Context The gastrointestinal tract is one of the most affected systems in hyperthyroidism. Although thyrotoxicosis is thought to be associated with gastrointestinal dysmotility, there are limited studies focused on motility disorders in hyperthyroidism. Objectives We aimed to investigate the manometric measurements to determine if esophageal motility is affected in Graves' disease. Materials and Methods Thirty patients with Graves' disease (18 female and 12 male) and 30, age and sex matched, healthy controls (22 female and 8 male) were recruited to the study between 2015 and 2016. Esophageal manometry was performed using MMS (Medical Measurement Systems bv. The Netherlands) Solar GI - Air Charged Intelligent Gastrointestinal Conventional Manometry. Results The mean lower esophageal sphincter pressure (LESP) was 16.9 ± 5.3 mmHg in hyperthyroid patients and 20.1 ± 8.8 mmHg in the control group and there was no significant difference (p>0.05). It was observed that the duration of contraction was 3.9 ± 0.7 s in healthy subjects and, significantly shorter 3.2 ± 0.5 s in hyperthyroid patients (p<0.001). Duration of contraction was negatively correlated with TSH receptor Ab titer in patients (p=0.006, r= -0.48). Also, it was observed that the duration of relaxation was negatively correlated with fT4 levels in the patient group (p<0.05, r= -0.46). Conclusion In this study, we observed that esophageal motility can be affected via shortened duration of contraction in Graves' disease. The gastrointestinal symptoms due to possible motility dysfunctions should be considered in the evaluation of hyperthyroid patients.

Objective: Obesity is a chronic metabolic disorder that leads to the increased risk of cardiovascular diseases. This study aims to investigate the effect of weight loss on the platelet count and volume, which is associated with cardiovascular diseases. Methods: In total, 56 obese patients were recruited for the study. The parameters were retrospectively evaluated before and after 6 months of surgery. Results: The mean weight of the patients was 126.2 +/- 23.1 kg before surgery and 91.8 +/- 20.5 kg after surgery (p<0.001). The mean platelet counts were 292.5 +/- 58.6x10(3)/mu L before surgery and 246.8 +/- 59.1x10(3)/mu L after surgery (p<0.001). The mean platelet volumes were 10.4 +/- 1.0 fL and 11.6 +/- 0.9 fL before and after surgery, respectively (p<0.001). The mean platelet counts before surgery were correlated with the mean platelet volume, mean weight, and mean body mass index (p<0.01, r=-0.39, p<0.01, r=0.35, p<0.01, r=0.41, respectively). The mean platelet counts after surgery were correlated with the mean platelet volume (p<0.001, r=-0.68). Conclusion: This study demonstrated decreased platelet counts and increased platelet volume at 6 months after surgery in obese patients. Further long-term and prospective studies are warranted to clarify these results and pathopsychological mechanisms involved.

A case of adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome, which develops in the course of ACTH-dependent Cushing's disease, is presented in this report. A 47-year-old woman with a past history of surgery and gamma knife radiosurgery because of Cushing's disease was admitted to the endocrinology clinic with weight gain and unregulated blood glucose levels. Hypercortisolemia was still persisting and diagnostic work-up indicated ACTH-independent Cushing's syndrome. Along with the rare possibility of this coexistence, longstanding ACTH hypersecretion can play a role in functional transition of adrenal adenomas. Further studies are needed to clarify the underlying mechanisms.

AIM:Prolactinomas are thought to arise from clonal expansion of a single mutated cell which is subjected to growth stimuli of several permissive factors, although the pathogenetic mechanisms underlying tumorigenesis remain unclear. The present study aimed to investigate the role of p16 (540C→G and 580C→T) and mouse double minute 2 (MDM2) (SNP309T→G) gene polymorphisms in tumorigenesis and characteristics of prolactinoma.PATIENTS AND METHODS:A total of 74 patients with prolactinoma and 100 age- and gender-matched healthy individuals were enrolled in the study. Serum prolactin levels were measured by enzyme-linked immunosorbent assay (ELISA). p16 and MDM2 polymorphisms were determined by polymerase chain reaction-restriction fragment polymorphism and agarose gel electrophoresis.RESULTS:p16 540C→G genotype distribution was found to be: CC: 66.2%, CG: 28.4%, GG: 5.4%; p16 580C→T genotype distribution was found to be: CC: 82.4%, CT: 17.6%, TT: 0% and MDM2 genotype distribution was found to be: TT: 31.1%, TG: 47.3%, GG: 21.6% in patients with prolactinoma. Tumor diameter before treatment was correlated with prolactin levels before treatment and percentage of prolactin decrease with treatment (r=0.719, p<0.001, p=0.034 r=0.256, respectively). The number of patients with tumor size decrease of more than 50% in those with homozygous genotype (TT+GG) of MDM2 SNP309T→G was significantly higher than in heterozygous genotype (TG) carriers (odds ratio(OR)=0.18, 95% confidence interval(CI)=0.06-0.58; p=0.003).CONCLUSION:This study showed that p16 and MDM2 polymorphisms do not play a decisive role in tumorigenesis, but some genotypes of these polymorphisms might be associated with follow-up characteristics of prolactinoma.

Paratiroid karsinomu hiperkalsemi ile seyreden ve çok ender görülen bir endokrin tümördür.Yaşamı tehdit eden hiperkalseminin kontrolünde sıvı replasmanı, diüretik tedavi, bifosfonatlar ve kalsimimetik ajanlar tedavinin ana basamağını oluşturmaktadır

The frequency of Cushing’s syndrome (CS) in obese patients was not properly determined and the studies focused on the frequency of occult CS and the possible improvement of diabetes and obesity with treatment of CS are needed. In this study, we aimed to investigate the frequency of CS in obese patients with type 2 diabetes. The study enrolled with 200 obese (body mass index (BMI) >30 kg/m2), type 2 diabetes patients between 2009 and 2011 in Sisli Etfal Training and Research Hospital, Turkey. Twenty-eight males and 172 females were recruited to the study. Mean age of the study group was 51.7 ± 8.5. Nineteen patients (9.5 %) failed to suppress cortisol levels less than 1.8 μg/dL after a 1-mg overnight dexamethasone suppression test (ODST) and these patients proceeded to have a 2-day 2-mg low-dose dexamethasone suppression test. After further screening, three (%1.5) patients were diagnosed with CS in our study. Among the three patients diagnosed with CS, the tumor was located in the pituitary gland in two patients. The present study revealed that the frequency of Cushing’s syndrome in obese and diabetic patients were 1.5 %, which was much higher than the general population. Occult CS should take into account as an exacerbating factor for diabetes and screening for CS should be considered in poorly controlled diabetic patients.

Oxidative status is attributed to endothelial dysfunction and might be one of the key mechanisms of endothelial dysfunction in acromegaly. In this study, we aimed to investigate the effect of acromegaly on superoxide dismutase (SOD) and total antioxidant capacity (TAC) levels, and the possible influence of human manganese superoxide dismutase (MnSOD) polymorphism on these levels. 51 acromegaly patients and 57 age and sex matched healthy subjects were recruited to the study in Bezmialem Vakif University Hospital between 2011 and 2014. The median SOD and TAC levels were 42.7 (33-60) pg/mL and 1,313.7 (155-1,902) μM in acromegaly; and 46.3 (38-95) pg/mL and 1,607.3 (195-1,981) μM in healthy subjects (p < 0.001, p < 0.001). SOD levels were decreased in controlled and uncontrolled patients compared to healthy subjects (p = 0.05 and p = 0.002, respectively). Controlled and uncontrolled acromegaly displayed significantly decreased levels of TAC compared to healthy subjects (p < 0.05 and p < 0.001, respectively). SOD levels were not associated with MnSOD polymorphisms in acromegaly. In conclusion, this study showed that acromegaly was associated with decreased levels of SOD and TAC, and controlling the disease activity could not adequately improve these levels.

Summary Background: Heart rate variability (HRV) is a signal obtained from RR intervals of electro -cardiography (ECG) signals to evaluate the balance between the sympathetic nervous system and the parasympathetic nervous system; not only HRV but also pulse rate va -riability (PRV) extracted from finger pulse plethysmography (PPG) can reflect irregularities that may occur in heart rate and control procedures. Objectives: The purpose of this study is to compare the HRV and PRV during hypogly -cemia in order to evaluate the features that computed from PRV that can be used in detection of hypoglycemia. Methods: To this end, PRV and HRV of 10 patients who required testing with insulininduced hypoglycemia (IIHT) in Clinics of Endocrinology and Metabolism Diseases of Bezm-i Alem University (Istanbul, Turkey), were obtained. The recordings were done at three stages: prior to IIHT, during the IIHT, and after the IIHT. We used Bland-Altman analysis for comparing the parameters and to evaluate the correlation between HRV and PRV if exists. Results: Significant correlation (r > 0.90, p < 0.05) and close agreement were found between HRV and PRV for mean intervals, the root-mean square of the difference of successive intervals, standard deviation of successive intervals and the ratio of the low-to-high frequency power. Conclusions: In conclusion, all the features computed from PRV and HRV have close agreement and correlation according to Bland-Altman analyses’ results and features computed from PRV can be used in detection of hypoglycemia.

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

OBJECTIVE:Diabetes mellitus (DM) is a growing health problem with serious complications.The chronic and progressive nature of the disease often leads patients to use complementary and integrative medicine.The present study aimed to investigate the frequency of use of alternative medicine by patients with DM and the products used. METHODS:Between September 2014 and May 2015, 301 patients with DM were selected from Bezmialem Foundation University Hospital Diabetes Clinic to participate in the study. RESULTS:The results of the study indicate that 81 (26.9%) patients had tried alternative medicine, and 50 (16.6%)patients continued to use some form of alternative medicine product.A total of 43 (14.3%)patients used such products every day and 24 (8%) patients had used alternative medicine products for up to 6 months.Glycated hemoglobin (HbA1c) levels were significantly decreased in patients using alternative medicine products compared to the remainder of patients in the study (p=0.017).No other significant difference was found between the two groups.It was observed that among patients using alternative medicine products, only 10 (12%) had informed their physicians. CONCLUSION:This study indicated that patients with diabetes are very likely to use alternative medicine products.Additional studies are needed to further determine the efficacy of these products.Patients as well as health providers must be educated about complementary medicine and alternative products.

Morbid obesity (MO) is associated with an increase in circulating levels of systemic acute phase proteins such as C-reactive protein (CRP). Toll-like receptor is possible candidate for inflammatory responses which is mainly mediated by NFKB1. The aim of this study was to investigate the relationship between NFKB1 and Toll-like receptor (TLR) 2 polymorphisms and the risk of MO in a Turkish population in the context of CRP serum levels which may contribute to susceptibility to the disease. We analysed the distribution of NFKB1-94 ins/del ATTG rs28362491 and TLR2 Arg753Gln rs5743708 polymorphisms using PCR-RFLP method and CRP serum levels using ELISA method in 213 MO and 200 healthy controls. The frequency of the ins/ins genotype and ins allele of rs28362491 was significantly higher in the patients compared to control group (P: 0.0309; P: 0.0421, respectively). Additionally, the frequency of GG genotype and G allele of rs5743708 was found to be statistically higher in the patient group (P: 0.0421; P < 0.0001, respectively). In addition, serum CRP levels (>20 mg/l) in MO patients with ins/ins genotype were significantly higher than in patients with del/ins genotype (P: 0.0309). Serum CRP levels were also higher in MO patients with GG genotype and G allele (P: 0.0001). According to combined analysis, the wild type of rs28362491 and rs5743708 polymorphisms (ins/ins/GG genotype) was also significantly higher in the patient group versus the control group when compared with the combined ins/ins/GA and del/ins/GA genotype (P < 0.0001). Therefore, our findings suggest that rs28362491 and rs5743708 polymorphisms were significantly associated with MO disease through acting by modulating serum CRP levels.

Pregnancy associated osteoporosis (PAO) is a rare disease characterized by multiple vertebral compression fractures, limitation of movement and severe back pain. A positive family history of PAO, decreased body mass index, sedentary life style, smoking, malnutrition and low calcium intake are among the risk factors of this disease. PAO should be considered in patients with back pain during pregnancy and postpartum period. As a specified therapy option is lack for PAO, discontinuation of lactation and the supplementation of calcium and vitamin D are the main steps of the treatment in patients who are planning to become pregnant in the future. The current data show that bisphosphonates should be avoided and teriparatide may be a treatment option in patients who are planning to become pregnant. In this case report, it was aimed to highlight the diagnosis and treatment approaches of PAO in a patient with back pain during postpartum period.

PURPOSE:Familial neurohypophyseal diabetes insipidus (FNDI) is a rare, autosomal dominant, inherited disorder which is characterized by severe polydipsia and polyuria generally presenting in early childhood. In the present study, we aimed to analyze the AVP gene in a Turkish family with FNDI. METHODS:Four patients with neurohypophyseal diabetes insipidus and ten healthy members of the family were studied. Diabetes insipidus was diagnosed by the water deprivation test in affected family members. Mutation analysis was performed by sequencing the whole coding region of AVP-NPII gene using DNA isolated from peripheral blood samples. RESULTS:Urine osmolality was low (<300 mOsm/kg) during water deprivation test, and an increase more than 50 % in urine osmolality and recovery of the symptoms were observed by the administration of desmopressin in all patients. Plasma copeptin levels were lower than expected according to plasma osmolality. Pituitary MRI revealed partial empty sella with a bright spot in index patient and a normal neurohypophysis in the other affected subjects. Genetic screening revealed a novel, heterozygous mutation designated as c.-3A>C in all patients. CONCLUSION:c.-3A>C mutation in 5'UTR of AVP gene in this family might lead to the truncation of signal peptide, aggregation of AVP in the cytoplasm instead of targeting in the endoplasmic reticulum, thereby could disrupt AVP secretion without causing neuronal cytotoxicity, which might explain the presence of bright spot. The predicted effect of this mutation should be investigated by further in vitro molecular studies.

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

INTRODUCTION:Although prolonged small intestine and colonic transit time has been demonstrated in acromegaly patients, the influence of acromegaly on oesophagus motility and the pathological mechanisms involved are still not clarified. We aimed to investigate manometric measurements to ascertain whether oesophagus motility is affected in active acromegaly patients.MATERIAL AND METHODS:The study was performed in an institutional referral centre at a tertiary care hospital. Twenty-three acromegaly patients (mean age 43.2 ± 13.2 years) and 25 sex- and age-matched healthy control subjects (mean age 48.6 ± 7.9 years) were recruited to a case-control study. Oesophageal manometry was performed using MMS (Medical Measurement Systems, Netherlands) Solar GI - Air Charged Intelligent Gastrointestinal Conventional Manometry.RESULTS:In manometric measurements the lower oesophageal sphincter pressure was 18 ± 7 mmHg in acromegaly patients and 15.6 ± 4.4 mm Hg in controls, and there was no significant difference (p = 0.17). The percentage of relaxation was 64.8% and 81.8%, respectively, and it was significantly lower in acromegaly patients than in controls (p < 0.001). Additionally, the duration of relaxation was found to be 4 ± 1.9 seconds and 5 ± 1.7 seconds in patients and controls, respectively (p = 0.049).CONCLUSIONS:Our study has demonstrated a significant reduction in the percentage and duration of lower oesophageal sphincter relaxation in oesophagus motility even in acromegaly patients without any gastrointestinal symptoms. Further clinical and pathophysiological studies are required to clarify the underlying mechanisms of gastrointestinal motility disorders in acromegaly.