Browsing by Author "Hekimsoy Z."

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    Diabetes mellitus due to olanzapine use: A case report; [Olanzapin'e baǧli diabetes mellitus: Bir olgu sunumu]
    (2003) Danaci A.E.; Mizrak S.; Hekimsoy Z.; Içelli I.
    Olanzapine, a serotonin-dopamine-receptor antagonist, is an atypical antipsychotic agent used to treat schizophrenia and other psychotic disorders. It has relatively low frequency of side effects such as sedation, orthostatic hypotension, extrapyramidal symptoms, and anticholinergic side effects. Here, a 32-years-old female patient with schizophrenia who developed diabetes after 3 years of olanzapine treatment is presented. Due to lack of family history and immune marker positivity in the occurrence of diabetes, the condition was attributed to olanzapine treatment. After discontinuation of the treatment DM was improved. Controlled studies are necessary both to elucidate the mechanism by which olanzapine can cause dysregulation of glucose homeostasis, and to develop guidelines for the use of olanzapine in patients with known as well as in patients with risk factors for diabetes.
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    Duration of obesity is not a risk factor for type 2 diabetes mellitus, arterial hypertension and hyperlipidemia
    (Blackwell Publishing Ltd, 2003) Hekimsoy Z.; Oktem I.K.
    Background: Obesity is known to be a risk factor for type 2 diabetes mellitus (DM), arterial hypertension (HT) and hyperlipidaemia (HL), but the relationship between the duration of obesity and these outcomes is variable in the literature. Aims: The aims of this study were 1) to evaluate whether the duration of obesity is a risk factor for type 2 DM, HT and HL, 2) to determine the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), type 2 DM, HT and HL in the patients attending our clinic because of obesity and 3) to determine the correlation between DM, HT and HL and age, body mass index (BMI), duration of obesity and waist-hip ratio (WHR). Methods: Informed consent was obtained from 200 consecutive women presenting to our Endocrinology and Metabolism Unit for the first time because of obesity. The patient's history of the age at onset of obesity, HT and family history of DM were obtained. Anthropometric measurements and a 75-g oral glucose tolerance test (OGTT) were performed. Results: On OGTT, 15 (7.5%) had IFG, 36 (18%) had IGT and 18 (9%) had type 2 DM; in addition, 96 (48%) had HT and 76 (38%) had HL. Upon multivariate logistic regression analysis, age was a common risk factor for IGT, type 2 DM, HT and HL, and a family history of diabetes was an additional risk factor for type 2 DM. Conclusion: The duration of obesity, as reported by women presenting for treatment of obesity, is not a risk factor for type 2 DM, HT and HL.
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    Plasma selenium and urinary iodine in patients with goiter
    (Dustri-Verlag Dr. Karl Feistle, 2004) Hekimsoy Z.; Biberoglu S.; Kirkali G.; Bicer N.; Erbayraktar Z.
    Objective: Iodine deficiency and related disorders are still major public health problems, with a high prevalence of endemic goiter in many regions of Turkey. In addition to measuring iodine excretion rates in patients with diffuse or nodular goiter, we examined plasma selenium concentrations, to see whether selenium deficiency might be related to goiterogenesis in our region. Methods: Seventy-two outpatients with goiter (67 female, 5 male; age 43.7 ± 13.0 years) presenting consecutively to our university medical center endocrinology clinic, were included in the study group. The control group consisted of 30 subjects (25 female, 5 male; age 40.6 ± 13.6 years) who were healthy and did not have any known thyroid disease. None of the subjects were using medications containing selenium or iodine. Serum thyroid hormones, plasma selenium and urinary iodine levels were measured, and an ultrasound of the thyroid was performed in both groups. Results: Serum thyroid hormone levels were in the normal range in both groups and the difference was not significant. Mean plasma selenium levels in the study and control groups were not significantly different (p = 0.30). However, urinary iodine excretion was significantly lower in the study group (17.4 ± 12.6 μg/l vs 23.2 ± 12.2 μg/l, p = 0.03). In both study and control group patients, a significant negative correlation between thyroid volume and urinary iodine levels was observed. Conclusion: Moderate to severe iodine deficiency is the primary etiologic factor for endemic goiter in our region. Plasma selenium levels were not related to the presence or absence of goiter in our population.
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    Coexisting acromegaly and primary empty sella syndrome
    (Maghira and Maas Publications, 2004) Hekimsoy Z.; Yünten N.; Sivrioglu S.
    The normal functions of the pituitary gland may be suppressed when the gland is compressed onto the sella floor by arachnoid tissue extending through an impaired sella diaphragm. Interestingly, pituitary hormone hypo- and hypersecretion, including acromegaly, have been observed in patients with an 'empty sella'(1-4). This 'empty sella syndrome' has been classified into a primary form, in which no inciting factor (pituitary irradiation or surgery for a pituitary tumor) is present, and a secondary form, in which the empty sella occurs after pituitary procedures. In this report we describe a patient who presented with clinical and biochemical features of acromegaly and who had an empty sella on pituitary magnetic resonance imaging (MRI). Copyright © Neuroendocrinology Letters.
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    Effects of a statin group drug, pravastatin, on the insulin resistance in patients with metabolic syndrome
    (Elsevier Masson SAS, 2004) Güçlü F.; Özmen B.; Hekimsoy Z.; Kirmaz C.
    Background. - In West of Scotland Coronary Prevention Study (WOSCOPS), development of type 2 diabetes mellitus (DM) was found to decrease by 30% in pravastatin-treated patients. In the study, it is suggested that pleiotropic effects of pravastatin may be responsible too as well as its lipid lowering effect. Objective. - The aim of this study was to assess the effects of pravastatin treatment on the insulin resistance in patients with metabolic syndrome with impaired glucose tolerance (IGT), by Homeostasis Model Assessment (HOMA) test, insulin sensitivity indices and glucose half activation time (glucose t1/2). Methods. - Study population consisted of 25 women who were diagnosed with metabolic syndrome. At baseline and 10 weeks after the 20 mg/daily tablet pravastatin treatment, waist/hip circumference, body weight and arterial blood pressure measurements, plasma glucose, total cholesterol, triglyceride, high density lipoprotein (HDL)-cholesterol, transaminases, glycosylated haemoglobin (A1C) and insulin level measurements were obtained along with HOMA test and insulin tolerance test after 12 h of fasting. Insulin sensitivity indices and glucose t1/2 were assessed. Results. - After the treatment, a statistically significant decrease was observed in arterial blood pressure values (P < 0.0001). While plasma total cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were found to decrease significantly and HDL-cholesterol levels increased significantly, a decrease in baseline insulin levels, an increase in insulin sensitivity levels were observed along with an decrease in glucose t1/2. Related to the improvement in aforementioned parameters, statistically significant decreases were noted in HOMA, postprandial and fasting glucose levels and A1C values (P < 0.0001). Conclusion. - Our study suggests that using pravastatin in the dyslipidemia treatment of metabolic syndrome with IGT may be an effective approach by its advantageous effects on insulin resistance. Based on this result, it is possible to say that this can be a risk lowering treatment approach for the development of type 2 DM. © 2004 Elsevier SAS. All rights reserved.
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    Serum osteocalcin levels in hyperthyroidism before and after antithyroid therapy
    (2004) Barsal G.; Taneli F.; Atay A.; Hekimsoy Z.; Erciyas F.
    Hyperthyroidism is characterized by accelerated bone turnover, caused from direct stimulation of bone cells by increased thyroid hormones. In this study, we aimed to investigate serum osteocalcin levels as a bone formation marker, before antithyroid (propylthiouracil) therapy at hyperthyroid stage and after antithyroid therapy at euthyroid stage of the patients. Twenty four hyperthyroid patients (18 females, 6 males) and 20 (13 females, 7 males) healthy controls were included into this study. Blood and urine samples were taken before medical treatment at hyperthyroid state, and after the antithyroid therapy until the patients reached the euthyroid state. Serum alkaline phosphatase, osteocalcin, calcium, phosphorus, Free T3, Free T4, TSH and urine calcium/creatinine levels were assessed. We found a significant decrease in serum osteocalcin (p=0.006), urinary calcium/creatinine (p=0.004), and serum phosphorus (p=0.038) levels in euthyroid state in comparison to hyperthyroid state. The increases in serum bone formation marker osteocalcin and bone resorption marker urinary calcium/creatinine levels in hyperthyroid state compared to euthyroid state in our study confirmed that hyperthyroid patients have high bone turnover. We conclude that, hyperthyroid patients has high bone turnover of formation and resorption even after attainment of euthyroidism. Osteocalcin and urine calcium/creatinine are sensitive markers in documenting bone remodeling during treatment of hyperthyroidism. © 2004 Tohoku University Medical Press.
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    Homocysteine levels in acromegaly patients
    (Maghira and Maas Publications, 2005) Hekimsoy Z.; Özmen B.; Ulusoy S.
    Acromegaly is associated with a two to three-fold increase in mortality related predominantly to cardiovascular disease. The excess mortality is associated most closely with higher levels of growth hormone (GH). Survival in acromegaly may be normalized to a control age-matched rate by controlling GH levels; in particular, GH levels less than 2.5 ng/mL are associated with survival rates equal to those of the general population. Hyperhomocysteinemia has also been recognized as a risk factor for cardiovascular disease, yet there are limited data on the prevalence of hyperhomocysteinemia in patients with acromegaly. Eightee n acromegaly patients (7 male, 11 female, mean age 42.8 ± 11.0 years) in our endocrine clinic consented to having the following tests performed: complete blood count (CBC), thyroid hormones, folic acid, vitamin B12, plasma homocysteine levels, uric acid, fibrinogen, CRP, fasting glucose, insulin, C-peptide, total serum cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, GH,insulin-like growth factor-1 (IGF-1) and GH levels after an oral glucose tolerance test (OGTT). By history, fourteen had macroadenomas and four had microadenomas; eight had hypertension; two had glucose intolerance, and four had diabetes. Fifteen had had transsphenoidal or transfrontal surgery: two had been cured, but 13 others were taking long-acting octreotide. Five patients had undergone radiotherapy and the acromegaly in two was treated primarily with long-acting octreotide. CBC, thyroid hormone, folic acid, and vit B12 levels were normal in all patients. We divided the patients into two groups according to mean GH levels after an OGTT: Group 1 (GH<2.5 ng/mL, n=10), and Group 2 (GH≥2.5 ng/mL, n=8). Comparison of the two groups using Mann-Whitney U testing revealed statistically significant lower levels in Group 1 of the following parameters: GH (1.91 ± 0.90 vs. 8.58 ± 5.55 ng/mL, p=0.002), IGF- 1 (338.30 ± 217.90 vs. 509.60 ± 293.58 ng /dL, p=0.06), GH after an OGTT (1.42 ± 0.81 vs. 9.01 ± 4.53 ng/mL, p=0.001), plasma homocysteine (12.85 ± 4.47 vs. 18.20 ± 4.99 μmol/L, p=0.05), total cholesterol (164.0 ± 20.81 vs. 188.0 ± 22.26 mg/dL, p=0.05) and LDL cholesterol (8 1.0 ± 9.64 vs. 116.70 ± 13.03 mg/dl, p=0.01). Differences between the other parameters were not significantly different. Acromegaly patients with high GH levels after an OGTT have much higher levels of homocysteine than patients with lower GH levels. The role of elevated homocysteine levels as an independent cardiovascular risk factor in the mortality of acromegaly patients should be determined in future studies. © Neuroendocrinology Letters.
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    Serum creatine kinase levels in overt and subclinical hypothyroidism
    (2005) Hekimsoy Z.; Oktem I.K.
    □ The aims of this prospective study were to determine serum levels of creatine kinase (CK) in overt and subclinical hypothyroidism; to investigate the change in CK levels with treatment; and to evaluate the relationship between free triiodsothyronine (FT3), free thyroxine (FT4), and thyrotropin (TSH) levels and the degree of skeletal muscle involvement, as determined by serum CK levels. Patients with hypothyroidism presenting to our endocrinology clinic were eligible for inclusion in this study. Patients with other causes of CK elevation were excluded. We included 28 patients (25 women and 3 men, ages 41.75 ± 13.65 years) with overt hypothyroidism, 38 patients (37 women, 1 man, ages 40.55 ± 10.48 years) with subclinical hypothyroidism, and 30 age- and gender-matched controls (27 women, 3 men, ages 40.81 ± 11.20 years) in the study. Serum levels of TSH, FT4, FT3, and CK were measured in all subjects. CK elevation was found in 16 patients (57%) with overt hypothyroidism and in 4 patients (10%) with subclinical hypothyroidism. Although a statistically significant elevation of CK levels was found in patients with overt hypothyroidism when compared with patients with subclinical hypothyroidism and controls (p = 0.0001, p = 0.01, respectively), no difference was found between the subclinical hypothyroidism and control groups (p = 0.14). In hypothyroid (overt and subclinical) patients, a positive correlation was found between CK and TSH (r = 0.432; p = 0.04), and a negative correlation between CK and FT3 (r = -0.556; p = 0.002) and between CK and FT4 (r = -0.448; p = 0.04). CK levels decreased to normal levels after thyroid function normalized with treatment. In conclusion, skeletal muscle is affected by hypothyroidism more profoundly in cases of overt hypothyroidism, less so when subclinical hypothyroidism is present. Copyright © 2005 Taylor & Francis, Inc.
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    Does thyroid replacement therapy affect pulmonary function tests in patients with subclinical hypothyroidism?
    (2006) Koral L.; Hekimsoy Z.; Yildirim C.; Ozmen B.; Yorgancioglu A.; Girgin A.
    Objective: Subclinical hypothyroidism is an elevation in serum thyroid-stimulating hormone (TSH) while having normal serum free thyroxine (FT4) and triiodothyronine (FT3) levels. The purpose of this prospective observational study was to evaluate the pulmonary function of patients diagnosed with subclinical hypothyroidism, both before and after treatment with thyroid hormone. Methods: This study took place at the Medical Faculty, Celal Bayar University, Manisa, Turkey between February 2003 and June 2004. Thirty-eight patients (37 females, one male) with subclinical hypothyroidism between 20 and 65 years of age were included in the study. Most were mildly obese. Arterial blood gases and pulmonary function tests were performed before treatment with thyroid hormone, and afterwards, the TSH value reached the normal range (indicating euthyroidism). Results: Oxygen saturation, but not partial oxygen pressure or partial carbon dioxide pressure, was statistically, but not clinically significantly higher after treatment with thyroid hormone (p=0.01). Pulmonary function tests were not significantly different before and after treatment with thyroid hormone. Conclusion: In our subclinical hy pothyroidism patients, pulmonary function tests were normal and did not significantly change with thyroid hormone replacement. The advantages of thyroid hormone replacement therapy, at least regarding respiratory function, seem to be clearly present in patients with overt, clinical hypothyroidism but not in patients with subclinical hypothyroidism.
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    Influence of the selective oestrogen receptor modulator (raloxifene hydrochloride) on IL-6, TNFα, TGF-β1 and bone turnover markers in the treatment of postmenopausal osteoporosis
    (2007) Özmen B.; Kirmaz C.; Aydin K.; Kafesciler S.O.; Guclu F.; Hekimsoy Z.
    Background. Osteoporosis that is encountered frequently in postmenopausal women, may cause an increased incidence of vertebral and iliac fractures that are associated with excess morbidity. Raloxifene hydrochloride, a selective oestrogen receptor modulator, has been shown to increase bone mineral density and decrease biochemical markers of bone turnover in postmenopausal women, without stimulatory effects on breast or uterus. Levels of proinflammatory cytokines, including IL-6, and TNF-α and TGF-β1 which are important cytokines involved in remodeling, have been evaluated previously in in vitro studies of osteoporosis. However, there seems to be a paucity of in vivo research concerned with changes in these cytokines in osteoporosis. Objective. In this study, we evaluated the effects of raloxifene (Evista®; Lilly Pharmaceutical Co. USA, 60 mg/day) on biochemical bone turnover markers, serum parathyroid hormone, and 25-OH vitamin D, as well as the serum levels of IL-6, TNF-α and TGF-β1, in 22 postmenopausal, osteoporotic women before and after 12 weeks of raloxifene treatment. Methods. Well-matched, postmenopausal, non-osteoporotic control subjects were also enrolled in the study. Serum levels of all the parameters were measured in postmenopausal, osteoporotic women at baseline and end of the study. Results. It was found that serum osteocalcin and parathyroid hormone, and urine deoxypyridinoline levels decreased to normal levels with treatment. Serum 25-OH vitamin D levels after treatment in the patient group were higher than those in the control group. Serum IL-6, TNF-α and TGF-β1 levels did not change significantly with treatment. However, serum levels of IL-6 and TGF-β1 in the patient group after treatment, decreased to levels lower than those found in the control group. Serum TNF-α levels in the patient group before and after treatment, were lower than those in the control group. Conclusion. Raloxifene treatment reduces bone turnover biochemical markers, parathyroid hormone and induces 25-OH vitamin D in postmenopausal women. Moreover, it also affects some serum cytokine levels in the postmenopausal period.
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    Atherosclerosis risk factors in children of parents with the metabolic syndrome
    (2007) Akinci G.; Coskun S.; Akinci B.; Hekimsoy Z.; Bayindir P.; Onur E.; Ozmen B.
    Background: Metabolic syndrome is a constellation of disorders that produces a high risk of atherosclerosis. Endothelial dysfunction is the key event in atherosclerosis and already present even in the childhood. The aim of the present study is to investigate inflammatory and radiological signs of atherosclerosis in children who have parents with the metabolic syndrome. Design and methods: Fifty children of parents with the metabolic syndrome and 38 age- and sex-matched controls were studied. Anthropometric measurements, blood pressure assessment, echocardiography, flow-mediated vasodilatation (FMD) which is a non-invasive test for the evaluation of endothelial function and fasting blood measurements including blood glucose, insulin, total cholesterol, HDL cholesterol, triglyceride, hsCRP and soluble CD40 ligand were performed. Results: Serum sCD40L and hsCRP levels were significantly higher in the study group compared to the controls. FMD values did not differ between the study and control groups. Increased serum sCD40L levels were positively correlated with body mass index, waist hip ratio, LDL/HDL cholesterol ratio, and the number of metabolic syndrome components in parents, whereas showed negative correlation with the serum HDL cholesterol levels. High hsCRP levels were positively correlated with body mass index and the number of metabolic syndrome components. Multiple regression analysis demonstrated that the number of metabolic syndrome components in parents presented as being a significant predictor of the serum sCD40L and hsCRP levels of their children. Conclusion: Our results suggest that children of patients with metabolic syndrome have higher values of the serum markers of inflammation, which may be associated with increased risk for development of cardiovascular disease. © 2007 Elsevier Ireland Ltd. All rights reserved.
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    Macular Edema in Unregulated Type 2 Diabetic Patients Following Glycemic Control
    (2007) Kayýkçýolu O.; Özmen B.; Seymenoglu G.; Tunali D.; Kafesçiler S.O.; Güclü F.; Hekimsoy Z.
    Background: We undertook this study to evaluate the changes in macular edema of uncontrolled type 2 diabetes mellitus patients with the regulation of hyperglycemia. Methods: The study population was comprised of 35 type 2 diabetes mellitus patients who had poorly regulated blood glucose values. Ophthalmic examinations including baseline and 6-month macular edema index values of patients by Heidelberg Retinal Tomography (HRT) macular module were done. Results: Twenty four (68.6%) female patients and 11 (31.4%) male patients with a mean age of 50.7 ± 10.3 (mean ± SD) years and mean diabetic duration of 9.8 ± 7.5 years participated in the study. Twenty two (62.9%) did not have diabetic retinopathy (DR), whereas 13 (37.2%) had background DR with macular edema. There was a significant correlation between duration of diabetes and HRT-II macula edema index for the right and left eyes (r = 0.40, p = 0.21 and r = 0.40, p = 0.22, respectively). Conclusions: Macular edema did not change significantly by regulation of glycemic control in the study group. © 2007 IMSS.
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    Glucagon-like peptide-1: Review; [Glukagon like peptid-1]
    (Turkiye Klinikleri, 2007) Güçlü F.; Özmen B.; Hekimsoy Z.; Özkaya Kafesçiler S.
    Glucagon-like peptide-1 (GLP-1) is a 30 amino-acid hormone produced by the pancreatic islet alpha cells, intestinal-L cells and central nervous sytem cells. The main target of action of GLP-1 is the islet, where the hormone stimulates insulin secretion, promotes beta cell proliferation and neogenesis, and inhibits glucagon secretion. However, GLP-1 receptors are also expressed outside the islets, increasing the likelihood that GLP-1 also plays a role in other organs. These functions are mainly the inhibition of gastric emptying, gastric acid secretion and exocrine pancreatic secretion, indicating that the hormone acts as an enterogastrone hormone released from the distal portion of the small intestine that inhibits proximal gastrointestinal events. Another important action of GLP-1 is to induce satiety. Other effects of the hormone include cardioprotection, neuroprotection, induction of antidiabetic actions unrelated to islet function. Thus, GLP-1 clearly has several manifestations of activity. The physiological relevance of these actions and their contribution to the overall antidiabetic action of GLP-1 when used in treatment of type 2 diabetes remains to be established. Copyright © 2007 by Türkiye Klinikleri.
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    Evaluation of markers of inflammation, insulin resistance and endothelial dysfunction in children at risk for overweight
    (Hellenic Endocrine Society, 2008) Akinci G.; Akinci B.; Coskun S.; Bayindir P.; Hekimsoy Z.; Özmen B.
    OBJECTIVE: Childhood obesity is associated with impaired endothelial function, insulin resistance and inflammation. Being at risk for overweight has been defined as having a body mass index (BMI) between the 85th and 94th percentile for age and sex. In this study, we looked for features linked to cardiovascular risk in children who are at risk for overweight. DESIGN: Twenty-one children who were at risk for overweight (study group) and 20 children with a BMI between the 25th-74th percentiles (controls) were studied. Fasting blood levels of glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, uric acid, fibrinogen and high sensitive C-reactive protein (CRP) were assessed in both groups. LDL-cholesterol, HOMA-IR and QUICKI indices were calculated. Flow-Mediated Vasodilatation (FMD) was determined for the evaluation of endothelial function. RESULTS: Increased HOMA-IR was observed in children who were at risk for overweight. Waist circumference was the main predictor of insulin resistance in these children. Higher levels of CRP were found in the study group compared to controls, while plasma fibrinogen did not differ in the two groups. The children who were at risk for overweight had lower FMD values and slightly elevated lipids compared to controls; however, these differences were not statistically significant. CONCLUSION: Insulin resistance and inflammation indices were higher in children who were at risk for overweight as has been shown for obese children. The data suggest that appropriate treatment strategies for weight control are essential not only for obese children but also for those at risk for overweight.
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    Down-regulation of the auto-aggressive processes in patients with hypothyroid Hashimoto's thyroiditis following substitutive treatment with L-thyroxine
    (2009) Guclu F.; Ozmen B.; Kirmaz C.; Kafesciler S.O.; Degirmenci P.B.; Taneli F.; Hekimsoy Z.
    Background. Hashimoto's thyroiditis is a chronic, organ-specific autoimmune disease. It is the most common cause of primary hypothyroidism during the adolescent period, via autoimmune thyroid tissue destruction, affecting 2% of the population. The pathogenesis of Hashimoto's thyroiditis involves a complex interaction between predisposing genetic and environmental factors. Objective. In this study, we wanted to investigate the role of cytokines such as IL-2, IL-4, IL-12 and IFN-γ in the pathogenesis of the disease, and the changes to cytokine levels brought about by treatment with L-thyroxine. Methods. Sixty five female patients, aged 18-73 years with Hashimoto's thyroiditis, referred to the Celal Bayar University Medical Faculty Endocrinology out-patients clinic, were included in this study. After a 10-12 week period of L-thyroxine treatment, all patients were restored to the euthyroid state. At the beginning and end of the treatment period, serum-free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), autoantibodies against thyroid peroxidase (anti-TPO), autoantibodies against thyroglobulin (anti-Tg) levels were measured using a chemiluminecent, immunometric method, and cytokine levels were measured using ELISA. Results. There was a statistically significant decrease in the serum levels of TSH (p < 0.0001) and a concomitant increase in FT4 serum levels (p < 0.0001). Also, during the post-treatment period, serum levels of anti-Tg (p < 0.01) and anti-TPO (p < 0.001) were significantly lower than during the pre-treatment period. A statistically significant decrease was shown for interleukin (IL)-12 serum levels during the post-treatment period (p < 0.001). However, the decrease in interferon (IFN)-γ serum levels was not statistically significant (p = 0.276). On the other hand, no change was demonstrated in serum IL-2 and IL-4 levels (p = 0.953 and p = 0.313, respectively) after treatment with L-thyroxine. Conclusion. Considering that our study involved a 10-12 week period of treatment, the statistically significant decrease in serum IL-12 levels, and the statistically non-significant decrease in IFN-γ levels, might indicate that a T helper type 1 inflammatory process had been halted or slowed down.
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    Vitamin D status among adults in the Aegean region of Turkey
    (2010) Hekimsoy Z.; Dinç G.; Kafesçiler S.; Onur E.; Güvenç Y.; Pala T.; Güçlü F.; Özmen B.
    Background. Vitamin D is a lipid-soluble hormone found in certain foods and synthesized from precursors in the skin when exposed to ultraviolet light. Vitamin D plays a critical role in bone metabolism and many cellular and immunological processes and low levels have been associated with several chronic and infectious diseases. Vitamin D status is assessed by measuring the concentration of serum 25-hydroxyvitamin D [25(OH)D]. Vitamin D deficiency is reported to be common worldwide, but little has been reported about the vitamin D status of adults in Turkey. In this cross-sectional study, we determined the prevalence of 25(OH)D deficiency in adults residing in a city in the Aegean region of Turkey. Methods. A survey was conducted on a representative sample of adults over 20 years old in a non-coastal city at the end of the winter season. Of the 209 households selected by random sampling, 8.6% (n = 18) were unoccupied and 21.5% (n = 45) refused to participate. Blood samples were taken and questions about medical history, vitamin supplementation, sunlight exposure, and dietary calcium and vitamin D intake were asked in face-to-face interviews of 391 adults living in the remaining households. Results. The mean serum 25(OH)D concentration was 16.913.09 ng/mL, with 74.9% of the subjects having 25(OH)D deficiency (<20 ng/mL), 13.8% having insufficiency (20-29.99 ng/mL), and 11.3% of the subjects having sufficient 25(OH)D (30 ng/mL) levels. 25(OH)D deficiency was more common among females (78.7%) than males (66.4%, p < 0.05). Conclusion. Adults living in an urban, non-coastal setting in Turkey have a high prevalence of vitamin D deficiency. © 2010 Hekimsoy et al; licensee BioMed Central Ltd.
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    Psychometric properties and responsiveness of the Turkish version of the Diabetes Treatment Satisfaction Questionnaire (s) on a sample of diabetics of three consecutive monitoring periods
    (2010) Özmen B.; Eser E.; Özkaya Kafesçiler S.; Pala T.; Güçlü F.; Hekimsoy Z.
    The aim of this study is to test the psychometric properties and the responsiveness of the original (status) version of Turkish DTSQ. The study sample included 88 patients with diabetes mellitus who were evaluated in three consecutive time points. The first data collection time point was during their initial contact to the clinic, and the two following (3rd month and 6th month) were during the monitoring visits to the Celal Bayar University Endocrinology Department in 2007. After the adaptation of the DTSQ to Turkish language by following standard procedures, this instrument was applied to the patients along with WBQ-12 and World Health Organization Quality of Life Measure (WHOQOL-Bref). The reliability of the DTSQ was evaluated by running internal consistency analysis (Cronbach Alpha) and item analysis. Construct validity of the instrument was evaluated by various tests such as Principal Components analysis, Confirmatory Factor Analysis, Concurrent validity and "Known Groups" comparisons. Finally the sensitivity (responsiveness to change) of the DTSQ scores to the changes of the metabolic conditions were assessed. 50.0% of the participants were male with a mean age of 51.1 ± 11.4 (min 22, max 78). Majority of them had type 2 diabetes (86.4%) and 72.7% of these patients had at least one co-morbid chronic conditions. While 53.4% of the patients had been treated by insulin the remaining 46.6% had been taking oral anti-diabetic agents. The results revealed satisfactory alpha values for DTSQ (α > 0.70). All of the three metabolic measures (i.e., FBG, PBG, and HbA1c) had significant correlations with the DTSQ scores. The criterion and construct validity of the scale were found to be very satisfactory. The Turkish version of the DTSQ showed acceptable fit indices (RMSEA = 0.03, CFI > 0.90) with the original (hypothetic) construct. Almost all of the sub-dimensions of the WBQ and WHOQOL were correlated with the DTSQ as expected, indicating a good concurrent validity. DTSQ status version was found to be a reliable and valid instrument for the assessment of treatment satisfaction in Turkish diabetes mellitus patients. © 2009 Springer-Verlag.
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    The prevalence of hyperprolactinaemia in overt and subclinical hypothyroidism
    (2010) Hekimsoy Z.; Kafesçiler S.; Güçlü F.; Özmen B.
    The aims of this study were to: 1) determine the prevalence of hyperprolactinaemia in patients with newly diagnosed subclinical and overt hypothyroidism, and 2) investigate the change in PRL levels with treatment. In this observational study, patients with a new diagnosis of hypothyroidism in our endocrinology clinic were approached for participation, as were healthy controls. Patients with medical reasons for having elevated PRL levels, lactating and pregnant women were excluded from the study. No patient had kidney or liver disease. After examination to determine if clinical causes of PRL elevation were present, serum levels of thyrotropin (TSH), free thyroxine, free triiodothyronine and PRL were measured and correlation of PRL levels with the severity of hypothyroidism (overt or subclinical) was performed. Fifty-three patients (45 women, 8 men, mean age 45.3±12.2 years) had overt hypothyroidism. One hundred forty-seven patients (131 women, 16 men, mean age 42.9±12.6 years) had subclinical hypothyroidism. One hundred healthy persons (85 women, 15 men, mean age 43.9±11.4 years) participated as controls. The same blood tests were repeated in patients after normalization of TSH levels with L-thyroxine treatment. PRL elevation was found in 36% of patients with overt hypothyroidism, and in 22% of patients with subclinical hypothyroidism. PRL levels decreased to normal in all patients after thyroid functions normalized with L-thyroxine treatment. In the hypothyroid patients (overt and subclinical) a positive correlation was found between TSH and PRL levels (r=0.208, p=0.003). PRL regulation is altered in overt and subclinical hypothyroidism, and PRL levels normalize with appropriate L-thyroxine treatment.© The Japan Endocrine Society.
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    Etiology of hypopituitarism in tertiary care institutions in Turkish population: Analysis of 773 patients from pituitary study group database
    (Humana Press Inc., 2014) Tanriverdi F.; Dokmetas H.S.; Kebapci N.; Kilicli F.; Atmaca H.; Yarman S.; Ertorer M.E.; Erturk E.; Bayram F.; Tugrul A.; Culha C.; Cakir M.; Mert M.; Aydin H.; Taskale M.; Ersoz N.; Canturk Z.; Anaforoglu I.; Ozkaya M.; Oruk G.; Hekimsoy Z.; Kelestimur F.; Erbas T.
    Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 ± 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: non-secretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndrome is still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries. © 2013 Springer Science+Business Media.
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    Real-life safety and efficacy of vildagliptin as add-on to metformin in patients with type 2 diabetes in Turkey - GALATA study
    (Informa Healthcare, 2015) Ayvaz G.; Keskin L.; Akin T.F.; Dokmetas H.S.; Tasan E.; Ar I.B.; Uren E.; Akber T.; Akdeniz Y.; Bambul N.; Bayraktaroglu T.; Borlu F.; Boz M.; Bozoglu E.; Buyukbese M.A.; Canberk A.; Comlekci A.; Delibasi T.; Demir S.; Eskioglu E.; Guler S.; Gulkan S.; Hekimsoy Z.; Karaca Z.; Keskin M.; Koca N.; Korkmaz H.; Onder E.; Ozisik L.; Peru C.; Sahin M.; Saygili F.; Serin S.; Sezer H.; Sezgin G.; Tasci I.; Tasliyurt T.; Torun A.N.; Tura Bahadir C.; Gursoy Yener G.; Yigit Z.
    Objective: To evaluate tolerability/safety and the efficacy of the combination of vildagliptin plus metformin in a real-life population of patients with type 2 diabetes mellitus (T2DM). Research design and methods: This multicenter, single-arm, 6 month, observational, prospective cohort study was conducted at 39 centers across Turkey. T2DM patients on vildagliptin and metformin for ≤4 weeks were enrolled regardless of their previous antidiabetic therapy. Main outcome measures: Efficacy was evaluated by measuring hemoglobin A1c (HbA1c) levels. Tolerability/safety parameters evaluated included hypoglycemic events, gastrointestinal events, peripheral edema and weight gain. Results: This study enrolled 665 patients with a mean±standard deviation (SD) age of 55.1±10.2 years and female predominance (n=394, 59.2%). Safety was assessed in all enrolled patients. Hypoglycemia was reported in 10 (1.5%) patients (95% confidence interval = 0.8-2.7%). Efficacy was assessed in 289 (43.5%) patients treated for 6±1 months; these patients showed a mean decrease in HbA1c of 0.8% from baseline value of 7.8% (p<0.001). The percentages of patients who achieved HbA1c targets of ≤6.5% and ≤7.0% were significantly increased, from 10.7% to 33.6% and from 22.1% to 52.6%, respectively (p<0.001 each). The decrease in HbA1c was independent of baseline HbA1c (≤8% vs. 8-10% vs. ≥10%), age (≤65 vs. >65 years) and body mass index (<30 vs. ≥30 kg/m2) (p<0.001 each). In total, 136 adverse events (AEs) were observed in 71 (10.7%) patients; 10 (1.5%) patients experienced hypoglycemia and gastrointestinal AEs were most commonly reported (n=29, 4.4%). Conclusions: In a 'real-life' setting, the vildagliptin and metformin combination was associated with significant improvements in reaching target HbA1c levels, even in elderly and obese patients with T2DM. Moreover, vildagliptin and metformin demonstrated a good overall tolerability/safety profile. © 2015 All rights reserved: reproduction in whole or part not permitted.