Browsing by Author "Karaca Z."

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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.
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    Prevalence of Vitamin D Deficiency and Hypervitaminosis D Among Adult Patients Admitted to the Tertiary Care Hospitals in Turkey
    (Turkiye Klinikleri, 2022) Yavuz D.G.; Ersoy R.; Altuntaş Y.; Bilen H.; Pamuk B.; Apaydın T.; Temizkan Ş.; Altuntaş H.; Mert M.; Akalın A.; Sert M.; Şimşir I.Y.; Hekimsoy Z.; Cantürk Z.; Üç Z.A.; İplikçi S.; Yaşar M.; Unubol M.; Sezer K.; Toplaoğlu Ö.; İyidir Ö.T.; Pekkolay Z.; Atmaca A.; Dikbaş O.; Özdemir N.; Gül K.; Deniz F.; Ertörer E.; Karaca Z.; Elbüken G.; Arpacı D.; Ağbaht K.; Turan E.; Anaforoğlu İ.; Bayraktaroğlu T.; Haklar G.; Dağlıoğlu G.; Tuzcu A.; Şahin İ.; Çetinkalp Ş.
    Objective: Vitamin D deficiency is a common health problem around the world. This study aimed to evaluate the nationwide prevalence of vitamin D status in tertiary care hospitals in Turkey. Methods: Retrospectively, the data on vitamin D levels from 33 tertiary care hospitals’ clinical biochemistry laboratories around Turkey between January and December were collected. Results: In total, 706 434 serum samples from adult subjects (female/male: 469 028/237 406; 66.4%/33.6%) were included. While vitamin D levels were sufficient in 20.3% (n = 14 222), they were insufficient in 21.9% (n = 154 360) and deficient in 57.8% (n = 408 882). We observed the highest rates of deficiency in those aged between 18 and 29 years (62.9%, n = 70 235) and lowest rates between 60 and 69 years (52.3%, n = 61 121) and between 70 and 79 years (52.3%, n = 32 397). Hypervitaminosis D was detected in 5.5% of adult subjects; highest rates of hypervitaminosis D were observed in those who were over 80 years (6.6%) and 70-79 years (6.5%) and the lowest in 18-29 years (2.8%). Discussion: In this cohort, over half of the subjects admitted to the tertiary care hospitals in Turkey had vitamin D deficiency and required vitamin D supplementation. The elderly population had the lowest prevalence of vitamin D insufficiency and the highest prevalence of hypervitaminosis D. © Author(s).
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    The Importance of DHEA-S Levels in Cushing's Syndrome; Is There a Cut-off Value in the Differential Diagnosis?
    (Georg Thieme Verlag, 2022) Ciftci S.; Soyluk O.; Selek A.; Erol S.; Hekimsoy Z.; Esen A.; Dursun H.; Sahin S.; Oruk G.; Mert M.; Soylu H.; Yurekli B.S.; Ertorer M.E.; Omma T.; Evran M.; Adas M.; Tanrikulu S.; Aydin K.; Pekkolay Z.; Can B.; Karakilic E.; Karaca Z.; Bilen H.; Canturk Z.; Cetinarslan B.; Kadioglu P.; Yarman S.
    The purpose of this study was to determine possible cut-off levels of basal DHEA-S percentile rank in the differential diagnosis of patients with Cushing's syndrome (CS) with ACTH levels in the gray zone and normal DHEA-S levels.In this retrospective study including 623 pathologically confirmed CS, the DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within reference interval. The patients were classified as group 1 (n=265 Cushing's disease; CD), group 2 (n=104 adrenal CS) and group 3 (n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate the optimal cut-off level of DHEA-S percentile rank in the reference interval in the differential diagnosis of CS, and the effectiveness of this cut-off level in the identification of the accurate etiology of CS was assessed in patients who were in gray zone according to their ACTH levels.The DHEA-S percentile rank in the reference interval were significantly lower in group 2 compared to the other two groups (p<0.001), while group 1 and group 3 had similar levels. The optimal cut-off level of DHEA-S percentile rank in the reference interval providing differential diagnosis between group 1 and group 2 was calculated as 19.5th percentile (80.8% sensitivity, 81.5% specificity) and the level demonstrated the accurate etiology in 100% of CD and 76% of adrenal CS patients who were in the gray zone.This study showed that the cut-off value of DHEA-S level less than 20% of the reference interval could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, and it should be taken into the initial evaluation. © 2022 ASTM International. All rights reserved.
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    Evaluation and follow-up of patients diagnosed with hypophysitis: A cohort study
    (Oxford University Press, 2024) Hacioglu A.; Karaca Z.; Uysal S.; Ozkaya H.M.; Kadioglu P.; Selcukbiricik O.S.; Gul N.; Yarman S.; Koksalan D.; Selek A.; Canturk Z.; Cetinarslan B.; Corapcioglu D.; Sahin M.; Sah Unal F.T.; Babayeva A.; Akturk M.; Ciftci S.; Piskinpasa H.; Dokmetas H.S.; Dokmetas M.; Sahin O.; Eraydln A.; Fenkci S.; Ozturk S.; Akarsu E.; Omma T.; Erkan B.; Burhan S.; Pehlivan Koroglu E.; Saygili F.; Kilic Kan E.; Atmaca A.; Elbuken G.; Alphan Uc Z.; Gorar S.; Hekimsoy Z.; Pekkolay Z.; Bostan H.; Bayram F.; Yorulmaz G.; Sener S.Y.; Turan K.; Celik O.; Dogruel H.; Ertorer E.; Turhan Iyidir O.; Topaloglu O.; Cansu G.B.; Unluhizarci K.; Kelestimur F.
    Objective: Primary hypophysitis might be challenging to diagnose, and there is a lack of evidence regarding optimal treatment strategies due to rarity of the disease. We aim to investigate the clinical features and compare the outcomes of different management strategies of primary hypophysitis in a large group of patients recruited on a nationwide basis. Design: A retrospective observational study. Methods: The demographic, clinical, and radiologic features and follow-up data were collected in study protocol templates and analyzed. Results: One hundred and thirteen patients (78.8% female, median age: 36 years) were included. Lymphocytic (46.7%) and granulomatous hypophysitis (35.6%) were the prevailing subtypes out of 45 patients diagnosed after pathologic investigations. Headache (75.8%) was the most common symptom, and central hypogonadism (49.5%) was the most common hormone insufficiency. Of the patients, 52.2% were clinically observed without interventions, 18.6% were started on glucocorticoid therapy, and 29.2% underwent surgery at presentation. Headache, suprasellar extension, and chiasmal compression were more common among glucocorticoid-treated patients than who were observed. Cox regression analysis revealed higher hormonal and radiologic improvement rates in the glucocorticoid-treated group than observation group (hazard ratio, 4.60; 95% CI, 1.62-12.84 and HR, 3.1; 95% CI, 1.40-6.68, respectively). The main indication for surgery was the inability to exclude a pituitary adenoma in the presence of compression symptoms, with a recurrence rate of 9%. Conclusion: The rate of spontaneous improvement might justify observation in mild cases. Glucocorticoids proved superior to observation in terms of hormonal and radiologic improvements. Surgery may not be curative and might be considered in indeterminate, treatment-resistant, or severe cases. © 2024 The Author(s). Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved.
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    Comparison of clinical, hormonal, pathological and treatment outcomes of ectopic Cushing’s syndrome by sex: results of a multicenter study
    (Springer, 2024) Ciftci S.; Yilmaz N.; Selcukbiricik O.S.; Hekimsoy Z.; Canpolat A.G.; Topsakal S.; Yaylali G.F.; Misiroglu F.; Gul N.; Uzum A.K.; Hacioglu A.; Yorulmaz G.; Ozisik H.; Yurekli B.S.; Pekkolay Z.; Turgut S.; Karaca Z.; Duran C.; Kebapci M.N.; Yarman S.
    Objective: To compare clinical and hormonal data, neuroendocrine neoplasia (NEN) localization, treatment, and survival outcomes in ectopic Cushing’s syndrome (ECS) by sex. Methods: Eleven experienced centers from our country participated in this retrospective study. The clinical and hormonal features, tumor imaging, pathological results, treatment modalities, and disease courses of the patients were evaluated. Results: 28 female and 26 male patients with ECS were compared. The mean age at diagnosis, clinical characteristics, and hormonal evaluation results were similar. However, insulin-requiring diabetes mellitus (p = 0.04) and osteoporosis with fractures were more common in males (p = 0.03). While more patients with increased DHEA-S levels than the upper limit of normal were found to be higher in females, central hypothyroidism were higher in males (p = 0.02). At the diagnosis, 36 NENs (68% of females and 69% of males) were localized. Small cell lung carcinoma was higher in males (p = 0.02), and the frequency of other NENs was not different. Curative surgery was performed on 61% of females and 46% of males. Tumor size, Ki-67 labeling index, positive ACTH immunostaining, local lymph node and distant metastasis rates were similar in both sexes. In the follow-up, the tumor became visible in 7 of 10 females and 4 of 8 males after medical treatment and/or bilateral adrenalectomy. The remission rates (65% of females, 62% of males) and NEN-related death rates (14% of females, 30% of males) were similar. Conclusion: While ECS has a similar disease course in many aspects in males and females, hyperglycemia and osteoporosis are more severe in males. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.
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    Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies
    (John Wiley and Sons Inc, 2024) An İ.; Kahraman F.C.; Bilgiç A.; Aktürk A.Ş.; Albayrak H.; Kartal D.; Çınar S.L.; Solak S.S.; Uslu M.; Şanlı H.E.; Yıldızhan İ.K.; Şahin M.T.; Zindanci İ.; Savaş S.; Ayhan E.; Cinel M.; Ataş E.N.S.; Aydemir M.; Selek A.; Elbüken G.; Zuhur S.S.; Karaca Z.; Bülbül B.Y.; Ünübol M.; Demir Ö.; Hekimsoy Z.; Tuna M.; Asilsoy M.; Çetin S.
    Objectives: Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. Design, Patients, and Measurements: In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. Results: The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p:.001), while xerosis cutis was significantly more prevalent in patients remitted (p:.001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidism and galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values:.024,.034 and.027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p:.035). Conclusions: Cutaneous androgenization findings such as skin tag, seborrhoea, acne and acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier. © 2024 John Wiley & Sons Ltd.