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Öğe Acromegaly is associated with decreased skin transepidermal water loss and temperature, and increased skin pH and sebum secretion partially reversible after treatment(CHURCHILL LIVINGSTONE, 2012) Borlu, Murat; Karaca, Zuleyha; Yildiz, Hatice; Tanriverdi, Fatih; Demirel, Beril; Elbuken, Gulsah; Cakir, Ilkay; Dokmetas, Hatice Sebila; Colak, Ramis; Unluhizarci, Kursad; Kelestimur, FahrettinBackground: Acromegaly is characterized by an acquired progressive somatic disfigurement, mainly involving the face and extremities, besides many other organ involvement. Wet and oily skin was described in acromegaly patients and it was attributed to hyperhidrosis and increased sebum production but this suggestion has not been evaluated with reliable methods. Objective: The aim of this study was to examine the skin parameters of patients with acromegaly using measurements of skin hydration, sebum content, transepidermal water loss, pH and temperature and particularly the effects of 12 months of treatment on these parameters. Methods: 52 patients with acromegaly and 24 healthy control subjects were included in this two blinded prospective study. Skin properties were measured on forehead and forearm by Corneometer CM825, Sebumeter SM810, Tewameter TM210 and Phmeter PH900 as non-invasive reliable measuring methods. Serum GH, IGF-1 and all measurements of skin properties on forehead and forearm were repeated at the end of the 3, and 6 months of therapy in 20 cases. Patients were treated with appropriate replacement therapy for deficient pituitary hormones. Results: The sebum content and pH of the skin of acromegalic patients were significantly higher and transepidermal water loss and skin temperature were found to be significantly lower in acromegalic patients when compared to the control group both on forehead and forearm. GH and IGF-1 levels were positively correlated with sebum levels and negatively correlated with skin temperature on both forehead and forearm. The sebum levels of the patients were significantly decreased both on forehead and forearm at 3rd and 6th months of treatment. Conclusion: The present study demonstrated increased sebum secretion, decreased transepidermal water loss, alkali and hypothermic skin surface in patients with acromegaly by reliable methods for the first time. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics which can be at least partially reversible with treatment. (C) 2012 Elsevier Ltd. All rights reserved.Öğe Adrenal Ganglioneuroma: Case Report(Galenos Yayincilik, 2011) Kilicli, Fatih; Acibucu, Feffah; Dokmetas, Hatice Sebila; Elagoz, Sahande; Gokce, Gokhan; Oztoprak, IbrahimGanglioneuroma (ON) is a rare benign tumor arising mainly from neural crest cells and consisting of Schwann and ganglion cells. GN rarely occurs from the adrenal medulla and is observed most commonly in children and young adults. It is not associated with hormonal activity and is clinically asymptomatic. We present a 35-year-old woman whose abdominal ultrasonography for abdominal pain revealed in the right adrenal gland, a biochemically normal mass that was minimally hypointense on Tl-weighted and hyperintense on T2-weighted magnetic resonance images (MRI) and which was pathologically diagnosed as GN after adrenalectomy.Öğe Allgrove syndrome(SINGAPORE MEDICAL ASSOC, 2012) Kilicli, Fatih; Acibucu, Fettah; Senel, Soner; Dokmetas, Hatice SebilaAllgrove syndrome is a rare autosomal recessive disorder. It is also known as the 3A syndrome and characterised by the triad of achalasia, alacrima and adrenal insufficiency. The AAAS gene is encoded on chromosome 12q13. We report the case of a 23-year-old woman who presented at the hospital with adrenal crisis that was triggered by infection of the urinary system and gastrointestinal bleeding. She had a known diagnosis of achalasia for eight years, and ophthalmologic examination revealed alacrima. Based on our findings, the patient was diagnosed with Allgrove syndrome.Öğe Atrial fibrillation is associated with increased mean platelet volume in patients with type 2 diabetes mellitus(TAYLOR & FRANCIS INC, 2013) Turgut, Okan; Zorlu, Ali; Kilicli, Fatih; Cinar, Ziynet; Yucel, Hasan; Tandogan, Izzet; Dokmetas, Hatice SebilaPlatelet abnormalities in diabetes mellitus (DM) and atrial fibrillation (AF) may underline the etiology of a prothrombotic state in these conditions. Increased mean platelet volume (MPV) is a marker of abnormal platelet function and activation. We aimed to investigate the possible association of chronic AF with MPV in patients who have type 2 DM. Patients who had type 2 DM with either chronic (>= 6 months) AF or normal sinus rhythm (NSR) were included in the study. A total of 162 patients (aged 38-89 years) were divided into 2 groups according to the presence of either AF or NSR. Group 1 consisted of 81 diabetic patients with AF, and group 2 consisted of 81 diabetic patients with NSR. The two groups were not significantly different in terms of age, and gender, as well as in hypertension, smoking, history of coronary artery disease, previous cerebrovascular accidents, microalbuminuria, retinopathy, duration of DM, body mass index, hemoglobin A(1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (p > 0.05 for all variables). Although no significant difference was present between groups concerning platelet count; for patients with AF, MPV was higher compared with patients with NSR (9.0 +/- 0.2 fl vs. 8.4 +/- 0.2 fl; p = 0.001). Furthermore, no significant difference was noted between groups regarding routine medications received by patients. In multivariate logistic regression analysis, MPV was the only variable independently related to AF (OR = 2.659; 95% CI, 1.286-5.498; p = 0.008). Consequently, it is concluded that AF is associated with increased MPV in patients with type 2 DM, suggesting the presence of tentatively related processes leading to reciprocal interaction.Öğe Could total thyroidectomy become the standard treatment for Graves' disease?(SPRINGER, 2010) Koyuncu, Ayhan; Aydin, Cengiz; Topcu, Oemer; Gokce, Oruc Numan; Elagoz, Sahande; Dokmetas, Hatice SebilaGraves' disease is the most frequent cause of hyperthyroidism. Although treatment with antithyroid drugs or radioactive iodine is effective, surgery remains the preferred treatment for many patients. We analyzed the results of 55 prospectively followed patients who underwent total thyroidectomy for Graves' disease. Total thyroidectomy was performed by experienced endocrine surgeons in all 55 patients. We monitored the patients postoperatively for early and late complications. There were 19 men, with a mean age of 42 years (range, 34-68 years) and 36 women, with a mean age of 38 years (range, 19-78 years). One patient suffered postoperative hemorrhage and subsequent wound infection, two patients had transient recurrent laryngeal nerve palsy, and 24 patients had transient hypocalcemia. The mean follow-up time was 4 years (range, 10 months to 6 years). Recurrence of hyperthyroidism was not reported in this period. Removal of all thyroid tissue offers the best chance of preventing recurrent hyperthyroidism. Total thyroidectomy is the most effective surgery for achieving the goal of treatment of Graves' disease to ensure that hyperthyroidism will not recur.Öğe Etiologies of patients admitted to emergency department with hypoglycemia(ACADEMIC JOURNALS, 2010) Eren, Sevki Hakan; Caliskan, Haci Mehmet; Kilicli, Fatih; Korkmaz, Ilhan; Acibucu, Fettah; Dokmetas, Hatice SebilaHypoglycemia is the most common endocrinologic problem seen in emergency departments. To explore its causes in patients who admitted to the emergency department with symptoms resembling hypoglycemia, 225 hypoglycemia cases were evaluated from January 2000 to May 2008. Of 225 hypoglycemia cases, 158 (70.2%) were receiving treatment for diabetes mellitus, which was the most common group (94 patients were using insulin, 55 were receiving oral anti-diabetics (OAD) and 9 patients both OAD and insulin). The other causes for hypoglycemia were as follows: reactive hypoglycemia cases (11.6%), insulinoma (2.7%), malignancies (2.2%), Sheehan syndrome (0.9%), chronic liver disease (0.9%), gestational diabetes mellitus (0.4%), OAD use by mistake (3.6%), and use of OAD for suicidal purposes (13%). In eight of the cases, the reason could not be identified. The study revealed that diabetes mellitus constitute the most common reason for hypoglycemia among the patients seen in emergency departments. Efforts should be made to prevent hypoglycemia by giving the patients better education.Öğe Humoral Regulation of Osteoclasts and Their Role in Bone Resorption(Galenos Yayincilik, 2008) Dokmetas, Hatice SebilaOsteoclasts are derived from the macrophage haematopoietic lineage, resemble monocyte-like phagocytic cells, and are involved in bone resorption. The cells of the bone and the immune system communicate by cytokines and growth factors. The discovery of the receptor activator of nuclear factor kappa B (RANK) signalling pathway in osteoclasts provides a deeper understanding of osteoclastogenesis, mechanisms of the activation of bone resorption, and how bone structure and mass are affected by hormones.Öğe The prevalence of non-classic adrenal hyperplasia among Turkish women with hyperandrogenism(TAYLOR & FRANCIS LTD, 2010) Unluhizarci, Kursad; Kula, Mustafa; Dundar, Munis; Tanriverdi, Fatih; Israel, Shoshana; Colak, Ramis; Dokmetas, Hatice Sebila; Atmaca, Hulusi; Bahceci, Mithat; Balci, Mustafa Kemal; Comlekci, Abdurrahman; Bilen, Habip; Akarsu, Ersin; Erem, Cihangir; Kelestimur, FahrettinThe prevalence of non-classic adrenal hyperplasia (NCAH) among Turkish women with hirsutism has not been established so far. Thus, we aimed to evaluate the prevalence of 21-hydroxylase (21-OH) deficiency by ACTH stimulation test among hirsute women. The study population consisted of 285 premenopousal women, aged 16-46 years (mean: 23.2 +/- 0.3). All were hirsute and hyperandrogenic. Androgen secreting tumors of the ovaries and the adrenal glands were excluded as well as thyroid dysfunction and hyperprolactinemia. All the patients were evaluated by 0.25 mg (i.v.) ACTH stimulation test and 17-OHP responses were obtained at 30 and 60 min. The diagnosis of NCAH due to 21-OH deficiency was considered in patients with the poststimulation 17-OHP level exceed 10 ng/ml. Six (2.1%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. The rest of the patients were polycystic ovary syndrome (n = 166, 58.2%) and idiopathic hyperandrogenemia (n = 113, 39.7%). There were no patients with idiopathic hirsutism because patients with normal serum androgen levels were excluded. This first and most extensive national study investigating NCAH prevalence among Turkish population showed that NCAH is not prevalent in this population.Öğe Sheehan's syndrome(INFORMA HEALTHCARE, 2013) Kilicli, Fatih; Dokmetas, Hatice Sebila; Acibucu, FettahSheehan's syndrome (SS) is characterized by various degrees of hypopituitarism, and develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Increased pituitary volume, small sella size, disseminated intravascular coagulation and autoimmunity are the proposed factors in the pathogenesis of SS. Hormonal insufficiencies, ranging from single pituitary hormone insufficiency to total hypopituitarism, are observed in patients. The first most important issue in the diagnosis is being aware of the syndrome. Lack of lactation and failure of menstrual resumption after delivery that complicated with severe hemorrhage are the most important clues in diagnosing SS. The most frequent endocrine disorders are the deficiencies of growth hormone and prolactin. In patients with typical obstetric history, prolactin response to TRH seems to be the most sensitive screening test in diagnosing SS. Other than typical pituitary deficiency, symptoms such as anemia, pancytopenia, osteoporosis, impairment in cognitive functions and impairment in the quality of life are also present in these patients. Treatment of SS is based on the appropriate replacement of deficient hormones. Growth hormone replacement has been found to have positive effects; however, risk to benefit ratio, side effects and cost of the treatment should be taken into account.
