Slide Session : OS-END-46 ; Endocrinology : A Rare Cause of Secondary Hypertension: An Unusual Case of Conn`s Syndrome

( Samet Sayilan ),( Yildiz Okuturlar ),( Meral Mert ),( Ozlem Soyluk ),( Serkan Enki ),( Yesim Ozden Inan ),( Ozlem Harmankaya ),( A Baki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Primary hyperaldosteronism (PHA) is a syndrome arising from autonomous aldosterone secretion from the adrenal gland and suppression of plasma renin activity. PHA is usually seen due to unilateral adenoma or bilateral hyperplasia. We present a case of Conn`s syndrome with bilateral adrenal lesions but unilateral functioning adenoma. Methods: A 43 years old female admitted to the emergency service due to inability to walk for 3 days, fatigue and generalised pain. She had a history of diabetes mellitus and hypertension for 15 years. She was receiving angiotensin receptor blocker with thiazide, calcium channel blocker, beta-blocker and insulin treatment. Her blood tests revealed alkalosis and severe hypokalemia with normal renal function. In the examinations for the causes of secondary hypertension; 24-hour urinary cortisol, metanephrine, normetanephrine and VMA levels were normal. Results: After cessation of diuretic treatment plasma renin activity (PRA) was measured 0.17 ng / mL/ h while plasma aldosterone level (PAL) was measured 71 ng / dl. The ratio of PAL / PRA was very high. Her abdominal MRI revealed bilateral adrenal lesions with 23x14 mm and 12x8 mm in diameters in the right and left adrenal gland respectively compatible with adenoma. On the other hand adrenal venous sampling (AVS) showed lateralisation for the right side. Conclusions: Most common causes of PHA are unilateral aldosterone secreting adenoma and bilateral adrenal hyperplasia. Although the appearance of bilateral adrenal lesions in MRI in our case, results of AVS were compatible with autonomous aldosteron production on the right side. According to these findings we accepted the case as a unilateral functioning adenoma with an incidentaloma on the other side.

Slide Session : OS-END-44 ; Endocrinology : The Relationship Between Vitamin D and Testosterone Levels in Overweight Patients

( Ozlem Soyluk ),( Meral Mert ),( Yildiz Okuturlar ),( Samet Sayilan ),( Pinar Karakaya ),( Farid Babashov ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: There are studies showing the relationship between vitamin D deficiency and obesity in the literature. Also it is known that testosterone levels decrese in obesity. So it is hypothesized that testosterone levels can increase with vitamin D replacement. We aimed to investigate this relationship between vitamin D and testosterone level in patients with BMI over 25 kg/m2. Methods: The data of 3110 patients with BMI > 25 kg /m2 are evaluated retrospectively. The relation between 25 OH vitamin D3, tetsoterone, parathormone (PTH), A1c, fasting insulin, fasting glucose, HOMA values, age, sex were examined. We compared the data of 265 women and 38 men whose records included all these parameters. Results: Mean ages are found to be 46,38±12,82 yeasr and 40,42±12,60 years in female and male patients respectively. There are no significant differences between vitamin D, PTH, B12 and HOMA levels in female and male patients. In the female group there was a negative correlation between age and 25 (OH)D3 level and in the male group there was a negative correlation between 25(OH)D3 and HOMA value. In both groups no correlation was found between 25(OH)D3 and total testosterone levels (Table-1). Conclusions: There are several studies with different results about the realtionship between vitamin D and parameters like obesity, testosterone level. In our study we could not find any relationship between Vitamin-D and testosterone levels.

Slide Session : OS-END-23 ; Endocrinology : The Relationship Between Testosterone and Homa-R Levels in Overweight Patients

( Yildiz Okuturlar ),( Meral Mert ),( Ozlem Soyluk ),( Ozlem Harmankaya ),( Pinar Karakaya ),( Samet Sayilan ),( Didem Acarer ),( A Baki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It was shown that there is a correlation between low testosterone level and insulin resistance. Insulin resistance is related with metabolic syndrome and type 2 diabetes which represent a risk factor for cardiovascular disease. Obesity has become an important public health problem and it is known that it has an adverse effect on reproductive system and fertility. In our study it was aimed to investigate the relation between testosterone level and insulin resistance in overweight male and female patients. Methods: In our study total number of 2699 female and 377 male patients who admitted to our hospital because of weight problem and had BMI>25 were evaluated retrospectively. Correlation analyses between total testosterone level and parameters like fasting blood glucose, insulin level, Alc and HOMA values were performed. Results: While average age was 41.38±12.50 years in female patients it was detected 39.15±13.73 years for male patients. While negative correlations were found between testosterone level and age, testosterone level and glucose, testosterone level and Alc in the female group there were no correlations between testosterone level and HOMA, testosterone level and insulin in the same group. Whereas in the male group negative correlations were found between testosterone level and glucose, testosterone level and insulin, testosterone level and Alc and testosterone level and HOMA in the male group (Table 1). Conclusions: The correlation between testosterone level and insulin was reported in female patients with polycystic ovary syndrome. In our study glucose and A1c levels may increase while testosterone level decreases in both male and female groups. In addition to this finding insulin level and HOMA also increases with the decrease of testosterone in male patients. This may be explaned by the metabolic effect of testosterone.

Poster Session : PS 0446 ; Infectious Disease ; Fever of Unknown Cause Which is the Cause of Intestinal Tuberculosis

( Tugrul Burak Genc ),( Yildiz Okuturlar ),( Ozlem Harmankaya ),( Suut Gokturk ),( Bulent Durdu ),( Samet Sayilan ),( Selcuk Sezikli ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: In developing countries, tuberculosis (tbc) incidence is reduced; but immunocompromised patients still remain at high risk for the disease. Malignancy and Crohn`s disease should be considered in the differential diagnosis of gastrointestinal (GIS) tbc in immunocompromised patients. We present here the clinical course of a patient with fever of unknown origin and rectal bleeding. Methods: A 31-year-old male cachectic patient was admitted to hospital with abdominal pain, fever and diarrhea. The history of the patient revealed systemic lupus erythematosus, lupus nephritis and left middle cerebral artery infarction. Right hemiparesis was present. He was on warfarin 5mg/day, cilazapril 2,5mg/day, methylprednisolone 4mg/day, mycophenolate mofetil 2g/day, hydroxychloroquine 200mg/ day, levodopa+benserazide 375mg/day, levetiracetam 1 g/day. Creatinine was 2,79mg/dL, and C-reactive protein was 10 mg/dL. No pneumonic infi ltration was shown. Blood, urine and faeces cultures, Chlamydia IgM, mycoplasma IgM, toxoplasma IgM, EBV IgM, CMV IgM and PPD test were negative. Transesophageal echocardiography excluded infective endocarditis. Empiric antibiotic treatment with ceftriaxone, piperacillin-tazobactam and moxifi oxacin, and antifungal fi uconazole was started. On the 15th day hematochezia occured. Colonoscopy revealed three different massive lesions straightening the lumen in caecum, hepatic fi exure of colon and transverse colon (figure-1). Results: Pathologic examination demonstrated granulomatous lesion. Considering the positive results of Tbc-PCR treatment, the patient was diagnosed as GIS tbc and isoniazid, rifampicin, pyrazinamide and ethambutol were started. Conclusions: The ileocecal region is the most frequent localization of intestinal tbc. Colonic tbc is often localized in proximal colon and caecum, and usually associated with ileal tbc. It is rarely seen in transverse colon. Our patient is a rare case of gastrointestinal tbc presenting without pneumonic infi ltration and with an unusual localization in colon.