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.

Slide Session : OS-NEP-06 ; Nephrology : Paraoxonase-1 Activity in Patients with Anemia with or Without Chronic Renal Failure

( Yildiz Okuturlar ),( Nilgul Akalin ),( Ozlem Harmankaya ),( Nurten Turan Guner ),( Deniz Yilmaz ),( Asuman Gedikbasi ),( Ozlem Soyluk ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Paraoxonase (PON)-1 is an antioxidant enzyme. It has three known activities, paraoxonase, arylesterase and diazoxonase. It has been reported that PON-1 defi ciency is related to increased susceptibility to development of atherosclerosis and cardiovascular disease. The aim of this study is to evaluate antioxidative status and carotid intima-media thickness (CIMT) in patients with anemia with/without chronic renal failure. Methods: 42 patients with anemia and a control group of 47 patients were enrolled in to the study. Patients were divided into two groups as Group 1 with iron defi ciency anemia and Group 2 with chronic renal failure and anemia of chronic disease and Group 3 as the healthy control group. In all three groups antioxidative status was evaluated by measuring free sulfhydryl groups (-SH = total thiol), paraoxonase and arylesterase levels. CIMT measurements were also performed at the same time. Results: In all three groups, age, weight, average height, gender, presence of diabetes and smoking habit were not signifi cantly different (p>0.05). Hemoglobin levels were 7.85 ± 1.25 in Group 1, 8.62 ± 1.09 in Group 2 and 13.45±1.63 in Group 3. We have found that Arylesterase and -SH levels were decreased both in Group 1 and 2 according to Group 3. Bilateral CIMT was increased only in Group 2. Between group 1 and group 2 the only difference was the the more signifi cant decrease in Arylesterase levels in group 2 (Table 1-2). Conclusion: PON-1 activity and -SH levels may be independently associated with the presence of atherosclerosis.

Slide Session : OS-END-20 ; Endocrinology : Hemorheological Approach for Early Detection of Diabetic NephropathyCardiovascular Risk Rates in Metabolic Syndrome and Atherosclerotic Marker Serum MatrIx MetalloproteIn-ase-9 Levels

( Sibel Serin ),( Yildiz Okuturlar ),( Asuman Gedikbasi ),( Esra Demir ),( Sema Ucak Basat ),( Ozlem Harmankaya ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Metabolic syndrome (MS) is associated with increased cardiovascular risk. There are a lot of study that is releated with the correlation between metabolic syndrome and low grade inflammation. We have attempted to compare Framingham Risk Score(FRS) that calculates cardiovascular risc rates and Matrix Metalloproteinase- 9 levels that is an aterosclerotic proinflammatory marker, on metabolic syndrome`s between other healties. Method: We included 86 patients that contains 51 MS and 35 healties to this study..In both groups, age, length, weight, BMI, waist circumference, familial hearth disease and HT on family was registered. Framingham risk score (FRS) was calculated. Insulin, glucose, HOMA-IR, total cholesterol, LDL, HDL, Triglyceride levels saved. Blood samples for MMP -9 levels were taken and stored at -80 ℃. MMP-9 levels measured by the way of solid phase platinium ELISA (BIOSOURCE). Results: This case contained 86 patients, 51 of them is MS (%59.3) and the others are called as control group (%40.7). Ages of patients are changed between 20-55 years and the mean age is 38.52±10.02. FRS of MS patients were calculated statistically high compaired to control group (p=0.017). MMP-9 levels of MS patients were calculated statistically high compaired to control group (p=0.001).In both goups, there is no statistically significant relationship between MMP-9 levels and FRS (p>0.05) Conclusion: MMP-9 changes between the groups of MS young aged of 20-55 and health group may show us early atherosclerosis. At the group of high MMP-9 levels, even age releated cardiovasculary hearth disease risks are lower, risk was statistically calculated high compared to the other healthy populations. This situation is important in order to control risk factors as MS at early ages.

Slide Session : OS-END-37 ; Endocrinology : The Relationship Between Epicardial Adipose Tissue Thickness and Vitamin D in Patients with Metabolic Synrome

( Irem Kirac Utku ),( Yildiz Okuturlar ),( Esra Demir ),( Ozlem Harmankaya ),( Bulent Demir ),( Gonul Aciksari ),( Turgut Uygun ),( Alev Kural ),( Hanise Ozkan ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Metabolic syndrome is a systemic disorder and manifests a group of conditions such as abdominal obesity, dyslipidaemia, hypertension, coronary artery diseases. The importance of epicardial adipose tissue recognized its contribution to inflammation by pro-inflammatory cytokines discharge has been proved. Several investigations were performed on vitamin D receptor in different tissues except bone. In this study the epicardial adipose tissue thickness (EATT) and the levels of vitamin D were measured and compared with healthy control group. Methods: A total of 148 patients (84 patients who had metabolic syndrome without diabetes and 64 healthy individuals) were enrolled into the study. In all patients, the EATT was calculated by ecocardiography and the level of serum 25(OH) vitamin D was monitored. Results: It has been observed that the EATT in patients with metabolic syndrome increases significiantly compared with healthy control group (p<0.001). No significant difference between patients and control group was found on the levels of 25 (OH) vitamin D (p=0.507). There was no correlation between 25 (OH) vitamin D and the EATT (p=0.622). Conclusion: We observed that the EATT increased in patients with metabolic syndrome. In contradiction to the literature; the levels of 25(OH) vitamin D has not been found high in patients with metabolic syndrome. The reason of this can be small number of patients in our study. A significant correlation was not found between the EATT and the levels of 25 (OH) vitamin D. Further studies with a larger patient population are required assess the relationship.

Slide Session : OS-END-12 ; Endocrinology : Is There a Correlation Between Paraoxanase-1 Activity, MPV and Other Atherosclerotic Risk Factors in Prediabetic and Diabetic Patients?

( Meral Mert ),( Yildiz Okuturlar ),( Pinar Karakaya ),( Asuman Gedikbasi ),( Filiz Islim ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It has been reported that MPV is increased in diabetes while the status of MPV in prediabetes is not well known. It has been reported that decreasing level of paraoxonase-1 is related to increased probability of development of atherosclerosis and cardiovascular disease (CVD). In this study we compared the mean platelet volume (MPV), paraoxonase-1 (PON) and arylesterase (ARE) levels in patients with the diagnosis of prediabetes and diabetes mellitus (DM). Methods: Forty five prediabetic patients and 135 type 2 diabetic patients were enrolled into the study. Height, weight, BMI, age, gender, smoking, alcohol, exercise, family history of DM and CVD, childbirth, menopause status of all patients were recorded. Routine biochemical tests and A1c, lipid profiles, homocysteine, PON, ARE and MPV levels were performed. Results: Mean age of diabetics and prediabetic patients are 53.4 ±13.7 and 53.0±12.8 respectively. Age, weight, height, BMI and MPV levels were not significantly different in both groups but PON, ARE, A1c and HOMA levels were significantly different (p=0.0001). There were no significant differences in smoking, hypertension, hyperlipidaemia, exercise, coronary heart disease between the two groups. There was no significant correlation between MPV and PON, ARE but there was a negative correlation between Alc, glucose, WBC values and PON, ARE. We also found a negative correlation between triglyceride and PON levels and microalbuminuria and ARE levels. Conclusions: There was no difference in MPV level in both groups having different risk of atherosclerosis and probably because of the limited number of prediabetic patients in our study. However, lower levels of PON and ARE may have been caused by high risk of atherosclerosis in diabetic patients. It would be more reliable to analyse MPV, PON and ARE according to biochemical and clinical conditions.

Slide Session : OS-END-26 ; Endocrinology : Vitamin D Levels in Patients with Autoimmune Thyroid Disease

( Esref Erturk ),( Meral Mert ),( Yildiz Okuturlar ),( Ozlem Soyluk ),( Pinar Karakaya ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It is known that vitamin D has effects on the immune system. Vitamin D is an important immune system regulator. Several observational studies show that, vitamin D inhibits proinflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction. It has been suggested that vitamin D may play a role in the pathogenesis of several endocrine diseases, such as autoimmune thyroid diseases, hyperparathyroidism, diabetes mellitus, Addison`s disease. In this study it is aimed to find a correlation between autoimmune thyroid disease and vitamin D. Methods: Thyroid function test result, calcium, PTH and vitamin D levels were compared between a control group of 35 healthy people and 35 patients with a cross-sectional thyroid autoimmune disease. Results: Mean ages are found to be 41.8±14.08 years and 45.6±13.46 years in patients and controls respectively. Mean vitamin D, calcium and parathormone (PTH) levels in patients and control group are found to be 18.6±9.5 vs 39.13 ±14.6 ng/ml, 7.9±0.16 vs 8.67±0.80 mg/dl, 50.7±25.86 vs 56.21±18.17 pg/ml, respectively. Vitamin D levels were found to be significantly lower than the control group in patients with autoimmune thyroid disease. There was no difference between the levels of PTH. Conclusions: Analyzing of vitamin D, PTH and calcium parameters should be considered in patients with autoimmune thyroid diseases. Treatment of vitamin D deficiency may help increase the quality of life in tyroid patients.

Slide Session : OS-END-25 ; Endocrinology : Is There a Relation Between Thyroid Autoantibodies and MPV in Hypothyroidism ?

( Serkan Yucesan ),( Meral Mert ),( Zeynep Erturk ),( Selcuk Sezikli ),( Yildiz Okuturlar ),( Ozlem Harmankaya ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Hypothyroidism is a prevalent endocrine disorder. The most common cause of hypothyroidism is autoimmune thyroid disorder. A possible prothrombotic effect of elevated thyrotropin (TSH) has been suggested. MPV can be used as a marker of platelet activity. The objective of the present study was to determine if there is an association between the MPV, serum TSH and auto-antibody(anti-TPO and anti-TG) concentrations. Methods: We studied 145 adults with hypothyroidism (TSH >5 mlU/L ). We evaluate the mean values MPVs and their relation with auto-antibody and TSH levels. Results: 126 female and 19 male patients were in enrolled in our study retrospectively. The mean level of the MPV in all patients was 8.41 femtoliters (fL) and the mean level of TSH was 13.41 mlU/L. Negative correlation (r:0.015) between MPV, age, and anti-TPO ve TG was found. There was no correlation between MPV and TSH. There was no statistically significant difference between TSH, MPV, auto-antibody levels and age. Conclusions: MPV is reported to be increased in vascular events like atherosclerotic thrombosis and to be decreased in acute infl ammation. The main pathophysiological process is inflammation in autoimmune thyroid disease, so the possible explanation of negative correlation between MPV and autoantibodies is autoimmunity.

Poster Session:PS 0191 ; Endocrinology : In Circulation Increased Antithyroid Peroxidase Antibody and Matrix Metalloproteinase-9 Levels at Patients with Metabolic Syndrome

( Sibel Serin ),( Yildiz Okuturlar ),( Asuman Gedikbasi ),( Irem Kilic Utku ),( Sema Ucak Basat ),( Ozlem Harmankaya ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Objective: Frequent changes in parameters like blood pressure, plasma lipid changes, waist circumference which are accepted as a metabolic syndrome (MS) are observed in thyroid patients with hypothyroid. In this study we investigated serum levels of TPO which is the diagnosis of hypothyroid and prognosis criteria antithyroid peroxidase antibody (Anti-TPO) in patients with MS and we analysed the correlation with matrix metalloproteinases-9 (MMP-9) which is accepted as an indicator of infl ammation in MS. Method: 51 patients with MS and 35 controls were enrolled in the study. Age, body mass index (BMI), waist circumference and hypertension (HT) values of both group were recorded in the beginning. Medical records of HT were noted and cardiovascular diseases in their family were queried. Insulin, glucose, HOMA-IR, total cholesterol, LDL, HDL, TG, TSH and Anti-TPO levels were measured. Blood samples for measuring MMP- 9 were stored at -80°C. Measurement of MMP-9 was performed by using solid phase platinum ELISA kits (Biosource). Results: Study was performed with 51(59,3%) MS group and 35(40,7%) control group. Both Anti-TPO and MMP-9 levels of patients with MS were statistically and signifi cantly higher than the levels of control group (p<0.01 for both group). There is a statistically signifi cant correlation (positive, 83.2%) between MMP-9 and TPO in patients with MS (p<0.01). There is a statistically signifi cant correlation (positive, 37.5%) between MMP-9 and TPO in controls (p<0.05). Discussion: Researching Anti-TPO in patients with MS might be an indicator of higher rate of both hypothyroid and MS. High levels of both MMP-9 (>76 mg/ml) and TPO show that TPO can be used as a cheaper and more easily provided marker in patients with MS without acute thyroid. Anti-TPO follow-up might be necessary in MS diagnosis and monitoring.

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.