Poster Session:PS 0180 ; Endocrinology : The Relationship Between Function Tests and Tumour Markers in Nonfunctional Adrenal Adenomas

( Meral Mert ),( Yildiz Okuturlar ),( Ozlem Soyoyluk ),( Didem Acarer ),( Pinar Karakaya ),( Savas Tuna ),( Ozlem Harmankaya ),( A Baki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Adrenal neoplasms are common and are incidentally discovered in 4-10% of abdominal imaging studies. Most of them are not cancerous and nonfunctional. Every adrenal incidentaloma is evaluated with function tests for functionality. In our study we aimed to investigate the relation of tumor markers which were measured for other reasons and function tests in nonfunctional adrenal adenomas retrospectively. Methods: Patients diagnosed with nonfunctional adrenal adenoma in the last three years in our research hospital were evaluated retrospectively. Data of 133 patients including function tests (renin -aldosterone-17OHprogesterone-testosterone-dehydroepiandrosteronesulphate levels, 24 hour urinary metanephrine and normetanephrine levels, overnight dexamethasone supression test) were evaluated. Fortyfi ve of these 133 patients had tumor markers (CEA, alpha-fetoprotein, CA 19-9, CA15-3, CA125) recorded. The relation between function tests and tumor markers are examined. Results: The data of 31 women and 16 men with mean age 55,54±10,64 years and 56,06±11,41 years respectively were evaluated. There was a negative correlation between age and CA-125 levels. A negative correlation was also found between testosterone and CA15-3. There was a positive correlation between urinary cortisole and CEA and also between aldosterone and CA19-9 levels. Conclusions: Tumor markers may be used as alternative tests for function tests. But future studies with big sample size are needed to confi rm this hypothesis.

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-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-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.

Slide Session : OS-END-16 ; Endocrinology : Brachial intima-Media Thickness and Paraoxonase -1 Activity in Different Patients Group

( Yildiz Okuturlar ),( Meral Mert ),( Pinar Karakaya ),( Aysun Erbahceci Salik ),( Asuman Gedikbasi ),( Nilgul Akalin ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Atherosclerosis is one of the most important causes of death worldwide. Detection and prevention of the organ damage and determination of the risk due to atherosclerosis is getting more and more important in recent days. Brachial Intima-Media Thickness (B-IMT), mean platelet volume (MPV), paraoxonase (PON) and arylesterase (ARE) are accepted as markers of atherosclerosis. In this study we aimed to determine the importance of B-IMT, ARE, PON and MPV levels in four patient groups which are expected to have increased risk of atherosclerosis without vascular complications. Methods: A total of 100 patients (32 prediabetic patients = group 1, 13 subclinical hypothyroidism + prediabetic = group 2, 20 subclinical hypothyroidism = group 3, 35 diabetic patients = group 4) are enrolled into the study. Height, weight, BMI, age, gender, smoking, alcohol, exercise, family history of diabetes mellitus and cerebrovasculer disease, childbirth, menopause status and HOMA levels of all patients were recorded. Routine biochemical tests and Alc, lipid profiles, homocysteine, PON, ARE were performed and brachial artery index was measured. Results: There were no significant differences in age, B-IMT, BMI, homocysteine, MPV, PON and LDL, HDL levels between the groups. We found a significant difference in A1c (p=0.001), glucose (p=0.0001), ARE (p=0.0001), triglyceride (p=0.005) and HOMA-R (p=0.0001) levels between groups. The significant correlations were shown in Table-1. Conclusions: The relationship between insulin resistance, lipid profile, TSH, B-IMT, PON, ARE and MPV are not similar in different patient groups. This is probably due to varying degrees of atherosclerosis in patients.

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.

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.

An Early Prenatal Diagnosis of a 69, XXY Case Using Quantitative Fluorescent PCR (QF-PCR) in Uncultured Amniocytes

Mehmet Ali Ergun,Meral Yirmibes Karaoguz,Aydan Biri,Elif Pala,Mert Kuskucu 한국유전학회 2006 Genes & Genomics Vol.28 No.1

Slide Session : OS-END-48 ; Endocrinology : The Effect of Inhaled Corticosteroid Treatment on Glucose Level on Inpatients

( Munevver Mertsoylu Aydin ),( Meral Mert ),( Yildiz Okuturlar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Although Inhaled corticosteroids (ICS) have been considered as a safe therapy, some systemic effects may be observed. Many patients with type 2-diabetes have an indication to use inhaled corticosteroids (ICS) for coexisting asthma or COPD. But their effect on glucose metabolism in patients with type 2 diabetes has not been well defined. The aim of the study was to investigate the effect of ICS`s on glucose level on the inpatient with COPD acute exacerbation. Methods: 25 (female/male: 16/9) patients were enrolled the study. The glucose levels were recorded for a week while their oral antidiabetic therapy continues. Alc, CRP levels were measured on admission. Statistical analyses were performed on glucose change due to steroids. Results: Mean ages were found 68.8 9.91 years in female and 67 12.18 years in male patients respectively. No significant difference was found between two groups (p>0,05). There were no significant differences on the first, second, third, fourth, fifth and sixth days of week in all patients. We found significant difference in glucose level on between the first (151.32±58.902) and seventh days (205.28±99.192) (p= 0.043) and also eighth day (221.88±111.061) (p=0.017). Parenteral steroids added on 11 patients during clinical course. We compared the patients with and without parenteral steroids about glucose levels. There is a significant difference in glucose levels on seventh day between those two groups. Conclusions: Steroids are known as agents which affect glucose level. Inhaler steroid usage even causes increasing glucose levels in prolonged periods and it is more apparent during intravenous steroid treatment.

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.