ACTA ENDOCRINOLOGICA (BUC)

Context. Health anxiety was rarely investigated in Type II Diabetes Mellitus (T2DM). Objectives. The present study examines the effect of health anxiety on glycemic control and evaluates factors associated with health anxiety in patients with T2DM according to HbA1c level. Design. Cross-sectional. Subjects and Methods. Socio Demographic Data Form (SDVF), Health Anxiety Inventory-Short Form(SHAI), The Hospital Anxiety and Depression Scale (HADS) were administered to 185 patients with Type II DM . Patients were divided into two groups according to HbA1 c level (HbA1c levels below 7 (Group 1, n=69) and above 7 (Group 2, n=185)). We analyzed prevalence of health anxiety, factors associated with health anxiety between poor and good glycemic control and evaluated of T2DM patients according to health anxiety scale scores. Results. SHAI scale scores were low in 52 (28%), intermediate in 58 (31.2%) and high in 76 (40.8%) of the patients. We found the severity of depressive symptoms was positively correlated with health anxiety in both groups. As a result of this study, there was a relationship between high education and low socioeconomic level, having a job, exercise and anxiety level and low SHAI score in T2DM patients. Depression, stressful life events in the last 6 months were related with high health anxiety. Although the level of health anxiety was not different between groups, low blood sugar levels were related with high health anxiety. Conclusions. This study found that the prevalence of health anxiety in T2DM patients was higher than expected irrespective to poor or good glycemic control, but level of health anxiety in patients with T2DM is not a good predictor for the HbA1c level.

Purpose. To investigate the association between papillary thyroid cancer (PTC) and Hashimoto’s thyroiditis (HT). Design. This study is a retrospective study that conducted during 7 consecutive years with a median 119.5 months follow-up. Subjects and Method. Patients who underwent thyroidectomy in Dokuz Eylül University Hospital during 7 consecutive years were included. Patients’ demographics, biochemical, radiological, and pathological results were retrospectively assessed. Results. Four hundred sixty nine patients were evaluated. Among 469 patients who underwent thyroidectomy, 132 (28.1%) were malignant, while 182 patients were diagnosed with HT (38.8%). PTC was ranked first at 92.4% (n: 122). The prevalence of HT was 54.9% in patients with PTC and 33.1% in patients without PTC diagnosis (p<0.001). Younger age and the presence of HT were independently associated with PTC. The presence of HT was associated with increased risk of development of PTC (OR: 2.2, %95 CI: 1.4-3.5, p<0.001) but not with TNM stage or recurrence. Lymph node metastasis at presentation was the strongest predictor of recurrence (OR: 13.9, CI: 3.5-54.6, p<0.001) Conclusions. HT was an independent risk factor for development of PTC. According to our findings, HT patients (particularly with nodular HT) should be observed carefully and thyroid fine needle aspiration biopsy (TFNAB) should be encouraged if necessary.

Background. Heart rate recovery after exercise is a predictor of mortality that is thought to reflect autonomic imbalance. The association between heart rate recovery and prediabetic stages is unclear. Aim. To evaluate the heart rate recovery in patients with diabetes and prediabetes. Patients and Methods. Thirtyfive patients with impaired fasting glucose, 32 patients with impaired glucose tolerance, and 34 patients with diabetes mellitus were included. The control group consisted of 30 healthy individuals. All study participants underwent a maximal graded exercise test, and heart rate recovery was calculated by subtracting the 1st, 2nd and 3rd minute heart rates from the maximum heart rate achieved during the stress testing. Results. The 1st, 2nd and 3rd minute heart rate recovery values of the diabetes mellitus, impaired glucose tolerance and impaired fasting glucose groups were significantly lower than that of the control group. For the 1st minute, heart rate recovery values of the diabetes mellitus patients were significantly lower than that of the control group (19.8±9.4 vs. 25.4±9.9, p<0.001) and the impaired fasting glucose group (19.8±9.4 vs. 22.1±9.3, p<0.01), and the 1st minute heart rate recovery of the diabetes mellitus patients was similar to that of the impaired glucose tolerance group (19.8±9.4 vs. 20.7±5.8, p=0.88). Similar results were obtained in the 2nd and 3rd minute heart rate recovery measurements. The heart rate recovery values of the impaired fasting glucose were significantly higher than those of the diabetes mellitus and impaired glucose tolerance patients. In comparing the impaired glucose tolerance and diabetes mellitus groups in terms of heart rate recovery values, there was no significant difference.

Radioiodine treatment of hyperthyroidism is easy to perform, has a low cost and presents a low risk adverse effects.\r\nDespite many reports on the efficiency and results, the number of studies investigating the efficiency of radioiodine treatment in subclinical hyperthyroidism is limited.\r\nAim. Therefore, this study aimed to investigate the efficiency of radioiodine treatment in subclinical hyperthyroidism.\r\nMethods. The study involved 50 patients with subclinical hyperthyroidism (42 females, 8 males, mean age: 60.3?10.8)\r\ntreated by radioiodine in our department. Thirtyfour (68%) of the 50 patients had multinodular hyperplasia; 9 (18%) had diffuse hyperplasia, and 7 (14%) had solitary nodule.\r\nThe patients were applied I-131 treatment with a dose of 5-20 mCi (mean 11.52?3.63 mCi) based on the thyroid gland volumes, TSH levels, age, any clinical findings, and\r\nalso, the type of hyperplasia (diffuse or nodular hyperplasia). The patients were followed for 5.13 to 46.5 months (mean: 24.62?11.47).\r\nResults. Forty-three (86%) of the 50 patients were euthyroid after a mean of 2.36?1.18 months following radioiodine\r\ntreatment. The mean dose of radioiodine was 11.91?3.73 mCi. Only 5 (10%) of 50 patients developed hypothyroidism 1-5 months (mean: 2.8?1.48) after radioiodine therapy with 8-10\r\nmCi (mean: 8.4?0.89) I-131 administration. When hypothyroidism is also considered as a criterion for cure in addition to euthyroidism, the success rate of radioiodine treatment was 96% (48/50) in the patients with subclinical\r\nhyperthyroidism.\r\nConclusion. Radioiodine treatment provides quick and high efficiency of recovery, easy application, and quick\r\nadaptation by patient; thus, it can be a preferred choice of subclinical hyperthyroidism treatment, particularly for the\r\nelderly patients who cannot adapt treatment with antithyroid tablets easily.

Context. Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, generally associated with a favorable prognosis. However, variants such as the hobnail subtype exhibit more aggressive pathological and clinical features. Objective. The 2022 WHO classification defines hobnail PTC (HPTC) as tumors with at least 30% hobnail cell morphology, yet the prognostic impact of varying hobnail cell proportions remains unclear. Design. This study aimed to evaluate the clinicopathological characteristics and prognostic significance of PTC with different degrees of hobnail features, contributing to improved risk stratification and management strategies. Subjects and Methods. A comprehensive analysis was conducted on PTC cases exhibiting hobnail features at varying proportions. Pathological characteristics, including vascular and lymphatic invasion, calcification, lymph node metastasis, and capsule involvement, were assessed. Logistic regression analysis was performed to determine associations between hobnail morphology and aggressive disease behavior. Results. Tumors with ≥30% hobnail features exhibited significantly (p< 0.05) higher rates of vascular invasion, lymphatic invasion, calcification, and lymph node metastasis compared to tumors with fewer hobnail features and classic PTC. Logistic regression confirmed a strong association between hobnail morphology and lymphatic invasion/metastatic lymph nodes (p = 0.026). However, no significant correlation (p>0.05) was observed with extrathyroidal invasion, bilaterality, or the necessity of radioactive iodine (RAI) treatment. Conclusion. The findings emphasize the aggressive nature of PTC with prominent hobnail features, underscoring the need for tailored therapeutic strategies and close monitoring in affected patients. Further research is warranted to refine prognostic models and optimize treatment approaches.

The objective of this review is to summarise what is known about mortality in ACTH dependent Cushing&#8217;s disease (CD). Specifically, mortality in other causes of Cushing&#8217;s\r\nsyndrome (CS) such as ectopic ACTH syndrome and adrenal adenomas is not considered because of the relative rarity of these causes of CS. Six papers addressed mortality of CD in relation to the background population.\r\nThe overall mortality in CD is increased 2-4 fold, but in patients that achieved early remission of hypercortisolaemia the standardised mortality ratio (SMR) is not different from that of the background population. Those in whom hypercortisolaemia was not controlled had a poor outcome (SMR 4-11), and died prematurely. Persistence of disease, older age at\r\ndiagnosis, and presence of hypertension appear as the main determinants of mortality. However, there are several caveats to these conclusions: 1. The number of patients studied is small and the number of deaths even smaller; 2. On average the patients were young (40yrs old) at diagnosis, their follow-up was 10 yrs, and by the age of 60 the expected number of deaths in the background population is going to be small so that differences in causes of death will be difficult to ascertain; 3. SMR of 1.5 -2.0 for patients in remission may not be statistically significant in the reported studies but could become so with larger numbers followed for a much longer time (30-40 yrs). Notwithstanding these caveats, it is encumbent on us as endocrinologists not only to treat the symptoms and complications of CD but also to ensure that patients are &#8216;cured&#8217; of their hypercortisolism in order to maximise long-term survival.

Background. Secreting different adipocytokines, adipose tissue plays an important role in health and disease. Upon omega-3 consumption, changes in the secretion of adipose tissue and its effects on glycemic profile are a controversial subject at the present time. Objectives. We evaluated the effects of eicosapentaenoic acid (EPA) alone and in combination with vitamin E on adiponectin and serum glycemic indices in type II Diabetes patients. Design. This double-blind clinical trial divided all patients randomly into four balanced permuted blocks of EPA, Vitamin E, EPA and vitamin E and placebo (Corn oil). Subjects and Methods. 127 patients with type II diabetes living in Kashan in 2008, 35-50 years old, and 25≤BMI ≤30 were enrolled. ELISA, Glucose Oxidase, spectrophotometry, and Radioimmunoassay methods were used for measurement of serum adiponectin, Fasting Blood Glucose (FBG), HbA1C, and Insulin, respectively. Results. Serum adiponectin increased significantly after EPA consumption in EPA and EPA+E groups. Moreover, FBG, HbA1c, serum insulin and Homeostasis Model HOMA-IR decreased significantly after EPA consumption in the two previously mentioned groups. Conclusions. This study showed that EPA supplementation affects the secretion of adipose tissue, improves the FBS as well as HbA1c values and significantly decreases fasting serum insulin and insulin resistance.

The effects of finasteride on insulin resistance and of metformin on hyperandrogenism in patients with polycystic ovary syndrome (PCOS) are not clear. This study therefore compared the effects of finasteride, metformin, and finasteride plus metformin treatments on hormone levels, insulin resistance, and hirsutism score in women with PCOS. Fifty-two patients with PCOS were randomly assigned to receive finasteride 5 mg/day, metformin 1700 mg/day or finasteride plus metformin for 12 months. Body mass index (BMI), Ferriman Gallway score (FGS), serum concentrations of estradiol, sex hormone-binding globulin, free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and homeostasis model assessment of insulin resistance (HOMA-IR) index and areas under the curve (AUC) for insulin and glucose were evaluated before and after 12 months of treatment. Reductions in FGS, free testosterone, DHEAS, androstenedione, HOMA-IR, AUCinsulin, and AUC-glucose were significant within each group, whereas BMI and estradiol were not. Comparisons of changes in parameters in the 3 groups did not clearly show the superiority of any treatment modality. The treatment with finasteride alone significantly reduced both androgen levels and parameters of insulin resistance. In addition, metformin alone was effective, and not inferior to finasteride, in the treatment of hyperandrogenism.

Introduction. Fahr’s syndrome is an infrequent disorder characterized by bilateral symmetrical calcification of basal ganglia and the cerebral cortex. It can be seen genetic, idiopathic, or secondary to endocrine diseases. This disease is related to different metabolic disorders particularly with diseases of the parathyroid gland. Case 1. A 63-year-old female patient applied to our clinic due to having hypoparathyroidism with bilateral basal ganglia calcification in head computed tomography(CT). She had subtotal thyroidectomy 25 years ago. In the neurological examination, mild symmetrical parkinsonism was determined. In laboratory examination Ca:8 mg/dL (8.6- 10.2), P:5.1 mg/dL (2.3-4.5), PTH:9.53 pg/mL (15-65) were detected. Calcitriol 0.25 μ/day was added to her treatment. Her parkinsonism disappeared after the treatment. Case 2. A 49-year-old male patient was consulted when he was admitted to the department of neurology in our hospital. The physical examination demonstrated the characteristics of Albright’s hereditary osteodystrophy. The neurological examination shows bilateral symmetrical bradykinesia, dysphagia, and moderate dysarthria. In the laboratory examination PTH: 46.5 ng/L(15-65), Ca:8.6 mg/dL (8.6-10.2), P:2.7 mg/dL (2.3-4.5) were detected and were all within the normal ranges. Consequently, pseudopseudohypoparathyroidism was decided as a diagnosis. G protein alpha subunit mutation (Gsα) was not detected due to technical limitations. Conclusion. When a patient is diagnosed as Fahr’s syndrome, we should keep in mind parathyroid disorders. Fahr’s syndrome must be evaluated in patients showing intracranial calcification accompanied by parathyroid diseases.

Context. Graves' disease is the most prevalent cause of hyperthyroidism worldwide. Adiponectin, the most abundant adipokine, plays a significant role in a cluster of prevalent diseases connected to metabolic disorders. Objective. Although the association between adiponectin and Graves' disease has been studied, the existing data is inconsistent. Therefore, we conducted this systematic review and meta-analysis to evaluate the relationship between adiponectin levels and Graves' disease. Methods. We performed a systematic electronic search on PubMed, EMBASE, Scopus and Cochrane Library using predefined keywords. We used the NHLBI quality assessment tools to assess the included studies. Results. There were 11 studies involving 781 subjects included in our qualitative synthesis, while 6 studies were included in our quantitative synthesis. We observed significantly increased adiponectin levels in Graves' disease patients compared to controls (MD 2.983 [95% CI 0.138– 5.828]) and hypothyroidism patients (MD 3.389 [95% CI 1.332–5.446]). Nevertheless, no significant MD was observed when comparing Graves' disease patients with and without Graves' ophthalmopathy (MD -27.124 [95% CI -88.893 – 34.645]). Conclusions. Adiponectin levels were significantly higher in patients with Graves' disease compared to controls and hypothyroidism patients. However, patients with and without Graves' ophthalmopathy did not present a significant mean difference in adiponectin levels.