ACTA ENDOCRINOLOGICA (BUC)

Background. The frequency of subclinical hypothyroidism (SH) in patients with obesity is increased compared with the normal population. However, data on the risk of cardiovascular disease (CVD) in patients with SH are still scarce. Lipid parameters are strong predictors of early CVD. We aimed to investigate the role of lipid indices in predicting CVD risk compared to conventional lipid components. Methods. A total of 220 euthyroid obese children (EU) and 90 obese children with SH were included in the study. All data were collected from hospital files. Lipid indices were evaluated. Atherogenic index of plasma (AIP), cardiac risk ratio (CRR) and atherogenic coefficient (AC) were calculated. AIP>0.24, CRR>5 ve AC>3 were considered as cardiovascular risk criteria. Results. The presence of SH increased the risk of higher AIP and the risk of CRR, compared to euthyroid obese children. Conclusion. Subclinical hypothyroidism in obese children may cause dislipidemia carrying a high cardiovascular disease risk.

Context. The first study delves into the postpartum diabetes screening during the postpartum 3rd month period and exploration of non-compliance reasons. Objective. The primary aim of this study is to examine the adherence to postpartum diabetes screening recommendations among women with gestational diabetes in Turkey. Design. A cross-sectional study was conducted on 783 postpartum women diagnosed with gestational diabetes. Materials and Methods. Participants were categorized into three groups based on their screening behavior. Group 1 did not undergo any postpartum screening, Group 2 only underwent fasting plasma glucose (FPG) or HbA1c tests, and Group 3 only underwent oral glucose tolerance tests (OGTT). Data on demographic characteristics and reasons for non-compliance were collected. Results. Only 3.45% of women complied while 55.81% did not undergo any screening. Adherence was significantly higher among primigravid women. Statistically significant differences were observed based on education level, GDM treatment method, and information received during pregnancy or postpartum (p<0.001). The most common reason for non-compliance was normal FPG values observed post-delivery. Conclusion. This study emphasizes the crucial need for enhanced education and information provision to high-risk women diagnosed with gestational diabetes, both during pregnancy and the postpartum period, particularly during their hospital stay.

Introduction. Our goal was to evaluate and compare the diagnostic utility of thyroid hormone withdrawal (THW) and recombinant thyroid-stimulating hormone (rhTSH) methods in detecting recurrence/persistence (R/PD) of differentiated thyroid carcinoma (DTC). Methods. The study included 413 patients with DTC who underwent total thyroidectomy and had remnant ablation. DxWBS, s-Tg levels, R/PD were evaluated retrospectively. A s-Tg level≥2 ng/mL was considered as “positive s-Tg”. Results. DxWBS and s-Tg levels were evaluated with rhTSH in 116 and THW in 297 subjects, respectively. The sensitivity and specificity of “positive s-Tg” for R/PD in THW group were 77.3% and 92.7%, with 90.3% accuracy, respectively. The sensitivity and specificity of “positive s-Tg” for R/PD in rhTSH group were 58.8% and 100% with 93.9 % accuracy, respectively. An uptake outside thyroid bed at WBS showed a sensitivity of 17.1%, specificity of 100% for R/PD with 89.4% accuracy in THW group. An uptake outside thyroid bed at WBS showed a sensitivity of 7.7%, specificity of 100% for R/PD with 88.8% accuracy in rhTSH group. Conclusion. Method of TSH stimulation did not influence the reliability of DxWBS. The “positive s-Tg level” had a higher sensitivity with THW when compared to rhTSH in detecting R/PD.

Background. Up to this point, individual or population-based approaches for treating and preventing obesity have not yielded lasting success. We assessed the impact of orlistat with or without metformin on anthropometric and laboratory measurements as well as cardiovascular risk factors in patients suffering from severe obesity. Methods. A total of 116 patients with morbid obesity, consisting of 105 females and 11 males, were involved in the study. Of these, 30 patients (29 females and 1 male) underwent treatment with orlistat, while 86 patients (70 females and 10 males) were given a combination of orlistat and metformin. The effects of orlistat treatment, either 360 mg/day alone or orlistat plus metformin at a dose of 1700 mg/day, were retrospectively examined in patients who had been compliant with therapy for at least three months and had also made adjustments to their diet and lifestyle. Results. The mean age in the orlistat group was 46.26 ± 11.30 years, and 43.13 ± 11.37 years in the orlistat plus metformin group. Significant reductions in weight, body mass index (BMI), waist circumference (WC), systolic blood pressure (BP), total cholesterol, LDL-cholesterol, and carotid intima media thickness (CIMT) resulted from three months of orlistat treatment (p < 0.01). The combination of orlistat and metformin produced substantial reductions in weight, BMI, WC, systolic BP, diastolic BP, CIMT, fasting blood glucose, total cholesterol levels, homeostatic model assessment for insulin resistance (HOMA-IR), and HbA1c levels (p < 0.01). The groups showed comparable weight, BMI, and WC. Neither group experienced notable side effects. Conclusions. Treatments with orlistat and orlistat in combination with metformin led to a significant reduction in body weight. Similar body weight changes were observed between the groups, whereas the alterations in fasting plasma glucose, HOMA-IR, and HbA1c levels were greater with orlistat combined with metformin treatment.

Thyrotoxic hypokalemic periodic paralysis (TPP) is a disorder leading to hypokalemia and muscle weakness. It mainly affects the Asian population, and it is rare in the Balkan and Caucasian people. We describe a case of a 34 year-old male presenting with TPP. To our knowledge, this case is the third Turkish patient diagnosed as TPP in the English medical literature. He was admitted to the Emergency Department (ED) with generalized weakness. Initial laboratory analysis showed that serum potassium was 1.6 mmol/L. His serum potassium was normalized after intravenous administration of potassium chloride (KCl) of 80 mmol over 4 h and 40 mg of propranolol administered orally, and then his generalized weakness was recovered. Thyrotoxicosis was treated with propylthiouracil and propranolol.

Context. Therapeutic plasma exchange (TPE) provides time for thyroidectomy in thyrotoxic patients. Objective. TPE is indicated in cases where antithyroid medications cannot be used due to the side effects or attain no adequate hormonal suppression response at the highest dosage and in cases of rapid onset of clinical symptoms. This study presents the treatment results of patients who underwent TPE and were subsequently operated for thyrotoxicosis. Design. The patients who underwent thyroidectomy and TPE between January 1999 and February 2019 were retrospectively analyzed. Subjects and Methods. The files of 27 patients with thyrotoxicosis who performed TPE prior to surgery were analyzed in relation to the demographic and clinical features. Results. We included 15 (55.6%) females, 12 (44.4%) males with a mean age of 44 (23-82) years. The pre-TPE mean free thyroxine (fT4) level was 12 (5-46) pmol/L while free tri-iodothyronine (fT3) level was 34 (17- 141) pmol/L. The post-TPE fT4 level was 6 (3-10) pmol/L while the fT3 level was 21 (12-41). There was one case of an allergic reaction during the procedure. In the postoperative follow-up, there was transient hypocalcemia in 8 (29%) patients, permanent hypocalcemia in 1 (3.7%) patient, and surgical site infection in 1 (3.7%) patient. Conclusion. Preoperative TPE is an alternative treatment option for thyrotoxic patients. This is an especially effective treatment for patients with inadequate response or adverse reaction to antithyroid drugs or patients who need urgent surgery for thyroid storm.

Background. Although diseases such as diabetes, hypertension, obstructive sleep apnea and hyperlipidemia are clearly documented as obesity associated diseases, it is not wellknown whether obesity causes renal pathologies. The aim of the present study was to evaluate the effect of weight loss following laparoscopic sleeve gastrectomy on clinical, renal parameters and urinary Neutrophil gelatinase-associated lipocalin (NGAL) levels in diabetic and non-diabetic obese patients. Methods. Nineteen morbidly obese patients (10 diabetic and 9 non diabetic) who underwent laparoscopic sleeve gastrectomy were evaluated clinically (anthropometric measurements) and biochemically before surgery and at 6 months from surgery. Results. Significant decreases in weight, BMI, FPG, PPG and HbA1c levels were observed in the diabetic group when the baseline and 6th month parameters of the patients were compared. There was also a significant decrease in SBP and DBP. At 6th month following laparoscopic sleeve gastrectomy, renal parameters such as creatinine, mAlb/creatinine, NGAL/ creatinine did not differ in the diabetic group. In the nondiabetic group, serum creatinine levels were significantly decreased, but other renal parameters such as mAlb/creatinine and NGAL/ creatinine were not significantly different. Conclusions. Our findings revealed significant decreases in weight, body mass index and glycemic parameters after sleeve gastrectomy in diabetic and non-diabetic patients, while no significant alteration was noted in renal functions, urinary NGAL and microalbumin levels.

Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disease characterized by multiple hamartomas in multiple organs. However, there is limited evidence about neuroendocrine tumors (NETs) in patients with TSC, and routine screening of NETs is not recommended in the guidelines. Insulinomas are also an extremely rare disease. According to our knowledge, we presented the 10th TSC patient diagnosed with insulinoma in the literature. Thirty-two years old male patient diagnosed with TSC at the age of 27 due to typical skin findings, renal angiomyolipoma, history of infantile seizures, and cranial involvement was referred to our clinic. The main symptoms of the patient were palpitations, diaphoresis, confusion, and symptoms were improved after consuming sugary foods. Seventy-two hours fasting test was performed, and a low glucose level at 41 mg/dl, a high insülin level at 21.65 μIU/mL, and a high C-peptide level at 7.04 ng/mL were found at the 8th hour. In addition, a 12x7 mm lesion in the pancreatic tail was detected in abdominal imaging. Ga-68 PET-CT (gallium-68 positron emission tomographycomputed tomography) detected an increased uptake of Ga-68 in the pancreatic tail. The patient underwent distal pancreatectomy, and pathological evaluation was consistent with an insulinoma. The patient’s symptoms improved postoperatively. Since in nearly all TSC cases, as in our case, neuropsychiatric abnormalities, such as epilepsy, are one of the main disease manifestations, and these symptoms may be confused with the clinical manifestations of hypoglycemia in insulinoma. Therefore, patients with newly developed neurological symptoms and behavioral defects should be evaluated in terms of insulinoma.

This editorial discusses the context of thediscovery of GNRH 1 as a cause of congenital hypogonadotropic hypogonadism published last year by Bouligand et al in the New England Journal of Medicine

Background. Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of the luteal\r\nphase or early pregnancy after ovulation induction or ovarian stimulation. The late OHSS form presents an onset more than 10 days after ovulation triggering and is\r\ninfluenced by pregnancy-related HCG secretion.\r\nReport. This paper presents three cases of pregnancy-related OHSS after IVF/ICSI cycles discussing risk factors and management according to European Guidelines.\r\nResults. Individual risk factors are identified such as low BMI, high antral follicle count at the beginning of the ovarian stimulation, high estradiol over 3000 pg/ml.\r\nPatients had moderate OHSS (case 2) and severe OHSS (case 1 and 3). In-patient treatment was 3-14 days. OHSS resolved in\r\nall cases, without manifestations of the critical form.\r\nConclusion. The duration of OHSS is longer in the late form, is pregnancy-related and should be monitored for adverse\r\npregnancy outcomes. However the incidence of fatal risks is low and the treatment is successful.