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Öğe Carotid artery intima-media thickness and erectile dysfunction in patients with metabolic syndrome(Int Scientific Information, Inc, 2014) Ünal, Mustafa; Aksoy, Duygu Yazgan; Aydın, Yusuf; Tanrıöver, Mine Durusu; Berker, Dilek; Karakaya, Jale; Güler, SerdarBackground: Metabolic syndrome (MS) has become a pandemic in Turkey, as is the case globally. Increase in carotid artery intima-media thickness (CIMT) and erectile dysfunction (ED) may be evident before the clinical signs of cardiovascular disease appear. We aimed to investigate the prevalence of increased CIMT and ED as markers of atherosclerotic disease in patients with MS. Material/Methods: Thirty-two patients with MS and 29 healthy controls were included. Anthropometric and biochemical parameters, along with total testosterone (TT), high sensitive C-reactive protein (hs-CRP), were recorded. Carotid artery intima-media thickness was measured. Erectile dysfunction was assessed with International Index of Erectile Function. Results: Patients with MS had higher BMI, fasting plasma glucose, post-prandial plasma glucose, insulin, HOMA-IR, total cholesterol, triglycerides, hs-CRP, and CIMT, whereas TT levels were lower (p<0.0001). The prevalence and severity of erectile dysfunction were higher in patients with MS (p<0.0001). Erectile dysfunction scores correlated inversely with CIMT. MS patients with ED were older and had higher CIMT compared to those without ED. Increase in age and HOMA and decrease in TT increased the risk of ED. When KIMT exceeding the 95th percentile of healthy controls was accepted as a risk factor for CVD, presence of ED was the only determinant for this increase. Conclusions: Erectile dysfunction was more prevalent and severe in patients with MS and correlated with subclinical endothelial dysfunction. Total testosterone deficiency was prominent among MS patients. Presence of ED points to an increased risk of cardiovascular disease when MS is present.Öğe Clinical and radiological findings in macroprolactinemia(Humana Press Inc, 2012) Işık, Serhat; Berker, Dilek; Tütüncü, Yasemin Ateş; Özuğuz, Ufuk; Gökay, Ferhat; Erden, Gönül; Güler, SerdarHyperprolactinemia is the most common abnormality of the hypothalamic-pituitary axis. The aim of this study was to investigate the clinical and radiological features of patients with macroprolactinemia. The study population consisted of patients with elevated serum prolactin (PRL) concentrations who presented to our Endocrinology outpatient clinic. Detection of macroprolactin (macroPRL) was performed using the polyethylene glycol precipitation method. Patients in which macroPRL made up more than 60% of total PRL levels were stratified into the macroPRL group, while the remaining patients were placed in the monomeric prolactin (monoPRL) group. A total of 337 patients were enrolled with a mean age of 33.8 +/- 10.8 (16-66) years and a male/female ratio of 29/308. Eighty-eight of the patients (26.1%) had an elevated macroPRL level. The mean age in the monoPRL group was higher than in the macroPRL group (35.0 +/- 10.1 vs. 30.7 +/- 9.8, P = 0.016). The mean PRL levels (ng/ml) in the macroPRL and monoPRL groups were similar (168.0 +/- 347.0 vs. 238.8 +/- 584.9, P = 0.239). Frequency of amenorrhea, infertility, irregular menses, gynecomastia, and erectile dysfunction were also similar in both groups. More patients in the macroPRL group were asymptomatic compared to the monoPRL group (30.2 vs. 12.0%, P = 0.006). Compared to the macroPRL group, the monoPRL group had a higher frequency of galactorrhea (39.2 vs. 57.1%, P = 0.04) and abnormal magnetic resonance imaging findings (65.3 vs. 81.1%, P = 0.02). Elevated macroPRL levels should be considered a pathological biochemical variant of hyperprolactinemia that may present with any of the conventional symptoms and radiological findings generally associated with elevated PRL levels.Öğe Clinical presentation of Von Hippel Lindau syndrome type 2B associated with VHL p.A149S mutation in a large Turkish family(Humana Press Inc, 2014) Mete, Türkan; Berker, Dilek; Yılmaz, Engin; Özgen, G.; Yalçın, Yavuz; Tuna, Mazhar Müslüm; Güler, SerdarVon Hippel Lindau (VHL) syndrome is an autosomal dominant disorder characterized by benign and malignant tumors. This study presents the clinical and genetic features of VHL syndrome in a Turkish family. For the diagnosis of pheochromocytoma-related diseases, 49 family members from three generations were evaluated between March 2008 and January 2013. Family members were examined to identify components of pheochromocytoma- related genetic syndromes through physical examination, laboratory tests, and imaging methods. For the causative mutation, sequence analysis of VHL gene was performed. Nine patients were diagnosed with pheochromocytoma. Lumbal spinal hemangioblastoma and pancreatic neuroendocrine tumor without pheochromocytoma were detected in one patient. In patients with pheochromocytoma, additional tumors, such as retinal angioma, renal cell carcinoma, pancreatic serous cystadenoma, and pancreatic neuroendocrine tumors were detected. All patients were diagnosed as VHL syndrome type 2B. Sequence analysis of VHL gene revealed heterozygous p.A149S mutation in all symptomatic patients and in seven of the asymptomatic family members. This is the first study that identified VHL p.A149S mutation in a Turkish family with VHL syndrome. However, VHL p.A149S mutation was identified in an American family by Atuk et al. (J Clin Endocrinol Metab, 83:117-120, 14) and the family was defined as VHL type 2A. In our study, the family was identified as VHL type 2B. This variability in the phenotypic features suggests that further studies are required to beter assess the genotype-phenotype correlation in such cases.Öğe A comparative study of pre-operative imaging methods in patients with primary hyperparathyroidism: Ultrasonography, Tc-99m sestamibi, single photon emission computed tomography, and magnetic resonance imaging(Springer, 2012) Akbaba, Gülhan; Berker, Dilek; Işık, Serhat; Aydın, Yusuf; Cılız, Deniz Sözmen; Peksoy, İrfan; Güler, SerdarAim: This study compares the accuracy rates achieved in ultrasonography (US), 9(9m)Tc-sestamibi (MIBI), single photon emission computed tomography (SPEC), and magnetic resonance imaging (MRI) as imaging methods used in the pre-operative localization of the enlarged parathyroid glands. Subjects and methods: For the purposes of this study, US, MIBI, SPECT, and MRI were performed on 98 patients with primary hyperparathyroidism (pHPT). All patients underwent parathyroidectomy. Results: Pre-operative localization of an abnormal parathyroid gland was successfully performed in 82 of the cases scanned with US (83.7%), while the result was 66 in the cases scanned with MIBI (67.3%), 71 of the cases were successfully localized with SPECT (72.4%), while MRI revealed the diseased gland in only 60 of the total'cases (61.2%). In MIBI-positive and -negative patients there was a statistically significant difference among cases in terms of adenoma volume (1.30 +/- 1.51 vs 0.58 +/- 0.91, p < 0.05). Sensitivity, specificity and diagnostic accuracy values were 87.2%, 25.0%, and 83.0%; 70.2%, 50.0%, and 69.4%; 75.5%, 50.0%, and 74.5%; 63.8%, 50.0%, and 63.3% for US, MIBI, SPECT, and MRI, respectively. The respective values for sensitivity, specificity, and diagnostic accuracy were 94.9%, 25.0%, and 91.1% when US was combined with MIBI. Conclusions: Combining US and MIBI as imaging methods for pre-operative imaging of pHPT often produces more satisfactory results. While the accuracy of US is relatively low in the ectopic localizations, the size of the lesion can be an important factor in the accuracy achieved with MIBI. (J. Endocrinol. Invest. 35: 359-364, 2012) (c) 2012, Editrice KurtisÖğe Comparison of Endoscopic and Microscopic Endonasal Transsphenoidal Surgery Approaches in Acromegalic Patients.(Endocrine Soc, 2010) Berker, Dilek; Berker, Mustafa; Tütüncü, Yasemin Ateş; Aydın, Yusuf; Işık, Serhat; Özuğuz, Ufuk; Güler, Serdar…Öğe Comparison of octreotide LAR and lanreotide autogel as post-operative medical treatment in acromegaly(Springer, 2012) Tütüncü, Yasemin Ateş; Berker, Dilek; Işık, Serhat; Özuğuz, Ufuk; Akbaba, Gülhan; Küçükler, Ferit Kerim; Güler, SerdarLong-acting somatostatin analogs are frequently used as adjuvant treatment of acromegaly patients after noncurative surgery. This sudy aims to compare the efficacy of octreotide long-acting release (OCT) and lanreotide Autogel (LAN) in acromegaly patients. Sixty-eight patients not cured by transsphenoidal endoscopic or microscopic pituitary surgery between 2003 and 2009 were retrospectively analyzed (25 men; 43 women; mean age 41.1 +/- A 10.9 years [range 18-65 years]). The patients were assigned randomly to OCT (n = 36) and LAN (n = 32) groups. Evaluations included insulin-like growth factor I (IGF-I) and growth hormone (GH) after oral glucose tolerance test (OGTT) 3, 6, 12 and 18 months after starting medical treatment; pituitary magnetic resonance imaging was performed before treatment and after 3 and 12 months. Patients achieving IGF-I levels within the age and gender normal range and GH level < 1 mu g/l following OGTT were considered a 'biochemical cure'. Mean IGF-I and GH values and tumor volumes (cm(3)) in the LAN and OCT groups were similar in the post-operative period before initiation of medical treatment. A statistically significant decrease in GH and IGF-I levels was obtained for both treatment groups at each follow-up visit compared to the previous value. Tumor shrinkage after 12 months of treatment was statistically significant in both groups but the percentage tumor shrinkage (28.5% vs. 34.9%, P = 0.166) and rate of patients achieving biochemical cure (63.9 and 78.1%, P = 0.454) were similar between OCT and LAN groups, respectively. OCT and LAN treatment options have similar efficacy for ensuring biochemical cure and tumor shrinkage in acromegaly patients who had noncurative surgery.Öğe Comparison of Preoperative Examinations in Patients with Primary Hyperparathyroidism: US, MIBI, SPECT and MRI.(Endocrine Soc, 2010) Akbaba, Gülhan; Berker, Dilek; Aydın, Yusuf; Işık, Serhat; Cılız, Deniz Sözmen; Peksoy, İrfan; Güler, Serdar…Öğe CUSHING DISEASE ASSOCIATED WITH RATHKE'S CLEFT CYST(Editura Acad Romane, 2010) Berker, Dilek; Aydın, Yusuf; Işık, S.; Söylemezoğlu, F.; Tütüncü, Y.; Berker, Mustafa; Güler, SerdarObjective. Co-existence of Cushing disease and Rathke's cleft cyst (RCC) has been reported in a few cases in the literature so far. We herein describe a rare condition of Cushing disease that might originate from epithelium of RCC. Case. A 48-year-old woman was admitted to the hospital with complaints of headache, weakness, and weight gain. The patient underwent endoscopic transsphenoidal surgery due to Cushing disease. Histopathological examination revealed cyst contents and walls compatible with RCC, and normal adenohypophysis and neurohypophysis tissues. Immunohistochemical stainings with ACTH, GH, and prolactin were positive on the epithelium of the cyst. Conclusion. In our case, Cushing disease might he associated with hormonal activity derived from cyst wall of RCC or disappearance of a small microadenoma during surgical or pathological processing. According to the recent data, origin of this lesion and histogenetic link between RCC with Cushing disease could not be explained.Öğe Evaluation of carotid intima media thickness in impaired fasting glucose and impaired glucose tolerance(Edizioni Minerva Medica, 2011) Aydın, Yusuf; Berker, Dilek; Üstün, İhsan; Gül, Kamile; Erden, Gönül; Kutlucan, Ali; Güler, SerdarAim. Increased carotid intima media thickness (CIMT) is recognized as the early indicator of atherosclerosis. We aimed to evaluate the effect of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) on the CIMT. Methods. We evaluated 51 dysglycemic patients (IFG [N.=22]; IGT [N.=29]) and 25 controls who have similar age and gender. Patients who were known to have coronary heart disease, cerebrovascular disease, hypertension, hyperlipidemia, diabetes mellitus and hypo-hyperthyrodism were excluded. We measured fasting blood glucose (FBG), postprandial blood glucose (PPG), insulin, insulin resistance, lipid profile, hsCRP, microalbuminuria, and glycosylated hemoglobin A1c (HbA1c). We measured the CIMT by Doppler ultrasonography. Results. Both IFG and IGT patients have increased CIMT according to controls (P<0.001). Mean CIMT of IFG, IGT and control were 0.704, 0.738 and 0.555 respectively. There were no differences in point of fasting insulin and HOMA-IR between IFG and IGT. There were positive correlation of CIMT and FBG, PPG, HbA1c, fasting insulin and HOMA-IR in both groups. In linear regression analysis, PPG and HbA1c is the major factor affecting CIMT (t=0.017 and 0.036). Conclusion. IFG and IGT have increased CIMT according to controls, and PPG and HbA1c are the major affecting factors to CIMT.Öğe EVALUATION OF THE RELATION BETWEEN PRIMARY HYPERPARATHYROIDISM AND CONCOMITANT THYROID DISEASE(Editura Acad Romane, 2010) Özuğuz, Ufuk; Işık, Serhat; Akbaba, Gülhan; Berker, Dilek; Tütüncü, Yasemin; Aydın, Yusuf; Güler, SerdarObjective. Thyroid diseases coexisting with primary hyperparathyroidism (PHPT) may individually change the diagnosis, treatment and follow-up of the patients. In our study, we aimed to investigate the thyroid diseases coexisting with PHPT and the relation between these two clinical situations. Methods. We retrospectively investigated 255 patients who were diagnosed as PHPT between 2004-2009 in our clinic. The general characteristics of the patients, laboratory tests, which were performed preoperatively, neck ultrasonography, thyroid and parathyroid scintigraphy and fine needle aspiration biopsy (FNAB) results were assessed. Cytological results of the nodules with preoperative FNAB were compared with the postoperative histological results. Results. Of the patients, 49 were male (19.2%) and 206 were female (80.8%). Mean age was 54.5+/-12.8. Bilateral neck exploration (BNE) was performed on 69 cases (27%), minimal invasive parathyroidectomy (MIP) on 78 cases (30.5%) and BNE plus thyroidectomy on 108 cases (42.5%). When all thyroid diseases were taken into account, prevalence of the coexisting thyroid disease was 65%, prevalence of nodular thyroid disease 52.1%, thyroid cancer 16.7% and thyroid dysfunction 11.8%. The mean age of the patients with a nodular goitre was significantly higher than of the patients who did not have nodules (p<0.001). General demographic data, calcium and PTH levels did not show any difference. Number of nodules was correlated with age (p<0.001, r=0.227). Conclusion. The relation between PHPT and nodular thyroid diseases is coincidental and this can be explained by the fact that both diseases occur in advanced age.Öğe The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology(Humana Press Inc, 2014) Tütüncü, Yasemin Ateş; Berker, Dilek; Işık, Serhat; Akbaba, Gülhan; Özuğuz, Ufuk; Küçükler, Ferit Kerim; Güler, SerdarVarious approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) or suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were >= 1 cm, 82.9 % of the benign nodules were >= 1 cm (p = 0.042). In the current study, malignancy was observed in 33.3 % of the Hurthle cell lesion group, 23 % of the follicular neoplasm group and 53.7 % of the suspicious for malignancy group. In addition, we detected that microcalcification and benign hypoechoic at patients with indeterminate cytology can be related with increased risk of malignancy. We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia, total thyroidectomy will be suitable for these patients.Öğe The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology (vol 45, pg 37, 2014)(Humana Press Inc, 2014) Tütüncü, Yasemin Ateş; Berker, Dilek; Işık, Serhat; Akbaba, Gülhan; Özuğuz, Ufuk; Küçükler, Ferit Kerim; Güler, SerdarVarious approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) or suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were =1 cm, 82.9 % of the benign nodules were =1 cm (p = 0.042). In the current study, malignancy was observed in 33.3 % of the Hurthle cell lesion group, 23 % of the follicular neoplasm group and 53.7 % of the suspicious for malignancy group. In addition, we detected that microcalcification and benign hypoechoic at patients with indeterminate cytology can be related with increased risk of malignancy. We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia, total thyroidectomy will be suitable for these patients.Öğe Importance of radioiodine dosage in the treatment of patients with toxic nodular and toxic multinodular goiter(2010) Aydın, Yusuf; Özşeker, Burak; Berker, Dilek; Özuğuz, Ufuk; Üstün, İhsan; Işık, Serhat; Güler, SerdarAmaç: Toksik multinodüler guatr (TMNG) ve toksik nodüler guatr (TNG) hastalarında verilen radyoaktif iyot (RAI) tedavisinin dozla ilgili etkinliğini ve yan etkilerini değerlendirmek Gereç ve Yöntem: Çalışmamıza 2003-2006 yılları arasında hastanemizdeki klinik muayene ve laboratuvar testleri sonucu TMNG ve TNG tanısı almış 57 hasta dahil edildi. Hastalara tiroid fonksiyon testleri (TFT), tam kan sayımı, biyokimya testleri, tiroid ultrasonografi (TUSG), tiroid sintigrafisi ve 4/24 saatlik RAI tedavisi gören hastalarda radyoaktif iyot uptake testleri uygulanarak tanı konuldu. RAI tedavisi gören hastalarda TUSG ve TFT radyoaktif iyot tedavisi öncesi ve tedaviden 12 ay sonra tekrar değerlendirildi. RAI tedavi öncesi ve sonrası tiroid loblarının ve nodüllerin volümleri değerlendirildi. Bulgular: TMNG ve TNG hastalarına uygulanan ortalama RAI tedavi dozu 15.6 mCi idi. Tedavinin 12. ayında hastaların %52.6’sında (30/57) ötiroidizm ve %26.4’ünde (15/57) hipotiroidizm gelişirken sadece %21’inin (12/57) tirotoksik kaldığı izlendi. Hem tiroid loblarında hem de nodüllerin volümlerinde başlangıç boyutlarına göre istatistiksel olarak belirgin azalma vardı (p0.001). RAI tedavi dozu ile tiroid loblarının ve nodüllerin volümündeki azalmada anlamlı bir fark yoktu. On iki aylık takip sırasında hipotiroidi dışında hiçbir yan etki rapor edilmedi. Sonuç: RAI tedavisi, TMNG ve TNG hastalarında başarılı bir şekilde hastaların semptomlarını kontrol etmiştir. RAI tedavisi, hem tiroid lobları üzerinde hem de nodüller üzerinde yararlı etkisini dozdan bağımsız olarak göstermektedir. Ortalama 15 mCi RAI tedavisi TMNG ve TNG hastalarının tedavisinde yeterlidir.Öğe Preoperative therapeutic plasmapheresis in thyrotoxic patients who did not effectively treated with antithyroid drugs, iodine and corticosteroid(2010) Aydın, Yusuf; Tütüncü, Yasemin Ateş; Berker, Dilek; Işık, Serhat; Özoğuz, Ufuk; Güler, SerdarIntroduction: Preoperative treatment options in thyrotoxic patients are antithyroid drugs, potassium iodide, beta blockers and corticosteroids. Sometimes these treatment regimens have not been so successful for the patients to make them ready for the operation. So we thought that plasmapheresis (PP) could be an alternative to these treatments. Methods: Two thyrotoxic patients with Graves' disease and one patient with toxic multinodular goiter were included in the study. All patients were candidates to surgical operation due to the contraindication of other medical treatment choices. On admission, all patients had severe uncontrolled hyperthyroidism. In order to prepare our patients to operation, all the patients were given beta blockers and inorganic potassium iodide and corticosteroid at first but disease control could not be achieved in terms of thyrotoxicosis. So PP was performed at an average of 3 to 5 sessions. Results: After PP, all patients' thyroid hormone concentrations were significantly reduced. One patient had an anaphylactic reaction during 3th session of PP. Total thyroidectomy was performed to all patients without any complications. Conclusions: We concluded that PP could be used as an alternative therapeutic option in the preoperative management of severe thyrotoxic patients. © 2010 Düzce Medical Journal.Öğe Serum transforming growth factor-beta levels in patients with vitamin D deficiency(Elsevier Science Bv, 2012) Işık, Serhat; Özuğuz, Ufuk; Tütüncü, Yasemin Ateş; Erden, Gönül; Berker, Dilek; Acar, Kadir; Güler, SerdarBackground: Transforming growth factor-beta 1 (TGF-beta 1) contributes to tissue repair by promoting tissue fibrosis, and elevations have been reported in patients with bone marrow fibrosis. The aim of this study was to evaluate the relationship between TGF-beta 1 levels and vitamin D deficiency. Methods: All patients presenting to the outpatient Endocrinology and Metabolic Diseases clinic between June and September of 2008 were approached, and consenting patients who were deemed suitable candidates were enrolled. Hematological parameters were measured, along with serum levels of total and ionized calcium, phosphorus, parathyroid hormone, iron, folic acid vitamin B12 levels, 25 OH vitamin D3 (25OHD(3)) and TGF-beta 1. Results: A total of 132 patients were included in the study. Patients were divided into 4 groups based on levels of 25OHD(3) [group 1 (< 5 ng/ml), 20 patients; group 2 (5-15 ng/ml), 38 patients; group 3 (16-30 ng/ml); and group 4 (> 30 ng/ml), 28 patients]. TGF-beta 1 levels were higher in patients in group 1 compared to the other groups. Transforming growth factor-beta levels correlated negatively with vitamin D3 and positively with leukocyte count, platelet count, of MCV and MCH. Multiple regression analyses revealed TGF-beta 1 levels to be associated with 25OHD(3) as well as with platelet count. Conclusions: Results of this study are suggestive of the presence of a significant relationship between TGF-beta and vitamin D deficiency. Increased TGF-beta 1 and platelet count may be an early indicator of bone marrow fibrosis in patients with vitamin D deficiency. Crown Copyright (C) 2011 Published by Elsevier B. V. on behalf of European Federation of Internal Medicine. All rights reserved.Öğe SEVERE HYPERKALEMIA WITHOUT ELECTROCARDIOGRAPHIC CHANGES IN A PATIENT WITH ADDISON DISEASE(Editura Acad Romane, 2010) Işık, Serhat; Berker, Dilek; Aydın, Yusuf; Özuğuz, Ufuk; Tütüncü, Yasemin; Şimşek, Yasin; Güler, SerdarObjective. Hyperkalemia is one of the most common acute life-threatening metabolic emergencies. Alterations in scrum potassium (K(+)) levels can have dramatic effects on cardiac cell conduction and may lead to electrocardiographic (ECG) changes. But in some patients ECG changes do not accompany serum K(+) abnormalities. Severe hyperkalemia secondary to Addison Disease (AD) is rare. Case. A 40-year-old woman with AD was admitted to emergency service with generalized pain. The patient's serum K(+) level was found to be at the highest level that can be detected in our laboratory (>10.0 mmol/L, normal 3.5-4.5 mmol/L) and repeated serum K(+) confirmed the previous result. Results of repeated ECGs have revealed a normal sinus rhythm. Our case is particularly interesting because it demonstrates an Addison patient that has an extremely high level of K(+) (>10 mmol/L) without any accompanying ECG changes. Conclusion. Our case confirms that diagnostic ECG changes do not always accompany severe hyperkalemia. Therefore, clinicians should be careful that ECG may look normal in the presence of severe hyperkalemia.Öğe THYROID-RELATED FACTORS THAT INFLUENCE PREOPERATIVE LOCALIZATION OF PARATHYROID ADENOMAS(Amer Assoc Clinical Endocrinologists, 2012) Işık, Serhat; Akbaba, Gülhan; Berker, Dilek; Tütüncü, Yasemin Ateş; Özuğuz, Ufuk; Aydın, Yusuf; Güler, SerdarObjective: To evaluate the effect that thyroid-related factors have on the preoperative localization of parathyroid adenomas. Methods: This retrospective study included adult patients who were referred for further evaluation of primary hyperparathyroidism between December 2005 and October 2009 at a teaching and research hospital in Turkey. High-frequency ultrasonography and sestamibi scintigraphy (MIBI) were performed in all patients. Surgical procedure involved focal or bilateral exploration on the basis of concordant or discordant imaging studies. Selection of patients for minimally invasive parathyroidectomy was made based on the presence or absence of a single parathyroid adenoma detected by both ultrasonography and MIBI scan. Patients with negative or discordant imaging studies and a concomitant thyroid nodule underwent bilateral neck exploration. Results: Two hundred and forty-eight patients with primary hyperparathyroidism who underwent parathyroidectomy were included in the study. Parathyroid gland abnormalities were successfully detected preoperatively by ultrasonography in 231 patients and by MIBI scan in 152 patients. When used together, ultrasonography and MIBI scan were unsuccessful in detecting an abnormality in 11 cases. MIBI scan visualized a lesion in 6 cases that remained undiagnosed by ultrasonography. Fifty-six of 85 patients with lesions detected by ultrasonography, but not by MIBI scan, had thyroid nodules. The frequency of thyroid nodules was higher in the 96 patients in whom a MIBI scan could visualize a parathyroid lesion than in the 152 patients in whom MIBI scan was successful (P = .004). No difference was observed regarding ipsilateral thyroid lobe involvement or nodule volume. Parathyroid adenomas were significantly smaller in patients with negative MIBI scans (P<.001). Conclusion: Our results suggest that ultrasonography is more sensitive than MIBI scan in the detection of parathyroid adenomas, particularly in the presence of small parathyroid adenomas or other thyroid related-factors. (Endocr Pract. 2012;18:26-33)
