The diagnosis of Cushing's syndrome (CS) is still one of the most challenging problems in end... more The diagnosis of Cushing's syndrome (CS) is still one of the most challenging problems in endocrinology. In ACTH-dependent CS, bilateral inferior petrosal sinus sampling (BIPSS) is a useful method for distinguishing between pituitary and ectopic sources of ACTH secretion. BIPSS is an interventional radiology method, in which ACTH levels obtained from petrosal sinuses are compared to peripheral venous blood ACTH levels at basal conditions and after corticotropin-releasing hormone (CRH) or desmopressin (DDAVP) stimulation. A gradient between central and peripheral sources of ACTH indicates Cushing's disease (CD), whereas the absence of a gradient suggests ectopic CS. In some cases, intrapituitary gradients from side-to-side may also help to predict the side of the adenoma within the pituitary. However, anatomical variations may lead to false lateralization of the lesion in the pituitary gland during BIPSS. We report the case of a 51-year-old woman with CD in whom BIPSS indicat...
Sheehan&a... more Sheehan's syndrome (SS) is a parturition-related pituitary disease resulting from severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. Pathological and clinical findings of SS were first described by Harold L. Sheehan in the previous century. Although his definitions are still valid, various studies and reports including new data have subsequently been published. Additionally, the diagnosis of SS has often been overlooked and thus delayed for long years due to its nonspecific signs and symptoms. Therefore, a large number of patients may be remained undiagnosed and untreated. SS is not as rare as assumed in developed countries, probably due to migrant women and unawareness of physicians regarding the syndrome. In this review, we provide a detailed review of the epidemiology, etiopathogenesis, clinical, laboratory and radiological features, new diagnostic criteria, differential diagnosis, and treatment of SS.
Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (... more Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (CVD) are identified as risk factors for hypopituitarism. Pituitary dysfunction after TBI, SAH, and CVD may present in the acute phase or later in the course of the event. Chronic hypopituitarism, particularly growth hormone (GH) deficiency is related to the increased cardiovascular morbidity and mortality. In patients with serious ventricular arrhythmias, who need cardiopulmonary resuscitation, brain tissue is exposed to short-term severe ischemia and hypoxia. However, there are no data in the literature regarding pituitary dysfunction after ventricular arrhythmias. Forty-four patients with ventricular arrhythmias [ventricular tachycardia (VT), ventricular fibrillation (VF)] (mean age, 55.6 ± 1.8 years; 37 men, 7 women) were included in the study. The patients were evaluated after mean period of 21.2 ± 0.8 months from VT-VF. Basal hormone levels, including serum free triiodothyronine (fT3), free thyroxine (fT4), TSH, ACTH, prolactin, FSH, LH, total testosterone, estradiol, IGF-1, and cortisol levels were measured in all patients. To assess (GH)-insulin like growth factor-1 (IGF-1) axis, glucagon stimulation test was performed and 1 µg ACTH stimulation test was used for assessing hypothalamic-pituitary-adrenal (HPA) axis. The frequencies of GH, gonadotropin and TSH deficiency were 27.2, 9.0, 2.2 %, respectively. Mean IGF-1 levels were lower in GH deficiency group, but it was not statistically significant. The present preliminary study showed that ventricular arrhythmias may result in hypopituitarism, particularly in growth hormone deficiency. Unrecognized hypopituitarism may be responsible for some of the cardiovascular problems at least in some patients.
Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely f... more Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely frequent, until the drainage of purulent material during surgery because of the non-spesific clinical signs and laboratory findings. The diagnosis can be made preoperatively with awareness of the disease and careful assessment of radiological investigations, especially magnetic resonance imaging (MRI). We report a 43-year-old man who presented with acute purulent meningitis. Control MRI scans, performed because of the deterioration in patient's general status during follow-up, revealed a pituitary abscess. We preferred a conservative approach initially, but abscess drainage later became essential, since there was no response to antibiotic therapy. The lesion disappeared after transsphenoidal drainage. The general health status of the patient, receiving a replacement therapy for anterior pituitary deficiency, was good 2 months after discharge. Pituitary abscess should be kept in mind i...
Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely f... more Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely frequent, until the drainage of purulent material during surgery because of the non-spesific clinical signs and laboratory findings. The diagnosis can be made preoperatively with awareness of the disease and careful assessment of radiological investigations, especially magnetic resonance imaging (MRI). We report a 43-year-old man who presented with acute purulent meningitis. Control MRI scans, performed because of the deterioration in patient’s general status during follow-up, revealed a pituitary abscess. We preferred a conservative approach initially, but abscess drainage later became essential, since there was no response to antibiotic therapy. The lesion disappeared after transsphenoidal drainage. The general health status of the patient, receiving a replacement therapy for anterior pituitary deficiency, was good 2 months after discharge. Pituitary abscess should be kept in mind in pa...
BackgroundThis case–control study was conducted to investigate the relationship between serum nes... more BackgroundThis case–control study was conducted to investigate the relationship between serum nesfatin-1 levels and nutritional status and blood parameters in patients diagnosed with metabolic syndrome.MethodsThirty patients (case) diagnosed with metabolic syndrome according to National Cholesterol Education Program-Adult Treatment Panel III criteria were included. Thirty healthy subjects (control) matched with patients with metabolic syndrome in terms of age, gender and body mass index were included. Three-day food consumption records were obtained. Anthropometric indices were measured and body composition was determined by bioelectrical impedance method. Biochemical parameters and serum nesfatin-1 levels were measured after 8 hours of fasting.ResultsSerum nesfatin-1 levels were 0.245±0.272 ng/mL in the case group and 0.528±0.987 ng/mL in the control group (p>0.05). There was a positive significant correlation between serum nesfatin-1 levels and body weight, waist and hip circum...
Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism du... more Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Symptoms are caused by a decrease or absence of one or more of the pituitary hormones, and vary, among others, from failure to lactate and nonspecific symptoms (such as fatigue) to severe adrenal crisis. In accordance with the location of hormone-secreting cells relative to the vasculature, the secretion of growth hormone and prolactin is most commonly affected, followed by follicle-stimulating hormone and luteinizing hormone; severe necrosis of the pituitary gland also affects the secretion of thyroid-stimulating hormone and adrenocorticotropic hormone. Symptoms usually become evident years after delivery, but can, in rare cases, develop acutely. The incidence of Sheehan syndrome depends, to a large extent, on the occurrence and management of PPH. Sheehan syndrome is an important cause of hypopituitarism in developing countries, but has become rare in developed countries. Diagnosis is based on clinical manifestations combined with a history of severe PPH; hormone levels and/or stimulation tests can confirm clinical suspicion. Hormone replacement therapy is the only available management option so far.
Journal of clinical research in pediatric endocrinology, Jan 18, 2015
This retrospective multicenter study was carried out to evaluate the impact of free RET proto-onc... more This retrospective multicenter study was carried out to evaluate the impact of free RET proto-oncogene testing of medullary thyroid cancer (MTC) patients, centrally conducted and supported by Society of Endocrinology and Metabolism. Surgical timing, adequacy of the treatment and frequency of prophylactic thyroidectomy for mutation carriers were assessed. Society of Endocrinology and Metabolism sponsored RET genetic screening for MTC and pheochromocytoma between July 2008 and January 2012 in 512 patients. An evaluation form was sent to physicians of eligible 319 patients who had confirmed sporadic MTC, familial MTC, MEN 2 or mutation carriers. Physicians were asked to give information about, surgical history, latest calcitonin levels, morbidity, mortality, genetic screening and prophylactic thyroidectomy among family members. Twenty-five centers responded by filling in the forms of 192 patients. Among 319 eligible patients, RET mutation was detected in 71 patients (22.3%). Cys634Arg ...
The diagnosis of Cushing's syndrome (CS) is still one of the most challenging problems in end... more The diagnosis of Cushing's syndrome (CS) is still one of the most challenging problems in endocrinology. In ACTH-dependent CS, bilateral inferior petrosal sinus sampling (BIPSS) is a useful method for distinguishing between pituitary and ectopic sources of ACTH secretion. BIPSS is an interventional radiology method, in which ACTH levels obtained from petrosal sinuses are compared to peripheral venous blood ACTH levels at basal conditions and after corticotropin-releasing hormone (CRH) or desmopressin (DDAVP) stimulation. A gradient between central and peripheral sources of ACTH indicates Cushing's disease (CD), whereas the absence of a gradient suggests ectopic CS. In some cases, intrapituitary gradients from side-to-side may also help to predict the side of the adenoma within the pituitary. However, anatomical variations may lead to false lateralization of the lesion in the pituitary gland during BIPSS. We report the case of a 51-year-old woman with CD in whom BIPSS indicat...
Sheehan&a... more Sheehan's syndrome (SS) is a parturition-related pituitary disease resulting from severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. Pathological and clinical findings of SS were first described by Harold L. Sheehan in the previous century. Although his definitions are still valid, various studies and reports including new data have subsequently been published. Additionally, the diagnosis of SS has often been overlooked and thus delayed for long years due to its nonspecific signs and symptoms. Therefore, a large number of patients may be remained undiagnosed and untreated. SS is not as rare as assumed in developed countries, probably due to migrant women and unawareness of physicians regarding the syndrome. In this review, we provide a detailed review of the epidemiology, etiopathogenesis, clinical, laboratory and radiological features, new diagnostic criteria, differential diagnosis, and treatment of SS.
Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (... more Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (CVD) are identified as risk factors for hypopituitarism. Pituitary dysfunction after TBI, SAH, and CVD may present in the acute phase or later in the course of the event. Chronic hypopituitarism, particularly growth hormone (GH) deficiency is related to the increased cardiovascular morbidity and mortality. In patients with serious ventricular arrhythmias, who need cardiopulmonary resuscitation, brain tissue is exposed to short-term severe ischemia and hypoxia. However, there are no data in the literature regarding pituitary dysfunction after ventricular arrhythmias. Forty-four patients with ventricular arrhythmias [ventricular tachycardia (VT), ventricular fibrillation (VF)] (mean age, 55.6 ± 1.8 years; 37 men, 7 women) were included in the study. The patients were evaluated after mean period of 21.2 ± 0.8 months from VT-VF. Basal hormone levels, including serum free triiodothyronine (fT3), free thyroxine (fT4), TSH, ACTH, prolactin, FSH, LH, total testosterone, estradiol, IGF-1, and cortisol levels were measured in all patients. To assess (GH)-insulin like growth factor-1 (IGF-1) axis, glucagon stimulation test was performed and 1 µg ACTH stimulation test was used for assessing hypothalamic-pituitary-adrenal (HPA) axis. The frequencies of GH, gonadotropin and TSH deficiency were 27.2, 9.0, 2.2 %, respectively. Mean IGF-1 levels were lower in GH deficiency group, but it was not statistically significant. The present preliminary study showed that ventricular arrhythmias may result in hypopituitarism, particularly in growth hormone deficiency. Unrecognized hypopituitarism may be responsible for some of the cardiovascular problems at least in some patients.
Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely f... more Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely frequent, until the drainage of purulent material during surgery because of the non-spesific clinical signs and laboratory findings. The diagnosis can be made preoperatively with awareness of the disease and careful assessment of radiological investigations, especially magnetic resonance imaging (MRI). We report a 43-year-old man who presented with acute purulent meningitis. Control MRI scans, performed because of the deterioration in patient's general status during follow-up, revealed a pituitary abscess. We preferred a conservative approach initially, but abscess drainage later became essential, since there was no response to antibiotic therapy. The lesion disappeared after transsphenoidal drainage. The general health status of the patient, receiving a replacement therapy for anterior pituitary deficiency, was good 2 months after discharge. Pituitary abscess should be kept in mind i...
Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely f... more Pituitary abscess is a rare and potentially life-threatening disease. Misdiagnosis is extremely frequent, until the drainage of purulent material during surgery because of the non-spesific clinical signs and laboratory findings. The diagnosis can be made preoperatively with awareness of the disease and careful assessment of radiological investigations, especially magnetic resonance imaging (MRI). We report a 43-year-old man who presented with acute purulent meningitis. Control MRI scans, performed because of the deterioration in patient’s general status during follow-up, revealed a pituitary abscess. We preferred a conservative approach initially, but abscess drainage later became essential, since there was no response to antibiotic therapy. The lesion disappeared after transsphenoidal drainage. The general health status of the patient, receiving a replacement therapy for anterior pituitary deficiency, was good 2 months after discharge. Pituitary abscess should be kept in mind in pa...
BackgroundThis case–control study was conducted to investigate the relationship between serum nes... more BackgroundThis case–control study was conducted to investigate the relationship between serum nesfatin-1 levels and nutritional status and blood parameters in patients diagnosed with metabolic syndrome.MethodsThirty patients (case) diagnosed with metabolic syndrome according to National Cholesterol Education Program-Adult Treatment Panel III criteria were included. Thirty healthy subjects (control) matched with patients with metabolic syndrome in terms of age, gender and body mass index were included. Three-day food consumption records were obtained. Anthropometric indices were measured and body composition was determined by bioelectrical impedance method. Biochemical parameters and serum nesfatin-1 levels were measured after 8 hours of fasting.ResultsSerum nesfatin-1 levels were 0.245±0.272 ng/mL in the case group and 0.528±0.987 ng/mL in the control group (p>0.05). There was a positive significant correlation between serum nesfatin-1 levels and body weight, waist and hip circum...
Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism du... more Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Symptoms are caused by a decrease or absence of one or more of the pituitary hormones, and vary, among others, from failure to lactate and nonspecific symptoms (such as fatigue) to severe adrenal crisis. In accordance with the location of hormone-secreting cells relative to the vasculature, the secretion of growth hormone and prolactin is most commonly affected, followed by follicle-stimulating hormone and luteinizing hormone; severe necrosis of the pituitary gland also affects the secretion of thyroid-stimulating hormone and adrenocorticotropic hormone. Symptoms usually become evident years after delivery, but can, in rare cases, develop acutely. The incidence of Sheehan syndrome depends, to a large extent, on the occurrence and management of PPH. Sheehan syndrome is an important cause of hypopituitarism in developing countries, but has become rare in developed countries. Diagnosis is based on clinical manifestations combined with a history of severe PPH; hormone levels and/or stimulation tests can confirm clinical suspicion. Hormone replacement therapy is the only available management option so far.
Journal of clinical research in pediatric endocrinology, Jan 18, 2015
This retrospective multicenter study was carried out to evaluate the impact of free RET proto-onc... more This retrospective multicenter study was carried out to evaluate the impact of free RET proto-oncogene testing of medullary thyroid cancer (MTC) patients, centrally conducted and supported by Society of Endocrinology and Metabolism. Surgical timing, adequacy of the treatment and frequency of prophylactic thyroidectomy for mutation carriers were assessed. Society of Endocrinology and Metabolism sponsored RET genetic screening for MTC and pheochromocytoma between July 2008 and January 2012 in 512 patients. An evaluation form was sent to physicians of eligible 319 patients who had confirmed sporadic MTC, familial MTC, MEN 2 or mutation carriers. Physicians were asked to give information about, surgical history, latest calcitonin levels, morbidity, mortality, genetic screening and prophylactic thyroidectomy among family members. Twenty-five centers responded by filling in the forms of 192 patients. Among 319 eligible patients, RET mutation was detected in 71 patients (22.3%). Cys634Arg ...
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