TÜRKİYE ENDOKRİNOLOJİ VE METABOLİZMA DERNEĞİ BÜLTENİ

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1 TÜRKİYE ENDOKRİNOLOJİ VE METABOLİZMA DERNEĞİ BÜLTENİ Sayı 49 Ocak - Şubat - Mart 2015 Üç ayda bir yayımlanır Üyelere ücretsiz olarak gönderilir ENDOBRIDGE ULUSLARARASI HABERLERDE Türkiye Endokrinoloji ve Metabolizma Derneği, Amerikan Endokrin Derneği ve Avrupa Endokrinoloji Derneğini bir araya getiren, Prof. Dr. Okan Bülent Yıldız ın fikir sahibi ve kurucusu olduğu EndoBridge projesi Amerika ve Avrupa Derneklerinin tüm dünyada 15 binden fazla aboneye sahip resmi yayın organlarında haber olarak yer aldı. I. ENDOKRİNOLOJİ SEMPOZYUMU TAMAMLANDI 20. Şubat 2015 tarihinde Kıbrıs Lefkoşa Merit Otelde, Yakın Doğu Üniversitesi, Tıp Fakültesi İç Hastalıkları Anabilim Dalı Endokrinoloji Bilim Dalı, Kıbrıs Burhan Nalbantoğlu Devlet Hastanesi Endokrinoloji ve Metabolizma Kliniği ve 9 Eylül Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Endokrinoloji Bilim Dalı'nın katkıları ve Türkiye Endokrinoloji ve Metabolizma Derneği'nin desteği ile Diyabetes Mellitus ve Tiroid Hastalıkları ile ilgili güncel konuların tartışıldığı I. Endokrinoloji Sempozyumu yapılmıştır. Açılışı, Kuzey Kıbrıs Türk Cumhuriyeti Sağlık Bakanı Uzm. Dr. Ahmet Gülle ve Yakın Doğu Üniversitesi Tıp Fakültesi Dekanı Prof. Dr. Gamze Mocan tarafından yapılan Sempozyumda Endokrinoloji Uzmanı Dr. Hasan Sav, Prof. Dr. Abdurrahman Çömlekçi, Doç Dr. Barış Akıncı, Yr. Doç. Dr. Serap S. İnançlı'nın konuşmacı olarak görev aldıkları Sempozyum da; Diyabetes Mellitus, İnsulin Tedavisi ve Tiroid Hastalıkları ile ilgili güncel konular anlatılmış, tartışmaya açılmış ve olgular üzerinden interaktif bilgi alışverişi yapılmıştır. Katılımcılara yapılan anketle, Sempozyumun bir çok sorulara yanıt getirdiği ve çok yararlı olduğu sonucu çıkmış ve mümkünse bu tip Sempozyum'ların tekrarlanması isteği dile getirilmiştir.

2 2 TÜRKİYE ENDOKRİNOLOJİ VE 3. LİPİD METABOLİZMASI VE BOZUKLUKLARI EGİTİM KURSU TAMAMLANDI Türkiye Endokrinoloji ve Metabolizma Derneği, Obezite - Lipid Metabolizması - Hipertansiyon - Çalışma Grubu nun organize ettiği 3. Lipid Metabolizması ve Bozuklukları Eğitim Kursu 28 Mart 2015 cumartesi günü Sheraton Otel-Bursa da yapıldı. 3. Lipid Metabolizması ve Bozuklukları Eğitim Kursunda; - Lipoprotein metabolizması, dislipideminin tanısı, etyolojisi ve sınıflaması, - Dislipidemik hastanın değerlendirilmesi ve tedavileri - Özel durumlarda görülen lipid bozukluklarının değerlendirilmesi ve tedavileri,gibi konular örnek vakalarla anlatıldı. Katılımcılarının soruları ile de bilgiler pekiştirildi. Kursa yaklaşık 110 kadar değişik branşdan hekim (Endokrinoloji uzmanı, Dahiliye uzmanı, Aile hekimi ve pratisyen hekim) katıldı. Kurs, lipidoloji konusunda tecrübeli yaklaşık 15 hocanın katılımıyla gerçekleşti. Katılımcılar böyle bir kursun kendi illerinde yapılmasından çok memnuniyet duyduklarını ve çok istifade ettikleri ifade ettiler. Kongre, Kurslar ve Sempozyumlar Bilimsel Kongreler, Ulusal ve Uluslararası Sempozyumlar Ayrıntılara ve 2015 yılına ait Bilimsel Toplantı Takvimine derneğimiz internet sayfasından ( ulaşabilirsiniz Nisan 2015 Çanakkale nin 100. Yılı Anısına TEMD Endokrinoloji Buluşması Kolin Otel, Çanakkale Mayıs 2015 AACE 24th Annual Scientific and Clinical Congress Nashville, USA Mayıs Türkiye Endokrinoloji ve Metabolizma Hastalıkları Kongresi Susesi Hotel, Antalya Mayıs th European Congress of Endocrinology Dublin, Ireland Mayıs 2015 Türkiye Doğal Beslenme ve Yaşam Boyu Sağlık Zirvesi 2015 Bilecik Mayıs th European Congress on Menopause and Andropause Madrid, Spain Mayıs nd European Congress on Obesity Prague, Czech Republic Haziran 2015 ADA Scientific Sessions 2015, 75th Scientific Sessions of American Diabetes Association Boston,MA

3 TÜRKİYE ENDOKRİNOLOJİ VE 3 Üyelerimizden Literatür Seçmeleri TOPOGRAPHIC AND BIOMECHANICAL EVALUATION OF CORNEA IN PATIENTS WITH ACROMEGALY. Altinkaynak H 1, Duru N, Ersoy R, Kalkan Akcay E, Ugurlu N, Cagil N, Cakir B. Cornea Jan;34(1): doi: /ICO Abstract Purpose: The aim of this study was to compare topographic and biomechanical properties of corneas in patients with acromegaly with those of healthy individuals. Methods: Thirty-five patients with acromegaly (study group) and 35 healthy individuals (control group) were enrolled in this prospective study. Topographic measurements, including central corneal thickness (CCT), mean keratometry (K) value, K1, K2, surface asymmetry index, corneal volume (CV), and anterior chamber depth in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius; Costruzione Strumenti Oftalmici). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-corelated intraocular pressure (IOPg) were measured using Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments). Results: Mean CCT, CV, CH, CRF, and IOPg values were higher in acromegalic eyes (549.3 ± 30.2 μm, 59.1 ± 3.1 μm, 11.3 ± 1.2 mm Hg, 11.3 ± 1.2 mm Hg, and 17.5 ± 2.9 mm Hg, respectively) than in healthy eyes (531.4 ± 33.6 μm, 57.4 ± 2.7 μm, 10.4 ± 1.2 mm Hg, 10.2 ± 1.6 mm Hg, and 14.8 ± 3.1 mm Hg, respectively; CCT, P = 0.042; CV, P = 0.032; CH, P = 0.044; CRF, P = 0.035; IOPg, P < 0.001). Conclusions: CCT, CV, CH, CRF, IOPg, and IOP with Goldmann applanation tonometry were significantly higher in acromegalic eyes. These corneal topographic and biomechanical properties, disease duration, and disease status should be considered when planning corneal refractive surgery and determining accurate intraocular pressure in patients with acromegaly. OCULAR FINDINGS IN SHEEHAN S SYNDROME. Atmaca M 1, Kızıldağ E, Candan Z, Özbay MF, Seven İ. Graefes Arch Clin Exp Ophthalmol May;253(5): doi: /s Epub 2015 Jan 10. Background: Sheehan s syndrome (SS) is one of the most common causes of hypopituitarism. The primary effect of SS is a deficiency in production of growth hormone (GH). A number of studies have supported the association between congenital GH deficiency and ocular anomalies. However, ocular findings such as central corneal thickness (CCT), intraocular pressure (IOP), and retinal nerve fiber layer thickness (RNFLT) have not been evaluated in patients with adult GH deficiency. The objective of this study was to evaluate ocular anomalies in SS with GH deficiency under a cross-sectional design. Methods: Thirty three SS patients with GH deficiency and 28 controls with no history of thyroid, adrenal, or pituitary gland diseases or surgery underwent complete hormonal and ophthalmological evaluation, including an assessment of CCTs, IOPs, and RNFLT. Results: The mean CCTs were significantly lower in the SS group compared with the control group (p < 0.001). There was no significant difference between patients and controls in terms of mean IOP, mean corrected IOP, and mean RNFLT (p = 0.517, p = 0.186, p = 0.965, respectively). The mean CCT was positively correlated with insulin-like growth factor 1 (IGF-1; p < 0.01) and adrenocorticotropic hormone (ACTH; p < 0.01) and negatively correlated with the corrected mean IOP (p < 0.05). In covariance analysis, IGF-1 was found to be a potential predictor of the mean CCT (p = 0.023). Conclusions: This study is the first investigation of ocular findings in SS and adult GH deficiency. Adult GH deficiency is characterized by lower CCT values. ASSESMENT OF OXIDATIVE STATUS AND ITS ASSOCIATION WITH THYROID AUTOANTIBODIES IN PATIENTS WITH EUTHYROID AUTOIMMUNE THYROIDITIS. Baser H 1, Can U, Baser S, Yerlikaya FH, Aslan U, Hidayetoglu BT. Endocrine Apr;48(3): doi: /s Epub 2014 Aug 23. Oxidative stress results from either overproduction of free radicals or insufficiency of several anti-oxidant defense systems. It leads to oxidation of main cellular macromolecules and a resultant molecular dysfunction. Thyroid hormones regulate oxidative metabolism and, thus, play a role in free radical production. Studies evaluating oxidative stress in patients with hypothyroidism and hyperthyroidism have been encountered in recent years; however, oxidative status in patients with euthyroid autoimmune thyroiditis (AIT) was not investigated previously. Thirty-five subjects with euthyroid AIT and 35 healthy controls were enrolled in the study. Serum oxidative status was determined by the measurement of total anti-oxidant status (TAS), total oxidant status (TOS), ischemia-modified albumin (IMA), and oxidized-low density lipoprotein (ox-ldl) levels. Serum TAS levels were significantly lower (p<0.001), while serum TOS levels and IMA levels were significantly higher (p<0.001 and p=0.020, respectively) in patients compared to controls. In both groups, ox-ldl levels were similar (p=0.608). Serum TAS levels were negatively correlated with anti-thyroid peroxidase and antithyroglobulin (anti-tg) levels (rho=-0.415, p=0.001 and rho=-0.484, p<0.001, respectively). Serum TOS was positively correlated with anti-tg levels (rho=0.547, p<0.001). Further, TAS was positively correlated with free T4 levels (r=0.279, p=0.043). No correlation was observed between thyrotropin, free T3 levels, and TOS and TAS levels. These results suggest

4 4 TÜRKİYE ENDOKRİNOLOJİ VE that oxidants are increased, and anti-oxidants are decreased in patients with euthyroid AIT, and oxidative/anti-oxidative balance is shifted to the oxidative side. Increased oxidative stress might have a role in thyroid autoimmunity. COMPARISON OF ADRENOCORTICAL STEROIDOGENESIS IN WOMEN WITH POST-ADOLESCENT SEVERE ACNE AND POLYCYSTIC OVARY SYNDROME. Cinar N 1, Cetinozman F, Aksoy DY, Elcin G, Yildiz BO. J Eur Acad Dermatol Venereol May;29(5): doi: /jdv Epub 2014 Aug 29. Background: Increased adrenocortical production appears to be associated with acne and hirsutism in acne and polycystic ovary syndrome (PCOS). However, the aetiological role of androgens in the pathogenesis of acne per se is far from being clear. Objective: We aimed to evaluate adrenocortical function in women with post-adolescent severe acne in comparison with patients with PCOS and healthy women. Methods: The study included 32 women with post-adolescent severe acne, 32 women with PCOS and 32 age and body mass index (BMI)-matched healthy controls (age years, BMI: 20.8 ± 1.9 kg/m2). Women with acne did not have hirsutism or ovulatory dysfunction whereas all PCOS patients had androgen excess and ovulatory dysfunction. Measurements included basal testosterone (T), sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEAS) levels and serum 17-hydroxyprogesterone (17- OHP), androstenedione (A4), DHEA and cortisol levels in response to corticotropin (ACTH) stimulation. Results: T, free androgen index, DHEAS levels, basal and AUC (area under the curve) values for A4 were significantly higher in PCOS than women with acne and controls (P < 0.05 for all), whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Women with PCOS and those with severe acne had significantly and similarly higher AUC values of 17-OHP compared to controls (P < 0.05). Conclusion: Women with isolated post-adolescent severe acne do not have increased levels of adrenal androgens basally or in response to ACTH. However, these women have similar secretion pattern of 17-OHP with PCOS patients suggesting increased enzymatic activity in this pathway. NORMOCALCEMIC HYPERPARATHYROIDISM AND INSULIN RESISTANCE. Temizkan S 1, Kocak O 2, Aydin K 1, Ozderya A 1, Arslan G 3, Yucel N 4, Sargin M 2. Endocr Pract Jan;21(1):23-9. doi: /EP14195.OR. Objective: To determine whether insulin resistance (IR) accompanies normocalcemic primary hyperparathyroidism (NCPHP). Methods: Twenty-five patients with NCPHP and 25 age-, sex-, and body mass index (BMI)-matched controls were included the study. Patients were diagnosed NCPHP if their serum calcium (Ca) concentrations and ionized serum Ca levels were in the normal range but parathyroid hormone (PTH) levels were inappropriately and persistently high. Subjects with 25-hydroxyvitamin D (25[OH]D) levels 20 ng/dl were included in the study. The upper limit of PTH was calculated using a nomogram for each subject. Patients and controls underwent a standard 75-gram oral glucose tolerance test (OGTT). IR was assessed by the homeostasis model assessment (HOMA-IR) and insulin sensitivity index (ISogtt). Results: There were no differences between the demographic features of patients with NCPHP and the control group. IR frequency was not different between groups (P =.14). HOMA-IR was higher and ISogtt was lower in patients with NCPHP than the control group, but the differences were not significant (P =.17 and P =.22, respectively). We did not find any correlation between PTH and glucose metabolism markers (HOMA-IR, ISogtt, glycated hemoglobin [HbA1c], and BMI) in either of the groups. Conclusion: The results of this study indicate that IR is not more common in patients with NCPHP, and PTH is not related to ISogtt or HOMA-IR. SUCRALOSE ENHANCES GLP-1 RELEASE AND LOWERS BLOOD GLUCOSE IN THE PRESENCE OF CARBOHYDRATE IN HEALTHY SUBJECTS BUT NOT IN PATIENTS WITH TYPE 2 DIABETES. Temizkan S 1, Deyneli O 1, Yasar M 1, Arpa M 2, Gunes M 1, Yazici D 1, Sirikci O 2, Haklar G 2, Imeryuz N 3, Yavuz DG 1. Eur J Clin Nutr Feb;69(2): doi: /ejcn Epub 2014 Oct 1. Background/objective: Artificial sweeteners were thought to be metabolically inactive, but after demonstrating that the gustatory mechanism was also localized in the small intestine, suspicions about the metabolic effects of artificial sweeteners have emerged. The objective of this study was to determine the effect of artificial sweeteners (aspartame and sucralose) on blood glucose, insulin, c-peptide and glucagon-like peptide-1 (GLP-1) levels. Subjects/methods: Eight newly diagnosed drug-naive type 2 diabetic patients (mean age 51.5±9.2 years; F/M: 4/4) and eight healthy subjects (mean age 45.0±4.1 years; F/M: 4/4) underwent 75 g oral glucose tolerance test (OGTT). During

5 TÜRKİYE ENDOKRİNOLOJİ VE 5 OGTT, glucose, insulin, c-peptide and GLP-1 were measured at 15- min intervals for 120 min. The OGTTs were performed at three settings on different days, where subjects were given 72 mg of aspartame and 24 mg of sucralose in 200 ml of water or 200 ml of water alone 15 min before OGTT in a singleblinded randomized order. Results: In healthy subjects, the total area under the curve (AUC) of glucose was statistically significantly lower in the sucralose setting than in the water setting (P=0.002). There was no difference between the aspartame setting and the water setting (P=0.53). Total AUC of insulin and c-peptide was similar in aspartame, sucralose and water settings. Total AUC of GLP-1 was significantly higher in the sucralose setting than in the water setting (P=0.04). Total AUC values of glucose, insulin, c-peptide and GLP-1 were not statistically different in three settings in type 2 diabetic patients. Conclusions: Sucralose enhances GLP-1 release and lowers blood glucose in the presence of carbohydrate in healthy subjects but not in newly diagnosed type 2 diabetic patients. APPROACH TO THE PATIENT: CONTRACEPTION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME. Yildiz BO 1. J Clin Endocrinol Metab Mar;100(3): doi: /jc Polycystic ovary syndrome (PCOS) is a common reproductive and metabolic disorder. Patients with PCOS present with clinical signs of androgen excess (ie, hirsutism and acne), menstrual irregularities, and infertility. Combined oral contraceptive (OC) pills are the first-line medical therapy for the long-term management of PCOS. Containing a combination of estrogen and progestin, OCs restore regular menses, improve androgen excess, and provide effective contraception and protection from endometrial cancer. The benefits of hormonal contraception outweigh the risks in the vast majority of women with PCOS. However, concerns have been raised about potential adverse cardiovascular and metabolic effects of OCs. Currently available evidence indicates an increased relative risk of venous thrombosis associated with OCs varying among different formulations. Arterial thrombosis risk attributable to OCs does not appear to be significantly increased in young nonsmoking women. OC use might be associated with increased risk of diabetes in morbidly obese women with PCOS with severe insulin resistance. A tailored clinical approach to oral contraception in women with PCOS requires individualized risk stratification and management by determination of each PCOS patient s personal cardiometabolic risk profile at baseline and during follow-up. Before prescribing an OC, clinicians should document individual risk factors including age, smoking, obesity, any degree of glucose intolerance including prediabetes and diabetes, hypertension, dyslipidemia, thrombophilia, and personal or family history of a venous thromboembolic event. THE EFFECT OF PROLACTIN LEVELS ON MPV IN WOMEN WITH PCOS. Yilmaz Ö 1, Calan M, Kume T, Temur M, Yesil P, Senses MY. Clin Endocrinol (Oxf) May;82(5): doi: /cen Epub 2014 Dec 4. Objective: Polycystic ovary syndrome (PCOS) is associated with cardiovascular risk factors including hypertension, obesity, hyperlipidaemia and glucose intolerance. Several studies demonstrated the link between PCOS and an increased risk of cardiovascular disease. Platelets play a crucial role in the development of atherothrombotic disease. Mean platelet volume (MPV) is a marker of platelet size that reflects its activity. Research points to a link between prolactin (PRL) and platelet activation. The purpose of this study was to investigate whether prolactin levels are associated with MPV in women with PCOS. Design: The research was designed as a cross-sectional study. Patients: Participants were divided into three groups-pcos patients with mildly elevated PRL levels (n = 72), patients with PCOS with normal PRL levels (n = 207) and healthy controls (n = 90). They were body mass index and agematched and consecutively recruited. Measurements: Complete blood counts, serum glucose, prolactin, insulin, lipids, high-sensitivity C-reactive protein and free-testosterone levels were measured. Results: Among the three groups, MPV levels were higher in women with PCOS having mildly elevated PRL levels (P < 0 001) and MPV was found to be correlated with PRL levels (r= 0 387, P < 0 001). Multiple regression analysis showed that PRL levels were associated with MPV levels (R(2) = 0 239, β= 0 354, P < 0 001). Conclusion: Mean platelet volume levels are significantly increased in women with PCOS having mildly elevated PRL. Our results suggest that there is a link between prolactin and MPV levels. In women with PCOS, elevated PRL levels may increase the risk of developing atherothrombotic events via the activation of platelets.

6 6 TÜRKİYE ENDOKRİNOLOJİ VE LOWER COCAINE- AND AMPHETAMINE-REGULATED TRANSCRIPT LEVELS POSE A RISK FOR DEVELOPING PCOS. Yilmaz Ö 1, Calan M 2, Kume T 3, Yesil P 4, Isik D 5. Horm Metab Res Sep;46(10): doi: /s Epub 2014 Jul 4. Cocaine- and amphetamine-regulated transcript (CART) is an anorectic neuropeptide abundantly expressed in the central, peripheral, and enteric nervous systems, as well as in several different endocrine cell types. Besides regulating food intake and endocrine function, it is also proposed to modulate ovarian function during follicular waves in cattle and has potent inhibitory effects on follicular development. Polycystic ovary syndrome (PCOS), presenting itself with multiple follicular ovarian cysts, is the most common endocrinological disorder among women of reproductive age. Here we aimed to investigate the association of this peptide with PCOS. Our research was designed as a case-control study, in which a total of 148 subjects (73 with PCOS and 75 age- and BMI-matched CONTROLS) were consecutively recruited. Fasting blood glucose (FBG), insulin, high-sensitivity C-reactive protein, lipids, follicle stimulating hormone, luteinizing hormone, estradiol, CART, and free testosterone levels were measured in all participants. Homeostasis model assessment of insulin resistance (HOMA-IR) and body mass index (BMI) were calculated. CART levels were found to be significantly lower in patients with PCOS (PCOS: ± 5.98 pg/ml, Controls: ± 8.17 pg/ml, p=0.038). Pearson s correlation analysis showed that CART was significantly and negatively correlated with BMI and waist circumference in both (PCOS and control) groups. In CONTROLS only, CART was positively correlated with insulin and HOMA-IR, and negatively correlated with FBG. Logistic regression analysis results are suggestive of a possible protective effect of CART against PCOS (OR: 0.94, 95% CI= , p=0.038). Yeni Üyelerimiz Uzm. Dr. Ümit Cınkır Uzm. Dr. Mahmut Serbülent Ibanoğlu Uzm. Dr. Hümeyra Bozoğlan Uzm. Dr. Tülay Omma Uzm. Dr. Pervin Cavadzade Uzm. Dr. Xalid Qurbanzade Mersin Üniversitesi Tıp Fakültesi, Mersin Mersin Üniversitesi Tıp Fakültesi, Mersin Akdeniz Üniversitesi Tıp Fakültesi, Antalya Ankara Eğitim ve Araştırma Hastanesi, Ankara Ankara Eğitim ve Araştırma Hastanesi, Ankara Ankara Eğitim ve Araştırma Hastanesi, Ankara Üyelerimizi tebrik eder, başarılar dileriz. Türkiye Endokrinoloji ve Metabolizma Derneği Bülteni Türkiye Endokrinoloji ve Metabolizma Derneği nce üç ayda bir yayımlanır. Yayın Türü: Yaygın süreli TEMD Adına Sahibi Prof. Dr. M. Sait Gönen Sorumlu Yazı Işleri Müdürü Doç. Dr. Oğuzhan Deyneli Yayın Danışma Kurulu Prof. Dr. Nilgün Güvener, Prof. Dr. Bülent Okan Yıldız, Prof. Dr. Abdurrahman Çömlekçi, Prof. Dr. İlhan Yetkin, Prof. Dr. Fahri Bayram Baskı tarihi: Eylül 2015 TEMD bülteninde yayımlanacak derneğimiz ile ilgili haberlerin bekletilmeksizin ve en geç her ayın 1 ine kadar TEMD merkezine ulaşmış olması gerekmektedir. TEMD bülteni, adresinden de PDF formatında görüntülenebilir. Yönetim Yeri: Meşrutiyet Cad. Ali Bey. Apt. 29/12, Kızılay Ankara Tel: (0312) Faks: (0312) E-posta: president@temd.org.tr Grafik Tasarım: BAYT Bilimsel Araştırmalar Basın Yayın ve Tanıtım Ltd. Şti. Tel: (0312) Faks (0312) E-posta: info@bayt.com.tr Baskı: Miki Matbaacılık San. Tic. Ltd. Şti. Matbaacılar sitesi 560. Sk. No: 27 İvedik, Ankara Tel: (312)