Samet Alkan

Background and Objectives: Mild autonomous cortisol secretion (MACS) has been associated with adverse metabolic outcomes, but its relationship with hepatic steatosis remains incompletely understood. This study aimed to compare computed tomography (CT)-derived hepatic steatosis parameters between patients with MACS and non-functioning adrenal incidentaloma (NFAI) and to evaluate the associations between biochemical markers of cortisol secretion and hepatic attenuation measures. Materials and Methods: This retrospective study comprised 123 patients with adrenal incidentaloma (39 MACS and 84 NFAI) who underwent unenhanced abdominal CT between January 2020 and November 2024. Hepatic steatosis was assessed using mean liver attenuation, liver–spleen attenuation difference, liver-to-spleen attenuation ratio, and conventional CT-defined steatosis thresholds. Non-invasive metabolic indices were also computed. Associations between cortisol secretion parameters and CT-derived hepatic attenuation measures were examined using correlation analysis and multivariable regression. Results: The liver-to-spleen attenuation ratio was lower in the MACS group, although this difference did not reach statistical significance (p = 0.050), and a significantly lower liver–spleen attenuation difference (p = 0.048) was observed compared with the NFAI group, whereas mean liver attenuation (p = 0.167), conventional CT-defined hepatic steatosis, and non-invasive metabolic indices did not differ significantly between groups. Among biochemical markers of cortisol secretion, only 24-h urinary free cortisol showed significant correlations with all CT-derived hepatic attenuation parameters. After adjustment for age, sex, and BMI, urinary free cortisol remained significantly associated with liver–spleen attenuation difference (p = 0.047), whereas its associations with liver attenuation (p = 0.056) and liver-to-spleen attenuation ratio (p = 0.051) did not reach statistical significance. Conclusions: Patients with MACS exhibit subtle CT-derived hepatic fat accumulation despite similar conventional CT-defined steatosis and non-invasive metabolic indices compared with patients with NFAI. Continuous CT-derived attenuation parameters may be more sensitive than conventional CT-defined steatosis thresholds for detecting subtle hepatic fat accumulation associated with mild cortisol excess. The consistent associations observed between 24-h urinary free cortisol and CT-derived hepatic attenuation parameters, including the significant association with liver–spleen attenuation difference after adjustment for age, sex, and BMI, warrant confirmation in larger prospective studies.

Purpose: Our study evaluated skeletal muscle mass, function and quality among mild autonomous cortisol secretion (MACS) patients and non-functioning adrenal incidentaloma (NFAI) patients in comparison with the control group without adrenal mass. Methods: 63 NFAI (49 female, 14 male) and 31 MACS (24 female, 7 male) patients were included in the study. As the control group, 44 patients (31 women, 13 men) who were known to have no radiological adrenal pathology on computed tomography or magnetic resonance imaging performed for other reasons were selected. After recording the laboratory parameters of the patients, anthropometric measurements, handgrip strength test with dynamometer, SARC-F survey and bioelectrical impedance analysis (BIA) measurements were performed. Results: There was no statistical difference among the groups in terms of age, gender, and BMI parameters. Handgrip strength (HGS), skeletal muscle mass (SMM) index (SMM/BMI), and skeletal muscle quality (HGS/SMM), values used to evaluate muscle strength and quality, were found to be significantly lower in both the MACS and NFAI groups compared to the control group (p = 0.004, p = 0.012 and p = 0.034 respectively). This significance was also present in women subgroup analyses (p = 0.002, p = 0.037 and p = 0.039 respectively), but these parameters lost their statistical significance in men. In the correlation analysis of the female subgroup, 24-h free urine cortisol value was inversely proportional to skeletal muscle quality (r_s = -0.417, p = 0.008). Conclusion: Our study showed that there is a decrease in muscle mass and function in female AI patients, and this decrease is more severe in MACS patients. These results may suggest that mild cortisol excess also has negative effects on skeletal muscle metabolism.

Purpose: The increasing trend of metabolic diseases causes endocrine emergencies to be encountered more frequently in emergency services. This trend increases the importance of endocrinology consultations from emergency services. Examining the features of these consultations will allow the process to be concluded more quickly and effectively. Materials and Method: Patients who applied to Manisa Celal Bayar University Faculty of Medicine Emergency Department between March 1, 2017 and March 1, 2022, and were consulted with the Department of Endocrinology were included. The patients' age, gender, diagnoses, the day, the duration and the results of the consultations were evaluated. Results: The mean age of the 326 patients included in the study was 51.56 ± 19.4 years. 53.4% (n=174) were female, 46.6% (n=152) were male. Of the patients, 29.4% (n=96) were diagnosed as diabetic ketoacidosis, 21.5% (n=70) hyperglycemia, and 10.7% (n=35) diabetic ketosis. The mean consultation duration was 65.21 ± 46.23 minutes. 32.2% of the patients (n=105) were discharged from the emergency department. This was followed by endocrinology service admission (23.9%; n=78) and intensive care unit admission (17.8%; n=58). Conclusion: In the sample group with homogeneous gender and age distribution, it was observed that the majority of the patients applied to the emergency service with diabetes-related emergencies. The diagnosis spectrum of the patients was quite wide, and the consultations were concluded within an average of about one hour. A further investigation of the emergency department endocrinology consultations in detail will contribute to detecting the problems in this process and; therefore, its improvement.

Giriş Hipogonadotropik hipogonadizm, gonadotropik hormonların farklı nedenlerle salınımındaki eksikliğe bağlı gelişen gonadal yetmezlik tablosudur ve önemli klinik sonuçlara yol açar. En önemli sebepleri arasında hipofizer hastalıklar yer almakta olup hipofize yönelik görüntüleme tanısal amaçlı önemli bir yere sahiptir. Biz bu çalışmada kliniğimizde son beş yılda takip edilen hipogonadotropik hipogonadizm tanılı erkek hastaların hipofiz MR (Manyetik Rezonans) görüntüleme sonuçlarını ve laboratuvar bulgularını inceledik. Materyal ve Metod 2017-2021 yılları arasında endokrinoloji polikliniğimize başvuran ve hipofiz MR görüntüleme sonuçları hastane bilgi işlem sisteminde mevcut olan hipogonadotropik hipogonadizm tanılı 56 hasta retrospektif olarak incelendi. Hastaların yaşları, geliş şikayetleri, hipofiz MR görüntüleme bulguları ve hormon düzeyleri irdelendi. IBM SPSS Versiyon 22.0 programı kullanılarak verilerin istatistiksel analizi yapıldı. Bulgular Hastaların yaş ortalaması 37.75 ± 10.95 olarak saptandı. Hastaların başvuru şikayetleri incelendiğinde en sık libido kaybı %37.5 (n=21) olduğu görüldü. %42.9 hastanın (n=24) hipofiz MR’ının normal saptandığı görüldü. Hastalar MR bulgularına göre alt gruplara ayrılarak hormon değerleri analiz edildiğinde “Makroadenom” grubunda “Mikroadenom” grubuna göre ortalama total testosteron düzeyi anlamlı olarak daha düşük saptandı (p < 0.05). Sonuç Hipogonadotropik hipogonadizm tanılı hastalarda hipofize yönelik görüntüleme yapılmasının özellikle laboratuvar bulgularına göre endikasyonları net olmayıp bu konuda yapılacak geniş kapsamlı çok merkezli çalışmalara ihtiyaç bulunmaktadır.

Giriş ve Amaç: Paraneoplastik artrit bulguları birçok romatizmal hastalığı taklit edebilmektedir. RF ve anti-CCP vaka sunumlarında ve çalışmalarda paraneoplastik artriti diğer romatolojik hastalıklardan ayrımında kullanılabilirliği araştırılan belirteçlerdendir. Çalışmalarda romatolojik nedenli artritlerde bu belirteçlerin sıklığı artmış gösterilmekle birlikte hematolojik malignite ve solid organ tümörü gelişen hastalarda RF ve anti-CCP sıklığını gösteren çalışma yoktur. Bizde çalışmamızda hematolojik malignite ve solid organ tümörü gelişen hastalarda RF ve anti-CCP sıklığını saptamayı planladık. Gereç ve Yöntemler: Çalışmaya Gaziantep Üniversitesi Şahinbey Eğitim ve Araştırma Hastanesi hematoloji ve onkoloji polikliniklerine başvuran yeni tanı almış hematolojik ve solid organ malignitesi olan 102 hasta alındı. Kontrol grubu olarak ise aynı merkezde iç hastalıkları polikliniğine başvuran malign hastalık öyküsü olmayan 84 hasta alındı. Bulgular: 186 hastanın tamamında Anti-CCP negatif olarak saptandı. RF çalışma grubunda 12 (Hematolojik malignite:3, Solid organ tümörü:9), kontrol grubunda 10 olmak üzere 22 hastada pozitif saptandı. Çalışma grubunda RF pozitifliği %11,76 olarak saptandı. Hematolojik malignite ve solid organ tümörü olan hastalarda RF ve Anti-CCP sıklığı normal popülasyona göre anlamlı farklılık göstermemektedir. Sonuç: Hasta grubu ve kontrol grubunda antikor pozitiflik oranlarının benzer saptanması paraneoplastik artrit ayırıcı tanısında kullanılan ve daha yaygın kullanılabilirliği araştırılan bu belirteçlerin artrit olmaksızın malignitelerle direkt ilişkili olmadığını düşündürebilir. Ancak daha çok hasta ve farklı klinik tablolarda çalışmanın tekrarlanması faydalı olabilir.

Objective. Acne vulgaris is a chronic inflammatory disease involving the pilosebaceous unit of the skin. Isotretinoin is a systemic retinoid that is often used as an effective treatment option for severe and treatment-resistant acne. Isotretinoin may also cause rheumatologic symptoms. The aim of this prospective observational study was to present followup results regarding the rheumatologic symptoms of patients who received systemic therapy for the treatment of acne (isotretinoin and tetracycline). Methods. For inclusion in the study, all consecutive patients with acne who were aged > 18 years were evaluated by the same dermatologist. The first 42 consecutive patients were included in the isotretinoin group, and after matching for age and sex, 32 consecutive patients were included in the tetracycline group. Isotretinoin treatment was planned as an average dose of 30 mg daily and a total dose of 120–150 mg/kg for 4–6 months. The patients were administered a dose of 1 g/day of tetracycline as 2 equal doses for 3 months. Results. Forty-two patients diagnosed with acne vulgaris were treated with isotretinoin 20.6 ± 4.4 (male/female: 17/22), and 32 patients were treated with tetracycline 20.6 ± 2.7 (male/female: 8/24). There was no significant difference between the 2 groups with respect to age and sex. Unilateral Achilles enthesopathy developed in 3 patients, whereas both Achilles enthesopathy and unilateral sacroiliitis developed in 1 patient. Inflammatory back pain developed in 6 patients in the isotretinoin group. Conclusion. To our knowledge, this was the first prospective observational study that assessed the rheumatologic symptoms of isotretinoin treatment. The spondyloarthropathy findings were identified in 23.1% of the patients who used isotretinoin.

Fibromyalgia syndrome (FMS) is an extra-articular rheumatic illness, characterized by widespread body pain and decreased muscle function. Generalized loss of muscle mass and strength is named as sarcopenia. The objective of this study was to evaluate patients with FMS regarding sarcopenia.