Mustafa Ünübol

Obstructive sleep apnea syndrome (OSAS) is strongly associated with obesity; however, a substantial proportion of patients are non-obese, raising the possibility of underlying endocrine etiologies. This study aimed to investigate the prevalence of primary aldosteronism (PA) and acromegaly in non-obese patients with OSAS and to evaluate the necessity of routine screening. Non-obese individuals, defined as those with a body mass index (BMI) < 30 kg/m², who were diagnosed with OSAS by polysomnography were prospectively evaluated. Clinical characteristics, comorbidities, plasma aldosterone-to-renin activity ratio (ARR), and insulin-like growth factor-1 (IGF-1) levels were assessed. Patients with elevated ARR underwent confirmatory saline infusion testing and adrenal imaging when indicated. Among 103 patients, biochemical evidence of PA according to the original study protocol was identified in 20 patients (19.4%), whereas post hoc application of the 2025 Endocrine Society screening criteria identified 29 patients (28.2%) with a screen-positive/probable PA phenotype. Hypertension was more frequent in patients with primary aldosteronism than in those without primary aldosteronism (70.0% vs. 24.1%). Adrenal adenomas were detected in 3.9% of the cohort. IGF-1 levels were within age- and sex-adjusted reference ranges in all patients, and no cases of acromegaly were identified. These findings suggest that screening for primary aldosteronism may be clinically warranted in non-obese patients with OSAS, whereas routine screening for acromegaly should be reserved for those with suggestive clinical features.

Introduction Paget's disease of bone, osteitis deformans is a benign disease of bone that affects one or more bones. Its prevalence and clinical features show geographical region differences. In this study, it was aimed to investigate the treatment responses and follow-up results as a single center experience by using the demographic, clinical, laboratory and radiological characteristics of patients with Paget's Disease of the Bone. Method Fifty one patients who were diagnosed and followed up in Aydın Adnan Menderes University Endocrinology clinic between September 2004 and December 2021 were included in the study retrospectively. Results The mean age of onset of the disease was 61.8±12.5 years and the mean follow-up period was 9.3±8.2 years. It was observed that 68.63% of the patients were asymptomatic. Polyostotic involvement is present in 62.7% of the patients. It was observed that the disease most commonly involved the pelvis. It was determined that alkaline phosphatase value was above the upper reference limit in all patients at the time of diagnosis. All patients have increased activity in whole body bone scintigraphy. Except for one patient, all patients received bisphosphonate therapy. Remission was achieved in all patients who received zolendronic acid treatment as the first treatment. Since there was no response in the treatment of 8 patients receiving oral bisphosphonate and 2 patients receiving pamidronate, IV zolendronic acid treatment was started. Treatment response was achieved in 6 (75%) of 8 patients who did not go into remission with oral bisphosphonate, and in 1 (50%) of 2 patients who received pamidronate and did not go into remission, after switching to zolendronic acid, and serum alkaline phosphatase values were found to regress to the normal range. Conclusion In this study, it was determined that patients with asymptomatic alkaline phosphatase elevation should also be examined for Paget's disease of the bone and that zolendronic acid provides an effective treatment in Paget's disease of the bone.

Context: The aims of the study are to compare characteristics of subacute thyroiditis (SAT) related to different etiologies, and to identify predictors of recurrence of SAT and incident hypothyroidism. Methods: This nationwide, multicenter, retrospective cohort study included 53 endocrinology centers in Turkey. The study participants were divided into either COVID-19–related SAT (Cov-SAT), SARS-CoV-2 vaccine–related SAT (Vac-SAT), or control SAT (Cont-SAT) groups. Results: Of the 811 patients, 258 (31.8%) were included in the Vac-SAT group, 98 (12.1%) in the Cov-SAT group, and 455 (56.1%) in the Cont-SAT group. No difference was found between the groups with regard to laboratory and imaging findings. SAT etiology was not an independent predictor of recurrence or hypothyroidism. In the entire cohort, steroid therapy requirement and younger age were statistically significant predictors for SAT recurrence. C-reactive protein measured during SAT onset, female sex, absence of antithyroid peroxidase (TPO) positivity, and absence of steroid therapy were statistically significant predictors of incident (early) hypothyroidism, irrespective of SAT etiology. On the other hand, probable predictors of established hypothyroidism differed from that of incident hypothyroidism. Conclusion: Since there is no difference in terms of follow-up parameters and outcomes, COVID-19– and SARS-CoV-2 vaccine–related SAT can be treated and followed up like classic SATs. Recurrence was determined by younger age and steroid therapy requirement. Steroid therapy independently predicts incident hypothyroidism that may sometimes be transient in overall SAT and is also associated with a lower risk of established hypothyroidism.

DOI: 10.20452/pamw.16037, Published online: June 24, 2021, Authors: Mustafa Unubol, Zehra Erdemir, Gokhan Colak, Engin Guney, Imran K. Omurlu