Cem Sulu

Objective: This study aimed to evaluate the effect of gender-affirming hormone therapy (GAHT) on social functioning in individuals with female-to-male (FtM) gender dysphoria (GD) and to examine the roles of social support, bilateral mastectomy, and real-life experience. Methods: This cross-sectional study included 77 individuals with FtM GD, 41 of whom were receiving GAHT. The Social Functioning Scale (SFS) was used to evaluate participants’ social functioning. Data on family support, partner status, history of bilateral mastectomy, and duration of real-life experience were collected. Results: Individuals receiving GAHT had higher overall social functioning, particularly in social engagement, interpersonal behavior, and pro-social activities, respectively (P = .01, P = .001, P = .002, P = .027). There were no significant differences in the recreation, independence–competence, independence–performance, and employment/occupation subscales (for all P > .05). Family support was associated with better social functioning across several domains, whereas having a partner was linked to improvements in specific areas. Participants who had undergone bilateral mastectomy also demonstrated higher social functioning scores. In addition, longer real-life experience was positively associated with overall social functioning, pro-social activities, and recreation. Conclusion: Gender-affirming hormone therapy is associated with improved social functioning in individuals with FtM GD, especially in interpersonal domains. Bilateral mastectomy, social support, and real-life experience also appear to contribute to better social adaptation. These findings highlight the combined role of medical interventions and supportive social environments in shaping social functioning. Cite this article as: Durcan G, Durcan E, Turan Ş, et al. Social Functioning in female-to-male Individuals: gender-affirming care and social supports. Cerrahpaşa Med J 2026, 50, 0071, doi: 10.5152/cjm.2026.26071.

Objective: To compare the clinical presentation, tumor characteristics, surgical remission, and long-term biochemical control between patients with growth hormone (GH) and prolactin (PRL) co-staining pituitary adenomas (GH&PRL-PAs) and those with merely growth hormone–secreting pituitary adenomas (GH-PAs). Methods: This retrospective, single-center cohort included adults with acromegaly who underwent transsphenoidal surgery between 2000 and 2023. GH&PRL-PAs were defined by positive immunostaining for both GH and PRL. Predictors of surgical remission were assessed using multivariable logistic regression, and determinants of last-visit insulin-like growth factor 1 (IGF-1) were evaluated using multivariable linear regression. Results: Among 358 patients, 125 patients (34.9%) were classified as GH&PRL-PAs. Median follow-up was 103 [51-144] months. Women comprised 59.2% of the cohort; female sex was similarly distributed between GH&PRL-PAs and GH-PAs (54.4% vs. 61.8%, P = .174). GH&PRL-PAs had lower GH levels at diagnosis (6.3 [3.2-23] vs. 12.4 [5-29.7] ng/mL, P = .023), postoperatively (1.2 [0.3-3.9] vs. 2.2 [0.3-3.9] ng/mL, P = .021), and at the last visit (1.2 [0.5-3.3] vs. 1.4 [0.6-3.6] ng/mL, P = .006). Insulin-like growth factor 1 levels were comparable at diagnosis and the last visit. Tumor size and Ki-67 index were similar, whereas cavernous sinus invasion was less frequent in GH&PRL-PAs (39.8% vs. 53.1%, P = .027). Surgical remission neither differed significantly between groups (37.6% vs. 28.8%, P = .087) nor did active disease at the last visit (17.6% vs. 17.2%, P = .918). Prolactin staining was not an independent predictor of surgical remission or last-visit IGF-1. Conclusion: Growth hormone and prolactin co-staining pituitary adenomas show a distinct hormonal profile, but PRL co-staining alone does not appear to determine surgical or long-term biochemical outcomes. Cite this article as: Sulu C, Tanrıöver N, Sarıçoban CT, Gazioğlu N, Kadıoğlu P. Prolactin co-staining in acromegaly: clinical features and long-term outcomes. Cerrahpaşa Med J 2026, 50, 0096, doi: 10.5152/cjm.2026.26096.

Objective Cushing Disease (CD) presents with typical clinical findings, even though, there is a wide spectrum of manifestations. Over the years, the sings and symptoms of Cushing’s syndrome (CS) have become more subtle and atypical forms of CS have emerged. In this study, we aimed to investigate the changes in the clinical presentation of CD in recent years. Materials and methods In this study, CD patients followed by our center were examined. A total of 258 patients with CD were included in the study. The clinical findings at the time of presentation, laboratory and imaging findings, treatment modalities and remission status in the first year after treatment were evaluated. Results The mean age of the patients included in the study was 41.3 ±13.28 years. CD patients diagnosed between 2013 and 2023 were older than those diagnosed between 1990 and 2012 (p < 0.001). There was no difference between the groups in terms of gender. Moon face, purple striae, hirsutism, and menstrual irregularities were statistically significantly less frequent in the last 10 years than in previous years (p < 0.001; p = 0.004; p < 0.001; p < 0.001, respectively). In addition, patients who applied after 2013 had lower baseline cortisol and adrenocorticotropic hormone (ACTH) levels, and a smaller median size of the pituitary adenoma. Limitations of the study include its retrospective design and the subjectivity of clinical data. Conclusion As the clinical presentation of Cushing’s disease changes over time, waiting for the typical Cushing’s clinic can delay diagnosis. It is important that clinicians take this into account when they suspect CD.

This study aimed to explore disordered eating behaviors in gender-affirming treatment (GAT)-seeking transgender (TG) adults and cisgender people, in addition to analyzing the association between gender dysphoria intensity, body mass index, and disordered eating behaviors. Data were collected from 132 GAT-seeking TG people with gender dysphoria who had never received GAT (91 TG men, 41 TG women), and 153 cisgender (99 cisgender men, 54 cisgender women) participants from Turkey. The Utrecht Gender Dysphoria Scale was used to evaluate the intensity of gender dysphoria. Eating Disorder Examination Questionnaire and Questionnaire on Eating and Weight Patterns-5 were utilized to assess disordered eating. There was no difference between TG women and TG men in terms of ED psychopathology. The most prominent characteristic in all four groups was shape concern, which was significantly higher in TG men and TG women when compared to cisgender men and cisgender women. Binge eating was notably more frequent in TG men and TG women compared to cisgender men, with 11% of the TG men and 7.3% of the TG women meeting the criteria for possible binge eating disorder. Screening for disordered eating behaviors, particularly binge eating, may be recommended in routine care for TG people.

Objective To develop machine learning (ML) models that predict postoperative remission, remission at last visit, and resistance to somatostatin receptor ligands (SRL) in patients with acromegaly and to determine the clinical features associated with the prognosis. Methods We studied outcomes using the area under the receiver operating characteristics (AUROC) values, which were reported as the performance metric. To determine the importance of each feature and easy interpretation, Shapley Additive explanations (SHAP) values, which help explain the outputs of ML models, are used. Results One-hundred fifty-two patients with acromegaly were included in the final analysis. The mean AUROC values resulting from 100 independent replications were 0.728 for postoperative 3 months remission status classification, 0.879 for remission at last visit classification, and 0.753 for SRL resistance status classification. Extreme gradient boosting model demonstrated that preoperative growth hormone (GH) level, age at operation, and preoperative tumor size were the most important predictors for early remission; resistance to SRL and preoperative tumor size represented the most important predictors of remission at last visit, and postoperative 3-month insulin-like growth factor 1 (IGF1) and GH levels (random and nadir) together with the sparsely granulated somatotroph adenoma subtype served as the most important predictors of SRL resistance. Conclusions ML models may serve as valuable tools in the prediction of remission and SRL resistance.

Background Severe acute kidney injury (AKI) requiring urgent hemodialysis (uHD) is associated with considerable morbidity and mortality in patients with multiple myeloma (MM). Purpose To evaluate the renal function, outcome, and survival status of patients with MM who received uHD and to compare their overall survival with MM patients who did not receive uHD. Materials and methods A total of 70 eligible MM patients who received uHD were included together with 70 control patients with MM. Results In the study group, 11 patients (15.7%) were known to have pre-existing chronic kidney disease. Thirty-four percent of the study group had AKI requiring uHD at MM diagnosis. Seventy-eight percent of the study group had severe AKI due to myeloma kidney. Renal function recovered in 36 patients (51.4%). Patients with MM who became hemodialysis dependent had significantly higher serum creatinine (sCr) levels at the time of AKI compared to patients with renal recovery (p < 0.05). Logistic regression analysis showed that high sCr on admission was significantly associated with hemodialysis dependence (odds ratio 0.78; 95% CI: 0.63–0.96; p = 0.018). The median overall survival was 30 months [IQR: 26] in the study group and 84 months [IQR: 96.25] in the control group (p < 0.05). Cox regression analysis showed that the need for uHD at initial MM diagnosis was associated with reduced survival (hazard ratio (HR) 1.9; 95% CI: 1.1–3.2; p = 0.017). Renal recovery did not provide a survival benefit. Conclusion The need for uHD was associated with poor survival. Recovery of renal function was not associated with improved survival.

SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, in particular, secondary adrenal insufficiency, using a dynamic test and the role of autoimmunity in pituitary dysfunction in patients with COVID-19. The single-center, prospective, case-control study included patients with polymerase chain reaction (PCR)-confirmed COVID-19 and healthy controls. Basal hormone levels were measured, and the adrenocorticotropic hormone (ACTH) stimulation test was performed. Antipituitary (APA) and antihypothalamic antibodies (AHA) were also determined. We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. Patients with COVID-19 had lower free T₃, IGF-1, and total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. In conclusion, COVID-19 may result in adrenal insufficiency, thus routine screening of adrenal functions in these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormalities in COVID-19. Received: 21 November 2021 Accepted after revision: 27 January 2022 Publication Date: 11 March 2022 (online) © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany