Fulya Odabaş

Background: Adrenal incidentalomas have increased over the past years. Although there are a lot of studies related to the frequency of adrenal masses and comorbidities, whether patients with functional or nonfunctional adrenal masses have higher risk is still a controversial issue. Methods: A total of 464 patients (female/male: 309/155) with adrenal incidentalomas were evaluated and followed up for 8 years. The patients were divided into 5 subgroups, including Autonomous Cortisol Secretion (ACS), Cushing Syndrome (CS), Pheochromocytoma (Pheo), Non-functional Adrenal Incidentalomas (NFAI), and Primary Aldosteronism (PA). Results: While 336 (72.4%) of the patients had NFAI, the others suffered from ACS (10.8%), CS (4.3%), Pheo (4.1%), and PA (8.4%), respectively. When comparing biochemical and demographical data, BMI (p=0.77), Hba1c (p=0.495), FPG (p=0.28), LDL (p=0.66), and HDL (p=0.521) were similar among the patients with functional and nonfunctional adrenal masses. The most common comorbidities were hypertension (n=259, 55.8%), diabetes mellitus (n=158, 34.1%), and dyslipidemia (33.4%), respectively. While 84 (32.4%) patients with hypertension had functional adrenal masses, the others (n=175, 67.6%) had non-functional adrenal incidentalomas. In subgroup analyses, hypertension was more common in patients with PA (87.2% vs. 72%, p=0.001) and ACS. In multivariable regression analyses, hypertension (p<0.001), cortisol (p=0.003), and aldosterone (p=0.04) levels were significantly correlated with functionality. Conclusion: Hypertension was the most common comorbidity in patients with adrenal adenomas, especially in functional adrenal adenomas related to serum cortisol and aldosterone levels.

Purpose: The study aimed to evaluate metabolic parameters and bone density measurements during the active phase and after long-term remission, as well as to present long-term follow-up results of patients with Cushing Syndrome. Materials and Methods: In 20 patients with Cushing Syndrome, weight, waist circumference, fasting plasma glucose, lipid parameters, blood pressure and bone mineral density were evaluated during the active disease and after endocrine remission. Results: All patients were female, premenopausal with mean age of 35±9.5 (range 27-45). During the long-term follow-up (median 60 months), weight (87.6±21.2 vs 71.1±18.8) and waist circumference (98.02±11.5,) were decreased significantly compared to baseline measurements. While total cholesterol and triglyceride values were similar between before and after remission, LDL cholesterol (143.6±35.8 vs 127.7±37.06) was decreased significantly in all patients. During the hormonal remission, 63.6% of patients’ antihypertensive medication was discontinued. Bone mineral density in lumbar spine was increased compared to the baseline values of all patients. Conclusion: Metabolic parameters and bone status were improved during the long-term follow-up time in patients with Cushing syndrome. Age, gender and duration of hypercortisolism or following time can influence the recovery of these comorbidities.

Amaç: Korunmuş ejeksiyon fraksiyonlu kalp yetmezliği, klinik pratiğinde yüksek morbidite ve mortalite oranlarına sahip olmasıyla önemli bir sağlık sorunudur. Bu çalışma, korunmuş ejeksiyon fraksiyonlu kalp yetmezliği tanılı hastalarda mortaliteyi etkileyen faktörleri retrospektif olarak analiz etmeyi amaçlamaktadır. Gereç ve Yöntem: Bu retrospektif çalışmada 105 hasta incelenmiştir. Hastaların demografik özellikleri, klinik verileri ve laboratuvar sonuçları değerlendirilmiş; mortalite üzerinde etkili olabilecek faktörler tek ve çok değişkenli lojistik regresyon analizleri ile analiz edilmiştir. İstatistiksel anlamlılık düzeyi p

Purpose: This study aimed to explore the impact of continuous autonomous cortisol secretion on visceral (VAT), abdominal subcutaneous (SAT) adipose tissue, and total body fat. Materials and Methods: A total of 57 patients (36 female, 21 male) with adrenal masses, referred to our single center, were included in this study. Among them, 31 patients had adrenal cortical carcinoma (ACS) and 26 had nonfunctional adrenal mass (NFAM). Hormonal evaluation was conducted for all patients. Measurements of total, visceral, and subcutaneous adipose tissue were performed using 3.0 T magnetic resonance imaging (Ingenia, Philips Medical Systems, Best, The Netherlands). Results: Mean age, gender distribution, and body mass index (BMI) were comparable between patients with ACS and NFAM. Patients with ACS exhibited higher volumes of both total (422.1±131.3 vs. 346.2±86.0 cm3) and visceral adipose tissue (199.9±77.3 vs. 160.6±60.8 cm3) compared to those with NFAM. Incidence rates of diabetes mellitus and hepatosteatosis were similar in both groups. Subcutaneous adipose tissue volumes, visceral-to-subcutaneous ratio, and visceral-to-total fat ratio showed no significant differences between the two groups. Conclusion: Patients with ACS demonstrated increased total and visceral fat tissue volumes compared to NFAM patients matched for gender, age, and BMI. This observation may elucidate the potential influence of continuous mild autonomous cortisol secretion in ACS patients. Such findings could serve as indicators of heightened cardiovascular risk among ACS patients.

According to the recent studies, immunohistochemical subtypes of growth hormone (GH) secreting adenomas have been considered as a predictive factor in determining the clinical outcomes including biochemical, radiologic, and endocrine remission. In a 20 year-of time period, acromegaly patients who were treated and followed at the Endocrinology Department of our University Hospital were screened for the study. Of total 98 patients, 65 patients who had been operated by transsphenoidal surgery and having postoperative specimens were included. Postoperative specimens of the surgery of the patients were classified into 3 groups based on the histochemical characteristics (densely, sparsely, and mixed). Parasellar extensions of pituitary tumors were classified into the five grades according to Knosp classification. The patients were investigated and evaluated for postoperative clinical progress, remission rates, comorbidities regarding with the histopathological patterns. Of total 65 patients, 31 were classified as densely granulated (group 1), 32 were classified as sparsely granulated (group 2), and 2 patients were assessed as mixed granulated (group 3). There was no difference between groups for age and gender. Pre-treatment of adenoma size in all groups was correlated with each other and the frequency of macroadenoma (1 vs. 2, 77.4 vs. 84.3%) was higher in two groups. Although mean initial GH levels in group 1 was higher than the other groups (p=0.03), IGF1 levels (age and gender matched) were similar in each group. Adenomas in all groups demonstrated noninvasive radiological characteristics (Knosp grade 0–1–2). Ki-67 proliferation index of both groups (64.5 vs. 50%) was predominantly 1%. With a similar follow-up period, the endocrine remission rates (GH<1 μg/l) in groups were 64 vs. 69%, respectively. In conclusion, classification according to immunohistochemical subtypes of growth hormone secreting adenomas may not be a qualified parameter to evaluate patients with patterns of aggressiveness, clinical outcomes, or treatment response.

Background: According to neuroradiological findings, empty sella seems to be deprived of pituitary tissue in sella turcica. Changing size of the pituitary volume is closely related to the occurrence of primary empty sella. The aim of the study is to determine pituitary dysfunction in patients with partial or total primary empty sella and the significance of pituitary volume measurements in these patients. Methods: This study was designed retrospectively. 67 patients (55 females, 12 males) diagnosed with primary empty sella syndrome between the years of 2015-2019 were included in the study. Patients were divided into two groups: partial (PES) and total (TES) empty sella by magnetic resonance imaging (MRI). Basal anterior pituitary and its hormones were assessed. We also included 26 healthy control subjects (19 females, 7 males) to compare the differences in pituitary volumes. Volumes were measured by using Osirix Dicom Viewer (Pixmeo SARL, Geneve, Swiss) in 3.0 Tesla scanner MRI. Results: 82.1% (n=55) of all patients were PES and the others were (n=12) TES. Hypopituitarism, known as one or more pituitary hormones deficiency, was found in 12 patients (17.9%). While 9 of them had total PES, the others had partial PES. Secondary adrenal insufficiency and gonadotropin deficiency were more prevalent in patients with TES. Mean volume measurements of patients with TES, PES and healthy subjects were 0.23±0.17, 0.35±0.15, 0.54±0.17 cm3, respectively. Except for IGF1 values (p=0.026), there was not any significant correlation found between the anterior pituitary hormones and volume measurements. Conclusion: Although volume measurement has helped in the diagnosis of pituitary empty sella (partial or total), it does not seem to have any significant correlation with pituitary secretory function.

Purpose: The aim of the study was to review our clinical 7 years experiences with silent corticotroph adenoma (SCA) and Cushing disease (CD) with regard to clinical, radiological features, immunohistochemical and surgical outcomes and compare the results between two groups. Material and Methods: We retrospectively reviewed a series of patients (n=17; SCA 10, CD 7) with corticotroph adenomas and collected biochemical, neuroradiological and pathological data of those during follow-up time. Results: Mean pre-operative ACTH values of the patients with CD and SCA were 60.429.5, 45.5 +/- 34.6 pg/mL, respectively. Mean preoperative cortisol of the patient with CD (21.2 +/- 4.4 vs 11.5 +/- 4.0 mcg/dL) was increased than the patients with SCA measurements'. Patients with SCA had larger pituitary mass (20.4 +/- 4.5 vs 8.8 +/- 4.0 mm) than the patients with CD. And cavernous sinus invasion also was determined in all patients with SCA. Sparsely granulation staining was more common in all patients with SCA (7/10) or CD (4/7). Conclusion: SCAs are totally different from functional CD adenomas related with clinical characteristics and postoperative outcomes. SCA can be thought of as a diverse group of pituitary adenomas.