Zehra Kara

Background: The management of benign thyroid nodules causing compressive symptoms, cosmetic concerns, or rapid growth in older adults is challenging because of multimorbidity and increased surgical risk. Ultrasound-guided microwave ablation (MWA) is a minimally invasive treatment option; however, data regarding its efficacy and safety in older patients remain limited. This study compared clinical outcomes of MWA between older and younger adults with benign thyroid nodules. Methods: This retrospective comparative study included 98 patients with benign thyroid nodules causing compressive symptoms, cosmetic concerns, or rapid growth (defined as more than a twofold increase in volume within 6 months) who underwent ultrasound-guided MWA. Patients were divided into older adults (≥60 years, n = 33) and younger adults (18–59 years, n = 65). Nodule volume, volume reduction rate (VRR), symptom and cosmetic scores, thyroid function, and procedure-related complications were evaluated at baseline and 3- and 6-month follow-up. Comorbidity burden was assessed using the age-adjusted Charlson Comorbidity Index (aCCI). Results: MWA significantly reduced nodule volume in both groups. At 6 months, median VRR was comparable between older and younger patients (66.1% vs. 66.7%, p = 0.50). Symptom and cosmetic scores significantly improved in both groups (for both groups p < 0.001), while thyroid function remained stable. Despite higher comorbidity burden among older patients, treatment outcomes were similar between groups. No major complications occurred; transient hoarseness developed in two younger patients and resolved during follow-up. Conclusions: Ultrasound-guided MWA appears to be an effective and safe minimally invasive treatment for benign thyroid nodules in older adults. Comparable outcomes between older and younger patients suggest that age and comorbidity burden should be considered in clinical decision-making rather than as absolute limitations to treatment.

Amaç: Bu çalışma, yaşlı bireylerde kırılganlık durumunun; hemoglobin, albümin, lenfosit ve trombosit parametrelerinden oluşan HALP skoru ile, beslenme ve immünolojik durumu değerlendiren prognostik nutrisyonel indeks (PNI) arasındaki ilişkiyi incelemeyi amaçlamaktadır. Gereç ve Yöntemler: Çalışmaya 65 yaş ve üzeri toplam 205 katılımcı dâhil edildi. Kırılganlık değerlendirmesi için klinik kırılganlık ölçeği, yorgunluk (fatigue), direnç (resistance), ambulasyon (ambulation), hastalıklar (illnesses) ve kilo kaybı (loss of weight) bileşenlerini değerlendiren FRAIL ölçeği ve Edmonton Kırılganlık Ölçeği kullanıldı. Tüm katılımcıların HALP ve PNI skorları hesaplanarak istatistiksel analiz yapıldı. Bulgular: Tüm kırılganlık ölçeklerine göre kırılgan bireylerde HALP ve PNI skorları anlamlı olarak daha düşüktü (tüm karşılaştırmalar için p

Aim: The aim of this study was to describe the frequency of post-vaccination SARS-CoV-2 infection and to compare SARS-CoV-2 IgG antibody levels between patients with severe obesity and individuals without obesity after two doses of the BNT162b2 vaccine. Methods: One hundred two consecutive patients with severe obesity seen in the obesity outpatient clinic and 54 individuals without obesity who visited a vaccination outpatient clinic were included in the study. Inactivated Severe Adult Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) IgG levels of these two groups were measured four weeks after administration of two doses of BNT162b2 vaccine. SARS-CoV-2 infection was defined as a PCR-confirmed infection documented in hospital records during the 12-month follow-up after completion of two-dose BNT162b2 vaccination. PCR testing was performed only when participants presented to the hospital with clinical suspicion of COVID-19 and was not conducted as routine screening. Clinical characteristics, protective measures and contact history were also queried. Results: There was a statistically significant difference in SARS-CoV-2 infection rates after vaccination between the patients with severe obesity (n=28, 27%) and individuals without obesity (n=3, 5%) (p=0.001). In patients with severe obesity, SARS-CoV-2 IgG levels after BNT162b2 vaccination were lower in the group with SARS-CoV-2 infection than in the group without SARS-CoV-2 infection [2697 (1096-8955); 8103 (2208-26903) AUml, respectively] (p=0.008). The antibody levels of those with severe fatigue were lower than those without these complaints [2440 (365-4447); 8955 (2440-16317) AUml, respectively] (p=0.03). A loss of taste or smell was observed in 75% of patients with severe obesity but was not observed in individuals without obesity (p=0.03). In patients with severe obesity, those with taste/smell loss had statistically significantly lower SARS-CoV-2 IgG titres than those without severe obesity [2568 (400-4830); 9526 (2611-16810) AUml, p: 0.02]. Multiple logistic regression analysis revealed a correlation between body mass index (BMI) and having had a SARS-CoV-2 infection after BNT162b2 vaccination (p = 0.028, Exp(B) = 1.072). There was no need for hospitalisation due to SARS-CoV-2 infection and there were no deaths in either group. Conclusion: Patients with severe obesity had higher rates of SARS-CoV-2 infection after BNT162b2 vaccination compared to individuals without obesity. SARS-CoV-2 IgG levels were lower in patients with severe obesity after BNT162b2 vaccination. Based on these findings, given the higher frequency of post-vaccination infections in the patients with severe obesity, timely booster vaccination policies may be particularly important for this population. Severe obesity, SARS-CoV-2, BNT162b2, SARS-CoV-2 IgG, breakthrough infection. Key points: The rate of SARS-CoV-2 infection after vaccination was higher in patients with severe obesity than in individuals without obesity. It has been found that antibody levels are lower in patients with severe fatigue symptoms than in patients without these symptoms. Loss of taste or smell was observed at a high rate (75%) in the group with severe obesity, but not in individuals without obesity. In this study, there were no hospitalisations or deaths after vaccination with BNT162b2 in patients with severe obesity. Body mass index (BMI) has been found to negatively affect the likelihood of contracting SARS-CoV-2 infection after receiving the BNT162b2 vaccine. In our study, we emphasise the importance of vaccination in patients with severe obesity.

Aim: To evaluate the clinical findings of nonfunctional pituitary adenomas in the geriatric population, functional status, cognitive function, quality of life, frailty, and incidence of anxiety and depression during treatment and follow-up. Material-method: We evaluated operated nonfunctional pituitary adenoma (NFA) cases aged 65 years and older followed up in our clinic between 2010 and 2022. Patients without pituitary adenoma who were followed up in the geriatrics outpatient clinic were included as the control group in the study. Data on clinical, endocrinological, pathological, and radiological findings, as well as on treatment methods, were taken from the files. Bioimpedance was used to assess muscle strength, walking speed, and muscle to fat ratio in patients. In addition, quality of life, anxiety, depression, cognitive function, and vulnerability were assessed. Results: The study included 43 elderly patients diagnosed with NFA and 60 elderly patients without NFA. The mean ages, sex ratios, and body mass indices (BMI) of patients diagnosed with NFA and the control group were similar (age: 70.9 ± 0.66; 73.1 ± 0.8, p = 0.6; female/male: 24/19, 35/25, p = 0.1; BMI: 28.3 ± 3.9/28.5 ± 4.8, p = 0.9, respectively). Cognition status (MMT: 28;29, p=0.002), frailty scores (2[2-3]; 1[1-2], M[IQR], p<0.001), sarcopenia rates (62%; 30%, p=0.007) was worse in patients with NFA. Conclusion: In the study comparing patients diagnosed with surgical pituitary NFA with patients of similar age and comorbidity, the frailty score and rate of sarcopenia were higher and their cognition was worse. The findings indicate that complications from surgery and postoperative treatment in patients with pituitary NFA make elderly patients more vulnerable. We emphasize that patients with NFA in this age group should be examined more carefully.

We present a case of anorexia nervosa (AN), which is a rare cause of hypercortisolism. We discuss the case of a female patient with a body mass index (BMI) of 12.4 kg/m2 who was referred to us because of hypercortisolism. When the patient was evaluated for Cushing's syndrome (CS), the clinical presentation was not suggestive. However, hypercortisolism indicators showed CS. Pituitary and ectopic focus were not found in the radiological evaluation. The patient, who was noted not eating due to the fear of gaining weight, was consulted with a psychiatrist; a diagnosis of anorexia nervosa was made. Hypercortisolism is caused by conditions able to chronically activate the hypothalamic-pituitary-adrenal axis (HPAa), and although rare, it can also occur in psychiatric disorders such as AN. In patients diagnosed with AN, CS should be suspected if the typical clinical features of Cushing's syndrome are present. In AN-associated pseudo-Cushing's syndrome (PCS), an improvement in clinical features and laboratory parameters can be expected with appropriate weight gain. Recognizing PCS at presentation protects patients from unnecessary testing and treatment.

Aim: To investigate the relationship of serum lipoprotein(a) [Lp(a)] and other serum lipids with presence of Graves' ophthalmopathy (GO). Methods: A total of 99 consecutive patients diagnosed with Graves' disease (GD), aged 18–65 years, who had not received prior treatment for GO, thyroid surgery, or radioactive iodine therapy, were recruited between June 2020 and July 2022. In addition, 56 healthy controls (HCs) were included as the control group. All patients underwent an ophthalmological examination, and were classified based on the presence of GO into the GO group (n = 45) and no GO group (n = 54). Fasting blood samples were collected from all participants to analyze serum lipid parameters, including Lp(a), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. Results: The median serum levels of Lp(a) were 5.7 [4.3–9.2] in the GO group, 6.7 [3.7–9.9] in the no GO group, and 4.7 [3–7.6] in the HC group. The intergroup comparisons of serum Lp(a) levels showed no significant result. The serum levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were also similar between the groups (P > 0.05 for all). However, when analyzing only euthyroid GD patients and the control group, the serum LDL cholesterol levels were found to be significantly higher in the euthyroid GO group [median: 132 interquartile range (IQR) (110–148) mg/dL] than in the HCs [median: 96 IQR (94–118) mg/dL] (P = 0.002). Conclusion: The findings of our study did not support the association between serum Lp(a) levels and GO.

In this study, we aimed to reveal the pro-inflammatory effects of serum 25-hydroxyvitamin D3 (Vit D) deficiency and insufficiency in new-onset type 2 diabetes mellitus (T2DM) and prediabetes. We recruited 84 prediabetes patients, 94 new-onset T2DM patients and 113 healthy participants. We measured the levels of C-reactive protein (CRP), fibrinogen, ferritin, interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), nuclear factor kappa-B (NF-κB) and mitogen-activated protein kinase (MAPK) in the serum of the participants. ANOVA Bonferroni and Kruskal–Wallis Dunn tests were used to compare the inflammation markers and vitamin D levels between the groups. Based on covariance analysis with age, gender and BMI, the Vit D levels of the T2DM group were significantly lower (p < 0.003). Pro-inflammatory markers and CRP were significantly higher in prediabetic and diabetic subjects. In the prediabetes group, IL-1β, IL-6, IL-8, TNF-α and MAPK were significantly higher in those with Vit D insufficiency and deficiency groups. In the T2DM group, IL-1β, IL-6, IL-8, TNF-α, NF-κB, MAPK and CRP were significantly higher in those with Vit D insufficiency and deficiency. Our study emphasizes the pro-inflammatory effects of Vit D deficiency and insufficiency in new-onset type 2 diabetes mellitus and prediabetes.

Aim To investigate the autoimmune and genetic relationship between primary hypophysitis (PH) and celiac disease (CD). Methods The study was retrospective and patients with PH followed in our clinic between 2007 and 2022 were evaluated. Clinical, endocrinologic, pathologic, and radiologic findings and treatment modalities were assessed. Patients diagnosed with CD in the Gastroenterology outpatient clinic in 2020–2022 were included in the study as a control group. Information such as sociodemographic data, year of diagnosis, human leukocyte antigen (HLA) DQ2/8 information, CD-specific antibody levels, pathologic results of duodenal biopsy, treatment received, follow-up status, additional diseases, hormone use, and surgical history was obtained from patient records at PH.In patients diagnosed with PH, a duodenal biopsy was obtained, and the tissue was examined for CD by experienced pathologists. Anti-pituitary antibody (APA) and anti-arginine-vasopressin (AAVP) antibody levels of individuals with PH and CD were measured. Results The study included 19 patients with lymphocytic hypophysitis, 30 celiac patients, and 30 healthy controls. When patients diagnosed with lymphocytic hypophysitis were examined by duodenal biopsy, no evidence of CD was found in the pathologic findings. The detection rate of HLA-DQ2/8 was 80% in celiac patients and 42% in PH (p=0.044). (APA and AAVP antibodies associated with PH were tested in two separate groups of patients and in the control group. APA and anti-arginine vasopressin (AAVP) levels in PH, CD and healthy controls, respectively M [IQR]: 542 [178–607];164 [125–243]; 82 [74–107] ng/dL (p=0.001), 174 [52–218]; 60 [47–82]; 59 [48–76] ng/dL (p=0.008) were detected. The presence of an HLA-DQ2/8 haplotype correlates with posterior hypophysitis and panhypophysitis (r=0.598, p=0.04 and r=0.657, p=0.02, respectively). Conclusion Although patients with PH were found to have significant levels of HLA-DQ2/8, no CD was found in the tissue. Higher levels of pituitary antibodies were detected in celiac patients compared with healthy controls, but no hypophysitis clinic was observed at follow-up. Although these findings suggest that the two diseases may share a common genetic and autoimmune basis, the development of the disease may be partially explained by exposure to environmental factors.

In this study, we aimed to reveal the proinflammatory effects of serum 25-hydroxyvitamin D3 (Vit D) deficiency and insufficiency in new-onset type 2 diabetes mellitus (T2DM) and prediabe-tes. We recruited 84 prediabetes patients, 94 new-onset T2DM patients and 113 healthy partici-pants. Levels of C-reactive protein (CRP), fibrinogen, ferritin, interleukin-1β (IL-1β), interleu-kin-6 (IL-6), interleukin-8 (IL-8), tumour necrosis factor-α (TNF-α), nuclear factor kappa-B (NF-κB) and mitogen-activated protein kinase (MAPK) were measured in the serum of the par-ticipants. The ANOVA Bonferonni and Kruskal Wallis Dunn tests were used for the comparison of the inflammation markers and vitamin D levels between the groups. Upon covariance analy-sis with age, gender and BMI; Vit D levels of T2DM group were found to be significantly lower (p<0.003). Proinflammatory markers and CRP were found to be significantly higher in predia-betic and diabetic subjects. In the prediabetes group, IL-1β, IL-6, IL-8, TNF-α and MAPK were significantly higher in those with Vit D insufficiency and deficiency groups. In T2DM group, IL-1β, IL-6, IL-8, TNF-α, NF-κB, MAPK and CRP were significantly higher in those with Vit D insufficiency and deficiency. Our study emphasizes the proinflammatory effects of Vit D on the initiation of inflammation in both prediabetes and diabetes mellitus.