Sebnem Burhan

Aim: Type 2 diabetes mellitus (T2DM) imposes psychological and behavioral challenges. While prior research links eating habits, distress, and glycemic control, few studies explore these factors together. This study assessed the associations between night eating, eating patterns, diabetes distress (DDS), glycemic control, BMI, gender, and medication use in adults with T2DM. Methods: This study included 105 adults with T2DM. Night eating behavior, eating patterns, and DDS were evaluated using the Night Eating Questionnaire (NEQ), the 18-item version of the Three-Factor Eating Questionnaire-Revised (TFEQ-R18), and the Diabetes Distress Scale (DDS). Results: NEQ score correlated with BMI (r=0.38, p=0.001) and remained significant after adjusting for age, gender, and HbA1c (p=0.002). TFEQ-R18 emotional eating inversely correlated with BMI (r=−0.36, p=0.001) and persisted after adjustment (p=0.004). Uncontrolled eating and cognitive restraint showed no links. Men scored higher on emotional eating than women (10.0 ± 2.54 vs. 8.69 ± 3.20, p = 0.02). Poor glycemic control had higher DDS emotional burden and regimen-related distress; NEQ and TFEQ-R18 scores did not differ by glycemic status or medication classes. Conclusion: DDS, particularly emotional burden and regimen-related distress, differed across HbA1c categories, but this was not confirmed in multivariable models. BMI, not glycemic control, more consistently predicted eating behavior and distress. Given the cross-sectional design and small sample size, the no significant association between eating behavior and glycemic control does not rule out a relationship. These findings support routine distress screening in diabetes care and larger prospective studies of these associations and their relationship to body weight.

Purpose: Pituitary Tumor Centers of Excellence (PTCOE) were developed to standardize multidisciplinary care for pituitary disorders; however, their impact on patient-reported outcomes remains insufficiently characterized. This study aimed to compare health-related quality of life, illness perception, and outpatient satisfaction between patients followed in a PTCOE-aligned, though not formally accredited, specialized pituitary clinic and those managed in general endocrinology clinics, and to identify organizational factors associated with these outcomes. Methods: In this cross-sectional study, 175 adults with prolactinoma ( n = 70), non-functioning pituitary adenoma ( n = 54), acromegaly ( n = 35) and Cushing’s disease ( n = 16) were evaluated across two tertiary endocrinology centers. Patient-reported outcomes were assessed using validated Turkish versions of the SF-36, Illness Perception Scale, and Outpatient Satisfaction Scale. Results: Certain baseline clinical profiles differed significantly between the two groups, with patients in the specialized clinic exhibiting higher rates of pituitary surgery (63.9% vs. 32.1%, p = 0.001) and hypopituitarism (28.9% vs. 14.1%, p = 0.02). Patients in the specialized clinic showed significantly lower SF-36 Role Physical, Role Emotional, Social Functioning, and Bodily Pain scores (all p ≤ 0.03). Illness-perception patterns also diverged, with higher Timeline, Consequences, and Treatment Control scores in the specialized clinic. Outpatient satisfaction, however, was consistently higher across all subscales in the specialized clinic (all p ≤ 0.006). In multivariable analyses, clinic type, sex, hypopituitarism, surgical history, and follow-up duration independently contributed to variation in multiple patient-reported outcome domains. Conclusion: PTCOE-aligned specialized care was associated with more favorable illness representations and higher patient satisfaction, even among cases with greater disease burden. This underscores the need for integrating patient-reported outcomes into the evaluation and refinement of pituitary care models.

Background: Calcitonin gene-related peptide (CGRP) is a potent vasodilatory neuropeptide involved in inflammation, vascular regulation, and pain mechanisms with potential relevance to endocrine and neurological processes. Furthermore, it exerts specific effects on the tumor microenvironment in certain malignancies. The contribution of CGRP to pituitary adenogenesis has yet to be elucidated. This study aimed to investigate CGRP expression by immunohistochemistry in patients with acromegaly and nonfunctioning pituitary adenomas (NFPAs) and its associations with tumor features, symptoms, and treatment response. Methods: This study included tissue samples obtained from 49 patients who were followed and underwent transsphenoidal surgery at our center: 30 with acromegaly and 19 with NFPAs. Tumor samples were evaluated for CGRP using a polyclonal anti-CGRP antibody (GeneTex, 1:200). Clinical, radiological, and surgical data were collected. Histopathology included hormone staining, estrogen receptor, granularity, transcription factors, Ki-67, and mitotic count. Results: CGRP positivity was observed in 50% of acromegaly patients and in none of the NFPA group (p < 0.001). CGRP expression was not significantly associated with tumor size, invasion, need for surgery, residual tumor, treatment resistance, or granularity. In acromegaly cases with CGRP-positive adenomas, chronic headache tended to be more common (40% vs. 13%, p = 0.09), and postoperative headache resolution rate was lower (33.3% vs. 80%, p = 0.07). The postoperative remission rate tended to be lower (60% vs. 86.7%, p = 0.09). Conclusion: CGRP was found to be notably present in somatotropin-producing adenoma tissues, yet it was entirely absent from nonfunctioning adenoma tissues. The detection of CGRP within adenoma tissue could correlate with an increased incidence of persistent headaches and diminished postoperative remission probabilities in acromegaly.

Objective: Beta-thalassemia minor (BTM) has traditionally been viewed as a benign hematologic condition, yet recent evidence indicates possible subclinical vascular abnormalities. Urotensin II (UII), a vasoactive and proinflammatory peptide, is involved in endothelial dysfunction. This study aimed to evaluate serum UII levels in BTM patients and determine their associations with clinical, hematological, and metabolic parameters. Methods: Forty-six patients with BTM and 45 age- and sex-matched healthy controls were enrolled. Serum UII concentrations were measured and compared between groups. Correlations between UII levels and demographic, hematologic, lipid, and anthropometric variables were analyzed. Subgroup analyses were performed based on sex and smoking status. Results: UII levels were significantly higher in BTM patients compared to controls (p < .001). Elevated concentrations were detected in both sexes, with the highest levels observed among current smokers. UII showed positive correlations with HbA₂ (r = .482, p < .001) and RBC count (r = .314, p = .003), and a negative correlation with MCV (r = –.410, p < .001). No significant associations were found with age, BMI, or lipid parameters. Conclusion: Increased UII levels in BTM may reflect erythropoietic stress and endothelial activation. The observed hematologic correlations and potential involvement of UII in MAPK signaling suggest a role in the subclinical vascular pathophysiology of BTM.

Objective: Acromegaly reduces quality of life. Neurosteroids can impact neuropsychological status and anxiety, but their effects on anxiety in acromegaly cases and quality of life are unclear. This study aims to evaluate the relationship between neurosteroids, anxiety, and quality of life in acromegaly patients. Design: This study included 33 cases in the acromegaly group (AG) and 30 healthy subjects in the control group (CG). Beck Anxiety Inventory (BAI) and Short Form-36 (SF-36) were used to assess anxiety levels and Quality of Life (QoL), respectively. The research assessed how anxiety and quality of life scores correlate with the concentrations of growth hormone, IGF-1, and specific neurosteroids (Allopregnanolone (AP), pregnenolone (PRG), 24S-hydroxycholesterol (24OHC), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), androsterone (ADT)). Results: AG had significantly higher BAI scores in comparison to CG. The SF-36 subdomain scores of general health, physical functioning, role limitations due to physical health, energy/fatigue, emotional well-being, social functioning, and pain were significantly lower in the AG. Conclusion: Neurosteroids may affect the quality of life and be associated with depression and anxiety levels in acromegaly.

Purpose Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard for localizing ACTH-dependent Cushing’s syndrome (CS). While corticotropin-releasing hormone (CRH) was initially used for stimulation, desmopressin has become a common alternative. This research evaluates desmopressin’s effectiveness in lateralizing Cushing’s disease (CD) during BIPSS compared to CRH stimulation. Methods The study included 33 individuals with ACTH-dependent CS who underwent BIPSS and had diagnoses confirmed by endoscopic endonasal transsphenoidal pituitary surgery (EETPS). Fourteen participants underwent BIPSS with CRH and 19 with desmopressin. A comparative analysis was conducted. Results BIPSS accurately lateralized 76% of cases, specifically, 71% with CRH and 79% with desmopressin (p = 0.2). For tumors < 6 mm on MRI, overall accuracy was 82%, namely, 75% with CRH and 90% with desmopressin (p = 0.4). IPSS achieved 100% accuracy in the four cases with no lesion on preoperative MRI. Conclusion This study demonstrates no significant difference in lateralization accuracy between desmopressin and CRH for IPSS. In challenging cases, especially those with microadenomas or non-lesional CD, desmopressin with IPSS aids in preoperative lateralization.

Objective: Primary hypophysitis might be challenging to diagnose, and there is a lack of evidence regarding optimal treatment strategies due to rarity of the disease. We aim to investigate the clinical features and compare the outcomes of different management strategies of primary hypophysitis in a large group of patients recruited on a nationwide basis. Design: A retrospective observational study. Methods: The demographic, clinical, and radiologic features and follow-up data were collected in study protocol templates and analyzed. Results: One hundred and thirteen patients (78.8% female, median age: 36 years) were included. Lymphocytic (46.7%) and granulomatous hypophysitis (35.6%) were the prevailing subtypes out of 45 patients diagnosed after pathologic investigations. Headache (75.8%) was the most common symptom, and central hypogonadism (49.5%) was the most common hormone insufficiency. Of the patients, 52.2% were clinically observed without interventions, 18.6% were started on glucocorticoid therapy, and 29.2% underwent surgery at presentation. Headache, suprasellar extension, and chiasmal compression were more common among glucocorticoid-treated patients than who were observed. Cox regression analysis revealed higher hormonal and radiologic improvement rates in the glucocorticoid-treated group than observation group (hazard ratio, 4.60; 95% CI, 1.62-12.84 and HR, 3.1; 95% CI, 1.40-6.68, respectively). The main indication for surgery was the inability to exclude a pituitary adenoma in the presence of compression symptoms, with a recurrence rate of 9%. Conclusion: The rate of spontaneous improvement might justify observation in mild cases. Glucocorticoids proved superior to observation in terms of hormonal and radiologic improvements. Surgery may not be curative and might be considered in indeterminate, treatment-resistant, or severe cases.

Aim: To explore the relationships between psychological factors, especially experiential avoidance (EA) and psychological inflexibility, and obesity, and to assess their mediating roles in the association between general psychological symptoms and obesity. Methods: The study employed Pearson correlation analysis and mediation analysis to examine relationships among Body Mass Index (BMI), the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R), its subscales, and the General Health Questionnaire (GHQ12). Participants predominantly consisted of females, with a mean age of 39.3 years and an average BMI of 38.5. Results: Significant correlations were found between BMI, AAQW-R, and GHQ12 (p < 0.05). However, the correlation between BMI and AAQW-R-fc was not significant (p = 0.142). Mediation analysis revealed that AAQW-R fully mediated the relationship between GHQ12 and BMI, indicating a significant role of psychological factors in obesity. Conclusions: The findings highlight the importance of incorporating psychological elements, such as psychological inflexibility and EA, into obesity interventions. Addressing these factors may enhance the effectiveness of weight control strategies. Future research is encouraged to explore potential biological pathways linking obesity and psychological variables.