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    Clinical and Laboratory Features at the Onset of Childhood Type 1 Diabetes Mellitus in the Nortwest Region (Trakya) of Turkey
    (Karger, 2018) Dilek, Emine; Bezen, Digdem; Comlek, Fatma Ozguc; Ozkaya, Beyhan; Tutunculer, Filiz
    [Abstract Not Available]
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    Clinical-Laboratory Findings of the Cases with Premature Pubarche and the Value of Acth Stimulation Test in the Differential Siagnosis
    (Karger, 2016) Dilek, Emine; Tutunculer, Filiz; Bezen, Digdem; Sut, Necdet
    [Abstract Not Available]
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    Etiological evaluation of primary congenital hypothyroidism cases
    (Aves, 2017) Bezen, Digdem; Dilek, Emine; Torun, Nese; Tutunculer, Filiz
    Aim: Primary congenital hypothyroidism is frequently seen endocrine disorder and one of the preventable cause of mental retardation. Aim of study was to evaluate the frequency of permanent/transient hypothyrodism, and to detect underlying reason to identfy any marker which carries potential to discriminate permanent/transient form. Material and Methods: Forty eight cases older than 3 years of age, diagnosed as primary congenital hypothyroidism and started thyroxin therapy in newborn-period, and followed up between January 2007-June 2013 were included in the study. Thyroid hormon levels were evaluated and thyroid ultrasonography was performed in cases who are at the end of their 3 years of age, after 6 weeks of thyroxine free period. Thyroid sintigraphy was performed if serum thyroid-stimulating hormone was high (>= 5 mIU/mL) and perchlorate discharge test was performed if uptake was normal or increased on sintigraphy. Cases with thyroid-stimulating hormone levels >= 5 mIU/mL were defined as permanent primary congenital hypothyroidism group and as transient primary congenital hypothyroidism group with normal thyroid hormones during 6 months. Results: The mean age was 3.8 +/- 0.7 years. Mean diagnosis age was 16.6 +/- 6.5 days and 14 cases (29.2%) were diagnosed by screening program of Ministry of Health. There were 23 cases (14F, 9M) in permanent primary congenital hypothyroidism group and 12 (52.2%) of them were dysgenesis (8 hypoplasia, 4 ectopia), and 11 (47.8%) dyshormonogenesis. In transient primary congenital hypothyroidism group, there were 25 cases (17M, 8F). The mean thyroid-stimulating hormone levels at diagnosis were similar in two groups. The mean thyroxin dose in permanent primary congenital hypothyroidism group was significantly higher than transient group at the time of thyroxin cessation (2.1 +/- 0.7, 1.5 +/- 0.5 mg/kg/d, respectively, p=0.004). Thyroxin dose >= 1.6 mcg/kg/d was 72% sensitive and 69.6% specific for predicting permenant primary congenital hypothyroidism. Conclusions: Transient primary congenital hypothyroidism is more frequent than expected and found often in males in the primary congenital hypothyroidism cases, started thyroxin therapy in neonatal period. While fT4, thyroid-stimulating hormone, Tg levels at diagnosis do not predict transient/permenant primary congenital hypothyroidism, thyroxin dose before the therapy cessation at the age of 3 may make the distinction between transient/permenant primary congenital hypothyroidism.
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    Etiological, clinical and biochemical characteristics of 367 children with early pubertal development from the Trakya region of Turkey
    (Cukurova Univ, Fac Medicine, 2022) Kilavuz, Sebile; Bezen, Digdem; Sut, Necdet; Dilek, Emine; Tutunculer, Filiz
    Purpose: The aim of this study was to describe etiologies, clinical findings, and compare anthropometric properties and biochemical characteristics of children with Precocious Puberty (PP).Materials and Methods: In this single-center study, 367 patients of whom medical records were reviewed diagnosed as premature thelarche (PT), premature adrenarche (PA), Central PP (CPP), and peripheral PP (PPP). The diagnosis was based on clinical, laboratory, and radiologic investigations and their follow-up.Results: During six years, 349 girls (%95,1) and 18 boys (%4,9) diagnosed as PP. The most common etiologies were CPP;127 (%34,6), PT;117 (%31,9), PA;112(%30,5) and PPP 11(%3), respectively. CPP group had significantly higher levels of height, weight, body mass index (BMI) and obesity/overweight incidence, estradiol (E2), basal luteinizing hormone (LH), peak LH, and peak LH/ follicle -stimulating hormone (FSH) ratio and higher uterine dimensions compared to the PT group while the PT group had significantly higher levels of peak FSH compared to the CPP group. It is impossible for the laboratory results to exactly match in each case with CPP, and the cases should be evaluated along with other clinical findings.Conclusion: Our study detected an increase in the frequency of girls referred to with PP signs. However, most children with PP were revealed as an incomplete type with a very low incidence of endocrine pathology. The complexity of pathogenesis in PP should lead us to be cautious about the consequences of PP in patients andevaluate their complaints, physical findings, and laboratory work-up seriously, such as a piece of a puzzle.
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    Etiologies of Short Stature in Pedaitric Endocrine Clinic in Northwest Region (Trakya) of Turkey
    (Karger, 2018) Ozkaya, Beyhan; Dilek, Emine; Bezen, Digdem; Comlek, Fatma Ozguc; Tutunculer, Filiz
    [Abstract Not Available]
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    Evaluation of Autoimmune Thyroiditis Development on Onset and During Follow Up in Cases with Type 1 Diabetes Mellitus
    (Karger, 2016) Bay, Bade; Tutunculer, Filiz; Bezen, Digdem; Dilek, Emine; Ekuklu, Galip
    [Abstract Not Available]
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    Evaluation of Glucose Metabolism and Cardiovascular Risk Factors in Prepubertal Girls with Premature Pubarche
    (Galenos Publ House, 2022) Bezen, Digdem; Kokenli, Filiz Tutunculer; Dilek, Emine; Seleci, Didem Ag; Erbas, Hakan
    Objective: Premature pubarche (PP) is a risk factor for metabolic syndrome (MS). The aim was to evaluate if glucose-insulin metabolism, cardiovascular risk factors, familial cardiovascular risk factors (FCVRF) created a risk for insulin resistance (IR) and if PP was a risk factor alone for MS in normal weight prepubertal girls with PP. Methods: Thirty-five prepubertal, non-obese girls with PP with normal birth weight and 35 age-matched control girls were evaluated for FCVRF, anthropometric measurements, blood pressure, lipid profile, fasting blood glucose-insulin, hemoglobin A1c (HbA1c), sex hormone binding globulin (SHBG), leptin, adiponectin, tumor necrosis factor-alpha (TNF-alpha), androgen levels, and bone age. Oral glucose tolerance test was performed in PP participants. Homeostasis model of assessment of IR (HOMA-IR), fasting glucose/insulin ratio, atherogenic index (AI), and free androgen index (FAI) were calculated. PP participants were further stratified by FCVRF. Results: HbA1c, lipid profile, testosterone, leptin, adiponectin, TNF-alpha, HOMA-IR, glucose/insulin ratio, AI, and fasting glucose-insulin levels were similar. In the PP group FAI was significantly higher (p=0.001), whereas SHBG was significantly lower (p=0.010) than the control group. Leptin levels of FCVRF+ and FCVRF-subgroups were 15.2 +/- 9.1 and 9.7 +/- 7.2 ng/mL, respectively and the difference was significant (p=0.016). Conclusion: As PP does not appear to be a risk factor alone for impaired glucose metabolism and IR in prepubertal non-obese girls with normal birth weight, it is our opinion that it is unnecessary to examine in detail such cases before puberty. Low SHBG levels in the PP group and high leptin levels in FCVRF+ subgroup might suggest that these may be predictive for MS in the future.