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Öğe Comparative neurophysiological study for the diagnosis of mild polyneuropathy in patients with diabetes mellitus and glucose intolerance(Taylor & Francis Ltd, 2006) Turgut, Nilda; Guldiken, Sibel; Balci, Kemal; Tugrul, Armagan; Berberoglu, Ufuk; Altun, Betul UgurThis article evaluates diagnostic sensitivity of minimal F-wave latency, sural/radial amplitude ratio ( SRAR), dorsal sural/radial amplitude ratio ( DSRAR), sympathetic skin response ( SSR), and R-R interval variability ( RRIV) for detecting early polyneuropathy in patients with glucose intolerance and diabetic patients. F-wave latencies were more prolonged in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). SRAR was lower, SSR latency was more prolonged, and RRIV was lower in diabetic patients with abnormal nerve conduction studies than healty controls ( p < .001). SSR latency was more prolonged and RRIV was lower in diabetic patients with normal nerve conduction studies than healty controls ( p < .01, p < .05, respectively). DSRAR was lower in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). DSRAR was also lower in patients with glucose intolerance than control subjects ( p < .01). DSRAR was the most sensitive and specific test in either of diabetic patients with normal nerve conduction studies ( sensitivity 66%, specificity 90%) and diabetic patients with abnormal nerve conduction studies ( sensitivity 100%, specificity 90%). DSRAR is the most reliable method for detection of early nerve pathology. Patients with glucose intolerance might have subclinical neuropathy that can be demonstrated with DSRAR analysis.Öğe The Effects of Spironolactone on Nephron Function in Patients with Diabetic Nephropathy(Taylor & Francis Ltd, 2008) Ustundag, Ayten; Tugrul, Armagan; Ustundag, Sedat; Sut, Necdet; Demirkan, BoraIncreasing evidence suggests that circulating aldosterone per se contributes directly to renal and cardiovascular diseases. We sought to evaluate the effects of a three-month treatment with 25 mg spironolactone, an aldosterone receptor antagonist, on nephron function in 20 type II diabetic patients with persistent microalbuminuria, despite at least six months' use of an ACEi or ARB (combination group), and in eleven type II diabetic patients with persistent microalbuminuria who have never used an ACEi or an ARB (spironolactone group). In the combination group, urinary protein excretion (UPE, p = 0.015), urinary albumin excretion (UAE, p = 0.010), and the urinary albumin to creatinine ratio (ACR, p = 0.007) decreased, and serum potassium (sK+, p = 0.004) was significantly elevated. ACR (p = 0.016) decreased significantly in the spironolactone group. In 31 patients given spironolactone (all patients group), UPE (p = 0.019), UAE (p = 0.002), and ACR (p = 0.011) decreased, and serum creatinine (sCr, p = 0.025) and sK+ (p = 0.002) were significantly elevated. Changes in albuminuria showed a positive correlation with changes in GFR (p = 0.002) and a negative correlation with changes in sCr (p = 0.007), and changes in ACR showed a negative correlation with changes in sCr (p = 0.004) in all patient groups. In our study, we observed that spironolactone, both alone and in combination with ACEi/ARB treatment, was well tolerated, and that it slowed down the progression of diabetic nephropathy with a marked antialbuminuric effect. Our results showed that the antialbuminuric effect developed by the decrease of intraglomerular pressure, particularly in patients with persistent microalbuminuria despite long-term ACEi/ARB treatment; adding aldosterone blockers to treatment was beneficial.Öğe Evaluation and surgical approach of surrenal masses: experience of Trakya University(Aves, 2011) Inci, Osman; Aktoz, Tevfik; Bilir, Betl Ekiz; Atakan, Irfan Huseyin; Tugrul, ArmaganObjective: In this study, patients with adrenal masses treated with surgery in our clinic were evaluated for endocrinological and surgical aspects, and open surgical techniques were compared. Materials and methods: Between January 2003 and January 2011, we retrospectively evaluated 31 patients who underwent surgical exploration for adrenal masses in Trakya University Urology Department following consultations with Endocrinology Department. There were 21 (67.7%) female and 10 (32.3%) male with a mean age of 47.2 years (range 16-74 years). Adrenal mass was detected on the right side in 9 (29%) patients and on the left side in 22 (71%) patients. We performed open retroperitoneal approach in 17 (54.8%) cases and open transperitoneal (Chevron) approach in 14 (45.2%) cases. Results: Fifteen of the cases were functionally active. Of the functional cases, 9 had Cushing syndrome, 3 had pheochromocytoma, and 3 had aldosterone producing adenoma. Sixteen of these cases were not producing hormones and non-functional as a result of preoperative endocrinological evaluation. Conclusion: Adrenal masses should be considered endocrinologically before surgical treatment, and endocrine evaluation must be completed preoperatively. Preoperative, peroperative, and postoperative evaluation of hormone active cases has particular importance. Surgical success is proportional to the multidisciplinary study.Öğe An Evaluation of Glucose Tolerance in Essential Hypertension(Yonsei Univ Coll Medicine, 2009) Tugrul, Armagan; Guldiken, Sibel; Ugur-Altun, Betul; Arikan, EnderPurpose: This study aimed to detemine the impaired glucose tolerance and diabetes prevalence in patients with essential hypertension (HT) and to compare the developed microvascular complications of these groups. Materials and Methods: An oral glucose tolerance test (OGTT) was performed on 338 essential hypertensive cases and glucose tolerances were classified according to ADA-2002 criteria. Results: Of the 338 cases, 32 people had diabetes (DM, 9.460/6), 78 people had glucose intolerance (IGT, 23.1%), and 228 people had only hypertension but not IGT and DM (67.4%). Both the mean ages of the DM group (56.9 +/- 6.7 years, p = 0.002) and IGT group (56.3 +/- 8.4 years, p = 0.003) were older than the mean age of the control group (51.1 +/- 6.4 years). The risk of IGT development was found to be four times greater in male cases than female cases when compared to the control group (p = 0.004, add ratio = 4.194). There were no significant differences in the body mass indexes (BMI's), hypertension durations, and microvascular complications between the groups. Conclusion: In conclusion, the risk of IGT and DM development in hypertensive cases increases with aging and longer hypertension duration. The risk of IGT development in hypertensive cases is four times more in males.Öğe Evaluation of pulmonary alveolo-capillary permeability in Type 2 diabetes mellitus using technetium 99mTc-DTPA aerosol scintigraphy and carbon monoxide diffusion capacity(Elsevier Science Inc, 2006) Ozsahin, Kemal; Tugrul, Armagan; Mert, Selva; Yuksel, Mahmut; Tugrul, GozdeThe thickening of alveolar basement membrane is found in autopsies, along with microvascular pathologies, in Type I and 2 diabetes mellitus (DM). To detect the function and permeability of alveolar basement membrane, carbon monoxide diffusion capacity (DLCO) and technetium 99m-diethyltriaminepentaaceticacid (Tc-99m-DTPA) aerosol scintigraphy methods can be used. The aim of this study was to determine alveolar basement membrane damage using these two methods. Nineteen women and 6 men, nonsmoking, Type 2 DM cases, without any lung and/or heart disease and who had neither anemia nor obesity, made up the patient group. They were compared with six female and nine male healthy cases who had the same characteristics with the diabetes cases. All of the cases DLCO were measured by single-breath method and 99mTc-DTPA aerosol scintigraphy was performed. DLCO showed no difference between the two groups. Aerosol scintigraphy was significantly decreased in the diabetic group (P=.01). In cases with > 5 years of diabetic duration (P <.01), in cases with glycolized hemoglobin (HbA(1c)) <= 8% (P <.05) and > 8% (P <.05), and in microangiopathic cases (P <.01), alveolo-capillary permeability was significantly decreased than in the control group. Among the same groups, no significant difference could be detected for DLCO. The permeability of alveolar basement membrane can reduce in respect to diabetes duration and poor metabolic control. According to our investigation, Tc-99m-DTPA aerosol scintigraphy method is more sensitive than DLCO method for determining these pathologies. (c) 2006 Elsevier Inc. All rights reserved.Öğe Frequency of rheumatic diseases in patients with autoimmune thyroid disease(Springer, 2007) Soy, Mehmet; Guldiken, Sibel; Arikan, Ender; Altun, Betul Ugur; Tugrul, ArmaganWe aimed to investigate the frequency of rheumatic diseases in patients suffering from autoimmune thyroid diseases (ATD). Sixty-five patients (56 F, 9 M), who were followed by diagnosis of ATD, were questioned and examined for the presence of rheumatic disease. Basic laboratory tests and antithyroid antibodies, antinuclear antibody and rheumatoid factor (RF) levels were also measured by appropriate methods. Various rheumatic diseases were detected in 40 (62%) of patients with ATD. The most frequent rheumatic conditions were fibromyalgia, recurrent aphthous stomatitis, osteoarthritis, keratoconjunctivitis sicca and xerostomia and carpal tunnel syndrome which were detected in 20 (31%), 13 (20%), 10 (15%), 9 (14%) and 8 (12%) of patients, respectively. Autoimmune diseases, except Sjogren's syndrome, which were detected in ten patients with ATD, are as follows-vitiligo: two; autoimmune hepatitis: two; oral lichen planus: one, ulcerative colitis: one, inflammatory arthritis in four patients (two of them had rheumatoid arthritis, one had psoriasis and psoriatic arthritis and one had mixed collagen tissue disease). RF was positive in two patients, one of them had rheumatoid arthritis and FANA was positive in six (9%) patients; all of them had hypothyroidism. The frequency of rheumatic diseases seems to be higher in patients suffering from ATD. Initial evaluation and a regular checking for rheumatic diseases in patients suffering from ATD were recommended.Öğe Frequency Of Thyroid Diseases in Type 2 Diabetic Patients(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2009) Taskiran, Benguer; Guldiken, Sibel; Peynirci, Hande; Altun, Betuel Ugur; Tugrul, ArmaganObjectives: Thyroid diseases and type 2 diabetes mellitus are two abundant diseases in general population. In this study, we evaluated the frequency of thyroid diseases in type 2 diabetic patients. Patients and Methods: The study included 306 type 2 diabetic patients, who were followed up in Trakya University Department of Endocrinology and Metabolism Disorders. All patients had thyroid function tests, antithyroglobulin antibody values, antithyroid peroxidase values, and thyroid imaging (scintigraphy and/or ultrasonography). Results: A total of 38 (12.4%) patients had thyroid diseases with the following distribution: 29 (9.5%) Hashimoto thyroiditis, five (1.7%) multinodular goitre, three (%1) Graves' disease, and one toxic solitary adenoma (0.3%). Conclusion: We found that thyroid diseases in type 2 diabetics were seen as frequent as in general population. We suggest that there is no need to screen type 2 diabetics for thyroid diseases, hypothyroid in particular, that increase the risk for cardiovascular diseases, in addition to the recommended screening of the general population in guidelines.Öğe Impact of osteoprotegerin and leptin on amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in healthy young adults(Elsevier Ireland Ltd, 2007) Altun, Armagan; Ugur-Altun, Betul; Arkan, Ender; Kunduracilar, Hakan; Guldiken, Sibel; Kara, Mujdat; Tugrul, Armagan[Abstract Not Available]Öğe The levels of circulating markers of atherosclerosis and inflammation in subjects with different degrees of body mass index: Soluble CD40 ligand and high-sensitivity C-reactive protein(Pergamon-Elsevier Science Ltd, 2007) Guldiken, Sibel; Demir, Muzaffer; Arikan, Ender; Turgut, Burhan; Azcan, Sennur; Gerenli, Murat; Tugrul, ArmaganBackground: It is welt demonstrated that obesity is an independent risk factor for cardiovascular diseases. Recent studies have shown that obesity, insulin resistance and atherosclerosis are closely related phenomena in which low-grade inflammatory state and prothrombotic condition has pivotal roles. It has been shown that CD40-soluble CD40 ligand (sCD40L) interactions might constitute an important mediator for vascular inflammation. The aim of the present study was to assess sCD40L in relation to hs-CRP and cardiovascular risk factors in relation to body mass index (BMI). Materials and methods: Serum sCD40L and hs-CRP concentrations were measured in 52 obese patients and 28 non-obese subjects by ELISA. Insulin resistance was calculated by homeostasis model assessment-insulin resistance (HOMA-IR). We divided the participants into three groups depending in their BMI levels (Group 1: BMI < 25 kg/m(2), Group 2: BMI 30-34.9 kg/m(2), Group 3: BMI >= 35 kg/m(2)). Results: We determined that the mean sCD40L of group 3 was significantly higher than group 1 and group 2 (p < 0.05, p < 0.05, respectively). However, there was no significant correlation between plasma sCD40L levels and BMI. Plasma levels of hs-CRP were higher in obese group than the non-obese group (p < 0.001). The Levels of sCD40L were not significantly different between the two groups. The mean hs-CRP levels increased gradually in accordance with groups of BMI, there was a strong correlation between hs-CRP levels and BMI (r = 0.724, p < 0.001). There was no significant correlation between sCD40L and hs-CRP levels in all participants. Conclusions: It is still a subject for debate whether sCD40L Levels are increased or not in obesity. However, the results of this study showed that sCD40L is substantially increased in patients with severe obesity. In terms of causality, the relatively small sample size and cross-sectional design of this study are considered to be the limitation factors. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Levels of high-sensitivity C-reactive protein, leptin, and resistin in patients with overt hypothyroidism and subclinical hypothyroidism(Lippincott Williams & Wilkins, 2008) Guldiken, Sibel; Demir, Muzaffer; Arikan, Ender; Azcan, Sennur; Tugrul, ArmaganHypothyroidism is associated with an increased risk for obesity and cardiovascular diseases. Resistin and leptin exert proinflammatory actions by activating a specific receptors which are expressed in human endothelial cells. The aim of the study was to investigate whether the relations between the leptin, resistin, and high-sensitivity C-reactive protein (hs-CRP), which is a marker of low-grade inflammation, in patients with subclinical (SH) and overt hypothyroidism (OH). The levels of leptin, resistin, and hs-CRP were measured in 25 patients with CH, 30 patients with SH, and in 25 healthy subjects, using enzyme-linked immunosorbent assay method. The leptin and resistin levels in patients with OH and SH were similar to those in the control group. The hs-CRP level in OH group was significantly higher than SH and control groups (P < 0.001, P < 0.001). In the OH group, hs-CRP levels were positively correlated with thyroid-stimulating hormone levels (P < 0.001, r = 0.728) and negatively correlated with fF4 levels (P = 0.01 r = -0.51). Combining the OH and SH groups, serum hs-CRP levels were significantly correlated with thyroid-stimulating hormone levels (P < 0.001, r = 0.765) and fr4 (P < 0.001, r = -0.716). No significant correlation was found between hs-CRP and leptin or resistin in patients with OH and SH. We suggest that the elevated hs-CRP levels in hypothyroidism may play a role in the increased risk for atherosclerosis in these patients.Öğe Low leptin levels in migraine: A case control study(Wiley, 2008) Guldiken, Baburhan; Guldiken, Sibel; Demir, Muzaffer; Turgut, Nilda; Tugrul, ArmaganBackground.-Obesity has been shown to be a risk factor for transformation of episodic migraine to chronic form, and adipocytokines have been implicated to modulate some of the cytokins such as interleukin-6 and tumor necrosis factor, which also act in the neurogenic inflammation in migraine. The aim of the study was to assess leptin levels, one of the adipocytokines, in headache-free period of migraine patients and investigate its relation to vascular risk factors. Material and Methods.-Sixty-one patients with episodic migraine headaches and 64 control subjects were enrolled in the study. Demographic data and anthropometric measurements were obtained from all participants; body mass index and fat mass values were calculated. Glucose and lipid parameters were measured by oxidase technique and cholesterol esterase enzymatic assays, and leptin levels were measured by ELISA in serum samples obtained after an overnight fasting. Results.-Leptin levels were found significantly lower in migraineurs than controls (40.1 +/- 21.2 ng/mL, 48.5 +/- 24.5 ng/mL; P < .05). Although body mass index did not differ between 2 groups, fat mass, and fat percentages were significantly lower in migraine patients (19.4 +/- 8.8 kg, 26.0 +/- 8.7 kg; P < .001 and 28 +/- 9%, 34 +/- 5%; P < .001, respectively). Conclusion.-Migraine patients have low leptin levels and fat mass which may be related to the pathogenesis of migraine. The importance and impact of our findings on the prevalence, characteristics, and treatment of migraine needs to be investigated in further detailed studies.Öğe Migraine in Metabolic Syndrome(Lippincott Williams & Wilkins, 2009) Guldiken, Baburhan; Giddiken, Sibel; Taskiran, Bengur; Koc, Gonul; Turgut, Nilda; Kabayel, Levent; Tugrul, ArmaganObjectives: Recent studies suggest that insulin resistance is In ore common in patients with migraine. Insulin resistance underlies the pathogenesis of obesity, diabetes. and hypertension that are components of metabolic syndrome. As migraine is associated with an increased risk of vascular disorders, such as stroke. and migraine patients have higher diastolic blood pressure than healthy individuals, we aimed to investigate the I-year prevalence of migraine in metabolic syndrome. Methods: Two hundred ten patients with metabolic syndrome were enrolled in the study. Migraine was diagnosed according to International Classification of Headache Disorders-II criteria. Results: Migraine prevalence was estimated its 11.9% in men and 22.5% in women with metabolic syndrome. Of the metabolic syndrome Components, diabetes, increased waist circumference, and body mass index were significantly more frequent in patients with migraine in contrast to those without migraine (P <0.05). Hypertension and dyslipidemia frequencies showed no difference between 2 groups. Conclusions: Our results demonstrate that migraine prevalence it) metabolic syndrome was higher than in file general population.Öğe Obese Subjects Have Low Global Fibrinolytic Capacity Associated with Insulin Resistance(Galenos Yayincilik, 2006) Turgut, Burhan; Guldiken, Sibel; Demir, Muzaffer; Ugur-Altun, Betul; Gerenli, Murat; Vural, Ozden; Tugrul, ArmaganObese subjects frequently have insulin resistance and they are at particularly risk of cardiovascular complications, possibly related to haemostatic and fibrinolytic system dysfunction. The aim of this study was to determine the effects of obesity on global fibrinolytic capacity (GFC) which is a new test used to assess fibrinolytic activity, and to evaluate the relationship of GFC with cardiovascular risk (CVR) factors. Fifty obese subjects, with a body mass index (BMI)> 30 kg/m(2) (36 women, 14 men; mean age, 30 +/- 7 years; mean BMI, 34 +/- 3 kg/m(2)); and 30 non-obese subjects, with a BMI< 25 kg/m(2) (19 women, 11 men; mean age, 30 +/- 6 years; mean BMI, 22 +/- 2kg/m(2)) were enrolled the study. Anthropometric measurements (weight, height, hip and waist circumferences) were recorded down. Plasma fasting glucose, insulin, lipid profiles, fibrinogen levels, Ddimer and GFC were determined. Insulin resistance was calculated by homeostasis model assessment (HOMA-IR). The gender and age were well matched in the two groups. Mean GFC was significantly lower in obese subjects than non- obese ones (7.6 +/- 7.5 mu g/ml, 16.3 +/- 11.9 mu g/ml, P< 0.001). However, there was no difference between mean D-dimer levels of the two groups. Mean plasma levels of fasting glucose (P< 0.05), insulin (P< 0.001), HOMA- IR (P< 0.01), fibrinogen (P<0.001) in the obese group were higher than in the non- obese group. GFC showed inverse correlations with HOMA- IR (r=- 0,41, P< 0,001) and fasting insulin (r=- 0,30, P<0,05). These data showed that obese subjects have a net hypofibrinolytic state which is associated insulin resistance.Öğe Oxidative Stress and Total Antioxidant Capacity in Diabetic and Nondiabetic Acute Ischemic Stroke Patients(Sage Publications Inc, 2009) Guldiken, Baburhan; Demir, Muzaffer; Guldiken, Sibel; Turgut, Nilda; Turgut, Burhan; Tugrul, ArmaganFree radical formation is the pivotal mechanism of neuronal injury of ischemic and reperfused brain tissue. In healthy individuals, antioxidant activity counterbalances free radical production, but in the case of ischemia, the balance between reactive oxygen species and antioxidant activity is shifted toward free radicals, causing oxidative stress. The aim of this study is to assess total antioxidant capacity (TAC) and oxidative stress in diabetic and nondiabetic acute stroke patients with 2 different stroke subtypes: large and small vessel disease stroke. Sixty-five acute ischemic stroke patients (29 diabetic and 36 nondiabetic) and 20 age-matched healthy control subjects were recruited in the study Plasma TAC and nitric oxide (NO) metabolite levels (nitrite and nitrate) were measured by enzyme-linked immunosorbent assay. The subtypes of stroke were defined according to Trial of Org 10172 in Acute Stroke Treatment criteria. The main findings of this study are that the TAC and NO levels were significantly higher in diabetic acute stroke patients than in nondiabetic patients and control cases (P < .001 and P < .001, respectively). The TAC and NO levels were higher also in nondiabetic stroke patients than in controls, but the difference did not reach any significance. No difference was found between NO and TAC levels in large and small vessel stroke subtypes of diabetic and nondiabetic patients. The authors conclude that oxidative stress and counterbalancing antioxidant capacity are more pronounced in diabetic acute stroke patients than in nondiabetic acute stroke patients.Öğe Pheochromocytoma presenting with rhabdomyolysis and acute renal failure: a case report(Informa Healthcare, 2014) Celik, Huseyin; Celik, Ozlem; Guldiken, Sibel; Inal, Volkan; Puyan, Fulya Oz; Tugrul, ArmaganRhabdomyolysis ranges from an asymptomatic illness with elevated creatine kinase levels to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure, and disseminated intravascular coagulation. The most common causes are crush injury, overexertion, alcohol abuse, certain medicines, and toxic substances. A number of electrolyte abnormalities and endocrinopathies, including hypothyroidism, thyrotoxicosis, diabetic ketoacidosis, nonketotic hyperosmolar state, and hyperaldosteronism, cause rhabdomyolysis. Rhabdomyolysis and acute renal failure are unusual manifestations of pheochromocytoma. There are a few case reports with pheochromocytoma presenting rhabdomyolysis and acute renal failure. Herein, we report a case with pheochromocytoma crisis presenting with rhabdomyolysis and acute renal failure.Öğe Silent myocardial ischemia in middle-aged asymptomatic patients with type 2 diabetes in Turkish population(Sage Publications Inc, 2007) Ugur-Altun, Betul; Altun, Armagan; Guldiken, Sibel; Tatli, Ersan; Kara, Mujdat; Tugrul, ArmaganThe authors investigated silent myocardial ischemia in unselected consecutive middle-aged asymptomatic patients with type 2 diabetes without any evidence of coronary heart disease documented by treadmill exercise test. Ninety asymptomatic patients with type 2 diabetes (48 men; mean age; 49 +/- 6 years) were included in the study. Mean duration of diabetes in the study group was 4 +/- 4.2 years (range 1 to 21 years); 38% of the study population, diabetes duration was only 1 year). All patients were subjected to treadmill exercise test with Bruce protocol. A positive test was noted in 4 of 90 (4%) study patients. Two male patients (4%) and 2 (4%) women patients developed exercise-induced ST-segment depression, but none had concomitant chest pain. Diabetics with silent myocardial ischemia were older (55 +/- 3 years vs 49 +/- 6 years, p = 0.04) than those without silent myocardial ischemia. Also, diabetics with silent myocardial ischemia had higher fibrinogen level (372 +/- 51 vs 307 +/- 71 mg/dL, p = 0.04) than diabetics without silent myocardial ischemia. In treadmill exercise test, diabetics with silent myocardial ischemia had lower total exercise time and peak workload (375 +/- 30 vs 474 +/- 115 seconds, p = 0.04; 7.3 +/- 0.5 vs 8.9 +/- 1.9, p = 0.04, respectively) than without silent myocardial ischemia. Insulin resistance is associated with a variety of atherosclerosis risk factors. Exercise test findings show increased cardiac sympathetic activity and parasympathetic withdrawal in increased insulin resistance.Öğe Spontaneous Cure of an Apoplectic Somatotropinoma in the Setting of Coronary Angiography(Galenos Yayincilik, 2008) Taskiran, Bengur; Guldiken, Sibel; Altun, Betul Ugur; Tuncbilek, Nermin; Tugrul, ArmaganPituitary apoplexy, which results from spontaneous hemorrhage into a pituitary adenoma, may be associated with a number of clinical settings including head trauma, hypertension, diabetes mellitus, acute hypovolemic shock, contrast media usage, and anticoagulation therapy. Clinical manifestations are due to the mechanical compression of the optic apparatus and cavernous sinus content, and pituitary insufficiency. Pituitary insufficiency does not recover in most of the cases. Ophthalmoplegia may resolve spontaneously over time or after surgery. Rarely, pituitary apoplexy may be followed by an endocrinologic cure. We present an apoplectic somatotropinoma in the setting of coronary angiography and unstable angina pectoris, which was spontaneously cured after pituitary apoplexy. This is one of few reports of pituitary apoplexy in association with contrast medium and anticoagulant-antiaggregant drug administration.Öğe Thrombin-Activatable Fibrinolysis Inhibitor (TAFI) Antigen and Activity Assay in Patients With Primary Hypothyroidism(Sage Publications Inc, 2010) Ermantas, Nilay; Guldiken, Sibel; Demir, Muzaffer; Tugrul, ArmaganHypothyroidism causes a tendency for cardiovascular diseases. It was recently shown that thrombin-activatable fibrinolysis inhibitor (TAFI) attenuates fibrinolysis and also fibrin-plasminogen interaction by the removal of lysine and arginine residues from fibrin monomers. The aim of this study was to determine the effects of overt hypothyroidism on the levels of TAFI antigen (TAFI Ag) and TAFI activity (TAFIa). Thirty-one overt primary hypothyroid patients and age- and gender-matched 25 healthy controls were enrolled in the study. Patients were treated with L-thyroxine after the collection of blood samples. Thyroid functions were reevaluated following the achievement of euthyroid status. Thrombin-activatable fibrinolysis inhibitor Ag, tissue plasminogen activator (t-PA), and plasminogen activator inhibitor 1 (PAI-1) levels were measured with the enzyme-linked immunosorbent assay (ELISA). Thrombin-activatable fibrinolysis inhibitor activity was assessed with the chromogenic assay. Thrombin-activatable fibrinolysis inhibitor Ag (1.63% +/- 0.42% vs 1.32% +/- 0.36%, P < .01) and TAFIa (14.2 +/- 4.12 vs 11.6 +/- 3.49 mu g/mL, P < .05) levels were elevated in hypothyroid patient compared to controls. Plasminogen activator inhibitor 1 and t-PA levels were not significantly different between both groups. In hypothyroid patients, TAFI Ag levels were correlated with free T-4 (r = -.373, P < .05) and thyroid-stimulating hormone (TSH) levels (r = .748, P < .001). Regression analysis showed that TSH levels were predictors of TAFI Ag levels (P < .001, beta = .671, 95% confidence interval [CI]: 0.008-0.017). Following L-thyroxine treatment, TAFI Ag (1.63% +/- 0.42%, 1.34% +/- 0.33%, P < .05) and TAFIa (14.2 +/- 4.12 mu g/mL, 12.0 +/- 2.77 mu g/mL, P < .05) levels were significantly decreased, but t-PA and PAI-1 levels remained unchanged. This results point out that the fibrinolytic activity was decreased in hypothyroid patients, and therefore the achievement of euthyroid status is important in ameliorating the increased risk of cardiovascular disease.
