Relationship Between Dexamethasone Suppression Test Cortisol Level >0.9 µg/dL and Depression and Quality of Life in Adrenal Incidentalomas: A Single Center Observational Case-Control Study.

OBJECTIVE: There has been increasing evidence that patients with adrenal incidentalomas (AIs) who have 1-mg dexamethasone suppression test (DST) cortisol levels >0.9 µg/dL may be exposed to the adverse consequences of hypercortisolaemia. We aim to evaluate whether there is a difference in Beck Depression Inventory-II (BDI-II) and quality of life (QoL) score in patients with AI based on the threshold of a DST cortisol level >0.9 µg/dL. METHODS: This case-control study included 42 nonfunctional adrenal incidentaloma (NFAI), 53 mild autonomic cortisol secretion (MACS) and 42 healthy controls (HCs). In addition, patients were categorized as ≤0.9 and >0.9 µg/dL according to their DST cortisol results. RESULTS: There was no difference in the QoL and BDI-II scores of MACS compared to NFAI. The BDI-II score was higher and QoL was lower in MACS and NFAI compared to HCs. The difference in QoL and BDI-II scores between MACS and NFAI remained insignificant when the DST cortisol levels threshold was graded upward (5.0 µg/dL). The prevalence of depression was higher in the AI >0.9 µg/dL group than the AI ≤0.9 µg/dL group (respectively, 16.7% and 55.8%, P = .003), BDI-II scores were higher in the AI >0.9 µg/dL group than in the AI ≤0.9 µg/dL group and HCs. The DST was an independent factor affecting the frequency of depression (odds ratio: 1.39, P = .037). CONCLUSION: MACS and patients with NFAI had similar QoL and depression scores according to the 1.8 µg/dL and above, whereas, had lower QoL and higher depression scores according to the 0.9 µg/dL.

Increased Prevalence of Autoimmune Rheumatologic Diseases in Patients With Primary Hyperparathyroidism.

Background Parathyroid hormone (PTH) and Dickkopf-related protein 1 (DKK-1) have been mentioned together at the intersection of autoimmune rheumatologic diseases (ARDs) and osteoimmunology. However, few studies have evaluated the association between primary hyperparathyroidism (PHPT) and ARDs. Methodology This retrospective study included 225 PHPT patients and 386 patients with thyroid nodules as a control group. The electronic hospital records of all patients were screened going back nine years for the presence of ARDs. Patients who were diagnosed at least three months ago, had complete serologic tests, and were continuing with rheumatologic follow-up were included. Results The prevalence of ARDs in the PHPT group was 9.77% (22/225), while the prevalence of ARDs in the CG was 1.04% (4/386, p < 0.001). The prevalence of rheumatoid arthritis in the PHPT group was 4.4% (10/225), ankylosing spondylitis 3.1% (7/225), systemic lupus erythematosus 0.88% (2/225), Behçet's disease 0.88% (2/225), and mixed connective tissue disease 0.44% (1/225). Of the 22 patients with ARDs, 21 (95.45%) were diagnosed before they were diagnosed with PHPT, and the median time from diagnosis with ARD to the onset of PHPT was 36 months (interquartile range = 61.5). Logistic regression analysis showed a positive correlation between the duration of PHPT and ARDs (odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.02-1.09, p < 0.001) and a negative correlation between ARDs and calcium levels (OR = 0.26; 95% CI = 0.09-0.79, p = 0.018). Conclusions The prevalence of ARDs increased in PHPT patients and PHPT accompanying ARDs developed after rheumatologic disease. ARDs with PHPT are cases with a prolonged duration of PHPT and mildly elevated calcium, probably preceded by parathyroid hyperplasia. Therefore, the factors that cause ARDs may trigger a process that leads to mild PHPT.

Tissue Parathyroid Hormone Washout: A Reliable Method for the Localization and Exclusion of Parathyroid Adenomas.

Background and objective Accurate identification of parathyroid adenoma (PA) is essential for minimally invasive treatment of primary hyperparathyroidism (PHPT). The aim of this study is to evaluate the results of parathyroid hormone (PTH) assay in aspirates of suspicious neck lesions and to clarify its reliability in determining whether the lesion is of parathyroid origin. Methods A total of 134 lesions (104 imaging-suspected PA and 30 concomitant thyroid nodules as a control group) of 101 patients were retrospectively analyzed. Patients with positive, negative, or never scintigraphy were included in our study. Ultrasound (US) was performed again and US-guided tissue fine needle aspiration with PTH washout (PTH-WO) was performed from suspicious lesions. A PTH-WO level higher than the patient's serum PTH levels is proposed for a positive test, and a PTH-WO level lower than the upper limit of the laboratory PTH level is proposed for a negative test. A definitive diagnosis was made postoperatively histopathologically. Results PTH-WO levels (median (IQR)) were significantly higher in the positive group (n = 93, 5000 (1600) ng/L) compared to the negative group (n = 11, 17 (13.1) ng/L) and thyroid nodule aspirate group (n = 30, 14 (4.3) ng/L) (p < 0.001). Among 93 PTH-WO-positive lesions, 42 lesions (45.1%) were not identified by parathyroid scintigraphy (PS), 20 (21.5%) lesions were suspiciously PS, and 33 lesions (35.4%) were negative or suspicious by first US findings. Of the 93 patients localized with PTH-WO, two were cystic PAs ablated by aspiration. The final pathology result of 91 operated patients proved PA. The sensitivity, specificity, negative predictive value, and positive predictive value of the PTH-WO were observed as 1.00, 0.82, 0.09, and 0.91, respectively. Conclusion Comprehensive repeated US and PTH-WO from the lesion increase the accurate localization of PAs. PTH-WO is a highly reliable method for differentiating parathyroid lesions from other cervical lesions.

The Impact of Moderate Hypophosphatemia on the Clinical Management of Primary Hyperparathyroidism.

Background and objective The impact of moderate hypophosphatemia (hypoP) on primary hyperparathyroidism (PHPT) and its use as an independent surgical criterion has not been adequately evaluated in the literature. In light of this, we conducted this study to address the scarcity of data on this topic. Methods We conducted a retrospective evaluation of data related to 164 (133 females and 31 males) patients with PHPT who met the criteria for inclusion in the study. HypoP, which is indicated by phosphorus (P) levels lower than 2.5 mg/dL, was found in 78 (47.5%) patients, and moderate hypoP (1-1.99 mg/dL) was found in 25 patients (15.2%). Results PHPT severity was worse in hypoP patients than non-hypoP patients, as evidenced by higher levels of mean serum calcium (12.9 ±1.0 mg/dL vs. 11.1 ±0.3 mg/dL respectively, p<0.001), parathormone (PTH) [median (interquartile range, IQR): 455.3 (455.3) ng/L vs. 124.0 (84.0) ng/L respectively, p<0.001] and mean 24-hour urinary calcium (414.6 ±168.5 mg/day vs. 291.5 ±161.4 mg/day respectively, p=0.026) as well as lower levels of mean BMI (25.6 ±3.9 kg/m2 vs. 29.0 ±4.0 kg/m2 respectively, p=0.18) and mean 25-hydroxy vitamin D3 (13.8 ±7.3 µg/L vs. 18.2 ±7.8 µg/L respectively, p=0.001). Among the whole study population as well as among patients with Ca levels <1.0 mg/dL according to the upper limit of normal, P level was determined to be an independent factor affecting the indication for surgical treatment [ß: -1.96,p=0.038, odds ratio (OR): 0.14, 95% confidence interval (CI): 0.02-0.89 and ß: -2.3, p=0.034, OR: 0.10, 95% CI: 0.12-0.84 respectively]. Conclusion We found a strong correlation between moderate hypoP and the severity of the biochemical manifestations of PHPT. In asymptomatic PHPT patients, moderate hypoP was predictive of surgical indication, independent of age and level of hypercalcemia.

Topical Insulin as an Add-On Therapy for Leg Ulcer: A Case Report.

Leg ulcers affect millions of people worldwide, and are a significant cause of morbidity and mortality. Various factors can be etiological agents of leg ulcers such as vascular, neuropathic, infectious, and traumatic factors. Treatment of the leg ulcer can be difficult in some cases despite using different systemic treatments and local wound care, but various newly defined treatment modalities are discussed in the literature and topical insulin application is one of them. Insulin is a hormone that is essential for regulating blood glucose and lipid levels, also insulin can have local effects when applied topically. Various mechanisms like regulation of inflammation, collagen synthesis, and angiogenesis have been explained to understand topical insulin's effects on the wound. There are case reports and studies on the usage of topical insulin on diabetic ulcers and decubitus ulcers. We applied topical insulin as an add-on therapy on a treatment-resistant leg ulcer and observed the healing of the lesion. The use of topical insulin as an add-on therapy may reduce treatment time and speed up wound healing. Topical insulin can be considered as an additional therapy for treatment-resistant ulcers.

Effects of Pilates-Based Exercises on Functional Capacity and Mental Health in Individuals with Schizophrenia: A Pilot Study.

BACKGROUND: Although there is considerable evidence that exercise improves the physical and mental health of individuals with schizophrenia, the most useful exercise technique for this population is still the subject of research. PURPOSE: The aim of this study was to investigate the effects of Pilates exercises on functional capacity and mental health in individuals with schizophrenia. METHODS: Twenty-three participants were not randomly assigned to either Pilates exercise group (PEG) or nonspecific exercise group (NSEG). Ten participants from each group completed the study (87% response rate). The PEG participated in a 6-week Pilates exercise training twice per week, while the NSEG participated in a nonspecific activity program. 6-Minute Walk Distance (6-MWD) was assessed for functional capacity. Mental health was evaluated using Calgary Depression Scale for Schizophrenia (CDSS), and Brief Psychiatric Rating Scale (BPRS). RESULTS: 6-MWD significantly increased (p = .025), CDSS (p = .023) and BPRS (p = .012) scores significantly decreased in the PEG compared to baseline. Inter-group comparison showed that PEG had significantly better scores than NSEG in terms of the final 6-MWD (p = .005), CDSS (p = .008) and BPRS (p = .008). CONCLUSION: Results showed that Pilates may help improve the functional capacity and mental health of individuals with schizophrenia, but the small sample size and methodological limitations limit the interpretability of this study.

Comparison of the effects of medical and surgical treatments in giant prolactinoma: a single-center experience.

PURPOSE: Giant prolactinomas, which have extremely large sizes and high prolactin (PRL) values, are rarely seen. Although medical therapy is effective, surgical treatment is more frequently applied due to slightly lower response rates and compression symptoms. This study aimed to compare the medical and surgical treatment results in giant prolactinomas. METHODS: Thirty-nine patients who were followed up in our center for giant prolactinoma were included in the study, and the response rates of the patients were evaluated after the medical and surgical treatments. The treatment responses were compared in terms of tumor volume, PRL level, visual field, and pituitary function. RESULTS: The outcomes of the 66 treatment periods (medical n = 42; surgical n = 24) in 39 patients (mean age, 47.2 years; men, 89.7%) were evaluated. The most common presentations were hypogonadism and visual defects. The mean longest tumor diameter at diagnosis was 52.2 ± 11.8 mm, and the median PRL levels were 5000 ng/mL. PRL level normalization was achieved in 69% with medical therapy, and a curative response was obtained in only two patients with surgery. Tumor volume reduction was 67% (no cure) in the medical and 75% (13% cure) in the surgical groups (p = 0.39). Improvement of visual field was 70.8% in the medical and 84.2% in the surgical group (p = 0.12). CONCLUSION: In our study, it was observed that medical therapy was effective and safe in patients with giant prolactinomas. The use of surgical treatment should be limited to prolactinomas with compression or post-resistance to medical treatment in serious cases.

[Comparison of patients with schizophrenia, obsessive-compulsive disorder, and schizophrenia with accompanying obsessive-compulsive symptoms]. / Obsesif kompulsif belirtileri olan sizofreni hastalarinin sizofreni ve obsesif kompulsif bozukluk hastalari ile karsilastirilmasi.

OBJECTIVE: The present study aimed to determine if schizophrenic patients with OC-symptoms represent a subtype of schizophrenia and to evaluate the differences between schizophrenic patients with OC symptoms and OCD patients. METHODS: The study included 20 patients diagnosed with OCD, 40 schizophrenic patients, and 20 schizophrenic patients with OC symptoms. While the distribution and the severity of psychotic symptoms in the OC-schizophrenia group were compared to those of the schizophrenic patients, and while the distribution and severity of obsessive-compulsive symptoms of the OC-schizophrenia group were compared to OCD patients, all 3 groups were compared to each other in terms of demographic data and other clinical characteristics. RESULTS: There were no differences in the distribution and severity of psychotic symptoms between the OC-schizophrenia group and the schizophrenia group. Moreover, the distribution and severity of OC symptoms in the OC-schizophrenia group were no different than those in the OCD group. Brief Disability Questionnaire scores were significantly higher in the OC-schizophrenia group than in the other 2 groups. Hamilton Depression Scale and Hamilton Anxiety Scale mean scores were significantly higher in the OCD and OC-schizophrenia groups than in the schizophrenia group. Moreover, Yale-Brown Obsessive-Compulsive Scale total scores were not correlated to the Scale for the Assessment of Negative Symptoms or the Scale for the Assessment of Positive Symptoms scores in the OC-schizophrenia group. CONCLUSION: According to our results OC-schizophrenia might be a sub-type of schizophrenia, which doesn't have more severe psychotic symptoms, but more severe depression and anxiety, which are related to greater disability.