Daily life reflections of acromegaly guidelines.

PURPOSE: To determine the differences in acromegaly diagnosis, treatment, and follow-up among Turkish endocrinologists, and to investigate how the published guidelines are applied in clinical practice. METHODS: The questionnaire was formatted as an electronic survey, conducted between November and December 2015, and sent weekly for 6 weeks via e-mail to 528 endocrinologists in Turkey. RESULTS: The questionnaire was answered by 37.4 % of endocrinologists. Insulin-like growth factor-1 and nadir growth hormone level after 75 g oral glucose tolerance test (nadir GH-OGTT) were the most commonly preferred methods for the initial diagnosis. A total of 49.5 % of the participants reported using preoperative medical therapy (MT) either routinely or on a case-to-case basis. Somatostatin analogs were the most commonly used drugs, both in pre- and postoperative MT. Disease activity following surgery was assessed in the 3rd postoperative month using IGF-1 levels. Similarly, IGF-1 monitoring was preferred in the follow-up period. Monitoring nadir GH-OGTT levels was the most commonly used method in the assessment of discordant test results. The dose titration was done at month 3 after the start of MT. Resistance to SRLs was considered after using the maximal dose for at least 6 months. Pegvisomant was generally used in second- and third-line therapy. Similarly, cabergoline was not preferred in monotherapy by the majority of participants. Radiotherapy was considered in patients with incomplete response to surgery and medical treatments. CONCLUSIONS: Although there were subtle differences, clinical practice guidelines were usually followed among Turkish endocrinologists.

Effect of vitamin D deficiency and replacement on endothelial functions in Behçet's disease.

OBJECTIVES: Endothelial dysfunction is previously demonstrated in Behçet's disease (BD) and vitamin D is implicated to affect endothelial functions. We aimed to evaluate the status of serum 25(OH)Vit D3 levels and its association with disease activity, endothelial function and carotis intima media thickness (CIMT) in patients with BD. METHODS: Thirty-six BD (F/M: 22/14, mean age: 39.6 years) patients and 51 healthy controls (F/M: 28/23, mean age: 34.5 years) were studied. Rheumatoid arthritis (RA) (n=33) patients (F/M: 26/7, mean age: 50.82 years) were also enrolled, as a disease control group. Endothelial function was evaluated by brachial artery flow mediated dilatation (FMD) and CIMT with B-Mode ultrasound. The vitamin D-deficient BD patients received 1000 IU Vitamin D3 daily for 3 months. RESULTS: Less than 50 nmol/L levels of 25(OH) Vit D3 were present in 61.1% (n=22) of BD and 35.3% (n=18) of HC (serum 25(OH)Vit D3 levels: BD: 44.5 (9-112) vs HC: 56 (14-125) nmol/lt, p=0.01). CIMT and FMD were also significantly different between BD and HC [0.56 (0.35-9.26) vs. 0.39 (0-0.52) and 5.20 (0.56-30.58) vs. 9.04 (-6.9-34.17), p=0.001 and p=0.02, respectively]. However, no correlation was observed between 25(OH)VitD3 levels and CIMT or FMD (r=0.6, p=0.7 and r=0.03, p=0.8, respectively) at baseline. CIMT measurements improved after replacement therapy (0.56 vs. 0.49, p=0.02), FMD measurements also improved, but not reaching statistical significance (5.2 vs. 8.28, p=0.06). CONCLUSIONS: A high presence of vitamin D deficiency was observed in BD patients from Turkey and replacement of vitamin D had favourable effects on endothelial function.