OBJECTIVE:To assess the relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus in Turkish pregnant women according to the severity of 25-hydroxyvitamin D deficiency and assess intact parathyroid hormone levels in women with gestational diabetes mellitus and controls with low and sufficient 25-hydroxyvitamin D levels.METHODS:We analyzed serum 25-hydroxyvitamin D and intact parathyroid hormone levels in 234 women with gestational diabetes mellitus and 168 controls. To define the deficiency status, 25-hydroxyvitamin D levels were further classified into severely deficient, deficient, insufficient and sufficient groups.RESULTS:Women with gestational diabetes mellitus had significantly lower 25-hydroxyvitamin D levels compared to controls (30.8±16.3 vs. 36.0±16.2 nmol/L). However, when subgroups of 25-hydroxyvitamin D were analyzed, gestational diabetes mellitus was significantly more common only in women with severely deficient 25-hydroxyvitamin D levels. After adjusting for covariates, only severely deficient 25-hydroxyvitamin D levels were independently associated with an increased relative risk of gestational diabetes mellitus. The relative risk of gestational diabetes mellitus in women with insufficient and deficient 25-hydroxyvitamin D levels was not statistically significant. Intact parathyroid hormone concentrations were also significantly higher in women with gestational diabetes mellitus compared to the controls (45.3±26.2 vs. 38.7±27.6 pg/ml).CONCLUSIONS:The results obtained from this study provide novel data indicating that only severely deficient maternal serum 25-hydroxyvitamin D levels are significantly associated with an elevated relative risk of gestational diabetes mellitus, even after adjusting for established risk factors of gestational diabetes mellitus.

AIm:To compare anterior pituitary functions between subjects with total and partial primary empty sella (PES) and to assess whether all cases with PES need endocrinological evaluation. mATERIAL and mETHods: Eighty-one subjects with PES (34 total and 47 partial) were included in the study. Basal anterior pituitary and its target hormones were assessed and those with low insulin like growth factor-1 and/or low basal cortisol levels underwent insulin tolerance test (ITT).REsuLTs: 67.4% of the subjects with total and 14.9% of those with partial PES had different degrees of hypopituitarism. However, the frequency of hypopituitarism was significantly higher in cases with total PES. The odds ratio (OR) and 95% confidence interval (CI) of secondary hypothyroidism, secondary adrenal, growth hormone and gonadotropin deficiency in subjects with total compared to those with partial PES were as follows: OR = 20.0, 95% CI 4.16 -95.9, OR = 2.4, 95% CI 1.34 -5.7, OR = 15.3, 95% CI 4.48 -52.6 and OR = 10.6, 95% CI 3.37 -33.5, respectively. CoNCLusIoN:A substantial number of subjects with PES, particularly those with total PES, have pituitary hormone deficiency, so regardless of the type of PES, all subjects must be promptly and carefully evaluated for anterior pituitary hormone deficiency.KEywoRds: Primary empty sella, Hypopituitarism, Clinical evaluation, MRI ÖZ AmAÇ: Bu çalışmada parsiyel ve total primer boş sella (PBS) olguları arasında ön hipofiz fonksiyonları bakımından karşılaştırma yapılması ve tüm olgularda endokrinolojik değerlendirme gerekliliğinin saptanması amaçlanmıştır. yÖNTEm ve GEREÇLER: PBS tanısı konan 81 olgu (34 total ve 47 parsiyel) çalışmaya dahil edildi. Tüm olguların bazal ön hipofiz ve bunların hedef hormonlarının düzeylerine bakıldı, insülin benzeri büyüme faktörü-1 ve/veya bazal kortizol düzeyi düşük olan olgulara insülin tolerans testi (İTT) uygulandı.BuLGuLAR: Total PBS'sı olan olguların % 67,4'ü ve parsiyel PBS'sı olan olguların %14,9'unda değişik düzeylerde hipopituitarizm saptandı. Ancak total PBS'sı olan olgularda hipopituitarizm belirgin olarak daha yüksek bulundu. Sekonder hipotiroidizm, sekonder adrenal yetmezlik, büyüme hormonu ve gonadotropin eksikliklerinin total PBS'sı olan olgularda parsiyel PBS'sı olan olgulara kıyasla odds oranları (OR) ve %95 güven aralıkları (%95 GA) sırasıyla OR = 20,0; %95 GA 4,9;OR = 2,4; %95 GA 1,7;OR = 15,3; %95 GA 4,[48][49][50][51][52]6 ve OR = 10,6; %95 GA 3,37 -33,5 bulundu. soNuÇ: Bu çalışmanın sonuçları özellikle total PBS'sı olan olgular olmak üzere PBS'sı olan olguların önemli bir kısmında değişik düzeylerde hipopituitarizmin varlığını göstermektedir. Bu nedenle PBS'nın tipine bakılmaksızın tüm olgular ön hipofiz hormon yetmezliği bakımından en kısa sürede uygun bir şekilde değerlendirilmelidirler.ANAHTAR sÖZCÜKLER: Primer boş sella, Hipopituitarizm, Klinik değerlendirme, MRG

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The low levels of HDL in AP cases during acute attack are associated with severity of the disease.

In hypothyroid cases, H. pylori gastritis may be responsible for an inadequate response to the treatment. H. pylori eradication in the cases receiving high doses of thyroxine has a risk for thyrotoxicosis.

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OBJECTIVE:To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.METHODS:The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age- and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography.RESULTS:The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease.CONCLUSIONS:This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

Recent publications suggest the utility of temozolomide (TMZ) in the management of aggressive pituitary adenomas and carcinomas, resistant to conventional treatments. The response to TMZ is inversely correlated with tumoral expression of O-6 methylguanine DNA methyl transferase (MGMT). Therefore, we aimed to assess MGMT immunoexpression in pure GH-secreting pituitary adenomas, in an effort to predict the likelihood of response to TMZ, and to correlate MGMT immunoexpression with Ki-67 LI and cytokeratin (CK) distribution pattern. Our material consisted of 36 GH-secreting pituitary adenomas (21 female,15 male, mean age 42.5±10.5), operated at our center between 2003 and 2010. Immunostaining for MGMT, Ki-67, and CK was performed using avidin-biotin-peroxidase complex method. Immunoreactivity for MGMT and Ki-67 was evaluated microscopically and recorded as percentages of positive nuclear immunostaining. CK distribution pattern was also evaluated microscopically and assoreted into dot-like and nondot-like pattern subtypes. MGMT immunoexpression scored as 0=none, 1=<10%, 2=<25%, 3=<50%, and 4=>50%. Staining for MGMT was <10% (score 1) in 30 (83.3%), 10-25% (score 2) in 3 (8.3%), 25-50% (score 3) in 2 (5.6%) and >50% (score 4) in 1 (2.8%) of the tumors, respectively. There was no correlation between Ki-67 LI and CK distribution pattern with MGMT immunoreactivity (P>0.05). Data from the current study suggest a large proportion of GH-secreting adenomas, including those with dot-like CK distribution pattern and high Ki-67 LI, demonstrate negative/low MGMT immunoreactivity and could be treated with TMZ, if conventional treatment fails.