A 50-year-old male was referred to our clinic for hypoglycemic attacks. He denied using oral antidiabetic drugs, insulin, or herbal substances but admitted using proton pump inhibitors, pregabalin, and alpha lipoic acid. Venous blood glucose level was 44 mg/dL, C-peptide was 15.6 ng/mL, and insulin levels were >1.000 µIU/mL. His BMI was 21.4. No evidence of pancreatic or extra pancreatic insulinoma was found in imaging studies. No diagnostic results were obtained in the selective calcium receptor stimulation test. Anti-insulin antibody test was positive. The insulin autoimmune syndrome was diagnosed with low glucose levels. The symptoms were associated with very high serum insulin levels, and the patient was positive for the anti-insulin antibody. Alpha lipoic acid and proton pump inhibitors, which may cause insulin autoimmune syndrome, were discontinued and alpha glucosidase inhibitor and diet therapy were started. During follow-up, the patient did not report hypoglycemia. Insulin autoimmune hypoglycemia should be kept in mind in patients with very high levels of insulin and without evidence of insulinoma.

Amaç: Tiroid hastalıkları sıklıkla saç, deri ve tırnaklarda çeşitli bulgulara neden olur. Bu bulguların bazıları tiroid hastalığının tedavisi ile gerileyebilir. Bu çalışmada tedavi altındaki tiroid hastalarında deri bulgularını değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu kesitsel çalışmaya tedavi altındaki 97 tiroid hastası ve 50 sağlıklı kontrol dahil edildi. Tiroid hastalığı otoimmün ve nonotoimmün olarak sınıflandırıldı. Tüm deri bulguları ve dermatolojik hastalıklar kaydedildi. Bulgular: Hasta grubunun 56'sında (%57,7) otoimmün, 41'inde (%43,3) non-otoimmün tiroid hastalığı mevcuttu. Seksen dört (%86,4) hasta tiroid hormon tedavisi, 13 (%23,6) hasta anti-tiroid tedavi alıyordu. Otoimmün grubun %73,2'sinde, non-otoimmün grubun %71,4'ünde ve kontrol grubunun %52'sinde en az bir deri bulgusu vardı (p=0,05). Kseroz (p=0,026), kaşıntı (p=0,00), fasiyal eritem (p=0,036), flushing (p=0,004), kuru saç (p=0,008), kırılgan tırnaklar (p=0,02), kuru tırnaklar (p=0,013) ve tırnaklarda uzunlamasına çizgiler (p=0,02) otoimmün grupta non-otoimmün ve kontrol grubuna göre daha sıktı. Alopesi (p=0,00) non-otoimmün grupta daha sıktı. Ayrıca, hasta grubunda diffüz hiperhidroz (p=0,016), tırnaklarda incelme (p=0,059) ve rozase hastalığı (p=0,03) kontrol grubundan daha sıktı. Tiroid hormon tedavisi alanlarda, en az bir deri bulgusu, kserozis ve çeşitli tırnak bulguları anti-tiroid tedavi alanlara göre daha sıktı. Ancak istatistiksel olarak anlamlı bir fark yoktu. Background and Design: Thyroid diseases often cause various findings in hair, skin and nails. Some of them may be regressed by the treatment of thyroid disease. We aimed to evaluate the cutaneous manifestations in patients with thyroid disease under treatment. Materials and Methods: This cross-sectional study included 97 consecutive patients with thyroid disease under treatment and 50 healthy controls. Thyroid disease was classiffied as autoimmune and non-autoimmune. All skin findings and dermatological diseases were recorded. Results: Of the patient group, 56 (57.7%) had autoimmune, 41 (43.3%) had non-autoimmune thyroid disease. Eighty-four (86.4%) patients were under thyroid hormone therapy and 13 (23.6%) patients were under anti-thyroid therapy. 73.2% of the autoimmune group, 71.4% of non-autoimmune group and 52% of the control group had at least one cutaneous manifestation (p=0.05). Xerosis (p=0.026), pruritus (p=0.00), facial erythema (p=0.036), flushing (p=0.004), dry hair (p=0.008), brittle nails (p=0.02), dry nails (p=0.013) and longitudinal streaking on nails (p=0.02) were more frequent in the autoimmune group than in the non-autoimmune and control group. Alopecia (p=0.00) was more frequent in the non-autoimmune group. Furthermore diffuse hyperhidrosis (p=0.016), thinning of nails (p=0.059) and rosacea disease (p=0.03) were more common in the patient group than in the control group. At least one cutaneous manifestation, xerosis and various nail findings were more common in patients under thyroid hormone therapy than in patients under anti-thyroid therapy, but t...

Objectives: Insulin therapy is associated with skin-related complications, such as lipoatrophy, lipohypertrophy (LH), edema, and allergy. Lipohypertrophy (LH) is the most common cutaneous complication of injectable insulin therapy in the treatment of diabetes. Our aim in this study was to evaluate skin-related complications in diabetic patients receiving insulin therapy. Methods: In this study, diabetic patients who were treated with insulin therapy in Endocrinology Department between 2015 and 2018 were evaluated. Observation and palpation technique was used in the evaluation of lipohypertrophy in diabetic subjects. The degree of lipohypertrophy was classified as follows: grade 0 = no change; grade 1 = visible hypertrophy of fat tissue but with normal consistency on palpation; grade 2 = intensive fat tissue thickening but with firm consistency; and grade 3 = lipoatrophy Results: A total of 204 diabetic participants (52, 5 % female) were evaluated. The number of patients using insulin for more than 10 years was 81 (39,7%). The 4-mm needle was used more commonly in the study (54, 4 %). The recommended injection sites are the abdomen, thigh, arm and buttocks. Overall, 55, 9 % of patients were injecting insulin in the area of abdomen and 40, 2 % were injecting insulin four times per day. The ratio of the patients who do not change needle tip for each injection was 43,6%. In addition, lipohypertrophy was seen in 61, 8 % of the 204 diabetics in the study and most patients were revealed to have grade 1 (35,3%). Lipoatrophy was seen in 5.6% of the patients. Of the cases diagnosed as lipohypertrophy, 56, 3 % were women and 43,7% were men. Females were significantly more likely to have LH than males were (P = 0.042). Conclusions: Increased prevelance of lipohypertrophy is an important complication of insulin therapy and clinicians must be aware of this complication. Disclosure B. Aydin Buyruk: None. N. Kebapci: None. G. Yorulmaz: None. E. Alaguney: None. A. Akalin: None. B. Efe: None.

Background/aim: It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients. Materials and methods:In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained. Results:In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003).

Background/aim: Hyperparathyroidism is an endocrine disorder characterized by hypercalcemia. Because of calcium's effects on parathyroid glands, bone, intestines, and kidneys, it has an important place in homeostasis. The results of studies regarding hyperparathyroidism hemostasis are conflicting. Thromboelastography helps to evaluate all steps of hemostatic system. Our aim in this study was to investigate the possible role of hemostatic mechanisms in the development of thrombosis in hyperparathyroid patients with the modified rotation thromboelastogram (ROTEM). Materials and methods: Twenty-two patients with primary hyperparathyroidism (PHPT) and 20 healthy controls were involved. This study was conducted in Eskisehir Osmangazi University Faculty of Medicine, Endocrinology and Hematology clinics for 2 years. The complete blood count, fibrinogen, D-dimer levels, prothrombin time, activated prothrombin time, and ROTEM parameters [clot formation time (CFT), clotting time (CT), and maximum clot formation (MCF)] were determined by two activated tests, INTEM and EXTEM analyses. A thromboelastographic evaluation was performed in the preoperative and postoperative (3 months after surgery) periods.Results: In INTEM assay, the CT (p = 0.012) and CFT (p = 0.07) values were increased in preoperative PHPT patients compared with the control group. Although there was a decrease in the postoperative CT and CFT values, no statistical difference was found. Conclusion:The prolongation of the CT and CFT values were consistent with a hypocoagulable state in patients with PHPT. Hyperparathyroidism causes a hypocoagulable state that can be successfully assessed by ROTEM. Hemostatic changes, do not seem to have an effect on increased cardiovascular mortality.