Background Insulinomas constituting the most common cause of endogenous hyperinsulinism-related hypoglycemia are neuroendocrine tumors originating from pancreatic beta cells. They are generally benign and solitary lesions. Although most cases are sporadic, multiple endocrine neoplasia (MEN) 1-related patients are also present. Material and Methods Thirteen patients followed up in Bursa Uludag University Medical Faculty Endocrinology and Metabolic diseases clinic between the years 2012 and 2021 were retrospectively evaluated. Demographical, clinical, biochemical, radiological and histopathological data of the patients were assessed. Results Eight of the patients were females, and five were males with an average age of 43±14.9 years. Ten of the patients had sporadic, and three had MEN1 syndrome-related insulinoma. During the prolonged fasting test, the patients had a mean lowest plasma glucose level of 36.4±6.2 mg/dL with a simultaneous mean insulin level of 11.3 (4.4-214.1) mIU/L and c-peptide level of 2.8 (0.46-12.8) mcg/L. In preoperative localization studies, a lesion was detected in 11 out of 13 (84.6%) patients with upper abdominal computed tomography and 6 out of 10 patients (60%) with magnetic resonance imaging. Six patients had grade 1, and 7 patients had grade 2 neuroendocrine tumor. The whole group's mean lesion diameter was 15 (11-48) mm. The mean patient follow-up duration was 30.5±23 months. Hypoglycemia recurred in none of the patients in the postoperative period, and only two patients (15.4%) developed postoperative diabetes mellitus. Conclusions Preoperative localization rates in insulinomas increased due to non-invasive imaging methods and technological developments in recent years. This will probably cause earlier diagnosis and treatment, and pancreas preserving surgery option will be more available in most insulinoma cases.

Background: Radiofrequency ablation (RFA) is used in selected patients with recurrent or metastatic thyroid cancer who have high surgical risk or do not accept surgical treatment. However, long-term follow-up data are limited. Here, we present our single-center experience with the use of RFA in the treatment of recurrent or metastatic papillary thyroid carcinoma (PTC). Material and Methods: Patients who underwent RFA for recurrent or metastatic PTC at Bursa Uludag University Faculty of Medicine between September 2014 and January 2021 were included. The data in the endocrinology outpatient clinic follow-ups of the patients were analyzed retrospectively. Results: A total of 10 patients, 11 RFA procedures, and 13 residual or metastatic sites were evaluated. The mean age was 44.50±14.04 years. The mean largest diameter of the tumor in which RFA was applied was 11.85±5.95 mm. Patients developed no major complications. Two patients experienced minor complications. The mean follow-up duration was of 51.20±19.86 months. During the follow-up period, 12 (92.30%) of 13 RFA sites completely disappeared. In one patient (7.69%) residual tumor tissue was detected after RFA. There was no recurrence at the procedure site. A significant decrease was found in the largest diameter of the treated regions after RFA (p=0.002). Thyroglobulin and anti-thyroglobulin levels were not significantly different before and after RFA (p=0.44 and p=1.00, respectively). Conclusions: RFA is highly effective and safe for locally recurrent PTC. It shows promise as an alternative to surgery to control locoregional recurrence of PTC.

Background Therapeutic plasma exchange (TPE) is a treatment method that can be used to provide euthyroidism before permanent treatment in patients with severe thyrotoxicosis, in cases of thyroid storm and in cases where antithyroid drug (ATD) cannot be used due to side effects or ineffectiveness. This study presented our results and experience on TPE in thyrotoxic patients. Material and MethodsThe data of 10 patients who underwent plasmapheresis for thyrotoxicosis in Bursa Uludag University Faculty of Medicine Endocrinology Clinic were retrospectively analyzed and compared with the literature. Results Ten patients, 6 female and 4 male, were included. The cause of hyperthyroidism was Graves' disease in 8 patients and toxic multinodular goiter (TMNG) in 2 patients. It was observed that the reason for applying plasmapheresis in the patients was primarily due to toxic hepatitis. The mean number of plasmapheresis required to maintain euthyroidism was 4 (1-8). While no difference was found between the thyroid-stimulating hormone (TSH) results before and after TPE, free T4 (fT4) and free T3 (fT3) values were statistically significantly lower after TPE. It was observed that the leukocytes were considerably higher after TPE and the sodium and calcium values were markedly lower after TPE in the patients. After TPE, 7 patients underwent total thyroidectomy, 1 patient received radioactive iodine (RAI) treatment, and 2 were discharged with ATD treatment. Conclusions TPE is an effective and safe treatment option that can be applied in cases where it is necessary to provide rapid euthyroidism before permanent treatments or non-thyroid surgical procedures or to treat life-threatening thyrotoxicosis. It requires experience in application and follow-up and provides rapid euthyroidism when performed in experienced centres.

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Background Primary hyperaldosteronism (PHA) is a primarily treatable cause of arterial hypertension characterized by low plasma renin and high aldosterone levels. The prevalence of secondary hypertension as a common endocrine cause is 5-13%. The plasma aldosterone/renin ratio (ARR) is the best available method for PHA screening. One or more confirmatory tests may be required to confirm or exclude patients' diagnoses. One frequently used confirmatory test is the saline infusion test (SIT). We aimed to screen the patients who underwent SIT with the preliminary diagnosis of PHA and to compare the results of the patients diagnosed with essential hypertension (EH) and PHA. Material and Methods Seventy-seven patients with a history of drug-resistant hypertension or unexplained spontaneous or diuretic-induced hypokalemia or adrenal incidentaloma, or a family history of earlyonset hypertension or cerebrovascular accident at a young age (<40 years) and undergoing saline infusion testing were included in the study. Results Twenty-six (33.8%) of the patients were male, and 51 (66.2%) were female. The mean age of the patients was 54.5±13.7 years. EH was present in 39 (50.6%) patients, and PHA was present in 38 (49.4%) patients. Patients with PHA and EH were compared. There was no significant difference between mean systolic blood pressure, diastolic blood pressure, potassium, and aldosterone renin ratio (ARR) in the two groups (p>0.05). Basal plasma aldosterone (p<0.05), SIT 0 th , and 4 th -hour plasma aldosterone levels (p<0.01) was significantly higher in PHA than in EH. Aldosterone synthesizing adenoma (ASA) and idiopathic hyperaldosteronism (IHA) were compared. There were no significant differences between basal plasma aldosterone, SIT 0 th , and 4 th -hour plasma aldosterone levels, ARR, and potassium values (p>0.05). The mean sodium value was significantly higher than the IHA (p <0.05). Conclusions Our study determined that the saline infusion test could be used to confirm the diagnosis of primary hyperaldosteronism. Its use alone was not sufficient in the differential diagnosis of aldosteronesynthesizing adenoma and idiopathic hyperaldosteronism.