Browsing by Author "Algün, E"

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Clinical Characteristics and Genetic Screening of an Extended Family With Men2a
(Editrice Kurtis S R L, 2002) Algün, E; Abaci, N; Kösem, M; Kotan, C; Köseoglu, B; Boztepe, H; Aksoy, H
MEN-2A is characterized by medullary thyroid carcinoma (MTC) with pheochromocytoma and sometimes parathyroid adenoma. In affected members of the family, the risk of MTC is about 100%. Biochemical screening allows tumors to be detected early but even at this stage treatment is not always curative. Missense mutations in exon 10 and 11 of the RET proto-oncogene are associated with MEN2A. Early detection of this mutation by DNA analysis allows the identification of the carriers of the gene. We performed genetic screening in 88 members of an extended family with MEN2A and found 18 members positive for RET mutation (Cys634Gly). Only three of these 18 RET positive cases had a previous diagnosis of medullary cancer and/or pheochromocytoma. Up to now, 12 of the RET positive cases have undergone thyroidectomy. There was extended disease with cervical lymph node metastasis in 6 of them, bilateral medullary microcancer in 3 and c-cell hyperplasia in the remaining 3. Three of the 18 RET positive patients had also pheochromocytoma. Primary hyperparathyroidism was present in only one patient. The mean age of diagnosis of medullary cancer was between 25-50 yr and mean age of death was between 35-95 yr in affected members of the family. The family had many other affected members in other cities in Turkey and in other countries throughout the world from Australia to the Netherlands. So this family is perhaps one of the most extended families with MEN2A. (C) 2002, Editrice Kurtis.
Clinical Laboratory Findings and Results of Therapy in 55 Patients With Cushing's Syndrome
(Editrice Kurtis S R L, 2003) Erem, C; Algün, E; Ozbey, N; Azezli, A; Aral, F; Orhan, Y; Sencer, E
In this study, 55 patients with Cushing's syndrome (CS) (50 female, 5 male; mean age 34+/-12.3 yr) who attended our clinics between the years 1983 and 2000 were retrospectively evaluated for clinical and laboratory features and modalities and results of therapy, due to a few similar studies over the last ten years. Cushing's disease was diagnosed in 39 patients (71%), adrenal adenoma in 13 patients (23.6%) and adrenal carcinoma in 3 patients (5.5%). Centripedal obesity, moon face, hypertension, hirsutism and purplish stria were the most frequent findings. Loss of normal serum F circadian rhythm was found in all patients with CS. The overnight 1 mg oral dexamethasone suppression test and low-dose dexamethasone suppression test (LDDST) yielded 100% and 100% diagnostic sensitivity for CS, respectively. Sensitivity and specivity of the high-dose dexamethasone suppression test (HDDST) in distinguishing Cushing's disease was found to be 82% and 100%, respectively. All of the patients with adrenal CS were not suppressed with HDDST. Sellir CT and/or MRI accurately identified the tumor in 58% of these patients. Recurrence was observed in 3 (11%) of the 28 patients with Cushing's disease, treated by transsphenoidal adenomectomy. Recurrence was diagnosed 1.5, 3 and 6 yr after the operation in these 3 patients. One patient had residue tumor. In our case series, bilateral adrenalectomy plus pituitary irradiation achieved the highest remission rate (100%) in Cushing's disease. In 2 out of 4 patients (50%) treated by left adrenalectomy associated with pituitary irradiation, recurrence was observed. Panhypopituitarism due to tumor apoplexy was observed in one of the patients with Cushing's disease. All of the patients with adrenal CS, the tumor was accurately localized with imaging methods before the operation. The appropriate operative procedure resulted in complete remission in patients with adrenal adenoma. Consequently, Cushing's disease was the most common form of CS. The overnight 1 mg oral DST and 24-h urine free IF excretion (UFC) as screening tests, 2-day LDDST as diagnostic test and 2-day HDDST as differential diagnostic test were good studies. More successful outcomes have been achieved in treatment of Cushing's disease with the development of pituitary surgery in the recent years, as well as in our case series. Surgery is also curative for adrenal adenoma patients. Survival remains poor among carcinoma patients. ((C))2003, Editrice Kurtis.
Coexistence of Subacute Thyroiditis and Renal Cell Carcinoma
(Canadian Medical Association, 2003) Algün, E; Alici, S; Topal, C; Ugras, S; Erkoç, R; Sakarya, ME; Özbey, N
RENAL CELL CARCINOMA IS CHARACTERIZED by varied manifestations, which include unusual metastatic sites and paraneoplastic and vascular syndromes. We describe the case of a 57-year-old man who presented with high fever, weight loss, palpitations and a tender goitre. We suggest that, in this patient, subacute thyroiditis manifested as a paraneoplastic syndrome of renal cell carcinoma.
Coexistent Thyroid Pathologies and High Rate of Papillary Cancer in Patients With Primary Hyperparathyroidism
(Acta Medical Belgica, 2004) Kösem, M; Algün, E; Kotan, Ç; Harman, M; Öztürk, M
Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999-2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6%) had coexistent papillary thyroid cancer. Nine patients (17.6%) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multi-focal papillary cancer. One of the two cases with thyroid adenomas was Hurthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre- and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.
Low Cholesterol Level in Patients With Panic Disorder
(Elsevier Science Bv, 1998) Agargün, MY; Algün, E; Sekeroglu, R; Kara, H; Tarakçioglu, M
Background: The purpose of this study was to examine whether an association exists between low cholesterol level and major depression in patients with panic disorder. Methods: The subjects of the study were 16 patients panic disorder only, 16 panic disorder patients had also current major depressive episode, and 16 normal control subjects. An automated enzymatic colorimetric method was used for cholesterol determination. Results: Panic disorder patients had higher serum cholesterol than panic disorder patients with major depression and normal controls. Conclusion: There is an association between low cholesterol level and the presence of major depression in patients with panic disorder. Limitation: Future studies with large sample are needed to confirm this finding. Clinical Relevance: A low serum cholesterol level might serve as biological marker of major depression in patients panic disorder. (C) 1998 Elsevier Science B.V.
Malignant Pheochromocytoma With Peritonitis Carcinomatosa
(Lippincott Williams & Wilkins, 2005) Algün, E; Kösem, M; Alici, S; Harman, M; Güler, O; Kotan, E
Pheochromocytomas and functioning paragangliomas are rare tumors arising from the primitive neural crest. Approximately 10% of adrenal pheochromocytomas are malignant. Malignant pheochromocytomas usually recur in the retroperitoneum or appear as metastatic deposits in bone, lung, or liver. Here, we report a 51-year-old woman with malignant pheochromocytoma with a peritoneal metastasis, which is a very unusual metastatic site. She was referred to the hospital with headache, abdominal pain, and ileus. A right adrenal mass was surgically removed in May 1997. Pathologic examination revealed pheochromocytoma and capsular with adjacent muscle invasion. During the next 3 years, the patient remained well. The disease recurred in 2001, with hypertensive episodes and peritonitis carcinomatosa. Further investigation revealed no other metastatic sites. Peritoneal metastasis is very rare in malignant pheochromocytoma and generally is attributed to direct peritoneal seeding during surgery.
Simultaneous Occurrence of Papillary Intrafollicular and Microcarcinomas With Bilateral Medullary Microcarcinoma of the Thyroid in a Patient With Multiple Endocrine Neoplasia Type 2a
(Springer-verlag, 2002) Kösem, M; Kotan, Ç; Algün, E; Topal, C
We report the case of a simultaneous occurrence of papillary intrafollicular and microcarcinomas with bilateral medullary microcarcinoma of the thyroid in a patient with multiple endocrine neoplasia type 2A. The concurrent presence of two thyroid carcinomas is rare. The simultaneous occurrence of two different tumors in the same thyroid each being multifocal and smaller than 1 cm in diameter has not been previously reported in the literature. Furthermore, we define the first case of intrafollicular papillary thyroid carcinoma (carcinoma in situ).
Spontaneous Pregnancy in a Patient With Sheehan's Syndrome
(Elsevier Sci Ireland Ltd, 2003) Algün, E; Ayakta, H; Harman, M; Topal, C; Aksoy, H
Urinary Beta-2 Microglobulin in Renal Dysfunction Associated With Hypothyroidism
(Wiley, 2004) Algün, E; Topal, C; Öztürk, M; Sekeroglu, MR; Durmus, A
Hypothyroidism is associated with a number of functional renal disorders primarily affecting water and salt handling. In this study, we aim to investigate functional renal disorders in overt and subclinical hypothyroidism. We utilised urinary beta-2 microglobulin (beta2M) as a sensitive marker of tubular dysfunction. Urinary beta2M excretion and tests for renal functions were repeated before and after T4 replacement therapy. Forty-four patients (28 with overt disease, 16 with subclinical disease) and 31 healthy control subjects were involved in the study. There was a significant increase in urinary beta2M in both overt and subclinical hypothyroidism (p < 0.05 in both). TSH levels were correlated with beta2M excretion. Effects of hypothyroidism on renal functions were readily reversible by 3 weeks of thyroid hormone replacement therapy. Urinary beta2M was a sensitive marker of renal tubular dysfunction associated with overt and subclinical hypothyroidism. (C) 2004 Black-well Publishing Ltd.