Background: COVID-19 has caused a pandemic and is associated with significant mortality. The pathophysiology of COVID-19, affecting many organs and systems, is still being investigated. The hypothalamus, pituitary gland, and possibly adrenal glands are the targets of SARS-CoV-2 because of its angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors expression. Hypocortisolemia can be seen in the postinfection period. COVID-19 infection tends to be severe in diabetic patients due to immune dysfunction. In this study, our aim was to investigate the relationship between basal cortisol levels and the course of COVID-19 infection in diabetic and non-diabetic patients. Methods: Our retrospective study included 311 PCR-positive COVID-19 patients over the age of 18 who were hospitalized in Ankara City Hospital Infectious Diseases Department or Intensive Care Unit (ICU) between 15 March 2020 and 15 May 2020. Serum basal cortisol, fasting plasma glucose (FPG), HbA1c values, and diabetes history were recorded within the first 24 h of hospitalization. The presence of pulmonary involvement was noted from the patients’ imaging records. Pregnant and breastfeeding women, patients with chronic liver disease or chronic kidney disease, and patients who were already using steroids or had started COVID-19 infection treatment within the 72 h before blood collection were excluded from the study. Results: Of the 311 patients, 100 had Type 2 Diabetes Mellitus (T2D), while 211 did not. The age, serum basal cortisol, and glucose levels of the patients with T2D (64.51 ± 12.29, 19.5 ± 13.12, and 143.5 (77–345)) were higher than those of the patients without T2D (46.67 ± 16.38, 15.26 ± 8.75, and 96 (65–202)), and the differences were statistically significant (p = 0.004, p = 0.004, and p < 0.001, respectively). The basal cortisol values of the ICU patients (27.89 (13.91–75)) were significantly higher than those of the ward patients (13.68 (1.48–51.93)) and patients who were transferred to the ICU from the ward due to worsening conditions (19.28 (7.74–55.21)) (p < 0.001 and p = 0.007, respectively). The factors affecting ICU admission were determined to be age, T2D history, basal cortisol, and elevation in FPG using univariate logistic regression analysis. In the multiple logistic regression analysis, age, basal cortisol level, and infiltrative involvement in thorax CT were determined to be the risk factors affecting intensive care admission. Conclusion: High basal cortisol levels in patients with T2D may predict the severity of COVID-19 infection or mortality. Although high basal cortisol levels are among the risk factors affecting ICU admission, patients with COVID-19 should also be evaluated in terms of clinical and laboratory findings and relative adrenal insufficiency.

Background: Bariatric surgery is an important treatment option of obesity over the last decade. While bariatric surgery reduces weight and helps maintanence, it significantly reduces the obesity-related comorbidities, as well. Secondary hyperparathyroidism is a common metabolic complication of bariatric surgery, despite the recommended dose of calcium and vitamin D replacement. We have presented in our article that one of the results of bariatric surgery may be parathyroid adenoma (PA), although the long-term results are unknown. Methods: A total of 838 patients who had undergone sleeve gastrectomy (SG) between 2015 and 2018 were screened retrospectively. We analyzed the data of five patients with parathyroidectomy with PA and indicative of operation according to international guideline. Parathormone (PTH), 25-OH vitamin D3 (25OHD), calcium, phosphate (P), albümin, and alkaline phosphatase were evaluated, which were measured before and after parathyroidectomy. Weight changes of patients before and after bariatric surgery were calculated. Results: Mean age of the 838 patients were 38.7 ± 10.4 (years) with SG. Six hundred and eighty three subjects (81.5%) were women and 155 (18.5%) were men. Mean body weight changed before and after SG was respectively, 45.04 ± 6.37 kg/m², 35.80 ± 7.6937 kg/m², (p = 0.002). All patients with PA were female and the mean age was 41.4 ± 9.0 (years). The mean time from bariatric surgery to parathyroid surgery was 2 ± 1 years. In 838 cases, PA was detected in five cases and the prevalence was found to be 0.6%. Conclusion: Long-term hypocalcemia may cause development of PA as a result of parathyroid gland stimulation. Clarification of increased PTH secondary to hypocalcemia, intestinal adaptation mechanisms, local effect of the wnt signaling pathway, change in carrier proteins, and the effect of adipokines on multifactorial conditions are extremely important to prevent bone loss in patients who underwent bariatric surgery. Development of PA after bariatric surgery is a serious complication and should not be overlooked. Therefore, long-term and strict follow-up is very important after surgery.

Background: This study aimed to reveal changes in thyroid gland volume and functions in patients having undergone sleeve gastrectomy (SG). Methods: In this retrospective cohort study, the thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) levels of 48 morbidly obese patients who underwent SG operations were examined within the last 1 year before the operation and in the sixth month after the operation and then compared. The volume of the thyroid gland and, if present, nodules of patients were also calculated through ultrasonographic measurements before and after SG. Results: It was determined that there was a decrease in fT3 and TSH levels, but an increase in fT4 levels, in the postoperative period. There was no significant difference in thyroid volume change. In addition, it was observed that the difference in weight before and after the operation was inversely proportional to the nodule width and average nodule size (p = 0.05 and p = 0.033). Conclusions: We have shown that there were some changes in the thyroid function tests carried out in the sixth month following SG compared with the preoperative period, but there was no statistically significant difference in the thyroid gland and nodule volumes.

The aim of this study was to compare metabolic parameters, plasma Osteopontin (OPN) and Hepatocyte Growth Factor (HGF) levels between Sleeve Gastrectomy (SG) patients in their 6^th post-operation month and healthy control patients. Height, weight, Body Mass Index (BMI) and laboratory parameters of 58 SG patients aged 18‒65 years (Group 1) and 46 healthy control patients (Group 2) were compared. In addition, preoperative and postoperative sixth-month BMI and laboratory parameters of the patients in Group 1 were compared. The mean age and gender distributions of the groups were similar (p > 0.05). Mean BMI was 28.9 kg/m² in Group 1 and 27 kg/m² in Group 2 (p < 0.01). While plasma HGF levels were similar between both groups, plasma OPN levels were higher in Group 2 (p < 0.001). Fasting plasma glucose, total cholesterol, triglyceride, fasting plasma insulin and insulin resistance values were higher in Group 1, while alanine aminotransferase and aspartate aminotransferase levels were higher in Group 2 (p < 0.05). There was a strong correlation between plasma HGF and OPN levels in Group 1, but not in Group 2 (Rho = 0.805, p < 0.001). OPN and HGF are promising biomarkers that can be used to better understand and detect problems related to obesity. The fact that patients in the early post-SG period had lower plasma OPN and similar plasma HGF compared to non-surgical patients of similar age and gender with higher BMI may be another favorable and previously unknown metabolic effect of SG.