Context Dopamine agonist (DA)-induced impulse control disorder (ICD) in prolactinomas is not sufficiently known. Objective To evaluate the prevalence of DA-induced ICDs and possible risk factors related to these disorders in patients with prolactinoma. Design, Setting and Participants This is a cross-sectional multicenter study involving 308 prolactinoma patients followed-up in tertiary referral centers who received at least 3 months of DA therapy. DA-induced ICDs (pathological gambling, hypersexuality, compulsive shopping and compulsive eating) and impulsivity were assessed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP) and the Barratt Impulsiveness Scale-11 (BIS-11), respectively. Patients were evaluated in terms of parameters related with ICD development. Results Any ICD prevalence was 17% (n=51). Most common type was hypersexuality (6.5%). While any ICD and hypersexuality were more common in male patients (p=0.009, p<0.001, respectively), compulsive eating was more common in female patients (p=0.046). Current smoking, alcohol use and gambling history were more frequent (p=0.033, p=0.002, p=0.008, respectively) in patients with any ICD. In BIS-11 total, attentional, motor and non-planning scores were significantly higher in patients with any ICD (p<0.001). Current smoking and alcohol use were more frequent (p=0.007, p=0.003, respectively) and percentage increase of testosterone levels at last visit was higher (p=0.021) in male prolactinomas with hypersexuality. Conclusion Any ICD may be seen in one out of six with prolactinoma patients who are receiving DA therapy and endocrinology specialists should be aware of this significant side effect particularly in male patients with a history of gambling, smoking or alcohol use.

Aim: To describe the Turkish generalized lipodystrophy (GL) cohort with the frequency of each complication and the death rate during the period of the follow‐up. Methods: This study reports on 72 patients with GL (47 families) registered at different centres in Turkey that cover all regions of the country. The mean ± SD follow‐up was 86 ± 78 months. Results: The Kaplan–Meier estimate of the median time to diagnosis of diabetes and/or prediabetes was 16 years. Hyperglycaemia was not controlled in 37 of 45 patients (82.2%) with diabetes. Hypertriglyceridaemia developed in 65 patients (90.3%). The Kaplan–Meier estimate of the median time to diagnosis of hypertriglyceridaemia was 14 years. Hypertriglyceridaemia was severe (≥ 500 mg/dl) in 38 patients (52.8%). Seven (9.7%) patients suffered from pancreatitis. The Kaplan–Meier estimate of the median time to diagnosis of hepatic steatosis was 15 years. Liver disease progressed to cirrhosis in nine patients (12.5%). Liver disease was more severe in congenital lipodystrophy type 2 (CGL2). Proteinuric chronic kidney disease (CKD) developed in 32 patients (44.4%) and cardiac disease in 23 patients (31.9%). Kaplan–Meier estimates of the median time to diagnosis of CKD and cardiac disease were 25 and 45 years, respectively. Females appeared to have a more severe metabolic disease, with an earlier onset of metabolic abnormalities. Ten patients died during the follow‐up period. Causes of death were end‐stage renal disease, sepsis (because of recurrent intestinal perforations, coronavirus disease, diabetic foot infection and following coronary artery bypass graft surgery), myocardial infarction, heart failure because of dilated cardiomyopathy, stroke, liver complications and angiosarcoma. Conclusions: Standard treatment approaches have only a limited impact and do not prevent the development of severe metabolic abnormalities and early onset of organ complications in GL.

The purpose of this study was to determine possible cut-off levels of basal DHEA-S percentile rank in the differential diagnosis of patients with Cushing’s syndrome (CS) with ACTH levels in the gray zone and normal DHEA-S levels. In this retrospective study including 623 pathologically confirmed CS, the DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within reference interval. The patients were classified as group 1 (n=265 Cushing’s disease; CD), group 2 (n=104 adrenal CS) and group 3 (n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate the optimal cut-off level of DHEA-S percentile rank in the reference interval in the differential diagnosis of CS, and the effectiveness of this cut-off level in the identification of the accurate etiology of CS was assessed in patients who were in gray zone according to their ACTH levels. The DHEA-S percentile rank in the reference interval were significantly lower in group 2 compared to the other two groups (p<0.001), while group 1 and group 3 had similar levels. The optimal cut-off level of DHEA-S percentile rank in the reference interval providing differential diagnosis between group 1 and group 2 was calculated as 19.5th percentile (80.8% sensitivity, 81.5% specificity) and the level demonstrated the accurate etiology in 100% of CD and 76% of adrenal CS patients who were in the gray zone. This study showed that the cut-off value of DHEA-S level less than 20% of the reference interval could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, and it should be taken into the initial evaluation.

Macroprolactinomas are rarely seen in women, and pregnancy is a risk factor for tumor growth. More studies are needed to determine appropriate management for macroprolactinoma and pregnancy. The aim of our study is to evaluate effects of treatment with dopamine agonists on macroadenoma before and during pregnancy, safety of dopamine agonists on fetus, post-pregnancy prognosis and long-term results. This is a single center retrospective study. Thirty-four pregnancies occurred in 21 patients under medical therapy. Prolactin levels, treatment results, tumor diameter changes, maternal-fetal outcomes, and disease activity were evaluated. The median tumor size at the time of diagnosis was 15 mm (10–28). Residual adenoma diameter was smaller in those receiving medical therapy longer than one year till the conception (p=0.047). Treatment was discontinued in 28 pregnancies after pregnancy confirmation, and 6 patients were exposed to bromocriptine throughout pregnancy. There was no symptomatic tumor growth during gestation. Among 27 live births, none of the fetuses developed neonatal malformation except for a case of Down syndrome. While early remission rate after pregnancy was 9.5%, this rate reached 33.3% at last follow-up visit. Lowered PRL levels at postpartum period (p=0.040), smaller tumor size at last follow-up visit (p=0.030), and total disappearance of tumor (p=0.026) were the contributor factors for remission. Use of dopamine agonist over one year may reduce the risk of symptomatic tumor growth during pregnancy in patients without invasive or large macroprolactinoma before pregnancy. Exposure to dopamine agonists seems generally safe for the fetus.

Hyperthyroidism’s impact on cardiovascular, hematopoietic systems and metabolism might lead to hemorheological changes. This study aimed to investigate the changes in hemorheological properties via erythrocyte deformability and aggregation, whole blood viscosity (WBV) and plasma viscosity (PV) in hyperthyroid patients. The effect of anti-thyroid treatment on hemorheology was also studied. Thirty-six patients with overt hyperthyroidism, 19 patients with subclinical hyperthyroidism and 66 controls were included in the study. Hematocrit, erythrocyte deformability and aggregation, plasma and whole blood viscosity values were measured before treatment. Hemorheological parameters of the patients were compared with the control. Before and after treatment results of overt hyperthyroidism were analyzed. Methimazole was given as anti-thyroid treatment. Deformability and aggregation measurements were conducted using a laser ektacytometer (LORRCA) while viscosity measurements were performed with a cone-plate viscometer (Brookfield DV-III). The maximum elongation index (EImax) decreased significantly from 0.664 (0.01) pre-treatment to 0.657 (0.01) post-treatment (p = 0.04). The aggregation index was significantly higher in both the subclinical hyperthyroidism group [68.05 (7.66), p = 0.001] and the overt hyperthyroidism group [66.78 (8.815), p = 0.001] compared to the control group. Additionally, the aggregation half-time was significantly shorter in the subclinical hyperthyroidism group [1.9 (1.21–2.27), p = 0.001] and the overt hyperthyroidism group [1.91 (1.43–2.46), p = 0.001] relative to the control group. The hemorheological status of patients was influenced by excessive thyroid hormones in both subclinical and overt hyperthyroidism groups. Additionally, anti-thyroid therapy with methimazole may play a role in the observed decrease in the maximum elongation index following treatment.

Background/Objectives: Comorbidity and risk factor management and avoiding stroke are pillars of optimal atrial fibrillation management. In this article, the latest literature on additional stroke risk factors not included in the CHA₂DS₂-VA score is reviewed in patients with non-valvular atrial fibrillation (NVAF). The possible clinical impacts of the additional risk factors in NVAF patients with a CHA₂DS₂-VA score of 1 are compiled with insights in an interdisciplinary panel discussion to refine daily clinical practice. Methods: The panel was composed of three cardiologists, one endocrinologist, and a nephrologist. The panel members finalized twenty open-ended questions covering major problems in stroke risk stratification in NVAF patients with a score of 1. The shortcomings of this clinical-based model for stroke prevention and its possible outcomes were discussed with evidence-based recommendations. The meeting outcomes are addressed for daily clinical adaptation in the present article. Results: Recent evidence suggests that the CHA₂DS₂-VA score may have shortcomings in a striking rate of NVAF patients with a score of 1. The growing body of evidence suggests that combining clinical, laboratory, and imaging predictors with the CHA₂DS₂-VA score may further refine stroke risk prediction and aid in decision-making for anticoagulation of NVAF patients with a score of 1. Conclusions: The interdisciplinary expert panel offered several recommendations based on the assessment of additional risk factors, which may enable clinicians to identify individualized patient characteristics and early multidisciplinary prevention of disease progression and personalized improvements in the long-term cardiovascular outcomes in NVAF patients with a CHA₂DS₂-VA score of 1.