Objective Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder that is frequently seen in the eastern Mediterranean region. The thyroid gland can be affected in FMF patients through autoimmunity or amyloidosis. Here, we aimed to evaluate the structure and functions of the thyroid gland in addition to possible autoimmunity in FMF patients. Subjects and methods The study was conducted by the Endocrinology and Metabolism and Internal Medicine Departments. Thirty FMF patients and 30 age and gender-matched healthy controls were enrolled in the study. Free thyroxin (fT4), free triiodothyronine (fT3), thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase (anti-TPO) autoantibodies were investigated. Detailed thyroid grayscale and Doppler Ultrasonography examinations and shear-wave elastosonography (SWE) were performed in the patient and control groups. Results Anti-TPO was detected in 24% (n = 7) of the patients. On the grayscale US, mean thyroid volumes were similar between the FMF and the control groups (p > 0.05). By Doppler US, thyroid vascularity observed was detected in 10.3% (n = 3) of the patients. SWE revealed that the mean velocity value of right vs. left lobe in the patient group was 1.77 ± 0.45 m/s and 1.95 ± 0.51 m/s, respectively. Compared to the control group, the mean velocity values were significantly higher in the right (p = 0.004) and left (p = 0.01) lobes of the patient group. The mean stiffness value in the patient group was also significantly higher in the right and left lobes [10.13 ± 5.65 kPa (p = 0.005) and 12.24 ± 6.17 kPa (p = 0.02), respectively]. Conclusion Recognizing the complications of FMF early in the course of the disease is as important as the early diagnosis of the disorder. Based on this, thyroid functions and changes in its structure should be evaluated carefully for early diagnosis of a possible coexisting thyroid disorder. Arch Endocrinol Metab. 2020;64(1):66-70.

The relationship between neutrophil/lymphocyte ratio and clinical and radiological findings in patients with nonfunctional adrenal incidentaloma

Aim: Long term persistently high blood glucose levels result in various complications and conditions in diabetic patients. One of them is gastrointestinal disorders and the other is increased risk of infectious diseases like parasitosis. The aim of the study is to demonstrate of intestinal parasites with various techniques in diabetic patients and confirm of the frequency of the parasites.Methods: A total of 65 patients with type 2 Diabetes Mellitus were included in the study. Laboratory tests were done and gastrointestinal symptoms were recorded. Fecal specimens were evaluated with direct microscopy, Kinyoun acid-fast staining method, trichrome staining method and antigen screening test.Results: Of the patients included in the study 31 were male and 34 were female. While 53.8% of the patients had no chronic complications of diabetes, 33.8% had multiple complications. Thirty (46.2%) patients had gastrointestinal complaints. Examination of stool samples revealed G. intestinalis in two patients (3.07%), C. parvum in three patients (4.6%), and G. intestinalis + E. histolytica in six patients (9.2%) by RAT. No association was found between the existence of parasite determined by RAT and any of the patient characteristics of age, sex, duration of diabetes, and dyspeptic complaints (p-values are 0.27; 0.14; 0.90; 0.68, respectively).Conclusion: This is the first study to explore the prevalence rate of parasitosis detected by RAT in patients with diabetes. In this study, we also compared different parasite detection methods in this patient population and showed that RAT is a more sensitive method.

Type 2 diabetes (T2DM) is a complex, metabolic disease driven by genetic susceptibilities, environmental interactions, and various genes. Nowadays, increasing number of studies show the relationship between diabetes mellitus (DM) and epigenetics, especially DNA methylation. In this study, we aimed to measure the methylation levels of fat mass and obesity associated (FTO) and peroxisome proliferator activated receptor gamma (PPARG) in the peripheral blood samples of patients with clinical diagnosis of T2DM. In our study, whole blood was taken from T2DM patients (n=43) who applied to the Endocrinology Outpatient Clinic and from age-gender-matched healthy individuals (n=42). After the bisulfide conversion of isolated genomic DNAs from whole blood samples, the methylation profiles of target genes were analyzed with methyl-specific PCR and gel electrophoresis methods. Post-statistical analyses, no significant difference was found between the T2DM and control groups regarding FTO methylation status. The methylation level of PPARG gene in T2DM was significantly higher compared to the control group. Given the insulin sensitizing effects of PPARG, our findings confirm the possibility that methylation-mediated suppression of PPARG gene expression may lead to elevation of insulin resistance in T2DM patients. Further gene expression studies with more patients and quantitative methods will be required to better understand the effects of methylation in the PPARG gene in T2DM patients and its relationship to the disease.

Objective: Exenatide and similar drugs which have Glucagon Like Peptide-1(GLP-1) like effects have been used frequently in the treatment of diabetes and obesity in recent years. In this study we aimed to investigate the effects of exenatide on ghrelin, FGF-21 and GDF-15 which are known to be associated with appetite and metabolic disorders.Material and Methods: Thirty patients with Type 2 Diabetes Mellitus with a Body Mass Index of 35 kg/m2 and above who are still ongoing treatment for diabetes but not on target (HbA1c>7%) and exenatide treatment was started were included in the study. Venous blood samples were collected for the measurements of complete blood count, biochemical parameters, HbA1c, ghrelin, FGF-21, GDF-15. After 3 months of treatment initial evaluations and biochemical tests were repeated.Results: Mean age of the patients was 50.43±10.35 years. Twenty-one (70%) were female and 9 (30%) were male. Mean Hb A1c of the patients was 9.68±2.02%. After 3 months of exenatide treatment a significant decrease in body weight and body mass index was observed (p<0.001). There was also significant decrease in Ghrelin and GDF-15 levels (p<0.001).Conclusion: Our study is the first study in which these three markers were evaluated together in obese type 2 diabetics. It is thought to be that Ghrelin, FGF-21 and GDF-15 are play role in obesity and type 2 diabetes mellitus pathogenesis together in different ways.