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 Methods: The 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.

Introduction 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 Method Thirteen patients followed up in Bursa Uludağ 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 (CT) and 6 out of 10 patients (60%) with magnetic resonance imaging (MRI). 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 (DM). Conclusion 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.

IIntroduction The aim of this study was to evaluate the clinicodemographic factors and features of tumors in patients with malignant pheochromocytoma. Methods: We retrospectively evaluated the data of 5 cases admitted to our department between 2013 and 2020 and diagnosed with malignant pheochromocytoma. Results: The patients included three females with mean age of 45 years at presentation. Three cases were diagnosed with pheochromocytoma after hypertensive attack and two cases were diagnosed after detection of adrenal mass. The average diameter of the adrenal mass of the cases was 58 mm. Extesion to periadrenal adipose tissue was detected in two patients, vascular invasion in one patient, and capsule invasion in 1 patient in the surgery-resected specimen. Intraabdominal lymph node metastasis was found in 1 patient and metastatic focus was seen in the liver in 1 patient at the time of the diagnosis. During follow-up, perirenal region metastasis was detected in 1 patient. Bone metastasis was seen in 3 patients, lymph node metastasis in 2 patients and lung metastasis in 1 patient. Transperitoneal surrenalectomy was performed in all cases. Lutetium-177, radiotherapy and surgery were the preferred adjuvant therapies. Three patients died because of progression of the disease or acute complications and the other 2 patients are still under follow-up in our clinic. Conclusion: Malignant pheochromocytoma is rare and definitive criteria for malignancy is not established. Prognosis is poor and there is no curative treatment. Resection of malignant pheochromocytoma with intent to cure, which may improve symptoms and possibly survival is important.

Purpose Atypical parathyroid tumor (APT) is a rare disease that can be challenging to distinguish from parathyroid adenoma. APT shows some laboratory and histopathological features with parathyroid cancer. This study attempts to compare clinical, laboratory, radiologic and histopathological characteristics in APT and parathyroid adenoma (PA). Methods This was a retrospective study was based on the database of eighty-two subjects who underwent surgery for primary hyperparathyroidism at a tertiary referral center between 2010 and 2021. Forty-one patients with APT matched by age and gender to controls with PA. Clinical, laboratory, radiologic and characteristics were obtained from the hospital database. Results Forty-five (54.8%) of primary hyperparathyroidism (PHPT) patients were symptomatic, 36 (90%) had nephrolithiasis, 6 (15%) had fracture and 3 (7.5%) had hypercalcaemic crisis. APT patients present with significantly inceased serum calcium, parathormone (PTH) and alkalen phosphatase levels (P < .001, all). No significant difference was observed in the results of bone mineral density (BMD), T-scores and Z-scores. The size of adenoma was significantly greater in APT group (24 (8.8–70) mm vs. 12 (3.8–32) mm, P = 0.005). During the follow-up, multiple metastases due to parathyroid cancer were detected in one patient. Conclusion Our study revealed that increased preoperative serum calcium, parathormone, alkalen phosphatase concentrations and parathyroid adenoma size on ultrasound may have predicted the atypical parathyroid tumor.