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.

Summary: We assessed bone health in over 2500 adults with diabetes across Türkiye. T1DM patients had lower BMD, while T2DM patients showed higher fracture risk despite higher BMD. Several modifiable factors were linked to osteoporosis. These findings support personalized bone assessments in diabetic populations. Background: Diabetes mellitus (DM) is a recognized risk factor for bone fragility. While type 1 DM (T1DM) is typically associated with low bone mineral density (BMD), type 2 DM (T2DM) often presents with higher BMD despite increased fracture risk. Large-scale comparative studies remain limited. Objective: To evaluate bone health, including osteopenia, osteoporosis, and fracture risk, in adults with T1DM and T2DM. Methods: This multicenter, cross-sectional study included 2562 patients (224 with T1DM, 2338 with T2DM) from 27 centers across Türkiye. BMD was assessed using dual-energy X-ray absorptiometry (DXA) and fracture risk was estimated via the Turkish-adapted FRAX® algorithm in patients aged ≥ 40 years. Multinomial logistic regression was used to identify independent predictors of low BMD. Results: Osteoporosis prevalence was 5.5% in T1DM and 9.6% in T2DM (femoral neck T-score). Adjusted BMD was significantly lower in T1DM at all skeletal sites, while FRAX-based fracture risk and fall-related fractures were higher in T2DM. Independent predictors of osteoporosis included older age, female sex, lower BMI, reduced calcium levels, corticosteroid use, albuminuria, hypertension, and less frequent sodium-glucose cotransporter-2 (SGLT2) inhibitor use. T1DM was independently associated with osteopenia but not osteoporosis. Conclusion: This multicenter study demonstrates distinct patterns of BMD and fracture risk across diabetes subtypes and supports individualized bone health assessment in routine diabetes care.

In this single-center retrospective study, we aimed to evaluate the results of medical therapy as primary or secondary treatment following surgery and compare follow-up outcomes between the two approaches. Patients were grouped as medical therapy alone (Group M) and surgery plus medical therapy (Group S+M). Patients' demographics, such as age and gender, and age at the diagnosis were recorded. Differences between the pre-and post-treatment tumor size, prolactin (PRL) levels, Knosp grades, tumor response to treatment, improvement in hypofunctions, visual field, and biochemical control were recorded and compared between the two groups. A total of 41 patients diagnosed with giant prolactinomas were included in the study. Hypopituitarism was found in 82.93%, hypogonadism in 80.59%, GH deficiency in 51.22%, ACTH deficiency in 36.59%, and TSH deficiency in 41.46% of the patients. Visual field defects were found by 60.53%. Tumor volume at diagnosis was significantly higher in Group M (p 0.05). This study's results demonstrate no statistically significant difference between medical therapy alone and surgery plus medical therapy regarding the reduction of tumor volume and normalization of PRL values in patients with giant prolactinomas. Surgery should be reserved for severe compression conditions, and potentially unnecessary surgical approaches should be avoided.

Alemtuzumab (ATZ) is an anti-CD52 humanized monoclonal antibody indicated for treating highly active relapsing-remitting MS (RRMS). It alters the regulation of the immune system by depleting circulating lymphocytes. Changes in blood cell count, infusion-related reactions, and changes in vital parameters can be seen in the early period with ATZ. Changes in blood tests, serum tests, vital parameters, and characteristics of infusion-associated reactions (IARs) observed during the first course of ATZ treatment and thereafter were evaluated. The systolic blood pressure (SBP), diastolic blood pressure (DBP), fever, heart rate (HR), changes in blood and serum tests, and IARs developed after the first course of 23 patients with RRMS who received ATZ treatment were evaluated by comparing the results of 26 patients with RRMS who received only intravenous methylprednisolone. Mean age was 36.60 ± 8.98, 73.9% female (n = 17), diagnosis time was 8.52 ± 3.64 years, pre-EDSS: 3.93 ± 1.80. No significant difference was found in vital parameters except for sub-febrile fever that developed on the first day. The number of white blood cells increased significantly after the first day. The hemoglobin level did not change. Lymphocyte (very high) and platelet (mild) counts decreased starting from the first days, and eosinophil (very high) and monocyte (moderate) counts decreased from the third day. There were no significant changes in liver enzymes, thyroid function tests, serum urea, creatinine, and lipid profile during 1-year follow-up. The IAR rate was 95.6% and occurred most frequently on the second and third days. The most common are dermatological findings (52%), headache (20%), pain (10%) and fatigue (8%). Alemtuzumab has no appreciable effect on vital parameters during infusion. However, these changes are not clinically correlated, even if there is. Headache in the first days, dermatological (most common) findings, pain, and fatigue are seen in the following days. Most IARs can be resolved with symptomatic treatment and close follow-up. Lymphocytes, eosinophils, and monocytes are significantly reduced and return to baseline levels towards the end of the first year. The first year does not cause significant pathologies in other serum parameters. However, after the first year, watch out for associated autoimmune pathologies, especially thyroid involvement.