Background: Diabetes mellitus (DM) is a condition that may increase the severity of acute pancreatitis (AP) through chronic inflammation and disturbances in immune responses. However, the independent effect of DM on clinical outcomes in AP has not yet been fully elucidated. Methods: In this retrospective cohort study, 492 patients diagnosed with acute pancreatitis at the Gastroenterology Clinic of Ankara Bilkent City Hospital between January 2022 and March 2025 were included. Patients were divided into two groups based on the presence of diabetes, and outcomes were compared using statistical methods. Results: Of the total 492 patients (mean age 58.6 ± 17.2 years; 50.2% female) included, 98 (19.9%) had DM. Moderate-to-severe AP occurred in 67.3% of diabetic versus 37.8% of non-diabetic patients (p < 0.0001), and severe disease developed more frequently in the diabetic group (6.1% vs. 1.0%, p = 0.0057). Systemic complications were significantly more common in patients with diabetes (45.9% vs. 26.9%, p = 0.0004). Hospital mortality was higher among patients with diabetes (9.2% vs. 4.6%, p = 0.0344), and Kaplan–Meier analysis demonstrated numerically lower overall survival in patients with diabetes (log-rank p = 0.095), with early divergence in survival curves. Cox proportional hazards analysis confirmed diabetes as an independent predictor of in-hospital mortality (adjusted HR 2.64, 95% CI 1.17–5.97; p = 0.019). After adjustment for confounders, diabetes remained independently associated with the development of moderate/severe pancreatitis (adjusted OR 2.00, 95% CI 1.24–3.22; p = 0.004). Diabetes also independently predicted in-hospital mortality (adjusted OR 3.36, 95% CI 1.35–8.34; p = 0.009), along with APACHE II score. ROC analysis demonstrated that adding diabetes mellitus to the APACHE II score significantly improved mortality prediction compared with APACHE II alone (AUC 0.785 vs. 0.724). The retrospective and single-center design of this study may limit its generalizability and create potential selection bias. There were insufficient data on the type of diabetes, its duration, and glycemic control (e.g., HbA1c), and therefore, we could not assess these factors, all of which may influence risk estimates. Although the survival curves showed early divergence, the borderline log-rank significance (p = 0.095) highlights the limited statistical power to detect long-term survival differences in this cohort. Conclusions: DM is associated with substantially increased severity and in-hospital mortality in AP, primarily through an elevated risk of systemic organ failure. Incorporation of diabetes status into early severity stratification may improve prognostic accuracy and guide closer monitoring and timely interventions in this high-risk population.

Introduction: This study investigates the link between mild autonomous cortisol secretion (MACS) in adrenal incidentaloma (AI) patients and the occurrence and severity of cardiovascular and metabolic comorbidities. It aims to provide a detailed overview of this relationship, highlight gaps in current research, and propose directions for future studies. Material and methods: We conducted a retrospective analysis at Ankara City Hospital’s Endocrine Department outpatient clinic, reviewing 627 AI patients from February 2019 to May 2021. The study involved a detailed analysis of clinical records, hormonal evaluations, and imaging, focusing on differentiating MACS from non-functioning adrenal incidentalomas (NFAI) and examining the impact of MACS on associated health conditions. Results: The study found that MACS patients had a statistically higher incidence of diabetes mellitus (35% vs. 20%), hypertension (60% vs. 45%), hyperlipidaemia (40% vs. 25%), and coronary artery disease (30% vs. 15%) compared to the NFAI group. Independent predictors of MACS included the presence of bilateral adrenal masses, larger adrenal mass diameter (with a cutoff value of ≥ 18.5 mm, showing 83% sensitivity and 56% specificity for predicting MACS, and lower dehydroepiandrosterone sulphate (DHEAS) levels (≤ 49.31 μg/dL predicting MACS, with 61% sensitivity and 73% specificity). Conclusion: This research underscores the critical clinical implications of detecting MACS in AI patients, particularly its association with increased cardiovascular and metabolic risks. It calls for vigilant screening and a comprehensive management approach for affected patients. Additionally, the findings highlight the need for further studies to improve patient care and outcomes in this population. Keywords: adrenal incidentalomas mild autonomous cortisol secretion cardiovascular risk metabolic comorbidities endocrinology

SUMMARY Euglycemic diabetic ketoacidosis (DKA) is a rare complication of diabetes mellitus (DM) characterized by metabolic acidosis, ketosis, and blood glucose levels < 250 mg/dL. The prevalence of euglycemic DKA is increasing with the popularity of ketogenic (low-carbohydrate) diets. We present herein the case of a patient with newly diagnosed type 1 DM who developed euglycemic DKA following a ketogenic diet. A 22-year-old woman presented to the emergency department with malaise, fatigue, nausea, and vomiting. She had no family history

Introduction: Non-alcoholic fatty liver disease, now termed metabolic dysfunction-associated steatotic liver disease (MASLD), represents a significant health burden worldwide. Patients with Cushing's syndrome (CS), a condition characterized by excessive cortisol production, may be at an elevated risk for MASLD due to associated metabolic disturbances.Material and methods: This study aimed to evaluate the predictive value of the hepatic steatosis index (HSI) in diagnosing MASLD in patients with CS. 101 endogenous CS patients were included, and hepatosteatosis was assessed using ultrasonography. HSI scores were calculated, and associations with clinical and biochemical parameters were analyzed.Results: Hepatosteatosis was observed in 62.4% of CS patients, with all these individuals meeting the criteria for MASLD. The HSI demonstrated hepatosteatosis with high sensitivity (92.1%) and specificity (78.9%) compared to ultrasonography. Factors significantly correlated with hepatosteatosis included higher BMI, diabetes, hypertension, and hyperlipidemia. There was no correlation with basal morning cortisol, 24-hour urinary free cortisol, low-dose dexamethasone suppression tests, or the etiology of CS.Conclusions: Our study represents a pioneering effort to explore MASLD in patients with endogenous CS by evaluating the HSI as a diagnostic tool. Utilizing the HSI, we demonstrated high sensitivity and specificity in diagnosing hepatosteatosis, emphasizing its potential as a valuable non-invasive tool in this population. Furthermore, our study fills a significant gap in the literature by being the first to investigate the predictive power of HSI for MASLD diagnosis, specifically in CS patients. Integrating these findings into clinical practice could enhance the early detection and management of MASLD in endogenous CS, ultimately improving patient outcomes.

Aims: Hypoparathyroidism is a disorder that causes renal complications, bone disease, an increased risk of cardiovascular diseases, neuromuscular complications, and ocular findings. In this study, we aimed to determine how well the existing guidelines were followed in the follow‐up of patients with hypoparathyroidism. Materials and Methods: In the endocrinology and metabolism outpatient clinic, routine controls were conducted on patients 18 years of age and older with a diagnosis of hypoparathyroidism between February 2019 and September 2021. These individuals’ test findings, imaging, hormones, and additional disorders were assessed. Results: The mean age of 264 patients included in the study was 49.34 ± 12.98 (22–91). Of the patients, 211 (79.9%) were female. Blood biochemistry tests were performed on all patients. Ophthalmological examination was performed in 3% of the patients, brain imaging in 9.8%, renal imaging in 18.6%, and 24‐h urinary Ca measurements in 11%. According to the results of the examinations, cataract was found in 2 (0.8%) patients and basal ganglia calcification was found in 4 (1.5%) patients. In addition, nephrocalcinosis or nephrolithiasis was seen in 2 patients (0.8%). Hypercalciuria was defined as a 24‐h urinary calcium excretion of > 300 mg/24 h for males and > 250 mg/dL for females and was detected in 12 patients with hypoparathyroidism. Conclusion: In our research, it was discovered that patients with hypoparathyroidism had low compliance rates with the guidelines. We believe that the cause of this is the inability to provide the patients with enough time in intense polyclinic conditions. Given the information gathered from our study, it has been concluded that complication screening in hypoparathyroidism patients is just as crucial as blood tests and that allocating enough time for patients will enhance their follow‐up and treatment.