Person: ELBASAN, ONUR
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ELBASAN
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ONUR
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Publication Open Access REFRACTORY HYPOTHYROIDISM TO LEVOTHYROXINE TREATMENT: FIVE CASES OF PSEUDOMALABSORPTION(EDITURA ACAD ROMANE) YAVUZ, DİLEK; Elbasan, O.; Yavuz, D. GogasContext. A persistently elevated thyroid stimulating hormone (TSH) level is a common clinical problem in primary hypothyroidism patients treated with levothyroxine (LT4). Pseudomalabsorption, which is characterized by poor adherence,should be considered in cases of refractory hypothyroidism after excluding other causes, such as malabsorption. Objective. We reviewed the features of the patients with persistently elevated TSH despite high-dose LT4 therapy. Design. Symptom evaluation, medications, comorbid diseases and physical examination features of five patients who applied to our outpatient clinic between 20162019 and diagnosed with LT4 pseudomalabsorption were retrospectively analyzed. Subjects and methods. The LT4 loading test was performed with an oral dose of 1,000 mu g LT4. Demographic parameters, BMI, thyroid function tests, laboratory parameters for malabsorption were recorded. Results. We observed at least two-fold increase of free thyroxine levels during the test, which was considered pseudomalabsorption. Euthyroidism was achieved in two patients by increasing the LT4 dosage and in one patient with a change in the preparation. TSH decreased significantly after being informed about compliance in one patient. Another one was given LT4 twice weekly, but TSH remained elevated because of nonadherence. Conclusion. The LT4 loading/absorption test is a valuable tool to confirm the diagnosis of pseudomalabsorption. Informing patients, changing the preparation, increasing the dose, supervised intake of daily/weekly LT4 forms are treatment options for managing these cases.Publication Open Access Evaluation of sarcopenia in patients with hyperthyroidism(2022-12-01) TUFAN ÇİNÇİN, ASLI; ENGİN, EBRU; ELBASAN, ONUR; ILGIN, CAN; TUFAN ÇİNÇİN A., Engin E., Elbasan O., Durmus N. S., Can B., Ilgin C., Can B.Background and aim: Sarcopenia is a generalized skeletal muscle disease and thyroid hormones have regulatory effects on skeletal muscle metabolism. This study aims to evaluate the association between hyperthyroidism and sarcopenia. Methods: Thirteen patients with overt hyperthyroidism (OH), 13 patients with subclinical hyperthyroidism (SH) and 30 healthy volunteers were included. OH was defined as serum thyroid-stimulating hormone (TSH) 1.12 ng/dL and/or free T3 (fT3) >4.37 ng/L; while SH was defined as TSH <0.34 when fT4 and fT3 were within the normal reference range (0.61-1.12 ng/dL for fT4; 2.6-4.37 ng/L for fT3). Handgrip strength (HGS) measurement and chair stand test were performed for muscle strength, while skeletal muscle mass index measurement with bioelectrical impedance analysis and calf circumference (CC) measurement were performed for muscle mass evaluation. Results: The median age was 44.9 (21-76), and 16 (61.5%) were female. HGS and CC were found to be significantly lower in the OH and SH groups than in the control group (p=0.007; p=0.008, respectively). Sarcopenia was more common in the OH and SH groups than in the control group (p=0.007), and the risk of sarcopenia was higher in the OH group than in the SH group (OR: 2.44, 95% CI: 0.26-31.87). In hyperthyroid patients, a high fT4 increased the possibility of sarcopenia (OR: 6.0 95% CI: 0.59-79.23). Conclusions: Sarcopenia is significantly more common in patients with hyperthyroidism.Publication Metadata only Hyperandrogenism-related metabolic changes in drug-naïve transmen compared to cisgender women: a case-controlled study(2023-01-01) EREL, PINAR; ELBASAN, ONUR; YORGUNER, NEŞE; İMRE, EREN; ÜSTAY, ÖZLEM; EREL P., ELBASAN O., Yorguner N., İmre E., ÜSTAY Ö.Introduction: The aetiology of gender dysphoria is still unclear. Although prior studies have shown that trans men have higher androgen levels than cisgender women, they all concluded unselected populations. Our reason for performing this study is to evaluate trans men’s hormone profile and metabolic status to compare with cisgender women in a more selected population. This is the first case-controlled study to compare anthropometric, metabolic, and endocrinological parameters of drug-naïve trans men with those of cisgender women. Material and methods: We designed this study as a single-centre observational cohort study. We included 70 drug-naïve trans men, and the control group comprised 34 healthy cisgender women. We measured and compared hormone profiles and metabolic parameters in the 2 groups. Results: Of the 70 trans men individuals, 16 (22.85%) met the Rotterdam criteria and were diagnosed with polycystic ovary syndrome (PCOS); 4 individuals in the control group met the criteria (11.7%). Although we matched body mass index in the groups, total testosterone, free androgen index, androstenedione, 17 hydroxyprogesterone, muscle strength, triglyceride, and homeostatic model assessment of insulin resistance levels were significantly higher in the trans men than in the cisgender women (p < 0.05). Even after were excluded PCOS patients, hyperandrogenaemia was apparent in the trans men. Conclusion: Our study showed that trans men have clearly higher androgen levels, which may have been the reason for metabolic changes compared to cisgender women. However, the main reason for hyperandrogenism in drug-naïve trans men is still not known, and more comprehensive studies are needed.Publication Open Access Accurate interpretation of thyroid dysfunction during pregnancy: should we continue to use published guidelines instead of population-based gestation-specific reference intervals for the thyroid-stimulating hormone (TSH)?(2022-03-01) TURAN, CEM ARMAĞAN; ELBASAN, ONUR; ÜNLÜ, OZAN; TEKİN, AHMET FARUK; ŞİRİKÇİ, ÖNDER; GÖZÜ, HÜLYA; HAKLAR, GONCAGÜL; ESİM BÜYÜKBAYRAK, ESRA; Turkal R., TURAN C. A., ELBASAN O., Aytan S., Cakmak B., Gozaydinoglu B., Takir D. C., ÜNLÜ O., Bahramzada G., Tekin A. F., et al.Background Considering the changes in thyroid physiology associated with pregnancy and poor outcomes related to abnormal maternal thyroid function, international guidelines recommend using population-based trimester-specific reference intervals (RIs) for thyroid testing. If these RIs are not available in the laboratory, implementing recommended fixed cut-off values globally is still controversial. To address this issue, we aimed to establish appropriate RI of thyroid-stimulating hormone (TSH) in pregnant Turkish women for our laboratory and compare the prevalence of thyroid dysfunction based on the established and recommended criteria. Methods Of 2638 pregnant women, 1777 women followed in the obstetric outpatient were enrolled in the reference interval study after applying exclusion criteria related to medical and prenatal history. A retrospective study was conducted by collecting data from July 2016 to March 2019. Serum TSH was measured by UniCel DxI 800 Immunoassay System (Beckman Coulter Inc., Brea, CA, USA). The study design relied on two approaches in order to classify pregnant women: trimester-specific and subgroup-specific; the latter involved dividing each trimester into two subgroups: T1(a), T1(b), T2(a), T2(b), T3(a), T3(b). The lower and upper limits of the RIs were derived by the parametric method after normalizing the data distribution using the modified Box-Cox power transformation method. Results The lowest TSH value was detected at 8-12 weeks in early pregnancy, and the median value of TSH in the T1(b) subgroup was significantly lower than the T1(a) subgroup (P < 0.05). TSH levels showed a gradual trend of increase along with the pregnancy and increased significantly in the T2(a), T2(b,) and T3(b) subgroups compared to the preceding subgroups (P < 0.05). Compared to the diagnostic criteria recommended by American Thyroid Association (ATA), the prevalence of thyroid dysfunction was significantly different from the established trimester- and subgroup-specific RIs throughout the pregnancy (P < 0.001). Conclusions We conclude that establishing gestation- and laboratory-specific RIs, especially for TSH, is essential for diagnosing thyroid disorders in pregnancy, and the recommended universal cut-off values, which may contribute to the risk of a misdiagnosis or a missed diagnosis, should be taken with caution in the clinical setting. However, regarding the fluctuation of thyroid function tests throughout pregnancy, trimester-specific RIs are insufficient, and implementing split phases is required.Publication Metadata only The association of free testosterone levels with coronavirus disease 2019(2022) ILGIN, CAN; Apaydin, Tugce; Sahin, Bahadır; Dashdamirova, Saida; Dincer Yazan, Ceyda; Elbasan, Onur; Ilgin, Can; Bilgin, Hüseyin; Cam, Haydar Kamil; Bahramzada, Gunel; Kucuk, Aleyna; Haklar, Goncagul; Iliksu Gozu, HulyaPublication Open Access Genetic and Clinical Characterization of Patients with Maturity-Onset of Diabetes of the Young (MODY): Identification of Novel Variations(AVES, 2021-09-22) GÜNEY, AHMET İLTER; Ates, Esra Arslan; Ustay, Ozlem; Polat, Hamza; Apaydin, Tugce; Elbasan, Onur; Yildirim, Ozlem; Guney, Ahmet IlterBackground: Maturity-onset diabetes of the young (MODY) is a rare monogenic type of diabetes, and accounts for 2-5% of all diabetes cases. An early age of onset, a family history supporting autosomal-dominant inheritance, insulin resistance, and the absence of autoimmunity are the major characteristics of MODY. However, genetic testing is crucial for diagnosis. Aims: To investigate the 7 MODY-related genes and clinical findings of patients with a preliminary clinical diagnosis of MODY. Study Design: Retrospective cross-sectional study. Methods: In this study, 7 genes (KCNJ11, ABCC8, INS, GCK, HNF4A, HNF1A, and HNF1B) related to MODY were screened via targeted sequencing in 182 cases with a confirmed pre-diagnosis of MODY. The clinical characteristics of the patients were evaluated retrospectively. Results: A total of 182 patients, 48% of whom were women, between the ages of 18-62 were included in the study. In 30 cases (16.4%), 28 different pathogenic variations were found, of which 20 were previously reported and 8 were novel variations segregated by disease within the family. Pathogenic variations were detected in the following genes in order of mutation frequency; GCK, HNF1A, ABCC8, HNF4A, HNF1B and KCNJ11. Interestingly, six of the 30 cases (20%) carried a pathogenic variation in the ABCC8 gene. No mutation was detected in the INS gene. A family history of vertically transmitted diabetes and elevated HbA1C at the time of diagnosis were found in 20 (66%) and 16 (52%) cases, respectively. Conclusion: In this series, 28 different pathogenic variations are identified, 8 of which are novel. The rate of pathogenic variation in the ABCC8 gene is unexpectedly high. Two-thirds of cases have a family history of vertically transmitted diabetes.Publication Open Access Serum 25(OH) Vitamin D Levels in Severely Obese Patients Evaluated Before Bariatric Surgery(TURKIYE KLINIKLERI, 2020) YAVUZ, DİLEK; Gunhan, Hatice Gizem; Uygur, Meliha Melin; Imre, Eren; Elbasan, Onur; Gogas Yavuz, DilekObjective: Obesity is a risk factor for vitamin D deficiency, which is reported to be detected differently in each population. This study aimed to evaluate the 25(OH) vitamin D (25(OH)D) levels, intact parathormone (iPTH) levels, and their relationship with body mass index (BMI) in obese patients, screened prior to bariatric surgery. Material and Methods: This retrospective study comprised of 1.082 obese patients (41 +/- 10 years, female/male: 823/259) who were candidates for bariatric surgery. BMI, waist circumference (WC), serum 25(OH)D, iPTH, calcium, phosphorus values of these patients were recorded from patient files. Results: BMI, WC, iPTH, and 25(OH)D levels were 48 +/- 8.9 kg/m(2), 128 +/- 11.9 cm, 64 +/- 36 pg/mL, and 15 +/- 18 ng/mL, respectively. Mean 25(OH)D level of 79.1% of the patients belonged to the deficiency range. Very low 25(OH) vitamin D levels (<10 ng/mL) were witnessed among 40.9% (443/1.082) of the study group. Female obese subjects possessed significantly lower serum 25(OH)D levels as compared to male obese patients. Significant negative correlations were perceived between 25(OH)D levels and iPTH (r=-0.34, p<0.0001), BMI (r=-0.20, p<0.0001), and waist circumferences (r=-0.14, p=0.002) in the whole group. Multivariate analysis indicated that BMI to be an independent risk factor for vitamin D deficiency. Conclusion: A high rate of vitamin D deficiency was documented in our morbidly obese patients who were candidates for bariatric surgery. BMI is a determinant of 25(OH)D levels. It is essential to screen for vitamin D deficiency and possible osteomalacia among the candidates for bariatric surgery of obese patients and should be treated appropriately before bariatric surgery.Publication Metadata only Comparison Between Sleeve Gastrectomy and Exenatide on Type 2 Diabetic Patients(MARY ANN LIEBERT, INC, 2020) ELBASAN, ONUR; Elbasan, Onur; Sisman, Pinar; Peynirci, Hande; Yabaci, Aysegul; Ersoy, CananBackground: Diabetes and obesity are major causes of mortality and morbidity that are increasing all over the world. As obesity is a major risk factor for type 2 diabetic patients, weight loss is important in the treatment of type 2 diabetic patients. In our study, our aim was to evaluate the effects of exenatide and laparoscopic sleeve gastrectomy (LSG) in obese type 2 diabetic patients on the clinical and laboratory parameters. Methods: Twenty-five LSG and 25 exenatide patients followed up in our outpatient clinic were involved in the study. Results: At the end of the 6-month follow-up, weight loss was similar to 35.4 kg in the surgery group and 11.5 kg in the exenatide group. Although postprandial glucose and hemoglobin A1c were significantly decreased in both groups, the decrease was significantly higher in LSG group compared to the exenatide group. Although there was no significant change in fasting blood glucose (FBG) in the exenatide group, there was a significant decrease in FBG in LSG group. Conclusion: LSG is a method that should be performed up on indication and much more radical compared to exenatide administration, but appears to be a more efficient application that corrects diabetes- and obesity-related metabolic parameters compared to exenatide therapy in type 2 diabetic obese patients.Publication Metadata only Hormon naif transerkeklerde endokrin bozucu etkilerin Tiyometoksam, Fipronil ve Bisfenol-A düzeyleri ile incelenmesi: tek merkez vaka control çalışma(2022-05-19) ÜSTAY, ÖZLEM; ELBASAN, ONUR; Üstay Ö., Elbasan O., Erel P.İlaç naif transerkeklerde Bisfenol-A ve pestisit düzeyleri kontrol grubu ile karşılaştırıldığında istatistiki olarak fark saptanamamıştır