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Akromegali hastalarında nodüler tiroid hastalığı ve metabolik parametreler ile ilişkisi

Yıl 2018, , 59 - 65, 01.03.2018
https://doi.org/10.18663/tjcl.310185

Öz

Amaç: Akromegali hastalarında nodüler guatr sık görüldüğü iyi bilinmektedir. İnsülin benzeri büyüme faktörü-1 (IGF-1)’in etiyolojik faktörlerden biri
olduğu iddia edilmiştir. Bu çalışmanın amacı akromegali
hastalarında tiroid lezyon insidansının değerlendirilmesi ve insülin direnci ve
hormonal paramatreler başta olmak üzere tiroid nodül gelişimini etkileyen olası
faktörleri değerlendirmektir.



Gereç ve Yöntem: Bilinen tiroid hastalığı olmayan ortalama yaşları 52.7±10.0 olan 60
akromegali hastası (32 kadın 28 erkek) çalışmaya dahil edildi. Yaş ve cinsiyet uyumlu 100
kontrol hastası çalışmaya alındı. Tüm hastalarda vücut kitle indeksi (VKİ),
bel-kalça çevresi, boy, kilo, açlık kan glukozu, tokluk kan glukozu, insülin,
tiroid fonksiyon testleri, tiroid otoantikorları, lipid profili, IGF-1, büyüme
hormonu ve diğer ön hipofiz hormonların
ın ölçümleri
yapıldı. Manyetik rezonans görüntüleme ve tiroid ultrasonografi tüm hastalarda
uygulandı. Tiroid volümü ve tiroid nodül volümü hesaplandı.





Bulgular: Kontrol
grubu (%25) ile kıyaslandığında 35 
(%58.3)
akromegali hastasında tiroid nodülü mevcuttu (p<
0.0001). Hasta ve kontrol grupları arasında VKİ, tiroid volümü, açlık
kan şekeri ve TSH düzeyleri açısından anlamlı farklılıklar bulundu (p<0.05).
 Regresyon analizi
sonrasında tiroid volümü ile insülin, bel çevresi, HOMA-IR, LDL-kolesterol ve
pituiter adenom boyutu arasında ilişki saptandı 
(p<0.05). Lojistik
regresyon analizinde nodül varlığı ile lüteinizan hormone (LH) (p<0.02) ve
HDL-kolesterol (p<0.05) arasında
güçlü ilişki bulundu. Regresyon analizinde nodül volümü ile LH düzeyi (p<0.05)ACTH (beta = -0.51, p<0.01), plasma kortizolü (beta= 0.965, p <0.05), serbest T4 (beta=
0.522, p<0.05), adenom boyutu (beta= 0.615, p<0.05) arasında anlamlı
ilişki bulundu.



Tartışma: Akromegali hastalarında tiroid nodül prevelansı genel populayona göre
daha yüksektir. Bununla birlikte IGF-1, diğer hormonlar ve insülin direnci gibi
parametreler akromegali hastalarında tiroid volümü, nodül volümü ve nodül
formasyon mekanizmalarında önemli rol oynayabilir.

Kaynakça

  • 1. Melmed S. Medical progress: acromegaly. N Engl J Med. 2006; 355:2558–2573 2. Ribeiro-OliveiraAJr, Barkan A. The changing face of acromegaly–advances in diagnosis and treatment. Nat Rev Endocrinol. 2012;8:605–611 3. Cheung NW, Boyages SC: The thyroid gland in acromegaly: An ultrasonographic study, Clin Endocrinol (Oxf) 46:545–549, 1997). 4. Wolinski K, Czarnywojtek A, Ruchala M. Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly--meta-analysis and systematic review. PLoS One. 2014 Feb 14;9(2):e88787

Relationship between nodular thyroid disease and metabolic paramethers in patients with acromegaly

Yıl 2018, , 59 - 65, 01.03.2018
https://doi.org/10.18663/tjcl.310185

Öz

Aim: The
high prevalence of nodular goiter in patients with acromegaly is well known. Insulin-like growth factor-1 (IGF-1) has been claimed to be one of the etiologic factors. The aim of the study was to
evaluate the incidence of thyroid lesions in our
acromegalic patients and to analyze possible factors influencing thyroid nodule
development, especially insulin resistance and hormonal parameters.



Material and Methods: Sixty patients with acromegaly, 32 females, and 28 males,
with a mean age of 52.7 ± 10.0 years without
known thyroid disease
were included. Age and sex matched 100 control subjects
also included in the study. Waist and hip circumference, weight,
and height,
fasting blood glucose, postprandial blood glucose,
insulin, thyroid function
tests
, thyroid autoantibodies,
lipid profile, IGF-1, growth hormone, other anterior pituitary
hormone levels were measured in all
patients.
Magnetic Resonance Imaging (MRI) and
thyroid
ultrasonography (US)
was performed in all
patients.
Thyroid nodule
volume and thyroid volume were calculated.



Results: Thirty-five (58.3%)
patients with acromegaly
had thyroid nodules according to
(% 25) in control group (p<
0,0001). There were significant differences in
BMI, thyroid volume, fasting glucose and TSH levels between patients and
controls.
After regression
analysis, thyroid volume was associated with insulin, waist circumference, HOMA-IR, LDL-cholesterol
and the size of the pituitary adenoma (p<0.05) or diabetes occurrence. During the logistic
regression
analysis, the presence
of
nodules was strongly associated with luteinizing
hormone (LH) (p<0.02) and HDL-cholesterol levels (p<0.05). Nodule volume were
significantly associated with LH level (p<0.05), ACTH (beta
= -0.51, p< 0.01),
plasma cortisol (beta= 0.965, p <0.05), free
T4
(beta= 0.522, p<0.05), the size of adenoma (beta= 0.615,
p<0.05) in the regression analysis.



Conclusion: The prevalence of nodules in acromegalic patients
were found to be higher than usual prevalence. In addition to IGF-1, other
hormones and insulin resistance might play an important role in thyroid volume,
nodule volume, and nodule formation mechanism in patients with acromegaly.

Kaynakça

  • 1. Melmed S. Medical progress: acromegaly. N Engl J Med. 2006; 355:2558–2573 2. Ribeiro-OliveiraAJr, Barkan A. The changing face of acromegaly–advances in diagnosis and treatment. Nat Rev Endocrinol. 2012;8:605–611 3. Cheung NW, Boyages SC: The thyroid gland in acromegaly: An ultrasonographic study, Clin Endocrinol (Oxf) 46:545–549, 1997). 4. Wolinski K, Czarnywojtek A, Ruchala M. Risk of thyroid nodular disease and thyroid cancer in patients with acromegaly--meta-analysis and systematic review. PLoS One. 2014 Feb 14;9(2):e88787
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Makale
Yazarlar

Bekir Uçan

Mustafa Şahin

Muhammed Kızılgül

Mustafa Özbek Bu kişi benim

İlknur Ünsal

Erman Çakal Bu kişi benim

Yayımlanma Tarihi 1 Mart 2018
Yayımlandığı Sayı Yıl 2018

Kaynak Göster

APA Uçan, B., Şahin, M., Kızılgül, M., Özbek, M., vd. (2018). Relationship between nodular thyroid disease and metabolic paramethers in patients with acromegaly. Turkish Journal of Clinics and Laboratory, 9(1), 59-65. https://doi.org/10.18663/tjcl.310185
AMA Uçan B, Şahin M, Kızılgül M, Özbek M, Ünsal İ, Çakal E. Relationship between nodular thyroid disease and metabolic paramethers in patients with acromegaly. TJCL. Mart 2018;9(1):59-65. doi:10.18663/tjcl.310185
Chicago Uçan, Bekir, Mustafa Şahin, Muhammed Kızılgül, Mustafa Özbek, İlknur Ünsal, ve Erman Çakal. “Relationship Between Nodular Thyroid Disease and Metabolic Paramethers in Patients With Acromegaly”. Turkish Journal of Clinics and Laboratory 9, sy. 1 (Mart 2018): 59-65. https://doi.org/10.18663/tjcl.310185.
EndNote Uçan B, Şahin M, Kızılgül M, Özbek M, Ünsal İ, Çakal E (01 Mart 2018) Relationship between nodular thyroid disease and metabolic paramethers in patients with acromegaly. Turkish Journal of Clinics and Laboratory 9 1 59–65.
IEEE B. Uçan, M. Şahin, M. Kızılgül, M. Özbek, İ. Ünsal, ve E. Çakal, “Relationship between nodular thyroid disease and metabolic paramethers in patients with acromegaly”, TJCL, c. 9, sy. 1, ss. 59–65, 2018, doi: 10.18663/tjcl.310185.
ISNAD Uçan, Bekir vd. “Relationship Between Nodular Thyroid Disease and Metabolic Paramethers in Patients With Acromegaly”. Turkish Journal of Clinics and Laboratory 9/1 (Mart 2018), 59-65. https://doi.org/10.18663/tjcl.310185.
JAMA Uçan B, Şahin M, Kızılgül M, Özbek M, Ünsal İ, Çakal E. Relationship between nodular thyroid disease and metabolic paramethers in patients with acromegaly. TJCL. 2018;9:59–65.
MLA Uçan, Bekir vd. “Relationship Between Nodular Thyroid Disease and Metabolic Paramethers in Patients With Acromegaly”. Turkish Journal of Clinics and Laboratory, c. 9, sy. 1, 2018, ss. 59-65, doi:10.18663/tjcl.310185.
Vancouver Uçan B, Şahin M, Kızılgül M, Özbek M, Ünsal İ, Çakal E. Relationship between nodular thyroid disease and metabolic paramethers in patients with acromegaly. TJCL. 2018;9(1):59-65.


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