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Hulusi Atmaca, Fatih Tanriverdi, Kursad Unluhizarci, Fahri Bayram and Fahrettin Kelestimur

Objective: Some patients with hyperandrogenemia had no identifiable cause, which was named as idiopathic hyperandrogenemia (IHA). The role of the adrenal glands in these patients was investigated.

Design: Clinical study in patients with IHA at the Endocrinology Department of a University Hospital.

Patient(s): In this study, 26 pre-menopausal women with IHA and 20 healthy women were included. Basal hormonal investigations, ACTH test and a 75 g oral glucose tolerance test (OGTT) were performed. Basal levels of total testosterone, free testosterone, androstenedione (A4), sex hormone-binding globulin, DHEA sulfate (DHEAS), cortisol, 17-hydroxyprogesterone (17-OHP), 11-deoxycortisol (11-S) and ACTH-stimulated levels of cortisol, A4, DHEAS, 17-OHP, and 11-S were measured. Additionally, glucose and insulin responses to OGTT were obtained.

Results: The patients and the control subjects had similar age and body mass index. Peak and area under the curve (AUC) responses of 11-S (P < 0.05), DHEAS (P < 0.005), and A4 (peak, P < 0.005; AUC, P < 0.001) to ACTH test were significantly higher in the patients with IHA than in the control subjects. There was a significant correlation between the basal DHEAS levels, peak 11-S, and AUC11-S, in response to ACTH-stimulation test in patients with IHA (P < 0.005, r, 0.6). Four (16.6%) patients with IHA had glucose intolerance.

Conclusion: Our data suggest that adrenal androgen excess may playanimportant role in patients with IHA and these patients exhibit increased prevalence of glucose intolerance.

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Feyzi Gokosmanoğlu, Aygül Güzel, Elif Kilic Kan and Hulusi Atmaca


Diabetes mellitus and obesity are well-known risk factors associated with obstructive sleep apnea (OSA). Cushing’s syndrome (CS) is also characterized by obesity and diabetes mellitus. However, the association between CS and OSA remains unclear. Therefore, we investigated the possible associations between CS and OSA in this study.

Patients and methods

Thirty female patients with newly diagnosed active CS and 30 age-, gender- and body mass index (BMI)-matched controls were included in this study. All participants were evaluated by overnight polysomnography. OSA was defined as having an apnea–hypopnea index (AHI) score of ≥5 events/h. Insulin resistance was calculated by homeostasis model assessment (HOMA) scores. Fasting serum cortisol was also determined.


The prevalence of OSA was higher (50% vs 23%, P = 0.003) in patients with CS compared with the control subjects. The mean HOMA (P = 0.046) and AHI (P = 0.028) scores were higher in patients with CS compared with the control subjects. AHI was positively correlated with the HOMA scores (r = 0.281, P = 0.046) in both groups. Linear regression analysis showed that serum cortisol remained as an independent predictor for AHI after controlling for BMI and HOMA score (P < 0.001).


The prevalence of OSA increased in patients with CS compared with control subjects with similar ages and BMI levels. Hypercortisolemia is an independent risk factor for developing OSA. The presence of OSA needs to be considered in patients with CS.

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Hulusi Atmaca, Fatih Tanriverdi, Cumali Gokce, Kursad Unluhizarci and Fahrettin Kelestimur

Objective: We studied posterior pituitary function in 27 patients with Sheehan’s syndrome and 14 controls.

Design: All patients were investigated by water deprivation test and 26 of them by 5% hypertonic saline infusion test. None of the patients had symptoms of diabetes insipidus and all patients were on adequate glucocorticoid and thyroid hormone replacement therapy before testing.

Results: According to dehydration test, 8 (29.6%) patients had partial diabetes insipidus (PDI group) and 19 (70.3%) had normal response (non-DI group). During the 5% hypertonic saline infusion test, the maximal plasma osmolality was higher in PDI (305 ± 4.3) and non-DI (308 ± 1.7) groups when compared with controls (298 ± 1.7 mOsm/kg; P < 0.005), but the maximal urine osmolality was lower in PDI group (565 ± 37) than in non-DI (708 ± 45) and control (683 ± 17 mOsm/kg) groups (P < 0.05). The osmotic threshold for thirst perception was higher in PDI (296 ± 4.3) and non-DI (298 ± 1.4) groups when compared with control group (287 ± 1.5 mOsm/kg) (P < 0.005). Basal plasma osmolalities were also higher in PDI (294 ± 1.0) and non-DI (297 ± 1.1) groups than in controls (288 ± 1.2 mOsm/kg; P < 0.001).

Conclusions: Our findings demonstrated that patients with Sheehan’s syndrome have an impairment of neurohypophyseal function. The thirst center may be affected by ischemic damage and the osmotic threshold for the onset of thirst in patients with Sheehan’s syndrome is increased.

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Halit Diri, Fatih Tanriverdi, Zuleyha Karaca, Serkan Senol, Kursad Unluhizarci, Ahmet Candan Durak, Hulusi Atmaca and Fahrettin Kelestimur


Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients.

Study design

A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations.


The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whose basal prolactin was below 4.0 ng/ml had adequate prolactin responses to TRH test, while all patients whose basal prolactin was above 7.8 ng/ml had adequate responses. Mean sella volume was found to be significantly lower in the SS group (340.5±214 mm3) than that in the healthy group (602.5±192 mm3).


SS is a common cause of hypopituitarism in underdeveloped and developing countries. The main reasons for diagnostic delay seem to be the high frequency of patients with nonspecific complaints and neglect of SS. In addition, the TRH stimulation test was found to have a high sensitivity and specificity to recognize PRL deficiency. Furthermore, small sella size may have an important contributing role in the etiopathogenesis of SS.