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    Choroidal Thickness in Mild Autonomous Cortisol Secretion
    (Kare Publ, 2024) Cakir, Sezin Dogan; Cakir, Akin; Ozturk, Feyza Yener; Basmaz, Seda Erem; Batman, Adnan; Saygili, Emre Sedar; Erol, Rumeysa Selvinaz
    Objectives: To evaluate the patients with mild autonomous cortisol secretion (MACS) by means of choroidal thickness (CT) and also investigate whether CT may be a diagnostic tool in the management of MACS or not. Methods: Twenty-seven patients with MACS and 25 age -sex -matched healthy controls were enrolled in this cross-sectional comparative study. All the participants underwent CT measurement by using Spectralis optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) with enhanced deep imaging mode at the subfoveal, 500-1000-1500 mu m nasal and 500-10001500 mu m temporal to the foveola. Results: The groups were similar in terms of spherical equivalence, age and axial lengths. The mean CT was significantly thicker in patients with MACS than controls in all measurement quadrants (p<0.001). There was no significant correlation between CT, size of the adenoma, basal cortisol, 1mg dexamethasone suppression test, salivary cortisol, 24 -hour total urine -free cortisol, ACTH and DHEAS levels. However, 2 mg dexamethasone suppression test results were found to be significantly correlated with CT in temporal 500-1000 and 1500 m quadrants (r=0.436, p=0.023, r=0.443, p=0.021 and r=0.488, p=0.010, respectively). Five (18.5%) eyes had pachychoroid pigment epitheliopathy in the MACS group. Conclusion: CT increases in patients with MACS and those tend to have pachychoroid pigment epitheliopathy more frequent than healthy individuals. A thicker choroid in the patients with MACS may be a novel biomarker both as a diagnostic tool for the degree of hypercortisolemia and cortisol-related comorbidity.
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    Comment on: Vertebral Fractures Increase the Long-Term Mortality of Patients with Coronavirus Disease 2019
    (AVES, 2025) Karakilic, Ersen; Saygili, Emre Sedar
    [No abstract available]
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    Impact of COVID-19 Vaccination on Fatality and Intensive Care Unit Admission in Patients with Type 2 Diabetes Mellitus
    (Aves, 2024) Karakilic, Ersen; Saygili, Emre Sedar; Yildiz, Ozlem; Kuyucu, Asli
    Objective: This study aims to investigate the influence of coronavirus (COVID-19) vaccination on hospital outcomes among patients with type 2 diabetes mellitus (T2DM). Methods: A total of 324 patients hospitalized for COVID-19 were evaluated retrospectively. Type 2 diabetes mellitus patients were matched 1:1 by the propensity score matching method to individuals without diabetes for age and gender. After matching, we analyzed 70 patients with T2DM and 70 without diabetes. Results: Individuals with T2DM exhibited a slightly higher vaccination rate than those without diabetes (67.1% vs. 54.3%, P = .119). Regardless of diabetes status, vaccinated participants experienced significantly lower rates of intensive care unit (ICU) admission (T2DM: 14.9% vs. 60.9%, P = .001; non- diabetics: 5.3% vs. 37.5%, P = .001) and fatality (T2DM: 2.1% vs. 60.9%, P = .001; non-diabetics: 0% vs. 46.9%, P = .001) compared to the unvaccinated group. The length of hospitalization and ICU admission rate were insignificantly higher in vaccinated individuals with T2DM than those without diabetes (9.0 days vs. 7.0 days, P = .154; 14.9% vs. 5.3%, P = .179). Multivariate logistic regression in T2DM patients revealed that CoronaVac vaccination significantly reduced ICU admission (OR: 0.089, 95% CI 0.022-0.360, P = .001), while male gender increased the risk (OR: 6.59, 95% CI 1.545-28.11, P = .011). Conclusion: In vaccinated individuals with T2DM, the risk of severe COVID-19 and fatality significantly decreased, similar to individuals without diabetes. This protection is not affected by vaccine type, vaccination count, or age.
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    Is predicting metastatic phaeochromocytoma and paraganglioma still effective without methoxytyramine?
    (Elsevier, 2024) Saygili, Emre Sedar; Elhassan, Yasir S.; Ronchi, Cristina L.
    [Anstract Not Available]
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    Machine Learning-Based Survival Prediction Tool for Adrenocortical Carcinoma
    (Endocrine Soc, 2025) Saygili, Emre Sedar; Elhassan, Yasir S.; Prete, Alessandro; Lippert, Juliane; Altieri, Barbara; Ronchi, Cristina L.
    Context Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with difficult to predict clinical outcomes. The S-GRAS score combines clinical and histopathological variables (tumor stage, grade, resection status, age, and symptoms) and showed good prognostic performance for patients with ACC.Objective To improve ACC prognostic classification by applying robust machine learning (ML) models.Method We developed ML models to enhance outcome prediction using the published S-GRAS dataset (n = 942) as the training cohort and an independent dataset (n = 152) for validation. Sixteen ML models were constructed based on individual clinical variables. The best-performing models were used to develop a web-based tool for individualized risk prediction.Results Quadratic Discriminant Analysis, Light Gradient Boosting Machine, and AdaBoost Classifier models exhibited the highest performance, predicting 5-year overall mortality (OM), and 1-year and 3-year disease progression (DP) with F1 scores of 0.79, 0.63, and 0.83 in the training cohort, and 0.72, 0.60, and 0.83 in the validation cohort. Sensitivity and specificity for 5-year OM were at 77% and 77% in the training cohort, and 65% and 81% in the validation cohort, respectively. A web-based tool (https://acc-survival.streamlit.app) was developed for easily applicable and individualized risk prediction of mortality and disease progression.Conclusion S-GRAS parameters can efficiently predict outcome in patients with ACC, even using a robust ML model approach. Our web app instantly estimates the mortality and disease progression for patients with ACC, representing an accessible tool to drive personalized management decisions in clinical practice.
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    Predictors of Hypothyroidism Following Empirical Dose Radioiodine in Toxic Thyroid Nodules: Real-Life Experience
    (Elsevier Inc, 2022) Demir, Busra Kuyumcu; Karakilic, Ersen; Saygili, Emre Sedar; Araci, Nilgun; Ozdemir, Semra
    Objective: We aimed to determine the factors predicting hypothyroidism after radioactive iodine (RAI) treatment in patients with toxic adenoma and toxic multinodular goiter.Methods: We retrospectively collected the data of 237 patients with toxic multinodular goiter or toxic adenoma who had consecutively received RAI treatment between 2014 and 2020 at 2 medical centers. Patients who received the second RAI treatment and whose medical records could not be accessed were excluded from the study. Finally, 133 patients were included in the study. RAI was administered at an empirical dose of 15 or 20 mCi.Results: The median age of the 133 participants was 69 years (interquartile range, 62-75 years), and 64.7% of the participants were women. A total of 42.1% of the patients had toxic adenoma, whereas 57.9% of patients had toxic multinodular goiter. The median follow-up was 24 months (interquartile range, 11-38 months). During the follow-up, 61.7% of patients became euthyroid, 30.8% developed hypothy-roidism, and 7.5% remained hyperthyroid. The median month of hypothyroidism onset was 4 months (interquartile range, 2-9 months). Regression analysis revealed 2 factors that could predict hypothy-roidism: thyroid-stimulating hormone (odds ratio, 2.548; 95% CI, 1.042-6.231; P = .04) and thyroid volume (odds ratio, 0.930; 95% CI, 0.885-0.978; P = .005).Conclusion: Overall, 30.8% of the cases developed hypothyroidism after the RAI treatment. Approxi-mately 78% of hypothyroidism developed within the first 10 months. The risk of hypothyroidism was higher in patients with higher thyroid-stimulating hormone and smaller thyroid volume.(c) 2022 AACE. Published by Elsevier Inc. All rights reserved.
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    Tamoxifen Treatment for Riedel's Thyroiditis: A Case Report
    (Aves, 2023) Karakilic, Ersen; Saygili, Emre Sedar; Yildiz, Oezlem; Kuyucu, Asli
    Riedel's thyroiditis is a rare variant of thyroiditis, and treatment recommendations are based on case reports. This thyroiditis form is considered among immunoglobulin G4-related diseases. Intense fibrosis of the thyroid gland can cause compression of the surrounding tissues and hypothyroidism. Glucocorticoids are recommended as first-line therapy, and tamoxifen is second-line therapy. Other immunosuppressive agents have also been used in some resistant cases. Our case was presented with a palpable firm mass in the neck, shortness of breath, and hypothyroidism. The exact diagnosis of Riedel's thyroiditis was made after a pathological examination of a true-cut biopsy. We present the successful management of this case with glucocorticoid and tamoxifen combination treatment.
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    The Relationship Between the Admission Blood Glucose Level and 90-Day Mortality in Non-Diabetic Patients with Coronavirus Disease-2019
    (Galenos Publ House, 2022) Saygili, Emre Sedar; Karakilic, Ersen
    Introduction: The admission blood glucose (ABG) level is associated with increased mortality in non-diabetics patients with Coronavirus disease-2019 (COVID-19) in short-term follow-up studies. However, post-discharge mortality has also increased in COVID-19. Thus, this study aimed to examine the relationship between ABG and 90-day mortality including the post-discharge period. Methods: Non-diabetic patients who are hospitalized due to COVID-19 in 2020 were evaluated. Patients were divided into groups according to the ABG level. Groups 1, 2, and 3 have ABG level of <100 mg/dL, 100-139 mg/dL, and 140-199 mg/dL, respectively. Intensive care unit admission, in-hospital mortality, and 30- and 90-day mortality rates were evaluated as outcomes. COX regression analyzes were used to assess mortality risk factors. Results: A total of 1207 non-diabetic patients, of whom 49.2% were females, with a mean age of 65.2 +/- 13.4 years, were included in the study. The patients were followed up for a median of 153 (inter quartile range: 107.5-251, maximum: 369) days. The in-hospital and 30-day mortality of group 2 was higher than group 1 in the univariate analysis but without statistical significance in multivariate analysis. Group 3 had worse outcomes than group 1 in both univariate and multivariate analysis at all endpoints. Group 3 had 2.533 adjusted hazard ratios (95% confidence interval: 1.628-3.941, p<0.001) 90-day mortality compared with group 1. Conclusion: Non-diabetic patients with COVID-19 with an admission glucose level of >= 140 mg/dl had 2.5-fold increased all-cause mortality at 90 days. Therefore, being more careful in treating and following non-diabetic patients with COVID-19, especially those with hyperglycemia at admission, was recommended.