The comprehensive evaluation of oral and fecal microbiota in patients with acromegaly.

Acromegaly Gut Microbiota Oral microbiology Periodontitis

Journal

Pituitary
ISSN: 1573-7403
Titre abrégé: Pituitary
Pays: United States
ID NLM: 9814578

Informations de publication

Date de publication:
19 Aug 2024
Historique:
accepted: 05 08 2024
medline: 19 8 2024
pubmed: 19 8 2024
entrez: 19 8 2024
Statut: aheadofprint

Résumé

The alteration of the microbiota in the mouth and gut could potentially play a role in the pathogenesis of various diseases, and conversely, these diseases may have an influence on the composition of the gut microbiota. Acromegaly disease can potentially affect physiological processes in the mouth and gut. The present study was designed to investigate the relationship between acromegaly and the oral and gut microbiota, as data on this topic are scarce. This was a multicenter, cross-sectional study. Our study included individuals diagnosed with acromegaly (who were treated and followed up, and also as an another group of patients with newly diagnosed acromegaly) and healthy participants. All three groups were assessed and compared based on age, sex, serum IGF-1, body mass index BMI as well as their stool and oral microbiota We collected demographic information from the patients, collected fecal and oral samples, performed DNA isolation followed by 16 S rRNA sequencing, and then performed bioinformatic analysis. We also analyzed the oral and fecal samples with respect to medical and surgical treatment and disease control status, specific treatments received for acromegaly, presence of comorbidities, hypopituitarism status, presence of intestinal polyps. One hundred and three patients with acromegaly, 15 newly diagnosed patients with acromegaly without comorbidities and 34 healthy controls were included in the study. The Firmicutes/Bacteroidetes ratio was significantly lower in patients with acromegaly who received treatment (medical and/or surgical) than in healthy controls. In addition, a significant difference was found in the fecal and oral microbiota of patients with acromegaly with disease control compared to healthy controls. Furthermore, a significant difference was found in the fecal and oral microbiota of patients with acromegaly without disease control. Nevertheless, it was not possible to establish a clear relationship between disease control status, the presence of intestinal polyps, the presence of type 2 diabetes and the composition of the oral and gut microbiota in acromegalic patients who had received different forms of treatment. Patients with acromegaly show distinct gut microbiota profiles, and it is evident that factors beyond the GH/IGF-1 axis play a role in shaping the gut microbiota of individuals with acromegaly.

Identifiants

pubmed: 39158810
doi: 10.1007/s11102-024-01444-6
pii: 10.1007/s11102-024-01444-6
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925
Organisme : Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa
ID : TSA-2020-34925

Informations de copyright

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Références

Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25(1):102–152. https://doi.org/10.1210/er.2002-0022
doi: 10.1210/er.2002-0022 pubmed: 14769829
Bogazzi F, Colao A, Rossi G et al (2013) Comparison of the effects of primary somatostatin analogue therapy and pituitary adenomectomy on survival in patients with acromegaly: a retrospective cohort study. Eur J Endocrinol 169(3):367–376. https://doi.org/10.1530/EJE-13-0166
doi: 10.1530/EJE-13-0166 pubmed: 23828855
Bolfi F, Neves AF, Boguszewski CL, Nunes-Nogueira VS (2018) Mortality in acromegaly decreased in the last decade: a systematic review and meta-analysis. Eur J Endocrinol 179(1):59–71. https://doi.org/10.1530/EJE-18-0255
doi: 10.1530/EJE-18-0255 pubmed: 29764907
Ursell LK, Haiser HJ, Van Treuren W et al (2014) The intestinal metabolome: an intersection between microbiota and host. Gastroenterology 146(6):1470–1476. https://doi.org/10.1053/j.gastro.2014.03.001
doi: 10.1053/j.gastro.2014.03.001 pubmed: 24631493
Morgan XC, Segata N, Huttenhower C (2013) Biodiversity and functional genomics in the human microbiome. Trends Genet 29(1):51–58. https://doi.org/10.1016/j.tig.2012.09.005
doi: 10.1016/j.tig.2012.09.005 pubmed: 23140990
Qin J, Li R, Raes J et al (2010) A human gut microbial gene catalogue established by metagenomic sequencing. Nature 4;464(7285):59–65. https://doi.org/10.1038/nature08821
Faith JJ, Guruge JL, Charbonneau M et al (2013) The long-term stability of the human gut microbiota. Science 5;341(6141):1237439. https://doi.org/10.1126/science.1237439
Musso G, Gambino R, Cassader M (2011) Interactions between gut microbiota and host metabolism predisposing to obesity and diabetes. Annu Rev Med 62:361–380. https://doi.org/10.1146/annurev-med-012510-175505
doi: 10.1146/annurev-med-012510-175505 pubmed: 21226616
Tang WHW, Kitai T, Hazen SL (2017) Gut microbiota in cardiovascular health and disease. Circulation Research 31;120(7):1183–1196. https://doi.org/10.1161/CIRCRESAHA.117.309715
Farzi A, Fröhlich EE, Holzer P (2018) Gut microbiota and the neuroendocrine system. Neurotherapeutics 15(1):5–22. https://doi.org/10.1007/s13311-017-0600-5
doi: 10.1007/s13311-017-0600-5 pubmed: 29380303 pmcid: 5794709
Collins SM, Surette M, Bercik P (2012) The interplay between the intestinal microbiota and the brain. Nat Rev Microbiol 10(11):735–742. https://doi.org/10.1038/nrmicro2876
doi: 10.1038/nrmicro2876 pubmed: 23000955
Hacioglu A, Gundogdu A, Nalbantoglu U et al (2021) Gut microbiota in patients with newly diagnosed acromegaly: a pilot cross-sectional study. Pituitary 24(4):600–610. https://doi.org/10.1007/s11102-021-01137-4
doi: 10.1007/s11102-021-01137-4 pubmed: 33721175
Yan J, Herzog JW, Tsang K et al (2016) Gut microbiota induce IGF-1 and promote bone formation and growth. Proc Natl Acad Sci USA 22(47):E7554–E7563. https://doi.org/10.1073/pnas.1607235113
doi: 10.1073/pnas.1607235113
Jensen EA, Young JA, Jackson Z et al (2022) Excess growth hormone alters the male mouse gut microbiome in an age-dependent manner. Endocrinology 1;163(7):bqac074. https://doi.org/10.1210/endocr/bqac074
Peng X, Cheng L, You Y et al (2022) Oral microbiota in human systematic diseases. Int J Oral Sci 2;14(1):14. https://doi.org/10.1038/s41368-022-00163-7
Dawes C, Wong DTW (2019) Role of saliva and salivary diagnostics in the advancement of oral health. J Dent Res 98:133–141. https://doi.org/10.1177/0022034518816961
doi: 10.1177/0022034518816961 pubmed: 30782091 pmcid: 6900436
Xian P, Xuedong Z, Xin X et al (2018) The oral microbiome bank of China. Int J Oral Sci 3;10(2):16. https://doi.org/10.1038/s41368-018-0018-x
Turnbaugh PJ, Ley RE, Hamady M, Fraser-Liggett CM, Knight R, Gordon JI (2007) The human microbiome project. Nature 18;449(7164):804–810. https://doi.org/10.1038/nature06244
Graves DT, Correa JD, Silva TA (2019) The oral microbiota is modified by systemic diseases. J Dent Res 98:148–156. https://doi.org/10.1177/0022034518805739
doi: 10.1177/0022034518805739 pubmed: 30359170
Melmed S (2009) Acromegaly pathogenesis and treatment. J Clin Invest 119(11):3189–3202. https://doi.org/10.1172/JCI39375
doi: 10.1172/JCI39375 pubmed: 19884662 pmcid: 2769196
Hughes JB, Hellmann JJ, Ricketts TH, Bohannan BJM (2001) Counting the uncountable: statistical approaches to estimating microbial diversity. Applied and Environmental Microbiology 67:399–4406. https://doi.org/10.1128/AEM.67.10.4399-4406.2001
Caporaso JG, Lauber CL, Walters WA et al (2012) Ultra-high-throughput microbial community analysis on the illumina HiSeq and MiSeq platforms. ISME Journal 2012;6(8):1621–1624. https://doi.org/10.1038/ismej.2012.8
[([ http://earthmicrobiome.org/protocols-and-standards/16s ] (Accessed on April 1, 2023))]
Bolyen E, Rideout JR, Dillon MR et al (2019) Reproducible, interactive, scalable and extensible microbiome data science using QIIME 2. Nat Biotechnol 37(8):852–857. https://doi.org/10.1038/s41587-019-0209-9
doi: 10.1038/s41587-019-0209-9 pubmed: 31341288 pmcid: 7015180
Bolger AM, Lohse M, Usadel B (2014) Trimmomatic: a flexible trimmer for illumina sequence data. Bioinformatics 1;30(15):2114–2120. https://doi.org/10.1093/bioinformatics/btu170
Quast C, Pruesse E, Yilmaz P et al (2013) The SILVA ribosomal RNA gene database project: improved data processing and web-based tools. Nucleic Acids Res 41(Database issue):D590–596. https://doi.org/10.1093/nar/gks1219
doi: 10.1093/nar/gks1219 pubmed: 23193283
Sahin S, Gundogdu A, Nalbantoglu U et al (2022) Acromegaly is associated with a distinct oral and gut microbiota. Pituitary 25(3):520–530. https://doi.org/10.1007/s11102-022-01223-1
doi: 10.1007/s11102-022-01223-1 pubmed: 35467272
Lin B, Wang M, Gao R et al (2022) Characteristics of gut microbiota in patients with GH-secreting pituitary adenoma. Microbiol Spectr 23(101):e0042521. https://doi.org/10.1128/spectrum.00425-21
doi: 10.1128/spectrum.00425-21
Sendur SN, Ergunay K, Akyon Y et al (2020) Probable alterations in fecal bacterial microbiota by somatostatin receptor analogs in acromegaly. Turk J Biochem 45(6):695–700. https://doi.org/10.1515/tjb-2020-0293
doi: 10.1515/tjb-2020-0293
Macfarlane GT, Macfarlane S (2011) Fermentation in the human large intestine: its physiologic consequences and the potential contribution of prebiotics. J Clin Gastroenterol. https://doi.org/10.1097/MCG.0b013e31822fecfe . 45 Suppl:S120-127
doi: 10.1097/MCG.0b013e31822fecfe pubmed: 21992958
Plöger S, Stumpff F, Penner GB et al (2012) Microbial butyrate and its role for barrier function in the gastrointestinal tract. Ann N Y Acad Sci 1258:52–59. https://doi.org/10.1111/j.1749-6632.2012.06553.x
doi: 10.1111/j.1749-6632.2012.06553.x pubmed: 22731715
Flint HJ, Scott KP, Duncan SH, Louis P, Forano E (2012) Microbial degradation of complex carbohydrates in the gut. Gut Microbes 3(4):289–306. https://doi.org/10.4161/gmic.19897
doi: 10.4161/gmic.19897 pubmed: 22572875 pmcid: 3463488
Miquel S, Martín R, Rossi O et al (2013) Faecalibacterium prausnitzii and human intestinal health. Curr Opin Microbiol 16(3):255–261. https://doi.org/10.1016/j.mib.2013.06.003
doi: 10.1016/j.mib.2013.06.003 pubmed: 23831042
Sokol H, Pigneur B, Watterlot L et al (2008) Faecalibacterium prausnitzii is an anti-inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. Proc Natl Acad Sci U S A 28;105(43):16731–16736. https://doi.org/10.1073/pnas.0804812105
Swidsinski A, Loening-Baucke V, Vaneechoutte M, Doerffel Y (2008) Active Crohn’s disease and ulcerative colitis can be specifically diagnosed and monitored based on the biostructure of the fecal flora. Inflamm Bowel Dis 14(2):147–161. https://doi.org/10.1002/ibd.20330
doi: 10.1002/ibd.20330 pubmed: 18050295
Miller WD (1891) The human mouth as a focus of infection. Lancet 138:340–342. https://doi.org/10.1016/S0140-6736(02)01387-9
doi: 10.1016/S0140-6736(02)01387-9
Maeda Y, Takeda K (2017) Role of gut microbiota in rheumatoid arthritis. J Clin Med 9;6(6):60. https://doi.org/10.3390/jcm6060060
Karamzin AM, Ropot AV, Sergeyev OV, Khalturina EO (2021) Akkermansia muciniphila and host interaction within the intestinal tract. Anaerobe 72:102472. https://doi.org/10.1016/j.anaerobe.2021.102472
doi: 10.1016/j.anaerobe.2021.102472 pubmed: 34743983
Slots J (2017) Periodontitis: facts, fallacies and the future. Periodontol 2000.75(1):7–23. https://doi.org/10.1111/prd.12221 (2017)
Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J (2017) Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action. J Clin Periodontol 44(5):456–462. https://doi.org/10.1111/jcpe.12732
doi: 10.1111/jcpe.12732 pubmed: 28419559
Chaushu S, Wilensky A, Gur C et al (2012) Direct recognition of Fusobacterium nucleatum by the NK cell natural cytotoxicity receptor NKp46 aggravates periodontal disease. PLoS Pathog 8(3):e1002601. https://doi.org/10.1371/journal.ppat.1002601
doi: 10.1371/journal.ppat.1002601 pubmed: 22457623 pmcid: 3310798
Park J, Shokeen B, Haake SK, Lux R (2016) Characterization of Fusobacterium nucleatum ATCC 23726 adhesins involved in strain-specific attachment to Porphyromonas gingivalis. Int J Oral Sci 8:138–144. https://doi.org/10.1038/ijos.2016.27
doi: 10.1038/ijos.2016.27 pmcid: 5113093
Polak D, Wilensky A, Shapira L et al (2009) Mouse model of experimental periodontitis induced by Porphyromonas gingivalis/Fusobacterium nucleatum infection: bone loss and host response. J Clin Periodontol 36(5):406–410. https://doi.org/10.1111/j.1600-051X.2009.01393.x
doi: 10.1111/j.1600-051X.2009.01393.x pubmed: 19419440
Waxler R (2007) Acromegaly. American Journal of Orthodontics and Dentofacial Orthopedics. 131(1):6. https://doi.org/10.1016/j.ajodo.2006.11.011
Capoglu I, Yilmaz AB, Unüvar N, Orbak R, Aksoy H, Yesilyurt H (2002) Gingival enlargement in acromegaly. Endocrine 18(3):207–210. https://doi.org/10.1385/ENDO:18:3:207
doi: 10.1385/ENDO:18:3:207 pubmed: 12450310
Lima DL, Montenegro RM Jr., Vieira AP, Albano MF, Rego DM (2009) Absence of periodontitis in acromegalic patients. Clin Oral Invest 13(2):165–169. https://doi.org/10.1007/s00784-008-0216-6
doi: 10.1007/s00784-008-0216-6
Bascil S, Serinsoz H, Tutuncu NB (2014) Acromegaly is protective for periodontal tissue - advanced chronic periodontitis is rare in acromegalics. Bratisl Lek Listy 115(9):588–592. https://doi.org/10.4149/bll_2014_114
doi: 10.4149/bll_2014_114 pubmed: 25318921
Song B, Xian W, Sun Y et al (2023) Akkermansia muciniphila inhibited the periodontitis caused by Fusobacterium nucleatum. NPJ Biofilms Microbiomes 17(91):49. https://doi.org/10.1038/s41522-023-00417-0
doi: 10.1038/s41522-023-00417-0
Lay C, Sutren M, Rochet V, Saunier K, Doré J, Rigottier-Gois L (2005) Design and validation of 16S rDNA probes to enumerate members of the Clostridium leptum subgroup in human faecal microbiota. Environ Microbiol 7:933–946. https://doi.org/10.1111/j.1462-2920.2005.00763.x
doi: 10.1111/j.1462-2920.2005.00763.x pubmed: 15946290
Ley RE, Turnbaugh P, Klein S, Gordon JI (2006) Microbial ecology: human gut microbes associated with obesity. Nature 444:1022–1023. https://doi.org/10.1038/4441022a
doi: 10.1038/4441022a pubmed: 17183309
Stojanov S, Berlec A, Štrukelj B (2020) The influence of probiotics on the firmicutes/bacteroidetes ratio in the treatment of obesity and inflammatory bowel disease. Microorganisms 8(11):1715. https://doi.org/10.3390/microorganisms8111715
doi: 10.3390/microorganisms8111715 pubmed: 33139627 pmcid: 7692443
Ben-Shlomo A, Melmed S (2008) Acromegaly. Endocrinol Metab Clinics North America. 37:101–122. https://doi.org/10.1016/J.ECL.2007.10.002
Gadelha MR, Kasuki L, Lim DST, Fleseriu M (2019) Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocr Rev 40(1):268–332. https://doi.org/10.1210/er.2018-00115
doi: 10.1210/er.2018-00115 pubmed: 30184064
Mercado M, Gonzalez B, Vargas G et al (2014) Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. J Clin Endocrinol Metab 99(12):4438–4446. https://doi.org/10.1210/jc.2014-2670
doi: 10.1210/jc.2014-2670 pubmed: 25210882
Maione L, Brue T, Beckers A et al (2017) Changes in the management and comorbidities of acromegaly over three decades: the French acromegaly registry. Eur J Endocrinol 176(5):645–655. https://doi.org/10.1530/EJE-16-1064
doi: 10.1530/EJE-16-1064 pubmed: 28246150
Arosio M, Reimondo G, Malchiodi E et al (2012) Predictors of morbidity and mortality in acromegaly: an Italian survey. Eur J Endocrinol 167(2):189–198. https://doi.org/10.1530/EJE-12-0084
doi: 10.1530/EJE-12-0084 pubmed: 22596288
Gadelha MR, Kasuki L, Lim DST, Fleseriu M (2019) Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocrine Reviews 1;40(1):268–332. https://doi.org/10.1210/er.2018-00115
Sobhani I, Tap J, Roudot-Thoraval F, Roperch JP, Letulle S, Langella P, Corthier G, Van Tran J, Furet JP (2011) Microbial dysbiosis in colorectal cancer (CRC) patients. PLoS ONE 6:e16393
doi: 10.1371/journal.pone.0016393 pubmed: 21297998 pmcid: 3029306
Chen CC, Lin WC, Kong MS, Shi HN, Walker WA, Lin CY, Huang CT, Lin YC, Jung SM, Lin TY (2012) Oral inoculation of probiotics Lactobacillus acidophilus NCFM suppresses tumour growth both in segmental orthotopic colon cancer and extra-intestinal tissue. Br J Nutr 107:1623–1634
doi: 10.1017/S0007114511004934 pubmed: 21992995
Perez F, Randall TA, Galanko J, Benson A, Sandler RS, Rawls JF, Abdo Z, Fodor AA, Keku TO (2012) Increased rectal microbial richness is associated with the presence of colorectal adenomas in humans. ISME J 6:1858–1868
doi: 10.1038/ismej.2012.43
Wang T, Cai G, Qiu Y, Fei N, Zhang M, Pang X, Jia W, Cai S, Zhao L (2012) Structural segregation of gut microbiota between colorectal cancer patients and healthy volunteers. ISME J 6:320–329
doi: 10.1038/ismej.2011.109 pubmed: 21850056
Brown K, Godovannyi A, Ma C, Zhang Y, Ahmadi-Vand Z, Dai C, Gorzelak MA, Chan Y, Chan JM, Lochner A et al (2016) Prolonged antibiotic treatment induces a diabetogenic intestinal microbiome that accelerates diabetes in NOD mice. ISME J 10:321–332
doi: 10.1038/ismej.2015.114 pubmed: 26274050
Koh A, Molinaro A, Ståhlman M, Khan MT, Schmidt C, Mannerås-Holm L, Wu H, Carreras A, Jeong H, Olofsson LE et al (2018) Microbially produced imidazole propionate impairs insulin signaling through mTORC1. Cell 175:947–961
doi: 10.1016/j.cell.2018.09.055 pubmed: 30401435
Sun L, Ma L, Ma Y, Zhang F, Zhao C, Nie Y (2018) Insights into the role of gut microbiota in obesity: pathogenesis, mechanisms, and therapeutic perspectives. Protein Cell 9:397–403
doi: 10.1007/s13238-018-0546-3 pubmed: 29725936 pmcid: 5960470
Virtue AT, McCright SJ, Wright JM, Jimenez MT, Mowel WK, Kotzin JJ, Joannas L, Basavappa MG, Spencer SP, Clark ML et al (2019) The gut microbiota regulates white adipose tissue inflammation and obesity via a family of microRNAs. Sci Transl Med 11:eaav1892
doi: 10.1126/scitranslmed.aav1892 pubmed: 31189717 pmcid: 7050429
Wang X, Wu Y, Liu Y, Chen F, Chen S, Zhang F, Li S, Wang C, Gong Y, Huang R, Hu M, Ning Y, Zhao H, Guo X (2023) Altered gut microbiome profile in patients with knee osteoarthritis. Front Microbiol 14:1153424. https://doi.org/10.3389/fmicb.2023.1153424 eCollection 2023.PMID: 37250055
doi: 10.3389/fmicb.2023.1153424 pubmed: 37250055 pmcid: 10213253

Auteurs

Serdar Sahin (S)

Department of Endocrinology and Metabolic Diseases, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Aycan Gundogdu (A)

Department of Microbiology and Clinical Microbiology, School of Medicine, Erciyes University, Kayseri, Turkey.
Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey.

Ufuk Nalbantoglu (U)

Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey.
Department of Computer Engineering, Erciyes University, Kayseri, Turkey.

Zuleyha Karaca (Z)

Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.

Aysa Hacioglu (A)

Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.

Muhammed Emre Urhan (ME)

Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.

Kursad Unluhizarci (K)

Department of Endocrinology and Metabolic Diseases, School of Medicine, Erciyes University, Kayseri, Turkey.

Mehmet Hora (M)

Genome and Stem Cell Center (GenKok), Erciyes University, Kayseri, Turkey.

Elif Seren Tanrıverdi (ES)

Medical Microbiology Laboratory, Malatya Training and Research Hospital, Malatya, Turkey.

Emre Durcan (E)

Department of Endocrinology and Metabolic Diseases, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Gülsah Elbüken (G)

Department of Endocrinology and Metabolic Diseases, School of Medicine, Namik Kemal University, Tekirdag, Turkey.

Hatice Sebile Dokmetas (HS)

Department of Endocrinology and Metabolic Diseases, University of Health Sciences, Cemil Tascıoğlu City Hospital, Istanbul, Turkey.

Sayid Shafi Zuhur (SS)

Department of Endocrinology and Metabolic Diseases, School of Medicine, Namik Kemal University, Tekirdag, Turkey.

Necmettin Tanriover (N)

Department of Neurosurgery, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Ugur Türe (U)

Department of Neurosurgery, School of Medicine, Yeditepe University, Istanbul, Turkey.

Fahrettin Kelestimur (F)

Department of Endocrinology and Metabolic Diseases, School of Medicine, Yeditepe University, Istanbul, Turkey.

Pinar Kadioglu (P)

Department of Endocrinology and Metabolic Diseases, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. kadioglup@yahoo.com.
Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Endocrinology-Metabolism and Diabetes, Istanbul University - Cerrahpasa, Kocamustafapasa Street No:53, Fatih, Istanbul, 34098, Turkey. kadioglup@yahoo.com.

Classifications MeSH