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Öğe Adherence to Growth Hormone Treatment in Children During the COVID-19 Pandemic(Galenos Publ House, 2024) Eren, Erdal; Cetinkaya, Semra; Ongen, Yasemin Denkboy; Tercan, Ummahan; Darcan, Sukran; Turan, Hande; Aydin, MuratObjective: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. Methods: This was a multicenter survey study that was sent to pediatric endocrinologists during the pandemic period (June-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, missed dose data and the causes in the recent year (after the onset of the pandemic) were questioned. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% non-adherence). Results: The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and others (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 big/kg, the annual growth rate was 1.15 standard deviation score (minimum-2.74, maximum 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for non-adherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as non-adherence rate increased. Conclusion: During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.Öğe Assessment of two different insulin regimens in children with type 1 diabetes: A longitudinal study(2022) Turan, Hande; Tarcin, Gurkan; Dagdeviren Cakir, Aydilek; Gunes Kaya, Didem; Ozer, Yavuz; Ercan, Oya; Olcay Evliyaoglu, SaadetAim: In type 1 diabetes, insulin therapy can be applied by either daily multiple dose injections with an insulin pen or subcutaneous continuous insulin infusion with an insulin pump. Numerous studies have investigated the superiority of both regimens over each other, and conflicting results have been reported. In this study, the periods when patients with type 1 diabetes were receiving subcutaneous continuous insulin infusion and multiple dose injections were compared in terms of clinical and metabolic outcomes. Materials and Methods: Children with type 1 diabetes who were receiving multiple dose injections and later switched to subcutaneous continuous insulin infusion were included. Follow-up period was evaluated in two periods: during multiple dose injections and subcutaneous continuous insulin infusion. Physical and laboratory findings, blood sugar monitoring and food chart records were compared between these two periods. Results: A total of 44 cases with a mean age of 10.6± 4.4 years were included. While a significant decrease was found in HbA1C values in the first year after the insertion of insulin pump, the values in the second year were similar to that in the pre-pump period. Mean body mass index was increased after switching to subcutaneous continuous insulin infusion. In the second year of the subcutaneous continuous insulin infusion, a significant decrease in hypoglycemic events was observed. Conclusion: In terms of glycemic control, no difference was found between subcutaneous continuous insulin infusion and multiple dose injections in the long term suggesting that similar clinical results can be obtained with multiple dose injections therapy in cases who cannot afford an insulin pump. Considering that HbA1c levels tend to increase in the second year of subcutaneous continuous insulin infusion and similarly body mass index after switching to subcutaneous continuous insulin infusion, clinicians should be aware of the misuse of insulin pump, and patients’ education should be revised regularly.Öğe Diagnostic Value of Bilateral Petrosal Sinus Sampling in Children with Cushing Disease: A Multi-center Study(Galenos Yayincilik, 2022) Turan, Hande; Catli, Gonul; Kardelen, Asli Derya; Bober, Ece; Akinci, Aysehan; Cetinkaya, Semra; Demirbas, OzgecanObjective: Although the sensitivity and specificity of bilateral inferior petrosal sinus sampling (BIPSS) were shown to be quite high in adult patients, pediatric studies are limited in number and have conflicting results, since BIPSS is much less commonly performed in children. The aim of this study was to assess the role of BIPSS in the detection and accuracy of lateralization of pituitary adenomas in pediatric patients with Cushing disease (CD) and its possible advantage over other diagnostic methods. Methods: This was a multicenter, nationwide, web-based study. The diagnostic value of BIPSS in 16 patients, aged between four and 16.5 years with a confirmed diagnosis of CD, was evaluated retrospectively. The sensitivity and specificity of BIPSS and magnetic resonance imaging (MRI) were calculated, and compared statistically. Results: Standard tests, except for morning cortisol level, were effective in proving the presence of Cushing syndrome. While MRI findings were consistent with microadenoma in eight cases (50%), CD presence and lateralization was successfully predicted in 14 of 16 patients using BIPSS. BIPSS compared with MRI examination was significantly more accurate, both in pre-stimulation and post -stimulation results (p=0.047 and p=0.041, respectively). BIPSS showed a significantly higher sensitivity (92.8%) than MRI in detecting the pituitary source of adrenocorticotropic hormone secretion. Conclusion: These results suggest that BIPSS is superior to MRI for diagnostic work-up to confirm the diagnosis of CD. Moreover, in line with previous studies, BIPSS was shown to provide better information about adenoma location, which is vital for possible surgical intervention.Öğe Survey to Investigate Adherence to Growth Hormone Treatment in Children: The Impact of COVID-19 Pandemic(Karger, 2022) Eren, Erdal; Cetinkaya, Semra; Ongen, Yasemin Denkboy; Tercan, Ummuhan; Darcan, Sukran; Turan, Hande; Aydin, Murat[Abstract Not Available]
