ACTA ENDOCRINOLOGICA (BUC)

Objective. Carpal tunnel syndrome(CTS) is a neuropathy of the upper limb that is quite common in patients with active acromegaly, but the diagnosis of acromegaly is often made years after the diagnosis of CTS. But in the absence of the typical acral phenotype it is difficult to know when CTS will appear as the first symptom. Method. Here, we present a 27-year-old female patient with a history of numbness that first appeared in her right hand and 2 weeks later in her left hand. While the etiology of acute CTS was being investigated on cervical MRI, the hormonal evaluation of the incidentally detected mass in the sella turcica revealed that it was a clinically silent somatotroph adenoma. Results. Considering the patient's age, desire to have children, lack of typical acral features, the fact that these adenomas may cause phenotypic changes over time, their aggressive course and more recurrences, the decision for transsphenoidal surgery was made. The patient, who has been followed for 14 years, has two healthy children and does not have any complaints, acral phenotype or GH hormone excess. Conclusion. Awareness that acute unilateral/ bilateral CTS without any risk factors may be the first sign of clinically silent somatotrophinoma may improve the prognosis of acromegaly by preventing diagnostic delay.

Adipocytokines involved in inflammation and the acute phase responders have been found to be increased in the metabolic syndrome (MS). The aim of the study was to compare the ‘normal’ weight women’s fibrinogen, hsCRP, adiponectin, TNF-α, vascular cell adhesion molecule (VCAM) with obese patients with MS, and to evaluate the association between fibrinogen, hsCRP, adiponectin, TNF-α, VCAM and insulin resistance. The study included 52 obese women who met the criteria for MS defined as in 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) ATP III and 24 normal women. Serum concentrations of glucose (FBG), triglyceride, total and HDL-Cholesterol were determined by enzymatic procedures, serum insulin was measured by chemiluminescence, plasma levels of adiponectin, TNF-α and VCAM by Elisa, hsCRP by immunoturbimetric assay and fibrinogen by coagulation method. Measurements of insulin resistance were obtained using the homeostasis model assessment. Mean plasma levels of adiponectin, TNF-α, VCAM, fibrinogen and hsCRP were found 6.11±2.39 mg/ml, 3.10±3.30 pg/ml, 14.21±4.00 ng/ml, 375.49±49.67 mg/dl, 0.33±0.10 mg/dl in the obese with MS; 6.20±2.48 mg/ml, 3.01±1.68 pg/ml, 12.63±2.54 ng/ml, 304.06±49.52 mg/dl, 0.30±0.19 mg/dl in the normal women, respectively. Mean fasting insulin level and HOMA-IR were measured 13.80±6.32 mU/ml and 3.69±1.90 mU/ml, respectively in obese with MS. In normal women, fasting insulin level and HOMA-IR were measured 8.30±3.08 mU/ml and 1.49±0.37, respectively. Mean levels of adiponectin were positively correlated with mean TNF-α levels in the obese with MS (r=0.472, p=0.001). VCAM was negatively correlated with TNF-α levels (r=-0.301, p=0.038) in the obese with MS. This study demonstrated that TNF-α showed a positive association with adiponectin and a negative association with VCAM in the obese women with MS.

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Introduction. Genetic disorders associated with the development of the pituitary gland and cranial bones may cause a genetic tendency toward Sheehan’s syndrome (SS). Our aim in this study was to investigate expression disorders in the genes responsible for the development of the pituitary gland and cranial bones in patients with SS. Materials and Methods. Forty-four patients who were previously diagnosed with SS and 43 healthy women were compared in terms of the mean expression values of genes including the prophet of PIT-1 (PROP1), HESX homeobox 1 (HESX1), POU class 1 homeobox 1 (POU1F1), LIM homeobox 3 (LHX3), LHX4, glioma-associated oncogene homolog 2 (GLI2), orthodenticle homeobox 2 (OTX2), SIX homeobox 3 (SIX3), SIX6, T-box transcription factor 19 (TBX19), transducin-like enhancer protein 1 (TLE1), TLE3, distal-less homeobox 2 (DLX2), DLX5, MSH homeobox 2 (MSX2), and paired box 3 (PAX3). Results. The mean expression values of the HESX1, TLE1, TLE3, and MSX2 genes were significantly different in the SS group from the healthy control group, while the mean expression values of the remaining genes were similar. Conclusion. The present study concludes that abnormal expressions of HESX1, TLE1, TLE3, and MSX2 genes may cause a genetic predisposition to the development of SS.

Background. Retinopathy is a common complication of diabetes and strongly related to the duration of the disease and the quality of its management. Despite this relationship, some studies have reported the prevalence of diabetic retinopathy at diagnosis to be 5-30%.\r\nAim. To investigate the prevalence of retinopathy in patients with newly diagnosed type 2 diabetes and its relation to some association factors in Isfahan, Iran.\r\nMethods. During 2001-2004, all newly diagnosed type 2 diabetics (n= 710) attending Isfahan Endocrine and Metabolism Research Center, were enrolled, by consecutive patient selection. Everybody accepted our invitation. The patients were examined by an internist and then by an ophthalmologist for retinopathy. Fasting plasma glucose, glycosylated hemoglobin, lipid profile, and 24-hour urinary albumin and creatinine concentrations were measured.\r\nResults. Of 710 patients, 286 were male. Mean age of the patients was 48.8(9.8) years (31-72 years) and median of diabetes duration was 6 months (0.5-12 months), respectively. Nine percent of patients (CI95%: 7-11) [(9.8% of men (CI95%: 6-13) and 8.5% of women (CI95%: 6-11)] had retinopathy (Odds ratio= 0.85, CI95%: 0.51-1.43, P= 0.5). In the final analysis using logistic regression test, body mass index (OR= 0.9, CI 95%: 0.8-1, P= 0.01), diastolic hypertension (OR= 3.9, CI 95%: 1.33-11.7, P= 0.01) and 24-hour urinary albumin concentration (OR= 1.005, CI 95%: 1-1.01, P= 0.01) were identified as association factors\r\nfor retinopathy.\r\nConclusions. Retinopathy was moderately prevalent in our patients.

Introduction. Diagnosing Cushing Syndrome (CS) remains challenging due to its diverse symptoms and the complexity of its subtypes. This study aimed to optimize diagnostic cut-off values for differentiating CS subtypes using the 1 mg dexamethasone suppression test (DST) in a cohort of 237 patients. Materials and Methods. Retrospective data from patients diagnosed with non-functional adrenal adenomas (NFA), mild autonomous cortisol secretion (MACS), adrenal CS, and pituitary CS at the Dokuz Eylül University Endocrinology and Metabolism Clinic (2005–2016) were analyzed. Sensitivity and specificity of morning cortisol levels after DST were evaluated using receiver operating characteristic (ROC) curve analysis. Results. The analysis identified optimal morning cortisol cut-off levels: 2.14 μg/dL (59.04 nmol/L) for MACS, 2.3 μg/dL (63.4 nmol/L) for adrenal CS, and 2.33 μg/dL (64.28 nmol/L) for pituitary CS. Conclusion. These optimized thresholds demonstrated high sensitivity and specificity, significantly improving diagnostic precision over the conventional threshold of 1.8 μg/dL (50 nmol/L). The findings underscore the importance of tailored cut-off values to address subtype-specific diagnostic challenges, reducing delays and mitigating long-term complications. Personalized diagnostic approaches, incorporating patient demographics and disease-specific characteristics, are essential for enhancing diagnostic accuracy and facilitating timely interventions.

Introduction. Bone formation takes place through a continuous remodeling process, which involves the resorption of old bone by osteoclasts and the formation of new bone tissue by osteoblasts, melatonin contributing to the hormonal modulation of the action of osteoblasts and osteoclasts. Aim. The aim of this study is to evidence the influence of melatonin administered in combination with estrogen on bone turnover markers in female Wistar rats with bilateral surgical ovariectomy. Material and method. The study was performed on 40 female Wistar rats with a weight of 160-200 g, which underwent bilateral surgical ovariectomy. At 14 days postovariectomy, hormone replacement therapy (estradiol benzoate – E2b – 10 μg/day) and combined estrogen (estradiol benzoate – E2b – 10 μg/day) and melatonin (added to the drinking water in a concentration of 25 μg/mL or 50 μg/mL – ethanol concentration 0.01%) – treatment were initiated over a period of 12 consecutive weeks. Subsequently, venous blood was collected for the determination of serum osteocalcin and C-terminal telopeptide of collagen type I levels. Results. Melatonin administered in combination with estrogen to ovariectomized female rats induces an increase in serum osteoalcin levels (statistically significant differences between all four groups p=0.001) and a decrease in serum C-terminal telopeptide of collagen type I levels (statistically significant differences between group I and the other three groups p=0.005; p=0.001; p=0.001 and between group II and group IV p=0.007). The influence on bone formation and resorption markers depends on the administered melatonin dose and on the post-ovariectomy estradiol level. Conclusions. Melatonin potentiates the effects of estradiol on bone in ovariectomized rats.

Context. Polycystic ovary syndrome (PCOS) is associated with increased prevalence of preeclampsia (PE); microRNAs (miRs) could play an important role in the pathogenesis of PE and PCOS. Objective. To investigate the expression levels of miRs 155-5p and 518b in blood leukocytes of patients with PE and PCOS. Design. Using real-time quantitative PCR method, miR-155-5p and miR-518b were examined from PE, PCOS, PE+PCOS, and controls. Subjects and Methods. The relative expression of the target miRs in patient samples was compared to control samples. The results were calculated as relative quantification values. Results. Confounding variables were controlled using analyses for covariance. Significant differences were observed in miR-155-5p (p=0.008) and miRNA-518 (p=0.016) expression levels among the groups. miR-155- 5p (p=0.014) and miR-518b (p=0.036) were upregulated in PCOS patients and miR-518b (p=0.028) were increased in cases with PCOS+PE. Near significant difference was found (p=0.06) in miR-518b expression levels in cases with PE, compared to controls. miR-518b was observed to be positively correlated with alanine transaminase in cases with PE (r=0.80; P=0.017) and PE+PCOS (r=0.80, p=0.017). Conclusions. Our preliminary findings suggested that expression profiling of miR-155-5p and miR-518b in blood leukocytes were upregulated in pregnant women with PCOS. Moreover, miR-518b was found to be related to PE in cases with PCOS

Background. This study aimed to assess the impact of oral iron replacement treatment on glucose metabolism and anthropometric measures in premenopausal women with iron deficiency anemia. Material and methods. This was a prospective study recruiting 30 premenopausal women diagnosed with iron deficiency anemia. The participants received standard oral iron (ferrous gluconate) at a dose of 567.7 mg/day for three months. After three months of iron treatment, the participants' height, weight, and waist circumference were measured again, and fasting blood tests and oral glucose tolerance tests were repeated. Results. The study included 30 premenopausal women with a median age of 24 years and a median BMI of 21.9 kg/m2. After three months of oral iron treatment, there was a significant increase in serum ferritin, hemoglobin, transferrin saturation, body weight, BMI, and waist circumference (p<0.001 for all). Fasting glucose levels decreased, and first-hour glucose at 75g OGTT increased significantly after treatment. Notably, HOMA-IR decreased significantly (1.46 vs. 1.15, p = 0.039). Conclusions. The findings indicate that after three months of treatment, there was a significant improvement in glucose metabolism as evidenced by the decrease in HOMAIR scores, despite an increase in weight, BMI, and waist circumference.

Context. It is unclear whether treatment is necessary for transient moderate hypocalcaemia occurring after total thyroidectomy; if it is present, it is unclear which treatment modality should be preferred. Objective. To investigate both the necessity and effectiveness of different treatment approaches of oral and/ or intravenous calcium treatment in patients with transient, postoperative, moderate hypocalcaemia. Design. This is a case control study made between June 2014 and June 2015. Subjects and Methods. Forty-five patients who had serum calcium levels 6 hours after total thyroidectomy between 7.5-8 mg/dL were divided into three equal groups: an oral calcium administration group, an intravenous calcium administration group and a no-treatment group. Serum calcium and parathyroid hormone levels were measured preoperatively and on postoperative days 1, 2, 5 and 10. Results. For post-thyroidectomy patients with serum calcium 7.5-8 mg/dL in the early postoperative period, no significant difference in serum calcium or parathyroid hormone was detected between groups. Conclusions. Follow-up without treatment seems to be the most effective approach for moderate hypocalcaemia occurring in the early period following total thyroidectomy; this suggests that intravenous treatment should be avoided.