ACTA ENDOCRINOLOGICA (BUC)

Background. The present study aims to evaluate the parameters for aortic stiffness by comparing gestational diabetes mellitus (GDM) with a healthy control group via transthoracic echocardiography. Methods. This was a cross-sectional study involving monitoring of 62 pregnant women (33 with GDM and 29 with uncomplicated pregnancy as controls) during the third trimester. The aortic strain, aortic distensibility, and aortic stiffness values were measured via transthoracic echocardiography. Measurements of GDM group were repeated after 6 months. Results. Blood pressure levels, heart rate, and basic echocardiography were similar in both groups, but BMI was significantly higher in the GDM group (p <0.001). Whereas, aortic strain and distensibility were significantly lower in the GDM group (p <0.001). Aortic stiffness index was significantly higher in the GDM group (p <0.001). Aortic stiffness parameters did not exhibit any significant difference between the insulin-receiving GDM group and the diet-controlled GDM group. Postprandial glucose levels were correlated positively with the aortic stiffness index (p=0.04) and negatively with the level of aortic strain (p<0.01) and distensibility (p=0.03). The aortic stiffness in normoglycemic postpartum group at 6th month showed a significant improvement (p<0.001); but not in hyperglycemic postpartum group. Conclusion. Arterial stiffness was increased in women with GDM compared to the control group. A correlation between postprandial glucose and arterial stiffness was found. The aortic stiffness can be affected irreversibly from increased clinical and subclinical levels of glucose in postpartum period.

Introduction. Ganglioneuromas are rare, benign tumors that arise from the neural crest tissue and are usually asymptomatic and discovered accidentally. GN have good prognosis with surgical removal and the standard treatment for such lesions is laparoscopic adrenalectomy. Case report. We report the case of a 13 year old patient who presented to our hospital with abdominal pain. The ultrasound and the CT scan confirmed the presence of a well-defined mass situated in the right renal space. Taking into account the size of the tumor, its position and the fact that CT scan showed no local signs of invasion, the decision was taken to perform a laparoscopic removal of the right adrenal mass. After dividing the main adrenal vein and while dissecting the adrenal gland, we noticed an intraoperative bleeding due to the fact that one of the clips used to ligate the vein had slipped. Because we were unable to control the intraoperative bleeding we decided to convert to open surgery. The histopathological result showed that the adrenal lesion was a ganglioneuroma. Conclusion. While the role of minimal invasive adrenalectomy in patients with larger lesion is still controversial, advantages such as reduced hospital stay and postoperative morbidity, lower rate of complications, have resulted in the laparoscopic approach for adrenal pathology becoming the choice procedure in the removal of adrenal lesion.

Background. A thyroid storm is an extreme disorder that occurs in severe thyrotoxicosis. This condition is life-threatening, with mortality rates up to 10-20%. A typical dose of iodinated contrast media (ICM) contains approximately 13,500 μg of free iodide and 15–60 g of bound iodine, representing an acute iodide load of 90 to several hundred thousand times the recommended daily intake of 150 μg. As a result of sudden exposure to high iodide loads, thyroid hormone regulation can be disrupted, leading to hypothyroidism (Wolff-Chaikoff effect) or hyperthyroidism (Jod-Basedow phenomenon), particularly in those with underlying nodular thyroid disease. Case description. A 37-year-old man presented to the emergency room (ER) with clinical and electrocardiographic signs of acute myocardial infarction. Primary PCI with iodinated contrast was performed. After the intervention, laboratory analyses revealed thyrotoxicosis, and the patient was administered initial thyrosuppressive therapy along with cardiac therapy and discharged from the hospital. One week later, he returned to the hospital with signs of a thyroid storm. Conclusion. This case report aimed to raise awareness regarding the routine evaluation of thyroid function in patients with and without previous signs and symptoms of thyrotoxicosis who had undergone acute myocardial infarction and coronary angiography.

Context. Hereditary hypophosphatemic rickets with hypercalciuria (HHRH) is a rare autosomal recessive disorder, which is characterized by renal phosphate wasting, hypercalciuria, increased 1,25-dihydroxyvitamin D, and decreased parathormone (PTH) levels. Objective. Here we report different clinical features of two siblings with HHRH, confirmed with molecular diagnosis. Subjects and methods. 16.4 years old boy (P1), and 8.7 years old girl (P2) were referred to our outpatient clinic due to clinical suspicion of metabolic bone diseases. Results. P1 had severe hypophosphatemia. Additionally, PTH concentration was near to the lower limit, 1,25-dihydroxyvitamin-D concentration was near to the upper limit. P2 had relatively milder clinical and laboratory findings. Bilateral renal calculi were detected on ultrasound in both of them. HHRH was suspected due to their described biochemistry and the presence of bilateral renal calculi. Molecular analysis of SLC34A3 gene revealed a homozygous variant c.756G>A (p.Gln252=) and a splice donor variant c.1335+2T>A. After oral phosphate treatment, clinical and biochemical improvements were observed. However treatment nonadherence of patients was a barrier to reach treatment goal Conclusion. The clinical phenotype due to the same mutation in the SLC34A3 gene may vary even among the members of the same family. An accurate diagnosis is important for the appropriate treatment.

Context. Alimentary supplements may have beneficial effects on retinal microvasculature in diabetic patients. Objective and Design. State-of-the-art imaging techniques were used to assess retinal microcirculation in diabetic patients in an observational study before and after 3 months treatment with a multinutrient complex including resveratrol, vitamins D3, C, E, essential fatty acids, trace elements (zinc and copper) and macular pigments (lutein and zeaxanthin)-Resvega. Subjects and Methods. Fifteen subjects were included in this study. Adaptive optics ophthalmoscopy was used to measure the parameters of temporal retinal arterioles. Optical coherence tomography angiography was employed to assess foveal avascular zone and vessel densities of the superficial capillary plexus, deep capillary plexus and choricapillary plexus. Results. After 3 months of treatment, there was a statistically significant median decrease in wall-to-lumen ratio (p=0.0001). The same tendencies were noticed for wall thickness values (p=0.008) and wall cross sectional area values (p=0.001). On the other side, no significant changes were noticed concerning the OCTA parameters. Conclusions. Resvega seems to have a beneficial effect on the retinal arterioles in diabetic patients.

Context. GnRHa treatment has been a standard of care in progressive early puberty (EP). Choice of the GnRHa formulation is dependent on the preference of the clinician. Objective. To compare the effects of triptorelin acetate (TA) and leuprolide acetate (LA) on anthropometry in girls with EP. Design. A descriptive observational study. Subjects and Methods. Girls diagnosed with central EP and treated with GnRHa at least for one year were included; treated with TA (n=46) and LA (n=35). First year anthropometric response and final height were evaluated. Results. The mean age at the initiation of GnRHa treatment of girls was 8.5±0.5 years. The ratio of obesity and of overweight was 7.4 and 25.9%, respectively. In both TA and LA groups, anthropometric data of the patients at initiation and at the first year of treatment were similar. Although growth velocity was similar in each group, in LA group height SDS at the first year of the treatment showed a significant decrease (p=0.045), but not in TA group (p=0.317). No significant ΔBMI was observed with treatment. The differences between FH – PAH at initiation (height gain) in TA and LA groups were 2.9±4.7 and 4.0±5.8 cm, respectively (p=.316). Height gain per treatment year was 1.7±3.0 cm. Conclusions. There was a significant decrease in height SDS at the first year of leuprolid treatment, but not in triptorelin. Although these two analogs show similar effects on treatment, a not significant but slightly better benefit in leuprolide was observed.

Context. State of art imaging techniques might be a useful tool to early detect the retinal vessels lesions in diabetes. Objective and design. This analytical observational study investigates the retinal microcirculation changes in type I and II diabetic patients without retinopathy using adaptive optics ophthalmoscopy (AOO) and optical coherence ophthalmoscopy angiography (OCTA). Subjects and methods. Fifty-five subjects were included in this study and were divided in three groups: type I diabetic group (n=16), type II diabetic group (n=19) and control group (n=20). An adaptive optics retinal camera was used to assess the parameters of the temporal superior retinal arterioles. Moreover, vessel density of the superficial capillary plexus across the parafoveal area was measured with OCT-A. All cases were investigated once, in a cross-sectional design. Results. Diabetic patients from both groups had a higher wall-to-lumen-ratio compared to the controls (p=0.01 and 0.01, respectively). Interestingly, no significant differences were found between the two diabetic groups (p=0.69). Moreover, the vessel density was smaller in the type I diabetic group than in the control group (p=0.001) Conclusion. AOO might be a useful tool to detect early retinal vascular changes in diabetes before any clinical signs and together with OCTA it might bring important information on the prognostic and pathophysiology of the disease.

Context. Obesity is a complex and heterogeneous disorder with multiple phenotypes described. Although metabolomic biomarkers of obesity have been extensively studied, biomarkers of obesity phenotypes and differences between these phenotypes and normal-weight (NW) persons have been less investigated. Objective. The objective of this cross-sectional analysis was to investigate serum amino acids (AA) as markers of metabolic alterations in obesity phenotypes and NW. Design. Cross-sectional Subjects and Methods. By targeted metabolomics we analyzed serum samples of 70 women using ultrahighperformance liquid chromatography/mass spectrometry. Participants were divided into 3 groups: NW, metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). Results. Five AAs were significantly different between study groups: cysteine, methionine, asparagine, glutamine, and lysine (p-value <0.05 and variable importance in the projection >1). Cysteine increased linearly with metabolic unwellness from NW to MUHO. Lysine and glutamine were significantly higher, and asparagine was significantly lower in NW and MHO than in MUHO. Conclusions. By trend and group analysis we identified specific changes in serum AAs along with the progression of metabolically unwellness.

Background. Although cardiovascular risk is increased in patients with subclinical hypothyroidism (SCH), replacement therapy is not recommended in those with TSH levels\r\nbetween 5 and 10 mU/L.\r\nObjective. We aimed to evaluate the effects of levothyroxine (LT4) treatment on cardiovascular risk factors and carotid artery intima media thickness (CIMT) in patients with SCH who had TSH levels between 5 and 10 mU/L.\r\nSubjects and Methods. Sixty SCH patients with TSH levels between 5 and 10 mU/L were included in the study. Patients\r\nwere randomized into two groups as treatment (n=30) and control (n=30) groups. BMI, blood pressure, lipid profile, fibrinogen, homocysteine, hs-CRP and CIMT were measured in all patients at baseline and after six months. LT4 treatment was initiated and the dose was tapered according to TSH levels in treatment.\r\nResults. There was no significant difference between baseline and six month measurements in the control group. However, TSH, LDL-C, fibrinogen and mean CIMT measurements were decreased and HDL-C level was increased in the treatment group.\r\nConclusions. We suggest that LT4 therapy is necessary for the prevention of modifiable cardiovascular risk factors in\r\npatients with TSH levels between 5 and 10 mU/L.

Nodular thyroid disease (NTD) is represented by palpable thyroid nodules (solitary, multiple) and thyroid incidentalomas (identified by means of thyroid ultrasonography). The discussed entities carry the same risk of malignancy (about 5 %). The main objective in evaluating NTD is represented by the exclusion of malignancy by means of corroborated investigations, focused on the value of a panel of IHC markers.\r\nMaterial and methods. We included in the study 27 cases of NTD, evaluated by means of: clinical investigation, ultrasonography of the thyroid, cytological examination, morphological analysis and IHC. The used panel of IHC markers comprised: Ki-67, PCNA, CK 19 and c-erbB2 (DAKO LSAB method)\r\nResults. From the total of cases, 8 presented positivity with Ki-67 and 17 with PCNA. Regarding CK 19, the majority of PTC cases stained ++ and diffusely, but not papillary hyperplasia (focal positivity).c-erbB2 diffuse and intense positivity (+++) was noticed in PTC.The case with a follicular tumor of uncertain malignant potential stained weakly only with c-erbB2.\r\nConclusions. From the used panel of IHC markers, CK 19 presented the best value, being able to differentiate FVPTC from FTC and PTC from papillary hyperplasia.