ACTA ENDOCRINOLOGICA (BUC)

Background. High-risk-HPV, metabolic disorders, and prior cesarean scar have been linked with adverse obstetric outcomes, but their combined effects are unclear. Methods. Retrospective cohort of 185 pregnancies at a Romanian tertiary center (2021–2024) with highrisk HPV DNA testing ≤24 weeks and thyroid profiling. Exposures: HPV status and comorbidities (gestational hypertension, gestational diabetes, prior cesarean scar). Primary outcome: cesarean delivery; secondary: preterm birth <37 weeks, major placental pathology, NICU admission. Multilevel logistic regression adjusted for age, BMI, parity, smoking, and twin gestation; interaction terms assessed HPV×comorbidity. Results. 41/185 (22.2%) HPV-positive. Cesarean odds were higher for HPV-negative with any comorbidity (aOR 2.9, 95% CI 1.5–5.6) and highest for HPV-positive with comorbidity (aOR 4.3, 1.8–10.2) versus HPV-negative without comorbidity. HPV-positive status was associated with a modest TSH increase (max Δ+0.25 mIU/L in T3, 95% CI 0.05–0.44; p = 0.013), with similar FT4/FT3 and values largely within pregnancy-specific ranges. A significant interaction was observed for HPV × prior cesarean scar on preterm birth (p_interaction = 0.008; aOR 2.9, 1.2–7.2); interactions with gestational hypertension or diabetes were non-significant. Conclusions. High-risk HPV combined with maternal comorbidity was associated with increased cesarean and preterm-birth risk. Findings support incorporating HPV status into antenatal risk assessment and warrant larger prospective studies.

Context. The growing use of home monitoring devices during pregnancy has raised concerns about their reliability and psychological impact. From an endocrine perspective, early modulation of maternal stress through the hypothalamic–pituitary–adrenal (HPA) axis may influence fetal neuroendocrine programming. Identifying safe, reassuring tools that stabilize maternal emotional state in early gestation may support healthier endocrine adaptation for both mother and fetus. Objective. To evaluate the feasibility and psychological effects of handheld Doppler use for fetal cardiac monitoring in early pregnancy and to explore correlations between maternal–fetal cardiac coupling and maternal anxiety. Design. Prospective, observational, single-center study conducted between January 2019 and December 2023 at Polizu Clinical Hospital, Bucharest. Subjects and Methods. One hundred women ≤14 weeks’ gestation completed questionnaires evaluating handheld Doppler and pulse oximeter use. 54 received the DASS-21 anxiety subscale online; 26 provided valid responses. Comparative and correlational analyses were performed using IBM SPSS v29. Results. Fetal heart rate was detected in 67% of cases, with higher detection at increasing gestational ages. Women who detected the heartbeat had higher gestational age (10.4 ± 1.8 vs. 8.6 ± 1.9 weeks, p < 0.01). Anxiety scores inversely correlated with gestational age (p = 0.019). Most participants (68%) found the Doppler reassuring. Conclusions. Handheld Doppler monitoring during early pregnancy is feasible and provides emotional reassurance, potentially stabilizing maternal stress responses and supporting maternal–fetal endocrine adaptation.

Breast cancer has surpassed lung cancer as the most common type of cancer globally, representing approximately 25% of all cancer cases and leading in cancer-related mortality among women. In Romania, breast cancer accounts for 26.9% of all female cancer diagnoses, with an increasing incidence and significant mortality rate despite one of the lowest incidence rates in Europe. The study highlights the disparities in breast cancer outcomes across Europe, with Romania showing lower survival rates compared to Western European countries. This disparity is partly attributed to the low participation in breast cancer screening programs, where only 9% of eligible Romanian women underwent mammography in 2020, far below the European average of 60%. The World Health Organization (WHO) and European Commission emphasize the importance of organized population-based screening for women aged 50-69, yet many barriers, including low health literacy, lack of awareness, and socio-economic challenges, hinder effective participation, especially among vulnerable populations. This study, conducted over three years at the “Alessandrescu Rusescu” National Institute for Mother and Child Health, involved 1,705 patients and aims to provide insights into improving breast cancer screening participation and outcomes in Romania.

Purpose. To determine the effectiveness of the basal calcitonin (CTb) determination in the early postoperative period to predict the possible recurrence (persistence) of medullary thyroid cancer (MTC). Material and Methods. A retrospective study of the treatment results in 194 patients with MTC (148 (76.3%) primary – group 1 and 46 (23.8%) recurrent – group 2) according to the levels of CTb in the first week after surgery and one year later. All groups were analyzed by staging, the level of preoperative and postoperative basal calcitonin 5 days and 1 year after the primary surgery. Findings. Among all patients, women prevailed – 144 (74.2%), the average age was (48.7±15.2), the average follow-up period was 67.5 months. Basal calcitonin was studied in patients of all groups in the preoperative and serially in the postoperative periods: 5 days and 1 year after the most radical surgical volumes. To test the hypothesis about the possibility of using CTb indicators in the early postoperative period, the degree of compliance with normal calcitonin indicators (≤18 pg/mL) was assessed by observation groups 5 days and 1 year after surgery. Conclusions. 1. The CTb value 5 days after surgery is no less a reliable marker of the result of surgical treatment of MTC than the currently recommended CTb measurement 2-3 months after surgery. 2. The technique is applicable for both primary and reoperations used for recurrent forms of medullary thyroid cancer.

Context. Diabetes insipidus (DI) is rare in the neonatal period but of great importance due to increased renal risk and mental retardation despite treatment. Objective. This report describes the case of a patient with congenital nephrogenic diabetes insipidus (NDI). Detection of this pathology during the neonatal period, especially in premature newborns, is difficult because of the electrolyte variations that occur as a result of the immature kidney function. Subjects and methods. The subject was a preterm infant with very low birth weight (VLBW) and persistent hypernatremic hyperosmolarity that developed polyuria and polydipsia in the first weeks of life. Results. Taking into account blood and urine laboratory tests, vasopressin levels, as well as family history, the infant was diagnosed with congenital NDI. Early treatment allowed a good development, proving that the prevention of long-term complications is possible through multidisciplinary care and frequent monitoring. The particularity of this case was the presence of persistently elevated presepsin levels. This association prompted the investigation into underlying renal hypernatremia. Conclusions. NDI is a rare condition and the onset in the neonatal period is a sign of severity and hereditary causality. Early diagnosis, symptomatic treatment and multidisciplinary monitoring may decrease the risk of longterm complications.

The aim of this study is to analyze and identify the main predictors that may indicate multifocal growth of PTC. Materials and methods. The main and control groups included patients with the category of malignant multifocal process T1-3mN0Mx (n=109) and unifocal T1- T3N0Mx (n=50) respectively, who underwent thyroidectomy with lymphadenectomy. Ultrasound characteristics of the nodes, tissue changes of the thyroid gland were taken into account. Results. Fibrous changes can be considered as one of the risk factors of the presence of additional PTC lesion. Discussion. There is no unambiguity in the definition of predictors of multifocal PTC growth. Conclusions. No clear predictors of multifocal PTC have been identified. It is advisable to improve the quality of ultrasound, to focus on single-focus PTC in patients with fibrinous changes in the thyroid gland at normal levels of TSH.