ACTA ENDOCRINOLOGICA (BUC)

Background and aims. Differences in the composition of the species of microorganisms in the gut may predict the evolution toward obesity and diabetes mellitus. We carried out a systematic review of the studies dedicated to the role of gut microbiota in diabetes mellitus and obesity. Methods. A systematic literature search of electronic databases was performed, using the search syntax: “Gut microbiota and diabetes and obesity”; abstracts in English, with data about mechanisms of pathogenesis and treatment options by changing the gut composition were included (259 articles). Studies were excluded if they did not have an abstract, or they contained no data about the exact implication mechanism of microbiota. Results. There are differences regarding the composition of the gut microbiota in healthy people and type 2 diabetes mellitus patients; the later proved to have significantly decreased Clostridium components, and increased Lactobacillus and Bifidobacterium populations. The intestines of obese subjects are less rich in microbial genes, have a reduced amount of Bacteroidetes and an increased amount of Firmicutes. Fecal microbiota transplantation from obese subjects resulted in adoption of the donor somatotype. Early differences in gut microbiota composition (higher number of Bifidobacteria) function as diagnostic markers for the development of type 2 diabetes mellitus in high-risk patients. The gut endotoxins contribute to metabolic syndrome manifestation. Experimental studies with prebiotic showed lower levels of cytokines and antiobesity potential. Conclusion. Microbiota composition and its changes since childhood have an important role in the metabolic syndrome. Any intervention in order to prevent or treat obesity and diabetes mellitus should have as target the gut immune system.

Context. Incidentally discovered solid adrenal tumors must be evaluated from two points of view: the risk of malignancy and the secretory feature. Objective. Our aim was to evaluate the surgical technique option in relation with clinical and histopathologic features. Design. We performed a retrospective study that included patients with adrenal gland tumors. Subjects and methods. All patients were operated between 2012 and 2019 by the same surgical team in a single center. Results. The batch included 102 patients with adrenal tumors operated through open surgery (OS, n=41) and laparoscopic surgery (LS, n=61). Tumor localization was especially on the right adrenal gland (n=52, 50.98%). Primary origin of the adrenal gland tumors was in 82 cases (80.39%) and a metastatic origin in 16 cases. Average dimension for surgical resected tumors was 4.02 cm (0.9-12 cm) for the LS group as compared to 7.22 cm (1.3-19 cm) for OS group with a predominant type of surgery represented by adrenalectomy and a conversion rate of 2.94%. The hospital stay was 7.22 days (5-12 days) in the LS group versus 12.72 days (6-57 days) in OS group with significant differences (p<0.01). Also, the postoperative recovery was significantly different (6.5 days versus 2.62 days, p<0.01). Conclusion. Laparoscopic approach represents the gold standard in adrenal gland tumors less than five centimeters in size. Adrenalectomy is mostly performed by LS and adenoma is the most frequent histopathologic type, while pheochromocytoma is operated through OS. LS has a significantly reduced hospitalization and postoperative stay compared to OS.

Aim is to evaluate atherosclerotic risk factors and carotid intima media thickness [CIMT] in offspring of type 2 Diabetes Mellitus [DM] patients with normal glucose tolerance. Methods. We evaluated 96 offspring of Type 2 DM patients and 39 healthy control who were in similar age, sex and body mass. We measured fasting blood glucose [FBG], postprandial blood glucose [PBG], insulin, uric acid, homocystein, fibrinogen, HOMA-IR, lipid profile, hsCRP, microalbuminuria, glycosylated hemoglobin A1c and CIMT by Doppler ultrasonography. Results. FBG was found higher in study group [p<0.001]. The HOMA-IR was 1.7±0.98 and 1.2±0.58 mg/dL x uUI/mL for study and control group, respectively [p=0.007]. TCholesterol, triglycerides, HDL-C, LDL-C and homocystein levels were not different. HsCRP and fibrinogen levels were higher in study group [p=0.014 and p=0.035, respectively]. Microalbuminuria levels were higher in study group but not significant [p=0.111]. CIMT in study group increased distinctively [p<0,001]. In regression analysis, being in study group causes a significant increase on the mean CIMT level by 0.057 mm [0.029-0.086] Conclusion. Our study demonstrated that various atherosclerotic risk factors are aggregated in offspring of Type 2 DM patients having NGT even before they develop glucose intolerance. Having a diabetic family alone might be effective in developing increased CIMT.

Iodine plays an important biochemical role in human organism; its insufficiency produces disturbances in the synthesis of thyroid hormones and increases the volume of the thyroid gland. Iodine deficiency in pregnant women has severe consequences on maternal\r\nbody and fetal development. The aim of this study was to determine the incidence of iodine deficiency in pregnant women from Cluj city and county. Urinary iodine levels were determined by the Sandell-Kolthoff method. A group of 100 pregnant women was studied. The results show a mean iodine concentration at the lower limit of the normal range (107.58 ? 91.16 &#956;g/L), not correlated with the period of pregnancy.

The most common cause of hypercalcemia is parathyroid hyperplasia and carcinoma. Tuberculosis(TB) and sarcoidosis are the most common granulomatous diseases of the parathyroid. We report a case of parathyroid adenoma that can mimic many lesions. A 46-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) with symptoms and signs of hypercalcemia. Laboratory findings were consistent with tertiary hyperparathyroidism. She underwent elective parathyroidectomy due to high PTH values despite effective treatment including calcimimetics and vitamin D receptor activators. Subtotal thyroidectomy and three and a half of parathyroid adenomas were removed. Histopathological examination revealed features of parathyroid adenoma with granulomatosis infection that supports tuberculosis. In order to confirm the pathological findings, the PCR study was performed on the pathology specimens. After obtaining a negative result, the treatment was stopped. We have reported a case of parathyroid adenoma that mimicking tuberculosis.

We present a 18 year old phenotypic female patient who presented for primary amenorrhea. Pelvic ultrasound revealed a hypoplastic uterus and CT scan showed a hypoplastic right gonad and a left gonadal tumor with extrapelvic location. Karyotype was 46XY. Hormonal assessment indicated hypergonadotropic hypogonadism: FSH was 39.69 mUI/ml, estradiol was 28.07 pg/ml, testosterone was 0.17 ng/ml. DHEA level was high &#8211; 21 ng/ml. Gonadectomy was performed at 15 years and histologic examination diagnosed left gonadoblastoma and right teratoma in a dysgenetic gonad. The patient had a good postoperatory evolution. Menses were induced with estrogenic and then estroprogestogenic treatment. Plastic breast surgery was performed at 18 years. Establishing the genotypic sex in patients with primary amenorrhea represents a crucial step knowing that intersex disorders bearing Y chromosomal material have a high risk for gonadoblastoma and germ cell tumors.

A 38 years old, heavy smoker, was admitted in our thyroid unit in August 1993 with left eye proptosis (21 mm), right eye prosthesis and euthyroidism. Orbital CT scan revealed inferior rectus muscle hypertrophy in the left orbit and possible residual (postoperative) lateral rectus muscle hypertrophy in the right orbit. Left eye proptosis was treated with both glucocorticoids and orbital radiotherapy.\r\nSeven years before (1986) the patient developed right eye proptosis, without clinical features of hyperthyroidism. Being suspected of a sphenoid ring meningioma and since orbital CT scan was not available at that time, a right orbit exploration was performed in November 1987; soon after orbital exploration, clinical features suggesting right orbital cellulitis occurred, followed by right eye evisceration and right eye prosthesis. After 18 years of Graves ophthalmopathy with euthyroidism, in February 2004 an autoimmune hyperthyroidism was diagnosed (suppressed TSH, high TT3, positive TRAb), being successfully treated with radioiodine. One year after the ablative therapy the patient is still euthyroid. A patient with euthyroid Graves ophthalmopathy should be monitored indefinitely, since a thyroid dysfunction may occur even after more than a decade.

Epidemic of obesity is ongoing and did not slow down. Causes of obesity are numerous and very complex. Among them, the concept of bidirectional signaling within the brain-gut-microbiome axis was recently proposed as possible pathophysiological mechanism and become a hot topic in the explanations for the control of food intake. Discoveries of new anti-obesity drugs that are analogs for the receptors for some hormones derived from gastrointestinal tract contribute to the investigations in this area. The human gut microbiota plays a fundamental role in human health and disease and it is considered that it represent an endocrine organ that participate in energy homeostasis and host immunity. Role of gut microbiome has been investigated in metabolic diseases such as obesity, type 2 diabetes and non-alcoholic fatty liver disease. Gut microbiome participate in regulation of various mechanisms inside the gastrointestinal tract due to its production of different bacterial metabolites. In our manuscript we present current knowledge about microbiota in the gut; the relation between gut microbiota and brain; neuroendocrine system and gut-brain axis; immune system and gut-brain axis; endocrine system and gut-brain axis; the role of gut microbiota in obesity development and possible use of gut microbiota for the treatment of obesity.

Background. Weight loss associated with long-term lifestyle changes has significant beneficial effects on metabolic syndrome (MetS) features on obese patients; unfortunately, the weight recidivism rate is high and the weight fluctuations could increase the cardiovascular and metabolic risk. On the other hand, there are many data about the endocrine role of adipose tissue. Objective. Taking into account the imbalance between pro-inflammatory and anti-inflammatory cytokines secreted by adipose tissue on obese patients, this study assessed the effects of one month-long supervised lifestyle change (SLC) program without weight loss on the MetS-associated inflammatory status. Methods. The study included 29 obese adults with MetS. The SLC program included supervised moderate physical activities and diet for one month. The levels of adipocytokines, lipids and inflammatory markers were analyzed before and after one month SLC program, and 2 months later at follow-up. Results. At follow-up, the leptin, vascular endothelial growth factor (VEGF), and hsCRP levels decreased, whereas the interleukin-4 (IL-4) and high-density lipoprotein (HDL) cholesterol levels increased from their baseline levels. So, an SLC program, even in the absence of weight loss, could have an extended antiinflammatory effect by decreasing the proinflammatory adipocytokines. Conclusion. Our data furthermore emphasize the importance of the adipocytokines gender-related variation for a more personalized evaluation protocol on obese patients.

Metabolic syndrome may have direct myocardial effects in addition to their atherogenic effects, and this has been related to left ventricular systolic and diastolic dysfunction, as well as left ventricular remodelling. The aim of the study was to analyze the correlation between the metabolic syndrome clustering components (individual and additive) and heart failure severity in patients with prior myocardial infarction. We performed a cross-sectional study including 65 patients with heart failure post-myocardial infarction (31 men and 34 women) with a mean age at 64.1 (9.1). We evaluated the metabolic syndrome parameters (individual and additive) and analyzed their impact on heart failure severity by comparing NYHA I+II and NYHA III+IV groups. The elements of metabolic syndrome independently correlated with heart failure severity were identified by means of logistic regression method. The frequency of metabolic syndrome in our study group was high (49.23%). High blood pressure, fasting glucose, central obesity and low HDL-Cholesterol levels were significantly associated with severe heart failure (NYHA III and IV classification) in univariate logistic regression analyses. The only two independent variables: hyperglycaemia and reduced HDL-Cholesterol returned high enough levels of OR and 95%CI (1.79; 1.45-2.89 and 0.83; 0.67-0.91 respectively) to reach statistical significance beyond adjustment risk factors. In our study it was identified a significant correlation between presence of complete metabolic syndrome criteria and heart failure severity, measured in either NYHA IV categories (p=0.002), or by means of echocardiographical parameters such as: left ventricular ejection fraction (p=0.026), left ventricular masse index (p=0.006), peak E velocity (p=0.011), peak A velocity (p=0.037), Mitral E/A ratio (p=0.001) and E-deceleration time (0.021). Conclusions: Among the criteria for metabolic syndrome, hyperglycaemia and reduced HDLCholesterol levels had a strong association with heart failure severity. Our findings are relevant for\r\nclinical practice and intervention, and the aggressive treatment for conventional risk factors has also been effective in the prevention of heart failure.