ACTA ENDOCRINOLOGICA (BUC)

Published data sustain the involvement of diet on pathogenesis of immune-mediated diseases.\r\nAim. To determine if the high fat diet (HFD), in the absence of obesity, could modulate the altered pulmonary arteries\r\nreactivity associated to allergic lung diseases.\r\nMaterials and Methods. Obese resistant rats were divided into 2 groups: standard chow diet and HFD. Randomly chosen rats from both groups were sensitized against ovalbumin. The histological aspect and reactivity of pulmonary arteries were comparatively assessed. Taking into account the involvement of adipokines on obesity associated vascular reactivity alteration we also studied the vasomotor effects of few adipokines on pulmonary vessels.\r\nResults. Lung histological examination revealed that HFD aggravated the remodelling of pulmonary arteries and\r\ninflammation of lung parenchyma. The HFD amplified the phenylephrine - induced contractions. Angiotensinogen amplified and apelin inhibited the Phe contractile effects on sensitized HFD fed rats.\r\nConclusion.These effects could be at least mediated, by both the alteration of adipokines vasomotor effects and\r\ninflammation associated to pulmonary allergic disease.

Today therapeutic options for obesity include miniinvasive methods. The authors present the results of a prospective study regarding a lot of 224 obese patients treated between January 2003 ? January 2005 with laparoscopic adjustable gastric banding (LAGB) (n=184) and endogastric balloon (n=40). The medium body mass index (BMI) of admission for LAGB was 46.08 kg/m2 (extremes between 36 ? 71 kg/m2), 42 patients being super obese (BMI over 50 kg/m2). There were no conversions to open techniques. Postoperative evaluations were at 1, 6 and 12 months. Medium BMI was 39.1 kg/m2 (115 patients) at six months after surgery and 38.78 kg/m2 (59 patients) at one year after surgery. Comorbidities were remitted at 72% of patients at 6 months postsurgery. The patients treated with endogastric balloon endoscopically introduced (40 cases) were followed 6 months, after that they were extracted (26 cases). The medium BMI of admission was 33 kg/m2 (extremes between 21 ? 43 kg/m2) and at 6 months the medium BMI was 26.8 kg/m2. Although we do not benefit of a long time follow-up, the favorable initial results allow us to state that miniinvasive techniques deserve an important place in the efforts of struggling against obesity and its consequences.

Background and aim. The goals of bariatric surgery are to improve the quality of life by lowering body mass index (BMI) but also to treat obesity comorbidities. The aim of our study was to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on metabolic parameters. Methods. 85 obese patients treated by bariatric surgery LSG procedure were included in the study. Basal, 6 and 12 months after surgery serum glucose levels and lipid fractions were measured. Metabolic syndrome criteria according to IDF 2006 were evaluated at baseline and after bariatric surgery. Results. Our group included 61.2 % female patients, the mean age was 40.2 ±10.2 years and the metabolic syndrome criteria at baseline were confirmed in 69.4% of the study group. At twelve months after the intervention, the mean excess weight loss (%EWL) was 72%, with age and BMI subgroups variations. We found significant improvements of serum concentrations for triglycerides (P-value = 0.001, decreased by 30%), HDL-cholesterol (P-value = 0.017, increased by 26%), total cholesterol (P-value = 0.043, decreased by 12%) and glucose (P-value = 0.007, decreased by 12%). Conclusions. The positive effect of bariatric surgery was confirmed for lipid fractions and fasting glucose levels, also the metabolic syndrome prevalence was significantly reduced, all these changes contribute to lower cardiovascular risk together with significant weight loss.

Context. Papillary thyroid carcinoma(PTC)s are the indolent progressive tumours. Survivin is a unique bifunctional protein with cell cycle regulation and apoptosis inhibition. The expression of this protein has been shown to be increased in thyroid tumours correlated with aggressive behavior from well differentiated to anaplastic. Objective. In this study, we aimed to investigate the relationship between immunohistochemically survivin expression and tumour-associated prognostic factors in papillary thyroid carcinomas. Design. In patients with thyroidectomy, we compared the clinicopathological findings and immunohistochemical positivity for survivin. Subjects and Methods. In 109 patients, sex, age, tumour size, histological tumour variant, tumour focality, tumour border pattern, tumour peripheral/intratumoural lymphocytic and stromal response, intraglandular spread, extrathyroideal spread, lymph node metastases, lymphocytic tiroiditis and relationships of these findings with survivin positivity were investigated. Results. When we indicated the tumour size and compared it with survivin expression, tumour size correlates with, survivin expression (p = 0.016). Survivin expression was correlated statistically significant with lymphovascular invasion, without stromal response and with intraglandular extension respectively (p<0.001, p = 0.043, p<0.001). No significant correlation was found between other clinicopathological parameters and survival. Conclusion. Few studies have investigated the relationship of survivin expression with prognosis in thyroid papillary carcinomas and showed that survivin was a poor prognostic marker. If its expression is detected in preoperative cytology smears, it may affects the surgical treatment strategy. When it is detected in the tissue, postoperative radioactive iodine treatment plan may be modified and the need for more aggressive follow-up may be considered.

Objective. In our study, we aimed to evaluate thyroid nodule ultrasound findings, nodule frequency and malignancy risk according to the ultrasonographic classification systems [(American Thyroid Association-2015 (ATA) and American College of Radiology - Thyroid Imaging Reporting and Data System (ACR-TIRADS)] in obese and non-obese subjects. Materials and methods. 111 obese subjects and 111 non-obese age- and sex-matched control subjects were included in the study. The malignancy risk of the identified nodules was evaluated using ultrasonographic classification systems. Fine needle aspiration biopsy (FNAB) was performed on the nodules according to ultrasonographic malignancy risk, and cytopathological evaluation was performed according to the Bethesda system. Results. We did not find any difference between the groups in terms of age, sex, thyroid stimulating hormone (TSH) levels and thyroid volumes. We detected thyroid nodules in 36 (32.4%) of 111 subjects in the obese group and 22 (19.8%) of 111 subjects in the control group. Compared with controls, the prevalence of nodules was higher in obese subjects (p=0.046). There was no difference in the malignancy risk of nodules in obese subjects compared to non-obese subjects according to both ultrasonographic classification systems. Conclusion. We have determined that the frequency of thyroid nodules is higher in obese patients than in nonobese subjects. However, we did not find any difference between the two groups in terms of malignancy risk of thyroid nodules according to ultrasonographic classification systems.

Context. Intraoperative parathyroid hormone (IO PTH) monitoring has determinative role in surgery for tertiary hyperparathyroidism (tHPT). Objective. We tried to find out whether the extent of surgery to be performed can be dedicated via IO PTH monitoring in tHPT. Design. Renal transplantation (RTX) recipients who had been operated and followed up because of tHPT between 9/2014 and 5/2021 at our institution were retrospectively analyzed. Subjects and Methods. We analyzed the preoperative and postoperative data of 41 patients with tHPT. Results. Considering IO PTH monitoring; 70% and more decrease of the hormone level leaded us favorable results (89% surgical success) regardless of the PTX method (p<0.05). We obtained the same surgical success rate (75%) in patients in whom monitoring was done and was not done. We observed high success ratios (100%) in the latter group via subtotal PTX and total PTX plus auto transplantation (AT) (p<0.05). Conclusions. In surgery for tHPT, IO PTH monitoring should be maintained. When we observe 70% or more decline in the hormone level, we can decide to finish the operation regardless of the surgical technique. If hormone level decrease is below 70%, we have to continue exploration.

About 15-20% of adults with Down?s syndrome have autoimmune hypothyroidism. Among patients with Down?s syndrome, prevalence of Graves disease (1-2%) may not be increased compared with the general population. About 15% of the patients with Turner?s syndrome have autoimmune hypothyroidism. Until 2006, only 15 cases of Graves disease have been reported among patients with Turner?s syndrome. We present two adult patients with chromosomial disorders (Down?s syndrome, Turner?s syndrome) with Graves? disease without clinical Graves ophthalmopathy. Clinical picture of thyrotoxicosis was oligosymptomatic in the patient with Down?s syndrome, probably because Down?s syndrome represents a syndrome of accelerated ageing. Both were pretreated with antithyroid drugs before radioiodine therapy. Both patients developed postradioiodine hypothyroidism: after 8 months in the case with Turner?s syndrome and after 11 years in the patient with Down?s syndrome. Adults with these two chromosomial disorders should be screened annually for autoimmune thyroid dysfunction.

Context. We aimed to examine the factors affecting adverse gestational outcome in gestational diabetes (GDM) patients, who were grouped as obese and normal- weight, having only-diet, or insulin treatments. Subjects and Methods. The study included 373 patients, treated with diet or insulin. These patients were sub-grouped as obese and non-obese, and examined retrospectively. The variables affecting adverse gestational outcome in obese GDM patients having dietary and/ or insulin treatments were detected with multiple regression analysis. Results. The weight gained during pregnancy in the GDM group having insulin treatment was more than the one in only-diet treated GDM group (p=0.004). Pre-pregnancy body mass index, the weight gained during pregnancy, hemoglobin A1C levels in the second and third trimesters, caesarian rates were higher in the insulin-treated obese patients than in the other groups (p<0.001). The odds ratio for fasting blood glucose level in insulin-treated obese GDM group was 1.081 (95% CI =1.004 - 1.163) (p=0.039); and it was 0.982 (95% CI =0.924 - 1.002) (p=0.048) for the weight gained during pregnancy, in only-diet treated obese GDM patients. Conclusion. The control of weight gained during pregnancy, and of fasting blood glucose levels in obese patients having GDM, is important to decrease adverse gestational outcome.

Introduction. Antigonadotropic effect of melatonin in seasonally breeding rodents is due to the influence of this indol on the reproductive axis hypothalamicpituitary-gonads, although it is known that melatonin has a negative effect on the hormonal function of the reproductive axis, and is unknown whether it can affect the fertility of male Wistar rats.\r\nAim. The objective of this study was to investigate the effects of melatonin application on the fertility of the male Wistar rat.\r\nMaterials and Methods. Sixteen male Wistar rats were used. Rats were divided into two groups, Control and the group of animals treated with melatonin 1mg/kg (M) injected i.p. daily for two months. The evaluation of fertility was\r\ndetermined by the number of pregnant female rats. In addition, it was quantified the number of spermatozoa and Leydig cells in the seminiferous tubules. After removing\r\nthe treatment for two months, the experiments were repeated, to determine the possible recovery.\r\nResults. The results showed that rats treated with melatonin were able to impregnate only 25% of the mated female rats\r\n(p<0.05). In this group, the number of sperm decreased with a significance of p< 0.001 while the number of Leydig cells increased with respect to the control group with a significance of p< 0.001. After removing the treatment for two months, both the sperm and the Leydig cells were recovered at similar levels as the control group, while the fertility was not totally recovered in the group treated\r\nwith melatonin. These results suggest that the exogenous melatonin application (1mg/kg i.p) induces infertility.

Objective. Unilateral adrenalectomy (UA) is an alternative for treatment in bilateral adrenal incidentaloma (AI) to avoid possible long-term risks of bilateral adrenalectomy. In this study, we aimed to evaluate the effectiveness of UA in bilateral AI patients with subclinical hypercortisolemia (SH). Method. A total of 35 patients were included in this study. The patients were divided into two groups; those who underwent UA (n=27) and patients without adrenalectomy (PWA) (n=8). Hormone tests related to cortisol mechanism were reviewed to analyze results at the time of diagnosis compared to the latest available results to figure out any changes in cortisol mechanism and determine whether SH has recovered or not. Results. Median age of PWA group were higher compared to UA group (p=0.03). Median duration of followup in groups were similar (p=0.3). In the PWA group, none of the patients recovered from hypercortisolemia during their follow-up. In UA group 92.6% of the patients went into remission, whereas during follow-up 3.3% had recurred and another 3.3% were found to have post-adrenalectomy persistent SH. Patients in UA group had lower final cortisol level following dexamethasone suppression (p=0.003) and higher final adrenocorticotrophic hormone (ACTH) levels (p=0.001) than patients in PWA group. In UA group, final basal cortisol level (p=0.009) and final cortisol level after 1 mg dexamethasone suppression test (DST) (p=0.004) were lower than corresponding levels at the time of diagnosis. Discussion. Our study demonstrates unilateral adrenalectomy targeting the side with the larger lesion is an effective approach to reduce excess cortisol levels in bilateral AI patients with SH.