ACTA ENDOCRINOLOGICA (BUC)

Context. Detection of parathyroid incidentalomas (PTIs) by ultrasonography (US) generally depends on clinical experience and it can be usually confused with perithyroidal lymph nodes. Objective. We aimed to evaluate the role of US for the detection of PTIs and define clinicopathologic features of PTIs detected during routine neck US. Design. In this retrospective study, we studied PTIs in a multidisciplinary clinical approach of nuclear medicine and general surgery clinics. Subjects and Methods. US indications and reports of 41275 were reviewed retrospectively. Of these patients, PTI was suspected in 66 (0.16%) patients. Those with a pathology-confirmed diagnosis after surgery formed Group PCD and those without a pathology-confirmed diagnosis and operation Group NPCD. These groups were compared statistically according to demographic data, laboratory tests, imaging results and postoperative findings. Results. The diagnosis of PTI was confirmed pathologically in 31 operated patients. Other pathologies rather than PTI on US were multinodular goiter, thyroiditis, thyroid nodule and perithyroidal lymph node. PTH and calcium levels were significantly higher in PCD Group;anti- TPO and anti-TG levels were significantly higher in NPCD Group. Conclusions. Lesions suspected of PTI on US should be followed-up with further evaluation by laboratory tests and imaging methods and a multidisciplinary working environment should be established.

Background. There is no immunohistochemical study to show luteinizing hormone receptor (LHR), estrogen receptor (ER) and progesterone receptor (PR) in the pregnant Fallopian tubes (FT). Objective. To study LHR, ER, PR expression in FT containing an ectopic pregnancy (EP) and during the menstrual phase. Design. Thirty FT were obtained from women diagnosed with EP and twenty FT collected by hysterectomy performed for benign diseases not affecting the tubes were included in this study. Assessment of immunohistochemical expression staining LHR, ER, PR in epithelium, smooth muscle cell and blood vessel endothelium in FT containing an EP and during the different phases of menstrual cycle. Results. In ectopic pregnancy group we found LHR expression in epithelium in 30 cases, muscle cell in 28 cases, and endothelium in 9 cases in FT. In menstrual cycle group we noted LHR expression in FT in epithelium in all cases, muscle cell in 4 cases. Conclusion. There is a significant difference in the proportions of the existence of LH receptor immunostaining in the muscle cells for ectopic pregnancy group as compared to the menstrual cycle groups (p < 0.001). Our findings may suggest that the women who have increased LH receptors on muscle cells in Fallopian tubes are at increased risk for having external pregnancy.

Context. The prevalence of patients with concomitant heart failure (HF) and diabetes mellitus (DM) is high. Objective. To analyze the role of NT-pro-BNP levels in the evaluation of diabetic patients with heart failure. Design. Retrospective comparative cohort study. Subjects and Methods. A total of 174 patients admitted to our Cardiology Department, previously diagnosed with HF, were enrolled. Among these patients, 47.7% had DM. HF was defined according to the 2016 ESC criteria. The NT-pro BNP levels above 126 pg/mL indicate a high probability of heart failure. Results. In diabetic patients there were significant correlations between NT-pro-BNP values and the following parameters: hemoglobin (rho=-0.28, p=0.01), hematocrit (rho= -0.27, p=0.014), total cholesterol (rho= -0.21, p=0.048), triglycerides (rho= -0.283, p=0.01), ejection fraction (rho= -0.465, p<0.0001), end-diastolic volume (rho= 0.253, p= 0.026), end-systolic volume (rho= 0.29 p=0.01). Only the following 3 parameters: ejection fraction (p= 0.0009), hemoglobin (p= 0.0092) and triglycerides (p= 0.0380) were independent predictive factors for elevated NT-pro-BNP values. Conclusion. In diabetic heart failure patients, the value of NT-pro-BNP holds a pivotal role in the evaluation of their overall status, facilitating the establishment of correct management and follow-up.

Objective. Thyroid diseases coexisting with primary hyperparathyroidism (PHPT) may individually change the diagnosis, treatment and follow-up of the patients. In our study, we aimed to investigate the thyroid diseases coexisting with PHPT and the relation between\r\nthese two clinical situations.\r\nMethods. We retrospectively investigated 255 patients who were diagnosed as PHPT between 2004-2009 in our clinic. The general characteristics of the patients, laboratory tests,\r\nwhich were performed preoperatively, neck ultrasonography, thyroid and parathyroid scintigraphy and fine needle aspiration biopsy (FNAB) results were assessed. Cytological\r\nresults of the nodules with preoperative FNAB were compared with the postoperative histological results.\r\nResults. Of the patients, 49 were male (19.2%) and 206 were female (80.8%). Mean age was 54.5?12.8. Bilateral neck exploration (BNE) was performed on 69 cases (27%),\r\nminimal invasive parathyroidectomy (MIP) on 78 cases (30.5%) and BNE plus thyroidectomy on 108 cases (42.5%). When all thyroid diseases were taken into account,\r\nprevalence of the coexisting thyroid disease was 65%, prevalence of nodular thyroid disease 52.1%, thyroid cancer 16.7% and thyroid dysfunction 11.8%. The mean age of the patients with a nodular goitre was significantly higher than of the patients who did not have nodules\r\n(p<0.001). General demographic data, calcium and PTH levels did not show any difference. Number of nodules was correlated with age (p<0.001, r=0.227).\r\nConclusion. The relation between PHPT and nodular thyroid diseases is coincidental and this can be explained by the fact that both diseases occur in advanced age.

abdominal cystic lesions should include investigation of cystic pheochromocytomas. To date only a few cases of purely cystic pheochromocytoma have been reported in the English literature. Aim. To present the management in four cases of silent pheochromocytomas patients who presented with pure or partially cystic abdominal lesions with benign (n:3) and malignant characteristics (nonspecific neuroendocrine tumor) (n:1) in histological evaluation. Results. Resection of the tumor is considered the primary treatment option in the management of pheochromocytoma, and preoperative preparation with alpha and beta antagonists is crucial in order to avoid precipitation of hypertensive crisis during surgical procedures. The absence of clinical symptoms and lack of typical radiological features may complicate the diagnosis of pheochromocytoma resulting with increased mortality and morbidity during surgery. Conclusion. Asymptomatic pheochromocytomas are rare and they are responsible for approximately 5% of adrenal incidentalomas. These lesions may be referred to surgery as clinically nonfunctional adrenal adenomas.

Background. Lipoprotein-associated phospholipase A2 is a novel inflammation marker that generates pro-inflammatory\r\nmolecules from oxidized LDL.\r\nAim. We aimed to investigate its role in individuals with insulin resistance and metabolic syndrome which is representative of early stages of atherosclerosis.\r\nMethods. We evaluated 114 subjects with metabolic syndrome in a cross-sectional pattern. Waist circumference was measured. Fasting plasma glucose, total cholesterol,\r\ntriglycerides, high-density lipoprotein cholesterol (HDL-C), LDL-cholesterol (LDLC), fasting insulin were measured by standard assays. Oral glucose tolerance test was applied\r\nto patients with fasting blood glucose < 126 mg/dL. Patients were classified to tertiles according to their insulin resistance states. Lp-PLA2 mass levels were measured.\r\nResults. There was a correlation between hypertension and HOMA tertiles; HDL-C, hypertriglyceridemia, hyperglycemia\r\nwere not correlated with HOMA tertiles (p = 0.024, p=0.66, p=0.66, p = 0.18, respectively). We cannot find any association between HOMA tertiles and Lp-PLA2 levels. Triglyceride was negatively correlated with Lp-PLA2.\r\nConclusion. Lp-PLA2 is not correlated with insulin resistance in subjects with metabolic syndrome.

Graves&#8217; disease and toxic nodular goiter both cause thyrotoxicosis by different pathophysiological mechanisms. Rare cases associates both etiologies are undertaken by the diagnosis of Marine-Lenhart syndrome. A woman aged 38, with Graves&#8217; unilateral ophthalmopathy and a solitary, echo-dense thyroid nodule, developed thyrotoxicosis within the following 3 months. The diagnosis was certified by suppressed TSH (0.002 mIU/L), high fT4 (5.6 ng/mL) associated with elevated TRAb (3.5 IU/L), moderately elevated TPOAb (63.1 IU/mL) and ATGl (248 IU/mL). The thyroid radioiodine scan revealed a solitary hot nodule in the left lobe with an elevated radioiodine uptake. Methyl prednisolone was started by oral and pulse therapy, with stabilization of ophthalmopathy within 5 months. After four months with antithyroid drug therapy followed by radioiodine (25 mCi 131I), the thyroid scan revealed diffuse radioiodine uptake. Nine months after radioiodine therapy, the patient was in clinical and biochemical hypothyroidism and substitutive therapy was instituted. A broad literature review suggested that in such rare cases, underlying autoimmune mechanisms might be involved in the development of thyroid nodules with variable function and proliferation activity.

Background. This study aimed to assess fractal dimension (FD) and the radiomorphometric indexes on the digital panoramic radiography (DPR) of patient with primary hypothyroidism receiving levothyroxine sodium replacement therapy. Methods. A total of 115 subjects were included in this cross sectional retrospective study. According to the results of the thyroid function tests, the subjects were divided into two groups as primary hypothyroidism (levothyroxine sodium replacement therapy given), (n = 57) and the healthy control group (n = 58). The fractal dimension (FD), panoramic mandibular index (PMI), mandibular cortical width (MCW), gonial index (GI) and mandibular cortical index (MCI) values of all patients were calculated on DPRs. The statistical analysis of all data was performed with SPSS version 22. Results. The distributions of age and gender in the primary hypothroidism group were similar to control group (p = 0.19 and p = 0.62, respectively). The two groups did not differ statistically significantly in terms of FD, PMI, MCW, GI, and MCI. Conclusion. We determined that mandibular cortical and trabecular bone structure did not significantly differ between healthy individuals and patients receiving drug replacement theraphy due to hypothyroidism, but our results should be further supported with the investigation of clinical parameters.

Objectives. We aimed to determine lipodystrophy frequency according to insulin treatment regimen and insulin injection frequency in type 2 diabetic patients. Methods. A total of 345 type 2 diabetic patients under insulin treatment for at least one year were included in this cross-sectional study. Patients were examined for presence of lipodystrophy, insulin injection frequency and dosage. Lipodystrophy was evaluated with visual inspection and palpation of all injection sites. Patients were evaluated into three categories according to daily insulin dose requirement: Group 1= Standard-dose insulin users 0.6 U/ kg/day; Group 2= Medium-dose insulin users 0.61-1.9 U/kg/ day, Group 3= High-dose insulin users ≥2 U/kg/day. Results. Lipodystrophy was seen in 28% of the patients. Lipodystrophy was significantly higher in group 3. There was no significant difference between the groups in terms of lipodystrophy size. Duration of insulin treatment, daily total insulin dose, daily insulin dose per weight and number of daily insulin injections were significantly higher in the group with lipodystrophy. Daily injection number of long-acting, rapidly-acting analog and total insulin injections were significantly higher in group 3 than group 1 and 2. Number of daily insulin injections and lipodystrophy frequency were significantly higher in basalbolus insulin user group. Multivariate analysis showed that insulin injection frequency is the independent risk factor for lipodystrophy. Conclusion. Lipodystrophy is still a clinical problem in patients with high-dose insulin requirement and frequent insulin injections. Reducing daily insulin requirement and daily number of injections should be given priority in the management of patients to prevent the development of lipodystrophy.

Objective. Personal discrepancies in gastrointestinal physiology might influence responses to GH suppression during OGTT. We aim to compare growth hormone (GH) response during oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT). Methods. Data of 18 healthy volunteers were analyzed in the study. Subjects were firstly evaluated with standard 75-g OGTT. In subjects with serum glucose <100 mg/dL at basal state and <140 mg/dL at 120th minute of oral loading, IVGTT was performed after at least 3 days. Serum glucose, insulin and GH levels were measured during two tests. Results. Basal GH levels had a wide distribution ranging from 0.00005 μg/L to 0.768 μg/L (median 0.0145 μg/L). Mean nadir GH level during OGTT was obtained at 60th minute and it was 0.0376 μg/L(range 0.00011-0.387, median 0.0016 μg/L, SD: 0.095, SEM: 0.038). Nadir GH level during IVGTT was observed at 10th minute and it was 0.112 μg/L(range 0.0005-0.770 μg/L, median 0.0053 μg/L, SD: 0.242, SEM: 0.057). There was a statistically significant difference between nadir GH levels obtained during IVGTT and OGTT (p=0.028). Conclusions. We found that mean nadir GH level was significantly higher during IVGTT in healthy subjects. This is a preliminary study and further large scale studies are required to suggest that IVGTT may be used in the diagnosis and follow-up of patients with acromegaly as an alternative to or instead of OGTT.