ACTA ENDOCRINOLOGICA (BUC)

Aim. The aim of our study was to investigate the effect of pioglitazone on glycemic and blood pressure control, on inflammation markers in diabetic patients.\r\nPatients and methods. Forty-nine diabetic patients who had been followed up as outpatients for 2.7 years and HbA1c was >7% were included in the study. The patients had never received thiazolidinedione therapy before. Clinical, metabolic variables, high-sensitive Creactive protein (hsCRP), homocysteine (HCY) and asymmetric dimethylarginine (ADMA) levels were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison.\r\nResults. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and HsCRP were decreased. Insulin resistance was improved and HOMA-IR index was decreased after pioglitazone treatment [8 (?6.5) vs 4(?3.1); p<0.0001]. Pioglitazone improved lipid metabolism. Mean total cholesterol and LDL cholesterol levels were decreased and HDL cholesterol was increased after treatment. The decrease in triglyceride and homocysteine levels did not reach significance. Mean ADMA level did not change after therapy [0.62 (?0.39) vs 0.61 (?0.44); p=0.85].\r\nConclusion. Pioglitazone treatment in type 2 DM produced significant improvements in measures of glycemic control, plasma lipids, blood pressure and homocysteine levels. Pioglitazone had no influence on ADMA levels.

Radioiodine treatment of hyperthyroidism is easy to perform, has a low cost and presents a low risk adverse effects.\r\nDespite many reports on the efficiency and results, the number of studies investigating the efficiency of radioiodine treatment in subclinical hyperthyroidism is limited.\r\nAim. Therefore, this study aimed to investigate the efficiency of radioiodine treatment in subclinical hyperthyroidism.\r\nMethods. The study involved 50 patients with subclinical hyperthyroidism (42 females, 8 males, mean age: 60.3?10.8)\r\ntreated by radioiodine in our department. Thirtyfour (68%) of the 50 patients had multinodular hyperplasia; 9 (18%) had diffuse hyperplasia, and 7 (14%) had solitary nodule.\r\nThe patients were applied I-131 treatment with a dose of 5-20 mCi (mean 11.52?3.63 mCi) based on the thyroid gland volumes, TSH levels, age, any clinical findings, and\r\nalso, the type of hyperplasia (diffuse or nodular hyperplasia). The patients were followed for 5.13 to 46.5 months (mean: 24.62?11.47).\r\nResults. Forty-three (86%) of the 50 patients were euthyroid after a mean of 2.36?1.18 months following radioiodine\r\ntreatment. The mean dose of radioiodine was 11.91?3.73 mCi. Only 5 (10%) of 50 patients developed hypothyroidism 1-5 months (mean: 2.8?1.48) after radioiodine therapy with 8-10\r\nmCi (mean: 8.4?0.89) I-131 administration. When hypothyroidism is also considered as a criterion for cure in addition to euthyroidism, the success rate of radioiodine treatment was 96% (48/50) in the patients with subclinical\r\nhyperthyroidism.\r\nConclusion. Radioiodine treatment provides quick and high efficiency of recovery, easy application, and quick\r\nadaptation by patient; thus, it can be a preferred choice of subclinical hyperthyroidism treatment, particularly for the\r\nelderly patients who cannot adapt treatment with antithyroid tablets easily.

Context. Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, generally associated with a favorable prognosis. However, variants such as the hobnail subtype exhibit more aggressive pathological and clinical features. Objective. The 2022 WHO classification defines hobnail PTC (HPTC) as tumors with at least 30% hobnail cell morphology, yet the prognostic impact of varying hobnail cell proportions remains unclear. Design. This study aimed to evaluate the clinicopathological characteristics and prognostic significance of PTC with different degrees of hobnail features, contributing to improved risk stratification and management strategies. Subjects and Methods. A comprehensive analysis was conducted on PTC cases exhibiting hobnail features at varying proportions. Pathological characteristics, including vascular and lymphatic invasion, calcification, lymph node metastasis, and capsule involvement, were assessed. Logistic regression analysis was performed to determine associations between hobnail morphology and aggressive disease behavior. Results. Tumors with ≥30% hobnail features exhibited significantly (p< 0.05) higher rates of vascular invasion, lymphatic invasion, calcification, and lymph node metastasis compared to tumors with fewer hobnail features and classic PTC. Logistic regression confirmed a strong association between hobnail morphology and lymphatic invasion/metastatic lymph nodes (p = 0.026). However, no significant correlation (p>0.05) was observed with extrathyroidal invasion, bilaterality, or the necessity of radioactive iodine (RAI) treatment. Conclusion. The findings emphasize the aggressive nature of PTC with prominent hobnail features, underscoring the need for tailored therapeutic strategies and close monitoring in affected patients. Further research is warranted to refine prognostic models and optimize treatment approaches.

Radioactive iodine (RAI) therapy is a mainstay adjuvant treatment for thyroid cancer. Administration of RAI therapy after total or near-total thyroidectomy has shown a survival advantage in numerous properly selected patients. However, the role of RAI therapy after reoperation for persistent or recurrent differentiated thyroid carcinomas (DTCs) is unclear. One reason may be the possible downregulation of the I- transport system after primary surgery. RAI is transported by the sodium iodide symporter (NIS), PENDRIN, anoctamin 1 (ANO1) and cystic fibrosis transmembrane conductance regulator (CFTR) and emits β particles that destroy follicular cells. The identification of pathways of iodide (I-) transport has allowed use of the transport system to render tumours susceptible to RAI treatment via gene therapy. This review focuses on the effect of RAI therapy in follicular cell-derived thyroid cancers and offers potential novel targets that enable improved radioiodine uptake and thus an improved prognosis of thyroid cancer.

COVID-19 primarily affects the respiratory system. What comes after the disease is now a greater concern for the scientific world. It is remarkable for causing endocrine organ involvement, particularly in the adrenal glands. However, its effect on the adrenal gland has not been fully elucidated. A case of primary adrenal insufficiency after COVID-19. A 31-year-old female patient who presented with complaints of weakness, anorexia, nausea, recent onset of vomiting, dizziness, and low blood pressure for two months was admitted to the outpatient Department of Endocrinology and Metabolism. After discharge, the patient had routine follow-ups, and here we present the information on the first and seventh month after discharge. The patient was diagnosed with primary adrenal insufficiency with cortisol <0.054 μg/dL and adrenocorticotropic hormone >1200 pg/mL in the laboratory. In the non-contrast computed tomography taken in the adrenal protocol, the stem and leaves of both adrenal glands are significantly thinned and appear atrophic, the right adrenal gland is hardly distinguished. Hydrocortisone was started. All complaints were resolved within a week, except hyperpigmentation, which was resolved six months later after treatment. Our study support adrenal gland involvement due to COVID-19, further research is needed to obtain data on damage mechanisms.

Context. Patients with renal malignancies present high risk of adrenal hyperplasia and adenoma, and part of these are primary lesions, mostly non-functional. Here we presented a case diagnosed as primary adrenal adenoma with autonomous cortisol secretion accompanied by homolateral renal cell carcinoma. Case presentation. A 79-year-old woman was referred for evaluation of a left adrenal mass, with a past medical history of severe hypertension, diabetes, and hyperlipidemia. On examination, no clinical signs of cushingoid features were found. Biochemical measurements showed plasma cortisol was 12.77 μg/dL and was not suppressed by 1 mg dexamethasone (DXM) overnight test (13.6 μg/dL). The contrast CT scan presented a 2.2 cm diameter adrenal mass and revealed, unfortunately, a hyperdense mass at the middle-upper pole of the left kidney. Laparoscopic nephrectomy with left adrenalectomy was performed and pathological examination indicated a final diagnosis of benign adrenocortical adenoma and renal clear cell carcinoma. At 2 months postoperatively, without replacement treatment of cortisol, a recovery of circadian rhythm of cortisol secretion was detected, indicated recovery of the hypothalamic-pituitary-adrenal axis. Conclusions. Patients with renal cancer might be accompanied with functional adrenal adenoma. Therefore, screening for adrenal function should be recommended in patients with renal tumors and/or adrenal incidentaloma.

Intracranial germ cell tumors (GCTs) include two categories: germinoma and non germinoma. The pineal gland and suprasellar are the most common site of involvement. The patient is a 14-year-old boy who presented with paralysis of upward gaze, polyuria, polydipsia and diplopia. Examination of vertical eye movements was impaired. Puberty then progressed to stage 3 of Marshall - Tanner and had stopped. In laboratory studies, the patient had anterior hypopituitarism and diabetes insipidus (DI). In pituitary and hypothalamic MRIs, a mass-like enlargement of the pituitary stalk and pineal region was seen, but due to the small size of the lesions, stereotactic biopsy was not possible. During this time, the patient developed recurrent attacks of hydrocephalus. Serum and CSF β-subunit of Human chorionic gonadotropin levels were negative. Treatment was not started because different lesions could cause disease in this area. After one year, a biopsy was performed and the germ cell tumor was diagnosed. Chemotherapy was started and after treatment the vision disorder and diplopia disappeared, but DI and pituitary dysfunction remained. Treatment of intracranial germinoma is multidisciplinary. GCTs are very sensitive to radiation therapy. They are treated with combination of chemotherapy, radiotherapy, surgery, endocrine therapy and have a good prognosis.

Context. Craniopharyngiomas (CPH) are benign tumors, rarely encountered in children, representing 5-6% of all intracranial tumors. Objective. This study aimed to analyze the surgical management and quality of life in a series of CPH pediatric cases. Design. This was a multicenter study performed over a 25-year period (1994 - 2019) in Bucharest. Subjects and Methods. 152 children (0-17 years old) were treated for CPH. Preoperative manifestations were intracranial hypertension, endocrine dysfunction, visual impairment, ataxia, intellectual performance decrease. Results. Considering all surgical approaches used, we advocate for pterional approach to best fit in CPH. We achieved gross-total removal (GTR) in 83 cases (54.4%), near-total resection (NTR) in 13 cases (9%), partial resection (PTR) in 51 cases (33.3%). 5 cases were biopsies (3.2%). Gamma Knife Surgery was performed in 10 cases (6.5%), all recurrences. At 6 months GOS revealed: Good Recovery 70 cases (46.2%), Moderate Disability 62 cases (40.7%), Severe Disability 13 (8.5%), Vegetative State 2 cases (1.3%), Deceased 5 cases (3.2%). Complications were: diabetes insipidus (89.3%); hypopituitarism (66.4%); hypothalamic damage (17.7%); visual deterioration (18.4%). Conclusions. Surgery remains the main option, but GTR complications prove the necessity for a multidisciplinary approach. Outcome predicting factors are: age, tumor size, hydrocephalus degree, hypothalamic dysfunction.

Introduction. Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that typically presents in childhood and involves multiple organ systems. Turner syndrome (TS) is a chromosomal condition resulting from complete or partial loss of one X chromosome. Both disorders can independently cause short stature and pubertal delay. Case Report. We present a 9-year-old girl diagnosed with NF1 at age 6, based on widespread café-aulait macules and a positive family history. She was referred to our pediatric endocrinology clinic for evaluation of severe short stature. Physical examination revealed TS stigmata, including height SDS: -4.07, cubitus valgus, webbed neck, low posterior hairline, and widely spaced nipples. Karyotype analysis confirmed mosaic TS: 45,X[12]/46,X,del(X) (p11.2)[18]. Cranial magnetic resonance imaging revealed hamartomatous lesions, an empty sella, and an optic pathway glioma, for which she had received chemotherapy. Laboratory findings were consistent with hypergonadotropic hypogonadism. Estrogen replacement therapy was initiated; however, recombinant human growth hormone treatment was declined by the family after counseling. Conclusions. This co-occurrence is exceedingly rare, with only a few pediatric cases having been reported in the literature. This dual diagnosis poses diagnostic and therapeutic challenges and necessitates a personalized approach to growth assessment, pubertal induction, and long-term tumor surveillance in pediatric endocrine care.

Introduction. Congenital hypothyroidism (CH) is a prevalent cause of intellectual disability, preventable with early detection and treatment. Levothyroxine (LT4) is the standard treatment, but its efficacy can be compromised by drug interactions. Case Description. We present an 18-day-old boy diagnosed with CH, who exhibited elevated thyroidstimulating hormone (TSH) levels despite LT4 treatment. Upon increasing the LT4 dose and observing persistent TSH elevation, further investigation revealed the concurrent use of simethicone-containing colic drops. Literature suggests that simethicone can interfere with LT4 absorption. The colic drops were discontinued, leading to normalized TSH levels. Additionally, macro-TSH, indicated by a polyethylene glycol (PEG) precipitation test, was considered to contribute to the elevated TSH levels. Discussion. This case underscores the necessity of thorough medication history reviews in patients with CH. Drug interactions, such as those with simethicone, can significantly impact LT4 efficacy. Moreover, the presence of macro-TSH should be considered when TSH levels are disproportionately elevated. Conclusion. Clinicians should be vigilant about over-the-counter medication use and potential interactions in managing CH. Comprehensive patient history and careful monitoring are critical to optimizing treatment outcomes.