ACTA ENDOCRINOLOGICA (BUC)

Objective. To monitor the iodine status in Romanian schoolchildren and neonates after 20 years of mandatory salt iodization. Subjects and methods. In a national representative sample of 1352 children (7-12 years) we measured median urinary iodine concentration (mUIC) and creatinine (UCC) in spot urine samples and investigated household use of iodized salt. From 18349 neonates registered in the MEDILOG program for TSH screening we calculated the percentage of neonatal TSH >5 mIU/L (<3% indicating adequate iodine intake). Results. mUIC in schoolchildren was 141 μg/L (bootstrapped 95% CI 134, 146), showing adequate iodine intake in all but 1 county; mUIC was similar in historical endemic and non-endemic counties (140 μg/L and 143 ug/L, respectively) and in urban and rural areas (140 μg/L and 142 μg/L, respectively); mUIC/UCC = 118 ug/g. Iodized salt was used in 62% of households. In children using iodized salt (61.7%), mUIC was higher than in those using coarse (non-iodized) salt (24.6%): 150 vs. 121 μg/L (p<0.001). The percentage of nTSH >5 mIU/L was 14.7% (3.2%-27.3%), higher in non-endemic counties and urban areas. Conclusion. The current salt iodization program for households and bakery industry ensures an adequate iodine intake in schoolchildren. Discordantly, nTSH levels indicate a mild-moderate ID in neonates, suggesting ID in pregnant women. The percentage of households using iodized salt is below the recommended >90% needed for an efficient ID prevention program. More efforts should be directed to increase the public awareness on the health risks of ID and the benefits of ID prevention, notably for the neurointellectual development in children.

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.

Endocrine disruptors (EDs) are considered to have an impact on the function of reproductive axis at different levels as well on reproductive organs in both sexes. Complexity of female reproductive system influenced with various stressors including EDs lead to morphological and functional alterations. This is resulting in modulation of neuroendocrine regulation with consequent developmental irregularities and derangements, causative infertility, endometriosis as well as premature ovarian insufficiency or polycystic ovary syndrome. A number of experimental clues was obtained on female animal models using various EDs such as synthetic estrogens and phytoestrogens, neurotransmitters, pesticides or various chemicals. These substances lead towards consequent derangement of the neuroendocrine control of reproduction from early phases of reproductive development towards different phases of adult reproductive period. This text will address some novel insights into the effects of EDs on neuroendocrine regulation of gonadal axis, effects on ovaries as well on endometrium during implantation period.

Background. Secreting different adipocytokines, adipose tissue plays an important role in health and disease. Upon omega-3 consumption, changes in the secretion of adipose tissue and its effects on glycemic profile are a controversial subject at the present time. Objectives. We evaluated the effects of eicosapentaenoic acid (EPA) alone and in combination with vitamin E on adiponectin and serum glycemic indices in type II Diabetes patients. Design. This double-blind clinical trial divided all patients randomly into four balanced permuted blocks of EPA, Vitamin E, EPA and vitamin E and placebo (Corn oil). Subjects and Methods. 127 patients with type II diabetes living in Kashan in 2008, 35-50 years old, and 25≤BMI ≤30 were enrolled. ELISA, Glucose Oxidase, spectrophotometry, and Radioimmunoassay methods were used for measurement of serum adiponectin, Fasting Blood Glucose (FBG), HbA1C, and Insulin, respectively. Results. Serum adiponectin increased significantly after EPA consumption in EPA and EPA+E groups. Moreover, FBG, HbA1c, serum insulin and Homeostasis Model HOMA-IR decreased significantly after EPA consumption in the two previously mentioned groups. Conclusions. This study showed that EPA supplementation affects the secretion of adipose tissue, improves the FBS as well as HbA1c values and significantly decreases fasting serum insulin and insulin resistance.

The effects of finasteride on insulin resistance and of metformin on hyperandrogenism in patients with polycystic ovary syndrome (PCOS) are not clear. This study therefore compared the effects of finasteride, metformin, and finasteride plus metformin treatments on hormone levels, insulin resistance, and hirsutism score in women with PCOS. Fifty-two patients with PCOS were randomly assigned to receive finasteride 5 mg/day, metformin 1700 mg/day or finasteride plus metformin for 12 months. Body mass index (BMI), Ferriman Gallway score (FGS), serum concentrations of estradiol, sex hormone-binding globulin, free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and homeostasis model assessment of insulin resistance (HOMA-IR) index and areas under the curve (AUC) for insulin and glucose were evaluated before and after 12 months of treatment. Reductions in FGS, free testosterone, DHEAS, androstenedione, HOMA-IR, AUCinsulin, and AUC-glucose were significant within each group, whereas BMI and estradiol were not. Comparisons of changes in parameters in the 3 groups did not clearly show the superiority of any treatment modality. The treatment with finasteride alone significantly reduced both androgen levels and parameters of insulin resistance. In addition, metformin alone was effective, and not inferior to finasteride, in the treatment of hyperandrogenism.

Introduction. Fahr’s syndrome is an infrequent disorder characterized by bilateral symmetrical calcification of basal ganglia and the cerebral cortex. It can be seen genetic, idiopathic, or secondary to endocrine diseases. This disease is related to different metabolic disorders particularly with diseases of the parathyroid gland. Case 1. A 63-year-old female patient applied to our clinic due to having hypoparathyroidism with bilateral basal ganglia calcification in head computed tomography(CT). She had subtotal thyroidectomy 25 years ago. In the neurological examination, mild symmetrical parkinsonism was determined. In laboratory examination Ca:8 mg/dL (8.6- 10.2), P:5.1 mg/dL (2.3-4.5), PTH:9.53 pg/mL (15-65) were detected. Calcitriol 0.25 μ/day was added to her treatment. Her parkinsonism disappeared after the treatment. Case 2. A 49-year-old male patient was consulted when he was admitted to the department of neurology in our hospital. The physical examination demonstrated the characteristics of Albright’s hereditary osteodystrophy. The neurological examination shows bilateral symmetrical bradykinesia, dysphagia, and moderate dysarthria. In the laboratory examination PTH: 46.5 ng/L(15-65), Ca:8.6 mg/dL (8.6-10.2), P:2.7 mg/dL (2.3-4.5) were detected and were all within the normal ranges. Consequently, pseudopseudohypoparathyroidism was decided as a diagnosis. G protein alpha subunit mutation (Gsα) was not detected due to technical limitations. Conclusion. When a patient is diagnosed as Fahr’s syndrome, we should keep in mind parathyroid disorders. Fahr’s syndrome must be evaluated in patients showing intracranial calcification accompanied by parathyroid diseases.

Context. Scarce data on dietary habits in Eastern European countries is available and reports investigated individual food items and not dietary patterns in these populations Objective. To identify dietary patterns and to explore their association with obesity in a sample from Romanian population. Design. Cross-sectional. Subjects and Methods. This was an analysis of data collected from 1398 adult participants in ORO study. Data on lifestyle, eating habits and food frequency consumption were collected. Results. By principal component analysis we identified 3 dietary patterns explaining 31.4% of the diet variation: High meat/High fat pattern, Western pattern and Prudent pattern. High meat/High fat pattern was associated with male gender, lower educational level, living in a rural, smoking and a higher probability for the presence of obesity (OR 1.2 [95%CI: 1.1-1.4]). Western pattern was associated with younger age, a higher level of physical activity and smoking. Prudent pattern was associated with older age, female gender, a higher level of physical activity, not smoking status and a lower probability for the presence of obesity (OR 0.8 [95%CI: 0.7-0.9]). Conclusions. This study provides for the first-time information on the association between dietary patterns in adults from an Eastern European country and the presence of obesity.

A 74 year old lady presented with difficulty in breathing and hypoxia. She was initially treated as pulmonary embolism\r\n(PE). However, confirmatory tests did not suggest the diagnosis of PE. Further tests gave the diagnosis of an ovarian carcinoid presenting with shortness of breath and\r\nhypoxia. After an initial treatment with Octreotide, she underwent salpingooophorectomy. She became asymptomatic and made an uneventful recovery. Ovarian carcinoids can\r\nproduce carcinoid syndrome without the presence of hepatic metastases. Here we provide a short review on ovarian carcinoids.

Background. Hyperglycaemia during acute ischaemic stroke (AIS) has been associated with poorer outcomes yet attempts to normalise glucose have not demonstrated clinical benefit. One proposed explanation is that the participants are not routinely stratified by the pre-stroke glycaemic status (diabetic hyperglycaemia [DHG], non-diabetic hyperglycaemia [NDHG]), which may contribute to heterogeneity in metabolic responses and dilute treatment effects. We compared early endocrine and inflammatory responses (insulin, C-peptide, cortisol, and cytokines) between DHG and NDHG and examined exploratory associations with stroke severity and 90-day functional outcomes. Methods. In this prospective multicentre cohort, 80 patients with AIS and hyperglycaemia (DHG or NDHG) were enrolled within 72 hours of admission. Biomarkers were measured on admission. Group comparisons were performed by diabetes status and stroke severity. Exploratory associations with 90-day functional outcome were assessed with LASSO regression. Results. Compared with DHG, NDHG was associated with higher insulin (142 vs 75 pmol/L;p<0.05), C-peptide (1.15 vs 0.87 nmol/L;p<0.05), IL-8 (23 vs 13 pg/ mL;p<0.01), and IL-6 (8 vs 3 pg/mL;p=0.094). Cortisol was numerically higher in DHG than NDHG (352 vs 271 nmol/ L;p=0.32). Within NDHG, endocrine and inflammatory measures varied by stroke severity, while remaining generally higher than DHG. Conclusion. Diabetes status was associated with differences in early endocrine and inflammatory profiles during AIS-associated hyperglycaemia. Given the observational design, single-time-point sampling, and modest sample size, these findings should be interpreted as hypothesis-generating. Future adequately powered studies with standardised sampling and detailed diabetes phenotyping are needed to determine whether diabetesstratified approaches to hyperglycaemia management and prognostic modelling improve clinical utility.

Primary bilateral adrenal lymphoma is a very rare cause of adrenal insufficiency. We report the case of a 63-year-old woman who presented with signs and symptoms of impending adrenal crisis when referred for evaluation of large bilateral adrenal masses diagnosed on a computed tomography scan two weeks prior. Based on a high clinical suspicion of adrenal insufficiency, patient was initiated on glucocorticoid and mineralocorticoid therapy prior to laboratory confirmation of adrenal insufficiency. After stabilizing the patient and excluding pheochromocytoma, we proceeded with adrenal biopsy that revealed a nongerminal center-type diffuse large B-cell lymphoma. Our patient was treated with R-CHOP chemotherapy, with good response after 3 cycles but eventually died after the fifth cycle from neurologic complications. This case highlights the notion that primary adrenal insufficiency should be considered in patients presenting with bilateral adrenal masses. Although primary adrenal lymphoma is a very rare adrenal malignancy it should be considered in patients presenting with bilateral rapidly growing adrenal tumors and primary adrenal insufficiency.