ACTA ENDOCRINOLOGICA (BUC)

A 55-year-old female patient was admitted for flushing and abdominal pain in the right upper quadrant. Her past medical history revealed high blood pressure and a recent echocardiography showed thickened appearance of tricuspid valve with coaptation defect and grade II tricuspid regurgitation. Contrast enhanced abdominal CT scan and MRI were subsequently performed and revealed a large macronodular liver mass, as well as other micronodular lesions disseminated in the liver parenchyma. CT guided biopsy from the main liver mass revealed neuroendocrine tumor of unknown origin (probably GI) with Ki-67 of 8%. Surgical exploration was decided. During laparotomy, the primary tumor was found in the proximal ileum and the patient underwent segmental enterectomy. Non-anatomical hepatectomy was also performed to remove the bulk of the tumor burden (more than 90%). Postoperative course was uneventful and the carcinoid syndrome relieved. At present, 15 months postoperatively, the patient is under treatment with somatostatin analogue for its antiproliferative effect, with good clinical, biochemical and tumoral control and stable heart disease. In patients with neuroendocrine liver metastases from unknown primary, surgical exploration could allow detection (and resection) of the primary tumor and surgical debulking of liver metastases to control carcinoid syndrome and carcinoid heart disease.

Background. Several studies observed metabolic disorders in pregnancy as risk factors for birth defects, including orofacial clefts. Diabetes is associated with approx. 10% of the pregnancies, but in Romania, less than 5%. An obese and diabetic woman has 3 times more risk for an offspring with a craniofacial defect than healthy women suggesting that diabetes mellitus contributes to their pathogenesis with complex mechanisms. Case report. We present the case of a newborn 4 days old, male with neonatal hypoglycemia, cleft lip and proportionate (symmetric) macrosomia. His mother is a 35 years old Caucasian woman with no important personal risk factors and no known history of diabetes mellitus. The glucose tolerance test performed to the mother at about 10 weeks during pregnancy led to the diagnosis of gestational diabetes. Discussion. The gestational diabetes mellitus diagnosed since the 10th week of pregnancy, the hyperglycemia status during pregnancy and the fetal overgrowth (macrosomia at birth) indicate the possible factors that lead to the Orofacial cleft (OFC). Conclusion. With the increased prevalence of obesity, diabetes, and the evidence of association of these syndromes with OFCs, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes prior to conception and early in pregnancy.

Context. Subacute thyroiditis (SAT) is a transient inflammatory disease that occurs often after an upper respiratory tract infection. Permanent hypothyroidism ratio is reported in 5-26% of the SAT patients. Objective. In this study, we tried to compare the treatment options on permanent hypothyroidism in our SAT patients. Design. It is a retrospective study. The medical records of SAT patients between 2010 and 2015 were analysed. Subjects and Methods. The medical records of 81 patients were analysed for demographic data, laboratory and clinical course, treatment and 1 year outcome. 81 patients were classified in steroid (n=29), nonsteroidal antiinflammatory drugs (NSAID) (n=33) and steroid+NSAID (n=19) groups. Results. Male/female ratio was similar and female domination was demonstrated in all groups. In the steroid and NSAID groups the pretreatment thyroid function tests were diagnosed as hyperthyroidism. In the steroid+NSAID group they were not diagnosed as hyperthyroidism in the beginning. In all groups the thyroid function tests were all in normal levels (p˃0.05) one year later. In all groups the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were increased in the pretreatment period and decreased with the treatment. In total, right lobe involvement of thyroiditis was more detected (40/81 (49%)) (p=0.018). Permanent hypothyroidism observed in steroid, NSAID, and steroid+NSAID groups were 7/29 (24%), 5/33 (15%), 3/19 (16%) respectively (p˃0.05). Conclusion. In this study, treatment drug option did not affect the permanent hypothyroidism one year after in our SAT patients.

Context. Acromegaly is a rare and serious syndrome and commonly associated with pituitary neoplasm. Classic cause of acromegaly in adults is the tumors of the somatotrophs that secrete growth hormone. Cirrhosis is the end stage of chronic liver disease and commonly a cause of death. It is\r\ncharacterized by diffuse hepatic fibrosis resulting in altered construction of the lobular parenchyma with widespread connective tissue septae, circumscribed\r\nregenerative nodules of hepatocytes and anastomoses between vascular channels linking portal and central vessels.\r\nObjective. To report the simultaneous cases of acromegaly and cirrhosis.\r\nCase report. A 62-year old, male patient came to the hospital complaining of severe abdominal swelling. Laboratory and imaging findings were compatible with the\r\npresence of hepatitis B virus related cirrhosis together with acromegaly. In this case, he had high GH level but lower IGF-1 level because of hepatic failure which can\r\nimpair IGF-1 production by the liver. Definitive diagnosis was made by pituitary MR and a 1 cm in diameter tumor was\r\ndetected.\r\nConclusion. This paper showed that cirrhosis can result in a low IGF-I level in patients with acromegaly. There is no\r\nprevious report available of the in the presence of coincidental combination of acromegaly and cirrhosis in a patient.

Background. Atypical antipsychotics proved efficacy in monotherapy and more so in\r\nassociation with mood stabilizers, but choosing the atypical antipsychotic requires special\r\ncautions due to metabolic adverse effects. The aim: to verify if Quetiapine-valproate\r\ncombination improves rapidly acute depressive symptoms and has a good endocrinemetabolic\r\ntolerability. Case presentation. A 49 years male, bipolar patient, admitted for a\r\nmajor depressive episode. The patient also has type 2 DM for which he takes oral antidiabetics.\r\nWhen inpatient, he had persistent hyperglycemia (>250mg/dL). DM&#8217;s\r\ncomplications (poly-neuropathy, retinopathy and right bundle-branch block). Diabetic status\r\noriented us to choose quetiapine (600 mg/day) for both antidepressive effect and its safe\r\nmetabolic profile associated with valproate (1000 mg/day). Antidiabetic medication was\r\nadjusted following the clinical outcome. Instruments. for depression we used Montgomery-\r\nAsberg Rating Scale (MARS), for mania Young Mania Rating Scale (YMRS), Clinical\r\nGlobal Impression for Bipolar Disorder (CGI-BP), for diabetes (glycemia, HbA1c,\r\nglycosuria, body weight, adverse events and relapse were followed-up for 6 months. The\r\nevaluations were performed weekly during hospitalization (6 weeks) and then monthly, for\r\n6 months quetiapine together with valproate therapy led to remission of depressive\r\nsymptoms (MADRS <50% vs. baseline). At the same time DM was compensated with\r\nglimpirid and metformin (glycemia < 120mg/dL). These results maintained till the end of\r\nthe follow-up period. Conclusion. Quetiapine associated to valproate in acute and chronic\r\nmanagement of bipolar depression proved to be efficient and well tolerated, along 6 months,\r\nin patient with type 2 diabetes.

Carpal tunnel syndrome (CTS) is a comorbid condition often seen in patients with acromegaly. It often causes neuropathy that is severe enough to require the patient to undergo median nerve release surgery multiple times. Excessive growth hormone secretion will cause endorgan damage in the patient and will manifest itself with different complaints. The degree of complaints will decrease with early diagnosis and treatment of acromegaly. This case highlights the natural course of CTS associated with acromegaly and the importance of questioning the etiology in CTS. When the primary disease is treated, the patient's functionality will improve.

Background. There are many systemic illnesses that constitute risk factors for cerebral vein thrombosis (CVT).The association between cerebral venous sinus thrombosis and polycystic ovary syndrome (PCOS) has been rarely reported in the literature. This report\r\ndescribes a case of cerebral venous sinus thrombosis following intake of contraceptive pill (cyproterone acetate 2mg + etinil-estradiol 35 micrograms), for dysfunctional uterine bleeding secondary polycystic ovary syndrome in young women.\r\nCase report. We reported a 22-year-old women presented with severe headache associated with vomiting sudden onset; she had been taking contraceptive pills for the previous ten days. CVT was diagnosed with CT scan, MRI and MR venography. Laboratory investigations showed no evidence of inherited thrombophilia. The patient was treated with classic heparine, followed by acenocumarol with good clinical outcome.\r\nConclusions. This case illustrates that patients with polycystic ovary syndrome may develop thrombosis, if the patient is treated with combined contraceptives, even for short period of time. The role of PCOS as independent prothrombotic factor and the risk associated with oral contraceptive as first line treatement in PCOS need to be further investigated.

Background. The recurrent paralysis is the most important complication after total thyroidectomy. Vocal dysfunction can have multiple causes. Based on strict clinical criteria, the follow-up of patients who underwent a thyroidectomy may lead to wrong conclusions concerning possible recurrent nerve injury. Purpose. The aim of this study was to evaluate recurrential complications after total thyroidectomy by an ENT endoscopic examination. Method. We prospectively analyzed 100 cases of thyroid operations with a total number of 190 recurrent laryngeal nerve with lesional risk. Fourteen patients were operated for malignant disease. The patients were divided into two groups: group A (patients with high risk of recurrential injury) and group B (patients with low risk of recurrential injury). The operations were performed by one surgical team. The surgical interventions were followed in the 2nd postoperative day by an ENT endoscopic examination in order to assess vocal cords mobility. In patients with voice changes, ENT examination was repeated as many times was needed. At the same time a clinical examination of the quality of phonation was carried out. Results. From the total number of 100 patients examined with 190 nerves at risk, there were 7 patients with recurrent temporary paralyses (3.7%). After 6 months postoperative, there was a single patient with recurrent paralysis (0.5% ). Regarding permanent recurrent paralysis, there was no patient with paresis after one postoperative year (0%). There was no significant difference regarding the recurrent paralysis between patients with high or low risk of recurrential injury. Conclusions. The damage function of the recurrent nerve is recovered in 30 days in most cases and almost 100% in six months. Belonging to a low or high risk group is not associated with the development of motility disorders. The simple following of the clinical manifestations can lead to erroneous conclusions.

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Background. Thyroid dysfunction during pregnancy may adversely affect mother and fetus. A number of disorders\r\nhave been described as a cause of thyrotoxicosis in pregnancy. Subacute thyroiditis is a rare cause of thyrotoxicosis in pregnant women. Although self limited, due\r\nto both hyper- and subsequent hypothyroidism, this disorder may have deleterious effects in outcome of pregnancy.\r\nCase report. A 29 year old woman in the first trimester of pregnancy was referred due to palpitation, malaise and pain in thyroid region. Laboratory data revealed a suppress TSH, elevated Free T4 and high ESR. Pregnancy test was positive. Diagnosis of subacute thyroiditis was made by Doppler\r\nsonography of thyroid. A dramatic response to prednisolone was observed. Two months later because of hypothyroidism,\r\nlevothyroxine was started and continued throughout pregnancy. She delivered a healthy baby at term without complication.\r\nConclusions. Although subacute thyroiditis is rare during pregnancy, its possibility should be kept in mind in hyperor\r\nhypothyroid pregnant women.