ACTA ENDOCRINOLOGICA (BUC)

Context. The variety of tumor-seeking radiopharmaceuticals, which are currently in clinical use, may have a potential role as imaging agents for adrenal gland tumors, due to physiological characteristics of this organ. Objective. The purpose of this study was to evaluate the diagnostic potential of 99mTc-HYNIC-TOC, 99mTc(V)- DMSA, and 99mTc-MIBI in the assessment of adrenal tumors, by correlating with imaging findings and histopathologic results. Design. The research is designed as a crosssectional prospective study. Patients and method. The study included 50 patients with adrenal tumors (19 hormone-secreting and 31 nonfunctioning) and 23 controls without adrenal involvement. In all patients, single-photon emission computed tomography (SPECT) was performed, using qualitative and semiquantitative analysis. The tumor to nontumor tracer uptake was conducted by using a region-ofinterest technique. Adrenal to background (A/B) ratio was calculated in all cases. Results. 99mTc-HYNIC-TOC scintigraphy showed a high statistical significance between A/B ratios, while other two tracers resulted in a lower sensitivity, specificity and accuracy. Futhermore, 99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumors (the receiveroperating- characteristic curve analysis, A/B ratio cut-off value of 8.40). Conclusion. A semiquantitative SPECT analysis showed that 99mTc-HYNIC-TOC is a highly sensitive tumorseeking agent for the accurate localization of adrenal tumors.

important role in insulin signaling and the common Gly971Arg polymorphism is related to type 2 diabetes (T2D). IRS-1 Gly971Arg polymorphism can modify tyrosine phosphorylation at a specific site of IRS-1 and may have a critical role in the development of insulin resistance (IR). Objective. The purpose of this study was to investigate the association between this polymorphism and IR in Iranian patients with newly-diagnosed type 2 diabetes. Design. The study was conducted on 114 individuals with newly-diagnosed T2D and 118 healthy matched controls, aged 20-80 years. Fasting blood glucose and insulin were measured by the enzymatic method and enzyme-linked immunosorbent assay, respectively. Insulin-resistance was calculated by homeostasis model assessment estimatedinsulin resistance (HOMA-IR). The gene polymorphism was examined by polymerase chain reaction-restriction fragment length polymorphism. Results. There are significant differences between IRS1 Gly971Arg polymorphism and studied individuals (P<0.0001). The findings showed that the risk of developing T2D in individuals who had R-alleles was 3.74 folds higher than those without R-alleles. However, IRS1 Gly971Arg polymorphism was not associated with high HOMA-IR, high BMI and familial history of diabetes. Conclusions. Even though there was not a significant relationship between IRS-1 G971R polymorphism with insulin resistance and high BMI, this polymorphism was correlated to newly-diagnosed diabetic patients. Thus, the evaluation of IRS-1 G971R polymorphism may be helpful for predicting T2D new cases.

Background. Primary hyperparathyroidism and vitamin D deficiency are both associated with increased prevalence\r\nof anemia. Relationship of hemoglobin and parathyroid hormone in normal ranges were not investigated appropriately.\r\nMethods. We analysed laboratory data of 476 patients without primary hyperparathyroidism. The patients had concurrent measurements of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, 25-OH vitamin D and hemoglobin.\r\nResults. Parathyroid hormone was negatively correlated with hemoglobin (p=0.01), the correlation persisted after\r\ncorrection for vitamin D levels (p=0.045), and in sub-group of normal (>20 ng/mL) 25-OH vitamin D levels (p=0.005). Parathyroid hormone was also correlated negatively with\r\nferritin (p=0.02), correlation persisted after being adjusted to vitamin D (p=0.021). In anemic patients, these with low ferritin (<12 ng/mL) had higher PTH levels than these with higher ferritin despite having similar calcium\r\nand vitamin D levels (p=0.014).\r\nConclusion. Interaction of parathyroid hormone and erythropoiesis seems to be present in normal ranges where\r\nerythropoietin may mediate key roles regulating both.

Context. Premature adrenarche (PA) is linked to prematurity, small for gestational age (SGA), and rapid weight gain. Understanding these factors is important for early identification and management of PA. Objective. To evaluate the impact of prematurity, SGA, obesity, and rapid weight gain on the development of PA in Turkish girls. Design. A retrospective review of medical records from girls diagnosed with PA between 2015 and 2020. Subjects and methods. A total of 104 girls diagnosed with PA were included. Clinical data, including birth weight, gestational age, body mass index (BMI), and hormone levels (DHEA-S), were analyzed. The relationships between PA and prematurity, SGA, obesity, and rapid weight gain (delta weight SDS) were assessed. Results. Of the 104 patients, 14.4% were born prematurely, 28.8% were SGA, and 30.5% were overweight or obese. A positive correlation was observed between delta weight SDS and DHEA-S levels (r=0.523, p<0.01). While obesity was not significantly associated with elevated DHEA-S levels, rapid weight gain was a key factor. Conclusions. Prematurity and SGA are significant risk factors for PA, with rapid weight gain playing a critical role. Monitoring weight gain in SGA and premature infants is essential to mitigate PA-related risks.

Background. Myocardial involvement is frequent in patients with systemic lupus erythematosus (SLE), and its early detection assures the prognosis improvement. Objective. To assess the NT-proBNP levels and its correlation with systolic longitudinal performance, during exercise testing in a SLE population Subjects and Methods. The study included 30 SLE patients (80 % females), with a mean age of 44.8 ± 9.91 years. All subjects were submitted to an echo Doppler examination, including the determination of the global longitudinal strain (GLS). Also, they performed a cardiopulmonary exercise testing (CPE) on cycloergometer, assessing the peak oxygen uptake. Venous blood samples were taken and NT-proBNP levels were determined before exercise, at peak effort and two hours after exercise. Results. The left ventricular ejection fraction was normal but GLS was low in SLE patients ( -16.96 ± 3.12%, vs. -19.5 ± 3.05% normal range) and much lower in those with diastolic dysfunction (-14.5 ± 2.3% vs. - 19.2± 1.85%, p=0.0014). During CPE, the patients performed a mean 71.96% ± 13.9% of predicted VO2 max. The mean values of NT-proBNP were: 186.84 ± 186.8 pg/mL at rest, 221.68 ± 245.76 pg/mL at peak effort and 412.48 ± 400.28 pg/mL post effort. No correlation was registered between GLS and peak VO2. We found a negative correlation between GLS ant NT-proBNP at peak effort (r = -0.508) and post exercise (r=-0.623). Conclusion. The exercise NT-proBNP levels can be used together with GLS for an early detection of systolic dysfunction in SLE patients.

Context. Sleeve gastrectomy is an effective method for management of obesity. The Bariatric Analysis and Reporting Outcome System (BAROS) is a comprehensive and standard system for the assessment of outcomes of weight loss surgery. It is consisted of weight loss, changes in obesityrelated comorbidities and quality of life measurements. We investigated results of the sleeve gastrectomy based on the BAROS. Material and Methods. Outcomes of laparoscopic sleeve gastrectomy surgery was studied in 45 patients with obesity (11 male, 34 female), after 45 months in Turkey. Results. Total weight loss was 26.4±0.1% of body weight at 45 months. Weight regain was seen in 97.8% of the patients with an average 14.5 kg and 13.7% body mass index points. The surgery caused 76% decrease in incidence of obstructive sleep apnea, 73% decrease in type 2 diabetes, 63% decrease in hyperlipidemia and 62% decrease in hypertension. Significant improvement is observed in all quality-of-life parameters. The final score of the BAROS was 4.23±1.02. Conclusion. Based on BAROS, sleeve gastrectomy provides significant improvements in weight loss, incidence of medical comorbidities and quality of life after surgery. Future studies should address prevention of weight regain after the surgery.

Objective. We aimed to investigate the prevalence of obesity and visceral obesity (VO) within children living on the small Greek island of Tinos and their associated factors. Methods. Three hundred and fifty two healthy children and pre-adolescents (54% boys) attending the primary schools of Tinos island were evaluated, aged (mean±SD) 8.53±1.72 years (range 6-11), from which 286 (81.25%) were of Greek origin and 65 (18.46%) foreign immigrants. Body weight, height and waist circumference (WC) were measured, plus BMI and WC percentiles were calculated. Children with WC > 90th percentile were categorized as having VO. Results. Among our patients, 235 (66.76%) were of normal weight, 88 (25%) overweight and 29 (8.2%) obese. Obese children, as opposed to their normal weight counterparts, were more likely to be of younger age (p=0.009). VO was found in 65 (18.47%) children, with a higher prevalence among the obese than overweight ones (96.43% vs. 42%, p<0.001). There was no difference in the prevalence of VO between children and pre-adolescents. However, foreign immigrants had lower frequency of overweight and obese children (p=0.026) and less viscerally obese children (9.09% vs. 20.63%, p=0.018) than the Greek participants. Conclusions. The prevalence of childhood obesity in rural Tinos was 8.24%, which was lower than the reported national prevalence of obesity in Greece, whilst almost all of the obese and 42% of the overweight children presented VO. The low prevalence of childhood obesity and VO on this small island could possibly be attributed to a more healthy diet and natural way of life.

Context. The 131I activity for treating Graves’ disease (GD) is usually determined based on physician’s experience. Objective. This study aimed to design an empirical method that was not only personalized and quantitative, but also simple, convenient, and easy to grasp. Subjects and Methods. The study population comprised patients with GD, selected between May 2013 and May 2016, who received 131I therapy in the Outpatient Department of Shanghai Ninth People’s Hospital. The firstvisit patients of physician 1 were placed in the traditional group: the activity of 131I (mCi) was calculated using the routine formula: [empirical activity (0.07–0.12 mCi/g) × thyroid mass]/[24-h thyroid 131I uptake]. The first-visit patients of physician 2 were placed in the personalized group. The activity of 131I (mCi) was calculated in two steps. First, the initial activity was calculated: 0.1 mCi/g × thyroid mass (g), and then a personalized and quantitative calibration table of 131I activity was used to obtain a final 131I activity. The cure rate with a single activity of 131I was recorded 1 year later. Results. The traditional and personalized groups included 241 and 282 patients, respectively. Interestingly, the personalized group achieved a higher cure rate [86.5% (244/282) versus 73.4% (177/241), P = 0.000] with a relatively higher 131I activity for the first treatment [8.7 (7, 3.5-30) mCi versus 6.7(6, 2.5-30) mCi, P = 0.000] compared with the traditional group, while the incidence rate of permanent hypothyroidism was not significantly different between the two groups (P = 0.175). Conclusion. The empirical method designed in this study was reliable.

Aims. To investigate the effect of sulphonylurea (SU) treatment on all-cause and cardiovascular mortality as compared with metformin (MET), when used in combination with insulin (INS) in type 2 diabetes. Methods. All type 2 diabetes patients aged ≥40 years were included at their first prescription of INS+MET or INS+SU, during 2001-2008. They were considered at risk until death or December 31st, 2011. Mortality rates were calculated per 1000 person-years. Crude and adjusted rate ratios (RR) were calculated using time dependent analysis with INS+MET as reference. Results. There were 7122 patients (60.8% women) included in the analysis, with a mean age at baseline of 62.0±9.9 years. During the 11 years of study, patients on INS+MET contributed 13620 person-years and 330 deaths (mortality rate 24, CI95% 22-27), while those on INS+SU contributed 8720 person-years and 393 deaths (mortality rate 45, CI95% 41-50). Adjusted all-cause mortality RR were: SU 1.6 (CI95% 1.21-2.11, p<0.001), glimepiride 1.18 (CI95% 0.73-1.91, p=0.51), gliclazide 1.78 (CI95% 1.07-2.95, p=0.024), glibenclamide 1.66 (CI95% 0.71-3.88, p=0.23), glipizide 1.24 (CI95% 0.68-2.27, p=0.49), and gliquidonum 2.32 (CI95% 1.54-3.50, p=0.001). Conclusions. When combined with insulin as dual therapy, patients treated with SU were at increased mortality risk as compared with insulin + MET.

Context. Identification of CV risk factors from T2DM diagnosis allows optimization of treatment to prevent CV complications and death. Objective. The primary objective of the study was to describe the CV risk factors in patients with T2DM at the time of diagnosis and/or therapeutic specific measures taken. Design. This was a non-interventional, multicenter, retrospective chart review of newly diagnosed patients with T2DM in 49 study centers in Romania. Subjects and Methods. Adults with a diagnosis of T2DM between January - December 2014. Statistical analysis used appropriate descriptive methods. Results. 1218 patients were included, mean age (SD) at diagnosis was 59.16 (10.87) years. Half of the patients (54%) presented obesity and 47.7% of patients had arterial hypertension. Overall, 76.2% of subjects had LDLcholesterol ≥ 100 mg/dL, and 59.1% had triglycerides ≥ 150 mg/dL. The mean glycemia was 198.8 mg/dL (78.3) and 50.2% of patients had HbA1c ≥7%. Sedentary lifestyle in 73.8% of the cases, and 91.3% unhealthy eating habits reported. In addition to diet, 82.2% of patients received antidiabetes treatment, 62.6% lipid-lowering, and 66.6% antihypertensive medication. Conclusion. This retrospective study showed a high prevalence of CV risk factors and/or established CV disease at the time of T2DM diagnosis in Romania.