ACTA ENDOCRINOLOGICA (BUC)

Background. Thyroid nodules are a common pathology worldwide. Fine needle aspiration biopsy (FNAB) is an important diagnostic method for the investigation of malignancy in thyroid nodules. However, according to the Bethesda System used to classify the results, patients with atypia of undetermined significance/follicular lesion of undetermined significance (AUS / FLUS) may not be classified as benign or malignant. Therefore, it may be necessary to determine some clinical risk factors to apply the best treatment in these patients. Aim. To determine the factors that increase the risk of malignancy in this patient group. Methods. A retrospective study including 138 patients with an FNAB categorized as AUS/FLUS and operated between June 2015–September 2018. Demographical, Laboratory (TSH) and Ultrasound variables (number, size and characteristics of nodules) of the patients were compared among postoperative histopathological results. Results. Hypo-echoic structure, microcalcification and irregular margin of the nodules were detected to be associated with malignancy in patients with FNAB results of AUS/FLUS (p <0.001). Conclusion. We suggest that surgical treatment should be considered if the patients have nodules with the hypo-echoic structure, microcalcification and irregular margin with an FNAB histopathological result of AUS / FLUS.

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Objective. Obesity is a metabolic condition characterized by increased body fat mass. Increased prevalence of nonalcoholic steatohepatitis (NASH) and increased atherogenicity are closely associated with morbidity and mortality in obesity patients. In this study, we investigated the effect of orlistat, a gastrointestinal lipase inhibitor, on atherogenicity-related and NASH-related indexes in obese patients. Material and Methods. This retrospective study was completed with a total of 139 class III obesity patients with NASH who were admitted to our hospital, creating an orlistat treatment group and a control group. NASH-related indices and atherogenicity indices were calculated at the beginning of the study. These parameters were repeated in the 12th week of the study. Statistical analyzes were performed on the entire patient population and in groups classified according to body mass index (BMI) (BMI <40 kg/m2 and BMI ≥40 kg/m2). Results. As a result of our 12-week study, in addition to the improvement in glycemic parameters and lipid profile, atherogenic indexes (Triglyceride-Glucose index and Triglyceride-Glucose-BMI index) and NASH-related indices (Nonalcoholic Fatty Liver Disease Fibrosis Score, Fibrosis-4 Index, Aspartate aminotransferase-Platelet Ratio Index) superior improvements were achieved compared to the control group (p<0.001). These improvements were similar in groups separated by BMI (p>0.05). Conclusion. In addition to its proven body weight loss effect, Orlistat may be beneficial in the treatment of atherogenicity and steatohepatitis.

Context. Accumulating data supports the key role of disrupted amino acids (AAs) metabolism in diabetes. Conflicting data regarding the relevance of serum AAs in diabetes and hypertension suggest that their relationship needs further investigation. Objective. To investigate serum AAs as biomarkers of increased BP variability evaluated during 24-hour ambulatory BP monitoring in the presence of type 2 diabetes. Design. Cross-sectional. Subjects and Methods. We analyzed serum AAs using targeted metabolomics (ultrahigh-performance liquid chromatography/mass spectrometry) in patients with type 2 diabetes (n=80). BP variability was assessed using 24-hour ambulatory BP monitoring. Participants were divided into two groups based on the 24-hour diastolic BP variability median value. Results. Aspartic acid, isoleucine, leucine, and phenylalanine were significantly lower, while glutamine was significantly higher in the group with higher diastolic BP variability (p-value <0.05 and variable importance in the projection >1). Corresponding pathways identified as disrupted in patients with diabetes and a higher 24-hour diastolic BP variability were phenylalanine, tyrosine, and tryptophan biosynthesis, phenylalanine metabolism, and alanine, aspartate, and glutamate metabolism (pathway impact value >0). Conclusions. We identified specific changes in serum AAs and target AAs pathways in relation to increased 24-hour diastolic BP variability in patients with type 2 diabetes.

Objective. This study aims to determine the prevalence of neuropathy in the prediabetic period. Design, Subjects and Method. Informed consent was attained from the patients who volunteered to participate in the study after ethics committee approval was obtained. Patients under the age of 18, having vitamin B12 or folic acid deficiency, history of collagen tissue-rheumatological disease, chronic kidney failure, cirrhosis, ethylism, thyroid disease, autoimmune disease, malignancy, tuberculosis, type 1 or 2 diabetes mellitus and pregnant women were excluded from the study. Patients diagnosed with prediabetes were evaluated by the DN4 neuropathy complaint questionnaire. Neuropathy was diagnosed in patients having a score of four or more. For the statistical analyses Student t-test, Pearson chi-square test, and Fisher's exact test were performed using the NCSS program. Results. A total of 224 volunteers, 167 women and 57 men, were included in the study. The mean age of the participants was 51 and the mean level of hemoglobin A1C was 5.9. Neuropathy was detected in 45% of the cases. Especially in women, there was a significant increase in the frequency of neuropathy compared to men. The most common complaints found in our study were burning sensation and numbness in the extremities. Conclusions. Similar to diabetic patients, prediabetic patients also have a high rate of neuropathy. For the early diagnosis of neuropathy and to be treated promptly, screening tests such as DN4 should be performed for all prediabetic patients. According to the test results, advanced examinations such as EMG or biopsy should be performed earlier.

Differentiated thyroid cancer (DTC) generally has an excellent prognosis, yet treatment strategies have traditionally been aggressive, often involving total thyroidectomy followed by radioactive iodine (RAI) ablation and long-term suppressive levothyroxine therapy even in cases considered to be low- or intermediate-risk. In recent years, several guidelines have recommended a more individualized, risk-based approach aiming for a more conservative treatment plan. Despite this paradigm shift, there is a gap between recommendations and actual clinical practice as many centers continue to advocate the more aggressive treatment model. De-escalating the care of selected patients with thyroid cancer include the avoidance of surgery in tumors < 10 mm, the recommendation for thyroid lobectomy for tumors < 4cm, the avoidance of prophylactic lymph node dissection. Evidence based studies show that such strategies do not worsen long-term outcomes, can reduce complications and can lead to better quality of life. Such studies will be summarized in this editorial with the aim of encouraging clinicians to reconsider established treatment protocols and empowering patients to make informed decisions for their care.

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Introduction. Primary hyperparathyroidism (PHPT) is a prevalent endocrine condition that presents with significant clinical symptoms. Ectopic adenomas commonly occur in the tracheo-esophageal groove, thymus, intrathyroidal, and mediastinum. While mediastinal ectopic adenomas are frequently observed, pericardial ectopic adenomas are only documented in case reports in the literature. Case report. We present a 65-year-old female patient who had persistent PHPT and underwent resternotomy and excision of a pericardial ectopic parathyroid adenoma. The typical treatment for PHPT has generally been conventional bilateral neck exploration without preoperative imaging. Conventional bilateral neck exploration has decreased in popularity because of the rise in the minimally invasive parathyroidectomy (MIP) procedure. The use of MIP is prevalent in surgical procedures, and it is crucial to have precise preoperative localization. Due to the ectopic localization of certain parathyroid adenomas, they are regarded as an important cause of the failure of primary surgery. Hence, particularly when dealing with persistent and recurrent PHPT, modern imaging techniques like 4D CT enhance the efficacy of surgical interventions. Therefore, particularly in cases of ectopic parathyroid adenomas located in the mediastinum, it is important to consider the possibility that if the adenoma cannot be found after surgery, it may be located in the pericardial region.

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Anorchia is a syndrome characterized by unilateral or bilateral absence of testicular tissue.\r\nAt puberty, growth and development are normal but secondary sexual development fails to\r\noccur if anorchia is bilateral.\r\nWe present the case of a 21 year-old male with a late diagnosis of bilateral anorchia. The\r\ndiagnosis was suggested by a bilateral empty scrotum, in a patient with male phenotype and\r\npoor secondary sexual development and established by karyotype analysis, hormonal profile\r\nand surgical exploration. The lack of testosterone response to hCG stimulation is the hormonal\r\nhallmark of bilateral congenital anorchia. In the absence of any information about germinal cell\r\npresence, bilateral excision of the testicular nubbins, implantation of testicular prostheses and\r\nhormonal replacement therapy were indicated.