ACTA ENDOCRINOLOGICA (BUC)

Context. Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. It is also a growing problem worldwide and is associated with many maternal and fetal complications during and after pregnancy. Objective. This study aimed to investigate the neonatal and maternal complications of gestational diabetes in the Iranian population of pregnant women. Design. This prospective cohort study was carried out on the health assessment data of pregnant women in the age range of 18-45 years who were referred to health centers affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2019 to September 2020. Subjects and Methods. Overall, 2,500 pregnant women with GDM and 7,700 healthy pregnant women were enrolled in the GDM and healthy groups, respectively. Individuals’ data were recorded in an electronic health record system (SINA System) and were later collected and analyzed. Results. Significant between-group differences were observed in terms of cesarean delivery risk, hypertension, fetal macrosomia, preeclampsia, preterm birth, fetal birth weight, and neonatal icterus in GDM and non-GDM groups. However, no significant differences were found in terms of stillbirth, and low birth weight between the two groups. Based on the logistic regression model, GDM significantly increased the risk of cesarean delivery, fetal macrosomia, and neonatal icterus. Conclusions. The fetal macrosomia leading to the cesarean delivery, and neonatal icterus were determined as the significant complications of GDM in the Iranian population. These results can provide valuable insight into healthcare planning.

Introduction. Radiation-induced hypothyroidism is a well-recognized entity that occurs after an interval of 15- 21 months. However, in the treatment of locally advanced Head and neck Squamous cell carcinoma (HNSCC), thyroidsparing techniques are infrequently employed. Aims. To evaluate the dosimetric and early clinical outcomes of thyroid-sparing SIB-VMAT technique (Simultaneous Integrated Boost - Volumetric Modulated Arc Radiotherapy) in patients of locally advanced HNSCC. Methods. In this two-arm prospective pilot study, patients in the study group received radiotherapy by SIBVMAT technique with a thyroid constraint to a dose of 70 Gy to the gross disease and 59.4 Gy to nodal and subclinical disease in 33 fractions over 6 ½ weeks with concurrent cisplatin. V50Gy<75% was the thyroid constraint used. The control group was treated with the same dose and technique but without using a thyroid gland constraint. The dosevolume parameters of the thyroid gland, PTV (Planning Target Volume) along with thyroid profile were analyzed. Results. Twenty-six patients were recruited. Thyroid V50Gy of the study group (65.33 ±6.63 %) was significantly lower than that of control group (80.35 ±13.40 %) (p=0.003). Tumor dose parameters of both groups were compared and revealed no significant difference. At 18 months follow-up, the incidence of any degree of hypothyroidism was 46.15% in the study group and 23.07% in the control group (p=0.216) Conclusion. In locally advanced HNSCC, it is feasible to spare the thyroid gland without compromising the tumour coverage. This has the potential to reduce the frequency of radiation-induced hypothyroidism.

Purpose. To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. Methods. Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. Results. Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). Conclusion. Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

Context. Ovarian failure leading to delayed puberty and infertility is a cardinal sign in patients with Turner syndrome (TS). Objective. We reviewed the pattern of puberty in a group of Irish patients with TS. Design. This was a prospective observational study conducted at the National Children’s Hospital, Dublin, Ireland. Subjects and Methods. All patients aged 12–19 years and attending the paediatric endocrinology service with a confirmed diagnosis of TS were enrolled. Eligible patients underwent puberty assessment using Tanner staging and had 3 ml of blood taken for measuring luteinising hormone (LH), follicle-stimulating hormone (FSH) and oestradiol. Results. Out of 65 patients with TS identified from the medical and laboratory records, 42 aged 12 to 19 years were enrolled. Clinical assessment of puberty using Tanner staging revealed that 21 patients (50%) had spontaneous puberty (breast stage 2–5). Fourteen individuals out of 23 with mosaicism experienced spontaneous puberty (61.9%) compared with 7 out of 19 (36.8%) carrying a 45,X karyotype (P = 0.10). Of the 21 patients who had spontaneous puberty, 9 (43%) achieved menarche ; 6 of them were mosaic while the other 3 had 45 X karyotype (P = 0.33). The mean age of spontaneous menarche was 13.9 ± 1.97 years (range 10.9–18.9). One patient with spontaneous puberty achieved two successful pregnancies. Conclusions. Spontaneous puberty occurred in half of TS patients in this cohort and among these, 43% achieved spontaneous menarche. Prevalence of both spontaneous puberty and menarche were higher in mosaic patients compared to those with 45X karyotype.

Context. Estimation of osteoporotic hip fracture incidence and Romanian FRAX model were based on nationally reported hospital ICD 10 coding admissions of all hip fractures (without a validation process). Objective. We aimed to calculate, based on individual hospital charts analysis, the incidence of osteoporotic hip fracture in the main urban area of Romania and compare it with data reported to the National Institute of Public Health (NIPH). Design. We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest and surrounding Ilfov County (11.8% of Romania population). Subjects and Methods. All ICD 10 fracture and event/fall codes were validated against the charts. We calculated the age and sex adjusted incidence of osteoporotic hip fracture and used the national reported hip fracture data base for comparison. Results. There were 2203 hip fractures of which 1997 (90.65%) were fragility fractures. The crude incidence of low-energy hip fractures was 171/100,000 (225/100,000 in women, 103/100,000 in men). The incidence rose with age to a maximum rate of 1902/100,000 in women >85 years. The NIPH-reported incidence of hip fracture was 181/100,000 for the region of interest and 176/100,000 at the national level. Conclusion. The incidence of osteoporotic hip fracture was lower than the incidence based on hip fractures reported codes in the national database, but the incidence of fragility fractures calculated by our group was higher than the incidence reported in previous national studies. Nationwide studies are warranted.

Background. Alcohol ingestion can induce either a hypoglycemia or a hyperglycemia,\r\nin patients with acute and chronic ethanol poisoning, unknown with diabetes mellitus.\r\nAim. The aim of this study was to evaluate whether 5 hours prolonged oral glucose\r\ntolerance test (5h-OGTT) is useful in evaluating the abnormalities of glucose metabolism in\r\nacute and chronic ethanol poisoning, in comparison with standard methods (fasting blood\r\nglucose - FBG, and/or 2h-OGTT).\r\nMethods. 497 consecutive patients were enrolled in a 34 months cross sectional study.\r\nIn all cases, glucose tolerance was assessed by a 75-g oral glucose tolerance, OGTT 2 hours,\r\nprolonged to 5 hours. The relationship between clinical and biochemical variables of ethanol\r\npoisoning (liver status, lipid profile, metabolic syndrome) and glucose tolerance was\r\ninvestigated. Risk factors for hypoglycemia in ethanol poisoning were identified.\r\nResults. 349 subjects presented acute ethanol poisoning, and 148 subjects had chronic\r\nethanol poisoning. 254 patients (51.10%) had documented alcoholic liver disease (ALD -\r\nclinical, biochemical and imagistic criteria). Glucose metabolism abnormalities were\r\nrecorded in 143 subjects with chronic ethanol poisoning and ALD (96.63%), and in 207\r\ncases with acute alcohol poisoning (59.31%). 371 patients (74.65%) showed normal FBG,\r\ndiabetes mellitus (DM) was diagnosed in 54 subjects (10.86%), impaired glucose tolerance\r\n(IGT) in 43 subjects (8.65%), delayed hypoglycemia in 172 subjects (34.60%) and normal\r\nglucose tolerance (NGT) in 147 subjects (29.57%) using OGTT and ADA diagnosis criteria.\r\nHypoglycemia was recorded in more than two thirds of acutely poisoned patients, when alcohol\r\nlevel was 0.5-1.5 g/L. Impaired glucose tolerance (IGT) were recorded in half of patients with\r\nblood ethanol levels > 2.5 g/L.\r\nConclusions. OGTT 2 hours and OGTT 5 hours revealed the same number of patients\r\nwith diabetes mellitus. Frequent co morbidities in patients with ethanol poisoning influence\r\nthe prolonged OGTT and revealed .especially delayed hypoglycemia, and IGT, as an indicator\r\nof alcoholic liver disease (ALD).

Background. Ghrelin is a gastro-duodenal hormone which plays a major role in the regulation of food intake, energy balance and gastrokinesis. Ghrelin represents a novel biological marker for assessment of the presence as well as the severity of liver cirrhosis. We aimed to measure the level of plasma ghrelin in patients with liver cirrhosis (compensated and decompensated) and to correlate its level with different studied clinical and laboratory parameters. Subjects and methods. 40 cirrhotic patients were included in a cross-sectional study and divided equally according to the Child-Pugh classification into Group I: patients with compensated liver cirrhosis (Child A), and Group II: patients with decompensated liver cirrhosis (Child B|C). Also, 20 age and sex matched healthy subjects were included as a control group (Group III). All patients were subjected to: full history taking, full clinical examination, routine biochemical studies together with estimation of plasma ghrelin level, assessment of the severity of liver disease according to Child–Pugh classification, also, abdominal ultrasonography was done. Results. Plasma ghrelin level was low among cirrhotic patients (both compensated and decompensated) in comparison to normal control subjects. Conclusion. Ghrelin can be used as a serum biomarker for detection and assessment of the severity of liver cirrhosis.

Introduction: Pseudo-primary hyperaldosteronism of pregnancy was previously reported by our group during correction in twin-to-twin transfusion syndrome (TTTS). Aim: Focus on plasma volume changes and renin-angiotensin (RAS) and aldosterone response in 45 TTTS patients requiring amnioreductions above 1000 ml for severe hydramnios. Methods: 45 patients necessitating placental surgery and amnioreduction >1000ml for severe TTTS, under local anesthesia, as previously described. Assesment of plasma volume variations (%ΔPV) and simultaneous assays of aldosterone, renin, angiotensin II and ANP performed by standard kits prior to, 6 hours after and 12-24 hours after procedure. Statistical results expressed as median and interquartile ranges for non-parametric data, after correction of post-op levels with %ΔPV. Results: Depletion of 1600 ml (1000-3700) amniotic fluid (extravascular depletion) unexpectedly increased the intravascular plasma volume by 20,38% and dramatically changed the hormonal picture of primary hyperaldosteronism. Aldosterone decreased from a median of 730 pg/ml (T0) to 553 pg/ml (T6) to 515,9 pg/ml (T24). ANP increased from 8,95 pg/ml (T0) to 14,51pg/ml (T6) to 19,9 pg/ml (T24) pg/ml (ANOVA p=0,0036), while renin and angiotenin II stayed unchanged (ANOVA p=0,91). Conclusion: Depletion of extracelular fluid (amnioreduction) is indicated for the correction of hyperaldosteronism in pregnancies with severe hydramnios, to reduce to normal the aldosteron levels without the interference of the renin-angiotensin system, while natriuretic activity increases through ANP and, possibly, other less known natriuretic factors .

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Context. The socio-economic and medical burden of obesity represents a continuous challenge for both developing and developed countries. For Romania, the available data on the eating patterns, behavior and other components of lifestyle are scarce. Objective. The objective of this study was to assess the prevalence of overweight and obesity in the Romanian general population and to identify lifestyle patterns characteristic for the Romanian population in terms of eating patterns and physical activity. Design. Cross-sectional, epidemiologic, multicenter non-interventional study Subjects and Methods. Between January 2014 and August 2014 were enrolled 2128 adults by 8 investigators spread in the main historical regions of Romania. The following data: demographic, anthropometric, employment status, education, family history, personal medical history, information on the lifestyle and eating habits. Results. The final population included in the analysis presented here consisted of 2103 participants with no missing information on height and weight. The prevalence of overweight and obesity was 31.1% and 21.3%, respectively. The prevalence of obesity was 9.9% in the 18-39 years age group, 30.1% in the 40-59 years age group, 41.6% in the 60- 79 years age group and 24.1% in the ≥80 years age group (p <0.001). Irregular meals together with eating while watching TV were the most frequent unhealthy eating habits of the participants. Conclusions. We found a high prevalence of overweight and obesity among the participants enrolled. Our study has important implications for increasing the knowledge on the prevalence of overweight and obesity in Romania and associated lifestyle habits.