ACTA ENDOCRINOLOGICA (BUC)

Objectives. Turner Syndrome (TS) is associated with a high risk of cardiac anomalies and cardiovascular disease. We aimed to evaluate patients with TS (n=33) for cardiac and aortic pathology using thorax magnetic resonance angiography (MRA). Subjects and methods. Clinical findings, karyotypes, echocardiogram (ECHO) findings and thorax MRA results were evaluated. Aortic dimensions were measured and standard Z scores of aortic diameters along with aortic size index (ASI) were calculated. Results. Mean age of the patients was 13.7±3.4 years. MRA revealed cardiovascular pathology in 10 patients (30%). CoA (n=4), aberrant right subclavian artery (n=3), dilatation of the ascending aorta (n=1), tortuosity of the descending aorta (n=1) and fusiform dilatation of the left subclavian artery (n=1) were found. Two of the four patients with CoA found on MRA were detected with ECHO. Mean diameter of the sinotubular junction was found to be elevated [mean±SD: 2.4±1.5]. Z scores for the diameters of the isthmus, ascending aorta and descending aorta were in normal ranges. 45,X patients were found to have significantly higher ASI values than non 45,X patients (p=0.036). Conclusion. Our findings indicate that patients with TS should be evaluated with MR imaging studies in addition to ECHO to reveal additional subtle cardiac and vascular anomalies. CoA which is very distally located or which has mild nature may not be seen by ECHO. The increase in ASI observed in 45,X patients may herald the development of life-threatening complications. Therefore, frequent followup is warranted in these patients.

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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The discovery of thyrotropin releasing hormone (TRH) in 1969 was the definitive step in decoding the hypothalamic-pituitary thyroid (HPT) axis, thereby opening up the era of neuroendocrinology, while it also revolutionized the diagnostic and therapeutic approach to patients with thyroid diseases. TRH, produced in the hypothalamus, is the central regulator of the HPT. It functions via neurons originating in the paraventricular nucleus (PVN), which integrates multiple neuronal and humoral signals and resets the HPT axis according to variations of external and internal environmental conditions. The TRH activates TSH in the pituitary that stimulates the secretion of thyroxine from thyroid which, in turn, exerts a negative feedback on TSH and TRH secretion. However, various factors are involved in the regulation of the HPT axis. Leptin has both indirect and direct effects on TRH regulation, the former by regulating agouti-related peptide (AGRP) in the arcuate nucleus (ARN) that antagonizes the α-MSH stimulatory activity on pro-TRH gene expression in the PVN, and the latter by stimulating hypothalamic TRH expression, TRH transcription via stimulation of proconvertase 1 and 2 expression, which lead to enhanced processing of pro-TRH into TRH. The interplay of TRH with leptin and the recently reported influence of ghrelin on the HPT axis can alter the setpoint of the axis. The polyphenol resveratrol, as recently observed, exerts an anxiolytic and antidepressant activity in subclinical hypothyroid (SCH) rats. Resveratrol, by decreasing both TSH and TRH mRNA expression, regulates the HPT axis, while in parallel it regulates the Wnt/β-catenin pathway in the hippocampus. These findings open up possibilities for the therapeutic use of resveratrol as coadjuvant, especially in overt and SCH states marked by anxiety and depression. The clinician should be aware of clinical changes that can invalidate the normal regulation of the HPT axis, the most commonly observed being medications and comorbidities.

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.

Objective. Gestational diabetes mellitus (GDM) increases the foetal morbidity and mortality and there is also risk of development of type II diabetes for the mother. In pregnancy iron supplementations are given to all the females in India. Data are not available on the relationship between serum ferritin and GDM in Indian populations. Material & Methods. Case control study was done on 90 women (30 GDM patients approx 28 weeks of gestation and 60 control subjects without GDM) referred to the tertiary care hospital at New Delhi. Ferritin was analysed by ELISA kit. They were analyzed for the correlation of ferritin with blood glucose in GDM patients. Results. On comparison with blood glucose the levels of ferritin were statistically significantly high in GDM cases as compared to controls (p value 0.008). There was a negative correlation of ferritin with blood glucose level (r value -0.039, p value 0.794). Discussion. Pregnancy is an equivalent of an inflammatory state and the high levels of ferritin can help in determining the need of iron supplementation given in pregnant females. Women who had high serum ferritin had the greatest risk of GDM. Conclusion. This study suggests a possible link between elevated serum ferritin and low-grade inflammation. Further studies in larger populations are required to establish this study.

Context. Studies indicate a decrease in spatial memory across species as they age. Moreover, consistent administration of Gonadotropin-releasing hormone (GnRH) improves learning abilities in older rats that have undergone gonadectomy. Objective. The aim of this study was to investigate the effects of the GnRH agonist, leuprolide acetate (LA) on spatial memory in aged intact male rats and the expression of proteins associated with hippocampal plasticity. Subjects and methods. Aged male rats were injected with LA or saline every three days for nine weeks to assess the effects of LA on spatial memory. The aged rats were trained in the Morris Water Maze for four days, and the evaluation took place on the fifth day. Additionally, the Y-maze test was used to investigate short-term spatial memory. The expression of spinophilin and microtubule-associated protein 2 (MAP2) in the hippocampus was measured. Results. Behavioral tests revealed that LA improves spatial memory in aged rats. Additionally, we observed increased expression of spinophilin and MAP2 in the hippocampus of aged male rats following LA treatment. Based on these results, the administration of LA holds is a potential treatment for restoring cognitive function in aged individuals.