ACTA ENDOCRINOLOGICA (BUC)

Context. Post-operative clinical and biochemical hypocalcemia is a common complication of thyroid surgery and the correlation with incidental parathyroidectomy (IP) remains controversial. Objective. To evaluate the incidence of IP during TT, its correlation to early post-surgery hypocalcemia, and its potential risk factors. Patients and Methods. 77 consecutive patients submitted to thyroid surgery between January 2018 and December 2019. Demographic, clinical, biochemical, surgical and histopathological factors were assessed. Statistical multivariate analysis was performed to identify the risk of IP. Results. IP was evident in 22 (28.5%) patients who underwent TT, TT with lymph node dissection of the central compartment (CLND) and reoperation for previous hemithyroidectomy with CLND. Early symptomatic hypocalcemia 24 hours after TT was demonstrated in 12/22 (54.5%) patients, with PTH value of <14pg/mL in 7/12 (58.3%) patients, and in 6 of these 7 patients (85.7%) the PTH value was <6.3pg/mL. In 5/22 (22.7%) patients the IP was associated with biochemical hypocalcemia <8.4mg/dL, and in 5/22 (22.7%) patients anatomical damage was not associated with a reduction in plasma calcium levels. The severity of early post-op hypocalcemia was not correlated with the number of parathyroid glands left in situ. The multivariate analysis did not show statistically significant values between the clinical-pathological variables and increased risk of IP. Conclusions. No IP clinical-pathological risk factors have been identified during thyroid surgery. In all cases of TT, with or without CLND, the meticulous identification of the parathyroid glands, whose incidental removal is frequently associated with clinical and biochemical hypocalcemia, is recommended.

Context. Primary hyperparathyroidism is one of the most common endocrinological disorder and surgery of parathyroid glands is the main therapy of this disease. Minimally invasive surgery is getting more prominent in these days and its success in parathyroid surgery mostly depends on accuracy of the localization studies. Objective. The aim of this study is to understand the relationship between preoperative biochemical tests, intraoperative findings and Technetium-99mmethoxyisobutylisonitrile (MIBI) scan results. Design. Retrospective clinical study. Subjects and Methods. A total of 185 patients, who have been diagnosed with primary hyperparathyroidism (PHPT) and operated between January, 2010 and October, 2018, were included to the study. Patients with less than 6 months of follow up are excluded from the study. Results. Patients were divided into two groups according to their scintigraphy results; with positive scintigraphy findings as group 1 (n:135) and negative scintigraphy findings as group 2 (n:50). Mean preoperative serum parathyroid hormone (PTH) values were significantly different between the two groups (p<0.02). Mean preoperative serum calcium, creatinine, magnesium, phosphorus, alkaline phosphatase, 25-OH Vitamin D3 levels of both groups were analyzed and there were no statistical differences between the two groups considering these parameters. Also, mean diameter and mean volume of parathyroid adenomas were significantly higher in group 1 (2.1±1.0 cm vs. 1.55±0.72 cm, respectively, p<0.0001; 2.66±5.35 cm3 vs. 1±1.9 cm3, respectively, p<0.0001). Optimal cut-off values of parathyroid adenoma diameter for MIBI scan positivity were 1.55 cm, parathyroid volume for MIBI scan positivity were 0.48 cm3, preoperative serum PTH for MIBI scan positivity were 124.5 ng/L. Conclusions. Preoperative serum PTH levels, diameter and volume of adenomas might be helpful for the prediction of MIBI scan accuracy and possible need of another localization studies.

Context. Incidentally discovered solid adrenal tumors must be evaluated from two points of view: the risk of malignancy and the secretory feature. Objective. Our aim was to evaluate the surgical technique option in relation with clinical and histopathologic features. Design. We performed a retrospective study that included patients with adrenal gland tumors. Subjects and methods. All patients were operated between 2012 and 2019 by the same surgical team in a single center. Results. The batch included 102 patients with adrenal tumors operated through open surgery (OS, n=41) and laparoscopic surgery (LS, n=61). Tumor localization was especially on the right adrenal gland (n=52, 50.98%). Primary origin of the adrenal gland tumors was in 82 cases (80.39%) and a metastatic origin in 16 cases. Average dimension for surgical resected tumors was 4.02 cm (0.9-12 cm) for the LS group as compared to 7.22 cm (1.3-19 cm) for OS group with a predominant type of surgery represented by adrenalectomy and a conversion rate of 2.94%. The hospital stay was 7.22 days (5-12 days) in the LS group versus 12.72 days (6-57 days) in OS group with significant differences (p<0.01). Also, the postoperative recovery was significantly different (6.5 days versus 2.62 days, p<0.01). Conclusion. Laparoscopic approach represents the gold standard in adrenal gland tumors less than five centimeters in size. Adrenalectomy is mostly performed by LS and adenoma is the most frequent histopathologic type, while pheochromocytoma is operated through OS. LS has a significantly reduced hospitalization and postoperative stay compared to OS.

Context. Trabecular Bone Score (TBS) has been recently proposed as a good tool to investigate secondary osteoporosis. Objective. The aim of this study was to assess TBS from spine DXA images in patients with primary hyperparathyroidism (PHPT) and look at its correlates. Subjects and Methods. 153 patients, mean age 59.1 ± 12.1 yrs, females and males (10%), mean BMI 26.2 ± 4.8 kg/m2, mean serum calcium and PTH of 11.3 ± 1.2 mg/dL and 232 ± 329 pg/mL, respectively; 89% had osteoporosis/ osteopenia by LS DXA and 46% had renal involvement. There were 7.6% patients with vertebral fractures, 13.2% patients with nonvertebral fractures. TBS indices were derived from LS-DXA images and cutoff points used were those previously reported. Results. Mean TBS was in the partially degraded range (1.258 ± 0.115); 32% of patients had degraded microarchitecture (TBS ≤ 1.20), 51% had partially degraded microarchitecture (TBS > 1.20 and < 1.35) and 17% had normal TBS. TBS was significantly correlated with areal BMD both at the LS (r=0.544; p<0.001) and FN (r = 0.315; p < 0.001), and negatively with age (r= - 0.354; p < 0.001) and years since menopause - YSM (r = - 0.257, p = 0.005). Patients with vertebral fractures had mean values of TBS in the degraded range, significantly lower than those without vertebral fractures (1.173 ± 0.076 vs. 1.263 ± 0.115; p = 0.006). The presence of vertebral fracture was independently associated only with YSM (OR = 1.131, 95% CI = 0.032 – 0.214, p = 0.008) but not with TBS. Conclusions. In a cohort of symptomatic PHPT patients, including postmenopausal, premenopausal and male patients, we have shown that TBS was in the partially degraded range, but it was not independently associated with fractures.

Objective. Congenital hypothyroidism (CH) is one of the common preventable causes of intellectual disability in neonates, by early detection through neonatal screening. We present the 8-year experience of the National Institute for Mother and Child Health (INSMC) in using MEDILOG national registry for the neonatal screening of CH. Methods. Neonatal screening for CH, done by TSH measurement in dried blood spot, is organized in 5 regional centers, each with a reference laboratory. Results. In 2018 80% of all the newborns, from 80% of the maternity hospitals, were registered in MEDILOG. After re-testing of TSH and T4/FT4 from venous blood in positive cases, the incidence of confirmed CH in 2018 was 1/3576 - 1/ 4746. In INSMC center (which includes 26 counties and Bucharest, out of 41 counties), in 2018 the incidence of positive CH cases at screening was 1/2094 (TSH cut-off ≥17 mIU/L) and of confirmed CH cases 1/3576 newborns. For positive screening cases, the median duration from birth to the INSMC laboratory result was 19 days: median of 9 days between screening and laboratory registration and 6 days between registration and test result. Conclusion. MEDILOG registry is a practical instrument for monitoring the steps of neonatal CH screening, the incidence of CH, the evolution of the diagnosed cases, for evaluation of iodine deficiency (by neonatal TSH), and also for research, with the aim of improving early disease detection and treatment.

The discovery of the cannabinoid receptors CB1 and CB2 in 1990 and 1993, respectively, as well as of the two main endocannabinoids, anandamide in 1992 and 2-arachidonylglycerol in 1995, was an important step in identifying the strongest homeostatic system in the human body, namely the endocannabinoid system. Ever since, research has highlighted the crucial part played by this system in all the reproduction stages: folliculogenesis, spermatogenesis, oogenesis, fecundation, transport of the egg through the fallopian tubes, blastocyte implantation and pregnancy progression, as well as its implications in the physiopathology of the reproductive system: in endometriosis, ectopic pregnancy, miscarriage, preeclampsia, endometrial cancer, polycystic ovary syndrome, ovarian cancer. A special attention must be paid to the phytocannabinoids, natural components originating especially from the Cannabis plant inflorescences, whose medical effects are wellestablished nowadays with also acting on the receptors of the endocannabinoid system. The most recent research mainly focuses on the reproductive dysfunctions and disorders of the reproductive tissues, respectively, through its action upon the endocannabinoid system. Medical cannabis is nowadays legalized in more and more countries all over the world. At the same time, recreational cannabis remains one of the most consumed drugs (in Romania the most consumed one by young adults). Therefore, it is mandatory for specialists in obstetrics and gynecology, endocrinology, public health, hygiene or for general practitioners, to permanently update their information on this subject.

Anthracyclines are used in breast cancer both in early and advanced stages and their recommendation together with taxanes, either concurrently or sequentially, is debatable and individualized by phenotype. Circulating biomarkers have already been introduced in clinical practice for metastatic disease monitoring. We questioned whether it might be a role for these markers in neoadjuvant and adjuvant settings too and a general review was conducted. CK18 and CTC were found predictive for anthracycline related response in preoperative setting. Soluble E-cadherin is promising, a retrospective analysis showing a direct correlation with clinical response. CEA, CA 15-3 and HER2 ECD are not of interest for their predictive role.

Context. Patients with diabetes mellitus have high-risk of coronary artery disease that is often silent. NT-proBNP is a\r\nneurohormone that in recent studies proved useful in detecting ischemic heart disease.\r\nThe objective was to evaluate whether NT-proBNP can detect silent myocardial ischemia and can predict cardiovascular outcome and mortality in asymptomatic patients with type 2 diabetes.\r\nMethods. This study was conducted on 250 patients with type 2 diabetes mellitus without known coronary heart disease and heart failure. All patients were evaluated at baseline and were followed-up prospectively for 3 years for major cardiac events. Exercise ECG and Holter ECG were performed for silent ischemia detection. NT-proBNP was determined on a ROCHE cardiac reader.\r\nResults. NT-pro BNP was significantly raised in patients with silent ischemia (p<0.0001) and remained independent and the strongest predictor of silent ischemia in multiple regression analysis (p<0.0001). NTproBNP levels in patients who experienced major cardiac events were significantly higher (p<0.0001). In multiple regression analysis only silent ischemia (p<0.0001, r=0.20) and NT-proBNP (p<0.0001, r=0.67) remained independent predictors for major cardiac events.\r\nConclusions. NT-proBNP can be useful in screening for silent ischemia in asymptomatic type 2 diabetic patients and also is a strong predictor for major cardiac events.

Aim is to evaluate atherosclerotic risk factors and carotid intima media thickness [CIMT] in offspring of type 2 Diabetes Mellitus [DM] patients with normal glucose tolerance. Methods. We evaluated 96 offspring of Type 2 DM patients and 39 healthy control who were in similar age, sex and body mass. We measured fasting blood glucose [FBG], postprandial blood glucose [PBG], insulin, uric acid, homocystein, fibrinogen, HOMA-IR, lipid profile, hsCRP, microalbuminuria, glycosylated hemoglobin A1c and CIMT by Doppler ultrasonography. Results. FBG was found higher in study group [p<0.001]. The HOMA-IR was 1.7±0.98 and 1.2±0.58 mg/dL x uUI/mL for study and control group, respectively [p=0.007]. TCholesterol, triglycerides, HDL-C, LDL-C and homocystein levels were not different. HsCRP and fibrinogen levels were higher in study group [p=0.014 and p=0.035, respectively]. Microalbuminuria levels were higher in study group but not significant [p=0.111]. CIMT in study group increased distinctively [p<0,001]. In regression analysis, being in study group causes a significant increase on the mean CIMT level by 0.057 mm [0.029-0.086] Conclusion. Our study demonstrated that various atherosclerotic risk factors are aggregated in offspring of Type 2 DM patients having NGT even before they develop glucose intolerance. Having a diabetic family alone might be effective in developing increased CIMT.

An increased risk of non-Hodgkin?s lymphoma was found for a personal history of autoimmune conditions: rheumatoid arthritis, systemic lupus erythematosus, celiac disease, autoimmune hemolytic anemia, Crohn?s disease, psoriasis, sarcoidosis and thyroiditis. The associations may not be general but rather for specific non-Hodgkin?s lymphoma subtypes. These non-Hodgkin?s lymphoma subtypes develop during postantigen exposure stages of lymphocyte differentiation, consistent with a role of antigenic drive in autoimmunity-related lymphomagenesis. We present the case of a 30 years old mane, with simultaneous diagnosis of Graves? disease and a huge anterior mediastinal mass which was actually the mediastinal involvement of a diffuse large B-cell lymphoma stage III. The patient had also hypercalcemia, remitted after two courses of chemotherapy. The possible relationship between the two diseases and the role of parathyroid hormone related peptide PTHrP in paraneoplastic syndrome is discussed.