ACTA ENDOCRINOLOGICA (BUC)

Background. Clomiphene citrate (CC) is a safe and widely available first-line ovulation induction drug in women with polycystic ovary syndrome (PCOS). Obesity may trigger the syndrome development in the presence of genetic predisposition or independent causal factor by inducing low insulin sensitivity. Objectives. The aim of this study was to compare the serum AMH levels in obese women with PCOS and obese women with ovulatory cycles, and to assess the role of AMH as a predictor of ovulation induction in obese patients with PCOS by CC as compared to follicle-stimulating hormone (FSH). Subjects and methods. Fifty-six obese infertile women with PCOS with a BMI greater than 30kg/m2 were compared with a control group of 30 obese women with normal ovulation. After ovulation induction treatment with CC, the PCOS group was further subdivided in responders and nonresponders. AMH level was assessed as an ovulation induction predictor using area under the curve (AUC) analysis, logistic regression and statistical correlation. Results. Serum AMH level was significantly higher in women with PCOS than in the controls. There were no significant differences in age, duration of infertility, weight, height, LH, and FSH, but significant differences in AMH level (p < 0.01), endometrial thickness (p < 0.01) and progesterone level (p < 0.01) between the patients responding and non-responding to treatment. Endometrial thickness (AUC = 0.932) and progesterone level (AUC = 0.732) were of predictive value for treatment response. A cut-off level of 1.92 ng/mL for AMH showed a good discriminative power for the positive response to treatment (AUC value = 0.819, p< 0.0001). Conclusion. AMH measurement could be useful in predicting ovarian response to clomiphene citrate therapy in obese anovulatory women with PCOS.

The incidence of type 2 diabetes is continuously growing worldwide, with enormous costs for individuals as well as for society. In the last decades, bariatric surgery has emerged as a possible solution for ameliorating metabolic control or even obtaining diabetes remission. Observational trials and metaanalyses demonstrate consistent improvement of type 2 diabetes following various bariatric procedures, but they are generally uncontrolled or they use historic controls as comparators. In recent years, several randomized trials studying the effectiveness of bariatric surgery in type 2 diabetes have been conducted and they all show substantial benefits, with the observation that the majority are shortterm trials. With the increased popularity of diabetes surgery, concerns about its immediate and long-time safety have also grown. The most frequent peri-operative are ulcers or stenosis, obstruction, venous thrombosis, pulmonary embolism and other pulmonary complications, with a mortality of less than 1%. Gastro-intestinal diseases, nutritional deficiencies and psychiatric disorders are the most important longterm problems to be addressed. The uncertainty regarding the long-term effects of bariatric surgery, together with its potential for morbidity and mortality, underline the necessity of large, long-term, randomized clinical trials comparing the best medical therapy with bariatric surgery in patients with type 2 diabetes.

Parathyroid cancer is an uncommon endocrine malignancy. It has slow clinical course and low malignancy potential. It represents 1% of primary hyperparathyroidism. It results with more agrressive biological behaviour and severe clinical condition than benign reasons. Extended resection in the first operation is essential for PC treatment and decreases local recurrence that is observed in high frequency. Palliative surgery should be considered in patients with unresectable tumor. Immunotherapy and recent interventional radiological procedures are considered for patients that are unfit to surgery. Effect of adjuvant chemotherapy and radiotherapy is limited however recent immunization studies are promising. Parathyroid cancer epidemiology, staging system, diagnosis and advancements in treatment are considered according to recent literature in this review.

Background. A rising trend in obesity among children has been observed in recent years\r\nin most countries. The majority of obese children will become obese adults having an increased\r\nrisk for chronic diseases associated with obesity, with a negative impact on their lifespan.\r\nObjective. Assesing the obesity prevalence among school children in Cluj-Napoca.\r\nMethods. The study included 7904 school children of all grades (grade 1 to grade 12) from\r\n20 schools in Cluj-Napoca. The weight, height and body mass index (BMI) were recorded for\r\neach child. Using the BMI percentile, they were classified as: normal (BMI < 85th percentile),\r\noverweight (BMI between 85th and 95th percentile) or obese (BMI > 95th percentile). BMI average\r\nand standard deviation have been calculated per age groups and sex.\r\nResults. 8.29% of school children in Cluj-Napoca are obese, while 12.84% of them are\r\noverweight. The difference between sex groups is statistically significant with boys more likely to\r\nbe obese or overweight than girls (p<0.0001). The highest prevalence has been observed among\r\nthe 6-10 years age group, while teenagers have recorded the lowest prevalence figures.\r\nConclusion. Data derived from this study would place Romania among the countries\r\nwith an average prevalence of obesity. However, extending such studies at national level\r\nwould provide more accurate data about obesity prevalence in Romania.

Background. Gestational diabetes mellitus (GDM) is associated with high frequency of obstetric complications, such as gestosis, polyhydramnios, urogenital infection, premature birth. An increase in the number of cases of detection of GDM in pregnant women living in Kazakhstan is noted recently. Objective. This research was carried out in order to see the influence of GDM on the course of the third trimester of pregnancy, outcomes and fetal status in women of Kazakh ethnic group. Research design. Cohort observational study. Subjects and Methods. The main group of research consisted of 61 pregnant women with GDM (Meanage= 32.8±6.314), the control group included 39 pregnant women with normal glucose tolerance (Meanage=30±5.432 years). The pregnant women in both groups were examined by calculation of body mass index (BMI), determination of fasting plasma glucose and the system of hemostasis. Also, the fetal ultrasound was implemented and the uterineplacental, fetal-placental blood flow were evaluated using the Doppler mode. Results. In the main group initial BMI was equal to Mean=31.1±7.433 kg/m2; we revealed manifestation of gestational hypertension in 36.1%, 95%CI (2.52, 48.6); preeclampsia was diagnosed in 14.8% (95%CI (8; 25.7); the disorders of uteroplacental and fetoplacental blood flow recorded significantly more frequently in main group RR=6.393, 95%CI (1.581-25.840), like the diabetic fetopathy RR=5.115, 95%CI (1.240-21.033). The premature delivery, the prevalence of induction of delivery and intranatal trauma were significantly more frequent in women with GDM. Conclusions. GDM significantly worsens course of gestation.

Introduction. The functions of CD36 membrane receptor include removal of oxidized low-density lipoproteins from\r\nplasma. The aim of our study was to search association between the IVS3-6 C allele and hypercholesterolemia in overweight children.\r\nMaterial and Methods. The study groups comprised 55 Caucasian children with (33) and without hypercholesterolemia (22). Amplicons of exon 4 including\r\nfragments of introns 3 and 4 were studied using denaturing high-performance liquid chromatography (DHPLC).\r\nResults. Polymorphism detected by DHPLC was single nucleotide substitution in intron 3 (IVS3-6 T/C - rs3173798). The IVS3-6 T/C polymorphism is located in the\r\nregion encoding the oxidized LDL binding domain, at a conserved splice site. Total serum cholesterol concentrations were significantly lower in the IVS3-6 TC\r\nheterozygotes than in the TT patients. Furthermore we found tendency (p=0.06) to lower LDL-cholesterol level in IVS3-6 TC heterozygotes than in wild-type homozygotes.\r\nConclusion. The results of our preliminary study suggest that the IVS3-6 C allele of CD36 rs3173798 polymorphism\r\nmay be associated with lower serum total and LDL-cholesterol in overweight children diagnosed with hypercholesterolemia.

A 75 years old woman was referred to abdominal echography for pain related to biliaryduodenal motriceal dysfunction. The ultrasound discovered a dense (hyperechogenic) image under (posterior of) the 8th segment of the liver. The dense process was supposed to be a calcification situated medial from the right kidney in the cranial 1/3 length of it. Specific clinical and biological data related to possible adrenal destruction were analyzed: the patient was in good condition, body mass index was 29. She had no tuberculosis during her life. The current arterial pressure was 145/80 mm Hg. All laboratory data, including basal cortisol were normal. Cortisolemia at 8 a.m. was 523 nmol/l. The diagnosis was made by CT scan: clear and only organ-disseminated calcification in adrenals appeared as a rim. The management of this case was related to follow-up of adrenal lesions by abdominal ultrasound.\r\nThe calcification of one adrenal raised several issues for discussion: the role of ultrasound vs CT in adrenal lesions, the prevalence of calcifications in adrenal glands, the importance of the calcification process. Calcifications of adrenals are seldom found in primary autoimmune cortical atrophy associated with Addison's disease, but they are supposed to be more frequent in adrenal tuberculosis; calcification suggests a former local tuberculosis process, associated with pulmonary tuberculosis and with borderline adrenal insufficiency. Various etiologies and mechanisms for adrenal calcifications (infectious, tumor, hemorrhage, parasitic) are discussed. To our knowledge, the rim-like appearance of the adrenal calcification was described only in one patient. In conclusion, incidental diagnostic of adrenal gland calcifications was reported in patients without adrenal insufficiency, signaled by ultrasound and detailed by CT, associated with normal adrenal function. Therefore, we consider that calcifications in the right adrenal in our patient could mean a process of cicatrisation or healing after an autoimmune aggression, only on the right adrenal gland.

The coexistence of Cushing’s syndrome (CS) and pregnancy is uncommon due to the suppression of gonadotropin secretion in CS. Adrenocorticotropic hormone (ACTH) dependent CS in pregnancy is less frequent than adrenal causes. The diagnosis of CS during pregnancy is difficult since physiological changes in the hypothalamopituitary- adrenal axis may cause dynamic tests to be misinterpreted. Radiological imaging is limited. We report the case of a 27-year old woman with Cushing’s disease (CD) diagnosed in the 5th-week of pregnancy. The mild symptoms of hypercortisolism did not lead to serious complications for the mother or the fetus, so insulin was the only treatment used. The pregnancy was completed without any complications, and at 38 weeks of gestation a healthy female infant was delivered vaginally. Complications, such as hypocortisolemia and hypoglycemia, were not observed in the infant. Postpartum tests were consistent with CD. Contrast-enhanced pituitary magnetic resonance imaging revealed a microadenoma which was removed with transsphenoidal surgery. Histopathology revealed a pituitary adenoma with positive immunohistochemical staining for ACTH. Biochemical remission required prednisolone treatment, but the insulin requirement decreased significantly over time. As a conclusion, CD with mild features can be well tolerated during pregnancy, but the mother and the fetus must be monitored closely.