ACTA ENDOCRINOLOGICA (BUC)

Context. For control of blood glucose in diabetic patients on enteral feeding either insulin infusion or multiple insulin injections are used. However, both of these\r\nmethods necessitate a very close follow-up and are not easy to apply during home care.\r\nObjective. In this study we aimed to see whether insulin glargine once daily is proper for glucose regulation in enterally fed diabetic patients.\r\nDESIGN: Insulin glargine is given to enterally fed diabetic patients and they are followed up for three months.\r\nSubjects and methods. Thirteen diabetic stroke patients with PEG are involved in the study. Treatment of these patients is switched from insulin infusion or multiple insulin injections to once daily insulin glargine and they are followed up for 3 months.\r\nResults. Mean blood glucose values are improved with once daily insulin glargine regimen. HbA1c decreased from 7.2% ? 1.5 5. to 6.7% ? 0.8 with insulin glargine. Daily insulin requirement of the patients is significantly decreased as well. A significant decrease in the hypoglycemic episodes is\r\ndetected with glargine (p<0,0001).\r\nConclusion. Insulin glargine once daily is a safe and effective regimen for diabetic patients with PEG.

Bronchial carcinoid tumours (typical and atypical carcinoid) are endobronchial tumours that can benefit from both local endobronchial treatment and surgical treatment. Given their relatively good prognosis compared to the other two forms of pulmonary neuroendocrine tumours, there is a current concern about the implications of lymph node involvement as well as the identification of new prognostic factors to shape the treatment of these patients in the future.

Context. Female adnexal tumors of probable Wolffian origin (FATWO) represent very rare borderline ovarian tumors with low malignant potential. Only 15 cases of malignant FATWO are described in the current literature, among which, only 5 are reported as being recurrent. Objective. Due to the rare presentation of the recurrence of the malignant FATWO and the few cases reported in the scientific database, there are no clear therapy recommendations. This paper should help practitioners to choose the best therapy approach. Design. This paper presents the 6th case of malignant recurrent FATWO and will compare all the cases available in the literature. Subjects and Methods. We present a review of the literature comparing the therapeutic approaches and outcomes of all the five cases of recurrent malignant FATWOs. Also, we introduce the case of a stage III Wolffian origin adnexal tumor with multiple recurrences appeared after 6 years of disease free interval. Results. Our case presents the longest survival reported in the literature and underwent most surgical procedures of the recurrences and more than 4 lines of chemotherapy regimens. Conclusions. This paper shows possible therapeutic approaches to be used as example by the practitioners according to the drug availability in their centers.

Background: Similarities between benign and malignant characteristics of enlarged\r\nLN,s are observed on radiological studies.\r\nCase report: We present a case of an inflammatory intramammary lymph node, which\r\non dynamic MRI presented enhancement features suspicious of malignancy. A 45-year-old\r\nfemale presented with a painful palpable lump in the upper outer quadrant of the right breast.\r\nPhysical examination revealed a firm, movable 2 x 1-cm mass in the upper outer quadrant\r\nand erythema of the skin of the right breast. The mammogram showed a well circumscribed\r\ndensity, whith incraesed echogenity on ultrasound and increased Doppler signal. Breast, on\r\ndynamic MRI presented enhancement features suspicious of malignancy and contrast media\r\nwas washed out on delayed phase images. Pathological diagnosis was reactive lymphoid\r\nhyperplasia of intramammary lymph node.

Serotonergic 5HT2A receptors constitute the sole subtype identifiable in platelets, their sole location outside CNS. They may intervene in intra-CNS pathways involved in GHRH and GH release, mainly during sleep. To gain information about such a subtype receptor in GH deficiency and, indirectly, on its role in GH release, studies on the platelets membrane binding sites of labelled LSD were undertaken in dwarf, GH-deficient children, assuming that the platelets sites number is parallel to their number in the brain. Five dwarf (Dw) children (3 boys) aged 7-13, having no signs of puberty, with a peak GH level under 5 ng/ml during ITT, no tumor in the hypothalamic and pituitary area and no previous rhGH therapy were compared with ten normally statured, non-obese children serving as controls (C). Fifty mL of platelet membrane preparation of pooled samples were incubated at 25?C with radioiodinated lysergic acid diethylamide ([125I] LSD) in concentrations of 0.35-3.5 nM/L. The reaction kinetics was followed up within 60 min weekly for 4 weeks. Bmax and Kd were calculated as means of 4 repetitions. Competitive inhibition curves were also drawn by using ketanserin (KET), mianserin (MIA) and cyproheptadin (CYP) in concentrations of 10-4 mM- 1nM/L and the inhibition constant (Ki) was calculated. The results showed that Bmax was (mean ? SEM) 33.0 ? 3.06 fmol/mg protein in C group versus 64.06 ? 13.82 fmol/mg protein in Dw group (F test in covar p<.05). Kd was 0.76? 0.166 nM in C and 2.0? 0.48 nM in Dw (t test p<0.01). The earliest time of 100% binding (Tmin) was 20 min in C and 5 min in Dw groups. Ki in C was 0.1 nM for KET, 18 nM for MIA and <0.1 nM/L for CYP. In Dw children Ki was 1.85 nM for KET, 18 nM for MIA and <0.1 nM for CYP. The results indicated that the number of 5HT2A receptors in platelets was significantly greater in GH-deficient children than in controls, as well as Kd. Tmin indicated an earlier steady state in Dw patients. Ki values pleaded to some extent in favour of the presence of excess 5HT2A receptors. In conclusion, excessive binding of labelled LSD and its inhibition by specific antagonists proves excess of 5HT2A receptors in platelets preparations collected from dwarf children.

Background. Multiple endocrine neoplasia type 2B (MEN 2B) is a rare hereditary syndrome caused mainly by Met918Thr germline RET mutation and characterized by medullary thyroid carcinoma (MTC), pheochromocytoma (PHEO), and typical phenotypic features. MEN 2B cases previously reported in the literature have variable clinical course. Objectives. We aimed to discuss the characteristics of four MEN 2B cases with unusual presentations,clinical course and review the recent clinical data on MEN2B Results. All patients had de novo M918T mutation and no family history. The mean age of patients was 38.2 years (27-56). Two patients had typical phenotypic features of MEN 2B; the other two patients had no striking phenotypic features. First detected MEN 2B component was MTC in two, intestinal ganglioneuromatosis in one, and PHEO in one of the cases. Bilateral PHEO was detected in all four cases. Conclusions. MEN 2B is a complex syndrome characterized by wide phenotypic variability and different clinical outcomes. To diagnose sporadic MEN 2B cases, genetic testing should be performed in all cases with suspicious clinical features. Although early diagnosis is the main factor that increases life expectancy, some MEN 2B patients with late diagnosis may exhibit a mild clinical course and better prognosis than expected, with effective treatment.

Context. Despite that the Triglycerides/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio has been associated with insulin resistance and cardiovascular disease, some outcomes differ between populations. Objective. The objective of this study was to evaluate the association between TG/HDL-C ratio and cardio-metabolic risk factors in both obese and normal weight women. Design. Cross sectional, from January to December of 2015. Subjects and Methods. Two hundred and fifty three women aged 40 to 60 years. Anthropometric and laboratory measurements were performed. Insulin resistance was measured by the homeostasis model assessment for insulin resistance (HOMA-IR). All participants underwent a Doppler ultrasound to measure intima-media thickness of carotid artery (cIMT). Results. TG/HDL-C ratio correlated with body mass index (r=0.194, p=0.01), and visceral adipose tissue (r=0.193, p=0.002). Additionally, TG/HDL-C correlated with glucose (r=0.367, p=0.001), insulin (r=0.354, p=0.001) and HOMA-IR (r=0.396 p=0.001). TG/HDL-C was associated with prediabetes, Odds Ratio (OR) was 1.83 (95%CI 1.07-3.13) and insulin resistance 3.27 (95%CI 1.78- 6.01), and this risk remains in normal weight women 4.7 (95%CI 1.2-17.81) for prediabetes and 4.38 (95%CI 1.42- 13.84) for insulin resistance. No significant risk for cIMT. Conclusion. A TG/HDL-C ratio ≥ 3.0 is a potential risk factor for prediabetes and insulin resistance in women 40-60 years, even in normal weight women.

Endogenous Cushing’s syndrome is rare, with an incidence of 0.7–2.4 per a million people a year. Clinical presentation of Cushing syndrome can be pleomorphic, and establishing diagnosis can be difficult. Early recognition and rapid control of hypercortisolaemia are necessary to decrease morbidity and mortality in these patients. We report a series of 6 endogenous Cushing’s syndromes of different etiologies (4 Cushing’s disease and 2 adrenal Cushing’s syndrome) assessed in our endocrine department over a decade (2009-2019). In order to highlight the diversity of clinical forms, diagnostic tools and specific management of this condition we labelled each case suggestively: the typical Cushing’s disease, the Pseudo Cushing’s, the elusive Cushing’s disease, the mild autonomous cortisol hypersecretion, Cushing’s syndrome in pregnancy and Cushing’s disease with thromboembolism. We discussed their particularities which were revelatory for the diagnosis, such as dermatologic, cardiovascular, musculoskeletal, neuropsychiatric, or reproductive signs, reviewing literature for each manifestation. We also discuss the commonalities and differences in laboratory and imagistic findings. Therapeutic approach can also differ with respect to the particular condition of each patient and the multiple choices of therapy will be reviewed.

Background. There is no standard definition for goitres extending below the thoracic inlet and no clear guidelines for pre-operative planning of surgery. The aim of this study is a practical classification of retrosternal goitres (RSG) based on the anatomical , radiological shape and size of the thyroid. Methods. Retrospective analysis of all thyroidectomies performed in a referral centre between January 2012 and December 2016. Patients with RSGs had a pre-operative CT scan of neck/thorax. Imaging was reviewed to establish features to predict the difficulty of delivering the goitre through the neck incision and to advise the best surgical approach. Results. 847 thyroidectomies were performed with n=98 involving RSGs. TypeA (n=47) are RSG with a shape of a “cone” or pyramid with the apex pointing down. Cervicotomy is the usual approach. TypeB (n=39) are goitres with a shape of a “pyramid’ with the apex pointing up, cervicotomy with ± manubriotomy or sternotomy ± thoracotomy maybe required. TypeC (n=6) are thyroid enlargements in the mediastinum connected by a pedicle with the thyroid in the neck. A cervical approach ± manubriotomy or sternotomy ± thoracotomy is needed. TypeD (n=6) are true intrathoracic or “forgotten” goitres. Sternotomy is indicated for thyroids in the anterior mediastinum though a thoracic approach for those located in the posterior mediastinum might be needed. Conclusion. The shape and size of goitres is important in carefully planning surgery. CT imaging with cross-sectional reconstruction should be analysed before operation. The proposed classification helps treatment planning and allows comparison of outcomes by anatomical complexity.

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