ACTA ENDOCRINOLOGICA (BUC)

Context. Subacute thyroiditis, a manifestation of Autoimmune/inflammatory syndrome induced by adjuvants that may develop after vaccination. Objective. The aim of this study is to determine the importance of vaccination against COVID-19 in the etiology of subacute thyroiditis. Design. This case reports/series is an observational, descriptive research design. Subjects and Methods. Five of the thirty patients who applied to our clinic with subacute thyroiditis in the last 6 months had a history of inactivated and mRNA vaccines in the last four weeks, after exclusion of infection and comorbidities. We present three cases of mRNAbased vaccination and two cases of inactive SARS-CoV-2 vaccination that met ASIA criteria. Results. Our findings suggest that subacute thyroiditis may be a complication of vaccination against COVID-19. Conclusion. Vaccine administration may led to autoimmune manifestation induction as well as autoantibody production. Adjuvant-induced autoimmune/inflammatory syndrome, an abnormal autoimmune response as a result of exposure to an adjuvant such as vaccine, appears likely in our cases.

We report the case of a 55-year-old-male with a large cell metastatic pancreatic neuroendocrine carcinoma treated for 14 months with lanreotide autogel having a stable disease (SD) and not responding to chemotherapy. The somatostatin analogues (SSA) were introduced after an episode of diarrhea and controlled the disease. Progression-free survival (PFS) as determined by Computerized Tomography (CT) scans was obtained for 14 months. After more than a year, the patient’s health state deteriorated along with progressive disease. The capecitabine-temozolomide regimen was challenged, but after three cycles, a rapid clinical decline was noted. Conclusion. This unexpected event (diarrhea) in the course of the disease could represent the beginning of carcinoid syndrome. While the lanreotide autogel helped the episode of diarrhea pass, it also helped gain control over the disease itself.

We studied the incidence, risk factors, presentation, treatment and prognosis of calcific uremic arteriolopathy (CUA) in 140 of our hemodialysis patients. Methods. Patients with CUA in the past 3 years have been compared to controls in a cross-sectional survey of 140 hemodialysis patients. Results. Prevalence of CUA was 6/140 (4.28%); common presentation was ulcerated acral necrosis. Age, sex ratio, BMI, prevalence of diabetes were similar in case (n=6) and control (n=134) patients. CUA patients had higher serum calcium (9.58?1.25 mg/dL vs. 8.50?1.03 mg/dL, p=0.01), calcium-phosphate product (71.06?19.67 mg2/dL2 vs. 58.73?17.20 mg2/dL2, p=0.01) and parathormone levels (1854?1407 pg/mL vs. 654?776 pg/mL, p=0.0002). Differences in ingestion of calcium, active vitamin D and non-calcium containing phosphate binders in the year prior to the assessment were not significant. CUA patients had higher CRP values in the 6 preceding months than non CUA patients (6.61?9.68 mg/dL vs. 1.97?4.20 mg/dL, p=0.01); logistic regression disclosed CRP as the only predictive factor for CUA (p=0.03). 4 (66%) of the CUA patients died due to sepsis, as compared to 3(2.23%) of the control group (p=0.001). 2 of 3 parathyroidectomised patients survived. In conclusion, this is, to our knowledge, the first series of CUA reported from Eastern Europe. In our center acral, ulcerated forms of CUA in patients with severe hyperparathyroidism are predominant.

The qualitative influence of free fatty acids (FFAs) on glucose metabolism is well documented while there is no data quantifying this relationship. An attempt to measure this correlation was made by employing a prospective, cross-sectional study involving 21 patients grouped in 5 categories established after a standard 2h Oral Glucose Tolerance Test (OGTT): normal glucose tolerance (N); insulin resistant (IR; IR2); impaired glucose tolerance (IGT) and diabetes (D). Two OGTTs were performed for each patient, separated by two weeks during which dietary supplements were taken along with restriction of saturated fat ingestion; levels of FFAs, aminoacids, etc., were measured on both patient visits. Glucose metabolism was quantified as the area under the curve and named glucose metabolic index (GMI). FFAs influence on GMI was dependent on their degree of saturation, with saturated and monounsaturated fats impairing glucose tolerance and polyunsaturated fats (especially tetraenoic and hexaenoic acids) improving it. Short chain FFAs (up to 14 C) had a negative effect; 16 and 18 C were weakly correlated and 20-26 C had a positive effect on glucose tolerance. Levels of aminoacids and metabolic intermediaries suggested involvement of aminoacids in energy production and showed mitochondrial energy overproduction. Glucose and energy metabolism were altered in IR, IGT and D patients in a similar fashion; those alterations were more pronounced in D than in the IR while none was present in the N group. Glucose tolerance was improved upon restriction of saturated fats intake along with administration of antioxidants in D, IGT and IR groups.

Objective. To describe an unusual case of lymphocytic hypophysitis in a man,\r\npresenting with an elevated serum Insulin like growth factor-1(IGF-1) level.\r\nCase report. We report the case of a 27 year old male presenting with a 2 week history\r\nof severe headaches. Magnetic resonance imaging of the head showed an adenoma-like\r\npituitary. The physical examination was normal, laboratory tests revealed secondary\r\nhypothyroidism and hypogonadism along with an elevated IGF-1. Complete\r\ntranssphenoidal resection of the pituitary mass was done. Tissue analysis was diagnostic for\r\nlymphocytic hypophysitis. No evidence of a somatotroph adenoma was found. After surgery\r\nthe patient developed panhypopituitarism and diabetes insipidus.\r\nDiscussion. IGF-1 is a sensitive disease related marker in acromegaly and corresponds\r\nto disease activity. However, it should not be used as the sole marker for diagnosis of\r\ndisease. Inflammatory lesions of the pituitary gland, such as lymphocytic hypophysitis, can\r\nclinically and radiologically mimic tumors of the sellar region.\r\nConclusion. We report an index case of a young male who presented with elevated\r\nserum IGF-1 level in the setting of lymphocytic hypophysitis. This case illustrates the\r\ndilemma associated with reliance on the IGF-1 levels for diagnosis of acromegaly, since an\r\nelevated IGF-1 level in the presence of a pituitary mass may not always be a somatotroph\r\ntumor. We propose the differential diagnosis should also include autoimmune hypophysitis.

Context. COVID-19 is more than a respiratory infection, with deep implications regarding multiple systems and organs. Thyroid damage is frequent in COVID-19 and may overlap previous HCV or HCC associated diseases. Objective. The objective of this study is to determine the effects of COVID-19 in patients with HCV associated HCC and thyroid comorbidities. Design. We performed a retrospective study of the thyroid function tests and autoantibodies in patients with HCV-associated HCC prior and during COVID-19. Subjects and Methods. We included 52 consecutive patients with HCV-associated HCC and documented thyroid disease, diagnosed with COVID -19 between April and October 2020. Serum values of thyroidstimulating hormone, free T3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxydase antibodies were determined and compared to baseline levels. Results. At baseline, 44 patients had positive antithyroid antibodies, 6 had hypothyroidism in substitution and 2 had hyperthyroidism under treatment. During COVID-19 we found an increase in serum values of antithyroid antibodies, and decreased levels of TSH, freeT3 and freeT4 levels. Specific therapies were discontinued in one patient with hyperthyroidism and 3 patients with hypothyroidism. Conclusion. There is a significant impact of COVID-19 on the thyroid homeostasis; a long-term prognostic value for patients with HCC infected with COVID-19 required further extensive research.

Context and objective. In this study, we aimed to investigate how moderate physical activity improves the bone ultrastructural parameters in rats with glucocorticoidinduced secondary osteoporosis. Animals and Methods. Research has been carried out on Wistar female rats. Secondary osteoporosis was induced through daily i.m.1.5 mg/kgbw methylprednisolone, over a period of 30 days. A group of rats with induced secondary osteoporosis were subjected to physical activity (swimming) for one hour/day for 30 days. Rats were sacrificed 24 hours after the last administration and femoral bones were used for electron microscopy analysis. Results. The ultrastructural findings obtained from the rats with osteoporosis showed varying degrees of alteration in all cellular components. A moderate physical effort led to the overall maintenance of the normal ultrastructure of the cells and connective components, protecting the lamellar structure of the compact bone from the deleterious effects of glucocorticoid. The shape and components of osteocytes were also preserved and the accumulation of lipids in the bone marrow diminished. Conclusions. Physical exercise has been shown to have a protective role by lowering the development of structural alterations specific to osteoporosis. Therefore, moderate physical exercises are recommended for improving the structure of the bone mass affected by glucocorticoid treatment.

A 62 years old woman was diagnosed with multinodular toxic goiter and primary hyperparathyroidism/ left parathyroid adenoma by hormonal assessment, ultrasound and nuclear thyroid/parathyroid scans. Cervical ultrasound illustrated a multinodular aspect of the thyroid with solid nodules and cystic-component nodules; the larger one represented a multinodular complex with necrosis areas in the left thyroid lobe, ACR TI-RADS score 4 (moderately suspicious). Functional nuclear imaging was performed for accurate differential diagnosis between thyroid vs. parathyroid localization, between cold vs. hot nodules, and eventually, for guiding the choice of a subsequent Fine- Needle Aspiration Biopsy (FNAB). Scans described an early intense 99mTc-sestaMIBI uptake with no 99mTc-pertechnetate uptake in the left thyroid lobe larger nodule. Due to the suspicion of malignancy for this nodule, we performed an additional scan (1 hour before the classical 2 hours parathyroid delayed scan). The intense uptake persists in both delayed scans suggesting no malignant phenotype and which was confirmed after surgery by benign histology. In conclusion, using a 99mTc-sestaMIBI personalized protocol, related to the radiotracer cellular uptake mechanisms: 1 hour scan (supplementary image, corresponding to the maximum uptake pattern of 99mTc-sestaMIBI for cancer cells) and 2 hours scan (for parathyroid washout evaluation) may avoid unnecessary extensive thyroid surgery.

The underlying mechanisms for endocrine disturbances in patients with kidney alterations are complex. Aim. To provide better longitudinal follow-up of children, especially to check their progress through puberty. Material and methods. A prospective study was conducted at the “Louis Turcanu” Emergency Hospital for Children in Timisoara, Romania during 01.01.2022- 31.12.2024. The study population included ten pediatric patients with end stage renal disease (ESRD) on hemodialysis. Data were collected from the electronic medical records and included demographic information and relevant laboratory parameters, which reflect the patients’ anemia status, inflammation, mineral metabolism and other endocrine abnormalities. Results. Erythropoietin doses ranged from 87 to 176 units/kg once a week at the beginning of our study, higher than guidelines recommendations. Most patients presented with hemoglobin levels below the normal range which slightly increased over the 3 years period. Vitamin D levels ranged from 8.1 to 55.8 ng/mL. These resulted in a poor control of the mineral bone disease associated with kidney failure. Conclusions. The loss of kidney function is associated with an impaired control of phosphor-calcium balance, and anemia, growth and pubertal delay in children. This study highlights the need for individualized treatment plans and a multidisciplinary approach in pediatric patients with ESRD.