ACTA ENDOCRINOLOGICA (BUC)

Context. GnRHa treatment has been a standard of care in progressive early puberty (EP). Choice of the GnRHa formulation is dependent on the preference of the clinician. Objective. To compare the effects of triptorelin acetate (TA) and leuprolide acetate (LA) on anthropometry in girls with EP. Design. A descriptive observational study. Subjects and Methods. Girls diagnosed with central EP and treated with GnRHa at least for one year were included; treated with TA (n=46) and LA (n=35). First year anthropometric response and final height were evaluated. Results. The mean age at the initiation of GnRHa treatment of girls was 8.5±0.5 years. The ratio of obesity and of overweight was 7.4 and 25.9%, respectively. In both TA and LA groups, anthropometric data of the patients at initiation and at the first year of treatment were similar. Although growth velocity was similar in each group, in LA group height SDS at the first year of the treatment showed a significant decrease (p=0.045), but not in TA group (p=0.317). No significant ΔBMI was observed with treatment. The differences between FH – PAH at initiation (height gain) in TA and LA groups were 2.9±4.7 and 4.0±5.8 cm, respectively (p=.316). Height gain per treatment year was 1.7±3.0 cm. Conclusions. There was a significant decrease in height SDS at the first year of leuprolid treatment, but not in triptorelin. Although these two analogs show similar effects on treatment, a not significant but slightly better benefit in leuprolide was observed.

Objective. This study assesses, in patients from counties with iodine deficiency (ID) and without ID, the concentrations of thyroid hormones in newborns (cord blood) and mothers at delivery, maternal and fetal thyroid volumes (less than 24 hours before delivery) and maternal urinary iodine at delivery. Another aim of this paper is to identify the interrelations between maternal and neonatal thyroid functions in the premature and full term delivery.\r\nMethods. In this study there were 83 mothers without thyroid pathology (goitre included) aged 26.51 ? 4.88 years, range 16-38 years) and their 83 newborns immediately after delivery. Four groups were identified: group A - 13 mothers from iodine sufficient area (IS) who delivered prematurely, group B - 13 mothers from iodine deficient area (ID), who delivered prematurely, group C - 38 mothers from IS area who delivered at term and group D - 19 mothers from ID area who delivered at term. The serum concentrations of TSH, total (T)T4, free (F)T4, TT3 and FT3 were evaluated by a microparticle enzyme immunoassay (MEIA). The thyroid volumes in mothers and their fetuses were measured by ultrasonography with a high resolution equipment (Accuvix XQ).\r\nResults. The values of TSH in newborns (cord blood serum), expressed as mean ? standard deviation (SD), were significantly higher in groups from ID areas (B+D) vs. groups from IS areas (A+C) (p<0.03). TSH levels were higher in group D vs. group C (6.62 ? 4.53 mU/L vs. 5.46 ? 2.83 mU/L [p<0.03]). The values of TT4 in newborns were significantly lower in group B vs group D (8.09 ? 1.68 ?g/dl vs. 9.45 ? 2.23 ?g/dl [p<0.05]), in premature group (A+B) vs term group (C+D) [p<0.007] and in groups from ID areas (B+D) vs. IS groups (A+C) vs [p<0.01]. Thyroid volumes (TV) in fetuses from IS areas (A+C) were lower than in ID areas (B+D) (p<0.002), but TV was similar in fetuses born at term or prematurely. Serum TSH levels in newborns (71.73 ? 26.54 ?g/l) were negatively correlated with maternal urinary iodine (r = -0.827, p<0.0001). Serum TSH in newborn was not correlated with maternal TSH in any group (A-D). The TV in fetuses (1.25 ? 0.1 ml) were highly correlated with TSH in newborns (r = 0.83, p<0.001), negatively correlated with maternal urinary iodine (r = -0.81, p<0.001) and correlated with maternal TV (17.12 ? 1.82 ml) (r = 0.44, p<0.02).\r\nConclusions. The status of the thyroid hormones and thyroid volumes in the newborn was dependent on the severity of iodine deficiency and in a less proportion on prematurity. The fetus is more sensitive to iodine deficiency than the mother.

Background. The prevention of type 2 diabetes has great clinical importance. Many pharmacologic and nonpharmacologic\r\nmethods are used to prevent type 2 DM. Metformin reduces the risk of developing diabetes in insulin resistant subjects. Oxidative stress plays pivotal roles in the pathogenesis and complications of diabetes mellitus. Paraoxonase 1 has\r\nantioxidant capacity.\r\nObjective. This study was planned to assess the effects of metformin and life style changes on paraoxonase activity and\r\noxidative stress markers in premenopausal, obese, insulin resistant women.\r\nDesign.Open-pilot clinical study.\r\nSubjects and methods. Thirty-two insulin resistant, premenopausal, obese women were enrolled into this clinical\r\nstudy. These women were treated by diet + exercise + metformin (1700 mg/d) for 6-month interval. All anthropometric characteristics, serum fasting and\r\npostprandial glucose, fasting insulin, paraoxonase, arylesterase, and malondialdehyde (MDA) levels and lipid\r\nsub-fractions were measured at the commencement and the finish of the study. Homeostasis model assessment (HOMAIR)\r\nwas used to estimate insulin resistance.\r\nResults. Significantly reduced body weight, body mass index, waist circumference measurements, HOMA-IR and serum fasting\r\ninsulin, postprandial glucose, triglyceride, MDA levels and paraoxonase/high density lipoprotein cholesterol (HDL-C) ratio were observed at the end of the study compared\r\nwith initial evaluations. Conversely, there were considerable increases in serum arylesterase and HDL-C levels following the treatment. Nevertheless, the increase in serum PON-1 level was statistically insignificant.\r\nArylesterase was inversely correlated with TC, LDL-C levels and HOMA-IR.\r\nConclusions. Metformin treatment with intensive life-style modification may be appropriate management in premenopausal,\r\nobese, insulin resistant women who have increased propensity for the development of type 2 diabetes, although long-term,\r\ncontrolled studies are needed for evaluation in greater detail.

Objective. Carpal tunnel syndrome(CTS) is a neuropathy of the upper limb that is quite common in patients with active acromegaly, but the diagnosis of acromegaly is often made years after the diagnosis of CTS. But in the absence of the typical acral phenotype it is difficult to know when CTS will appear as the first symptom. Method. Here, we present a 27-year-old female patient with a history of numbness that first appeared in her right hand and 2 weeks later in her left hand. While the etiology of acute CTS was being investigated on cervical MRI, the hormonal evaluation of the incidentally detected mass in the sella turcica revealed that it was a clinically silent somatotroph adenoma. Results. Considering the patient's age, desire to have children, lack of typical acral features, the fact that these adenomas may cause phenotypic changes over time, their aggressive course and more recurrences, the decision for transsphenoidal surgery was made. The patient, who has been followed for 14 years, has two healthy children and does not have any complaints, acral phenotype or GH hormone excess. Conclusion. Awareness that acute unilateral/ bilateral CTS without any risk factors may be the first sign of clinically silent somatotrophinoma may improve the prognosis of acromegaly by preventing diagnostic delay.

Pediatric chronic kidney disease (CKD) has a substantial global impact because is associated with notable morbidity. Secondary hyperparathyroidism (SPHT) frequently emerges as a complication in the early stages of renal insufficiency, it is an adaptive response to uphold mineral balance. It is a component of the chronic kidney disease-mineral and bone disorder (CKD-MBD). The development of SHPT in CKD involves multiple factors and it is important to understand them in order to properly manage it, starting with early diagnosis and continuing with proper treatment. In children with CKD and SHPT, the difficulty in case management is due to non-adherence to proper diet which makes it difficult for the pediatric nephrologist to manage the case. In this review we want to focus on new data regarding this CKD complication.

Background. Indication, type of surgery and choice of surgical approach for adrenal masses continues to be a subject of debate between surgeons. The aim of this study was to report our data and experience with adrenal surgery. Subjects and Methods. We performed a retrospective study on 297 patients diagnosed with adrenal masses and operated in our center between 2002 and 2011. Gender, age, surgical approach, operating time, hospital stay, histology report and complications were analyzed. Results. From a total of 297 patients who underwent adrenalectomies, 82 were performed by laparoscopic approach and 215 in a classical open approach. The most common indication for surgery was pheochromocytoma (50.2% in unilateral and 50% in bilateral adrenal masses) summing 149 patients for both types of surgery. The risk of malignancy was significantly correlated with tumor size and the cut off value of 5cm had 92.5% specificity and 74.6% sensitivity. Patients in laparoscopic group were younger (mean 44.13 years), had shorter operating times (mean 122.7 min), shorter hospital stays (mean 6.8 days), and less complications (1.7 %) compared to open adrenalectomy. Conversion rate to open procedure was 2.4 %. Conclusion. Although many adrenal masses are now excised by laparoscopic techniques, the number of procedures was still low in our center because of high surgical complexity of our cases and high institutional costs. Moreover, we should consider that the best adrenal surgery approach remains open surgical excision for larger masses and malignant conditions.

Debates flow in the medical and psychological field about burnout symptoms: from considering it as a distinct illness, a separate entity or correlated with physiological changes and/or job-related reaction. Seen as a form of depression, the researches are investigating the correlations between various changes in the normal human body functioning, environmental and job lever / implications. The following pages refer to the recent studies of neuroendocrine indicators involved in burnout. It is known that the endocrine system is highly interrelated with the immune and neural systems, the neuro-immuno-endocrine axis is subject to clear biphasic changes in the acute and chronic phases of a critical illness, most likely reflecting a beneficial adaptation.

Context. In medically treated Graves’ disease (GD) patients, prolonged low serum TSH levels represent an independent risk factor for relapse. The predictors of this prolonged TSH suppression are still debatable. Objectives. The primary endpoint of this study was to identify predictors of the time to TSH recovery (TTR), in GD patients, at diagnosis and during ATDs treatment. The secondary endpoint was to compare the TTR between patients with GD and autonomous hyperthyroidism. Subjects and Methods. We retrospectively analyzed 109 newly diagnosed hyperthyroid patients (90 with GD and 19 with autonomous hyperthyroidism), consecutively evaluated in a tertiary center. The main features recorded were: TSH and thyroid hormone levels at diagnosis and follow-up visits, the TTR and the mean dose of ATDs/day. Results. There was no significant difference regarding the TTR between patients with GD and autonomous hyperthyroidism. In GD patients, age at diagnosis, gender, goiter size, smoking status, thyroid antibody titers and ophtalmopathy presence did not seem to influence the TTR. GD patients with higher FT3, TT3 at diagnosis and higher TT3 at the first visit after ATDs administration (V1) needed longer TTR, after adjusting for the mean dose of ATDs/day. FT3 at diagnosis and TT3 at V1 are significant predictors for the TTR in GD patients. Conclusions. The time to TSH recovery was not significantly different between patients with GD and autonomous hyperthyroidism. In GD patients, the time to TSH recovery is longer in patients with more severe T3 hyperthyroidism at diagnosis and at the first visit after ATDs administration.

Complete heart block associated with hyperthyroidism is infrequent, and the diagnosis of hyperthyroidism is usually not considered in the absence of tachycardia. A 55-year-old woman was admitted to our emergency clinic with dizziness and syncope attack. Her electrocardiogram showed complete heart block.\r\nHyperthyroidism had been diagnosed, and she had been treated with propylthiouracil as an anti-thyroid treatment 3 years ago, although she had not taken this drug during the last 2 months. Her thyroid function tests showed hyperthyroidism. Antithyroid treatment was started again. Her rhythm returned from complete atrioventricular block to normal sinus rhythm\r\non the seventh day of hospitalization.

Adipocytokines involved in inflammation and the acute phase responders have been found to be increased in the metabolic syndrome (MS). The aim of the study was to compare the ‘normal’ weight women’s fibrinogen, hsCRP, adiponectin, TNF-α, vascular cell adhesion molecule (VCAM) with obese patients with MS, and to evaluate the association between fibrinogen, hsCRP, adiponectin, TNF-α, VCAM and insulin resistance. The study included 52 obese women who met the criteria for MS defined as in 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) ATP III and 24 normal women. Serum concentrations of glucose (FBG), triglyceride, total and HDL-Cholesterol were determined by enzymatic procedures, serum insulin was measured by chemiluminescence, plasma levels of adiponectin, TNF-α and VCAM by Elisa, hsCRP by immunoturbimetric assay and fibrinogen by coagulation method. Measurements of insulin resistance were obtained using the homeostasis model assessment. Mean plasma levels of adiponectin, TNF-α, VCAM, fibrinogen and hsCRP were found 6.11±2.39 mg/ml, 3.10±3.30 pg/ml, 14.21±4.00 ng/ml, 375.49±49.67 mg/dl, 0.33±0.10 mg/dl in the obese with MS; 6.20±2.48 mg/ml, 3.01±1.68 pg/ml, 12.63±2.54 ng/ml, 304.06±49.52 mg/dl, 0.30±0.19 mg/dl in the normal women, respectively. Mean fasting insulin level and HOMA-IR were measured 13.80±6.32 mU/ml and 3.69±1.90 mU/ml, respectively in obese with MS. In normal women, fasting insulin level and HOMA-IR were measured 8.30±3.08 mU/ml and 1.49±0.37, respectively. Mean levels of adiponectin were positively correlated with mean TNF-α levels in the obese with MS (r=0.472, p=0.001). VCAM was negatively correlated with TNF-α levels (r=-0.301, p=0.038) in the obese with MS. This study demonstrated that TNF-α showed a positive association with adiponectin and a negative association with VCAM in the obese women with MS.