Endocrine Abstracts

Rationale: The Aldosterone:Renin ratio (ARR) is commonly used for patients fulfilling screening criteria for primary hyperaldosteronism (PA), followed by confirmatory testing. Reference intervals for interpretation of the ARR vary in accordance with local population and assay 1. While ARR provides high sensitivity for PA, this is compromised by low specificity, further compounded by medication interference. However, additional variables may improve the specificity of ARR as a ...

Background: The diagnosis of hypocortisolism is challenging in hemodialysis (HD) patients due to shared clinical features between renal failure and cortisol deficiency. We hypothesize that in a significant percentage of HD patients we miss cortisol deficiency.Methods: A prospective cohort of 56 end stage kidney disease patients on maintenance HD treatment (mean age 65.3±13.1, females 80 %) was studied. Low dose (1 mg) adrenocorticotropic hormone (AC...

Background: Excess mortality after hip fracture remains a problem of public health concern. Until present, for Romania no data is available regarding long term mortality rate and excess mortality after hip fracture. We aimed to evaluate the mortality rate 3 years after hip fracture and also standardized mortality rates of osteoporotic hip fracture in the capital city of Romania and suburban area.Methods: we collected data from over 98 % of fractures admi...

Introduction: Normocalcemic Primary Hyperparathyroidism is today considered a variant of Primary Hyperparathyroidism. It is characterized by persistently normal calcium levels and increased levels of parathyroid hormone, after the exclusion of other causes of secondary hyperparathyroidism. We aimed to compare clinical, biochemical and imaging data from patients with normocalcemic and hypercalcemic primary hyperparathyroidism. Methods: This is a retrospec...

Glycogen Hepatopathy (GH) was initially described in 1930 by Pierre Mauriac. 90 years later, GH remains underrecognized in adults. The clinical or radiological characterization of GH is difficult, further compounded by lack of widespread literature. We present two cases of GH characterized by recurrent lactatemia and transient liver function and radiological abnormalities.• 19 years old male with Type 1 diabetes admitted with nausea and vomiting. pH...

Introduction: The gut microbiota plays an important role in host metabolism, immunity, digestibility and even a behavior. Candida spec. is common resident of the gastrointestinal tract and integral part of the microbiota. Number of 101 to 103 fungal cells per g stool are considered as normal range. However, when mucosal surface is disrupted or host immunity is compromised, life-threatening invasive infection can ensue.Objec...

Polyglandular autoimmune syndrome (PAS) is characterised by the coexistence of two or more autoimmune mediated disorders. While the pathophysiology remains poorly understood, environmental triggers and genetic susceptibility are thought to contribute to the dysregulated immune response. PAS has been classified into three main subgroups: Type 1 is seen in the paediatric population while types 2 and 3 are found in adults with autoimmune thyroid disease and insulin-requiring diab...

Background: Immune checkpoint inhibitors are now commonly used in melanoma, renal cell carcinoma and non-small cell lung cancers. Patients on immune check point inhibitors experience at least one type of immune related adverse event(irAEs) which can occur even after discontinuation of therapy. Endocrine toxicities are commonly reported irAE′s and tend to be irreversible. The most frequently recognized endocrine complications include thyroid dysfunction (30%) hypophysitis...

Background: Central diabetes insipidus (cDI), a rare neuroendocrine condition affecting 1 in 25.000, is characterized by deficiency of arginine vasopressin. Data about treatment-related side effects, psychological co-morbidities, and incidence of wrong management due to confusion with diabetes mellitus are scarce and limited to small studies or case series. Furthermore, increasing interest has arisen on a potential need for re-naming the condition.<p class="abstex...

Acromegaly is a rare disease usually diagnosed late in disease evolution. It implies for skeletal changes of most flat bones including those of the skull. Consequently, a progressive facial disfiguration occurs at slow velocity of irreversible nature. Even after curation most of these changes stay for the whole life of the patient.Aim: to study the potential relationship between disfiguring facial modifications and psychosocial and Quality of Life (QoL) ...

Background: Adrenocorticotropic hormone (ACTH)-producing pituitary adenoma is the most common cause of endogenous Cushing syndrome (CS), but the relative proportion of adrenal causes of CS is rising. Limited data are available on the clinical manifestations and cause of CS in older women.Objective: Determine the clinical presentation, biochemical profile, and cause of CS in women 65 years of age and older, compared with younger patients with CS.<p cl...

Background: Although papillary thyroid carcinoma (PTC) is considered to have an excellent prognosis, some more aggressive variants have been identified that show reduced overall survival rates. Besides from the diffuse sclerosing, tall cell, columnar cell, and solid variant, the hobnail variant was newly recognized as one of these aggressive forms, affecting recurrence, metastasis, and overall survival rates.Methods: We performed a systematic review and ...

The risk of malignancy in thyroid nodules correlates with the presence of ultrasound features. In adults, ultrasound risk-classification systems have been proposed to indicate the need for further invasive diagnosis. Furthermore, elastography has been shown to support differential diagnosis of thyroid nodules. The purpose of our study was to assess the application of the American Thyroid Association (ATA) and British Thyroid Association (BTA) ultrasound risk-classification sys...

Background: Tyrosine kinase inhibitors (TKI) are a chemotherapeutic group which include drugs known to cause thyroid dysfunction such as axitinib, imatinib, pazopanib, sorafenib, and sunitinib. However, reports of TKI-Ibrutinib causing thyroid dysfunction are scarce. Although several hypotheses have been proposed to explain TKI-associated thyroid dysfunction there is no clear guidance on how to manage this situation.Case: 86-year-old lady was referred to...

Background: Diagnosis of secondary adrenal insufficiency (SAI) during pregnancy is challenging due to physiological adaptations and progressive increase of cortisol level throughout the pregnancy (1). The 250-mg standard ACTH stimulation test (CST) is recommended for evaluation of adrenal hypofunction in pregnancy however, measurement of serum cortisol (SC) maybe misleading in patients with partial SAI. Furthermore, utility of salivary free cortisol (SaFC) (2) and serum DHEA-s...

Backgorund: Adrenal incidentalomas (AI) are lesions discovered incidentally on imaging without clinical symptoms or examination findings. AI can produce hormones in 5-30% of cases. Autonomic cortisol secretion (ACS) is the most common of these. Although ACS is asymptomatic, it increases the risk of metabolic disorders.Methods: Patients aged<18 years with adrenal adenoma and upper abdominal MRI who presented and were examined in the endocrinology outp...

Introduction: Primary hyperparathyroidism (PHPT) is an endocrine condition in which autonomous excessive secretion of parathyroid hormone (PTH) results in hypercalcaemia. In approximately 80% of cases the aetiology is due to a single parathyroid adenoma, the remainder are due to hyperplasia of more than one gland. Familial Hypocalciuric Hypercalcaemia (FHH) is an autosomal dominant, inactivating mutation of the calcium-sensing receptor, causing a right-shift in the concentrati...

Introduction: Oral semaglutide has been available in the Spanish market since November 2021. This new formulation has broken the self-injection barrier, and may enhance patient satisfaction.Methods: Retrospective review of the patients′ records and presential or telephonic interviews. All patients expressed their consent for the anonymous processing of their data. Numeric data are given as mean + s.d; paired t-test was used for comparison. Satisfac...

Introduction: Oral semaglutide (Rybelsus; Novo Nordisk) is the first glucagon-like peptide-1 receptor agonist (GLP-1 RA) developed for oral administration for the treatment of type 2 diabetes (T2D), and it has been approved by the US Food and Drug Administration and the European Medicines Agency. The efficacy and safety of oral semaglutide were assessed in the (PIONEER) program.Aim: The purpose of this study was to investigate the initial patterns of rou...

Background: Obesity (BMI< 30 kg/m2) is a chronic and progressive disease, that is associated with many co-morbidities such as cardiovascular and psychiatric diseases, cancer, and arthritis. Lifestyle interventions are the cornerstone of obesity treatment, but when ineffective, anti-obesity pharmacotherapy could be added. In recent years, several anti-obesity agents have been approved, such as the glucagon-like peptide -1 (GLP-1) analogue liraglutide. Liraglutide...

Background and aims: The most outstanding cardioprotective potential has been demonstrated for GLP-1 receptor agonists (GLP-1RA) and SGLT-2 inhibitors (SGLT-2i). But only long-acting GLP-1RA dulaglutide (DULA) and semaglutide decrease stroke incidence, while data concerning the influence of any drug on stroke severity are lack. At the same time, ischemic stroke remains one of the leading causes of death in type 2 diabetes mellitus (DM2). The aim of our study was to investigate...

Suppression of Cytokine Signalling-3 (SOCS-3) modulates the inflammatory pathways responsible for vascular stability by playing a role in inflammatory pathway. It acts by inhibiting the activation of Janus kinase-signal transducer and activating of transcription (JAK-STAT) pathway to transmit their information into the cell nucleus. Therefore, this study aimed to estimate SOCS-3 levels in 2 nd trimester pregnant females and correlate it with blood pressure. A case control stud...

Background: Mammosomatotroph cell adenoma is rare, accounting for fewer than 2% of all pituitary adenomas and about 8% of tumors associated with acromegaly. A variety of adenomas may present with clinical signs and symptoms of GH hypersecretion including pure GH cell adenomas, mixed GH and prolactin cell adenomas, and monomorphous adenomas with primitive cells able to secrete GH and prolactin including the acidophilic stem cell adenoma and the mammosomatotroph cell adenoma. He...

Objective: To study time-dependent changes in the prevalence and patient characteristics of acromegaly, as well as to access the impact of changes in treatment on disease control.Methods: A total of 107 patients with acromegaly were identified by healthcare registries and subsequently validated by patient chart review over a three-decade period (1992-2021).Results: The prevalence of acromegaly significantly increased throughout the...

Background: Alström Syndrome (ALMS, OMIM 203800) is an ultra-rare disease caused by autosomal recessive mutations of the ALMS1 gene (2p13). ALMS is characterized by double sensory impairment and systemic comorbidities, including hyperandrogenism in female patients. Fertility issue and conception have not been systematically studied.Case: This case report describes the pregnancy and birth by an ALMS patient with mild phenotype, characterized...

Introduction: Goiter means that the thyroid gland is larger than the normal size for the patient’s age and gender. Some of the causes of goiter are iodine deficiency, thyroid nodules, Graves’ disease(GD). Goiter, hyperthyroidism, ophthalmopathy and dermopathy can be seen in GD. Compression symptoms due to goiter (dyspnea, dysphagia, superior vena cava syndrome) are also seen. Here, we will present a case of GD with superior vena cava syndrome.C...

Introduction: The risk of malignancy in thyroid nodules is reported by the Bethesda system by performing fine needle aspiration biopsy (FNAB). Atypia of undetermined significance(AUS) or follicular lesion of undetermined significance(FLUS)(Bethesda 3) and suspicious for a follicular neoplasm (Bethesda 4) create uncertainty about treatment and follow-up. Molecular tests, ultrasonographic features of the nodules, and calcitonin level help us for this uncertainty. Here, we will p...

Introduction: Myxedematous coma is a rare endocrine emergency that settles in the absence of appropriate treatment for hypothyroidism for a long period. The severe and chronic reduction of serum thyroid hormones culminates in the insufficiency of compensatory mechanisms that maintain the physiological homeostasis of the organism. The clinical condition is severe, commonly associated with hypoxemia, hypercapnia, hypothermia, reduced cardiac output, and altered mental status.</p...

Introduction: Polymorphisms of the glucocorticoid (NR3C1) and mineralocorticoid receptor (NR3C2) have been linked to the regulation of HPA-axis and to glucocorticoid sensitivity. We investigated whether NR3C1 and NR3C2 polymorphisms correlate with the occurence of adrenal crises (AC) in patients with primary adrenal insufficiency (PAI).Material and methods: We investigated 100 patients with PAI (70% women, mean age 51±15 years). DNA was extracted fr...

Background: Adrenal insufficiency (AI) is can be often under recognised condition in the clinical practise which can potentially result in adrenal crisis or even death if not treated properly. Identification of patients who are at risk of developing AI is important in order to take appropriate steps in minimising unwanted incidents. Objectives: Study aims to assess whether we identify patients who are at risk of AI and take recommended precautions.<p...

Introduction: Pheochromocytomas and paraganglioma are neuroendocrine tumors that arise from the chromaffin cells of the adrenal medulla or originate from the autonomic nerve ganglia. Hypertension in patients with PPGL is the most frequent symptom and can be responsible of lethal cardiovascular complications. The aim of our work is to describe the clinical characteristics of hypertension in PPGL, the treatment and the outcomes after surgical treatment.Mat...

Some hematologic malignancies might increase the risk of fractures due to intrinsic factors of the disease but also because of the treatment with steroids or chemotherapy. The direct impact of novel targeted agents on the development of osteoporosis in these patients has not been recognized yet. A 64-years old female patient with B-cell chronic lymphocytic leukemia (B-CLL) has been followed for four years with no other comorbidities. In order to measure the burden of the disea...

The lipodystrophic syndromes are a heterogeneous group of congenital or acquired disorders characterized by either complete or partial lack of adipose tissue with the apparent accumulation of fat in other regions of the body. Their prevalence is low and ranges from 1:200000/500000 and they usually suffer metabolic abnormalities associated with the abnormal distributition of fat such as severe insulin resistance with acantosis and diabetes, progressive liver disease along with ...

Aim: To evaluate adiponectin and resistin levels and their relationship with various biochemical and metabolic and atherogenic parameters markers, as well as their correlation, and to investigate its contribution in pathogenesis of insulin resistance in cohort women with PCOS and of insulin resistance as well as in non-insulin resistant women with PCOS. Methods: This study was designed as a cross-sectional and involves 80 premenopausal women. Of these patients, 63 females have...

Aim: To compare the IGF-1, metabolic and clinical parameters among the ultrasonographically classified NAFLD groups, to examine the effect of weight loss on metabolic parameters and determine the factors that may predict the NAFLD severity in morbidly obese patients who underwent bariatric surgery.Method: This descriptive cross-sectional study was conducted in 316 morbidly obese patients (250 females, 66 males). The data of patients before and 1st year a...

Introduction: Hypopituitarism due to Sheehan′s syndrome is a rare complication and its diagnosis is often overlooked. The vast majority of people with hypothyroidism have primary hypothyroidism, often due to Hashimoto’s thyroiditis. Coexistence of hypopituitarism and primary hypothyroidism, may accelerate clinical manifestations, mainly those associated with hypothyroidism. Hashimoto′s Thyroiditis with concomitant hypopituitarism is rare but has been described...

A 36 years of old patient was admitted to the intensive care unit of cardiology when he experienced palpitations and orthopnea. The patient’s complaints started about 2 years ago as syncope and sudden shortness of breath. Thorax CT showed pleural effusion and increased cardiothoracic index. Findings on ECHO were : Ejection fraction 35%, severe mitral regurgitation and global hypokinesia. Coronary angiogram showed a fibrocalcific plaque noted in in the distal LAD. The pati...

Prostate cancer (PCa) represents the most diagnosed tumour pathology in developed countries among men population. The main pharmacological approach to treat this pathology is based on the blockade of the androgen receptor signalling pathway, commonly known as androgen-deprivation therapy. However, some of the patients does no longer respond to this therapy, therefore developing castration-resistant prostate cancer (CRPC), the most aggressive phenotype of this pathology, which ...

Introduction: The treatment of thyroid diseases with thionamides can cause agranulocytosis a potentially fatal side effect. The manifestations resulting from such a condition include, in most cases, infections that, if not treated immediately, have a high risk of septicemia. Therefore, the clinical presentation includes fever of unknown origin and infections such as pneumonia, tonsillitis, and abscesses. Most patients who do not receive immediate medical intervention progress ...

Background: Thyroid autoimmunity is the most prevalent autoimmune disorder among women of reproductive age and has been linked to pregnancy loss. In recurrent pregnancy loss (RPL), couples suffer several consecutive losses resulting in physical as well as psychological strains. Thyroid autoimmunity has been suggested as a risk factor in RPL, but most studies have focused on thyroid peroxidase antibodies (TPOAbs), not taking into account the presence of thyroglobulin antibodies...

Graves’s disease is the most common type of autoimmune hyperthyroidism. Numerous studies indicate different factors contributing to the onset of the disease. Despite years of research, the exact pathomechanism of Graves’ disease still remains unresolved, especially in the context of immune response. B cells can play a dual role in autoimmune reactions, on the one hand, as a source of autoantibody mainly targeted in the thyroid hormone receptor (TSHR) and, on the othe...