ACTA ENDOCRINOLOGICA (BUC)

Background. Dopamine agonists (DA) are first line treatment for prolactinomas. Optic chiasm herniation can rarely occur during therapy, while brain herniation is very uncommon. Case Reports. A 34 yo woman presented with headaches and vision changes. Prolactin (PRL) was 4300 ng/ mL. MRI showed a 4.5 cm pituitary adenoma with chiasm compression. After 3 months, PRL decreased to 201 ng/ mL while patient was taking CAB 0.75 mg twice a week. MRI showed ~30% tumor reduction with medial temporal lobe herniation and encephalocele. CAB was stopped and she underwent surgical debulking and encephalocele repair. Histopathology confirmed prolactin tumor. CAB 0.75 mg twice a week was resumed. A 50 yo man had incidental detection of a sellar mass after trauma. MRI showed 3.6 cm tumor with minimal contact of right optic nerve, and PRL 3,318 ng/ml. He received CAB 0.5mg twice a week with PRL improvement to 26 ng/mL after 1 month. After 2 months ophthalmology exam showed new left superotemporal depression. PRL was 68 ng/mL and MRI showed 35% mass reduction and new inferior displacement tethering of the chiasm. CAB dose was decreased to 0.25 mg twice a week. Conclusion. Our cases illustrate that rapid biochemical and radiographic response to DA therapy in large prolactinomas warrants close clinical and neuroophthalmologic follow-up. We recommend repeating the MRI 3 months after initiation of DA therapy or sooner in case of new mass effect manifestations. Decision regarding DA dose reduction or chiasmopexy for visual field deficits needs to be multi-disciplinary and on a case-to-case basis.

Background. Riedel thyroiditis is a rare, chronic inflammatory disease of the thyroid, characterized by a dense fibrosis that replaces normal thyroid parenchyma. In literature descriptions of individual cases of Riedel thyroiditis can be found. Case report. We present an euthyroid patient with multinodular goiter who was diagnosed with Riedel thyroiditis using pathology. Imaging diagnostic methods (Ultrasonography, X-ray computed tomography, Magnetic resonance imaging, Radionuclide imaging) or various tests of thyroid function cannot confirm the diagnosis of Riedel thyroiditis. Conclusion. Only level of IgG4 may be helpful for the diagnosis of Riedel thyroiditis, while pathology is used for its definitive confirmation.

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Background. The aim of the present study was to measure the effects of raloxifene on bone metabolism and strength in orchiectomized male rats. Materials/Methods. Forty-three 4-month-old Wistar albino male rats were used and divided into 3 groups as orchiectomy (ORCX; n=23), sham (n=15), and control (n=5). Raloxifene (10 mg/kg/day) and methylcellulose (0.5 mL/day, as a vehicle treatment) treatments were initiated 2 months after ORCX for 2 months, then the rats were sacrificed. The left femur and fourth lumbar vertebrae (LV4) were measured to assess the effects of the orchiectomy and the raloxifene treatment and maintenance regimens. Bone strength was assessed using a compression test for the vertebrae and a three-point bending test for the femurs (N/mm). Results. Raloxifene increased femoral and vertebral bone strength in osteoporotic rats, but this increase was not statistically significant. Bone strength was found to be 267.44±18.03 in the femurs of the ORCXraloxifene group and 246.32±49.37 in the femurs of the ORCX-C group (p>0.05). Vertebral bone strength was 147.78±09.51 in the ORCX-raloxifene group and 114.61±05.93 in ORCX-C group (p=0.488). Raloxifene also increased the femoral and vertebral bone density compared with the control group, but the change was not significant. While raloxifene significantly decreased the serum osteocalcin levels (p=0.007), it did not decrease the carboxyterminal cross-linking telopeptide of bone collagen (CTX) levels significantly (p=0.066). Conclusions. Raloxifene caused a statistically significant decrease in serum osteocalcin levels and a non-significant reduction in NTX levels in orchiectomized rats.

Adrenocortical tumors (ACT) are common malignancies of the cortex adrenal gland frequently non-functioning and benign. Differently, adrenocortical carcinoma (ACC) is a very rare neoplasia with an incidence of 0.7–2.0 cases per million people and an aggressive behaviour. Moreover ACC shows a poor prognosis with an estimated survival of 16-38%. Only surgery and the use of mitotane (sometime associated to standard chemotherapy) can represent a useful tool to fight against this malignancy, nonetheless ACC often metastasizes and recurs, decreasing considerably patient survival prospect. In the search of new potential tools to combat cancer, in the latest years omics works extended our knowledge on the ACC pathogenesis and made possible the investigation of novel ACC biomarkers. In this field of research, epigenetic studies identified a common signature in ACC, where the most altered miRNA found in ACC (miR-483-5p) seems now to represent a concrete biomarker to be used in the pre-operative diagnosis of ACC. A larger patient cohort is necessary to confirm this pivotal data: collaboration between scientific communities will be the key to determine the success of this fundamental discovery.

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Introduction. Thyroid hemiagenesis (TH) is a congenital developmental disorder. Most cases are euthyroid although hyperthyroidism, hypothyroidism, and malignancy may develop. We present a case of hemiagenesis with Graves’ disease (GD) and review the literature about the association. Case report. A 45-year-old female patient was admitted to the endocrinology department due to nausea and diarrhea. Her past medical history revealed hyperthyroidism diagnosed a year ago. On thyroid examination, right thyroid lobe was palpable, but left lobe and isthmus were not. Physical examination involving other organ systems was unremarkable except for fine tremor of the hands. Thyroid function tests revealed a high level of free T4 and T3 with a low serum TSH. Thyroid antibodies were all positive. Left lobe and isthmus were invisible on thyroid ultrasonography (US) and the right thyroid lobe measuring 44x18x12 mm was diffusely heterogeneous in echo texture. Thyroid scan using Technetium-99m showed increased homogeneous tracer uptake in the right lobe. The patient was diagnosed with TH and GD. Discussion. In case of unilateral increased uptake on scintiscan, GD with hemiagenesis must be kept in mind in the differential diagnosis of autonomous solitary adenoma, postinflammatory atrophy of thyroid in Hashimoto’s disease, focal or unilateral subacute thyroiditis, and primary or metastatic carcinoma. It is prudent to do thyroid ultrasound along with scintigram. US is a valuable tool for the quick diagnosis of TH and differential diagnosis from other causes.

Context. Literature shows that patients taking antipsychotic medication risk developing metabolic complications. Objective. The study aims to compare the presence of the metabolic syndrome (MS) and its components in outpatients treated with long acting injectable (LAI) olanzapine and risperidone. Design. A double-center study was performed on outpatients with psychosis, which were divided into two samples: one treated with olanzapine and another with risperidone. Subjects and Methods. The following data were analyzed: age, gender, severity of psychiatric symptoms, blood pressure, waist circumference, fasting blood glucose, lipid profile, tobacco use, medication, and time intervals related to psychosis duration (pre-LAI and LAI treatment). Results. The study included 77 patients with schizophrenia and schizoaffective disorder. MS was present in 45 (58.4%) patients. Subjects with MS and abdominal obesity had higher durations of psychosis and of LAI treatment. Patients with hypertension had a higher pre- LAI treatment interval. Risperidone was associated with higher rates of hypertension and higher values of abdominal circumference than olanzapine. Conclusions. The presence of MS is related to the duration of the psychosis and the time spent on LAI treatment with no differences between olanzapine and risperidone. Hypertension may be a consequence of age, disorder induced stress, or of treatment with risperidone.

Context. Thyroid fine-needle aspiration (FNA) cytology is the best tool for preoperative diagnosis of thyroid carcinoma; however, its learning curve is poorly described. Our aim was to assess the learning curve of a new thyroid FNA center involving unexperienced operator and pathologist. Methods. We retrieved from our tertiary endocrinology center database all thyroid FNA procedures done by a single operator (endocrinologist with no experience in FNA) between 2018 and 2021. Cytology was assessed by two pathologists with limited or no experience in thyroid cytology. We also got the corresponding sex, age, nodule diameter, EU-TIRADS score, Bethesda category and final pathology report. Results. There were 1872 FNA in 1618 patients. Proportion of Bethesda 1 nodules decreased significantly (p for trend=0.003) from 17% in the first 100 FNA procedures to 4% in the 401-500 group of procedures, and remained constant between 9% and 4% (p for trend=NS) for the rest of the study. Proportion of Bethesda 2 rose steady from 26% in the first 100 nodules to 80.1% in the last 241 nodules (p for trend<0.001). Indeterminate lesions (Bethesda 3 and 4) decreased significantly (p for trend=0.001) from 16% and 35% in the first 100 nodules to 2.5% and 5.8% in the last 241 lesions. Proportions of Bethesda 5+6 categories varied non-significantly over time. There were no time trends in the malignancy rate of surgically removed nodules. Conclusions. At least 300 procedures are needed to reach the standard performance. A steadily state for the whole center is obtained after about 500 procedures.