The International Journal of Romanian Society of Endocrinology / Registered in 1938

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  • General Endocrinology

    Ursu HI, Podia-Igna C., Delia C.E., Toma G.M., Goran D., Galoiu S., Niculescu D.A., Giurgiu D., Gheorghiu M.L. , Anca IA

    Iodine Status after a Decade of Universal Salt Iodization in Romania: A Bicentric Study in Urban Areas

    Acta Endo (Buc) 2014 10(1): 9-20 doi: 10.4183/aeb.2014.9

    Objective. To assess in a bicentric study the current iodine status of schoolchildren, ten years after implementation of the universal salt iodization (USI) in Romania. Subjects and methods. 102 children from 2 towns, aged between 6 and 11 years, were included in the study group: 66 children from Sibiu, a previously endemic area for iodine deficiency disorders and 36 children from Bucharest, a previously borderline iodine intake area. Body mass index (BMI), total body surface area (BSA), median urinary iodine concentration (UIC) and prevalence of goiter were evaluated. Thyroid volume was measured by ultrasonography. The study was approved by the Local Ethics Committee. An informed consent from the parents was obtained. Results. From the 102 schoolchildren in the study group, 59 were girls and 43 were boys. Median UIC in the total number of samples was 175.2 mcg/L, reflecting a sufficient iodine intake, with statistically significant differences between the two urban regions. The median UIC was 187.35 mcg/L in the Sibiu subgroup and 160.2 mcg/L in the Bucharest subgroup (p < 0.001). The total percentage of goiter in the studied subjects was 5.88%. Percentage of goiter, determined by adjusting ultrasound thyroid volume to sex and BSA, was 1.51% in Sibiu and 13.88% in Bucharest, a statistically significant difference (p = 0.011). None of the subjects showed ultrasonographic pattern suggestive of Hashimoto thyroiditis or macronodules. There was no statistically significant difference between the percentages of overweight or obesity in the two subgroups. Conclusions. Ten years after implementation of USI in Romania, a bicentric study suggests that our country is iodine sufficient in urban areas. In order to prevent recurrence of mild iodine deficiency in schoolchildren, a persistent surveillance, use of sustainable measures and public awareness are required. Recurrence of mild iodine deficiency should be avoided, because even mild iodine deficiency impairs cognition in children.
  • Endocrine Care

    Aslan A, Sancak S, Aslan M, Ayaz E, Inan I, Ozkanli SS, Alimoglu O, Yikilmaz A

    Diagnostic Value of Duplex Doppler Ultrasound Parameters in Papillary Thyroid Carcinoma

    Acta Endo (Buc) 2018 14(1): 43-48 doi: 10.4183/aeb.2018.43

    Context. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer due to its high fibrotic content; it can affect the blood flow resistance. Objective. To introduce duplex Doppler ultrasonography (DDUS) parameters of papillary thyroid carcinoma (PTC) and their correlation with size. Design. The study was designed as a prospective study. Subjects and Methods. Thyroid nodules of the patients who were already scheduled for thyroid surgery either for malignant thyroid nodules or multinodular goiter were evaluated for DDUS parameters. Size, systolic to diastolic flow velocity (S/D) ratio, pulsatility index (PI), and resistive index (RI) of each nodule were recorded. Nodules were diagnosed as PTC or benign nodules based on histopathology. DDUS parameters were compared between PTCs versus benign nodules and micro PTCs (≤ 10 mm) versus large PTCs (> 10 mm). A correlation analysis was performed between the size and DDUS parameters. Results. 140 thyroid nodules (30 PTCs, 110 benign nodules) were obtained. The mean S/D ratio, PI, and RI values were significantly higher in PTC than in benign nodules (p values were 0.0001, 0.0003, and 0.0001 respectively). The optimal cut-off values of S/D (0.732), PI (0.732), and RI (0.738) had accuracy rates of 71%, 69%, and 69%, respectively. There was no statistically significant difference between micro PTC and large PTC with regards to DDUS parameters. The size and DDUS parameters of PTC showed no significant correlation. Conclusions. PTC has a high resistive flow pattern regardless of its size; however the clinical utility of DDUS to differentiate a PTC from benign nodule is limited.
  • Case Report

    Stanescu Popp A, Anca I, Bica V, Ionesti C, Alexe G

    Association of celiac disease and Turner syndrome

    Acta Endo (Buc) 2007 3(1): 93-100 doi: 10.4183/aeb.2007.93

    Turner syndrome is one of the genetic disorders studied on their association with celiac disease. We present a 27 year old female with an association of Turner syndrome and celiac disease. Gluten intolerance presenting with atypical extraintestinal symptoms (recurrent aphthous stomatitis, iron-deficient anemia, short-stature) was confirmed by intestinal biopsy showing flat small bowel mucosa (Marsh IIIc lesion) and a peripheral lymphocyte karyotype analysis revealed a Turner syndrome determined by isochromosome 46,X,i (Xq) structural abnormality. Our patient fits perfect into this variant of Turner&#8217;s Syndrome presenting at least one autoimmune disorder (celiac disease) and hearing loss. Her clinical, biological and immunological disturbances caused by two irreversible disorders have a poor outcome in the absence of gluten-free diet associated with adequate endocrinologic treatment and need sustained long-term follow - up for a good quality of life.
  • Case Report

    Sancak S, Altun H., Aydin H., Tukun A. , Mantoglu B., Ender O., Karip B., Okuducu M., Baskent A., Alp T., Memisoglu K

    Bilateral Adrenal Myelolipoma in a 46 XX DSD patient with Congenital Adrenal Hyperplasia due to 21-hydroxylase Deficiency. case report

    Acta Endo (Buc) 2013 9(1): 109-119 doi: 10.4183/aeb.2013.109

    Increased frequency of adrenal tumours and adrenal myelolipoma has been reported in patients with 21-hydroxylase deficiency (21-OHD). Adrenal myelolipoma is an uncommon, benign, biochemically non-functioning tumor and occasionally reported in association with endocrine disorders. Diagnosis of myelolipomas is based on imaging with ultrasonography, CT or MRI being effective in more than 90% of cases. We present a 34-year-old man with massive bilateral adrenal masses which was detected on computed tomography and was diagnosed as 21-hydroxylase deficiency (21-OHD) based on biochemical findings. Computerized tomography of the abdomen demonstrated bilaterally very low-density adrenal masses (16x28 mm on the right side and 91x88 and 33x30 mm on the left side) consistent with adrenal myelolipomas. Since myelolipomas are considered as benign tumors, he was not operated. Tumor size did not increase during two year follow-up periods. It is recommended to the physicians to be aware of increased frequency of benign adrenal tumors that occur frequently in patients with 21-OHD. Untreated CAH with prolonged excessive ACTH stimulation might contribute to the growth of adrenal masses. CAH should always be ruled out in incidentally detected adrenal masses to avoid unnecessary surgical procedures.
  • Endocrine Care

    Branisteanu DD, Bottermann P, Zbranca E, Mogos V

    Sunlight exposure and vitamin D supplementation at the institutionalized elderly - effects on calcium and bone metabolism

    Acta Endo (Buc) 2007 3(2): 169-178 doi: 10.4183/aeb.2007.169

    Aims: we wanted to check the importance of sunlight exposure and vitamin D supplementation in reverting secondary hyperparathyroidism at IIIrd age institutionalized patients.\r\nDesign: cross-sectional study of calcium and bone metabolism in a group of 123 institutionalized IIIrd age volunteers after winter period, followed by a prospective double blind placebo-controlled study of effects upon calcium and bone metabolism, serum 25OHD3, 1,25(OH)2D3 and PTH levels of daily sunlight exposure during the summer months, with or without vitamin D supplementation (2000 IU 25OH-D3 po, daily). The study was performed on volunteers from the Elderly Resting House of Copou,\r\nIasi, Romania. 25OH-D3 was measured by an inhouse RIA technique. 1,25(OH)2D3 was measured by HPLC, serum calcium by photocolorimetry, bone alkaline phosphatase by immunoenzymatic technique, whereas serum PTH and urinary deoxypyridinoline (DPD) were measured by IRMA. Data was compared using Student&#8217;s t test and correlation analysis (R2). Almost all volunteers (93.5%) had low 25OH-D3 values, but normal or even increased levels of the active hormone, 1,25(OH)2D3. High PTH was found in 41 cases (33.3%), of which three were primary hyperparathyroidism, whereas the others had low or low-normal calcium levels (secondary hyperparathyroidism). More than half of the cases had high DPD levels, suggesting high bone turnover. Bone turnover parameters were higher in females than in males (p<0.05). A positive correlation between PTH and urinary DPD was noticed (R2=0.351). We further supplemented the vitamin D intake in 42 volunteers with a daily dose of 2000 IU of 25-OHD3 for three months in the summer period, whereas other 42 volunteers received placebo (vitamin B). Normalization of 25-OHD3 levels was seen in both vitamin D and placebo-treated sun-exposed groups. A more significant increase in 25OHD3, and also of 1,25(OH)2D3 at the upper limit of normal was however observed in the vitamin D-treated group. Normalization of serum PTH, but not of turnover parameters was observed in both groups. Mild hypercalcemia and increase in serum creatinine were noticed in the vitamin D-treated group.\r\nConclusions: Secondary hyperparathyroidism might be of importance in high turnover bone loss at institutionalized IIIrd age patients. Women seem to be more at risk, possibly due to sex hormone depletion. PTH-induced 1&#945; hydroxylation in the elderly with undamaged kidney function partially compensates the paucity of vitamin D substrate, by normalizing active hormone levels. Mild sun exposure at institutionalized patients increases skin resources of vitamin D, normalizing 25OH-D3 levels and reverting secondary hyperparathyroidism. Oral vitamin D supplementation added to sunlight exposure should be done with caution, since it might be accompanied in certain patients by hypercalcemic or nephrotoxic effects at doses higher than 2000 IU/day.
  • Case Report

    Anca IA, Brezan F, Stanescu-Popp A, Iordachescu M, Acs B, Terteliu M

    An unusual association: neonatal rickets and calcinosis cutis

    Acta Endo (Buc) 2008 4(2): 195-202 doi: 10.4183/aeb.2008.195

    We present the case of severe hypocalcaemia in a 5 weeks old baby, secondary to pre and postnatal vitamin D deficiency. The symptomatic hypocalcaemia led to several life threatening episodes of seizures. Following initial calcium gluconate infusion, multiple phospho-calcic deposits in the soft tissue and cerebral tissue were observed. A multifactorial etiology of calcinosis cutis was suggested by the association between infusion of high and repeated doses of calcium gluconate in a severely hypocalcaemic baby, with a low 25- hydroxyvitamin D3 level, associated to a renal and bone relative resistance to the high level of PTH. The aim of this report is to raise pediatric health care professionals awareness on the relatively rare entity known as calcinosis cutis.
  • Actualities in medicine

    Anca FA

    Molecular Pathways in the Endocrinology of Parturition

    Acta Endo (Buc) 2017 13(2): 254-256 doi: 10.4183/aeb.2017.254

    The entire complex process of labor is the central concern of obstetrics and premature labor poses a threat to the mother and fetus and represents a core medical and social issue. In this respect, understanding the mechanism of uterine contractions at a molecular level helps shed some light on possible future prevention and treatment. New research has emphasized the role of endocannabinoids by two metabolic pathways with final products that act as antagonists: prostaglandins and prostamides (prostaglandinethanolamides), but with competition on substrates and enzymes. Thus, the dominant pathway will be selected on account of cellular and tissue environment.
  • General Endocrinology

    Pop D, Zdrenghea D, Stanca L, Bodisz G, Petrovai D, Borz B

    Adiponectin and leptin levels correlate with body mass index and lipid fractions but not with disturbances of glucoe metabolism

    Acta Endo (Buc) 2009 5(3): 329-335 doi: 10.4183/aeb.2009.329

    Introduction. Considering the very important role of adiponectin and leptin in\r\natherogenesis, it is important to study their relationship with other important factors in\r\nestablishing the cardiometabolic risk: hyperglycemia and serum lipids.\r\nPatients and Methods. There were studied 79 subjects (s), aged 59? 9 years, divided\r\ninto 3 groups according to body mass index (BMI): group I with BMI<25 kg/m2 - 19 s,\r\ngroup II with BMI 25-30 kg/m2 - 30s, and group III with BMI >30 kg/m2 - 30 s. In all\r\nsubjects the plasmatic levels of adiponectin, leptin and other cardiometabolic risk factors:\r\nblood glucose, total cholesterol, triglycerides, high density cholesterol, low density\r\ncholesterol were measured.\r\nResults. Considering the values of adiponectin and leptin in the three groups,\r\nadiponectin was significantly increased (14355?9120.40 vs 5889.167?6278.963 ng/mL,\r\np=0.015) and leptin significantly decreased (7212?7428.45 vs 9235.81?10988.66 pg/mL,\r\np=0.03), in group I in comparison with group II+III. Adiponectin and leptin were not\r\nsignificantly different in subjects with fasting glucose less or more than 110 mg/dL and the\r\nsame insignificant difference was registered for both adipokines between diabetic and non\r\ndiabetic subjects. Considering the plasma lipid fractions, it was registered an inverse\r\nsignificant correlation between adiponectin and total cholesterol, respectively LDL\r\ncholesterol, and a positive correlation with HDL cholesterol; leptin was inversely correlated\r\nwith HDL cholesterol, but not with LDL cholesterol or total cholesterol.\r\nConclusion. In the present study, the plasmatic values of adipokines (adiponectin and\r\nleptin) were correlated only to the BMI values (obesity) and respectively to the lipidic\r\nfractions. No correlation was registered with diabetes or impaired fasting glucose.
  • Case Report

    Mogos V, Mogos S, Branisteanu DD, Onofriescu M, Cotea E, Tircoveanu E, Florea N, Zbranca E

    Primary hyperparathyroidism during pregnancy - case report

    Acta Endo (Buc) 2008 4(3): 337-343 doi: 10.4183/aeb.2008.337

    We present the case of a 28 year old pregnant primiparous woman, suspected of primary hyperparathyroidism due to hypercalcemia discovered by routine calcium assessment at 30 weeks of gestation. Diagnosis was strongly suggested by elevated serum calcium (15.2 mg/dL, normal range: 8.4-10.3 mg/dL), low serum phosphorus (0.55 mg/dL, normal range: 2.5-5 mg/dL) and increased urinary hydroxyproline excretion (118 mg/24h, normal range: 10- 40 mg/24h), suggesting high bone turnover and confirmed by coexistence of high levels of parathyroid hormone (PTH, 145 pg/mL, normal range 10-65 pg/mL). Neck ultrasound identified a solid nodule of 33x58x20.5 mm situated behind the inferior pole of a normal thyroid left lobe, suggestive for a solid parathyroid tumour located within the left inferior parathyroid gland. Medical treatment with furosemide and hydration decreased serum calcium level but failed to normalize it. After a 3 day preparation for lung maturation with dexamethasone (16 mg per day), successful adenomectomy was performed under local anaesthesia, without major intraoperative or postoperative events. The few uterine contractions were easily managed with papaverine and progesterone. Calcium levels immediately returned to normal after surgery. Our patient delivered a healthy newborn at 40 weeks by caesarean section. A DXA BMD assay performed after one year showed significant bone loss of the mother at radius level (T score of - 2.6).
  • Case Report

    Costan VV, Preda C, Bogdanici C, Trandafir D, Costan R, Vicol C, Moisii L, Zbranca E, Voroneanu M

    Surgical treatment in Graves ophthalmopathy - case report

    Acta Endo (Buc) 2008 4(3): 345-352 doi: 10.4183/aeb.2008.345

    Despite an adequate medical treatment of Graves ophthalmopathy (GO), sometimes surgery is required to establish accurate eye movement and avoid severe complications. We present such a woman with Basedow's disease and evolutive exophthalmia despite adequate medical approach. At the admission (2005) she had clinical signs of thyrotoxicosis, TSH = 0.1 mUI/L, FT4 = 4.2 ng/dl and antithyroperoxidase antibodies = 342 UI/ml. Proptosis was 26 mm at the right eye and 25 mm at the left one, with intraocular tension 20 mmHg and NO SPECS score 4. Treatment with methimazole (30 mg/day), propranolol (30 mg/day), and corticotherapy (Metilprednisolone, 3x1g/day iv), improved the hyperthyroidism but not the ocular signs. The euthyroidism was maintained with 5 mg Methimazole daily. In February 2006 a new pulse therapy with Metilprednisolone (1g/day iv 3 days) was started, followed by Prednisone 30 mg /day, without significant improvement of the ocular signs. In June 2006, TSH receptor antibodies were high, TRAb=16.3 U/l, with euthyroid status but evolutive proptosis. The MRI showed an increase of the volume of all intraorbital muscles, a decrease of the optic nerve diameter. The patient had progressive GO with photophobia, palpebral edema, hyperlacrimation and conjunctivitis. The surgical treatment was decided when the proptosis was 25 mm and the intraocular tension was 19 mm Hg for both eyes. The patient was submitted to orbital content decompression through lipectomy and osteotomy of the orbital floor. The postoperative follow-up was uneventful. Two years postsurgery, exophthalmometry was 17 mm at right eye and 18 at the left eye, with an intraocular tension of 13 mm Hg. The MRI showed normal intraorbital muscles and ocular globe; the bicanthal lines were anterior to the posterior pole of the ocular globe. The patient had no limitation of the eyes movements, photophobia or conjunctivitis and a significant esthetic improvement.