ACTA ENDOCRINOLOGICA (BUC)

Introduction. In our department the standard surgical procedure for multinodular\r\ngoiter used to be subtotal resection. Over the years, total thyroidectomy has progressively\r\nreplaced subtotal resections and is performed in most of our patients at present.\r\nPatients and Methods. In a prospective cohort, observational study, we assessed\r\nthe immediate surgical outcome in 742 consecutive patients with multinodular goiter\r\n(MNG), admitted for surgery and operated in our hospital. Of all patients, 664 were women\r\n(89.5%) and 78 men (11.5%), aged 15 to 85 years, mean (?SD) of 48 ?13.8 years. Pathology\r\nwas done on frozen and permanent sections. The complications directly related to surgery\r\nin subtotal thyroidectomy (STT) were compared to total thyroidectomy (TT) or near-total\r\nthyroidectomy (NTT) patients: temporary hypoparathyroidism, temporary RLN injury,\r\npermanent hypoparathyroidism and permanent RLN injury. The &#967;2 test (95% confidence\r\ninterval) was used and values of p<0.05 were considered significant.\r\nResults. There were no significant differences among the patients with SST for\r\nMNG, NTT or TT , and TT for recurrent MNG or completion thyroidectomy, with respect\r\nto temporary and permanent RLN injury. Significant differences were found for temporary\r\nhypoparathyroidism in STT for MNG (9 out of 361 patients, 2.45%) and NTT or TT for\r\nMNG (21 out of 266 cases, 7.89%) (p<0.01) and between STT for MNG (9 out of 361 cases,\r\n2.45%) and TT for recurrent MNG for completion thyroidectomy (8 out of 45 cases,\r\n17.77%) (p<0.01) and no difference between NTT or TT for MNG (21 out of 266 cases,\r\n7.89%) and TT for recurrent MNG or completion thyroidectomy (8 out of 45 cases, 17.77%)\r\n(p=0.11). We registered no permanent hypoparathyroidism in our patients.\r\nConclusions. Total thyroidectomy is now the preferred option for the management\r\nof patients with bilateral benign MNG. However, TT is associated with a considerable rate\r\nof complications, higher than of STT. In patients with bilateral MNG and no malignancy,\r\nSTT remains in our opinion, a valuable option.

Background. The COVID-19 pandemic hit the world in late 2019, and by 2020, everyone was affected. Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) belongs to the beta-coronavirus genre and uses the angiotensin-converting enzyme 2 (ACE2) receptor to penetrate cells. Thyroid cells are rich in such receptors. Therefore, this gland is frequently involved alongside other organs in the COVID-19 disease. Aim. To describe COVID-19 inflammation and, eventually, dysregulations of normal thyroid function in a case series of patients diagnosed in a tertiary endocrinology care centre. Patients and Methods. We described subacute thyroiditis cases related to COVID-19 infection or vaccination against SARS-CoV2 infection (clinical manifestations and evolution). We also reviewed the literature data regarding COVID-19 infection or vaccination implications in thyroid pathology. Results. The literature describes two types of thyroid involvement in SARS-CoV2 infection or vaccination: subacute thyroiditis (SAT) and non-thyroidal illness syndrome (NTIS). In our case series, 5 patients (3 males), aged 41-54 years, developed the classical clinical manifestation of SAT related to COVID-19 infection (3 patients, concomitantly to upper respiratory infection or a few weeks apart) or anti-SARS-CoV2 ARNm vaccination (1-2 weeks after the vaccine administration). Clinical, laboratory and imaging findings and the evolution (steroid anti-inflammatory treatment used in 4/5 cases) were unremarkable compared to other SAT etiologies. Conclusion. We found no differences between the ”typical” viral and post-COVID-19 SAT regarding clinical presentation, severity, response to treatment, and thyroid function alteration. The only remarkable difference is the association of SAT with anti-SARS-CoV2 ARNm vaccination

Context. We aimed to examine the factors affecting adverse gestational outcome in gestational diabetes (GDM) patients, who were grouped as obese and normal- weight, having only-diet, or insulin treatments. Subjects and Methods. The study included 373 patients, treated with diet or insulin. These patients were sub-grouped as obese and non-obese, and examined retrospectively. The variables affecting adverse gestational outcome in obese GDM patients having dietary and/ or insulin treatments were detected with multiple regression analysis. Results. The weight gained during pregnancy in the GDM group having insulin treatment was more than the one in only-diet treated GDM group (p=0.004). Pre-pregnancy body mass index, the weight gained during pregnancy, hemoglobin A1C levels in the second and third trimesters, caesarian rates were higher in the insulin-treated obese patients than in the other groups (p<0.001). The odds ratio for fasting blood glucose level in insulin-treated obese GDM group was 1.081 (95% CI =1.004 - 1.163) (p=0.039); and it was 0.982 (95% CI =0.924 - 1.002) (p=0.048) for the weight gained during pregnancy, in only-diet treated obese GDM patients. Conclusion. The control of weight gained during pregnancy, and of fasting blood glucose levels in obese patients having GDM, is important to decrease adverse gestational outcome.

Aims. In August 2015, FDA published a black box declaring that DPP-4 inhibitors may cause severe joint pains. The impact on autoimmunity marker positivity of these drugs has not been comprehensively evaluated. We compared the incidence of arthritis/arthralgia in patients with T2DM who were using DPP-4 inhibitors and patients who were not using. Methods. A number of 93 DPP-4 inhibitor users and 107 non-users were included into the study. Arthritis/ arthralgia were found in 41 of 93 (44.1%) DPP-4 inhibitor users and in 19 of 107 (17.8%) non-users (p<0.05). Results. No inflammatory rheumatological condition was identified in 27 of 41 (65.9%) patients in DPP-4 inhibitor user group as well as in 13 of 19 (68.4%) patients in non-user group (p>0.05). After adjusting for gender the incidence for arthritis/arthralgia was significantly increased in the DPP-4 inhibitor user group (p value for any DPP-inhibitor <0.05). There was 3.77 times increased risk for arthritis/arthralgia in the DPP-4 inhibitor using group (p value= 0.001) and this risk increases 2.43 times for each year of DPP-4 inhibitor usage. Conclusions. Arthritis/arthralgia were more common among T2DM patients who were using DPP-4 inhibitors compared to non-users, but the seropositivity did not differ between DPP-4 inhibitor users and non-users.

Context. Diabetes is a serious public health problem that is increasing worldwide. Objectives. The aim of this study is to evaluate acceptance of the illness, emotional distress, depression and quality of life in individuals with type 2 diabetes mellitus. Subjects and Methods. This study was conducted in 145 individuals with type 2 diabetes mellitus, 73 males (50.3%) and 72 females (49.7%), ranging in age from 20 to 65 years old. Research data were collected using the face-to-face interview technique by the researchers. The Acceptance of Illness Scale for the determination of individuals’ acceptance of the illness, Problem Areas in Diabetes Scale for emotional distress, Beck Depression Inventory for depression and Short Form-36 scales for quality of life was used. Results. The mean score of individuals’ Acceptance of Illness Scale was 30.2±5.62. Compared to women, men had lower emotional distress, depression levels (p<0.05), higher physical, mental quality of life (p<0.001). Correlations among acceptance of illness, emotional distress, depression and quality of life were found to be significant (p<0.05). Also, models of multiple linear regression analysis were statistically significant (p=0.000). Conclusions. The main goal in the treatment of diabetes should be to eliminate complaints in patients, to reduce, prevent or delay the development of complications, to increase the quality of life, to ensure that the individual has a physically, emotionally, spiritually and mentally regular life in addition to metabolic control. For this reason, it is beneficial to carry out the treatment with a multidisciplinary approach in type 2 diabetes mellitus.

Introduction. Antigonadotropic effect of melatonin in seasonally breeding rodents is due to the influence of this indol on the reproductive axis hypothalamicpituitary-gonads, although it is known that melatonin has a negative effect on the hormonal function of the reproductive axis, and is unknown whether it can affect the fertility of male Wistar rats.\r\nAim. The objective of this study was to investigate the effects of melatonin application on the fertility of the male Wistar rat.\r\nMaterials and Methods. Sixteen male Wistar rats were used. Rats were divided into two groups, Control and the group of animals treated with melatonin 1mg/kg (M) injected i.p. daily for two months. The evaluation of fertility was\r\ndetermined by the number of pregnant female rats. In addition, it was quantified the number of spermatozoa and Leydig cells in the seminiferous tubules. After removing\r\nthe treatment for two months, the experiments were repeated, to determine the possible recovery.\r\nResults. The results showed that rats treated with melatonin were able to impregnate only 25% of the mated female rats\r\n(p<0.05). In this group, the number of sperm decreased with a significance of p< 0.001 while the number of Leydig cells increased with respect to the control group with a significance of p< 0.001. After removing the treatment for two months, both the sperm and the Leydig cells were recovered at similar levels as the control group, while the fertility was not totally recovered in the group treated\r\nwith melatonin. These results suggest that the exogenous melatonin application (1mg/kg i.p) induces infertility.

Context. The intravenously administered selective α1 antagonist urapidil represents an alternative to phenoxybenzamine in the preoperative treatment of pheochromocytoma patients. Objective. The aim of the study was to investigate the blood pressure changes in pheochromocytoma patients with urapidil pretreatment with special regards to the need for interventions in order to estimate the safety of this treatment in a normal ward setting. Design. The medical records of all patients who underwent adrenalectomy for PCC were reviewed retrospectively. Systolic blood pressure values >180mmHg were defined as hypertensive episodes and systolic blood pressure values < 50mmHg as hypotensive episodes. Episodes of blood pressure instabilities were considered significant and recorded as intervention if they led to a direct action. Results. Twenty consecutive patients who received urapidil pretreatment were enrolled in this retrospective study. Preoperatively, a median of 9 blood pressure measurements per day have been performed on the ward. A total of 2 episodes of hypertension occurred, and 1 episode of hypotension has been recorded. In the period from 25-72 hours postoperatively the median number of blood pressure measurements was 5 per 24 hours. The blood pressure deviations led to a total of 3 interventions for hypertension in 1 (5%) patients and 5 interventions for hypotension in 3 (15%) patients. All interventions could be managed on the normal ward, without the need to transfer the patient to an ICU. Conclusions. Intravenous urapidil can safely be administered on a normal ward without putting patients at risk. Intensive monitoring beyond 24 hours postoperatively was not necessary, the blood pressure measurements during the shift on a normal ward were sufficient for maintaining patients’ safety.

Background. Ganglioneuroma (GN) is a rare, benign, neuroblastic tumor. It may arise from the sympathetic plexus or adrenal medulla. Its most common location is the posterior mediastinum (41.5%), while in approximately 21% of patients the tumor is located in the adrenal gland. Median age of adults at diagnosis is approximately 40 to 50 years of age. Since GN is most commonly asymptomatic, the diagnosis is usually accidental, i.e. when radiological examinations are performed due to other indications. This slow-growing tumor can reach a large size. In a small percentage of patients the tumor secretes catecholamines. We present five ganglioneuroma patients, who were hospitalized in our Department from 1993 through 2012. Their mean age was 31 years. In four cases the tumor was located in the adrenal gland and in one - extra-adrenally, which was revealed during surgery. In three out of five presented cases pathological hormone secretion by the tumor was confirmed in laboratory results.

Objective. Unilateral adrenalectomy (UA) is an alternative for treatment in bilateral adrenal incidentaloma (AI) to avoid possible long-term risks of bilateral adrenalectomy. In this study, we aimed to evaluate the effectiveness of UA in bilateral AI patients with subclinical hypercortisolemia (SH). Method. A total of 35 patients were included in this study. The patients were divided into two groups; those who underwent UA (n=27) and patients without adrenalectomy (PWA) (n=8). Hormone tests related to cortisol mechanism were reviewed to analyze results at the time of diagnosis compared to the latest available results to figure out any changes in cortisol mechanism and determine whether SH has recovered or not. Results. Median age of PWA group were higher compared to UA group (p=0.03). Median duration of followup in groups were similar (p=0.3). In the PWA group, none of the patients recovered from hypercortisolemia during their follow-up. In UA group 92.6% of the patients went into remission, whereas during follow-up 3.3% had recurred and another 3.3% were found to have post-adrenalectomy persistent SH. Patients in UA group had lower final cortisol level following dexamethasone suppression (p=0.003) and higher final adrenocorticotrophic hormone (ACTH) levels (p=0.001) than patients in PWA group. In UA group, final basal cortisol level (p=0.009) and final cortisol level after 1 mg dexamethasone suppression test (DST) (p=0.004) were lower than corresponding levels at the time of diagnosis. Discussion. Our study demonstrates unilateral adrenalectomy targeting the side with the larger lesion is an effective approach to reduce excess cortisol levels in bilateral AI patients with SH.