ACTA ENDOCRINOLOGICA (BUC)

Aim. To evaluate the diagnostic performance of radiomics features of two-dimensional (2D) and threedimensional (3D) ultrasound (US) in predicting extrathyroidal extension (ETE) status in papillary thyroid carcinoma (PTC). Patients and Methods. 2D and 3D thyroid ultrasound images of 72 PTC patients confirmed by pathology were retrospectively analyzed. The patients were assigned to ETE and non-ETE. The regions of interest (ROIs) were obtained manually. From these images, a larger number of radiomic features were automatically extracted. Lastly, the diagnostic abilities of the radiomics models and a radiologist were evaluated using receiver operating characteristic (ROC) analysis. We extracted 1693 texture features firstly. Results. The area under the ROC curve (AUC) of the radiologist was 0.65. For 2D US, the mean AUC of the three classifiers separately were: 0.744 for logistic regression (LR), 0.694 for multilayer perceptron (MLP), 0.733 for support vector machines (SVM). For 3D US they were 0.876 for LR, 0.825 for MLP, 0.867 for SVM. The diagnostic efficiency of the radiomics was better than radiologist. The LR model had favorable discriminate performance with higher area under the curve. Conclusion. Radiomics based on US image had the potential to preoperatively predict ETE. Radiomics based on 3D US images presented more advantages over radiomics based on 2D US images and radiologist.

Introduction. Life threatening heart disorders secondary to paediatric and adolescent hyperthyroidism are exceptional.\r\nAim. We aimed to study cardiothyreosis frequency and outcome in children and adolescents with hyperthyroidism diagnosed between 1980 and 2010.\r\nMaterial and methods. In this retrospective study we observed 160 clinical and biological hyperthyroidisms in children (≤ 16 years) and adolescents (16-20 years).\r\nResults. Among them four girls aged 3, 16, 17 and 18, without previous familial history of heart diseases, had congestive heart failure (2.5%) without rhythmic troubles. Symptoms of cardiac insufficiency were resistant to digitalis and diuretics, but after anti thyroid drugs, there was an integral restitution of heart function in three\r\ncases and a persistent mitral, aortic and tricuspid regurgitation in one case arguing for heart rheumatic disease prior to hyperthyroidism.\r\nConclusion. Heart failure secondary to thyroid hormones excess is extremely rare before age of 20. Among 160 paediatric and adolescent hyperthyroidisms seen in 30\r\nyears, four girls had life threatening congestive cardiac insufficiency (2.5%), but after euthyroidism, heart insufficiency disappeared totally in all cases which\r\npleaded for a direct action of thyroid hormones excess on heart function.

Prolactinomas are the largest pituitary tumours (PT) in males, but huge ones (defined arbitrarily as ≥ 8 cm in height) are exceptional. They are usually diagnosed after impotency, headaches and visual troubles. Other manifestations such as memory troubles, unconsciousness, meningitis, epilepsy, psychiatric disorders, and exophthalmos are unusual. We aimed to report two cases diagnosed after epistaxis. Case 1. A man, aged 38, suffering from chronic nasal bleeding and impotency was diagnosed with a huge prolactinoma [90x90x80 mm, PRL=3737 ng/mL (n<15)] invading the nasal cavity. Nasal biopsy confirmed PT with positivity to PRL antibodies. After dopamine agonists intake, PRL and tumour size were significantly reduced and nasal bleeding disappeared.Case 2. A male aged 29 was referred for a huge PT [PRL= 2586 ng/mL, tumour= 130x80x60 mm] diagnosed after epistaxis. Nasal endoscopy showed a bleeding greyish tumour whose immunostaining confirmed PT. Dopamine agonists stopped epistaxis after PT tumour reduction. Conclusion. Both cases suffered from epistaxis secondary to huge prolactinomas invading the nasal cavity. So, chronic nasal bleeding should be kept in mind as a possible sign of PT. Nasal biopsy should be kept in mind for diagnosis confirmation. Nasal invasion by PT can induce suppurative meningitis which is a life threatening condition, fortunately not observed in our cases.

Resistance to thyroid hormone (RTH) is an inherited disease transmitted in an autosomal dominant manner. The diagnosis is suspected when peripheral thyroid hormones are increased contrasting with normal or increased levels of thyroid stimulating hormone. Usually, people harboring the rare syndrome have few or no symptoms. However, in some patients signs of hyperthyroidism may be the revealing anomalies as in the following case: A 75 year-old woman was referred to our department for a benign adrenal incidentaloma. In her medical history she was treated for systemic hypertension and diabetes mellitus for 15 years. Clinical examination did not show any sign of adrenal secretion, but discovered rapid irregular cardiac rhythm with some hyperthyroidism features such as increased sweating and upper limbs and jaw tremor. Electrocardiogram showed atrial fibrillation. Hormonal assessment confirmed hyperthyroidism as FT4 levels were high (mean value: 30.2pmol/L (n= 9–23)), contrasting with non-suppressed TSH levels (13.8μU/mL (n = 0.2 – 4)). Cerebral magnetic resonance imaging was normal. Genetic testing revealed a new heterozygous mutation on exon 10 in the THRβ gene (c.1366T>G) compatible with RTH syndrome. Screening of her children showed the same hormonal profile in five out of ten. These results confirmed RTH and the familial character.

Aim. To explore the effects and underlying mechanisms of pioglitazone (pio) on insulin sensitivity in insulin-resistant KKAy mice. Methods. Sixteen eight-week-old male KKAy mice were randomly assigned to two groups based on body weight: an insulin resistance model group and a pioglitazone treatment group (hereafter referred to as the pio-group). Eight male C57BL/6J mice were used as an insulin resistance control group. Mice in all three groups were fed an AIN-93G diet, and pio was added to the diet in the pio-group. After twelve weeks of treatment, blood glucose, serum insulin, glucose tolerance, and insulin tolerance were measured. ELISA was used to determine adiponectin and leptin in serum. A real time PCR assay was used to detect the mRNA of adiponectin and leptin in epididymal adipose tissue. A Western blot assay was used to analyze protein expression and/ or phosphorylation levels of peroxisome proliferator activated receptor γ (PPARγ), insulin receptor substrate 1 (IRS1), and protein kinase B (PKB/AKT) in the liver and epididymal adipose tissue.Results. The results showed that Pio treatment may effectively reduce levels of blood glucose and serum insulin, improve insulin tolerance and glucose tolerance, increase serum adiponectin, decrease serum leptin, and enhance mRNA expression of adiponectin in epididymal adipose tissue. Furthermore, with pio treatment, protein expression of PPARγ and phosphorylation levels of IRS1 and AKT were increased in the liver and epididymal adipose tissue. Conclusion. These results suggested that Pio intervention may ameliorate insulin resistance and improve insulin sensitivity in KKAy mice, which may be due to an increase of PPARγ and further activation of the insulin signaling transduction pathway (IRS1 and AKT) in the liver and epididymal adipose tissue of KKAy mice.

We describe clinical features of women with extremely low bone density, and investigate secondary causes of osteoporosis. Our hypothesis was that this population would be enriched in identifiable causes of osteoporosis. We performed a retrospective review of medical records of all women seen at our university over 4 years with T-score on bone densitometry at/below -4 at any site. Historical and fracture details were abstracted. We considered a thorough work up to include Vitamin D, PTH, CBC, chemistry panel, cortisol, transglutaminase, myeloma screen, tryptase and 24-hour urine calcium. Results. 137 women were identified with T-score at/below -4. Percent identified as Asian was 26% (higher than local prevalence of 8%). Average BMI was 21.6 kg/ m2. Clearly identifiable causes of osteoporosis were noted in 57% (inflammatory disorder, glucocorticoid or antacid exposure, prolonged immobilization and alcoholism were most prevalent). Of the remainder, full work up was performed only in 8%. Endocrine consultation and white race predicted thoroughness of secondary work-up. Conclusion. Fragility fractures, leanness and Asian race were common in women with very low T-score. However, few new causes were identified. Underlying etiology was either immediately evident or inadequately studied, especially in minorities.

The role of osteocalcin in atherogenesis is unclear. We investigated the association between osteocalcin and carotid atherosclerosis in Chinese middle-aged and elderly male adults and further determined whether osteocalcin is independently associated with the carotid intima-media thickness (CIMT) in hyperglycemia subgroups. Subjects and methods. A total of 84 male participants (mean age, 59.13 years) were enrolled in groups of normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) according to the oral glucose tolerance test. A standard interview, anthropometric measurements and laboratory analyses were performed for each participant. Bilateral carotid intima–media thicknesses (CIMT) were measured using ultrasonography. The circulating osteocalcin was measured using quantitative enzyme immunoassay. Results. Both IGT and newly diagnosed T2DM groups had significantly lower osteocalcin levels compared with the NGT group (5.01 ± 0.68 μg/L, and 6.173 ± 0.68 ng/mL vs. 11.55 ± 0.57 μg/L, respectively). Multivariate linear stepwise regression analysis demonstrated that waisthip ratio(WHR) (standardized β = -0.408, P = 0.000), 2 hour plasma glucose after glucose load, (PPG) (standardized β = -0.235, P = 0.025), homeostasis model of assessment for insulin resistance index(HOMA-IR) (standardized β = -0.287, P = 0.004), and Glycosylated haemoglobin (HbA1c) (standardized β = -0.250, P = 0.015) were independently and inversely associated with serum osteocalcin in hyperglycemia subgroups; PPG(standardized β = -0.476, P = 0.015), osteocalcin(standardized β = -0.486, P = 0.001) were negatively associated with CIMT, while TG (standardized β = 0.647, P = 0.000) was positively associated with CIMT in T2DM. Conclusion. These results showed that osteocalcin is independently associated with carotid atherosclerosis in men with T2DM. It is tempting to suggest that osteocalcin may be implicated atherosclerosis.

Bardet Biedl syndrome (BBS) is a rare autosomal recessive disease, characterized by clinical and genetic heterogeneity. Many genes are involved. BBS seems to be\r\ndifferent from Lawrence Moon BBS, although they share some clinical symptoms. The main clinical signs are obesity, pigmentary retinopathy, kidney malformations, and hypogenitalism. Our aim is to report a case with typical\r\nretinis pigmentosa, hypergonadotrophic hypogonadism and cerebellum cyst. Case report. A man aged 18 was referred for obesity and blindness. His family history was marked by obesity and diabetes mellitus type II. His medical history began very soon, as he was born with polydactyly, then he became obese and had difficulty to learn and to see. His blindness was progressive, and his puberty was delayed.\r\nClinical and biological exams showed: severe android obesity (BMI = 40kg/m?, waist circumference = 130cm), pigmentary\r\nretinopathy, small testes with high FSH = 17 mU/mL (1-8), and normal LH = 6.13 mU/mL (0.6-12)], empty sellae, cerebellum cyst, renal malformations, and signs of chronic infections. He did not have any spasticity or ataxia.\r\nGenetic study was not done. Conclusion. In this case, all features argued for typical BBS, except for testicular\r\ninsufficiency which is classically described as hypogonadotrophic. Infections should be treated vigorously to avoid renal insufficiency.

Aim. The purpose of this study is to investigate the effect of self-monitoring of blood glucose (SMBG) on glycemic control in insulin-naive type 2 diabetic patients comparing SMBG plus self-regulatory behavioral education, and SMBG plus individual education. Methods. Participants with glycated hemoglobin A1C (HbA1C) of 7.5-12% were enrolled in this 24-week, prospective study. Forty-two and forty participants received SMBG plus selfregulatory behavioral education, and SMBG plus individual education, respectively. The glycemic and behavioral attitudes outcomes were evaluated. Results. The A1C level decreased in both groups, from 9.41± 1.7% to 7.84± 0.83% in the SMBG plus self-regulatory behavioral education and 9.62 ±1.08% to 9.09± 1.1% in the SMBG plus individual education. However, the postprandial glucose (PPG) level sustained more significant decreases from 277.1 ±80.1 to 175.7 ±53.9 mg/dL in the SMBG plus self-regulatory behavioral education, and from 261.2 ±80.5 to 221.6 ±41.2 mg/dL in the SMBG plus individual education. The frequency of PPG monitoring increased from 0.1 ± 0.81 to 3.46 ± 2.81 times/week in SMBG plus self-regulatory behavioral education, whereas it increased from 0.13± 0.78 to 1.01± 0.89 in SMBG plus individual education. The amount of carbohydrates consumed per day decreased and the amount of physical activity performed per week increased significantly in self-regulatory behavioral education group. Conclusions. The use of this model of SMBG plus self-regulatory behavior education appears to have resulted in superior improvements in glycemic control and behavioral outcomes compared with those achieved by SMBG plus individual education.