ACTA ENDOCRINOLOGICA (BUC)

Introduction. Surgery has lost a lot of ground as the main therapy of most prolactinomas as it is clear from the current guidelines in most prolactin secreting adenomas, even in the setting of optic compression. However, we believe that surgery is still an important part in the treatment of this type of adenomas. This study is aimed to define what is the role of pituitary surgery in the current setup of prolactinoma management. Material and methods. In this retrospective, single-center study we analyzed 12 consecutive patients who underwent primary endoscopic transsphenoidal surgery for prolactinomas, between 2013 and 2022. Surgical indication, previous dopamine agonist (DA) treatment, remission rates, surgical complications, pituitary function and imagistic appearance are presented. Results. Of the 12 patients included, 4 had giant PRL and 8 macroadenomas, while 9 of them had previous DA treatment. The main surgical indication was pituitary apoplexy in 5 patients followed by CSF leak after DA treatment, 3 cases, and DA resistance in 3 cases. The main surgical complications were transitory diabetes insipidus in 7 cases. Normalization of prolactin levels was achieved in 2 patients. Conclusions. Surgical intervention should be strongly considered in all patients with neurologic symptoms referable to the lesion, resistance to medical therapy, other treatment failure or with complications after DA treatment. The endoscopic endonasal surgery offers good surgical outcomes with low rates of surgical complications and should remain an open option for specific cases.

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Background. Our study outlines the implication of melatonin in organisms' pain regulatory mechanisms. The literature describes epiphysis opioidergic fibers with µ and d opioid receptors and also pleads for an analgesic dose-dependent effect of melatonin. We analyzed the biologic variability of the analgesic effect of the pineal hormone, based on the psychoneuroendocrine behavior type. In our previous studies we investigated the dinamics of melatonin's analgesic effect within the following psychoneuroendocrine behavioral types: the adrenergic type (hipersensitive to pain), the opioid type (pain hyporeactive) and the intermediate, equilibrated typology (N type). Objectives. Our present research focused on the antinociceptive pharmacologic psychoneuroendocrine variability in the case of co-administration of melatonin (50mg/kgbw, i.p.) with ondansetron (4 mg/kgbw, i.p.), petidine (4mg/kgbw, i.p.) and tramadol (4mg/kgbw, i.p.). Subjects and Methods. Experiments were performed in vivo, using Albino Swiss male mice. Pain sensitivity was assessed using the classical pharmacologic test hot-plate (60°C). Conclusions. Our results showed an amplification of the analgesic effect when petidine was co-administered with melatonin, with best results for the A type of behavior (p<0.02), as follows: 63.41% (melatonin + petidine co-administration) > 54.54% (melatonin + tramadol coadministration) ≈ 52% (melatonin). We also noticed an antagonism between ondansetron and the pineal biomolecule

Hyponatremia is a common abnormality found in patients admitted in an internal medicine department of an emergency hospital. Sometimes its cause is quite easy to find (in our clinic especially drug-induced due to thiazide or various antidepressant medication in geriatric population), but in other situations it proved to be a challenging diagnosis in what concerns etiology. It is not frequently found in young patients and if this situation occurs a tight diagnosis protocol is always recommended.

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.

Mixed gonadal dysgenesis and ovotesticular disorders of sex development, are rare conditions that occur sporadically,\r\nwith unknown prevalence. Clinical manifestation of this diseases is sexual ambiguity. The authors present a pediatric\r\ncase with sexual ambiguity and karyotype 45, X/46, XY, the child of a HIV-positive mother receiving multiple antiretroviral treatments for a period of 16 years.