ACTA ENDOCRINOLOGICA (BUC)

Context. Vitamin D is a steroid hormone that acts by binding to the vitamin D receptor (VDR) found in many tissues. According to the long-term mechanism, vitamin D causes the proliferation and differentiation of muscle cells by gene transcription. Objective. We aimed to evaluate the relationship between muscle strength and serum vitamin D levels in elderly men. Design. Cross-sectional study. Subjects and Methods. Male patients over age 50 were included in the study. Study population was divided into 2 groups with handgrip strength according to body mass index, either as subjects with weak or with normal handgrip strength test (HGST). Vitamin D levels and other variables compared between weak and normal groups. Results. Vitamin D level of weak and normal groups were 7.5 (3-19.9) μg/L, and 11.6 (11.6-34.9) μg/L, which means significant reduced vitamin D levels in weakness group (p=0.01). Vitamin D levels were significantly correlated with HGST levels (r:0.362, p=0.001). Vitamin D levels were found to be an independent predictor of weakness according to HGST in logistic regression analysis (OR: 0.453, 95% Cl:0.138-0.769, p=0.05). Conclusions. Low vitamin D level is an independent risk factor for muscle weakness in men aged more than 50 years. Therefore, vitamin D levels should be screened and early replacement should be initiated for the sake of improvement of muscle strength in elderly subjects that vulnerable for frailty.

Background. Thyroid nodules stiffness may predict thyroid malignancy. Objectives. The purpose of the study was to investigate the diagnostic value, interobserver agreement and reliability of real time ultrasound elastography (USE) when assessing solid thyroid nodules. Design. A prospective, observational study in a tertiary center. Subjects and Methods. In 49 patients scheduled for thyroidectomy, a senior radiologist and two radiologists in training independently assessed 81 solid thyroid nodules with USE using a 6600 Hitachi machine. Pathology results were used as a reference standard. Nodule stiffness was evaluated using the Asteria scoring system. The diagnostic ability of the elastography scores for the assessment of the thyroid solid nodules was evaluated using AUROC (area under the receiver operating characteristic curve) analysis. The Cohen’s kappa (k) values were used for interobserver agreement evaluation and interclass correlation coefficient (ICC) was used as a measure of reliability. Results. Pathology results revealed 20 papillary carcinomas and 61 benign nodules. The elastography identification of malignant nodules by the senior radiologist was performed with an AUROC of 0.84 [95% Confidence interval (CI) 0.74-0.91], with Sensitivity= 100%, and Specificity= 68.85%. When performed by ultrasound operators in training, the diagnostic performance slightly decreased. With no statistically significant difference between the diagnostic performance of the three readers, USE demonstrated good inter-observer agreement and good reliability (ICC= 0.81). Conclusion. USE may be an accurate tool of assessment for solid thyroid nodules, identifying with high sensitivity the malignant ones, particularly micronodules. USE is reproducible and reliable when used both by experienced operators and medical professionals in training.

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Introduction. Primary hyperparathyroidism (PHPT) is a prevalent endocrine condition that presents with significant clinical symptoms. Ectopic adenomas commonly occur in the tracheo-esophageal groove, thymus, intrathyroidal, and mediastinum. While mediastinal ectopic adenomas are frequently observed, pericardial ectopic adenomas are only documented in case reports in the literature. Case report. We present a 65-year-old female patient who had persistent PHPT and underwent resternotomy and excision of a pericardial ectopic parathyroid adenoma. The typical treatment for PHPT has generally been conventional bilateral neck exploration without preoperative imaging. Conventional bilateral neck exploration has decreased in popularity because of the rise in the minimally invasive parathyroidectomy (MIP) procedure. The use of MIP is prevalent in surgical procedures, and it is crucial to have precise preoperative localization. Due to the ectopic localization of certain parathyroid adenomas, they are regarded as an important cause of the failure of primary surgery. Hence, particularly when dealing with persistent and recurrent PHPT, modern imaging techniques like 4D CT enhance the efficacy of surgical interventions. Therefore, particularly in cases of ectopic parathyroid adenomas located in the mediastinum, it is important to consider the possibility that if the adenoma cannot be found after surgery, it may be located in the pericardial region.