ACTA ENDOCRINOLOGICA (BUC)

Background. Usually, silver stain is needed to differentiate between normal or hyperplastic hypophysis and pituitary adenomas. Many papers reported the lack of reticular fibers network as mandatory for pituitary adenoma diagnosis. \r\nAim. Differences between the architecture of reticular fibers in normal pituitary and pituitary adenomas \r\nMethods. Gordon- Sweet silver staining of pituitary specimens, prelevated during pituitary surgery performed in 138 patients with the endocrine and imagistic diagnosis of pituitary macro-adenomas. \r\nResults.Pituitary specimens of pituitary adenomas was confirmed in 133 cases; 3 specimens were with normal pituitary tissue, 1 with pituitary hyperplasia, 1 with pituitary apoplexy.Twelve of 133 pituitary adenomas specimens were associated also with normal pituitary tissue.There was a loss of acinar network of reticular fibres in 115 cases, but the present study describes the persistence of reticular fibers networks in 18 (13,53%) of 133 pituitary adenomas. We identified five distribution patterns of remanent reticular fibers network in pituitary adenomas using silver staining. \r\nIn conclusion, persistence of reticular fibers in a small number of pituitary adenomas could be a possible pitfall in the discrimination between the normal hypophysis and pituitary adenoma.

Introduction. In the community, hypoglycemic coma is commonly caused by therapies for diabetes mellitus, or excessive alcohol consumption. Little information is available on the causes and outcome of hypoglycemic coma in non-diabetic patients. Patients and Methods. We retrospectively surveyed adult patients admitted to a regional emergency hospital with hypoglycemic coma in a 18-years period, identifying 80 admissions of 79 patients. 72 cases (91.14%) presented hypoglycemic coma induced by anti-diabetic medications in attempted suicide. The others had hypoglycemic coma induced by deliberate selfpoisoning with other drugs influencing glucose metabolism, sometimes associated with excessive consumption of alcohol. Results. A history of psychiatric illness was present in 15 patients (19%), and 2 cases (2.53%) had chronic alcoholism. Neurological manifestations of hypoglycemia were the principal reason for admission, observed in all patients, and 15 patients (19%) had precipitated convulsions. Although some patients received treatment for hypoglycemia before admission, hypoglycemia recurred in 12 cases (15.19%) in hospital. Morbidity included ventricular arrhythmias (8.86%), non-cardiogenic acute pulmonary edema (1.26%), and transient neurological disturbances, in 2 elderly patients. Two cases died following admission, but death was not the direct result of hypoglycemia. Therapeutic measures consisted in antidote therapy, toxin removal, and supportive therapy. Conclusion. Though drug-induced hypoglycemic coma is rarely encountered in medical practice (2.44% in our study), management of these patients represents a challenging task in every practitioner.

Background. The aim of the present study was to measure the effects of raloxifene on bone metabolism and strength in orchiectomized male rats. Materials/Methods. Forty-three 4-month-old Wistar albino male rats were used and divided into 3 groups as orchiectomy (ORCX; n=23), sham (n=15), and control (n=5). Raloxifene (10 mg/kg/day) and methylcellulose (0.5 mL/day, as a vehicle treatment) treatments were initiated 2 months after ORCX for 2 months, then the rats were sacrificed. The left femur and fourth lumbar vertebrae (LV4) were measured to assess the effects of the orchiectomy and the raloxifene treatment and maintenance regimens. Bone strength was assessed using a compression test for the vertebrae and a three-point bending test for the femurs (N/mm). Results. Raloxifene increased femoral and vertebral bone strength in osteoporotic rats, but this increase was not statistically significant. Bone strength was found to be 267.44±18.03 in the femurs of the ORCXraloxifene group and 246.32±49.37 in the femurs of the ORCX-C group (p>0.05). Vertebral bone strength was 147.78±09.51 in the ORCX-raloxifene group and 114.61±05.93 in ORCX-C group (p=0.488). Raloxifene also increased the femoral and vertebral bone density compared with the control group, but the change was not significant. While raloxifene significantly decreased the serum osteocalcin levels (p=0.007), it did not decrease the carboxyterminal cross-linking telopeptide of bone collagen (CTX) levels significantly (p=0.066). Conclusions. Raloxifene caused a statistically significant decrease in serum osteocalcin levels and a non-significant reduction in NTX levels in orchiectomized rats.

Background. To evaluate iodine status and the prevalence of thyroid disorders in different populations of Zhoushan Island, China.\r\nMethods. A total of 3284 inhabitants of Zhoushan Island were surveyed, including 1389 urban residents, 737 salt workers, 502 peasants, 362 fishermen, and 294 monks from Mount Putuo. All subjects, except for salt workers, consumed iodized salt. A thyroid ultrasound was performed and serum levels of\r\nthyroid hormones and thyroid peroxidase antibody were measured.\r\nResults. The median urinary iodine concentration was significantly higher in subjects who consumed iodized salt than in those who consumed non-iodized salt. No significant differences were noted in the prevalence of thyroid ultrasound abnormalities and functional thyroid disorders between subjects who consumed non-iodized and iodized salt except between salt workers and monks from Mount Putuo. The prevalence of thyroid ultrasound abnormalities differed\r\nsignificantly between males and females and was positively correlated with advanced age (r=0.212, P<0.001).\r\nConclusions. Iodine intake is considered adequate, more than adequate, or excessive amongst the study populations. The\r\nprevalence of both thyroid ultrasound abnormalities and functional thyroid disorders is extremely high in Zhoushan Island. Advanced age and female gender are significant predictors of thyroid ultrasound abnormalities.

Objective. To investigate the correlation between serum levels of 25-hydroxy vitamin D [25(OH)D] and the visceral fat area of patients with type 2 diabetes mellitus (T2DM) in the context of different bone mass. Materials and Methods. A total of 180 patients with T2DM were randomly selected for bone mineral density (BMD) examination. According to the results, they were divided into three groups: T2DM normal bone group (group A); T2DM bone mass reduction group (group B); T2DM osteoporosis group (group C). Result. Serum 25(OH)D levels in NC group, A group, B group and C group decreased in turn, and Visceral fat area (VFA) in group B and group C were significantly higher than those in group A and NC [(29.41±4.87) vs. (22.76±4.23) vs. (17.78±3.61) vs. (9.70±3.01), P<0.05], [(117.76±38.79), (125.08±37.90) vs. (89.79±26.51), (97.53±28.61), P<0.05]. Pearson correlation analysis showed that L1-L4 lumbar vertebrae bone density was positively correlated with 25(OH)D and VFA; left femoral neck bone density was positively correlated with 25(OH)D, and negatively correlated with VFA. Conclusion. Serum 25(OH)D and VFA may be associated with the development of T2DM combined with OP.

This editorial discusses the context of thediscovery of GNRH 1 as a cause of congenital hypogonadotropic hypogonadism published last year by Bouligand et al in the New England Journal of Medicine

Gangliocytomas are extremely rare tumors, accounting for 0.1-0.5% of all brain tumors. We present a 25 years old woman with several characteristics of restrictive anorexia nervosa in association with a gangliocytoma of pineal region. The patient has been diagnosed with hydrocephalus shortly after birth. A ventriculoperitoneal shunt was initially inserted. At the age of 19 she underwent 2 consecutive occipital craniotomies for a well-defined large mass in the pineal region. Histopathological examination of this tumor revealed a gangliocytoma. Our patient began to reduce her food intake due to the concept that &#8221;the tumor must not be fed&#8221;. After an almost 30 kg weight loss over 5 years, the patient weighs 39 kg at 165 cm height (BMI 14.3 kg/sqm), associated with a 1 year history of secondary amenorrhea and a tumor remnant of 4 cm. The weight loss, amenorrhea and some other psychosocial traits are common for anorexia nervosa. We discuss the difficulty of the differential diagnosis between anorexia nervosa and a hypothalamic eating disorder induced by the pineal gangliocytoma.

Noonan syndrome is an autosomal dominant, variably expressed, developmental disorder with unilateral or bilateral cryptorchidism in up to 80% of boys and usually delayed puberty. Thus, precocious puberty is unexpected and intriguing in such a patient. A 4.6 year old boy was found to have pubic hair, penile enlargement, increased height velocity, with advanced bone age, bilateral cryptorchidism, dysmorphic facial features typical for Noonan syndrome, pectus deformity, brachydactyly, clinodactyly, camptodactyly, hyperpigmentation, acne and hypertrichosis. Hormonal assessment revealed 21-hydroxylase deficiency - more than 100 fold increase of 17 hydroxyprogesterone level, normal hCG, estradiol, FSH, LH. This previously unreported association of Noonan syndrome and congenital adrenal hyperplasia is challenging regarding diagnosis and management.

Adrenoleukodystrophy (ALD) is a hereditary metabolic disease X-linked (Xq28) with autosomal recessive traits, secondary to a mutation in the ABCD1 gene. The case of a boy aged 7 years and 10 months admitted for vision disturbances, muscle weakness, balance disturbances and spastic paraparesis is presented. Seventeen months prior to this admission, the child was diagnosed with acute adrenal insufficiency and was still on replacement therapy with dexamethasone and fludrocortisone. While on therapy the child presented several relapses that required treatment correction. MRI revealed cerebral atrophy lesions, which, together with the laboratory findings and clinical symptoms, conducted the diagnosis of ALD. This diagnosis was also supported by the pathogenic mutation detected in the ACBD1 gene identified in the pacient and patient?s mother and sister. The child died 8 months after the onset of neurological signs. Childhood ALD is classified as classical ALD form, the most frequent, affecting only boys aged 4 to 10 years. Family screening obliged by the identification of the homozygotes is helpful for the early therapy of heterozygotes, genetic counseling and disease prevention. The prognosis is still poor, the available treatment being hormone substitution therapy and psychological support.

Background. The aim of this experimental study was to examine the effect of erythropoietin (Epo) on rat model and particularly in an ischemia-reperfusion (IR) protocol. The beneficial effect or non-effectiveness of that molecule were studied haematologically using blood mean corpuscular hemoglobin levels (MCH). Materials and methods. Forty rats of mean weight 247.7 g were used in the study. MCH levels were measured at these time points: on 60 min after reperfusion (groups A and C), and on 120 min after reperfusion (groups B and D). C and D groups were administered by Epo. Results. Epo administration nonsignificantly increased the MCH levels by 0.19 pg [-0.34 pg - 0.72 pg] (P= 0.4762). This finding was in accordance with the results of paired t-test (P= 0.3827). Reperfusion time non-significantly increased the MCH levels by 0.02 pg [-0.51 pg - 0.55 pg] (P= 0.9404), also in accordance with paired t-test (P= 0.9049). However, Epo administration and reperfusion time together produced a nonsignificant combined effect in decreasing the MCH levels by 0.13 pg [-0.18 pg - 0.45 pg] (P= 0.4087). Conclusion. Results of this study indicate that Epo administration, even in short-term prospect of 2 hours reperfusion, starts reversing ischemic damages. These results are also reinforced by predicted MCH values adjusted for weight. However, the significant effect needs more than 2 hours in order to appear.