ACTA ENDOCRINOLOGICA (BUC)

In the latest decade, translational medicine has played an important role. In neuroendocrine tumor field, genetic results are associated with clinical and paraclinical disease implications. This translational knowledge allows a faster action in some mutation types with aggressive outcome. In the following pages we will make a review about actualities in translational approach from genetics to clinical neuroendocrinology.

Background. Fine needle aspiration biopsy (FNAB) is an important tool in the diagnosis of thyroid nodules. Aim. Our aim was to investigate the malignancy criteria in thyroid nodules by gray-scale ultrasonography (US) and duplex Doppler ultrasonography (DDUS), and their usefulness in reducing the number of unnecessary FNAB’s. Study design. This was a prospective observational study. Subjects and methods. 181 benign and 18 malignant thyroid nodules were evaluated by US and DDUS before FNAB or thyroidectomy. US was used to note size, shape, internal structure, nodule echogenicity, marginal properties, peripheral hypoechogenic halo, and microcalcifications. DDUS studies were used to evaluate the maximum and minimum flow velocity (Vmax and Vmin), systolic/diastolic flow velocity ratio (S/D), pulsatility index (PI), resistive index (RI), acceleration time (AT) and acceleration value. Results. Contour irregularity, size and presence of microcalcifications (p<0.001, p=0.02 and p=0.002, respectively) and S/D, Vmin, PI, RI and AT were significantly different (p=0.004, p=0.007, p=0.032, p=0.003 and p=0.003, respectively) were significant for malignant nodules. Benign and malignant nodules with or without suspicious US findings had similar DDUS findings. Vmax, Vmin, PI, RI, and AT were significantly different in the presence of microcalcification (p=0.043, p=0.001, p=0.031, p=0.04, and p=0.019 respectively). AT was significantly different in the case of absence of microcalcification (p=0.019). Comparing the irregular margins, Vmin, PI and RI were significantly different (p=0.014, p=0.003, and p=0.014 respectively). Conclusion. Benign and malignant thyroid nodules can be differentiated using gray-scale US findings and DDUS based indices together to reduce the number of unnecessary FNAB’s.

Introduction. Vinegar is known with its positive impact on post-prandial dysmetabolism. The aim of this study was to\r\nelucidate the acute effects of high amount vinegar on blood glucose and lipid parameters.\r\nMaterial and Methods. Sixteen type 2 diabetic patients who had been treated with metformin only, were served a\r\nstandardized meal to which 50 g vinegar was added on the first day but not on the second day. Blood glucose, insulin and lipid levels were measured during fasting and at the second hour after intake of the meal.\r\nResults. Postprandial increase in the levels of venous blood glucose measurements was not different in the vinegar group when compared with the reference group (p=0.163). There was no significant difference on postprandial insulinemia (p=0.796). While investigating the effect of the vinegar on postprandial lipemia, no differences in triglyceride\r\nchanges was found between vinegar and reference group (p=0.816).\r\nConclusion. In this study in which we have tried to find an answer to the question about the effect of high amount grape\r\nvinegar on postprandial metabolism, no favorable or deleterious effect on postprandial changes of glycemia and\r\nlipemia was found.

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Objective. The aim of this study was to compare the clinical effects of a triple oral antidiabetic combination versus basal insulin and metformin combination treatment in patients with poorly controlled type 2 diabetes.\r\nMethods. Eighty patients with type 2 diabetes, who were treated by metformin and sulphonylurea combination, and had\r\nHbA1c values between 7.5 and 10 % (58 and 86 mmol/L), were randomized into two groups. The first group was given triple oral antidiabetic therapy (pioglitazone, metformin, and sulphonylurea) and the second group was given metformin and a bedtime basal insulin (insulin detemir) combination for 12 weeks. Metabolic parameters were evaluated.\r\nResults. The mean fasting plasma glucose and HbA1c levels decreased in both groups. The decrease in HbA1c was slightly\r\nhigher in triple oral antidiabetic group (p=0.046). The patients in triple oral combination group gained 0.2 kg (p=0.881) and those in the metformin-insulin detemir combination group lost 1.7 kg (p=0.001) in 12 weeks (p=0.29 between groups). The frequency of hypoglycemia was higher in\r\ntriple oral antidiabetic group (11 vs. 2 episodes, respectively).\r\nConclusion. Both sulphonyureametformin-pioglitazone and insulin detemir-metformin therapies provided significant improvements in glycemic control. However, sulphonylurea,\r\npioglitazone and metformin combination led to more frequent hypoglycemic events, and weight management seemed in favor of insulin detemir-metformin combination.

Introduction. One of the diabetes complications in men is infertility. C-peptide and Nicotinamide have antidiabetic and antioxidant activity. So, the aim of this study was to investigate the effects of these drugs on male infertility caused by diabetes. Methods. In this experimental study 40 adult male NMRI mice (20- 25g) were obtained and randomly divided into 5groups: controls, diabetes model, diabetes+C-peptide, diabetes+Nicotinamide, diabetes+C-peptide+Nicotinamide. Diabetes induced was confirmed 3 days after administration of a single dose of streptozotocin (STZ) (65mg/kg) 15 min after an intraperitoneal injection of Nicotinamide (120mg/kg). Then C-peptide (25nmol/kg) and Nicotinamide (100mg/kg) were injected for 28 days. 24h after the last drugs injection serum samples, testes and cauda epididymis of animals were removed for hormonal, testis morphology and sperm count assessment. Results. Diabetes induced could decrease serum testosterone level and sperm count significantly (p<0.001, p<0.05 respectively). Serum LH, testosterone levels and sperm count increased in Diabetes+Cpeptide+ Nicotinamide versus diabetes group (p<0.05, p<0.001, p<0.01 respectively). Also administration of Nicotinamide alone showed an increase in serum testosterone (p<0.001). Conclusion. The results of this study demonstrated that combined administration of Nicotinamide and C-peptide improved diabetes induced male reproductive disorders by enhanced serum LH, testosterone levels and sperm count in diabetic mice.

Background. The literature contains several definitions of the metabolic syndrome, different from one another through the components included and the reference ranges considered normal. The aim of this study is to evaluate the prevalence of the metabolic syndrome and its components in a rural community from the North-East region of Romania. Methods. The study included 3248 persons from the rural environment. The data recorded regarded gender, age, anthropometric parameters (weight, waist circumference, body mass index), arterial blood pressure, and laboratory findings. The defining criteria for the metabolic syndrome used were IDF 2005 in comparison with the criteria NCEP-ATP III. Results. Over half of the studied population presents excess body weight, the prevalence of obesity (Body Mass Index - BMI≥30kg/m2) being 17.5% with a proportional relationship between age and BMI value (p<0.001), as well as between age and waist circumference value (p<0.001). The prevalence of the metabolic syndrome according to IDF criteria is 16.3% and 14.2% according to NCEP-ATP III criteria. Irrespective of the BMI value, there is an individual increase in the number of cardiovascular risk factors parallel to the increase of the WC. Conclusions. The metabolic syndrome is frequently encountered in the clinical practice and the use of the IDF definition criteria allows a wider identification of the patients with high cardiometabolic risk. This is the group of people that need to be targeted by the diagnostic and treatment of important cardiometabolic pathology.

Objective. Hypothyroidism accelerates atherosclerosis and thyroid hormone replacement inhibits this progression. Platelet activation and aggregation play major role in the pathophysiology of atherothrombosis. Mean platelet volume (MPV), a determinant of platelet function, is a newly emerging risk factor for atherosclerosis. The present study was designed to evaluate levels of MPV before and after the levothyroxine (LT4) treatment in patients with overt hypothyroidism. Design. The study included 30 Hashimoto’s thyroiditis patients with overt hypothyroidism and 20 healthy control subjects. Hypothyroid patients were given LT4 replacement therapy. Fasting glucose, lipid levels and blood counts were assessed before and after the maintenance of euthyroidism. Results. Fasting glucose, platelet count and all lipid parameters were similar between the two groups. The mean MPV level of hypothyroid patients was higher than of the control group (p<0.01). A significant decrease in the mean MPV level was detected after the maintenance of euthyroidism with LT4 treatment (p<0.05). Conclusion. This study suggests that patients with overt hypothyroidism tend to have increased platelet activation. This activation may cause increased risk of atherothrombotic complications that may be reversed by treatment of hypothyroidism.

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.

Xanthomatosis is a rare disease; predominantly, it is a response to altered lipid levels in the form of a mucocutaneous granulomatous proliferative disorder of unclear origin. When blood lipid levels exceed the normal values, the macrophages around the blood vessels may result in xanthoma. The present case was observed in a 55-year-old woman who suffered from Cushing’s disease and had atypical xanthomas in her oral mucosa that were diagnosed by histopathological analysis and were associated with normal serum cholesterol levels.