ACTA ENDOCRINOLOGICA (BUC)

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.

Medullary thyroid carcinoma (MTC) arising from aberrant tissue is almost unknown. Our aim is to report our first case.\r\nObservation. A woman, aged 46, was operated on for multinodular goiter with lateral mass considered as a metastasis. Thyroid surgery was well supported. The surgeon discovered a median thyroid which seemed normal, and a lateral mass totally separated from the thyroid. The pathologist who did very thin slices of the whole thyroid excluded the malignancy, but in the lateral tissue, he discovered a typical MTC with positivity to thyrocalcitonin (TCT), chromogranine A, and thyroid transforming factor1 antibodies. That lateral tissue did not contain any thyroid or lymphoid cells. The tumoral tissue was sent to another\r\npathologist who confirmed the diagnosis. In post operative period TCT was normal (mean value=4.5pg/mL, N<13), but urinary metanephrines were slightly increased (1.32\r\nmg/24h, N=1). Radiological explorations (except MIBG scintigraphy not done for low socioeconomic conditions) failed to show any pheochromocytoma. One year later that one was found by CT scan, and our patient was classified as multiple endocrine neoplasm type 2A. Laparoscopic surgery\r\ndone under thiopental and curare was uneventful, histological exam confirmed the pheochromocytoma. Genetic screening for RET proto-oncogene was negative arguing\r\nfor a sporadic case. Conclusion. MTC located in\r\naccessory thyroid is a scientific curiosity which can be mistaken with a lymph node metastasis. In our case a meticulous exam of the median thyroid and the lack of thyroid and lymph cells in the lateral mass were\r\nagainst the metastasis.

Developments in the understanding of the molecular basis of water permeability of the red blood cell (RBC) have taken place rapidly since the discovery in 1985 in Cluj- Napoca, Romania, by the group of Benga of a water channel protein (WCP), later called aquaporin 1 (AQP1), in the RBC membrane. However, the physiological role of AQP1 is not yet fully understood. Investigations of RBCs from human subjects of various ages could help shed light on this important issue. We present a short review of our studies on this topic that were published in less “visible” journals and books. The diffusional water permeability (Pd) of the RBC membrane has the lowest values in the newborns. Then Pd values are increasing in children, reaching at about 7 years a value that remains rather constant in young and mature subjects. The high permeability to water of the RBC membrane can be correlated at these ages with the ability to undertake a high level of physical activity. In elderly individuals (over 65 years) a further small, but statistically significant, increase in the diffusional water permeability of RBC was observed. In this case the higher RBC water permeability can be correlated with a requirement of the RBC membrane to favour the membrane undulations and the rapid entry or exit of solutes of molecular size greater than water, in conditions when the organism is less physically active, probably has lower metabolic rates and lower mean rates of blood circulation.

Background. Primary hyperparathyroidism (PHPT) is caused most commonly by a solitary adenoma and less commonly by multiglandular hyperplasia of the parathyroid glands (MGD). Minimally invasive parathyroidectomy (MIP) has become a frequently used strategy, but there are limitations to current preoperative localization techniques. Results. We report the case of a patient, 63 years old, female, with clinical and biochemical features of primary hyperparathyroidism (total serum calcium: 10.1mg/dL; PTH: 171pg/mL). Neck ultrasonography (USG) revealed a mixed hypoechoic tumor along the posterior aspect of the left thyroid lobe of 1.54x0.78 cm, being difficult to say if it was intrathyroidal or not. There was only minimal residual uptake in the left thyroid lobe at 4 h on Tc99m sestamibi imaging. She underwent USG-guided fine-needle aspiration (FNA) of the suspected tumor followed by PTH measurement from the needle washing (FNA-PTH). The cytology was non-diagnostic but the level of PTH in the aspirated fluid was 10.000 pg/ mL. The patient underwent an en bloc resection of the left thyroid lobe and the tumor, which was curative, as calcium (8.9 mg/dL) and PTH (25.52 pg/mL) decreased from the first day after surgery. Histopathology of the surgical specimen revealed a left parathyroid adenoma made of chief cells and included in the thyroid capsule together with the entire left thyroid lobe. Conclusion. This case report highlights the importance of FNA-PTH in the localization of functionally parathyroid tissue in difficult cases, where a clear target exists.