ACTA ENDOCRINOLOGICA (BUC)

Introduction. Surgery for thyroid cancer carries a higher risk of morbidity given the region’s complicated anatomy, the setting of malignancy and extent of the surgery. Aim. To investigate the rate of complications related to the recurrent nerve and parathyroid glands lesions in patients with thyroid carcinoma that undergo thyroid surgery and lymph node dissection. Patients and Methods. The data of 71 patients who underwent total thyroidectomy and 19 patients who underwent total thyroidectomy and central neck dissection with various associated neck dissection techniques were investigated using appropriate statistical tests. Results. As expected, the rate of recurrent nerve injury observed in the neck dissection group was higher than in the total thyroidectomy group (15.7% vs. 2.8%, p=0.05). As for postoperative hypocalcemia, the rate observed in the neck dissection group, both for postoperative day 1 (p<0.0001) and day 30 (p=0.0003) was higher than in the total thyroidectomy group (68.4% vs. 19.7% postoperative day 1, 31.5% vs. 4.2% postoperative day 30). Conclusions. The risk of morbidity concerning the recurrent nerve injury and postoperative hypoparathyroidism increases with the extent of surgery. Extensive surgery may achieve proper oncologic outcomes but increases the risk of postoperative morbidity and decreases quality of life. In deciding for extensive surgery, both patient and medical team need to understand these risks.

Abstract Introduction. Turner syndrome, a genetic disorder with an exclusively feminine phenotype, is caused by complete or partial X monosomy in some or all cells. Although the condition is usually diagnosed after birth, now, it is possible to detect the syndrome prenatally. Case reports. We present two cases of Turner syndrome diagnosed during the first trimester of pregnancy. The condition was suspected because of several ultrasound signs and was confirmed in both cases after an invasive prenatal technique. In one case, the fluorescent in situ hybridization technique was applied. In the other case, the chromosomal anomaly was detected using the G banding technique. Threedimensional ultrasound and HDlive technology were extremely useful in helping the patients to better understand the fetal pathology and accept an invasive procedure as a final step in establishing the diagnosis. Conclusion. These cases demonstrate the importance of using ultrasound as a screening method to detect suspected cases of Turner syndrome, however, the disorder needs to be confirmed with chromosomal analysis after performing an invasive prenatal technique.

Background. The recurrent paralysis is the most important complication after total thyroidectomy. Vocal dysfunction can have multiple causes. Based on strict clinical criteria, the follow-up of patients who underwent a thyroidectomy may lead to wrong conclusions concerning possible recurrent nerve injury. Purpose. The aim of this study was to evaluate recurrential complications after total thyroidectomy by an ENT endoscopic examination. Method. We prospectively analyzed 100 cases of thyroid operations with a total number of 190 recurrent laryngeal nerve with lesional risk. Fourteen patients were operated for malignant disease. The patients were divided into two groups: group A (patients with high risk of recurrential injury) and group B (patients with low risk of recurrential injury). The operations were performed by one surgical team. The surgical interventions were followed in the 2nd postoperative day by an ENT endoscopic examination in order to assess vocal cords mobility. In patients with voice changes, ENT examination was repeated as many times was needed. At the same time a clinical examination of the quality of phonation was carried out. Results. From the total number of 100 patients examined with 190 nerves at risk, there were 7 patients with recurrent temporary paralyses (3.7%). After 6 months postoperative, there was a single patient with recurrent paralysis (0.5% ). Regarding permanent recurrent paralysis, there was no patient with paresis after one postoperative year (0%). There was no significant difference regarding the recurrent paralysis between patients with high or low risk of recurrential injury. Conclusions. The damage function of the recurrent nerve is recovered in 30 days in most cases and almost 100% in six months. Belonging to a low or high risk group is not associated with the development of motility disorders. The simple following of the clinical manifestations can lead to erroneous conclusions.

Background. Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a profound impact on the quality of life of patients. Objectives. To describe a rare case of HS with postmenopausal onset, to review the literature data regarding late onset HS and to discuss the current knowledge on the role of endocrine abnormalities in the development of HS. Case report. We report the case of a 68-year-old patient in whom HS occurred 10 years after menopause. She was referred to our clinic for the presence of an open fistula on the left groin, fibrotic scars and visible alteration of the vulvar anatomy due to numerous surgical interventions. The patient shared features of the metabolic syndrome (obesity, arterial hypertension, dyslipidemia, aortic atherosclerosis), but showed no signs of virilism and no hormonal abnormality. HS was controlled using antiseptics, topical retinoids and antibiotics. Conclusions. This case is of particular interest given the late onset of HS, long time after menopause. The development of HS requires a complex interaction between genetic predisposing factors, endocrine dysregulation, metabolic alterations, bacterial overgrowth and an aberrant inflammatory response. Evidence points to an important role of sex-hormones in the emergence and progression of the disease, but the underlying mechanisms are still unclear. A better understanding of HS pathogenesis is needed to elucidate the precise way in which endocrine factors influence the disease onset and course. This would guide the way to novel therapies and a better control of this challenging disease.

Aims. To investigate the effect of sulphonylurea (SU) treatment on all-cause and cardiovascular mortality as compared with metformin (MET), when used in combination with insulin (INS) in type 2 diabetes. Methods. All type 2 diabetes patients aged ≥40 years were included at their first prescription of INS+MET or INS+SU, during 2001-2008. They were considered at risk until death or December 31st, 2011. Mortality rates were calculated per 1000 person-years. Crude and adjusted rate ratios (RR) were calculated using time dependent analysis with INS+MET as reference. Results. There were 7122 patients (60.8% women) included in the analysis, with a mean age at baseline of 62.0±9.9 years. During the 11 years of study, patients on INS+MET contributed 13620 person-years and 330 deaths (mortality rate 24, CI95% 22-27), while those on INS+SU contributed 8720 person-years and 393 deaths (mortality rate 45, CI95% 41-50). Adjusted all-cause mortality RR were: SU 1.6 (CI95% 1.21-2.11, p<0.001), glimepiride 1.18 (CI95% 0.73-1.91, p=0.51), gliclazide 1.78 (CI95% 1.07-2.95, p=0.024), glibenclamide 1.66 (CI95% 0.71-3.88, p=0.23), glipizide 1.24 (CI95% 0.68-2.27, p=0.49), and gliquidonum 2.32 (CI95% 1.54-3.50, p=0.001). Conclusions. When combined with insulin as dual therapy, patients treated with SU were at increased mortality risk as compared with insulin + MET.

Context. In medically treated Graves’ disease (GD) patients, prolonged low serum TSH levels represent an independent risk factor for relapse. The predictors of this prolonged TSH suppression are still debatable. Objectives. The primary endpoint of this study was to identify predictors of the time to TSH recovery (TTR), in GD patients, at diagnosis and during ATDs treatment. The secondary endpoint was to compare the TTR between patients with GD and autonomous hyperthyroidism. Subjects and Methods. We retrospectively analyzed 109 newly diagnosed hyperthyroid patients (90 with GD and 19 with autonomous hyperthyroidism), consecutively evaluated in a tertiary center. The main features recorded were: TSH and thyroid hormone levels at diagnosis and follow-up visits, the TTR and the mean dose of ATDs/day. Results. There was no significant difference regarding the TTR between patients with GD and autonomous hyperthyroidism. In GD patients, age at diagnosis, gender, goiter size, smoking status, thyroid antibody titers and ophtalmopathy presence did not seem to influence the TTR. GD patients with higher FT3, TT3 at diagnosis and higher TT3 at the first visit after ATDs administration (V1) needed longer TTR, after adjusting for the mean dose of ATDs/day. FT3 at diagnosis and TT3 at V1 are significant predictors for the TTR in GD patients. Conclusions. The time to TSH recovery was not significantly different between patients with GD and autonomous hyperthyroidism. In GD patients, the time to TSH recovery is longer in patients with more severe T3 hyperthyroidism at diagnosis and at the first visit after ATDs administration.

Autoimmune diseases are a heterogeneous group that involves almost any tissue and organ, a patient could frequently present more than one autoimmune disease. Type 1 diabetes mellitus is frequently associated with other autoimmune diseases in polyglandular autoimmune syndrome. Aim of the study is to evaluate a phenotype of diabetic patients with autoimmune diseases. There is a retrospective study; we analyzed type 1 diabetes inpatients from our department in late 4 years based on clinical records. We state that type 1 diabetes mellitus diagnosis is established based on insulin treatment at onset or less than 1 year from onset. We analyzed the presence of the following autoimmune diseases: Graves&#8217; disease, Hashimoto thyroiditis, autoimmune hypothyroidism, Addison&#8217;s disease, vitiligo, psoriasis, systemic lupus erythematosus, pernicious anemia. We recorded 151 patients with type 1 diabetes mellitus: 91 (60.3%) women. Mean age was 38.4?15.8 years, mean span of type 1 DM was 12 years, mean age at the onset of DM was 26.5 years, and mean BMI was 23.4 kg /m2. Patients were insulin treated with 2 doses of insulin 11.3%, 3 doses of insulin 41.6%, 4 doses of insulin 45%, and insulin pump 2%. 41 patients (27.2%) associated other autoimmune diseases, most frequently being chronic thyroiditis. Type 1 DM preceded autoimmune disease in 60%. Patients that associated autoimmune disease have mean age at the onset of type 1 DM 29.1 years. Mean glycated hemoglobin among patients with autoimmune diseases was 10.1% vs. 9.9% among patients without autoimmune diseases (NS); mean insulin needs were respectively 0.78 u/kgc vs. 0.72 u/kgc (NS). In conclusion, type 1 DM is frequently associated with other autoimmune diseases, patients being mainly women. The most frequent association is Graves&#8217; disease. In over 50% of cases type 1 DM precedes autoimmune disease with several years. Even though more than half of patients were treated with multiple doses of insulin, glycated hemoglobin was high, slightly higher among patients with autoimmune diseases but the differences were not statistically significant.

Introduction. Vitamin D is involved in differentiation and induction of erythropoiesis in bone marrow cells. Aim. We compared the serum 25(OH) vitamin D level in obese children versus control and found correlations between vitamin D level and hematological indices in obese children. Materials and methods. 25 overweight and obese patients and 15 normal weight children were enrolled in an observational study . Results. In obese children, the serum level of 25(OH) vitamin D was significantly (p<0.04) lower (20.60 ng/mL) compared with the value from normal weight ones (25.63 ng/mL) and the body fat percentage BFP was higher. We found a positive correlation (r=0.44, p<0.05) between serum vitamin D and hemoglobin level and a negative one between serum vitamin D and the number of platelets (r= -0.43, p<0.05). Also, the serum iron was at the lower normal limit in the obese children and negatively correlated with the percent of the body fat (r= -0,62, p<0.05). Conclusion. Obese children have vitamin D deficiency. The hemoglobin level and the number of platelets are correlated with the serum level of 25(OH) vitamin D. Supplements with vitamin D may have pleiotropic effects, including those on bone marrow activity.