ACTA ENDOCRINOLOGICA (BUC)

The International Journal of Romanian Society of Endocrinology / Registered in 1938

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Year Volume Issue First page
10.4183/aeb.
Author
Title
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  • Endocrine Care

    Giulea C, Enciu O, Toma EA, Martin S, Fica S, Miron A

    Total Thyroidectomy for Malignancy - is Central Neck Dissection a Risk Factor for Recurrent Nerve Injury and Postoperative Hypocalcemia? A Tertiary Center Experience in Romania

    Acta Endo (Buc) 2019 15(1): 80-85 doi: 10.4183/aeb.2019.80

    Abstract
    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.
  • Notes & Comments

    Giulea C, Martin S, Safta D, Miron A

    Evaluation of Recurrential Complications after Total Thyroidectomy

    Acta Endo (Buc) 2015 11(1): 124-129 doi: 10.4183/aeb.2015.124

    Abstract
    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.
  • Images in Endocrinology

    Badiu C, Alexandrescu D, Miron R, Gavan V

    Astrocytoma exophthalmia

    Acta Endo (Buc) 2008 4(2): 223-223 doi: 10.4183/aeb.2008.223

  • Case Report

    Giulea C, Enciu O, Nadragea M, Badiu C, Miron A

    Pemberton’s Sign and Intense Facial Edema in Superior Vena Cava Syndrome due to Retrosternal Goiter

    Acta Endo (Buc) 2016 12(2): 227-229 doi: 10.4183/aeb.2016.227

    Abstract
    Introduction. Retrosternal goitre enlargement can cause compression of several mediastinal structures, especially the trachea and the superior vena cava. Retrosternal goitre as a cause of superior vena cava syndrome is a rare occurrence. We report the case of a middle aged man that underwent surgery for retrosternal goitre with compression of both innominate veins presenting as superior vena cava syndrome. Case Presentation. A 50 year old man presented with a 2 year history of cyanosis of the upper limbs, head and neck, marked facial edema, plethora, dyspnea on exertion and choking sensation. Pemberton’s sign was present. Computer tomography diagnosed retrosternal goitre at the level of the aortic arch, tracheal compression and important collateral circulation. Endocrine evaluation showed normal thyroid function (fT4 15.8 pmol/L) with low-normal TSH (0.5mU/L), normal calcitonin (<2 pg/mL). The patient underwent successful total thyroidectomy with cervical approach and his symptoms dramatically improved. The facial oedema persisted for the next 3 weeks. Discussion. Less than 3% of superior vena cava syndromes are secondary to a variety of benign causes. Superior vena cava syndrome caused by slow growing retrosternal goitres is very rare and can be asymptomatic for a long period due to venous collateral development. Conclusion. Superior vena cava syndrome secondary to retrosternal goitres, a very rare occurrence, is an indication for total thyroidectomy, with low postoperative morbidity and dramatic resolution of symptoms.
  • Notes & Comments

    Voicu V, Medvedovici A, Miron D, Radulescu F

    A novel approach on pharmacokinetic/pharmacodynamic correlations of risperidone: understanding its safety and efficacy profiles

    Acta Endo (Buc) 2010 6(2): 265-285 doi: 10.4183/aeb.2010.265

    Abstract
    The pharmacokinetic characteristics of a compound as well as the immediate consequences of its physicochemical behavior during interactions with biological structures,\r\nrepresent the key issues for its pharmacodynamic profile, starting from the most fundamental global aspects (i.e. central and / or peripheral action) to the most detailed ones (i.e. molecular mechanism of action).\r\nSuccessive metabolic reactions lead to either bioactivation or bioinactivation of themolecular entity. A particular importance is currently assigned to several molecular\r\nphysicochemical descriptors, for instance the polarity degree (mirroring the changes of partition coefficients and of the permeability of biological structures), and emphasizing on distribution and renal excretion rate.\r\nThe active metabolite (9-hydroxy-risperidone) of the atypical antipsychotic agent risperidone has an increased polar character and, consequently, its pharmacokinetic profile is modified compared to the parent drug: especially the penetration through the bood brain barrier and the efflux pump mediated transport were considered. In this context, the kinetic characteristics and their correlation with the pharmacodynamic properties for the two active\r\nentities, as well as the consequences dealing with the antipsychotic efficacy, the safety and efficacy profiles can be anticipated. The present approach critically asseses the available data from literature corroborated with the personal findings over the last years.
  • Case Report

    Cucu CI, Giurcaneanu C, Mihai MM, Voiculescu VM, Beiu C, Martin S, Negoita S, Popa LG , Miron A

    Hidradenitis Suppurativa in Postmenopause

    Acta Endo (Buc) 2021 17(2): 274-277 doi: 10.4183/aeb.2021.274

    Abstract
    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.
  • Case Report

    Stanescu B, Miron R, Badiu C

    Anaplastic carcinoma of the thyroid mimicking acute thyroiditis

    Acta Endo (Buc) 2007 3(4): 493-502 doi: 10.4183/aeb.2007.493

    Abstract
    We report a case of anaplastic thyroid carcinoma mimicking acute thyroiditis with skin necrosis. A 82 years woman, with no significant previous medical disorders, was admitted with a few weeks history of a painful rapidly enlarging neck mass associated with hoarseness, dysphagia to solids, dyspnea and a general state deterioration. Physical exam was significant for a left-anterior lateral neck tumor of about 7 cm. The mass was tender, firm, nonpulsatile and nonfluctuant; it was fixed to the underlying cervical tissues. Antero-cervical skin tissues were swollen, hyperemic, presenting necrosis with penetrating tendency, severe neck pain and tenderness, associated with fever, suggesting an acute thyroiditis. The thyroid function was normal (TSH = 0.81 mUI/L, TT3 = 62 ng/dL, TT4= 8.77 ug/dL) as well as antithyroid peroxidase antibody (0.5 UI/mL), while thyreoglobulin was high (384 ng/mL). Thyroid scintigram revealed a cold nodule. Thyroid ultrasound revealed a giant left thyroid mass with necrosis, lymph nodes involvement and displacement of trachea. Fine needle aspiration confirmed the clinical suspicion features of anaplastic thyroid cancer: mitoses, anisocytosis and marked anisokaryosis with enlarged nuclei. Computed tomography confirmed a voluminous mass involving the thyroid, with calcifications, necrosis with multiple latero-cervical lymph nodes, compressing right carotid artery and internal jugular vein; it was detected also a pulmonary metastasis (right medium pulmonary lobe). The patient was diagnosed on having a thyroid carcinoma of the anaplastic type, TNM stage IVc. Surgery was performed through cervical approach without sternotomy, by total thyroidectomy and resection of proximal cervical structures involved by the tumor mass. After surgery, the patient was started on levothyroxine 100 &#956;g/ day and scheduled for cervical radiotherapy, but the tumor relapsed in several weeks. Local disease can be controlled with radiotherapy either alone or in combination with chemotherapy.
  • Editorial

    Miron I, Dumitrascu DL

    Gastrointestinal Motility Disorders in Obesity

    Acta Endo (Buc) 2019 15(4): 497-504 doi: 10.4183/aeb.2019.497

    Abstract
    The gastrointestinal (GI) motility, which is important for the digestion and absorption, may be altered in obesity. The aim of this review is to present the GI motility changes occurring in obesity, as well as their underlying mechanisms. We have conducted a systematic review of the published literature concerning GI motility and obesity and have described recent published data on the changes throughout the entire GI tract. Most recent discoveries include evidence supporting the increase of gastroesophageal reflux disease in obesity and inhibition of gastric motility. Intestinal transit of the distal small bowel generally slows down, ensuring enough time for digestion and absorption. Constipation is more frequent in obese patients than in those with a normal weight. The gut-brain axis plays an important role in the pathophysiology of GI motility disorders in obesity. This bidirectional communication is achieved by way of neurons, hormones, metabolites derived from intestinal microbiota and cytokines. The molecular mechanisms of GI motility changes in obesity are complex. Current data offer a starting point for further research needed to clarify the association of obesity with GI motility disorders.
  • Notes & Comments

    Enciu O, Toma EA, Badiu C, Miron A

    A Close Encounter – Left Pneumonia and Pancreatic Tail Fistula after Laparoscopic Left Adrenalectomy

    Acta Endo (Buc) 2020 16(4): 526-529 doi: 10.4183/aeb.2020.526

    Abstract
    Laparoscopic adrenalectomy is currently considered the gold standard for adrenal tumors up to 6 cm, and although with far less morbidity than the open alternative, when it comes to its complications we should not look away. The case concerns a 51-year old obese male that underwent left laparoscopic adrenalectomy for incidentaloma and developed pancreatic tail fistula. Without an evident pancreatic lesion during surgery and an uneventful early postoperative course the patient was discharged only to return 4 days later with respiratory symptoms and mild abdominal discomfort in the left upper quadrant. The CT scan diagnosed a left subphrenic fluid collection and left basal pneumonia, thus the patient underwent laparoscopic reintervention for drainage of the pancreatic fluid collection and received conventional antibiotherapy for pneumonia. The patient was discharged in good condition with the drainage tube in situ. The drainage tube was extracted 14 days later.
  • Book Review

    Miron R

    The Washington Manual of Medical Therapeutics

    Acta Endo (Buc) 2007 3(4): 531-531 doi: 10.4183/aeb.2007.531