ACTA ENDOCRINOLOGICA (BUC)

Renal osteodystrophy and low bone mass are frequently found in patients with end-stage renal disease (ESRD). Our aim was to identify the independent predictors of age - and sex-adjusted bone mineral density (BMD), measured at different traditional sites, in patients with ESRD treated by hemodialysis (HD) or peritoneal dialysis (PD). Patients and Methods. We consecutively assessed 23 patients with ESRD (17 on HD and 6 on PD). Patients treated with 1,25 dihydroxyvitamin D, vitamin D derivates (paricalcitol) or calcimimetics were excluded. Serum parathormone and 25OH vitamin D were measured in all patients. In HD patients all biochemical measurements were done in the day between dialysis sesions. BMD was assessed at following sites: femoral neck, total proximal femur, 1/3 radius, ultradistal (UD) radius and total radius. Radial BMD was assessed in the forearm without arteriovenous fistula. BMD Z-score provided by the manufacturer was used. Results. In patiens undergoing PD the femoral neck BMD Z-score was significantly higher than in HD patients (difference -0.77 DS, 95% CI for difference -1.48 to -0.06). PTH correlated significantly with BMD Z-score at the 1/3 (r=-0.664, p<0.001) and total (r=-0.583, p=0.002) radius levels. Total proximal femur and UD radius BMD Z-scores did not correlate with any of the proposed variables. Years of dialysis, 25OH vitamin D and body mass index did not correlate with BMD Z-score at any site. Conclusion. In patients with ESRD PTH correlates strongly with BMD Z-score at cortical sites. PD seems to be less harmful to BMD than HD.

A 51 years old woman, diagnosed 23 years ago with acromegaly and non-insulin dependent diabetes mellitus, who denied radical treatment and took bromocriptine 2.5 - 7.5 mg/day sporadically and oral antidiabetic drugs, presented with chronic headaches, acromegalic features, bilateral temporal hemianopia, hypertension, hyperglycemia. Her pituitary function was normal (random serum growth hormone 2.5 - 2.8 ng/mL). The skull X-ray showed an enlarged sella turcica, with blurred multiple contour and an &#8222;egg-shell&#8221; calcification boarding the interior sellar floor. Cranial CT scan revealed a 1.7/0.7 cm intrasellar macrocalcification with a low-density core, lying on most of the sellar floor. In addition there were partial empty sella, asymmetrical optic chiasm, multiple cerebral,\r\nvascular and pineal microcalcifications, but no visible pituitary or tumor mass. Apoplexy within a previous large pituitary growth hormone-secreting tumor, followed by resorption and peripheral calcification, may have produced this rare case of pituitary stone associated with remission of acromegaly and sequelar visual field defect.

Introduction. The gold standard for surgery of fibroids is vaginal surgery and a preoperative treatment that facilitates this approach through reduction of the uterine\r\nvolume is of utmost importance. GnRH agonists and selective progesterone receptor modulators (SPRM) have both been tested to this effect.\r\nObjective. To evaluate whether uterine shrinkage induced by preoperative GnRH agonists in women with uteruses > 280g may\r\nfacilitate vaginal hysterectomy (VH).\r\nMaterial and methods. 23 women scheduled to have an abdominal hysterectomy based on the uterine size over 280 g were allocated to receive the GnRH agonist triptorelin 3.75 mg monthly for three months. Uterine weight (estimated by ultrasound), serum levels of estradiol and Hb were assessed before treatment and monthly afterwards three times.\r\nResults. Estradiol levels decreased from 235.9?15 to 38?3.7pg/mL at three months (p<0.0001), after an initial flare up. Hb increased from 11.85?1.8 to 12.7?0.74 g/dL.\r\nThe uterine weight decreased from 443.5?39 to 294.8?31 g (by 33.5%), all patients benefitting from a VH.\r\nConclusion. In women with a large uterus impending an abdominal hysterectomy, a 3-month preoperative course of GnRH agonists facilitates VH by decreasing uterine size by 30%.

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Glycemic control can be impaired in active acromegaly and insulin sensitivity (IS) decreases with rising growth hormone (GH) levels.\r\nAim. To assess the short-term impact of transsphenoidal surgery for acromegaly on glycemic control. Methods. 11 patients with native active acromegaly due to pituitary macroadenoma were assessed before and after (2-3 months) transsphenoidal hypophysectomy. Serum glucose, GH and insulin levels were measured by immunoradiometric assay at 0, 30, 60 and 120 minutes during a 75 g OGTT before and after surgery. IGF-1 levels were measured by ELISA. Basal hepatic IS was assessed using HOMA-S% and QUICKI indexes and stimulated IS using OGTTISI. Basal and stimulated insulin secretion was assessed using HOMA-B% index and IGI respectively. Results. All patients had their acromegaly improved (mean?SD pretreatment nadir GH 34?24.7 ng/mL vs. 4.6?3.5 ng/mL postsurgery; p<0.001) but only one was cured (nadir GH<1 ng/mL, normal IGF- 1 level). Mean fasting serum glucose was lowered by 7.9 mg/dL (95% CI 1.3-14.4, p=0.03) and fasting serum insulin by 9.6 mU/mL (95% CI 1.0-18.1, p=0.02). IS increased after surgery as shown by HOMA-S% index which rose 0.25?0.18 to 0.5?0.36 (p<0.01), QUICKI which rose form 0.31?0.03 to 0.33?0.03 (p=0.001) and OGTTISI index which rose from 2.5?1.6 to 5.1 ? 3.5 (p=0.002). Insulin secretion was unchanged as shown by HOMA-B% index (313?229 presurgery vs. 227?139 postsurgery, p=NS) and IGI index (0.96 ? 0.86 presurgery vs. 0.55 ? 0.49, p=NS). Conclusions. Partial removal of the pituitary adenoma by transsphenoidal surgery in patients with acromegaly induces a significant increase in insulin sensitivity and an improvement in glycemic control at 3 months after surgery. This suggests that transsphenoidal surgery should be indicated even if complete removal of the pituitary adenoma is not achieved.

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Context. Thyroid fine-needle aspiration (FNA) cytology is the best tool for preoperative diagnosis of thyroid carcinoma; however, its learning curve is poorly described. Our aim was to assess the learning curve of a new thyroid FNA center involving unexperienced operator and pathologist. Methods. We retrieved from our tertiary endocrinology center database all thyroid FNA procedures done by a single operator (endocrinologist with no experience in FNA) between 2018 and 2021. Cytology was assessed by two pathologists with limited or no experience in thyroid cytology. We also got the corresponding sex, age, nodule diameter, EU-TIRADS score, Bethesda category and final pathology report. Results. There were 1872 FNA in 1618 patients. Proportion of Bethesda 1 nodules decreased significantly (p for trend=0.003) from 17% in the first 100 FNA procedures to 4% in the 401-500 group of procedures, and remained constant between 9% and 4% (p for trend=NS) for the rest of the study. Proportion of Bethesda 2 rose steady from 26% in the first 100 nodules to 80.1% in the last 241 nodules (p for trend<0.001). Indeterminate lesions (Bethesda 3 and 4) decreased significantly (p for trend=0.001) from 16% and 35% in the first 100 nodules to 2.5% and 5.8% in the last 241 lesions. Proportions of Bethesda 5+6 categories varied non-significantly over time. There were no time trends in the malignancy rate of surgically removed nodules. Conclusions. At least 300 procedures are needed to reach the standard performance. A steadily state for the whole center is obtained after about 500 procedures.

Background. Advances in imaging techniques have led to increasing discovery of\r\nadrenal and pituitary &#8220;incidentalomas&#8221;, tumors with normal endocrine function and no\r\ncompression mass effects. We evaluated the age at diagnosis (AD) in patients with benign\r\nnon-functioning adrenal incidentalomas, as compared to pituitary non-functioning tumors,\r\nin a series of patients from a national center of endocrinology. Methods. From 2,123\r\nconsecutive patients with adrenal and pituitary tumors hospitalized between 1977 - 2009,\r\n2,069 patients were analysed. The study groups included: group A - 137 patients with\r\nadrenal incidentalomas (AI), group B - 534 patients with pituitary incidentalomas (PI).\r\nControl groups included 1,398 patients: group C1 147 patients with adrenal carcinomas or\r\nbenign hormone-secreting adrenal tumors, and group C2, 1,251 patients with pituitary\r\nsecreting adenomas or large non-functioning pituitary macroadenomas (NFA). Imaging was\r\ndone by computed tomography and/or magnetic resonance after 1981 and by skull X-ray or\r\npneumoencephalography before 1981. Results. Mean age AD is more advanced in patients\r\nwith AI (53 ? 11.9 years, range 21 - 78 yr) than in patients with PI (36.8 ? 13.1 years, range\r\n10 - 81 yr), p < 0.01. AD was higher in AI than in patients with secreting adrenal tumors,\r\nbut similar in patients with adrenal malignancy. There is an age-related increase in the\r\nproportion of AI among patients with adrenal tumors, and of NFA, but not of PI, among\r\npatients with pituitary tumors. In patients aged over 65 years, 74% of patients with adrenal\r\ntumors have AI, while only 18% of patients with pituitary tumors have PI and 42% have\r\nNFA. AD in NFA (49.3 ? 13.1 yr, range 12 - 79 yr) was more advanced than in PI (p < 0.01).\r\nAD does not correlate with tumor size. Tumor growth occurred in 24% of AI (follow-up 3.0\r\n? 2.8 yr) and only in 0.7% of PI, p<0.01 (follow-up 3.1 ? 2.5 yr).\r\nConclusions. Adrenal non-functioning benign tumors show a clear association with ageing,\r\nin contrast with pituitary incidentalomas. It seems unlikely that most pituitary incidentalomas in\r\nyoung patients become large NFA, whose development seems to be also age-related. It is tempting\r\nto suggest that pituitary tumorigenesis starts earlier than adrenal tumorigenesis.