ACTA ENDOCRINOLOGICA (BUC)

Background. Gangliosides are Nacetyl - neuraminic - acid containing glycosphyngolipids that modulate several\r\ncellular functions.\r\nObjective. The present study confirmed the presence of cellular gangliosides in melanocytic tumors with\r\nneuroectodermal origin. These molecules showed large quantitative and structural variability in melanocytic cells.\r\nMethods. The spectrum and levels of gangliosides were performed from 1991 until 2010, in 411 specimens of melanoma, 108 cutaneous metastases of melanoma, 206\r\nnevocellular and dysplastic nevus and 130 specimens of normal skin.\r\nResults. Melanoma showed aberrant gangliosides expression. This included overexpression of normal ganglioside\r\nconstituents (GM2, GM3, GD2, GD3), which also appear in melanocytic nevus and epidermis tissues, and expression of\r\ngangliosides (O-Acetyl-Ganglioside) not found in normal adult tissue. The ganglioside composition of\r\nmelanoma is: GM1 (1,29?0,87%), GM2 (10,32?4,11%), GM3 (22,23?11,30%), GD2 (16,03?9,13%), GD3 (39,06?14,25%), GD1a\r\n(2,16?0,77%), GD1b (1,74?1,01%), GT1b (1,82?1,11 %), GQ1b (1,34?1,07%), OAcetyl-GD3 (4,01?2,81%).\r\nConclusions. The overexpression and variability of gangliosides in melanoma and the low expression of them in normal tissue was correlated with oncogenic process and\r\nmetastatic potential.

Introduction. Primary hyperparathyroidism is diagnosed earlier and more frequently with the introduction of routine serum calcium measurements. In literature, it is shown that mortality and morbidity decrease after parathyroidectomy. In our study, we aimed to determine the effect of parathyroidectomy on oxidative stress. Materials and Methods. The results of 41 patients who underwent parathyroidectomy for primary hyperparathyroidism between March 2018 and end of December 2018 were evaluated prospectively. Total antioxidant capacity (TAC), superoxide dismutase (SOD), thiobarbituric acid reactive substances (TBARS), 8-hydroxy- 2’-deoxyguanosine (8-OHdG), malondialdehyde (MDA), parathyroid hormone, calcium and albumin were measured before and after parathyroidectomy. Results. The mean age of the patients in the study was 45 ± 13.1 years (age range: 18-76 years). The female/ male ratio was 32/9. Postoperative values of 8OHdG, MDA and SOD 1 were significantly lower than preoperative values (p <0.05). There was no significant difference between preoperative and postoperative TAC and TBARS values. Conclusion. Oxidative stress decreased in patients with primary hyperparathyroidism after parathyroidectomy. Randomized prospective studies are needed to show the relationship between biochemical and clinical parameters in order to see the clinical reflection of the study.

Objective. This study aims to determine the frequency and prognostic significance of lactic acidosis in children with diabetic ketoacidosis (DKA) admitted to the pediatric intensive care unit. Methods. The study was carried out retrospectively by examining the patients admitted to the pediatric intensive care unit for the treatment of DKA. The ages of the patients ranged from 2 to 18 years. The patients with the following parameters were enrolled in the study: serum blood glucose>200 mg/dL, ketonuria presence, venous blood gas pH ≤7.1, bicarbonate <15. Results. A total of 56 patients were included in the study with a mean age of 111.07 ± 51.13 months. The recovery time from DKA was 16.05 ± 6.25 h in the group with low lactate level and it was 13.57 ± 8.34 h in the group with high lactate level with no statistically significant difference. There was a negative correlation between lactate levels and the recovery time from DKA. Conclusion. Lactic acidosis is common in DKA, and unlike other conditions, such as sepsis, it is not always a finding of poor prognosis that predicts the severity of the disease or mortality. We think that high lactate may even protect against possible brain edema-cerebral damage in DKA.

Context. In patients with suspected primary aldosteronism (PA), the aldosteroneto- renin ratio (ARR) is the most frequently recommended screening test. Further evaluation is based on hormonal changes during volume expansion. Both analyses are critically dependent on an accurate estimation\r\nof renin concentration. Direct active renin (DAR) is a novel laboratory technique used for plasma renin assessment.\r\nObjective. The objective of this study was to evaluate DAR for use in PA diagnostic work-ups.\r\nSubjects and Methods. The study enrolled 69 healthy volunteers. Blood sampling was conducted before and after an\r\nincrease in oral salt intake. Furthermore, a subset of 32 individuals underwent a saline infusion suppression test. DAR and serum aldosterone were measured in all blood samples. To calculate the ARR, serum aldosterone and DAR were expressed in ng/L.\r\nResults. ARR values [median (range); 97.5 percentile] associated with normal and elevated oral salt intake were 8.4 (0.6-37.7); 26.3, and 6.8 (1.1-37.7); 19.6, respectively. DAR and serum aldosterone concentrations\r\n[median (range); 97.5 percentile] after saline infusion suppression were 2.9 (2.7-10.7); 7.2 ng/L and 30 (30-72); 54 pmol/L, respectively.\r\nConclusions. The observed values may be useful in excluding a diagnosis of PA.

Background. We know that mortality had increased in diabetic patients with COVID-19 pneumonia. The aim of this study was to compare the mortality and inflammation parameters difference in critically ill COVID-19 patients according to their admission HbA1c levels and diabetes mellitus status. Secondary aim was to evaluate the effect of the first week hyperglycemic episode frequency on mortality. Methods. Critically ill COVID-19 patients who were tested for HbA1c levels on ICU admission were analyzed retrospectively. Results. Of 218 COVID PCR(+) patients, 139 met the inclusion criteria in study period. The median age was 67[57-76] years and 55(40%) of them were female. Seventy-six (55%) of the patients required invasive mechanical ventilation (IMV). The IMV requirement was higher in diabetic patients (p=0.01). When the groups were compared in terms of inflammatory parameters no significant difference was found except for admission and first week’s highest fibrinogen levels (p=0.02 and p=0.03, respectively). In multivariate analysis, fibrinogen levels were not determined as a risk factor for mortality. Overall ICU mortality was 43% (60/139). In group-1 23(37%), in group-2 27(57%), and in group-3 10(34%) patients had died. There was no statistically significant difference between groups in terms of mortality (p=0.05). Records of 96(69%) patients revealed there were more than five glucose readings over 180mg/dL during the first week. Mortality was higher in patients with more frequently hyperglycemic recordings (p=0.03). Conclusions. There was no significant mortality and inflammatory parameters difference in patients with and without diabetes. However, more than five glucose readings over 180mg/dL during the first week were found with increased mortality.

Context. Hypothyroidism and iron deficiency are among the most common pathologies in population. Therefore, there are a lot of patients assuming both iron salt supplements and levothyroxine therapy. Objective. To evaluate the effect of iron salt intake on L-T4 absorption among different L-T4 formulations. Materials and methods. A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Original studies and reviews written in English and published online up to 21 December 2022 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review. Results. The data show an impaired absorption of L-T4 in tablets formulation when taken concomitantly with iron salt supplements. These phenomena seem to be circumvented by new L-T4 formulations. Conclusion. Liquid L-T4 formulations can be ingested with iron salts, with no impairment of absorption. More studies are necessary to confirm these data for soft-gel capsules L-T4.

Context. Vitamin D is essential for skeletal and nonskeletal health and prolonged deficiency results in infantile rickets and adult osteomalacia. The aim of this study is to\r\ndetermine 25(OH) VitD and iPTH status in pregnancy and to evaluate the effects of monthly 100.000 IU dose of vitamin D\r\nsupplementation.\r\nMaterials and Methods. In a double blind trial of vitamin D supplementation in pregnant Iranian women, vitamin D3\r\n(cholecalciferol , 100/00 IU/month) was administered to 25 women and placebo to 25 controls during the last trimester. The two groups had similar distributions of maternal age, height, gravity, weight and age of gestation. Hydroxycholcalciferol and iPTH were measured in mothers at 27 weeks and at delivery. Cord blood was used to assess the\r\nsame parameters.\r\nResults. Comparing the data final maternal 25 - hydroxyvitamin D levels were significantly higher in the supplemented group versus control group (61.45?30 ng/mL versus 29.4?16 ng/mL); P &#8804; 0.001.Cord 25 - hydroxyvitamin D levels were significantly higher in supplementation group in\r\ncomparison to control group (52 ? 40.5 ng/mLversus 36?21.3 ng/mL); P<0.005.\r\nConclusion. Administration of 100/000 IU/monthly of vitamin D3 in the last trimester significantly increased 25(OH) VitD to high normal concentration. However, even with supplementation, only of mother and of newborn had serum\r\n25(OH) VitD greater than 30 ng/mL a small percentage of women and babies were vitamin D sufficient. According to data of study we propose 100/000 IU monthly is safe for pregnant women.

Background. Severe negative effects of diabetic foot ulcers on health related quality of life have been documented in western studies using quantitative and qualitative methods. Aim. The aim of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression. Methods. Thirty nine Nigerian adults with diabetes completed the WHO Quality of Life- Brief version (WHOQoL-Bref), modified mini mental state examination (mMMSE) and a rating scale for depression (Beck’s Depression Inventory). There were two matched groups composed of 21 subjects undergoing treatment for diabetic foot ulcers (index) and 18 subjects without foot related morbidity but with evidence of peripheral neuropathy as measured by Semmes-Weinstein 5.07(10 gm) monofilament (control). Results. Patients with diabetic foot ulcers had significantly poorer scores on domains of WHOQoL particularly in physical, psychological, overall quality of life and overall health score. There was evidence of depression in both groups with the index group more significantly depressed. There was no evidence of clinically significant cognitive impairment in either group. There was a relationship between clinical depression and negative effects of diabetic foot ulcer on health related quality of life. Conclusions. The results of this study suggest that the negative impact on healthrelated quality of life in diabetic patients with foot ulcers may be more severe than in diabetics without foot related morbidity. The negative effect did not seem to cause cognitive impairment in either group.

Fetal goitre is found in about 1 in 5,000 births, usually in association with maternal Graves’ disease, due to transplacental passage of high levels of thyroid stimulating antibodies or of anti-thyroid drugs. A goitre can cause complications attributable to its size and to the associated thyroid dysfunction. Fetal ultrasound examination allows easy recognition of the goitre but is not reliable in distinguishing between fetal hypo- and hyperthyroidism. Assessment of the maternal condition and, in some cases, cordocentesis provide adequate diagnosis of the fetal thyroid function. First-line treatment consists of adjusting the dose of maternal anti-thyroid drugs. Delivery is aimed at term. In cases with large goitres, caesarean-section is indicated.

COVID-19 primarily affects the respiratory system. What comes after the disease is now a greater concern for the scientific world. It is remarkable for causing endocrine organ involvement, particularly in the adrenal glands. However, its effect on the adrenal gland has not been fully elucidated. A case of primary adrenal insufficiency after COVID-19. A 31-year-old female patient who presented with complaints of weakness, anorexia, nausea, recent onset of vomiting, dizziness, and low blood pressure for two months was admitted to the outpatient Department of Endocrinology and Metabolism. After discharge, the patient had routine follow-ups, and here we present the information on the first and seventh month after discharge. The patient was diagnosed with primary adrenal insufficiency with cortisol <0.054 μg/dL and adrenocorticotropic hormone >1200 pg/mL in the laboratory. In the non-contrast computed tomography taken in the adrenal protocol, the stem and leaves of both adrenal glands are significantly thinned and appear atrophic, the right adrenal gland is hardly distinguished. Hydrocortisone was started. All complaints were resolved within a week, except hyperpigmentation, which was resolved six months later after treatment. Our study support adrenal gland involvement due to COVID-19, further research is needed to obtain data on damage mechanisms.