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

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  • Actualities in medicine

    Burcea I, Poiana C

    Updates in Aggressive Pituitary Tumors

    Acta Endo (Buc) 2020 16(2): 267-273 doi: 10.4183/aeb.2020.267

    Aggressive pituitary tumors lie between pituitary adenomas and carcinomas, displaying a particular behavior, with invasion, resistance to conventional therapy and early recurrence. The radiological grading, along with prognostic markers such as Ki-67 proliferation index, p53, MGMT and transcription factors are important factors in establishing the benign, aggressive, or malignant nature of pituitary tumors, with a more accurate treatment strategy. In this article, we report the novelties in defining, classifying, and managing aggressive pituitary tumors and their malignant potential, focusing on clinicopathological, histological, molecular and radiological data.
  • Endocrine Care

    Poiana C, Stoian L, Cucu C

    One ear raloxifene treatment in osteoporotic postmenopausal women reduces bone turnover to premenopausal range

    Acta Endo (Buc) 2006 2(3): 283-293 doi: 10.4183/aeb.2006.283

    treatment of postmenopausal osteoporosis. It has estrogen agonist effects on bone and on surrogate markers of cardiovascular risk, but estrogen antagonist effects on breast and endometrium. It inhibits bone resorption and decreases bone turnover, increases bone mineral density and reduces the risk of vertebral fractures in postmenopausal women.\r\nObjectives: The main endpoint of our study was to evaluate the effect of raloxifene therapy (60 mg/day) on biochemical markers of bone turnover in romanian osteoporotic postmenopausal women. Secondary endpoints were the effect on bone mineral density (BMD), body mass composition and lipid profile.\r\nMaterials and methods: We performed a longitudinal, prospective, open study, investigating 29 postmenopausal white women with osteoporosis (Group 1) aged 56.9?7.8 years (mean ? SD) and in addition a control group of 29 premenopausal healthy white women (Group 2) with a mean age of 35.10 ? 7.8 years. The diagnosis of osteoporosis was established by dual-energy x-ray absorptiometry. We appreciated in both groups the bone turnover, measuring a marker of bone resorption: serum beta CrossLaps and a marker of bone formation: serum osteocalcin. We determined also the lipid profile: plasma cholesterol (mg/dL), HDL cholesterol (mg/dL), LDL cholesterol (mg/dL) and triglycerides (mg/dL) in all patients. Osteoporotic women received raloxifene 60 mg/day for one year. Biochemical bone markers, lipid profile and body composition have been evaluated at 3, 6 and 12 months of treatment and BMD was performed at 6 and 12 months of therapy.\r\nResults: Postmenopausal osteoporotic women showed an increased bone turnover in comparison with premenopausal women, with statistically significant increased serum values of both resorption and formation biochemical bone markers: respectively 0.48?0.2 vs 0.23?0.1 ng/mL for beta CrossLaps and 27.94?12.1 vs 17.30?8.9 ng/mL for osteocalcin, p<0.001. Raloxifene therapy for three months reduced significantly both bone resorption and formation: 0.36 ? 0.2 vs 0.48 ? 0.2 ng/mL, p< 0.005 for beta CrossLaps and 22.03 ? 10.1 vs 27.94 ?12.1 ng/mL, p< 0.001 for osteocalcin. After 3, 6 and 12 months of therapy with raloxifene the bone markers were statistically significant reduced: -21.2%, -20.4% and respectively -31.6% for osteocalcin and -25%, -39.6% and respectively -50% for beta CrossLaps (p< 0.01). After six months of therapy, serum levels of beta CrossLaps were reduced to premenopausal range (0.29 ? 0.1 vs. 0.23 ? 0.1 ng/mL, p=ns). Total cholesterol and LDL-C were reduced after 12 months (p< 0.03), with no increase in triglycerides and at the same time body mass composition was unchanged.\r\nConclusions: Our results suggest that raloxifene reduces as early as three months the bone turnover in postmenopausal osteoporosis. It reduces bone turnover in premenopausal range after only six months of therapy, for the bone resorption (beta CrossLaps) and after 12 months for bone formation (osteocalcin). In addition raloxifene treatment has favorable effects on BMD and lipid profile, proving safety and a stable body mass composition.
  • Images in Endocrinology

    Poiana C, Hortopan D

    Shadows above pituitary fossa

    Acta Endo (Buc) 2009 5(2): 283-283 doi: 10.4183/aeb.2009.283

  • Case Report

    Poiana C, Carsote M, Hortopan D, Coculescu M

    Skull monostotic Paget's disease of bone - case report and review of the literature

    Acta Endo (Buc) 2007 3(3): 333-344 doi: 10.4183/aeb.2007.333

    Paget's disease of bone is a metabolic skeleton disorder with different epidemiological patterns: increased incidence up to 3% of the Northern Caucasian population over the age of 55 or a very rare occurrence as in Asia. We present a case of a 69 years old female patient with diffuse bone pain, suspected of osteoporosis after a DXA investigation of bones. She has developed progressive skull deformation over the last 17 years and bilateral sensoneural deafness. On admission in our hospital, she had alkaline phosphatase serum levels five times higher than the upper normal value and low values of 25 hydroxy vitamin D. Parathormone and calcium levels were in normal range. Radiologic findings confirmed the monostotic type of Paget's disease. Other biomarkers of bone remodeling: serum osteocalcin for bone formation and serum beta Cross Laps for bone resorption, showed moderately increased levels. High dose therapy with alendronate and alphacalcidol were given with the normalization of bone markers after 9 months of sustained treatment. The vitamin D deficiency of this patient is an independent, associated disease, producing a decrease of bone mineral density as shown by DXA measurement. The case presentation and the review of the medical literature on this subject are intended to remind clinicians of the importance of appropriate diagnosis and therapy in this disease, as well as the importance of establishing the prevalence of Paget's disease of bone in Romania.
  • Case Report

    Dumitrescu C, Procopiuc C,Chirita C, Carsote M, Dumitrascu A, Poiana C

    A case of severe growth retardation, probably Seckel syndrome

    Acta Endo (Buc) 2010 6(3): 361-369 doi: 10.4183/aeb.2010.361

    We report the case of a 6.6 years old boy, born to healthy unrelated parents, from a normal pregnancy, admitted for severe growth retardation. His height was 71 cm\r\n(-9.3 SD), with a weight of 6.6 kg and he presented a triunghiular face, mycrognatia, proeminent nose and hypertelorism resulting in a ?bird headed? profile. He associated clinodactyly of the 5th finger and a slightly longer left leg. Tanner stages were P1 G1. The\r\nbiochemical panel was normal, but he presented mild hypocromic anemia. The thyroid function was normal, and the IGF1 low. The karyotype was 46 XY and the bone age 4.5\r\nyears. The pituitary computed tomography revealed empty sella. Based on the clinical picture, the possible diagnosis of Seckel syndrome was suspected. A short course of treatment with Metandienonum 0.04 mg/kg/day for 3 months was recommended, without success (growth speed of 6 cm/year - -0.14 SD)
  • Endocrine Care

    Gheorghiu ML, Hortopan D, Dumitrascu A, Caragheorgheopol A,Stefanescu A, Trifanescu R, Niculescu DA, Baciu I, Carsote M,Poiana C, Badiu C, Coculescu M

    Age-related endocrine tumors: non-functioning adrenal tumors as compared to pituitary adenomas

    Acta Endo (Buc) 2009 5(3): 371-384 doi: 10.4183/aeb.2009.371

    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.
  • Editorial

    Poiana C

    "Interpretation and Use of FRAX in Clinical Practice": Does the Official Position Answer to our Concerns?

    Acta Endo (Buc) 2011 7(3): 373-378 doi: 10.4183/aeb.2011.373

    The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) developed the FRAX? Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF called ?Interpretation and Use of FRAX? in Clinical Practice?, in order to bring answers to the numerous questions raised by the introduction and implementation of FRAX in clinical practice and to enhance the quality and clinical utility of fracture risk assessment (1-3).
  • Clinical review/Extensive clinical experience

    Capatina C, Poiana C

    Dopamine Agonists in the Management of Non-Functioning Pituitary Adenomas

    Acta Endo (Buc) 2021 17(3): 377-382 doi: 10.4183/aeb.2021.377

    Non-functioning pituitary tumors (NFPA) are usually large at the time of diagnosis and present with symptoms caused by compression on the neighbouring structures. Transsphenoidal resection of the tumor is the firstline treatment but in many cases complete tumor resection cannot be attained. Close follow-up with repeated hormonal assessment and pituitary imaging is recommended after surgery. During follow-up of the tumor remnant sometimes radiotherapy is used to stop or prevent tumor progression. Medical treatment with dopamine agonists (DA) is the mainstay in the management of prolactinomas. For NFPA several small series or case reports suggested beneficial effects with tumor shrinkage in some cases. The aim of the current paper is to summarize the available evidence related to the potential efficacy of DA medical treatment in NFPA while underlining that in the absence of randomized, placebocontrolled studies, no final conclusion on the efficacy of these drugs in the treatment of NFPA can be drawn.
  • Case Report

    Paun S, Carsote M, Poiana C, Neamtu C, Ganescu R,Negoi I, Paun DL

    Laparoscopic Surgery - A Feasible Treatment in Morris Syndrome

    Acta Endo (Buc) 2011 7(3): 385-394 doi: 10.4183/aeb.2011.385

    Morris Syndrome is a pathological condition which needs a special approach regarding both diagnosis and treatment\r\nbecause of its rarity. While the diagnosis is based on karyotype test, the treatment should follow the idea of harmless and cosmetic benefits as well as complete gonads removal. This paper is presenting the usefulness and advantages of minimally invasive surgery as a feasible treatment for such a disease. A retrospective study was performed for two patients with Morris Syndrome, admitted to\r\nthe ?CI Parhon? National Institute of Endocrinology, Bucharest, Romania, followed-up for 4 - 16 years, and operated to the Department of Surgery, Emergency\r\nHospital, Bucharest, Romania. Patients with primary amenorrhea have been clinically observed and three patients\r\nwith 46, XY karyotype have been identified as Morris Syndrome cases needing surgical removal of the intraperitoneal gonads because of the risk of malignant transformation. A minimally invasive surgical technique has\r\nbeen chosen for proper treatment: the anterior transperitoneal laparoscopic approach. The surgery was adapted to every case, in according with preoperative imagistic diagnosis of the intraperitoneal testes\r\n(localization, dimensions, adjacent organs involvement, surgical access). No postoperative complications were noticed and specimens' pathology confirmed the final\r\ndiagnosis. Cosmetic benefits were achieved for every young patient as well as rapid postoperative recovery (discharge after 48 hours). The authors concluded that Morris Syndrome patients could benefit from the laparoscopic surgery which is a feasible, safe and proper treatment for such cases.
  • Book Review

    Poiana C

    Metabolic effects of psychotropic drugs

    Acta Endo (Buc) 2010 6(3): 394-394 doi: 10.4183/aeb.2010.394