ACTA ENDOCRINOLOGICA (BUC)

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Introduction. Orbitopathy is a common extrathyroidal feature of Graves’ disease. Initial immune infiltration may be followed by irreversible fibrosis and hypertrophy of extraocular muscles, leading to exophthalmos, diplopia and optic nerve compression. Surgery can improve the quality of life by adapting orbit volume to its content through orbital expansion and/or decompression and through interventions for functional or aesthetical reasons. Aim. To evaluate the impact of orbit surgery on the evolution of Graves’ ophthalmopathy. Patients and Methods. Our series includes 21 patients, operated between 2006 and 2012 mainly for proptosis (16 cases) or diplopia (5 cases). Results. Emergency orbit decompression was performed in one patient in the acute phase due to vision loss, reversible after intervention. Orbital extraconal lipectomy was used in all patients, involving both intraconal and extraconal fat in five cases. Unilateral bone decompression was needed in two interventions. 7 patients developed upper eyelid retraction, treated with botulinum injection in the levator palpebrale. Another patient showed lower lid retraction, elongated with palatal mucosal graft. Conclusion. Adequate surgery should be chosen for each case in an integrated multidisciplinary approach. Both intraorbital fat removal and bone decompression could be concomitantly used in certain patients with severe orbitopathy. Surgery should be performed in stabilized orbitopathy, but emergency intervention might be beneficial in acute onset of vision loss due to optic nerve compression.

Background. The literature contains several definitions of the metabolic syndrome, different from one another through the components included and the reference ranges considered normal. The aim of this study is to evaluate the prevalence of the metabolic syndrome and its components in a rural community from the North-East region of Romania. Methods. The study included 3248 persons from the rural environment. The data recorded regarded gender, age, anthropometric parameters (weight, waist circumference, body mass index), arterial blood pressure, and laboratory findings. The defining criteria for the metabolic syndrome used were IDF 2005 in comparison with the criteria NCEP-ATP III. Results. Over half of the studied population presents excess body weight, the prevalence of obesity (Body Mass Index - BMI≥30kg/m2) being 17.5% with a proportional relationship between age and BMI value (p<0.001), as well as between age and waist circumference value (p<0.001). The prevalence of the metabolic syndrome according to IDF criteria is 16.3% and 14.2% according to NCEP-ATP III criteria. Irrespective of the BMI value, there is an individual increase in the number of cardiovascular risk factors parallel to the increase of the WC. Conclusions. The metabolic syndrome is frequently encountered in the clinical practice and the use of the IDF definition criteria allows a wider identification of the patients with high cardiometabolic risk. This is the group of people that need to be targeted by the diagnostic and treatment of important cardiometabolic pathology.

Context. Chronic idiopathic urticaria (CIU) is often associated with autoimmune thyroiditis (AT). Objective. The aim of this study was to analyze the clinical particularities of patients with CIU associated with AT and to evaluate the efficacy of dapsone in such patients. Design. We performed an observational study of patients hospitalized in our clinic between January 2010 - December 2013 for moderate/severe chronic urticaria (CU). Subjects and Methods. Data regarding medical history, clinical, paraclinical findings, coexistence of AT and response to treatment were compared between patients with CU and AT and those without AT. Patients continued oral H1 antihistamines. Severe flares required systemic corticotherapy. 11 patients with refractory CIU associated with AT received dapsone treatment. Levothyroxine was administered in patients with hypothyroidism. Results. Among the 210 patients admitted for CU, 39 (92% female) were diagnosed with CIU associated with AT. Patients with CIU associated with AT had a slightly longer disease duration, a higher prevalence of angioedema (25.6% vs. 16.7%) and a more frequent need of systemic corticotherapy for urticaria exacerbations (46.2% vs. 30.4%). All 39 patients achieved significant clinical improvement after a mean period of 4 weeks based on urticaria activity score (UAS) 7 (p<0.0001). Conclusions. Assays for thyroid autoantibodies and thyroid function should be part of the workup in patients with CU, enabling the diagnosis of autoimmune urticaria. Without correction of the underlying autoimmune mechanisms, CU may persist regardless of conventional treatment. Dapsone represents a therapeutic option in autoimmune CU.