ACTA ENDOCRINOLOGICA (BUC)

Background. Risk stratification and an appropriate therapeutic approach could be lifesaving in acute pulmonary embolism (PE). Echocardiographic (ECHO) acute right ventricular dysfunction (RVD) is the actual &#8220;gold standard&#8221; in risk evaluation of PE. We previously demonstrated that plasma BNP levels were significantly higher in patients with PE and acute RVD on ECHO vs. patients with normal RV function on ECHO.\r\nAim. Evaluation of the limits of plasma BNP in signalling acute RVD in PE. \r\nMethods. 70 patients with PE were prospectively investigated: 42(60.0%) men, mean ? SD(standard deviation) age 52.51?8.82. BNP was measured on admission using a quantitative fluorescence immunoassay (TriageBNP). ECHO evaluation of the RV function was performed in the first hour after admission. Study protocol was approved by local Ethical Committee. Patients were divided into two groups: group 1-with acute RVD on ECHO, n=24(34.3%) patients; group 2 - without acute RVD on ECHO, n=46(65.7%).Patients from group 1 were further divided into two subgroups: subgroup 1A-admitted in <12 hours after their PE symptoms onset, n=12(50.0%) patients, and subgroup 1B-admitted in >12 hours after the onset of PE symptoms, n=12(50.0%) patients.\r\nResults. BNP proved good in discriminating between patients with and without acute RVD (AUC=0.88, P<0.0001). The cut-off level of plasma BNP=50 pg/mL showed the best sensitivity=0.86 and specificity=0.82 in identifying acute RVD. BNP levels were significantly lower in subgroup 1A (admitted soon) compared to subgroup 1B (admitted later than 12 hours): medians 45.25 pg/mL vs. 344.50 pg/mL, P<0.0001. Eight patients from subgroup 1A, all admitted soon after the onset of their PE symptoms, and all experiencing at least one syncopal episode showed BNP under the cut-off level. In subgroup 1A BNP did not correlate with RV end-diastolic diameter (R=0.23, P=NS), while in subgroup 1B BNP and RV end-diastolic diameter showed a consistent positive correlation (R=0.91, P<0.0001). In subgroup 1A BNP correlated significantly, but negatively, with RV systolic pressure (R=-0.64, P<0.01). In subgroup 1B BNP was significantly positively correlated with RV systolic pressure (R=0.76, P<0.001).\r\nConclusions. BNP higher than a cut-off level of 50 pg/mL could predict acute RVD in patients with PE with a good sensitivity and specificity. Exception of this rule was found in some patients with recent (<12 hours) PE symptoms onset and poor clinical condition.

Background. Early prediction of anticancer therapy cardiotoxicity is essential for applying proper preventive and supporting therapeutic strategies. Objective. To evaluate plasma N-terminal fragment of pro-brain natriuretic peptide(NT-proBNP) related to cardiac dysfunction assessed by transthoracic 2 D echocardiography (2D-TTE) in patients with cancer and early onset asymptomatic anthracycline-induced cardiomyopathy(AIC). Methods. Prospective study of 68 patients with cancer treated with anthracyclines, followed up for 6 months. Diagnosis of AIC was set at 6 months by decreasing of left ventricular ejection fraction(LVEF) below 50% or with more than 10 units or 20% from baseline. NT-proBNP and 2D-TTE were assessed at enrollment, and thereafter at 3 and 6 months. Results. Fifteen(22.1%) patients developed AIC at 6 months of anthracycline treatment (group 1), and 53(77.95%) patients did not evolve with AIC (group 2). At 3 months, in patients from group 1 NT pro-BNP was significantly higher compared to group 2 [121.0 (119.8;140.8) pg/mL vs. 97.7(75.5;111.7) pg/mL, P=0.0001, values expressed as median (25th; 75th percentiles)]. Left ventricular(LV) diastolic dysfunction was significantly more frequent in group 1(93.3%) vs. group 2(37.7%), P=0.0002. NT-proBNP at 3 months proved accurate in predicting asymptomatic AIC at 6 months [area under the receiver operating characteristic curve(AUC)=0.845, 95%Confidence Interval(CI): 0.735-0.954, P=0.0001]. Newinstalled diastolic dysfunction at 3 months had a sensitivity of 60 %, a specificity of 77% in predicting AIC at 6 months. NT-proBNP assessed at 3 months above a cut-off=118.5pg/ mL was an independent predictor of AIC at 6 months. Conclusions. Plasma NT-proBNP at 3 months of anthracycline therapy proved to be an early independent predictor of asymptomatic anthracycline-induced cardiomyopathy.

Background. Several studies observed metabolic disorders in pregnancy as risk factors for birth defects, including orofacial clefts. Diabetes is associated with approx. 10% of the pregnancies, but in Romania, less than 5%. An obese and diabetic woman has 3 times more risk for an offspring with a craniofacial defect than healthy women suggesting that diabetes mellitus contributes to their pathogenesis with complex mechanisms. Case report. We present the case of a newborn 4 days old, male with neonatal hypoglycemia, cleft lip and proportionate (symmetric) macrosomia. His mother is a 35 years old Caucasian woman with no important personal risk factors and no known history of diabetes mellitus. The glucose tolerance test performed to the mother at about 10 weeks during pregnancy led to the diagnosis of gestational diabetes. Discussion. The gestational diabetes mellitus diagnosed since the 10th week of pregnancy, the hyperglycemia status during pregnancy and the fetal overgrowth (macrosomia at birth) indicate the possible factors that lead to the Orofacial cleft (OFC). Conclusion. With the increased prevalence of obesity, diabetes, and the evidence of association of these syndromes with OFCs, it is recommended that mothers planning to become pregnant to follow healthy habits, maintain healthy weight, and be screened for possible diabetes prior to conception and early in pregnancy.

Introduction. Ectopic sphenoid sinus pituitary adenomas are a rare, benign pituitary tissue neoplasm, occurring separate from and without involvement of the anterior pituitary gland. We present a case of ectopic pituitary adenoma confined to the sphenoid sinus, asociated with an empty sella. Case report. A 52-year-old man was addmitted to our neurosurgical department with persistent headache and nasal obstruction of one year duration. Patient presented no endocrine abnormalities and no visual disturbances. MRI revealed a well-defined mass lesion in the sphenoid sinus, hypointense on T1-weighted images, hyperintense on T2-weighted images, with moderate heterogeneous gadoliniumenhancement. A primary empty sella was associated. Surgery was performed by transnasal transsphenoidal approach. The tumor was removed in a piecemeal fashion. The bony sellar floor was intraoperatively proven to be intact. The pathologic studies confirmed the diagnosis of ectopic nonfunctional pituitary adenoma of the sphenoid sinus. The postoperative course was uneventful. Conclusions. When encountering a tumor within the sphenoid sinus, an ectopic pituitary adenoma should be suspected. A clinical, imaging and endocrinologic evaluation must be undertaken, aiming to identify the nature of the lesion and to initiate the specific therapy. Surgery remains the only way of obtaining a definite diagnosis and cure.

Right ventricular dysfunction (RVD) is critical for risk stratification of patients with pulmonary embolism (PE). Evaluation can be made by echocardiography or biological markers among which plasma levels of brain natriuretic peptide (BNP). The aim of our study is assessment of BNP levels in patients with PE associating or not RVD as diagnosed by classic echocardiographic criteria. We prospectively assessed 40 patients with deep venous thrombosis and confirmed PE (age range 52.5 ? 9.14 years, 22 men and 18 women), with (14) or without (26) RVD on echocardiography. Plasma BNP levels were significantly higher in RVD patients (190 ? 171.2 pg/mL vs. 15.75 ? 18.85 pg/mL, P < 0.0001). A cut-off level of plasma BNP = 50 pg/mL had a sensitivity, specificity, positive and negative predictive value for the diagnosis of RVD of 84% (C.I. 79% - 88%), 80% (C.I. 75% - 85%), 83% (C.I. 77% - 87%) and 79% (C.I. 75% - 84%), respectively. There was a significant correlation between plasma BNP levels and end-diastolic RV diameter (r = 0.56, P < 0.0001), RV systolic pressure (r = 0.50, P < 0.001) and the presence of a Qr complex in V1-lead on ECG (r = 0.55, P < 0.05). Four patients with RVD on echocardiography and syncope, all admitted relatively soon after the onset of their symptoms, had BNP in normal range. In conclusion, PE should be considered in the differential diagnosis of patients with dyspnoea and increased plasma BNP levels. A cut-off level of 50 pg/mL could identify the RVD in patients with PE with a good sensitivity and specificity. Normal range plasma BNP levels do not exclude even a severe PE and should be interpreted with caution, especially in highly symptomatic patients with recent symptom onset.

Background and aims. Increased fat accumulation associated to increased cardiometabolic risk factors is a prominent feature of type 2 diabetes. In type 1 diabetes, increased fat accumulation is not prevalent and its metabolic impact has not been fully evaluated. We aimed to evaluate differences in body composition, clinical and metabolic\r\nprofile in type 1 and type 2 diabetes patients with varying degrees of adiposity.\r\nMaterials and methods. Clinical, biochemical and body composition data (using a bioelectric impedance analyzer) from 96 type 1 and 253 type 2 adult diabetes patients have\r\nbeen collected.\r\nResults. In type 1 patients estimated visceral fat area (eVFA) increased significantly (84.3?27.9 vs. 103.0?27.9 vs. 128.1?29.1 cm2, p=0.006, 0.003, and <0.001) while BMI, body fat mass (BFM) did not differ across age tertiles. Between normal weight (BMI<25 kg/m2) and overweight (BMI>25 kg/m2) type 1 patients there were no significant differences either in triglycerides (128.7?135.6 vs. 92.8?50.6 mg/dl, p=0.1), HDL-cholesterol (53.6?15.9 vs.\r\n52.3?13.7 mg/dl, p=0.6) and uric acid levels (3.4?2.0 vs. 2.9?1.2 mg/dl, p=0.2), or in hypertension (39.5% vs. 40.0%, p=0.7) and nonalcoholic hepatosteatosis (NASH) (10.0% vs.\r\n10.5%, p=0.6) prevalences. In type 2 patients, BMI (32.3?5.9 vs. 29.5?5.1 vs. 27.9?5.0 kg/m2, p=0.001, p=0.04, p<0.001) and BFM (34.5?12.7 vs. 29.6?10.2 vs. 27.1?10.8 kg, p=0.007, p=0.11, p <0.001) decreased, while eVFA did not differ across age tertiles, suggesting that older age increases central fat distribution. Compared to normal weight, overweight type 2 diabetes patients had greater triglycerides (218.8?303.4 vs. 110.9?44.9 mg/dl, p=0.01), uric acid (4.5?2.4 vs. 3.3?1.4 mg/dl, p=0.01), and lower HDL-cholesterol (43.9?12.9 vs. 54.1?15.4 mg/dl, p<0.001) serum levels, and higher prevalences of hypertension (71.8% vs. 39.4%, p=0.005) and NASH (59.1% vs. 25.0%, p=0.005).\r\nConclusion. Visceral fat accumulation is associated with older age in both types of diabetes, but only in type 2 diabetes is associated with cardiometabolic anomalies.

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