ACTA ENDOCRINOLOGICA (BUC)

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Context. Accumulating data supports the key role of disrupted amino acids (AAs) metabolism in diabetes. Conflicting data regarding the relevance of serum AAs in diabetes and hypertension suggest that their relationship needs further investigation. Objective. To investigate serum AAs as biomarkers of increased BP variability evaluated during 24-hour ambulatory BP monitoring in the presence of type 2 diabetes. Design. Cross-sectional. Subjects and Methods. We analyzed serum AAs using targeted metabolomics (ultrahigh-performance liquid chromatography/mass spectrometry) in patients with type 2 diabetes (n=80). BP variability was assessed using 24-hour ambulatory BP monitoring. Participants were divided into two groups based on the 24-hour diastolic BP variability median value. Results. Aspartic acid, isoleucine, leucine, and phenylalanine were significantly lower, while glutamine was significantly higher in the group with higher diastolic BP variability (p-value <0.05 and variable importance in the projection >1). Corresponding pathways identified as disrupted in patients with diabetes and a higher 24-hour diastolic BP variability were phenylalanine, tyrosine, and tryptophan biosynthesis, phenylalanine metabolism, and alanine, aspartate, and glutamate metabolism (pathway impact value >0). Conclusions. We identified specific changes in serum AAs and target AAs pathways in relation to increased 24-hour diastolic BP variability in patients with type 2 diabetes.

Differentiated thyroid cancer (DTC) generally has an excellent prognosis, yet treatment strategies have traditionally been aggressive, often involving total thyroidectomy followed by radioactive iodine (RAI) ablation and long-term suppressive levothyroxine therapy even in cases considered to be low- or intermediate-risk. In recent years, several guidelines have recommended a more individualized, risk-based approach aiming for a more conservative treatment plan. Despite this paradigm shift, there is a gap between recommendations and actual clinical practice as many centers continue to advocate the more aggressive treatment model. De-escalating the care of selected patients with thyroid cancer include the avoidance of surgery in tumours < 10 mm, the recommendation for thyroid lobectomy for tumours < 4cm, the avoidance of prophylactic lymph node dissection. Evidence based studies show that such strategies do not worsen long-term outcomes, can reduce complications and can lead to better quality of life. Such studies will be summarised in this editorial with the aim of encouraging clinicians to reconsider established treatment protocols and empowering patients to make informed decisions for their care.

Anorchia is a syndrome characterized by unilateral or bilateral absence of testicular tissue.\r\nAt puberty, growth and development are normal but secondary sexual development fails to\r\noccur if anorchia is bilateral.\r\nWe present the case of a 21 year-old male with a late diagnosis of bilateral anorchia. The\r\ndiagnosis was suggested by a bilateral empty scrotum, in a patient with male phenotype and\r\npoor secondary sexual development and established by karyotype analysis, hormonal profile\r\nand surgical exploration. The lack of testosterone response to hCG stimulation is the hormonal\r\nhallmark of bilateral congenital anorchia. In the absence of any information about germinal cell\r\npresence, bilateral excision of the testicular nubbins, implantation of testicular prostheses and\r\nhormonal replacement therapy were indicated.

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