ACTA ENDOCRINOLOGICA (BUC)

OBJECTIVES: This study was carried out on 1290 patients, whose choroids plexus and pineal gland were examined on computed tomography. Aim: To check the correspondence between the choroid plexuses and the pineal gland calcifications along age groups and sex; and the connections between these calcifications and associated pathology.\r\nMATERIALS AND METHODS: The study group consisted of patients of both sexes, within six age intervals.\r\nRESULTS: In order to classify the calcification variants, eight types of combinations were ordered and can be seen in CT: two refer to extreme variants: totally uncalcified (type 1) and totally calcified (type 8); bilateral, symmetrical variants (types 4 and 5); the other four types include the asymmetrical calcifications (2, 3, 6 and 7). After the anthropological study the results demonstrate that there are significant differences between calcification of the choroids plexus and those of the pineal gland with the two sexes, on age groups and pathological ground. For type 1-totally uncalcified the maximum frequency is around 70% with ages under 19. For type 8 - totally calcified, bilateral, the maximum frequency is around 50% with age groups 48-59 and 60-71. For type 4 - calcification only of choroid plexus, one finds a continuous increase from about 10% at the first age group to about 25% at the last group, while for type 5- calcification only of the pineal gland the frequency is 10%−20%. We started from the hypothesis that the presence of these calcifications is physiological, and has an active adaptative metabolic part depending on many factors, among which the individual constitutional ground is also present.\r\nCONCLUSIONS: The age is not the main cause of the calcification types, but a process of adaptative-reactive variability of interface type, playing an integrating mediating part.

At least one fifth of pituitary adenomas exhibit plurihormonality when using immunohistochemistry for anterior pituitary hormones. However, the correlation with clinical features is weak, without an agreement upon pathological predictors of tumor behavior. The aim was to determine the immunoreactivity for anterior pituitary hormones and alpha subunit in 276 consecutive pituitary adenomas patients, aged 22-79 years (44.3 ? 8), 154 F/ 122 M: 83 acromegalics (ACM), 173 nonfunctioning adenomas (NFA) and 20 prolactinomas (PRM) submitted to surgery via transfrontal (81) or transsphenoidal (195) along 10 years (1995-2005). In addition, clinical data, hormonal secretion and tumour size were evaluated before pituitary surgery. Local ethical committee approved the study design. The immunoreactivity performed by the avidin-biotin-complex method was evaluated for beta FSH, LH, TSH, alpha subunit, PRL and GH, using a semiquantitative scale of stained cells: strong (>20%), positive (10-20%), weak (5-10%) and negative (<5%). CT or MRI tumor size (less than 1 cm, 1-2 cm, 2-4 cm and over 4 cm on maximal diameter) were considered together with the Hardy neuroradiological stage. The results showed that 16/83 ACM, 53/173 NFA and 4/20 PRM exhibited immunoreactivity for beta FSH and LH. TSH immunoreactivity was positive in 13/83 ACM, 11/173 NFA and 1/20 PRM. Tumor size in gonadotrophin - positive group (> 10% of stained cells) was between 1-2 cm in 6 ACM, 21 NFA and 2 PRM, while positive bigger tumors (2-4 cm) were in 7 ACM, 24 NFA and 2 PRM. Giant, over 4 cm tumors were positive in 3 ACM, 8 NFA and no PRM. A similar trend of the tumor size distribution was observed in the monohormonal or null cell adenomas. In conclusion, tumor size and gonadotrophin plurihormonality are independent factors in the management of pituitary adenomas.

The mechanism underlying anovulation in the polycystic ovary syndrome (PCOS) remains unclear, although an excessive number of small antral follicles at ultrasound scans and discrepancies with selected follicles sustain the hypothesis of altered follicular development. Anti-M?llerian (AMH) hormone is a member of TGF-b super family of growth factors produced by granulosa cells of pre- and small-antral follicle. The 2 to 3 fold increase in the number of growing follicles in the ovary from PCOS women is reflected by an increase in serum concentration of AMH and thus, this hormone may be a good marker of PCOS.\r\nAim. This study was intended to implement ultra-sensitive ELISA measurement of serum AMH from PCOS women and search for a potential correlation with clinical and laboratory parameters.\r\nSubjects and methods. Sera from patients with PCOS (n = 42) and control women (n = 22) were used for ELISA measurement of AMH (AMH-EIA, Beckman Coulter) with sensitivity of 0.7 pmol/L.\r\nResults. We found a serum concentration of AMH almost 3 folds higher in patients with PCOS compared to controls (73.7 ? 7.5 vs. 25.7 ? 3.9 pmol/L, P < 0.0001). Differences were even higher in lean subjects. A positive correlation was found between total testosterone and LH levels, but not with serum FSH or insulin. Moreover, AMH concentration was correlated to more hyperandrogenic PCOS and with amenorrhea, and thus to the severity of the syndrome.\r\nConclusion. Measurement of serum AMH may be used as a valuable marker for PCOS to confirm diagnosis and evaluate the extent of follicular dysfunction in relation with hyperandrogenism and menstrual disturbances.

The blood-CSF barrier (BCB), as a component of the blood-brain barrier, is protective for the maternal brain. This study assesses estradiol, prolactin, glycoproteic hormones (hCG, FSH, LH, TSH) and thyroxine across the BCB in pregnancy after 38 weeks. Method. 35 pregnant women were simultaneously sampled in serum and CSF during caesarian section and compared to 27 non-pregnant fertile women undergoing surgery for benign gynecological disorders. The study was approved by the local Ethics Committee. Results were analysed as nonparametric variables. Compared to non-pregnant controls, we found high serum estradiol levels at term, also reflected in the CSF, while the CSF/serum ratio was non-significantly modified (median ratio 0.1 versus 0.1, p=NS). Prolactin showed a similar proportional increase in serum and CSF levels at term, with unmodified CSF/serum ratio (median ratio 0.14 versus 0.18, p=NS). hCG showed a similar profile across the BCB. FSH was significantly lower at term, but still conserved the CSF/ serum ratio. LH was undetectable in pregnancy. In peripartum TSH showed a unique profile across the BCB as it was the only one showing an increased CSF/serum ratio compared to non-pregnant controls (median ratio 0.11 versus 0.04, p<0.0001). Thyroxine was significantly increased in both serum and CSF, and showed a CSF/serum ratio unmodified from non-pregnant women (median ratio 0.02 versus 0.02, p=NS). Conclusion. There is an increase of BCB permeablity for TSH in term pregnancy. The peripartum increase in estradiol and decrease in HCG could be involved. We suggest that the unique TSH profile maintains the necessary thyroxine levels in pregnancy at term.

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. Pineal and adrenocortical cell morphology, dynamics, hormonal analysis and function in response to both natural and synthetic corticoids awaits in depth investigation in mammals. Aim. To investigate the pineal responsiveness to corticoid treatment from combined morphological and hormonal studies in postpubertal male mice. Material and methods. Three groups, each with 14 mice were used as control (C) or treated with the natural corticoid, hydrocortisone (HYC) at a dose of 4 mg/100 g.b.w. and synthetic corticoid, dexamethasone (DEX) at a dose of 4 mg/100 g.b.w. for ten consecutive days. Results. The treatment induced inverse changes in pineal-adrenocortical karyomorphology, cell proliferation (mitotic percentage M%) and hormonal milieu. Whereas both these corticoids caused pineal stimulation as evidenced from significantly increased nuclear diameter (μm) values (C 3.35 ± 0.05, HYC 4.77 ± 0.02, DEX 4.59 ± 0.04, p<0.001) and cell proliferation (M%) (C 1.11 ± 0.09, HYC 1.59 ± 0.07, DEX 1.44 ± 0.05, p<0.01), the changes induced in adrenocortical nuclear diameter in all the zones (p<0.001), cell proliferation (M%) (C 1.38 ± 0.05, HYC 0.53 ± 0.06, DEX 0.70 ± 0.05, p<0.001) and decreased content of adrenal corticosterone (C 0.24 ± 0.03, HYC 0.13 ± 0.01, p<0.001 DEX 0.15 ± 0.02, p<0.01) were those of adrenocortical inhibition. Conclusion. There exists an inverse relationship between the pineal and adrenocortical functions in post pubertal male mice (Mus musculus).

Introduction. The blood brain barrier (BBB) restricts the transport of hydrophilic molecules such as peptidic pituitary hormones into the brain tissue. The blood-cerebrospinal fluid (CSF) is a part of the BBB.\r\nAim To compare the pituitary hormone levels on the two sides of the BBB in a group of subjects without endocrine diseases.\r\nPatients and methods. We investigated, with the approval of the local ethics committee, 78 subjects without endocrine diseases. Growth hormone (GH), prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and thyroid stimulating hormone (TSH) were measured by rapid fluoroimmunoassay with Europium in the blood and cerebrospinal fluid (CSF)sampled simultaneously before rachianestesia for minor surgery.\r\nResults. CSF concentrations are significantly lower than the corresponding serum ones for all hormones studied: 0.04 ? 0.009 mU/mL vs 2.29 ? 0.57 mU/mL for GH, 1.49 ? 0.078 ng/mL vs 10.07 ? 1.42 ng/mL for PRL, 0.57 ? 0.078 U/L vs 22.71 ? 3.65 U/L for FSH, 0.39 ? 0.038 U/L vs 11.11 ? 1.55 U/L for LH and 0.01 ? 0.003 &#956;U/mL vs 1.36 ? 0.17&#956;U/mL for TSH (mean ? SEM; p<0.001). The CSF/serum ratio was below 1 in the vast majority of cases (from all subjects studied we only found 3 cases with supraunitary CSF/serum ratio). The serum and CSF levels were not significantly correlated for\r\nany of the pituitary hormones. Comparing preand postmenopausal women the CSF gonadotropin levels were slightly but nonsignificantly increased after menopause,\r\ndespite marked differences in the serum concentrations: CSF FSH 1.21 ?0.17U/L after vs 0.84? 0.4U/L before menopause, CSF LH 0.60? 0.047U/L after vs 0.43? 0.14U/L before\r\nmenopause. The CSF/ serum ratio for FSH markedly decreased after menopause (0.02?0.003 vs 0.22?0.11) although the effect did not reach statistical significance. The same\r\nwas true for CSF/serum LH ratio (0.026?0.005 vs 0.09?0.002). For none of the hormones studied the CSF levels correlated with age.\r\nConclusion. Pituitary hormones are normally found in the CSF at much lower levels than in the serum. The CSF hormonal\r\nconcentrations do not significantly correlate with the serum ones.

The possibility that a patient with newly diagnosed hypertension has an underlying cause that is directly responsible for the increased blood pressure deserves more attention from clinicians than is currently the case. This limited attention and consideration is responsible for delaying and even missing the diagnosis and proper treatment of secondary hypertension. The reasons are manifold, varying from minimal knowledge of diagnostic tests to easy and low threshold in prescription of antihypertensive drugs. In addition there is the misconception that the prevalence of secondary hypertension is so low that it hardly needs any consideration. However, some forms of secondary hypertension are much more prevalent than previously thought and this applies in particular to endocrine hypertension. In addition, in recent years there are emerging new scientific developments in the field of endocrine hypertension, varying from pathogenesis, genetics, and therapeutics. It is therefore quite remarkable that endocrinologists seem to have hardly any interest in endocrine hypertension, unless there is a clear cut case such as a patient with an already diagnosed pheochromocytoma. They leave the analysis of hypertension to other specialists who have hardly any expertise in for instance the analysis of patients suspected to have primary or pseudo-aldosteronism. The contribution of endocrinology is however essential, not only for detecting more patients with concealed endocrine hypertension but also for optimizing the understanding of the pathogenesis and treatment of high blood pressure in the larger group of patients with primary hypertension.

The aim of this review is to indicate the current position on the role of thyroxine (T4) and fetal brain development with particular relevance to the human situation. Adequate maternal iodine nutrition and maternal circulating thyroxine (T4) concentrations are essential to ensure optimum T4 placental passage which in turn will ensure transport of T4 into fetal brain cells. These processes are discussed and the role of thyroid hormone transporters is considered. The emphasis on isolated maternal hypothyroxinaemia (IH) as an important factor affecting brain development is discussed from the animal experimental point of view as well as in the clinical setting. There is evidence of neurocognitive impairment as assessed by different modalities in children up to the age of 8 years and some suggestion of increased psychiatric disorder in older persons whose mothers had IH during gestation. Although international guidelines have not in general recommended thyroxine therapy for IH the recent demonstration of adverse obstetric outcomes in women with isolated maternal hypothyroxinaemia may warrant a revision of this strategy.

Purpose. To re-examine our clinical practice and review strategy for treatment of primary hyperparathyroidism in patients with multigland disease. Methods. Retrospective analysis of 121 consecutive primary hyperparathyroidism (PHPT) patients who underwent surgery in a tertiary center between January 2010 and December 2014. Results. Of 121 patients with PHPT 87% had single gland adenoma (SGD) and 13% had multigland disease (MGD). The overall cure rate was 95.86%. MGD was more frequent in younger persons (<40y)(50% vs. 13.2%). All patients had SPECT-CT (Single Proton Emission Computerized Tomography) with 28% being SPECT-CT negative. Patients with MGD had a higher rate of persistent disease (13.33% vs. 2.83%). Specimen weight was <600mg in 75% of MGD patients. 67% of SPECT-CT negative patients had mild hypercalcemia (Calcium <2.75 mmol/L) which was more frequent in MGD patients (43% vs. 19%). Conclusions. MGD patients were more likely SPECT-CT negative (40% vs. 25.4%) and benefit from bilateral neck exploration (BNE) (74%). However, most SPECT-CT negative patients still have a single adenoma. In our series MGD was more frequent in younger patients, more likely SPECT-CT negative, often associated with mild hypercalcemia and had a higher persistence rate than SGD. BNE is the operation of choice in young, SPECT-CT negative patients. If ultrasound parathyroids suggests a single large adenoma, minimally invasive parathyroidectomy with intraoperative PTH monitoring can be considered.