ACTA ENDOCRINOLOGICA (BUC)

The gastrointestinal (GI) motility, which is important for the digestion and absorption, may be altered in obesity. The aim of this review is to present the GI motility changes occurring in obesity, as well as their underlying mechanisms. We have conducted a systematic review of the published literature concerning GI motility and obesity and have described recent published data on the changes throughout the entire GI tract. Most recent discoveries include evidence supporting the increase of gastroesophageal reflux disease in obesity and inhibition of gastric motility. Intestinal transit of the distal small bowel generally slows down, ensuring enough time for digestion and absorption. Constipation is more frequent in obese patients than in those with a normal weight. The gut-brain axis plays an important role in the pathophysiology of GI motility disorders in obesity. This bidirectional communication is achieved by way of neurons, hormones, metabolites derived from intestinal microbiota and cytokines. The molecular mechanisms of GI motility changes in obesity are complex. Current data offer a starting point for further research needed to clarify the association of obesity with GI motility disorders.

Objective. This study aims to determine the prevalence of neuropathy in the prediabetic period. Design, Subjects and Method. Informed consent was attained from the patients who volunteered to participate in the study after ethics committee approval was obtained. Patients under the age of 18, having vitamin B12 or folic acid deficiency, history of collagen tissue-rheumatological disease, chronic kidney failure, cirrhosis, ethylism, thyroid disease, autoimmune disease, malignancy, tuberculosis, type 1 or 2 diabetes mellitus and pregnant women were excluded from the study. Patients diagnosed with prediabetes were evaluated by the DN4 neuropathy complaint questionnaire. Neuropathy was diagnosed in patients having a score of four or more. For the statistical analyses Student t-test, Pearson chi-square test, and Fisher's exact test were performed using the NCSS program. Results. A total of 224 volunteers, 167 women and 57 men, were included in the study. The mean age of the participants was 51 and the mean level of hemoglobin A1C was 5.9. Neuropathy was detected in 45% of the cases. Especially in women, there was a significant increase in the frequency of neuropathy compared to men. The most common complaints found in our study were burning sensation and numbness in the extremities. Conclusions. Similar to diabetic patients, prediabetic patients also have a high rate of neuropathy. For the early diagnosis of neuropathy and to be treated promptly, screening tests such as DN4 should be performed for all prediabetic patients. According to the test results, advanced examinations such as EMG or biopsy should be performed earlier.

Context. Metabolic surgery is currently the most efficient treatment for obesity, but concern is raised about the possible long-term nutritional side effects. Bone metabolism is often adversely affected after surgery, but literature data are contradictory. Objective. The aim of this study was to evaluate the evolution of bone mass parameters in the first year after laparoscopic sleeve gastrectomy in relation to anthropometric and body composition parameters and specific hormones of obesity. Design. We conducted a prospective study on 75 patients with obesity that underwent metabolic surgery over a course of 18 months at our center, with a follow-up period of 12 months. Subjects and Methods. All patients underwent a complex preoperative assessment and were required to return for medical follow-up at 6 and 12 months after surgery. Each visit included anthropometric parameters, DEXA and determination of specific hormonal parameters. Results. We noticed a significant improvement in anthropometric and body composition parameters after surgery. The value of adiponectin presented a significant increase after surgery and leptin showed a significant decrease at 6 and 12 months postoperative; ghrelin level decreased postoperative compared to preoperative, but without statistical significance. We observed no reduction in BMD after surgery, but a significant improvement in BMC at 12 months after surgery compared to preoperative. Ghrelin negatively correlated to BMD preoperative. Conclusions. Despite the significant alterations in anthropometric, body composition and hormonal parameters, we found no negative effect on BMD and BMC in our study population.

Context. Parental history of osteoporosis is associated with an increased risk of fracture. However, there are not many data on the mechanism of action. Our objective was to determine if heredity influences fracture rate: independently or through the bone mineral density; to identify also the strongest independent risk factors of osteoporotic fractures among our study population. Methods. We processed data of 541 women outpatients with an average age of 55 years, participating in an osteoporosis screening program. Our results confirm that the presence of family history significantly increases fracture prevalence, (37% vs. 17%, p<0.001, OR 2.853, p=0.001) and decreases BMD scores. Fractures occur at higher (better) T and Z-scores. The risk of having T values in the range of (0- -1) and Z values in (-1--2) is much higher in the positive group. The logistic regression analysis confirms the BMD-independent influence of heredity on fracture risk. Conclusions. Parental history of osteoporosis negatively affects bone density and significantly increases the incidence of fractures. The latter happens also independently of the bone density values. Timely intervention in these easy-to-detect cases may be the most effective prevention of osteoporotic fractures.

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Overview of necessity of universal screening as the tool for adequate diagnosis of GDM in 2016. Identifying of gestational diabetes mellitus (GDM) overpasses the medical discussion of utility, both for the mother and child, both for the short term and long term possible complications.

Context. Non-psychogenic polydipsia-induced hyponatremia is a rare clinical finding. The effects of severe hyponatremia on the electrical activity of the heart in this setting are far from clear. Case report. Resting ECG and 24-h ambulatory ECG monitoring performed in an 80-year-old hypertensive female accusing nonspecific symptoms of confusion, lethargy, disorientation, nausea, and palpitations, demonstrated significant intraatrial and atrioventricular conduction disorders and numerous atrial tachyarrhythmia episodes. Laboratory analysis revealed severe hyponatremia (108 mEq/L) as only significant disorder. Extensive endocrine, neurological, cardiology, and pulmonary examinations excluded the most common causes of hyponatremia, including the inappropriate antidiuretic hormone secretion syndrome. Careful history revealed excessive voluntary water intake of up to 6 L/day and low sodium intake, associated with long-term thiazidelike diuretic treatment. Correction of sodium levels was associated with complete resolution of both atrial arrhythmias and conduction disorders. Conclusions. This report presents the first case of severe hyponatremia caused by combined non-psychogenic polydipsia and thiazide-like diuretic use complicated with reversible cardiac conduction disorders and atrial arrhythmias. The close temporal relationship between the fully reversible cardiac electric abnormalities and severe hyponatremia strongly indicates hyponatremia as key feature in the pathogenesis of these electric abnormalities.

Aim. Alpha-lipoic acid (ALA) is a potent naturally occurring antioxidant and in the\r\npast years several studies suggested the fact that ALA can have positive effects on glucose\r\nmetabolism. We intended to evaluate in an open-label, non-randomized study, in usual\r\nambulatory settings, the effect intravenous ALA infusion on fructosamine level, in patients\r\nwith type 2 diabetes and painful peripheral diabetic neuropathy.\r\nPatients and methods. 28 consecutive patients with type 2 diabetes and painful\r\nperipheral diabetic neuropathy, treated with 10 daily infusions of 600 mg ALA in 300 ml of\r\nnormal saline, were included in the study. Fructosamine was measured with a colorimetric\r\nmethod. For the analysis of the results we have used the non-parametric Wilcoxon Signed\r\nRanks test.\r\nResults. There were 15 women and the mean (? SD) age and duration of diabetes were\r\n59.39 (? 7.92) and 9.46 ? 6.19 yr respectively. Mean (?SD) HbA1c at enrolment was 7.77\r\n? 1.18 %. The mean (?SD) value of fructosamine decreased significantly from 568.14\r\n(?190.67) &#956;mol/L to 467.10 (?126.98) &#956;mol/L (p < 0.0001). The mean decrease between the\r\nfirst and second measurement was 17.8%, 101.03 (?132.17) &#956;mol/L in absolute term.\r\nConclusions. Decrease in fructosamine concentration can be described at least as a\r\n&#8220;positive side effect&#8221; of ALA used for the treatment of the painful peripheral diabetic neuropathy.\r\nAs far as we know there is only one study that used fructosamine as a criterion for evaluating the\r\nsafety and tolerability of orally administred ALA 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 tumors < 10 mm, the recommendation for thyroid lobectomy for tumors < 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 summarized in this editorial with the aim of encouraging clinicians to reconsider established treatment protocols and empowering patients to make informed decisions for their care.

Context. Hyponatremia is a common electrolyte abnormality. Objective. We report a patient who presented with hyponatremia and diagnosed as small cell lung cancer metastatic to hypothalamus and pituitary. Case report. A 68 year old male patient was admitted with fever and cough and pneumonia was considered. Serum sodium level was 113 mmol/L. Syndrome of in appropriate ADH (SIADH) is considered. Thyroid function tests and cortisol levels pointed out a central deficiency in both axes. Pituitary MRI was performed and a hypothalamic and pituitary mass were observed. Prednisolone therapy was started followed by L thyroxine replacement. A chest computer tomography (CT) was taken 2 weeks later revealed a mass lesion. Bronchoscopic biopsy was performed and histopathological diagnosis of the tumor was reported as small cell lung cancer. Result. Many mechanisms were considered as the cause of hyponatremia in our patient. SIADH, secondary adrenal insufficiency and secondary hypothyroidism due to pituitary metastasis are possible causes. Conclusion. The reason of hyponatremia is sometimes complex. When the underlying causes of hyponatremia are not evaluated in detail, many diagnoses can be missed.