ACTA ENDOCRINOLOGICA (BUC)

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.

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. 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.

Background. Langerhans cell histiocytosis (LCH) is a rare group of neoplastic diseases resulting from Langerhans dendritic cells. The most common site (80%) is bones. Thyroid gland involvement is exceedingly rare and usually expected to be seen as a part of multisystemic disease. Case Report. We present a 45 year old male patient operated due to multinodular goiter and neck pain, and diagnosed with LCH in his postoperative pathologic examination. As a result of the systemic screening performed after the pathological diagnosis, the disease was interestingly localized to the thyroid gland. Systemic involvement did not develop in the two-year follow-up of the patient who did not receive additional chemotherapy treatment. Conclusion. It is difficult to diagnose LCH in the thyroid gland before surgery. Although surgical treatment with or without chemotherapy is recommended, surgery is not recommended alone since it is generally systemic involvement. However, in primary thyroid LCH cases limited to the thyroid gland, we recommend that only total thyroidectomy treatment should be kept in mind.

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.

Neuroendocrine carcinoma (NEC) of the larynx is the most frequent neuroendocrine neoplasm of the head and neck and the most common nonsquamous carcinoma of the larynx. It usually occurs in the supraglottic area, in smoking men. We report a case of a 58-year-old woman with no history of smoking who presented with an atypical carcinoid, arising in the right piriform sinus of the larynx. During the 5-year follow-up, the patient developed metastases in the lymph nodes, palatine tonsils, parotid glands, breasts and skin. For this reason the patient underwent several surgical procedures, radiotherapy and eventually was qualified for chemotherapy. Our case shows that NEC of the larynx can have an atypical presentation. The diagnosis requires careful pathological evaluation with immunohistochemistry and a wide spectrum of imaging. The serum concentration of chromogranin A seems to be not useful in the diagnosis and follow-up of laryngeal NEC.

Resistance to thyroid hormone (RTH) is an inherited disease transmitted in an autosomal dominant manner. The diagnosis is suspected when peripheral thyroid hormones are increased contrasting with normal or increased levels of thyroid stimulating hormone. Usually, people harboring the rare syndrome have few or no symptoms. However, in some patients signs of hyperthyroidism may be the revealing anomalies as in the following case: A 75 year-old woman was referred to our department for a benign adrenal incidentaloma. In her medical history she was treated for systemic hypertension and diabetes mellitus for 15 years. Clinical examination did not show any sign of adrenal secretion, but discovered rapid irregular cardiac rhythm with some hyperthyroidism features such as increased sweating and upper limbs and jaw tremor. Electrocardiogram showed atrial fibrillation. Hormonal assessment confirmed hyperthyroidism as FT4 levels were high (mean value: 30.2pmol/L (n= 9–23)), contrasting with non-suppressed TSH levels (13.8μU/mL (n = 0.2 – 4)). Cerebral magnetic resonance imaging was normal. Genetic testing revealed a new heterozygous mutation on exon 10 in the THRβ gene (c.1366T>G) compatible with RTH syndrome. Screening of her children showed the same hormonal profile in five out of ten. These results confirmed RTH and the familial character.

Increase in obesity pandemic all over the world consequently leads to the investigation of possible causes. In addition to the traditional explanation using the so-called caloric model, the field of endocrine disruptors (EDs), especially subgroup called obesogens, offered more light on the pathogenetic mechanisms involved. After the Second World War a correlation between an increased production of exogenous pollutants and actual obesity epidemic was suggested. “Obesogen hypothesis” implies that molecules called obesogens inadequately stimulate the development of adipose cells and lipid accumulation in existing adipose cells, as well as change metabolic balance or hormonal control of appetite and satiety, leading to an increase in body fat mass. The list of obesogens includes some industrial chemicals, biocides, pharmaceuticals, pollutants, and smoke. EDs from the group of obesogens may exert their effects by the impairment in the programming development of adipocytes, by an increase in energetic depot in the adipose tissue, and by influencing neuroendocrine control of appetite and satiety. Increased scientific evidence on obesogens and their mechanisms of action may help to prevent obesity and mitigate deleterious effects of the environment on human life and development. New translational studies are needed to explain the possible mechanism proposed.

As men are aging, their testosterone levels decline, while the morbidity of atherosclerosis (AS) rises in accordance\r\nwith their age. Recent studies indicate that inflammation contributes to atherosclerosis. Whether hypogonadism in old men is associated with inflammation deserves to be\r\ninvestigated.\r\nBackground. To examine the relationship between free testosterone (FT) and inflammatory cytokines such as\r\npregnancy-associated plasma protein A (PAPP-A), interleukin-6 (IL-6), vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion factor-1 (ICAM-1) in old men with\r\nacute coronary syndrome (ACS).\r\nMethods. Serum was collected from 107 men aged 60-86 years. Among them, 52 were patients with ACS. The relationships\r\nbetween FT and PAPP-A, IL-6, VCAM-1 and ICAM-1 were examined respectively.\r\nResults. Levels of weight, body mass index, total cholesterol, low density lipoprotein cholesterol, triglyceride, PAPPA, IL-6, VCAM-1 and ICAM-1 of old male\r\nACS patients were higher than those of controls; FT and high density lipoprotein cholesterol levels were lower than those of controls. FT level was inversely associated with PAPP-A, IL-6, VCAM-1 and ICAM-1.\r\nConclusions. FT level is inversely associated with inflammatory cytokines such as PAPP-A, IL-6, VCAM-1 and\r\nICAM-1 in old men with ACS. This might imply that low testosterone is associated with inflammation in old men with ACS.