ACTA ENDOCRINOLOGICA (BUC)

Context. Vitamin D is essential for skeletal and nonskeletal health and prolonged deficiency results in infantile rickets and adult osteomalacia. The aim of this study is to\r\ndetermine 25(OH) VitD and iPTH status in pregnancy and to evaluate the effects of monthly 100.000 IU dose of vitamin D\r\nsupplementation.\r\nMaterials and Methods. In a double blind trial of vitamin D supplementation in pregnant Iranian women, vitamin D3\r\n(cholecalciferol , 100/00 IU/month) was administered to 25 women and placebo to 25 controls during the last trimester. The two groups had similar distributions of maternal age, height, gravity, weight and age of gestation. Hydroxycholcalciferol and iPTH were measured in mothers at 27 weeks and at delivery. Cord blood was used to assess the\r\nsame parameters.\r\nResults. Comparing the data final maternal 25 - hydroxyvitamin D levels were significantly higher in the supplemented group versus control group (61.45?30 ng/mL versus 29.4?16 ng/mL); P &#8804; 0.001.Cord 25 - hydroxyvitamin D levels were significantly higher in supplementation group in\r\ncomparison to control group (52 ? 40.5 ng/mLversus 36?21.3 ng/mL); P<0.005.\r\nConclusion. Administration of 100/000 IU/monthly of vitamin D3 in the last trimester significantly increased 25(OH) VitD to high normal concentration. However, even with supplementation, only of mother and of newborn had serum\r\n25(OH) VitD greater than 30 ng/mL a small percentage of women and babies were vitamin D sufficient. According to data of study we propose 100/000 IU monthly is safe for pregnant women.

Background. Early detection of coronary plaques in patients with diabetes mellitus (DM) could play a major role in improving the evolution of these patients, targeting a therapeutic intervention in early stages when the chances to reduce the progression of the disease are higher. Aim of the study was to evaluate the presence of coronary lesions and analyze the plaque morphology in patients with type 2 DM using multislice 64 computed tomography coronary angiography (MSCT), and to assess the cardiovascular risk expressed by calcium scoring (CS) in these patients. Methods. The study included 37 patients with type 2 DM. Mean age was 67.38 years (±19.62). In all cases MSCT was performed, CS was calculated and morphology of coronary plaques was analysed. Results. Coronary artery disease was present in 86.48% cases. CS was <100 in 6 patients (16.2%), between 100 and 400 in 7 patients (18.9%) and >400 in 24 cases (64.8%). Coronary plaques were classified as non-calcified in 142 segments, mixed in 78 segments and calcified in 114 segments. In 40.12% of lesions the plaques were nonobstructive, in 44.91% obstructive, and in 14.91% severely obstructive. Conclusions. In patients with type II DM there is a high incidence of coronary lesions and vascular calcification, which could represent an indicator of the severity of coronary artery disease even in asymptomatic diabetic patients. CS calculated with MSCT is increased in these patients, representing a marker of high cardiovascular risk.

Purpose. To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. Methods. Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. Results. Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). Conclusion. Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

Context. Estimation of osteoporotic hip fracture incidence and Romanian FRAX model were based on nationally reported hospital ICD 10 coding admissions of all hip fractures (without a validation process). Objective. We aimed to calculate, based on individual hospital charts analysis, the incidence of osteoporotic hip fracture in the main urban area of Romania and compare it with data reported to the National Institute of Public Health (NIPH). Design. We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest and surrounding Ilfov County (11.8% of Romania population). Subjects and Methods. All ICD 10 fracture and event/fall codes were validated against the charts. We calculated the age and sex adjusted incidence of osteoporotic hip fracture and used the national reported hip fracture data base for comparison. Results. There were 2203 hip fractures of which 1997 (90.65%) were fragility fractures. The crude incidence of low-energy hip fractures was 171/100,000 (225/100,000 in women, 103/100,000 in men). The incidence rose with age to a maximum rate of 1902/100,000 in women >85 years. The NIPH-reported incidence of hip fracture was 181/100,000 for the region of interest and 176/100,000 at the national level. Conclusion. The incidence of osteoporotic hip fracture was lower than the incidence based on hip fractures reported codes in the national database, but the incidence of fragility fractures calculated by our group was higher than the incidence reported in previous national studies. Nationwide studies are warranted.

Context. Ovarian failure leading to delayed puberty and infertility is a cardinal sign in patients with Turner syndrome (TS). Objective. We reviewed the pattern of puberty in a group of Irish patients with TS. Design. This was a prospective observational study conducted at the National Children’s Hospital, Dublin, Ireland. Subjects and Methods. All patients aged 12–19 years and attending the paediatric endocrinology service with a confirmed diagnosis of TS were enrolled. Eligible patients underwent puberty assessment using Tanner staging and had 3 ml of blood taken for measuring luteinising hormone (LH), follicle-stimulating hormone (FSH) and oestradiol. Results. Out of 65 patients with TS identified from the medical and laboratory records, 42 aged 12 to 19 years were enrolled. Clinical assessment of puberty using Tanner staging revealed that 21 patients (50%) had spontaneous puberty (breast stage 2–5). Fourteen individuals out of 23 with mosaicism experienced spontaneous puberty (61.9%) compared with 7 out of 19 (36.8%) carrying a 45,X karyotype (P = 0.10). Of the 21 patients who had spontaneous puberty, 9 (43%) achieved menarche ; 6 of them were mosaic while the other 3 had 45 X karyotype (P = 0.33). The mean age of spontaneous menarche was 13.9 ± 1.97 years (range 10.9–18.9). One patient with spontaneous puberty achieved two successful pregnancies. Conclusions. Spontaneous puberty occurred in half of TS patients in this cohort and among these, 43% achieved spontaneous menarche. Prevalence of both spontaneous puberty and menarche were higher in mosaic patients compared to those with 45X karyotype.

Background. Alcohol ingestion can induce either a hypoglycemia or a hyperglycemia,\r\nin patients with acute and chronic ethanol poisoning, unknown with diabetes mellitus.\r\nAim. The aim of this study was to evaluate whether 5 hours prolonged oral glucose\r\ntolerance test (5h-OGTT) is useful in evaluating the abnormalities of glucose metabolism in\r\nacute and chronic ethanol poisoning, in comparison with standard methods (fasting blood\r\nglucose - FBG, and/or 2h-OGTT).\r\nMethods. 497 consecutive patients were enrolled in a 34 months cross sectional study.\r\nIn all cases, glucose tolerance was assessed by a 75-g oral glucose tolerance, OGTT 2 hours,\r\nprolonged to 5 hours. The relationship between clinical and biochemical variables of ethanol\r\npoisoning (liver status, lipid profile, metabolic syndrome) and glucose tolerance was\r\ninvestigated. Risk factors for hypoglycemia in ethanol poisoning were identified.\r\nResults. 349 subjects presented acute ethanol poisoning, and 148 subjects had chronic\r\nethanol poisoning. 254 patients (51.10%) had documented alcoholic liver disease (ALD -\r\nclinical, biochemical and imagistic criteria). Glucose metabolism abnormalities were\r\nrecorded in 143 subjects with chronic ethanol poisoning and ALD (96.63%), and in 207\r\ncases with acute alcohol poisoning (59.31%). 371 patients (74.65%) showed normal FBG,\r\ndiabetes mellitus (DM) was diagnosed in 54 subjects (10.86%), impaired glucose tolerance\r\n(IGT) in 43 subjects (8.65%), delayed hypoglycemia in 172 subjects (34.60%) and normal\r\nglucose tolerance (NGT) in 147 subjects (29.57%) using OGTT and ADA diagnosis criteria.\r\nHypoglycemia was recorded in more than two thirds of acutely poisoned patients, when alcohol\r\nlevel was 0.5-1.5 g/L. Impaired glucose tolerance (IGT) were recorded in half of patients with\r\nblood ethanol levels > 2.5 g/L.\r\nConclusions. OGTT 2 hours and OGTT 5 hours revealed the same number of patients\r\nwith diabetes mellitus. Frequent co morbidities in patients with ethanol poisoning influence\r\nthe prolonged OGTT and revealed .especially delayed hypoglycemia, and IGT, as an indicator\r\nof alcoholic liver disease (ALD).

Background. Ghrelin is a gastro-duodenal hormone which plays a major role in the regulation of food intake, energy balance and gastrokinesis. Ghrelin represents a novel biological marker for assessment of the presence as well as the severity of liver cirrhosis. We aimed to measure the level of plasma ghrelin in patients with liver cirrhosis (compensated and decompensated) and to correlate its level with different studied clinical and laboratory parameters. Subjects and methods. 40 cirrhotic patients were included in a cross-sectional study and divided equally according to the Child-Pugh classification into Group I: patients with compensated liver cirrhosis (Child A), and Group II: patients with decompensated liver cirrhosis (Child B|C). Also, 20 age and sex matched healthy subjects were included as a control group (Group III). All patients were subjected to: full history taking, full clinical examination, routine biochemical studies together with estimation of plasma ghrelin level, assessment of the severity of liver disease according to Child–Pugh classification, also, abdominal ultrasonography was done. Results. Plasma ghrelin level was low among cirrhotic patients (both compensated and decompensated) in comparison to normal control subjects. Conclusion. Ghrelin can be used as a serum biomarker for detection and assessment of the severity of liver cirrhosis.

-

Introduction: Pseudo-primary hyperaldosteronism of pregnancy was previously reported by our group during correction in twin-to-twin transfusion syndrome (TTTS). Aim: Focus on plasma volume changes and renin-angiotensin (RAS) and aldosterone response in 45 TTTS patients requiring amnioreductions above 1000 ml for severe hydramnios. Methods: 45 patients necessitating placental surgery and amnioreduction >1000ml for severe TTTS, under local anesthesia, as previously described. Assesment of plasma volume variations (%ΔPV) and simultaneous assays of aldosterone, renin, angiotensin II and ANP performed by standard kits prior to, 6 hours after and 12-24 hours after procedure. Statistical results expressed as median and interquartile ranges for non-parametric data, after correction of post-op levels with %ΔPV. Results: Depletion of 1600 ml (1000-3700) amniotic fluid (extravascular depletion) unexpectedly increased the intravascular plasma volume by 20,38% and dramatically changed the hormonal picture of primary hyperaldosteronism. Aldosterone decreased from a median of 730 pg/ml (T0) to 553 pg/ml (T6) to 515,9 pg/ml (T24). ANP increased from 8,95 pg/ml (T0) to 14,51pg/ml (T6) to 19,9 pg/ml (T24) pg/ml (ANOVA p=0,0036), while renin and angiotenin II stayed unchanged (ANOVA p=0,91). Conclusion: Depletion of extracelular fluid (amnioreduction) is indicated for the correction of hyperaldosteronism in pregnancies with severe hydramnios, to reduce to normal the aldosteron levels without the interference of the renin-angiotensin system, while natriuretic activity increases through ANP and, possibly, other less known natriuretic factors .

Context. Subacute thyroiditis is an inflammatory thyroid disease, which is treated by nonsteroidal antiinflammatory drugs (NSAIDs) or steroids. Objective. Defining characteristics of patients with subacute thyroiditis at diagnosis and during follow-up. Investigating the efficacies of NSAID and different doses of steroids and their effects on rates of relapse, recurrence, development of hypothyroidism and on quality of life and sleep parameters. Design. A 3-year observational study in a tertiary referral center. Subjects and Methods. A total of 63 patients with subacute thyroiditis were included. Clinical outcomes of patients treated with NSAIDs and NSAID unresponsive patients treated with prednisolone with initial doses of 0.5 mg/kg/day and 15 mg/day were evaluated. Results. White blood cell count at diagnosis was an independent predictor of NSAID unresponsiveness. No relapse or recurrence was observed in patients receiving low dose of steroids. Long symptom duration until diagnosis and treatment with NSAIDs were associated with development of hypothyroidism. Subacute thyroiditis caused significant deterioration in quality of life and sleep of patients and low dose of steroid was as effective as higher doses in improving these parameters. Conclusions. For patients with no response to NSAID therapy, an initial low dose of prednisolone (15 mg/ day) is determined as a safe treatment method when dose reduction is performed with appropriate timing.