ACTA ENDOCRINOLOGICA (BUC)

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.

Context. Pakistan is considered to be severely iodine deficient with 70% population at risk of iodine deficiency. Objectives. This study was designed to determine the prevalence of goiter and status of iodine in district Charsadda, Pakistan. Design. The study was carried out using the 30 cluster approach. Subject and Methods. From each cluster, 40 school going children were randomly selected with equal number of male and female children making a total of 1210. A total of 202 pregnant women were sampled casually from different health units and hospitals of the districts. For goiter determination palpation, for urinary iodine wet digestion and for salt iodine rapid spot test kits were used. Results. The prevalence of goiter in school children was 10.9% (10.2% in boys and 11.5% in girls). In pregnant women the goiter prevalence was found to be 20.7% (16.6% in 1st trimester, 19% in 2nd trimester and 25% in 3rd trimester). The median urinary iodine concentration of school children and pregnant women was 89.9μg/L and 89.8μg/L respectively. Estimation of iodine content in salt illustrates that 70% households were consuming non-iodized salt. Conclusions. This study suggests mild iodine deficiency in the district Charsadda of Pakistan. Regular iodine prophylaxis is needed in the area.

Oxytocin is a complex molecule involved in a variety of biological processes at both the central and the peripheral level. Although its role was initially associated almost exclusively with birth and breastfeeding, recent studies are suggesting that in fact oxytocin could be involved in many other physiological and pathological processes. In this way, lately there is a growing interest towards a possible involvement of oxytocin in many etiopathogenic and psychopathological processes, as for example in the affective disorders, where the roles of oxytocin are not yet clearly understood. In this paper we shortly describe the main aspects regarding the relevance of oxytocin administration or its mechanisms in the affective disorders, as well as its relations with the hypothalamic-pituitary-adrenal axis and cortisol secretion. It seems that although the researches on the importance of oxytocin in the affective disorders are rather at the beginning, an increasing number of evidence is supporting the involvement of oxytocin in the pathogenic processes of these psychiatric disorders. Still, the studies covering this topic are still in their early days, and the results that are trying to understand if there is a major role of oxytocin in affective disorders are not consistent enough to draw definitive conclusions and establish with certainty where the place of oxytocin in the affective disorders pathology is

Introduction. Surgery has lost a lot of ground as the main therapy of most prolactinomas as it is clear from the current guidelines in most prolactin secreting adenomas, even in the setting of optic compression. However, we believe that surgery is still an important part in the treatment of this type of adenomas. This study is aimed to define what is the role of pituitary surgery in the current setup of prolactinoma management. Material and methods. In this retrospective, single-center study we analyzed 12 consecutive patients who underwent primary endoscopic transsphenoidal surgery for prolactinomas, between 2013 and 2022. Surgical indication, previous dopamine agonist (DA) treatment, remission rates, surgical complications, pituitary function and imagistic appearance are presented. Results. Of the 12 patients included, 4 had giant PRL and 8 macroadenomas, while 9 of them had previous DA treatment. The main surgical indication was pituitary apoplexy in 5 patients followed by CSF leak after DA treatment, 3 cases, and DA resistance in 3 cases. The main surgical complications were transitory diabetes insipidus in 7 cases. Normalization of prolactin levels was achieved in 2 patients. Conclusions. Surgical intervention should be strongly considered in all patients with neurologic symptoms referable to the lesion, resistance to medical therapy, other treatment failure or with complications after DA treatment. The endoscopic endonasal surgery offers good surgical outcomes with low rates of surgical complications and should remain an open option for specific cases.

Context. Natriuretic peptides (NP) and oxytocin (OT) play an important role in cardiovascular and hydroelectrolytic homeostasis. Changes in NP levels and their roles in cardiovascular adaptations in pregnancy and labor have not been clear. Objective. The present study aimed to investigate the changes and correlations in plasma levels of atrial natriuretic peptide (ANP), C-type natriuretic peptide (CNP), B-type natriuretic peptide (BNP) and OT during labor and the postpartum period. Study design. Blood samples were collected from 29 healthy pregnant women in the active phase of spontaneous labor, 15 minutes after delivery and 3 hours postpartum. Plasma levels of OT and the stable N-terminal fragments of NPs (NT-proANP, NT-proCNP, NT-proBNP) were measured using enzyme or electrochemiluminescence immunoassays. Results. The plasma levels of NT-proANP and NTproCNP significantly decrease 3 hours postpartum compared to the active phase of labor and to 15 minutes after delivery. The plasma NT-proBNP levels significantly higher after delivery and 3 hours postpartum compared to the active phase of labor. A significant correlation exists between OT and NTproANP levels during the active phase of labor and 15 minutes after delivery. Conclusions. The data show that during labor and postpartum, the plasma concentrations of the NPs change differently. Elevations in NT- proBNP after delivery suggest that BNP may be involved in postpartum adaptations. The correlations between OT and ANP levels indicate that OT may be partly responsible for the increased levels of ANP and may have a role in the modification of the cardiovascular system.

Introduction. Obesity was considered to protect against osteoporosis. Recent studies indicate the opposite.\r\nThe study aimed to see if adipose tissue has a protective effect on bone mass and if adipocytokines can explain the\r\nrelationship between obesity and osteoporosis.\r\nSubjects and methods We designed a study enrolling 83\r\npostmenopausal women, aged over 60, without diagnosed or treated osteoporosis and no secondary osteoporosis. We formed 3 groups- group 1- osteoporosis and metabolic syndrome (MetSyn), group 2- osteoporosis, group 3- MetSyn.\r\nWe evaluated the hematological, biochemical profile, bone turnover markers and adipocytokines. DXA of the spine and\r\nthe hip (left) was performed on all the enrolled women. Insulin resistance was appreciated using HOMA index. Metsyn\r\nwas defined using the International Diabetes Federation?s criteria.Results were statistically analyzed using SPSS program, version 15.\r\nResults. All groups were vitamin D insufficient with lower vitamin D, osteocalcin and adiponectin levels in the\r\ngroups with MetSyn and higher leptin levels. BMI correlated positively with spine BMD, while leptin correlated positively with hip BMD, pointing out to the protective effect of obesity against osteoporosis due to leptin?s involvement.\r\nConclusion. Obesity seems to have a protective effect against osteoporosis, probably due to leptin.

Background. Although thyroid nodules are a common finding in the general population, determining the clinically important nodules is essential. We investigated thyroid nodules or cysts by thyroid ultrasonography (US) in patients with β-thalassemia major (β-TM) and intermedia (β- TI). We also report a β-TI patient who was diagnosed with thyroid cancer six months before our screening. Methods. In this cross-sectional study, 178 patients with β-thalassemias referred to the Thalassemia Clinic in a tertiary hospital affiliated to Shiraz University of Medical Sciences were investigated, from January to June 2016, by US. Results. Thyroid nodules or cysts were detected in 11 patients [total: 6.17 %; 8 patients with β-TM (8.2%) and 3 patients with β-TI (3.7%)]. All nodules were < 1 cm in diameter and were not suspicious of malignancy. All patients, after 1 year of thyroid US follow-up, did not show any significant change in favor of malignancy. Conclusion. Based on our results, the frequency of thyroid nodules was similar to what was reported in the general population. However, a long-term follow-up of these patients is recommended because of the potential carcinogenic effects of iron and hepatitis C infection (HCV). To achieve more precise information, collaborative multicenter studies should be considered.

Context. We assessed the association between the severity of COVID-19 and the thyroid function, and the relationship of thyroid hormones with inflammatory markers in COVID-19 patients. Subjects and methods. This observational study contained 95 COVID-19 patients. The covariates of interest included the thyroid-stimulating hormone (TSH) and the total form of thyroid hormones thyroxine and triiodothyronine. Furthermore, the inflammatory markers including C-reactive protein, erythrocyte sedimentation rate, lactate dehydrogenase (LDH), and lymphocyte were measured. To analyze the data, the t-test, the nonparametric test for comparing the medians, and the Spearman correlation were used. Results. The median (interquartile range) of ages was equal to 53 (41-66) years old, including 54 men (56.8 %). As the severity of COVID-19 progressed from moderate to severe, increasing, though non-significant, trends of thyroid dysfunction were observed, the most remarkable for TSH. The only significant association between thyroid hormones and inflammatory markers was a Spearman correlation of -0.28 between TSH and LDH. Moreover, a direct association was found between the severity of COVID-19 and the LDH levels (p-value<0.001). Conclusions. A direct relation between the severity of COVID-19 and the LDH level and a reverse association between the LDH level and the thyroid hormone, TSH was obtained. Key

Objective. To investigate the significance of DHEAS assessment in males of different ages. Methods. Retrospective cohort study of patients investigated in two large academic centres. Results. The data of DHEAS assessment of 3533 patients (3013 females and 520 males) was analysed. DHEAS was 1.6 – 13.5 times more frequently investigated in women than in men. A peak of DHEAS evaluation test for women was at 25 years old and distribution was uniform in males over decades, excepting being lower in 0-9 and 75+ages. In the age group 10-24 years, DHEAS levels were higher in females. After 45 years, DHEAS was higher in men than in women. Analysis of 510 case records showed low DHEAS levels in boys (0-9 years) and in men aged 65 – 84+. Higher DHEAS levels were detected as a peak at 30 years old, but never after 55 years. In individuals with low DHEAS levels prevailed congenital adrenal hyperplasia (32%), adrenal tumours (30%) and primary or secondary adrenal insufficiency (19%). High DHEAS levels prevailed in patients with arterial hypertension (26%), overweightobesity -(19%), non-toxic goiter (17%) and alopecia (9%). In the normal DHEAS miscellaneous diagnoses were met most frequently – 40%. Disorders exceeding 5% were non-toxic goiter (19%), adrenal tumours – 17%, overweight/obesity – 16% and arterial hypertension– 8%. In 71 women and 124 men adrenal neoplasms were detected. Higher frequency of these was observed in women in their 30s. A peak of adrenal neoplasms in men was at their 70s. This gender difference was not conditioned by earlier attempts to seek medical care by women. A significant correlation of DHEAS, weight, body mass index and systolic blood pressure with diastolic blood pressure was found. Conclusion. Our study permits to determine which DHEAS secretion and clinical pattern might be associated in males of different ages.

Background. Previous sleep studies suggest that type 2 diabetes mellitus is associated with poor quality of sleep and sleep disorders. Aim. To evaluate sleep parameters and diurnal preference in type 2 diabetic patients, using a questionnaire. Methods. Ninety seven patients (aged 55.8±8.3, sex ratio 1:1), previously diagnosed with type 2 diabetes mellitus, together with 102 controls (aged 47.1±10.5, sex ratio 1:1), without diabetes, completed a questionnaire containing the Romanian translation of the Composite Scale of Morningness, the Sleep Disorders Questionnaire, the Pittsburgh Sleep Quality Index, the Pittsburgh Insomnia Rating Scale, the Multidimensional Fatigue Inventory, the Epworth Sleepiness Scale, the Alcohol Use Disorders Identification Test and the Beck Depression Inventory II (BDI). The study was cross-sectional, as we included subjects from outpatient and inpatient facilities. The recruitment process was based on handing invitation letters to patients consulting their physician, as well as to their acquaintances, using the snowball sampling. Participation was voluntary and anonymous. Results. Insomnia was more often reported in diabetic patients: 32 (33.0%) vs. 16 (15.7%) controls, a difference that was highly significant (P<0.001). Diabetic patients used to wake up at approximately the same hour as controls did; nevertheless they went to bed earlier (22:14 ± 0:57 vs. 22:32 ± 1:03), needed more minutes to fall asleep (28.84 ± 21.01 vs. 24.32 ± 23.45) and slept less than controls (7.01 ± 1.56 vs. 7.23 ± 1.18). Statistically significant differences between patients and controls were found regarding the Pittsburgh Sleep Quality Index (P=0.005), the Pittsburgh Insomnia Rating Scale (P<0.001) and the Multidimensional Fatigue Inventory (P=0.001) scores. Eighteen (18.5%) patients also met the criteria for a depressive disorder. No significant differences between patients and controls were found as related to their chronotype (P=0.32) Conclusion. Poor sleep, but not diurnal preference, was linked with the presence of type 2 diabetes mellitus.