ACTA ENDOCRINOLOGICA (BUC)

abdominal cystic lesions should include investigation of cystic pheochromocytomas. To date only a few cases of purely cystic pheochromocytoma have been reported in the English literature. Aim. To present the management in four cases of silent pheochromocytomas patients who presented with pure or partially cystic abdominal lesions with benign (n:3) and malignant characteristics (nonspecific neuroendocrine tumor) (n:1) in histological evaluation. Results. Resection of the tumor is considered the primary treatment option in the management of pheochromocytoma, and preoperative preparation with alpha and beta antagonists is crucial in order to avoid precipitation of hypertensive crisis during surgical procedures. The absence of clinical symptoms and lack of typical radiological features may complicate the diagnosis of pheochromocytoma resulting with increased mortality and morbidity during surgery. Conclusion. Asymptomatic pheochromocytomas are rare and they are responsible for approximately 5% of adrenal incidentalomas. These lesions may be referred to surgery as clinically nonfunctional adrenal adenomas.

Background. The transport of gametes and embryos is facilitated by motile cilia lining the inside of the fallopian tube. Progesterone regulates ciliary beat frequency (CBF) through multiple types of progesterone receptors in the fallopian tube. Membrane progesterone receptors beta and gamma (mPRβ and mPRγ) are both expressed in the ciliated cell lining of the fallopian tubes of humans. This study aimed at exploring the mRNA expression of mPRβ and mPRγ in the fallopian tubes of women with ectopic pregnancy. Materials and Methods. In this Case control study, a quantitative reverse transcriptase polymerase chain reaction was performed to determine the mRNA expression of mPRβ and mPRγ in the fallopian tubes obtained from 12 women with ectopic pregnancies, 12 women with normal pregnancies, and 12 healthy nonpregnant women in the luteal phase of their menstrual cycle. Results. It was indicated that mPRβ and mPRγ were expressed in the fallopian tube of the three groups of participants. However, the expression of mPRβ and mPRγ mRNA in the fallopian tube of women with ectopic pregnancy was not significantly different from that of the nonpregnant and normal pregnant women. Conclusion. These results suggest that mPRs might play no role in etiology of ectopic pregnancies associated with disturbed progesterone signalling.

Context. Anti-Mullerian hormone (AMH) assay is becoming the best indicator of successful IVF treatment response to fertility drugs and could be a useful marker of embryo implantation potential. Various protocols are being used for controlled ovarian stimulation (COS), but there is an uncertainty regarding the implementation of the best protocol for endometriosis patients and also little evidence is available concerning the clinical value of AMH levels in endometriosis. Objective. This study aimed to evaluate the prognostic value of serum AMH levels for pregnancy in COS using GnRH-agonist(GnRH-a) and GnRHantagonist( GnRH-ant) protocols in endometriosis patients. Design. This is a cross-sectional study between March 2012 and November 2015. Subjects and Methods. Data were collected from 249 COS cycles of endometriosis patients, including 129 cycles with GnRH-a and 120 cycles with GnRH-ant. Patients in each group were classified into three subgroups based on their serum AMH levels. The outcomes of ICSI program were evaluated. Results. The ROC curve analysis showed that embryo and oocyte counts and AMH were equally predictive for pregnancy, as demonstrated by a similar area under the curve (AUC) of 0.69, 0.66 and 0.64, respectively. The sensitivity and specificity for prediction of positive pregnancy were 70.91% and 67.01% for embryo counts, 70.91% and 67.53% for oocyte counts at the cutoff values of 5 and 7, respectively, and 83.64% and 52.58% for AMH levels at the cutoff values of 1.3ng/mL. Conclusions. This study demonstrates that AMH as a single test has substantial accuracy in the prediction of pregnancy using the GnRH antagonist protocol for patients with endometriosis. In other words, AMH assay prior to ovarian stimulation initiation guides the clinicians to choose the antagonist stimulation protocol for the patients with two extreme AMH levels. AMH levels can be used to individualize control ovarian stimulation in endometriosis patients.

Context. It is a challenge to determine the origin of Cushing syndrome (CS), especially in patients with low-normal adrenocorticotropic hormone (ACTH) concentrations. Objective. To evaluate the reliability of the corticotropin-releasing hormone (CRH) stimulation test in patients with CS whose origin of disease was not clearly identified using ACTH values, the high-dose dexamethasone suppression test (HDDST), and imaging in a single tertiary referral center. Design and Methods. Twenty-one patients with CS who were admitted to the endocrinology-metabolism clinic between 2004 and 2016 whose ACTH concentrations were 5-20 pg/mL and needed CRH stimulation test were retrospectively assessed. Results. Nine out of 21 patients were diagnosed as having Cushing’s disease (CD) and 12/21 had adrenal CS. The CRH stimulation test had a sensitivity and specificity of 100% and 8%, and positive and negative predictive values of 100% and 45% according to the current diagnostic criteria, respectively. An increase in ACTH ≥115% at 15 minutes and cortisol ≥86% at 60 minutes after CRH were associated with the highest likelihood ratio. The sensitivity and specificity of ACTH was 67% and 83% (AUC=0.75±0.12, 95% CI: [0.5-0.9]; p=0.03), and for cortisol it was 75% and 78% (AUC=0.71±0.15, 95% CI: [0.5-0.9]; p=0.03). Cortisol suppression of more than 64% from basal level in the HDDST suggested CD with the highest likelihood ratio. When these cut-off values were used together, both tests were negative in the patients with CD. Conclusion. The CRH stimulation test has low specificity to localize CS in patients with ACTH concentrations of 5-20 pg/mL according to the current diagnostic criteria. Different diagnostic criteria may be used in the CRH stimulation test and also in the HDDST in this group of patients.

Background and aim. Antithyroid drugs are first treatment for Graves hyperthyroidism worldwide. Although remission can be achieved in approximately 40-50% of patients in 12-18 months with antithyroid drugs, this period can be extended up to 24 months. We aimed to evaluate the effect of individual clinical/biochemical variables and GREAT score in predicting response to antithyroid drug in Graves disease. Material and methods. This is a retrospective single-center study including 99 patients with the first episode of Graves disease treated for at least 18 months. The patients were classified into two groups as those who responded to antithyroid medication at 18-24 months (group 1) and those who did not respond at 24 months and continued with low-dose antithyroid medication (group 2). Results. Medical treatment response was obtained in 38 (38.3%) of the patients at 18 months, and in 19 (19.1%) patients at 24 months. Long-term medical treatment (>24 months) was given to the remaining 43 patients due to the lack of response to medical treatment. Thyroid volume and free T4 levels were higher in those followed up with longterm antithyroid drugs, and orbitopathy was more common in this group. Median anti TPO value was significantly higher in group 1 when compared to group 2 (593 U/l and 191.6 U/l respectively). More patients were classified as GREAT class 3 in group 2 when compared to group 1 (46.5% and 12,5% respectively). We analyzed the Thyroperoxidase Antibody(anti TPO) titers, which we divided into three levels, according to groups 1 and 2. Post-hoc Chi-Square analysis revealed that falling into the highest anti TPO category was significantly associated with response to medical therapy in 24 months (p <0.05). Conclusion. According to our study, GREAT score and anti TPO Ab titers at presentation may help predict response to ATD in Graves disease

Aim: to evaluate the epidemiology of thyroid cancer (including their different forms)\r\nin two representative medical centers of Mure? County during 1984-2007 under the impact of\r\npossible regional risk factors: ionized radiation from Chernobyl, mild/ moderate iodine\r\ndeficiency (before 2003) and universal iodization of alimentary salt (from 2004).\r\nMethods: In our retrospective study we analysed the data of 288 patients diagnosed\r\nwith thyroid cancer in Endocrinology Clinic and Institute of Pathology T?rgu Mure? in this\r\nperiod. During 1984-1991 the incidence of thyroid cancer did not change practically, it began\r\nto increase progressively from 1992. This first significant elevation between 1992-1999 was\r\nassigned mainly to the newly appeared papillary thyroid carcinomas. Between 2000-2007 a\r\nsecond ascending wave in thyroid cancer incidence was recorded, with a progressively\r\nincreasing tendency.\r\nResults: The incidence was significantly higher compared to 1992-1999 (p<0.0001,\r\nRR=2.05, 95% CI=1.59 - 2.64). This second increase may be assigned, besides the radiation\r\nexposure, to the extension of diagnostic methods (thyroid ultrasonography from 1998 and\r\nfine-needle aspiration cytology from 2000). While before 1991 there were not found thyroid\r\ncancers in children in our county, during 1991-2006 there were registered 10 cases (most in\r\nthe first period): 7 papillary, 2 follicular and one papillary form associated with insular\r\ncarcinoma.\r\nConclusion: the universal iodine prophylaxis (applied from 2004) might influence the\r\ntype of thyroid cancers, increasing the papillary/follicular carcinoma ratio.

Background. Previous work has shown that the in vitro released prolactin (PRL) from the anterior pituitary (AP) of\r\nlactating rats, contains PRL variants i.e., from 7-14 to 70-97 kDa that when incubated with AP lactotrophs of male rats, and of rats in other conditions, they promoted the selective stimulation and/or inhibition of the in vitro release of PRL variants from APs of male rats and of rats in other conditions.\r\nMethods. In the present experiments, we sought to determine whether PRL variants, released in vitro from lactotrophs of\r\nlactating rats, non-suckled (NS) for 6h or suckled (S) for 15 min after NS, were electroeluted from SDS-PAGE, and then\r\nwere divided into 6 fractions, would influence the in vitro release of PRL variants from lactotrophs of NS and S rat APs.\r\nResults. The results obtained showed that, under non-reducing conditions, the fractions contained PRL variants of 7-23 to 97 kDa, and between 1 and more than 20 ng/&#956;l of PRL protein. Thus similar amounts of total PRL (about 60 ng/&#956;l), were released from each AP region of NS and S rats, except for the higher amount of PRL (80 ng/&#956;l) released from the central AP region of NS rats. The effects of PRL variants\r\nreleased from lactotrophs of NS and S rat APs i.e., of stimulatory and/or inhibitory type were exerted upon the release of PRL variants, and of total PRL.\r\nConclusions. These results indicate that in addition to hypothalamic influence, the release of PRL variants from the\r\nlactating rat AP is regulated also by autocrine influences exerted upon the gland by the previously released PRL variants.

Background. Lipoprotein-associated phospholipase A2 is a novel inflammation marker that generates pro-inflammatory\r\nmolecules from oxidized LDL.\r\nAim. We aimed to investigate its role in individuals with insulin resistance and metabolic syndrome which is representative of early stages of atherosclerosis.\r\nMethods. We evaluated 114 subjects with metabolic syndrome in a cross-sectional pattern. Waist circumference was measured. Fasting plasma glucose, total cholesterol,\r\ntriglycerides, high-density lipoprotein cholesterol (HDL-C), LDL-cholesterol (LDLC), fasting insulin were measured by standard assays. Oral glucose tolerance test was applied\r\nto patients with fasting blood glucose < 126 mg/dL. Patients were classified to tertiles according to their insulin resistance states. Lp-PLA2 mass levels were measured.\r\nResults. There was a correlation between hypertension and HOMA tertiles; HDL-C, hypertriglyceridemia, hyperglycemia\r\nwere not correlated with HOMA tertiles (p = 0.024, p=0.66, p=0.66, p = 0.18, respectively). We cannot find any association between HOMA tertiles and Lp-PLA2 levels. Triglyceride was negatively correlated with Lp-PLA2.\r\nConclusion. Lp-PLA2 is not correlated with insulin resistance in subjects with metabolic syndrome.

Introduction. The present study aimed to introduce a new formula for classification of nodules in TI-RADS and describe ultrasonography features of benign and malignant thyroid nodules. Methods. This study was conducted on thyroid mass in 1033 patients. The incidence of malignancy for thyroid nodules was determined by selecting malignancy coefficients. Then the patients were first classified using conventional TI-RADS classification criteria and once again according to a new proposed formula. Results. Among ultrasonography features of thyroid nodules, the irregular shape (46.7%), unclear margin (47.3%), extension to the capsule (irregular and infiltrative margin) (85%), the marked hypo-echoic nodules (63.8%), micro-calcification (49%), and to have vertical axis (74.0%) were associated with high incidence of malignancy. Conclusion. According to the proposed new formula for TI-RADS, there are four coefficients of 7, 3, 1 and 0 for incidence of malignancy of each one of ultrasound findings that help to standardization and unifying of TIRADS classification. The incidence of malignancy in TIRADS classification according to the new proposed formula was achieved as follows: group 2: 0.0%, group 3: 0.7%, groups 4a, 4b, 4c: 16.7%, 43.4%, 68.5%, and group 5: 95.2%, respectively.

Objective. We aimed to determine the risk of hypercalcemia in a geriatric population with very high dose levels of 25-hydroxy-vitamin D (25(OH)D). Patients and Method. This study was designed as a retrospective, cross-sectional two-center study for examining the elderly patients with very high 25(OH)D levels (>88ng/mL) between January 2014 and December 2019. After recruitment, subgroup analyses of the patients were performed based on their calcium and vitamin D levels. Results. A total of 81.101 elderly patients, who had been evaluated for their vitamin D levels, were screened. Of the 458 (0.6%) elderly patients with 25(OH)D>88 ng/ mL according to our criteria, 217 patients with complete data were accepted into our study. The median 25(OH)D level was 103.7ng/mL (min-max:88.2-275.9). Most of the elderly patients (86.6%) with very high 25(OH)D levels were normocalcemic. When patients with hypercalcemia were compared with normocalcemic group, no difference was observed in the levels of 25(OH)D, intact parathormone (iPTH), phosphorus, alkaline phosphatase (ALP), and their age. However, the PTH suppression rate was significantly higher in hypercalcemic group (p=0.005). Conclusion. The elderly patients with very high 25(OH)D levels would appear to be mostly normocalcemic whereas life-threatening hypercalcemia would also occur. Treatment and follow-up planning should be done according to the clinical guideline recommendations.