ACTA ENDOCRINOLOGICA (BUC)

Background. A rising trend in obesity among children has been observed in recent years\r\nin most countries. The majority of obese children will become obese adults having an increased\r\nrisk for chronic diseases associated with obesity, with a negative impact on their lifespan.\r\nObjective. Assesing the obesity prevalence among school children in Cluj-Napoca.\r\nMethods. The study included 7904 school children of all grades (grade 1 to grade 12) from\r\n20 schools in Cluj-Napoca. The weight, height and body mass index (BMI) were recorded for\r\neach child. Using the BMI percentile, they were classified as: normal (BMI < 85th percentile),\r\noverweight (BMI between 85th and 95th percentile) or obese (BMI > 95th percentile). BMI average\r\nand standard deviation have been calculated per age groups and sex.\r\nResults. 8.29% of school children in Cluj-Napoca are obese, while 12.84% of them are\r\noverweight. The difference between sex groups is statistically significant with boys more likely to\r\nbe obese or overweight than girls (p<0.0001). The highest prevalence has been observed among\r\nthe 6-10 years age group, while teenagers have recorded the lowest prevalence figures.\r\nConclusion. Data derived from this study would place Romania among the countries\r\nwith an average prevalence of obesity. However, extending such studies at national level\r\nwould provide more accurate data about obesity prevalence in Romania.

Background. Gestational diabetes mellitus (GDM) is associated with high frequency of obstetric complications, such as gestosis, polyhydramnios, urogenital infection, premature birth. An increase in the number of cases of detection of GDM in pregnant women living in Kazakhstan is noted recently. Objective. This research was carried out in order to see the influence of GDM on the course of the third trimester of pregnancy, outcomes and fetal status in women of Kazakh ethnic group. Research design. Cohort observational study. Subjects and Methods. The main group of research consisted of 61 pregnant women with GDM (Meanage= 32.8±6.314), the control group included 39 pregnant women with normal glucose tolerance (Meanage=30±5.432 years). The pregnant women in both groups were examined by calculation of body mass index (BMI), determination of fasting plasma glucose and the system of hemostasis. Also, the fetal ultrasound was implemented and the uterineplacental, fetal-placental blood flow were evaluated using the Doppler mode. Results. In the main group initial BMI was equal to Mean=31.1±7.433 kg/m2; we revealed manifestation of gestational hypertension in 36.1%, 95%CI (2.52, 48.6); preeclampsia was diagnosed in 14.8% (95%CI (8; 25.7); the disorders of uteroplacental and fetoplacental blood flow recorded significantly more frequently in main group RR=6.393, 95%CI (1.581-25.840), like the diabetic fetopathy RR=5.115, 95%CI (1.240-21.033). The premature delivery, the prevalence of induction of delivery and intranatal trauma were significantly more frequent in women with GDM. Conclusions. GDM significantly worsens course of gestation.

Introduction. The functions of CD36 membrane receptor include removal of oxidized low-density lipoproteins from\r\nplasma. The aim of our study was to search association between the IVS3-6 C allele and hypercholesterolemia in overweight children.\r\nMaterial and Methods. The study groups comprised 55 Caucasian children with (33) and without hypercholesterolemia (22). Amplicons of exon 4 including\r\nfragments of introns 3 and 4 were studied using denaturing high-performance liquid chromatography (DHPLC).\r\nResults. Polymorphism detected by DHPLC was single nucleotide substitution in intron 3 (IVS3-6 T/C - rs3173798). The IVS3-6 T/C polymorphism is located in the\r\nregion encoding the oxidized LDL binding domain, at a conserved splice site. Total serum cholesterol concentrations were significantly lower in the IVS3-6 TC\r\nheterozygotes than in the TT patients. Furthermore we found tendency (p=0.06) to lower LDL-cholesterol level in IVS3-6 TC heterozygotes than in wild-type homozygotes.\r\nConclusion. The results of our preliminary study suggest that the IVS3-6 C allele of CD36 rs3173798 polymorphism\r\nmay be associated with lower serum total and LDL-cholesterol in overweight children diagnosed with hypercholesterolemia.

A 75 years old woman was referred to abdominal echography for pain related to biliaryduodenal motriceal dysfunction. The ultrasound discovered a dense (hyperechogenic) image under (posterior of) the 8th segment of the liver. The dense process was supposed to be a calcification situated medial from the right kidney in the cranial 1/3 length of it. Specific clinical and biological data related to possible adrenal destruction were analyzed: the patient was in good condition, body mass index was 29. She had no tuberculosis during her life. The current arterial pressure was 145/80 mm Hg. All laboratory data, including basal cortisol were normal. Cortisolemia at 8 a.m. was 523 nmol/l. The diagnosis was made by CT scan: clear and only organ-disseminated calcification in adrenals appeared as a rim. The management of this case was related to follow-up of adrenal lesions by abdominal ultrasound.\r\nThe calcification of one adrenal raised several issues for discussion: the role of ultrasound vs CT in adrenal lesions, the prevalence of calcifications in adrenal glands, the importance of the calcification process. Calcifications of adrenals are seldom found in primary autoimmune cortical atrophy associated with Addison's disease, but they are supposed to be more frequent in adrenal tuberculosis; calcification suggests a former local tuberculosis process, associated with pulmonary tuberculosis and with borderline adrenal insufficiency. Various etiologies and mechanisms for adrenal calcifications (infectious, tumor, hemorrhage, parasitic) are discussed. To our knowledge, the rim-like appearance of the adrenal calcification was described only in one patient. In conclusion, incidental diagnostic of adrenal gland calcifications was reported in patients without adrenal insufficiency, signaled by ultrasound and detailed by CT, associated with normal adrenal function. Therefore, we consider that calcifications in the right adrenal in our patient could mean a process of cicatrisation or healing after an autoimmune aggression, only on the right adrenal gland.

The coexistence of Cushing’s syndrome (CS) and pregnancy is uncommon due to the suppression of gonadotropin secretion in CS. Adrenocorticotropic hormone (ACTH) dependent CS in pregnancy is less frequent than adrenal causes. The diagnosis of CS during pregnancy is difficult since physiological changes in the hypothalamopituitary- adrenal axis may cause dynamic tests to be misinterpreted. Radiological imaging is limited. We report the case of a 27-year old woman with Cushing’s disease (CD) diagnosed in the 5th-week of pregnancy. The mild symptoms of hypercortisolism did not lead to serious complications for the mother or the fetus, so insulin was the only treatment used. The pregnancy was completed without any complications, and at 38 weeks of gestation a healthy female infant was delivered vaginally. Complications, such as hypocortisolemia and hypoglycemia, were not observed in the infant. Postpartum tests were consistent with CD. Contrast-enhanced pituitary magnetic resonance imaging revealed a microadenoma which was removed with transsphenoidal surgery. Histopathology revealed a pituitary adenoma with positive immunohistochemical staining for ACTH. Biochemical remission required prednisolone treatment, but the insulin requirement decreased significantly over time. As a conclusion, CD with mild features can be well tolerated during pregnancy, but the mother and the fetus must be monitored closely.

Context. The immune system has an important role in the etiology of depression, through the pro-inflammatory cytokines and acute phase protein mechanisms. In elderly people, frequent association between depression and medical conditions leads to a difficult psychiatric diagnosis, becoming necessary to determine a specific biological marker for this category of population. C-Reactive Protein (CRP) did not prove to have a high level of validity, but higher levels of high-sensitivity C-Reactive Protein (hs-CRP) were found to be associated both with cardiovascular disease and depressive disorder, through a bidirectional relationship. Objectives. To investigate the possible association between a major depressive episode and levels of inflammatory markers among a population of elderly. Subjects and methods. A prospective study on a sample of 82 individuals aged over 65 years, who presented for laboratory evaluations in an outpatient setting. They were recorded socio-demographic and clinical data; depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. Blood samples were collected and analyzed according to the protocol of the study. Results. Anxiety, identified in 57 persons, was not statistically significant correlated with the levels of inflammatory markers. For depressive disorder (37 subjects), both CRP and hs-CRP were significantly higher, with an almost medium effect size. Conclusions. The high levels of CRP and hs-CRP are associated with the presence of depression in elderly patients, but not with the anxiety. Further and complex studies need to validate these findings on this group of age.

Context. Several studies have addressed the impact of sarcopenia on various health outcomes. As the most critical issue is the early identification of individuals, a short screening tool may help clinicians to simply test for sarcopenia and start early management of the disease. Recently, a simple questionnaire, Sarc-F was provided that may adequately realize this aim. Subjects and Methods. To validate the questionnaire we translated the original Sarc-F according to the recommended methodology. A total of 80 people, aged 65+ were evaluated for sarcopenia. Muscle mass, strength, and physical performance were measured. Volunteers completed the Sarc-F as well as other two questionnaires. Discriminative power, reliability, construct validity analyses, specificity, sensitivity, negative and positive predictive value evaluations were made. Results. A good discriminative power and internal consistency were found. With the functional sarcopenia diagnostic criteria the test demonstrates a high specificity (84%). The positive and negative predictive values were: 78% and 77%. Using the more conservative diagnostic criteria the negative predictive value was: 85.4%, sufficient to rule out those not at risk of having sarcopenia and eliminate the need for further investigations. Conclusions. A valid Romanian Sarc-F questionnaire is now available to simply detect patients at risk/no risk of sarcopenia.

We describe one case of sellar and suprasellar chordoma found in a 44 year old female, with bitemporal hemianopsia and secondary amenorrhea, submitted to transfrontal surgery and telecobaltotherapy. Chordomas are slow growing neoplasms arising from notochordal remnants of the axial skeleton. The second most common site for chordomas, after the sacrococcygeal region, is the base of the skull. Skull base chordomas commonly result in cranial nerve deficits, such as blurred vision, facial weakness and swallowing difficulty. Occasionally, chordomas localized in the hypothalamic or pituitary region may lead to pituitary stalk disjunction, pituitary insufficiency and diabetes insipidus. Studies show that early diagnosis, combined with aggressive surgical resection, offers the best chance for long-term survival. Although optimal treatment consists of wide excision with adjuvant radiotherapy, skull base chordomas are rarely amenable to complete surgical removal. Traditionally, postoperative irradiation is delivered to doses of 6000-6500 cGy; however this approach controls the chordoma only for a few years. Prognosis depends on the histological grade of the tumor, atypical chordomas showing the lowest survival rate.