ACTA ENDOCRINOLOGICA (BUC)

Introduction. Heart failure and dilated cardiomyopathy (DCM) in adults are rarely caused by hypoparathyroidism induced hypocalcemia. Case report. Female patient, 40 years old, diabetic, with previous history of thyroidectomy for Graves’ disease, was hospitalized for syncope and symptoms of heart failure. ECG revealed sinus tachycardia, long QT, negative T from V1 up to V4. Chest X-ray, cardiac ultrasound and contrast cardiac MRI confirmed dilated left chambers, severe systolic dysfunction of the left ventricle (left ventricle ejection fraction=15%) due to diffuse hypokinesia and restrictive type of diastolic dysfunction. Patient status insignificantly improved with specific heart failure depletion treatment but important signs of hypocalcemia occurred. Low levels of total and ionic serum calcium were detected (total serum calcium 3.6 mg/dL, ionic calcium=2.2 mg/dL) along with low serum levels of parathormone (10 pg/mL) and high level of phosphatemia (6.4 mg/dL). After one month of parenteral treatment with calcium and oral vitamin D, hypocalcemic signs disappeared and heart failure significantly improved. Conclusion. This rare adult condition is refractory to heart failure conventional therapy but promptly responds to restoration of normocalcemia. It is important to be aware of this pathophysiological setting, in order to treat it correctly.

Context. Female adnexal tumors of probable Wolffian origin (FATWO) represent very rare borderline ovarian tumors with low malignant potential. Only 15 cases of malignant FATWO are described in the current literature, among which, only 5 are reported as being recurrent. Objective. Due to the rare presentation of the recurrence of the malignant FATWO and the few cases reported in the scientific database, there are no clear therapy recommendations. This paper should help practitioners to choose the best therapy approach. Design. This paper presents the 6th case of malignant recurrent FATWO and will compare all the cases available in the literature. Subjects and Methods. We present a review of the literature comparing the therapeutic approaches and outcomes of all the five cases of recurrent malignant FATWOs. Also, we introduce the case of a stage III Wolffian origin adnexal tumor with multiple recurrences appeared after 6 years of disease free interval. Results. Our case presents the longest survival reported in the literature and underwent most surgical procedures of the recurrences and more than 4 lines of chemotherapy regimens. Conclusions. This paper shows possible therapeutic approaches to be used as example by the practitioners according to the drug availability in their centers.

Objective. We analyzed the correlation between glycemic variability and psychological problems such as depression, anxiety disorder, and low self-esteem in pregnant and non-pregnant (excluding gestational diabetes) patients with diabetes. Besides its originality, this study might contribute to better / earlier diagnosis of these psychological conditions, with a special interest in pregnant diabetic women. Better management and cost reduction of care could be a consequence. Methods. We compared diabetic pregnant and non-pregnant women from the perspective of the glycemic variability (for a period of 15 days prior inclusion in the study) and their results on the standardized questionnaires: Beck depression inventory, Hamilton anxiety scale – HRSA, Rosenberg self-esteem test. Results and Conclusions. A statistically significant correlation was identified in both groups between the glycemic oscillation and depression, anxiety, and low selfesteem. Diabetic pregnant women had a higher statistical significance for the correlation between the glycemic oscillation and depression, as well as between the glycemic oscillation and anxiety than non-pregnant diabetic patients. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients.

Context and objective. The new insights in the pathogenesis of osteoarthritis (OA) reveal the implications of adipocytokines. This study aims to analyze the correlations between the serum value of adiponectin and the clinical rehabilitation effects in patients diagnosed with knee OA, admitted and treated in the complex balneal resort of Techirghiol lake. Subjects and methods. The prospective randomized clinical study included 23 patients in the study group, diagnosed with knee OA according to ACR criteria, and a matching control group of 23 subjects. Serum level of adiponectin (using ELISA technique), uric acid, triglycerides, cholesterol, HDLcholesterol and clinical response using a visual analog scale (VAS) were evaluated in all patients on their admission day and after 10 days of balneal treatment. Control group benefited from the same procedures except for cold mud therapy and mineral water baths. Results. Plasma adiponectin levels (23.73±6.44 ng/dL) were statistically higher (p<0.05) in the study group compared to the control group (18.15±6.49 ng/dL). The mean VAS in both groups was decreased (p<0.005) compared to the initial moment. Conclusions. Cold peloidotherapy combined with physical therapy and balneal factors induces serum adiponectin elevation and improves knee pain in OA. Therapeutic properties of Techirghiol mud still need further research.

Objective. We analyzed the possible correlation between glycemic variability and psychological disorders such as depression, anxiety disorder, and low self-esteem, in diabetic patients. These correlations are relevant, as they consume a large number of resources. Their better understanding can increase the effectiveness of incident reduction techniques and could provide better management and cost reduction of care. Methods. We compared the relationships between the glycemic variability (for a period of 10 days prior to completing the depression questionnaire) and the results of two standardized questionnaires: Hamilton anxiety scale - HRSA (group 1: 500 patients), Rosenberg self-esteem test (group 2: 490 patients) and Beck depression inventory (both groups). Results. A statistically significant correlation was identified between the glycemic oscillation and depression as well as both anxiety and low self-esteem. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients. In conclusion, psychometric tests could be an important instrument in the management of diabetic patients.