The International Journal of Romanian Society of Endocrinology / Registered in 1938

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  • General Endocrinology

    Capatina CA, Caragheorgheopol A, Marzan L, Toma E, Gandea C, Constantinoiu S, Coculescu M

    Pituitary Hormones in Human Cerebrospinal Fluid

    Acta Endo (Buc) 2011 7(1): 1-10 doi: 10.4183/aeb.2011.1

    Introduction. The blood brain barrier (BBB) restricts the transport of hydrophilic molecules such as peptidic pituitary hormones into the brain tissue. The blood-cerebrospinal fluid (CSF) is a part of the BBB.\r\nAim To compare the pituitary hormone levels on the two sides of the BBB in a group of subjects without endocrine diseases.\r\nPatients and methods. We investigated, with the approval of the local ethics committee, 78 subjects without endocrine diseases. Growth hormone (GH), prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and thyroid stimulating hormone (TSH) were measured by rapid fluoroimmunoassay with Europium in the blood and cerebrospinal fluid (CSF)sampled simultaneously before rachianestesia for minor surgery.\r\nResults. CSF concentrations are significantly lower than the corresponding serum ones for all hormones studied: 0.04 ? 0.009 mU/mL vs 2.29 ? 0.57 mU/mL for GH, 1.49 ? 0.078 ng/mL vs 10.07 ? 1.42 ng/mL for PRL, 0.57 ? 0.078 U/L vs 22.71 ? 3.65 U/L for FSH, 0.39 ? 0.038 U/L vs 11.11 ? 1.55 U/L for LH and 0.01 ? 0.003 &#956;U/mL vs 1.36 ? 0.17&#956;U/mL for TSH (mean ? SEM; p<0.001). The CSF/serum ratio was below 1 in the vast majority of cases (from all subjects studied we only found 3 cases with supraunitary CSF/serum ratio). The serum and CSF levels were not significantly correlated for\r\nany of the pituitary hormones. Comparing preand postmenopausal women the CSF gonadotropin levels were slightly but nonsignificantly increased after menopause,\r\ndespite marked differences in the serum concentrations: CSF FSH 1.21 ?0.17U/L after vs 0.84? 0.4U/L before menopause, CSF LH 0.60? 0.047U/L after vs 0.43? 0.14U/L before\r\nmenopause. The CSF/ serum ratio for FSH markedly decreased after menopause (0.02?0.003 vs 0.22?0.11) although the effect did not reach statistical significance. The same\r\nwas true for CSF/serum LH ratio (0.026?0.005 vs 0.09?0.002). For none of the hormones studied the CSF levels correlated with age.\r\nConclusion. Pituitary hormones are normally found in the CSF at much lower levels than in the serum. The CSF hormonal\r\nconcentrations do not significantly correlate with the serum ones.
  • General Endocrinology

    Ursu HI, Podia-Igna C., Delia C.E., Toma G.M., Goran D., Galoiu S., Niculescu D.A., Giurgiu D., Gheorghiu M.L. , Anca IA

    Iodine Status after a Decade of Universal Salt Iodization in Romania: A Bicentric Study in Urban Areas

    Acta Endo (Buc) 2014 10(1): 9-20 doi: 10.4183/aeb.2014.9

    Objective. To assess in a bicentric study the current iodine status of schoolchildren, ten years after implementation of the universal salt iodization (USI) in Romania. Subjects and methods. 102 children from 2 towns, aged between 6 and 11 years, were included in the study group: 66 children from Sibiu, a previously endemic area for iodine deficiency disorders and 36 children from Bucharest, a previously borderline iodine intake area. Body mass index (BMI), total body surface area (BSA), median urinary iodine concentration (UIC) and prevalence of goiter were evaluated. Thyroid volume was measured by ultrasonography. The study was approved by the Local Ethics Committee. An informed consent from the parents was obtained. Results. From the 102 schoolchildren in the study group, 59 were girls and 43 were boys. Median UIC in the total number of samples was 175.2 mcg/L, reflecting a sufficient iodine intake, with statistically significant differences between the two urban regions. The median UIC was 187.35 mcg/L in the Sibiu subgroup and 160.2 mcg/L in the Bucharest subgroup (p < 0.001). The total percentage of goiter in the studied subjects was 5.88%. Percentage of goiter, determined by adjusting ultrasound thyroid volume to sex and BSA, was 1.51% in Sibiu and 13.88% in Bucharest, a statistically significant difference (p = 0.011). None of the subjects showed ultrasonographic pattern suggestive of Hashimoto thyroiditis or macronodules. There was no statistically significant difference between the percentages of overweight or obesity in the two subgroups. Conclusions. Ten years after implementation of USI in Romania, a bicentric study suggests that our country is iodine sufficient in urban areas. In order to prevent recurrence of mild iodine deficiency in schoolchildren, a persistent surveillance, use of sustainable measures and public awareness are required. Recurrence of mild iodine deficiency should be avoided, because even mild iodine deficiency impairs cognition in children.
  • General Endocrinology

    Cardenosa MC, Gonzalez-Custodio A, Tomas-Carus P, Timon R, Olcina G, Cardenosa AC

    Normobaric Hypoxia Exposure on Substrate Oxidation Pattern: Sex Differences

    Acta Endo (Buc) 2021 17(1): 14-21 doi: 10.4183/aeb.2021.14

    Context. Hypoxic exposure has been associated with a metabolic perturbation that might affect basal energy expenditure (BEE). Objective. The aim was to examine the metabolic response during hypoxic exposure of men and women adults. Design. Crossover design with two experimental trials: normoxic and hypoxic exposure. Subjects and Methods. Twenty-nine healthy subjects (14 women) participated in (1) control study (NOR), subjected first to normoxic exposure (FiO2 = 20.9%) and (2) after that, to passive normobaric hypoxic exposure study (HYP) (FiO2 = 15%). Respiratory gases and blood glucose samples were recorded every hour in hypoxia chamber (8 points in total), and blood lactate samples were collected at baseline, at 4 and 7 h to exposure. Results. In females, basal energy expenditure was significantly higher at 2h, 4h, 6h and 7h compared with NOR group. Also, BEE was lower in females compared with men from 2h of hypoxia exposure. In the HYP group the blood lactate concentration increased significantly at 4h and 7 h relative to NOR group (P < 0.05) in males. Conclusion. An exposure to moderate normobaric hypoxia did not alter metabolic response, but induced a different response on substrate oxidation in adults men and women.
  • Endocrine Care

    Tarcea M, Szavuj J, Toma F, Rada C, Zugravu C

    Sexual maturation amongst adolescents from Mures county

    Acta Endo (Buc) 2010 6(1): 57-72 doi: 10.4183/aeb.2010.57

    Background. Evaluation of features of puberal maturity on a representative specimen of adolescents from Mures county.\r\nMaterial and method. The collected data came from the Public Health Authority in 2008, from 2013 teenagers, with ages ranging between 11&#8211;18 years, according to the Physical development registration file, Tanner stages and demographic data.\r\nResults. Boys grew at a faster rate in both height and weight than girls. In the urban areas, there is a preponderence for children in Tanner stages I-IV, compared to Tanner stage V. In the rural area, girls from middle school cover stage I then stage V of development and boys prevail in stage III and decrease in stage V. The teenagers of Mures county between 15-18 of age, both boys and girls, have a higher frequency than the rest of the teenage population of the country in stage V development, and for ages between 11&#8211;14 there is a majority for stage I. Correlating the parent&#8217;s education level and the puberal maturation of teenagers, we concluded that elementary and medium education levels prevail for all Tanner stages involved, without significant differences between them. Late puberty is more frequently associated to the parent&#8217;s elementary education level (68.34%) and rural area, in both genders. In the rural area there is a higher preponderence of children with rank over 2, due to the tendency of families in the urban area to reduce the children&#8217; number in the past years. Out of the entire study group, 3.75% were disharmonious with obesity: 3.94% of boys and 3.56% of girls, with a slight predominance in younger girls. There is no significant correlation between obesity and birth weight (p=0.441) or between puberal maturity level and weight.\r\nConclusion. We must stress upon the importance of monitoring the aspects of physical, neuropsychic development and puberal maturity in children, considered influence factors of morbidity.
  • Endocrine Care

    Giulea C, Enciu O, Toma EA, Martin S, Fica S, Miron A

    Total Thyroidectomy for Malignancy - is Central Neck Dissection a Risk Factor for Recurrent Nerve Injury and Postoperative Hypocalcemia? A Tertiary Center Experience in Romania

    Acta Endo (Buc) 2019 15(1): 80-85 doi: 10.4183/aeb.2019.80

    Introduction. Surgery for thyroid cancer carries a higher risk of morbidity given the region’s complicated anatomy, the setting of malignancy and extent of the surgery. Aim. To investigate the rate of complications related to the recurrent nerve and parathyroid glands lesions in patients with thyroid carcinoma that undergo thyroid surgery and lymph node dissection. Patients and Methods. The data of 71 patients who underwent total thyroidectomy and 19 patients who underwent total thyroidectomy and central neck dissection with various associated neck dissection techniques were investigated using appropriate statistical tests. Results. As expected, the rate of recurrent nerve injury observed in the neck dissection group was higher than in the total thyroidectomy group (15.7% vs. 2.8%, p=0.05). As for postoperative hypocalcemia, the rate observed in the neck dissection group, both for postoperative day 1 (p<0.0001) and day 30 (p=0.0003) was higher than in the total thyroidectomy group (68.4% vs. 19.7% postoperative day 1, 31.5% vs. 4.2% postoperative day 30). Conclusions. The risk of morbidity concerning the recurrent nerve injury and postoperative hypoparathyroidism increases with the extent of surgery. Extensive surgery may achieve proper oncologic outcomes but increases the risk of postoperative morbidity and decreases quality of life. In deciding for extensive surgery, both patient and medical team need to understand these risks.
  • Notes & Comments

    Iliescu L, Toma L, Grasu M, Herlea V, Orban C

    Neuroendocrine Tumors. Four Case Reports

    Acta Endo (Buc) 2015 11(1): 116-123 doi: 10.4183/aeb.2015.116

    Context. Neuroendocrine tumors are tumors developing from primitive cells in the intestinal walls, but can also affect the lungs, liver, pancreas, ovaries. Objective. We aim to describe the clinical, imagistic and biologic aspect of neuroendocrine tumors with different localizations and present the evolution, treatment options and prognosis. Design. Four patients either with previously known neuroendocrine tumors or with newly discovered tumors were studied. Subjects and methods. The first patient was diagnosed with primary liver carcinoid with pulmonary metastases by abdominal and thoracic CT scan, liver biopsy and determination of serologic markers. The second patient was diagnosed with primary lung neuroendocrine tumor using thoracoscopy biopsy and serologic markers The third patient was diagnosed with a large gastric neuroendocrine tumor with liver and spleen metastases. using CT scan, MRI and biopsy from the abdominal mass. The fourth patient was diagnosed with primary liver carcinoid using imagistic methods (CT scan) and liver biopsy. Results. The first patient died after 4 months due to the extent of the disease and comorbidities. The second patient had a good evolution, as the tumor was diagnosed in a localized stage. The third patient had a decreased survival due to the dimensions of the primary tumor and the multiple liver metastases which later caused obstructive jaundice requiring external biliary drainage. The fourth patient has had a good evolution, the tumor masses in the liver are being kept under control using transarterial chemoembolization. Conclusion. Neuroendocrine tumors are very versatile both in location and clinical aspect. The diagnosis requires imagistic methods but it is imperative to perform biopsy of the lesions with special histologic stains in order to be sure of the diagnosis.
  • General Endocrinology

    Tanase A, Nemescu D, Popescu R, Toma BF, Matasariu RD, Onofriescu M

    FSH Receptor and FSH Beta Chain Polymorphism Involvement in Infertility and Endometriosis Disease

    Acta Endo (Buc) 2020 16(2): 142-147 doi: 10.4183/aeb.2020.142

    Objectives. The purpose of this study was to evaluate the association between the follicle-stimulating hormone (FSH) receptor (c.-29G>A) and FSH beta chain (c.- 280G>T) polymorphisms and endometriosis in Romanian women. Material and methods. We performed the polymorphic analysis of the FSH receptor gene and FSH beta chain in 44 patients with endometriosis and 34 controls. Genomic DNA was obtained from peripheral blood and polymorphisms were investigated using restriction fragment length polymorphism analysis (RFLP). Results. There were no significant differences in genotype frequencies of FSH receptor gene between endometriosis patients and controls. For the heterozygous type of the FSH receptor polymorphism (c.-29G>A) we did not find a significant difference in its frequency between patients with minimal/mild and moderate/severe endometriosis (p = 0.136). Also, the FSH beta chain (c.- 280G> T) polymorphism frequency was not significantly associated with the severity of endometriosis (p = 0.966). Conclusions. FSH receptor and FSH beta chain polymorphisms do not seem to influence the severity of endometriosis, but they could be correlated with female infertility (primary or secondary), therefore further studies are required to debate this topic.
  • Endocrine Care

    Toma A, Sava M, Delia C, Simescu M, Tomescu E, Coculescu M

    Universal salt iodization effects on endemic goiter in Arges county, Romania

    Acta Endo (Buc) 2005 1(2): 167-180 doi: 10.4183/aeb.2005.167

    Abstract References
    Background. In the Carpathian area of Romania the Iodine Deficiency Disorders (IDD) including endemic goiter are a public health problem. Recently, the legislation imposing salt iodization was strengthened (from 10 to 20 ± 5 mg iodine/kg salt) and enlarged (universal salt iodization, USI, has been applied to bread industry since 2002). Objective. The effect of bread iodization by law upon the characteristics of goiter endemy was assessed in Arges county, Romania. Design. The characteristics of goiter endemy (as defined by WHO/ICCIDD/UNICEF) were determined in children in the years 1999 (control group C) and 2004 (study group S), two years after universal bread iodization. In the control group C there were 1,241 schoolchildren 6-14 years old, living in 5 villages and in Pitesti town. In the study group S there were 408 schoolchildren 6-12 years old, living in 7 villages and in Pitesti town. After universal bread iodization, a neonatal screening for hypothyroidism was also performed on 11,216 newborns in Arges county, between January 2003 and December 2004. The content of KIO3 in the salt was assessed both in samples collected from village shops in the years 1999 (10 samples) and 2004 (17 samples). The iodine content of drinking water in Arges county villages was assessed in 1999. Methods. Three parameters of IDD endemy were evaluated, i.e. the thyroid volume in schoolchildren by palpation or/and ultrasonography, urinary iodine by the Sandell-Kolthoff method, and neonatal blood TSH levels in dry spot by immunoassay. A questionnaire was filled in by 912 schoolchildren in 1999 and by 408 schoolchildren in 2004.
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  • Case Report

    Iliescu L, Toma L, Minzala G, Orban C

    Acute Hepatitis after Methimazole. Case Report

    Acta Endo (Buc) 2014 10(2): 267-272 doi: 10.4183/aeb.2014.267

    Background. There are few cases of methimazole induced hepatitis. The mechanism is probably related to the fact that it is a hepatic- metabolised drug. Objective. To demonstrate the fact that an acute cholestatic hepatitis can be triggered by methimazole. Design. While dealing with a major cholestatic syndrome with cytolysis, we performed the following steps: correct and complete history, serum detection of acute viral hepatitis, an autoimmune cause and finally liver biopsy. Subjects and Methods. We present the case of an 80 year old woman, with a history of hyperthyroidism, in treatment with Methimazole. After a month, the patient developed jaundice, for which she was admitted to our clinic. On admission she presented an important cholestatic syndrome, with elevated transaminases (5 times normal). Results. None of the laboratory tests indicated a possible viral infection or autoimmune disease. Abdominal ultrasound revealed no possible obstruction of the biliary system. Ultimately we performed a liver biopsy, which revealed inflammatory infiltration and cholestasis. Conclusion. We conclude that the hepatitis was induced by methimazole. Corticotherapy was initiated, with a relatively slow but favourable evolution. I131- Radiation therapy was elected for the treatment of hyperthyroidism.
  • Endocrine Care

    Toma A, Diaconu B, Gheorghiu M, Sava N, Nedelcu L, Trifanescu R, Sava M, Barbos D, Coculescu M

    Persistence of neurological cretinism in old endemic goiter areas of the Carphatians

    Acta Endo (Buc) 2005 1(3): 311-324 doi: 10.4183/aeb.2005.311

    The subCarpathian areas of Arges county are now characterized by a moderate endemia of iodine deficiency disorders (IDD) due to salt iodization. However, we found some cases of endemic cretinism (EC), that is the major expression of anomalies in the physical and intellectual development caused by a severe iodine deficiency. There are presented 5 patients, 4 men and 1 woman, with neurological endemic cretinism (NEC) (n=2) and mixed forms of the disease (n=3), coming from 2 old endemic areas (medium urinary iodine excretion in the studied patients 20.8 g/day), diagnosed and treated in outpatients clinics or in hospitals. Four patients are members of the same family. The age of the patients is between 36 and 84 years old, the average age being 69. The intellectual capacity was assessed by using the Wechsler and Raven tests, the average intelligence quotient (IQ) value was of 20.8 points ? 1.47. The thyroid volumes (TV) were estimated by palpatory method and by ultrasonography and were between 8.7-200 ml. TSH values in studied patients ranged between 3.8-26 IU/ml and free T4 ranged between 0.272-1.22 ng/dl. Aggregation of more cases of endemic cretinism in the same family suggests the occurrence of some genetic factors. In conclusion, the old age (over 70 years old) of 4 cretins shows they are remnants of the old IDD endemia. However, there is also an isolated case of middle age (36 years old) suggesting an inadequate iodine intake, despite a law regarding salt iodization which has been operating since 1962. More attention to the universal salt iodization and to consumption of iodized salt in the rural areas is necessary.