ACTA ENDOCRINOLOGICA (BUC)

Introduction. The aim of this study was to investigate the effects of vitamin D deficiency on insulin resistance in patients with non-diabetic chronic kidney disease. Materials and Method. A total of 104 patients with non-diabetic, stage 2 and 3 chronic kidney disease, who had presented to the outpatient clinic during 2 winters, were included in the study. HOMA-IR rate of > 2.6 was accepted as insulin resistance. Severe 25-OH-vitamin D deficiency was defined as < 10 ng/mL, and 10-30 ng/mL was defined as vitamin D insufficiency. The difference in insulin resistance between the patients determined as having severe vitamin D deficiency and vitamin D insufficiency was investigated. Results. Severe vitamin D deficiency was observed to be higher among women (61.8% vs. 38.2%), whereas insufficiency was more common among men (63.3% vs. 26.7%, p<0.05). Insulin resistance was observed to be higher in the group with severe deficiency (11.5 vs. 7.82, p<0.05). Insulin resistance was observed in 60% and 36.7% of the groups with severe deficiency and insufficiency, respectively (p<0.05). Conclusion. Severe vitamin D deficiency had resulted in insulin resistance at a greater rate compared to vitamin D insufficiency in patients with non-diabetic chronic kidney disease (stage 2-3).

Context. The gastrointestinal tract is one of the most affected systems in hyperthyroidism. Although thyrotoxicosis is thought to be associated with gastrointestinal dysmotility, there are limited studies focused on motility disorders in hyperthyroidism. Objectives. We aimed to investigate the manometric measurements to determine if esophageal motility is affected in Graves’ disease. Materials and Methods. Thirty patients with Graves’ disease (18 female and 12 male) and 30, age and sex matched, healthy controls (22 female and 8 male) were recruited to the study between 2015 and 2016. Esophageal manometry was performed using MMS (Medical Measurement Systems bv. The Netherlands) Solar GI – Air Charged Intelligent Gastrointestinal Conventional Manometry. Results. The mean lower esophageal sphincter pressure (LESP) was 16.9 ± 5.3 mmHg in hyperthyroid patients and 20.1 ± 8.8 mmHg in the control group and there was no significant difference (p>0.05). It was observed that the duration of contraction was 3.9 ± 0.7 s in healthy subjects and, significantly shorter 3.2 ± 0.5 s in hyperthyroid patients (p<0.001). Duration of contraction was negatively correlated with TSH receptor Ab titer in patients (p=0.006, r= -0.48). Also, it was observed that the duration of relaxation was negatively correlated with fT4 levels in the patient group (p<0.05, r= -0.46). Conclusion. In this study, we observed that esophageal motility can be affected via shortened duration of contraction in Graves’ disease. The gastrointestinal symptoms due to possible motility dysfunctions should be considered in the evaluation of hyperthyroid patients.

Introduction. Primary bilateral macronodular adrenal hyperplasia (PBMAH) is one of the uncommon causes of endogenous Cushing’s syndrome (CS). Pheochromocytoma (PCC) is another adrenal tumor which is derived from neural crest arising in the adrenal medulla. Here we are reporting a case with recurrent overt CS due to PBMAH, 2 years after unilateral adrenalectomy, concomitant with recently developed PCC. Case Presentation. A 43-year-old woman was admitted to our clinic with a 30 kg weight gain, proximal muscle weakness, menstrual irregularity, easy bruising and excessive hair growth on face and body.The lab results were compatible with a diagnosis of solely ACTH-independent CS. Screening showed bilateral macronodular lesions and she underwent right adrenalectomy. Postoperatively, she had lost weight and her well-being had improved; 2 years later, she developed CS and paroxysmal hypertension. The left adrenal gland was laparoscopically removed. Histopatologically, the lesion was reported as a typical PCC and macronodularmicronodular hyperplasia of the adrenal tissue surrounding that lesion. Conclusions. Pheochromocytoma with synchronous ACTH-independent CS originating from the same adrenal gland is very rare. To the best of our knowledge,our case is the first one describing the coexistence of overt ACTHindependent CS due to PBMAH and metachronous PCC. The importance of detailed re-evaluation of patients with recurrent ACTH-independent CS is highlighted here.

We report the case of a 6.6 years old boy, born to healthy unrelated parents, from a normal pregnancy, admitted for severe growth retardation. His height was 71 cm\r\n(-9.3 SD), with a weight of 6.6 kg and he presented a triunghiular face, mycrognatia, proeminent nose and hypertelorism resulting in a ?bird headed? profile. He associated clinodactyly of the 5th finger and a slightly longer left leg. Tanner stages were P1 G1. The\r\nbiochemical panel was normal, but he presented mild hypocromic anemia. The thyroid function was normal, and the IGF1 low. The karyotype was 46 XY and the bone age 4.5\r\nyears. The pituitary computed tomography revealed empty sella. Based on the clinical picture, the possible diagnosis of Seckel syndrome was suspected. A short course of treatment with Metandienonum 0.04 mg/kg/day for 3 months was recommended, without success (growth speed of 6 cm/year - -0.14 SD)

Background. Elevated serum transforming growth factor-β (TGF-β) is associated with diabetes, cancers and several other diseases in numerous studies. However, there are a few studies reporting the possible relationship between serum TGF-β and obesity indices in apparently healthy individuals. In the present study we examined the possible relationship between body mass index (BMI), fasting serum glucose, lipid profile and liver enzymes in healthy women. Materials and methods. A total of 84 women (BMI 30.12 ± 5.74 kg/m2) were investigated. Anthropometric variables (weight, height, waist circumference and hip circumference) were measured in participants and BMI and waist to hip ratio (WHR) were calculated. Serum concentrations of TGF-β, fasting serum glucose (FSG), serum lipids and liver enzymes were assayed by commercial Enzyme-linked immunosorbent assay (ELISA) kits. Results. Among anthropometric variables, BMI and WC were potent positive predictors of serum TGF-β in stepwise multiple linear regression model (P<0.05). Serum ALT concentration was also positively correlated with serum TGF-β after adjustment for age and other biochemical variables (P = 0.031). In simple correlation analysis, serum TGF-β was positively associated with fat mass and negatively with fat free mass (P < 0.05). Conclusions. Our study confirms that serum TGF-β concentration is associated with indices of both general (BMI) and central obesity (WC), fat mass and liver enzyme in healthy Iranian women. Further studies are needed to possibly confirm these findings and to explore underlying mechanisms.

Context. Radioactivity has been known to be a causative factor for thyroid cancer. Objective. To answer whether the Chernobyl nuclear accident had any harmful effect on the rate of thyroid cancers after a wait-and-see period. Background. The Chernobyl accident in 1986 was chosen as a milestone because of its close proximity to the geographical area studied. Design. The time periods chosen were: I. 1990-1996 (latent period), II. 1997-2003 (sensitive period), III. 2004-2015 (control period). Subject and Methods. A retrospective study was conducted in a teaching and reference state hospital. The statistical analysis of the data of 4251 patients was made by chi-square and Fisher exact tests. Results. A total of 4251 patients were operated on because of thyroid diseases between 1990-2015. The number of patients in regard to the three time periods were 817, 1141 and 2293, respectively. Statistically significant rise of thyroid cancer and significant geographic vulnerability among different parts of the country were detected between the first two periods, but not between the second and third. The rising rates of malignancy were 1.71% (14/817), 6.83% (78/1141) and 8.59%(197/2293). The mean ages of malignant cases were 51.07 years, 46.2 years and 41.8 years although the mean ages of benign cases were 47.91,60.2, and 61.3 years according to groups, respectively. Conclusion. The Chernobyl nuclear accident seemed to have harmful effect on the rate of thyroid cancer or at least contributed to its increase.

Cushing syndrome in the paediatric age group is very difficult to diagnose due to atypical presenting features in children. Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of ACTH-independent Cushing syndrome in children and it has characteristic gross and microscopic pathologic features. We report a case of PPNAD in a 16-year-old boy who was evaluated in our hospital with chief complaints of poor height velocity and rapid weight gain for 2-3 years before presentation. Proper evaluation showed ACTH-independent Cushing syndrome with normal imaging. Total bilateral adrenalectomy was performed followed by hormones replacement. 6 months after surgery, significant acceleration of height velocity was noticed. Patient also lost body weight and developed secondary sexual characteristics.

Context. Optical Coherence Tomography (OCT) is a non-invasive diagnostic imaging technique, providing histological-like, high resolution transverse-section images of the eye structures. Objective. To quantify optic nerve’s alterations in optochiasmatic syndrome by OCT and with a classical investigation: visual field. Design. We present a patient with a giant pituitary tumor and chiasmatic compression, first seen in 2013, treated and reassessed in 2014. Subjects and Methods. Patient demanded an ophthalmological exam because of visual disturbances. Ophthalmic exam included: visual field (VF) test (with automated static perimetry – Oculus Centerfield), measurements of the Retinal Nerve Fibre Layer (RNFL) and optic nerve head (ONH) by OCT scans – using a Stratus Zeiss 3000 device. Brain MRI was made and the patient was then assessed by endocrinologist. Results. Patient has bitemporal hemianopia. OCT showed, in both eyes, slight optic disc (ONH) edema and RNFL loss, mainly in the nasal quadrant (optic nerve “band atrophy”), correspondent with visual field temporal defect. Brain MRI and endocrine evaluation revealed a macroprolactinoma, optochiasmatic syndrome, panhypopituitarism and abdominal obesity. Under treatment we noted significant reduction in tumour size, correlated with remission of ONH edema and visual field almost normalized. Reviewed published data about visual field defects and optic nerve OCT measurements, in different types of pituitary tumours, fits well the case presented. Conclusions. OCT is a very useful and accurate objective investigation for diagnosis and follow-up in structural optic nerve changes caused by chiasmatic compression. Measurements are complementary to those provided by perimetry – a subjective, functional investigation, depending on patient skills.