ACTA ENDOCRINOLOGICA (BUC)

The introduction of tumor necrosis factor-alpha (TNF-α) targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of ankylosing spondylitis (AS). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects, ranging from common ones, including infections, to uncommon thyroid neoplasms. Adalimumab (ADA), a fully human monoclonal antibody targeted against TNF-α, is indicated for AS. We describe the case of a patient with AS who developed a papillary thyroid carcinoma (PTC) while on therapy with ADA. Cervical lymphadenopathy and a heterogeneous nodule in the right thyroid lobe were detected in the 48-year-old female patient who had been using ADA (40 mg subcutaneously every 2 weeks) for 2 years with the diagnosis of AS. Fine-needle aspiration cytology confirmed PTC. ADA treatment was discontinued, and a total thyroidectomy surgery was performed. We believe that the thyroid gland should also be taken into consideration while screening for malignancy before and during TNF inhibitors (TNFi).

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Introduction. Ganglioneuromas are rare, benign tumors that arise from the neural crest tissue and are usually asymptomatic and discovered accidentally. GN have good prognosis with surgical removal and the standard treatment for such lesions is laparoscopic adrenalectomy. Case report. We report the case of a 13 year old patient who presented to our hospital with abdominal pain. The ultrasound and the CT scan confirmed the presence of a well-defined mass situated in the right renal space. Taking into account the size of the tumor, its position and the fact that CT scan showed no local signs of invasion, the decision was taken to perform a laparoscopic removal of the right adrenal mass. After dividing the main adrenal vein and while dissecting the adrenal gland, we noticed an intraoperative bleeding due to the fact that one of the clips used to ligate the vein had slipped. Because we were unable to control the intraoperative bleeding we decided to convert to open surgery. The histopathological result showed that the adrenal lesion was a ganglioneuroma. Conclusion. While the role of minimal invasive adrenalectomy in patients with larger lesion is still controversial, advantages such as reduced hospital stay and postoperative morbidity, lower rate of complications, have resulted in the laparoscopic approach for adrenal pathology becoming the choice procedure in the removal of adrenal lesion.

Context. The metabolic effects of primary hyperparathyroidism (PHPT) causing increased cardiovascular morbidity have begun to gain importance in medical science, and the number of studies investigating glucose metabolism disorders in asymptomatic PHPT patients is rare. Objective. To evaluate the relationship between glucose metabolism disorders and calcium, phosphorus and parathyroid hormone concentrations in asymptomatic PHPT patients. Subjects and Methods. Fifty-five asymptomatic PHPT patients were included into the study. Control group consisted of 55 normocalcemic cases. Oral glucose tolerance test (OGTT) of 75 g was performed with patients and controls. Insulin resistance was calculated by HOMA index. Results. No significant difference was present between groups regarding fasting plasma glucose, basal insulin and HOMA levels. Glucose levels measured at minutes 30, 90 and 120 after OGTT were higher in patients than in controls (p=0.041, p=0.025 and p=0.001, respectively). No individuals in both groups were diagnosed with diabetes mellitus. While impaired glucose tolerance was detected in six patients with asymptomatic PHPT, no impaired glucose tolerance was determined in controls. A positive correlation was found between serum calcium levels, and fasting plasma glucose and OGTT glucose levels were measured at minutes 60, 90 and 120. Mean fasting plasma glucose was significantly higher in patients with serum calcium levels ≥ 10.5 mg/dL than those with serum calcium levels <10.5 mg/dL (p=0.008). No significant correlation was detected between serum phosphorus and parathyroid hormone levels, and glucose levels were determined in OGTT and HOMA index. Conclusion. Increased levels of serum calcium affect glucose metabolism, so leading to glucose intolerance.

Lingual thyroid is a rare developmental disorder, and it is the result of failure of the thyroid gland to descend from the tongue root to its normal site. The ectopic thyroid with a functioning gland is even rarer. In this case, we present a 44-year-old female patient with a complaint of foreign body sensation, progressive dysphagia and dyspnea due to ectopic thyroid tissue. Her complaints were totally resolved after L-thyroxine treatment. Here we report a patient with functioning ectopic thyroid tissue who had had bilateral subtotal thyroidectomy 10 years ago due to multinodular goiter. In conclusion, if progressive\r\ndysphagia, dyspnea, and foreign body sensation occurs in a patient who had thyroidectomy and living in an endemic goiter region, lingual thyroid may be underlying disorder.

Non-functioning pituitary tumors (NFPA) are usually large at the time of diagnosis and present with symptoms caused by compression on the neighbouring structures. Transsphenoidal resection of the tumor is the firstline treatment but in many cases complete tumor resection cannot be attained. Close follow-up with repeated hormonal assessment and pituitary imaging is recommended after surgery. During follow-up of the tumor remnant sometimes radiotherapy is used to stop or prevent tumor progression. Medical treatment with dopamine agonists (DA) is the mainstay in the management of prolactinomas. For NFPA several small series or case reports suggested beneficial effects with tumor shrinkage in some cases. The aim of the current paper is to summarize the available evidence related to the potential efficacy of DA medical treatment in NFPA while underlining that in the absence of randomized, placebocontrolled studies, no final conclusion on the efficacy of these drugs in the treatment of NFPA can be drawn.

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