ACTA ENDOCRINOLOGICA (BUC)

We report the case of a 55-year-old-male with a large cell metastatic pancreatic neuroendocrine carcinoma treated for 14 months with lanreotide autogel having a stable disease (SD) and not responding to chemotherapy. The somatostatin analogues (SSA) were introduced after an episode of diarrhea and controlled the disease. Progression-free survival (PFS) as determined by Computerized Tomography (CT) scans was obtained for 14 months. After more than a year, the patient’s health state deteriorated along with progressive disease. The capecitabine-temozolomide regimen was challenged, but after three cycles, a rapid clinical decline was noted. Conclusion. This unexpected event (diarrhea) in the course of the disease could represent the beginning of carcinoid syndrome. While the lanreotide autogel helped the episode of diarrhea pass, it also helped gain control over the disease itself.

The qualitative influence of free fatty acids (FFAs) on glucose metabolism is well documented while there is no data quantifying this relationship. An attempt to measure this correlation was made by employing a prospective, cross-sectional study involving 21 patients grouped in 5 categories established after a standard 2h Oral Glucose Tolerance Test (OGTT): normal glucose tolerance (N); insulin resistant (IR; IR2); impaired glucose tolerance (IGT) and diabetes (D). Two OGTTs were performed for each patient, separated by two weeks during which dietary supplements were taken along with restriction of saturated fat ingestion; levels of FFAs, aminoacids, etc., were measured on both patient visits. Glucose metabolism was quantified as the area under the curve and named glucose metabolic index (GMI). FFAs influence on GMI was dependent on their degree of saturation, with saturated and monounsaturated fats impairing glucose tolerance and polyunsaturated fats (especially tetraenoic and hexaenoic acids) improving it. Short chain FFAs (up to 14 C) had a negative effect; 16 and 18 C were weakly correlated and 20-26 C had a positive effect on glucose tolerance. Levels of aminoacids and metabolic intermediaries suggested involvement of aminoacids in energy production and showed mitochondrial energy overproduction. Glucose and energy metabolism were altered in IR, IGT and D patients in a similar fashion; those alterations were more pronounced in D than in the IR while none was present in the N group. Glucose tolerance was improved upon restriction of saturated fats intake along with administration of antioxidants in D, IGT and IR groups.

We studied the incidence, risk factors, presentation, treatment and prognosis of calcific uremic arteriolopathy (CUA) in 140 of our hemodialysis patients. Methods. Patients with CUA in the past 3 years have been compared to controls in a cross-sectional survey of 140 hemodialysis patients. Results. Prevalence of CUA was 6/140 (4.28%); common presentation was ulcerated acral necrosis. Age, sex ratio, BMI, prevalence of diabetes were similar in case (n=6) and control (n=134) patients. CUA patients had higher serum calcium (9.58?1.25 mg/dL vs. 8.50?1.03 mg/dL, p=0.01), calcium-phosphate product (71.06?19.67 mg2/dL2 vs. 58.73?17.20 mg2/dL2, p=0.01) and parathormone levels (1854?1407 pg/mL vs. 654?776 pg/mL, p=0.0002). Differences in ingestion of calcium, active vitamin D and non-calcium containing phosphate binders in the year prior to the assessment were not significant. CUA patients had higher CRP values in the 6 preceding months than non CUA patients (6.61?9.68 mg/dL vs. 1.97?4.20 mg/dL, p=0.01); logistic regression disclosed CRP as the only predictive factor for CUA (p=0.03). 4 (66%) of the CUA patients died due to sepsis, as compared to 3(2.23%) of the control group (p=0.001). 2 of 3 parathyroidectomised patients survived. In conclusion, this is, to our knowledge, the first series of CUA reported from Eastern Europe. In our center acral, ulcerated forms of CUA in patients with severe hyperparathyroidism are predominant.

Objective. To describe an unusual case of lymphocytic hypophysitis in a man,\r\npresenting with an elevated serum Insulin like growth factor-1(IGF-1) level.\r\nCase report. We report the case of a 27 year old male presenting with a 2 week history\r\nof severe headaches. Magnetic resonance imaging of the head showed an adenoma-like\r\npituitary. The physical examination was normal, laboratory tests revealed secondary\r\nhypothyroidism and hypogonadism along with an elevated IGF-1. Complete\r\ntranssphenoidal resection of the pituitary mass was done. Tissue analysis was diagnostic for\r\nlymphocytic hypophysitis. No evidence of a somatotroph adenoma was found. After surgery\r\nthe patient developed panhypopituitarism and diabetes insipidus.\r\nDiscussion. IGF-1 is a sensitive disease related marker in acromegaly and corresponds\r\nto disease activity. However, it should not be used as the sole marker for diagnosis of\r\ndisease. Inflammatory lesions of the pituitary gland, such as lymphocytic hypophysitis, can\r\nclinically and radiologically mimic tumors of the sellar region.\r\nConclusion. We report an index case of a young male who presented with elevated\r\nserum IGF-1 level in the setting of lymphocytic hypophysitis. This case illustrates the\r\ndilemma associated with reliance on the IGF-1 levels for diagnosis of acromegaly, since an\r\nelevated IGF-1 level in the presence of a pituitary mass may not always be a somatotroph\r\ntumor. We propose the differential diagnosis should also include autoimmune hypophysitis.

Context and objective. In this study, we aimed to investigate how moderate physical activity improves the bone ultrastructural parameters in rats with glucocorticoidinduced secondary osteoporosis. Animals and Methods. Research has been carried out on Wistar female rats. Secondary osteoporosis was induced through daily i.m.1.5 mg/kgbw methylprednisolone, over a period of 30 days. A group of rats with induced secondary osteoporosis were subjected to physical activity (swimming) for one hour/day for 30 days. Rats were sacrificed 24 hours after the last administration and femoral bones were used for electron microscopy analysis. Results. The ultrastructural findings obtained from the rats with osteoporosis showed varying degrees of alteration in all cellular components. A moderate physical effort led to the overall maintenance of the normal ultrastructure of the cells and connective components, protecting the lamellar structure of the compact bone from the deleterious effects of glucocorticoid. The shape and components of osteocytes were also preserved and the accumulation of lipids in the bone marrow diminished. Conclusions. Physical exercise has been shown to have a protective role by lowering the development of structural alterations specific to osteoporosis. Therefore, moderate physical exercises are recommended for improving the structure of the bone mass affected by glucocorticoid treatment.

Context. COVID-19 is more than a respiratory infection, with deep implications regarding multiple systems and organs. Thyroid damage is frequent in COVID-19 and may overlap previous HCV or HCC associated diseases. Objective. The objective of this study is to determine the effects of COVID-19 in patients with HCV associated HCC and thyroid comorbidities. Design. We performed a retrospective study of the thyroid function tests and autoantibodies in patients with HCV-associated HCC prior and during COVID-19. Subjects and Methods. We included 52 consecutive patients with HCV-associated HCC and documented thyroid disease, diagnosed with COVID -19 between April and October 2020. Serum values of thyroidstimulating hormone, free T3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxydase antibodies were determined and compared to baseline levels. Results. At baseline, 44 patients had positive antithyroid antibodies, 6 had hypothyroidism in substitution and 2 had hyperthyroidism under treatment. During COVID-19 we found an increase in serum values of antithyroid antibodies, and decreased levels of TSH, freeT3 and freeT4 levels. Specific therapies were discontinued in one patient with hyperthyroidism and 3 patients with hypothyroidism. Conclusion. There is a significant impact of COVID-19 on the thyroid homeostasis; a long-term prognostic value for patients with HCC infected with COVID-19 required further extensive research.

Introduction. Irisin is a recently discovered novel adipomyokine that induces an increase in total body energy expenditure, improves insulin sensitivity and glucose tolerance. It has been shown that circulating levels of irisin are low in patients with obesity, diabetes mellitus and impaired glucose tolerance. However, the information about the level of circulating irisin in gestational diabetes mellitus (GDM) is controversial. Material and Methods. Serum irisin was measured by an ELISA in a longitudinal prospective cohort study in 221 women. There were 156 healthy pregnant and 65 women with GDM. Results. Circulating irisin levels were significantlly higher in the middle pregnancy compared with early pregnancy levels in healthy pregnant women and in women with GDM. Serum irisin levels were found to be lower in GDM compared to healthy pregnant women during first trimester but the difference was not observed throughout the pregnancy and it was comparable in middle pregnancy. There was a significant inverse correlation of BMI with serum irisin (r = -0.193, p = 0.004) and between HbA1c and mean glucose of OGTT with serum irisin (r =-0.377, p =0.0001) and (r = -0.147, p:0.03) in the early pregnancy of pregnant women repectively. Conclusions. The present study shows that serum irisin level increases throughout the gestational period from early to middle pregnancy in women with GDM, but there is no effect of irisin on the development of GDM.

Right ventricular dysfunction (RVD) is critical for risk stratification of patients with pulmonary embolism (PE). Evaluation can be made by echocardiography or biological markers among which plasma levels of brain natriuretic peptide (BNP). The aim of our study is assessment of BNP levels in patients with PE associating or not RVD as diagnosed by classic echocardiographic criteria. We prospectively assessed 40 patients with deep venous thrombosis and confirmed PE (age range 52.5 ? 9.14 years, 22 men and 18 women), with (14) or without (26) RVD on echocardiography. Plasma BNP levels were significantly higher in RVD patients (190 ? 171.2 pg/mL vs. 15.75 ? 18.85 pg/mL, P < 0.0001). A cut-off level of plasma BNP = 50 pg/mL had a sensitivity, specificity, positive and negative predictive value for the diagnosis of RVD of 84% (C.I. 79% - 88%), 80% (C.I. 75% - 85%), 83% (C.I. 77% - 87%) and 79% (C.I. 75% - 84%), respectively. There was a significant correlation between plasma BNP levels and end-diastolic RV diameter (r = 0.56, P < 0.0001), RV systolic pressure (r = 0.50, P < 0.001) and the presence of a Qr complex in V1-lead on ECG (r = 0.55, P < 0.05). Four patients with RVD on echocardiography and syncope, all admitted relatively soon after the onset of their symptoms, had BNP in normal range. In conclusion, PE should be considered in the differential diagnosis of patients with dyspnoea and increased plasma BNP levels. A cut-off level of 50 pg/mL could identify the RVD in patients with PE with a good sensitivity and specificity. Normal range plasma BNP levels do not exclude even a severe PE and should be interpreted with caution, especially in highly symptomatic patients with recent symptom onset.

A 62 years old woman was diagnosed with multinodular toxic goiter and primary hyperparathyroidism/ left parathyroid adenoma by hormonal assessment, ultrasound and nuclear thyroid/parathyroid scans. Cervical ultrasound illustrated a multinodular aspect of the thyroid with solid nodules and cystic-component nodules; the larger one represented a multinodular complex with necrosis areas in the left thyroid lobe, ACR TI-RADS score 4 (moderately suspicious). Functional nuclear imaging was performed for accurate differential diagnosis between thyroid vs. parathyroid localization, between cold vs. hot nodules, and eventually, for guiding the choice of a subsequent Fine- Needle Aspiration Biopsy (FNAB). Scans described an early intense 99mTc-sestaMIBI uptake with no 99mTc-pertechnetate uptake in the left thyroid lobe larger nodule. Due to the suspicion of malignancy for this nodule, we performed an additional scan (1 hour before the classical 2 hours parathyroid delayed scan). The intense uptake persists in both delayed scans suggesting no malignant phenotype and which was confirmed after surgery by benign histology. In conclusion, using a 99mTc-sestaMIBI personalized protocol, related to the radiotracer cellular uptake mechanisms: 1 hour scan (supplementary image, corresponding to the maximum uptake pattern of 99mTc-sestaMIBI for cancer cells) and 2 hours scan (for parathyroid washout evaluation) may avoid unnecessary extensive thyroid surgery.