ACTA ENDOCRINOLOGICA (BUC)

Context. In medically treated Graves’ disease (GD) patients, prolonged low serum TSH levels represent an independent risk factor for relapse. The predictors of this prolonged TSH suppression are still debatable. Objectives. The primary endpoint of this study was to identify predictors of the time to TSH recovery (TTR), in GD patients, at diagnosis and during ATDs treatment. The secondary endpoint was to compare the TTR between patients with GD and autonomous hyperthyroidism. Subjects and Methods. We retrospectively analyzed 109 newly diagnosed hyperthyroid patients (90 with GD and 19 with autonomous hyperthyroidism), consecutively evaluated in a tertiary center. The main features recorded were: TSH and thyroid hormone levels at diagnosis and follow-up visits, the TTR and the mean dose of ATDs/day. Results. There was no significant difference regarding the TTR between patients with GD and autonomous hyperthyroidism. In GD patients, age at diagnosis, gender, goiter size, smoking status, thyroid antibody titers and ophtalmopathy presence did not seem to influence the TTR. GD patients with higher FT3, TT3 at diagnosis and higher TT3 at the first visit after ATDs administration (V1) needed longer TTR, after adjusting for the mean dose of ATDs/day. FT3 at diagnosis and TT3 at V1 are significant predictors for the TTR in GD patients. Conclusions. The time to TSH recovery was not significantly different between patients with GD and autonomous hyperthyroidism. In GD patients, the time to TSH recovery is longer in patients with more severe T3 hyperthyroidism at diagnosis and at the first visit after ATDs administration.

Adipocytokines involved in inflammation and the acute phase responders have been found to be increased in the metabolic syndrome (MS). The aim of the study was to compare the ‘normal’ weight women’s fibrinogen, hsCRP, adiponectin, TNF-α, vascular cell adhesion molecule (VCAM) with obese patients with MS, and to evaluate the association between fibrinogen, hsCRP, adiponectin, TNF-α, VCAM and insulin resistance. The study included 52 obese women who met the criteria for MS defined as in 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) ATP III and 24 normal women. Serum concentrations of glucose (FBG), triglyceride, total and HDL-Cholesterol were determined by enzymatic procedures, serum insulin was measured by chemiluminescence, plasma levels of adiponectin, TNF-α and VCAM by Elisa, hsCRP by immunoturbimetric assay and fibrinogen by coagulation method. Measurements of insulin resistance were obtained using the homeostasis model assessment. Mean plasma levels of adiponectin, TNF-α, VCAM, fibrinogen and hsCRP were found 6.11±2.39 mg/ml, 3.10±3.30 pg/ml, 14.21±4.00 ng/ml, 375.49±49.67 mg/dl, 0.33±0.10 mg/dl in the obese with MS; 6.20±2.48 mg/ml, 3.01±1.68 pg/ml, 12.63±2.54 ng/ml, 304.06±49.52 mg/dl, 0.30±0.19 mg/dl in the normal women, respectively. Mean fasting insulin level and HOMA-IR were measured 13.80±6.32 mU/ml and 3.69±1.90 mU/ml, respectively in obese with MS. In normal women, fasting insulin level and HOMA-IR were measured 8.30±3.08 mU/ml and 1.49±0.37, respectively. Mean levels of adiponectin were positively correlated with mean TNF-α levels in the obese with MS (r=0.472, p=0.001). VCAM was negatively correlated with TNF-α levels (r=-0.301, p=0.038) in the obese with MS. This study demonstrated that TNF-α showed a positive association with adiponectin and a negative association with VCAM in the obese women with MS.

Complete heart block associated with hyperthyroidism is infrequent, and the diagnosis of hyperthyroidism is usually not considered in the absence of tachycardia. A 55-year-old woman was admitted to our emergency clinic with dizziness and syncope attack. Her electrocardiogram showed complete heart block.\r\nHyperthyroidism had been diagnosed, and she had been treated with propylthiouracil as an anti-thyroid treatment 3 years ago, although she had not taken this drug during the last 2 months. Her thyroid function tests showed hyperthyroidism. Antithyroid treatment was started again. Her rhythm returned from complete atrioventricular block to normal sinus rhythm\r\non the seventh day of hospitalization.

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Nicolae Paulescu (1869-1930) was born in Bucharest in an aristocratic family. His education from childhood to maturity (Paris University of Medicine) was marked by illustrious professors, even pioneers of their field. After completing his medical and scientific education in Paris under his mentor, Etienne Lancereaux, considered the founder of modern physiology, he returned to Romania where he founded the first Department of Physiology at “Carol Davila” University of Medicine and Pharmacy. His scientific career is marked by the publishing of 88 original research articles in renown international medical journals of the time and two Treatise on Physiology (comprising in total 8 volumes and 5976 pages). His activity as an endocrinologist reaches the peak with the discovery of insulin with the article Recherche sur le rôle du pancréas dans l’assimilation nutritive published in the Archives Internationales de Physiologie (Liege, Belgium) on August 31st, 1921. While he was not internationally or even nationally acclaimed for the discovery of insulin, his contribution to the reformation of the national education and medical system and the recommendation of his students to pioneers of their fields of interest still have reverberations even today.

Aim. To evaluate the diagnostic performance of radiomics features of two-dimensional (2D) and threedimensional (3D) ultrasound (US) in predicting extrathyroidal extension (ETE) status in papillary thyroid carcinoma (PTC). Patients and Methods. 2D and 3D thyroid ultrasound images of 72 PTC patients confirmed by pathology were retrospectively analyzed. The patients were assigned to ETE and non-ETE. The regions of interest (ROIs) were obtained manually. From these images, a larger number of radiomic features were automatically extracted. Lastly, the diagnostic abilities of the radiomics models and a radiologist were evaluated using receiver operating characteristic (ROC) analysis. We extracted 1693 texture features firstly. Results. The area under the ROC curve (AUC) of the radiologist was 0.65. For 2D US, the mean AUC of the three classifiers separately were: 0.744 for logistic regression (LR), 0.694 for multilayer perceptron (MLP), 0.733 for support vector machines (SVM). For 3D US they were 0.876 for LR, 0.825 for MLP, 0.867 for SVM. The diagnostic efficiency of the radiomics was better than radiologist. The LR model had favorable discriminate performance with higher area under the curve. Conclusion. Radiomics based on US image had the potential to preoperatively predict ETE. Radiomics based on 3D US images presented more advantages over radiomics based on 2D US images and radiologist.

Background. This study aimed to determine predictive clinical and endoscopic ultrasound (EUS) features for pancreatic neuroendocrine tumor (PNET) diagnosis, utilizing EUS-guided tissue acquisition. Methods. A prospective study from 2018-2022 included patients with pancreatic masses undergoing EUS with elastography. Univariate binomial logistic regression followed by multiple logistic regression with significant predictors was employed. A forward selection algorithm identified optimal models based on predictor numbers. Variables encompassed EUS tumor characteristics (e.g., location, size, margins, echogenicity, vascularity on Doppler, main pancreatic duct dilation, elastography appearance, vascular invasion, and hypoechoic rim), alongside demographic and risk factors (smoking, alcohol, diabetes). Results. We evaluated 165 patients (24 PNETs). EUS features significantly linked with PNET diagnosis were well-defined margins (79% vs. 26%, p < 0.001), blue elastography appearance (46% vs. 9.9%, p < 0.001), vascularization (67% vs. 25%, p < 0.001), hypoechoic rim (46% vs. 10%, p < 0.001). The top-performing model, with 89.1% accuracy, included two predictors: a homogeneous lesion (OR, 95% CI) and a hypoechoic rim (OR, 95% CI). Conclusions. EUS appearance can differentiate PNETs from non-PNETs, with the hypoechoic rim being an independent predictor of PNET diagnosis. The most effective predictive model for PNETs combined the homogeneous lesion and presence of the hypoechoic rim.

Background. Adipokine secretion is influenced by various disease conditions. Purpose. We wanted to check the impact of rectal carcinoma (RC) on adipokine profile. Patients and methods. We evaluated serum leptin and adiponectin levels in 24 RC patients (12 males and 12 females) as well as in the same number of age, sex and weight-matched healthy controls. Results. Adipokines were oppositely correlated with body weight (BW) in controls and RC patients. Women had higher adipokine levels than men. Healthy controls had higher leptin (37.6.±7.8 vs. 7.9±2.6 ng/mL in women and 11.9±4.6 vs. 1.4±0.34 ng/mL in men, p=0.0016 and 0.043) and lower adiponectin levels (9.3±1.1 vs. 14.9±1.1 μg/mL in women and 7.9±0.9 vs. 11.1±0.9 μg/mL in men, p=0.012 and 0.017) than RC patients. Conclusion. Adipokine profiles of patients with RC differ from the healthy population, possibly reflecting an adaptation to the disease rather than a triggering factor. These differences may find clinical applications for the prognosis of disease evolution.

Pseudoobstruction is an uncommon manifestation of hypothyroidism. However,\r\nhypotony of the bladder in myxedema is very rare, and there were only four such cases\r\nreported previously. We present a 45-year-old man with myxedema and ileus, who was\r\nstarted on thyroxine therapy and was detected to have bladder hypotony on the 5th day of\r\nadmission. There was no evidence of bladder outflow obstruction, and both bowel and\r\nurinary symptoms improved with thyroxine therapy. Bladder hypotony may be more\r\nprevalent in patients of hypothyroidism than previously reported; hence, it is important to\r\nhave a high clinical suspicion and perform early urodynamic studies to avoid back-pressure\r\ndamage to the upper tracts.