ACTA ENDOCRINOLOGICA (BUC)

Background. Vascular calcifications (VCs) represent an important complication in dialysis patients. It is still a subject of debate whether VCs are associated with low or high intact parathormone (iPTH), or if it is not any relation.\r\nThe purpose of this study was to assess the predictive value of iPTH and other mineral markers for VCs development.\r\nMethods. The study evaluated peripheral VCs in haemodialysis (HD) and peritoneal dialysis (PD) patients using radiographies. We counted a semiquantitative score ranging from 0 to 8. Each category was divided into two groups according to VCs score. We assessed the relationship between the VCs score and mineral markers.\r\nResults. A VC score=2 was positively associated with male gender, serum Ca, P, CaxP, ALP and iPTH levels in HD patients. There was no correlation with age, HD vintage, received treatment. In PD patients, did CaxP have a higher significance with VC score>/2; were iPTH, CaxP and P of higher significance for a score=5.\r\nConclusions. Hyperparathyroidism can be considered a predictor for VCs development in dialysis patients. Other risk factors are increased serum Ca, P, CaxP and ALP levels. In PD patients, high iPTH could predict VCs only for severe calcifications, but the CaxP could even predict for less extended VCs.

INTRODUCTION: The aim of our study was to evaluate the cure rate of macroprolactinomas treated for a long term (> 4 years) or a short term (<4 years) with dopamine agonists (DA) alone or combined with radiotherapy (RT). Sometimes pituitary\r\nsurgery was performed.\r\nMATERIAL AND METHODS: We performed a retrospective study in 111 patients with macroprolactinomas, hospitalized in the Institute of Endocrinology, Bucharest, between 1978-2005. There were two groups, according to the length of DA therapy: group\r\nA =41 patients, treated more than 4 years and group B =70 patients, treated less than 4 years. Overall, 25 patients underwent additional radiotherapy, 13 in group A and 12 in group B. 28 patients were submitted to pituitary surgery, 9 in group A and 19 in group B.\r\nRESULTS: The cure rate (i.e. normalization of prolactin=PRL level and absence or minimal residual tumor mass, stable minimum 2 years after DA withdrawal) was 5/41 (12.1%) in group A and none in group B. 48 out of 111 patients achieved significant improvement (serum prolactin level less than 20 ng/ml and tumor shrinkage more than 50%) during DA therapy, but not after DA withdrawal: 17/41patients (41.5%) in group A and in 31/70 patients (44.3%) in group B, p=NS. Radiotherapy produced an additional improvement: in serum PRL levels only in group A, in 4/13 patients- 2/8 patients responsive to DA therapy and 2/5 patients resistant to DA therapy. In group B, the 3 patients resistant to DA submitted to radiotherapy were evaluated before the interval necessary for maximal effect of radiotherapy, but in 4/9 patients responsive to DA, we noticed further reduction in tumor volume, 2/4 progressing from mild to significant tumor shrinkage and ? progressing from no shrinkage to mild shrinkage. After radiotherapy, the medium prolactin level was 5.1 ng/ml in 10 patients from both groups on low bromocriptine (BRC) dose (7.5 mg/day), significantly less than in patients without radiotherapy, i.e. than in 19 patients from group A (serum PRL 49.5 ng/ml, p=0.02) and in 29 patients from group B (serum PRL 30.3 ng/ml, p=0.01). So, the daily BRC dose could safely decrease from 30 mg/day to 7.5 mg/day in those patients previously submitted to radiotherapy. Among 23 patients resistant to initial DA treatment, only 8 patients were submitted to radiotherapy, 2 became responsive to DA thereafter and 2 others obtained a significant decrease of prolactin levels.\r\nCONCLUSIONS: The overall cure rate is quite low in prolactinomas and it was noticed only after long-term treatment with dopamine agonists; it was improved up to 12.1% by the additional high voltage radiotherapy, useful even in DA resistant cases. The addition of radiotherapy is indicated for the cure of most prolactinomas.

Introduction: The dexamethasone suppression tests (DST) in the diagnosis of Cushing's syndrome (CS) give frequently equivocal results. Our study evaluated the precision of DST in the diagnosis of CS. Patients and methods: 223 patients (15 - 77 years, 130 F / 93 M) were studied for putative CS by morning and midnight serum cortisol, urinary free cortisol (UFC) and 17 hydroxycorticosteroids (17OHCS) levels at baseline and after DST as follows: 1 mg overnight (oDST), 0.5mg q.d., 2 days (LDDST) and 2 mg q.d. 2 days (HDDST). Since not all cases were evaluated by all tests, statistical analysis used available results. Results: 79 patients had CS (47 pituitary, 3 ectopic, 21 adrenal adenoma and 8 adrenal carcinoma), 45 had adrenal tumor without all the criteria for CS (NCT) and 99 were controls. All patients with CS had abnormal cortisol biorhythm, but also 31.8% patients with NCT and 50% evaluated controls. The best basal screening test for CS is UFC, with a cut-off value of 100 g/24 h. For DST with a serum cortisol cutoff level (CCL) of 5 ?g/dl, oDST correctly diagnosed all CS, while lowering the CCL at 1.8 ?g/dl increased the false positive rate to 6.8%. At LDDST, the serum CCL of 5 ?g/dl correctly identified all patients with CS, but was 2.5 % false positive in controls. A significant correlation of serum cortisol values after oDST or LDDST with basal 17OHCS and UFC was found (r=0.6, p<0.001), suggesting that patients with mild CS are more prone to test as false negatives. The classical criterion of 50% suppression for UFC after LDDST correctly identified 12/14 CS patients and all 8 controls. Better sensitivity (Sn) had an UFC cutoff level of 10?g/24h, p<0.001. A 50% suppression of 17OHCS identified 45/61 CS patients and excluded the disease in 30/37 patients. In HDDST, serum cortisol suppression by > 50% diagnosed Cushing's disease (CD) with 85 % Sn and 57% specificity (Sp). The best HDDST accuracy had UFC (83%), with 27% false negative results (3/11 patients) for a cut-off value of\r\n50% from baseline. 17OHCS were suppressed by 50% in 19/35 patients with CD (54%) and in 3/33 (9%) patients with other causes of CS. NCT patients had higher basal values of UFC and 17OHCS than controls (p<0.01) and up to 50% had an abnormal biorhythm, suggesting a degree of hypercortisolism, with an inadequate oDST or LDDST . Therefore, only 6/45 NCT fulfilled the criteria for subclinical CS.\r\nConclusion: The best screening test was oDST (100% Sn and Sp), followed by UFC (100% Sn and 92% Sp). LDDST with serum CCL at 5 ?g/dl had 100% Sn and 97% Sp. HDDST identified CD by UFC with 73% Sn and 92% Sp and by serum cortisol with 85% Sn and 57% Sp. For NCT, the standard tests identified SCS in 13%. However, a thorough evaluation including multiple tests should be undertaken for the positive and differential diagnosis of Cushing's syndrome.

Cardiovascular disorders represented by congenital malformations, hypertension, aortic dilatation which can emerge in dissection or rupture and ischemic heart disease are common in Turner syndrome (TS) and life-threatening. Echocardiography and magnetic resonance imaging represent complementary diagnostic methods used to assess cardiovascular status. Unfortunately, normal reference ranges for cardiac and aortic measurements are established only in unselected TS patients, preventing a delineation between patients with and without cardiovascular pathology. We performed echocardiography in 15 patients with TS, aged 12-33 years (mean 21.8 years, standard deviation 6.37 years) without cardiovascular and renal malformations, hypertension or aortic dilatation and 30 normal controls; karyotype was 45,XO in 11 patients and 45,XO/46,XX in four patients. To minimize the influence of body size, ratios of aortic and cardiac chambers dimensions were calculated. As expected, we found smaller dimensions in TS versus controls but only the ascending aorta, left atrium and diastolic left ventricular diameters and the ratio diastolic / systolic left ventricular diameters reached statistical significance. Only aortic dimensions were entirely independent of age, height, weight and BMI with a 95% confidence interval of 14.28 &#8211; 25.32 (mean 19.8) mm for the aorta at the annulus and 95% CI 21.42 &#8211; 29.36 (mean 25.54) mm for the ascending aorta. The ratios ascending aorta/ systolic left ventricular diameter (95% confidence interval 0.54 &#8211; 1.34; mean 0.94), aorta at the annulus/systolic left ventricular diameter (95% CI 0.44 &#8211; 0.92; mean 0.68) and aorta at the annulus/ diastolic left ventricular diameter (95% CI 0.36 &#8211; 0.61; mean 0.49) are independent of age, height, weight and can also be reliable for detection of aortic dilatation.

Breast cancer has surpassed lung cancer as the most common type of cancer globally, representing approximately 25% of all cancer cases and leading in cancer-related mortality among women. In Romania, breast cancer accounts for 26.9% of all female cancer diagnoses, with an increasing incidence and significant mortality rate despite one of the lowest incidence rates in Europe. The study highlights the disparities in breast cancer outcomes across Europe, with Romania showing lower survival rates compared to Western European countries. This disparity is partly attributed to the low participation in breast cancer screening programs, where only 9% of eligible Romanian women underwent mammography in 2020, far below the European average of 60%. The World Health Organization (WHO) and European Commission emphasize the importance of organized population-based screening for women aged 50-69, yet many barriers, including low health literacy, lack of awareness, and socio-economic challenges, hinder effective participation, especially among vulnerable populations. This study, conducted over three years at the “Alessandrescu Rusescu” National Institute for Mother and Child Health, involved 1,705 patients and aims to provide insights into improving breast cancer screening participation and outcomes in Romania.

Introduction. First election treatment in Cushing’s syndrome is the surgical therapy (pituitary or adrenal). Pharmacotherapy is used: before surgery, when the surgery was ineffective, in association with radiotherapy or in cases of refuse or contraindications for surgery. Aim of the study. Testing the effectiveness and safety of Ketoconazole treatment in patients with Cushing’s syndrome. Methods. We studied 12 patients with Cushing’s syndrome treated with Ketoconazole between 2010 and 2013. We followed cortisol levels before and during treatment, the doses of Ketoconazole and the time required for normalization of cortisol, “the escape syndrome” and the adverse effects. Results. Eleven (91,66%) patients had ACTH – dependent Cushing’s syndrome. The mean basal cortisol before initiation of the therapy was 404.4 ± 71 ng/ml. Two thirds (eight) patients presented a normalization of serum cortisol levels with 300-800 mg Ketoconazole/day, during a mean of 8.5 weeks. Only one patient presented an “escape syndrome” and one presented adrenal insufficiency. None of the patients showed significant side effects under the treatment. Conclusions. Ketoconazole therapy is well tolerated and is effective in most patients with Cushing’s syndrome even in long term use. The resistance and the escape from the effect of the treatment is possible, but rare, patients requiring close monitoring during therapy.

Context. Studies of platelet function in diabetics are inconsistent, some studies reporting higher platelet reactivity, while others showed no change. Objective. We aimed to evaluate platelet indices and in vitro platelet aggregation in rats with long-lasting (28 weeks) diabetes mellitus. Design. Twelve controls and 14 diabetic rats were investigated. Diabetes was induced in 11-week-old rats using streptozotocin (60 mg/kg,i.p.). Platelet indices and in vitro adenosine diphosphate (ADP)-, protease-activated receptor 4 (PAR4) agonist-, and arachidonic acid (AA)-induced platelet aggregation were assessed at the age of 38 weeks. Results. Compared to controls, diabetic rats presented lower platelet count and plateletcrit (both p≤0.001), and higher mean platelet volume (p<0.01). ADP- (p=0.04) and AA-induced (p<0.01) platelet aggregation were lower in diabetic compared with control rats, whereas PAR4 agonistinduced platelet aggregation was similar between the two groups (p=1.00). Conclusions. This study demonstrates a paradox of high intrinsic platelet reactivity and low in vitro ADP- and AA-induced platelet aggregation in diabetic rats compared with non-diabetic controls. The relevance of in vitro platelet aggregation to the contribution of platelets to in vivo thromboembolic events in diabetic rats remains questionable.

Introduction. In this study we aimed to evaluate urinary iodine excretion and the serum levels of thyroidstimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4) and thyroglobulin (Tg) in pregnants and their newborn infants. Materials and Methods. This study was performed in Konya Faruk Sukan Children and Maternity Hospital, Konya Beyhekim State Hospital and Hospital of Selcuk University Medical Faculty. 180 pregnant women and their healthy infants born at 37-40 gestational weeks.Term infants included in this study were aged between 1-7 days, healthy. Midurination urine samples were taken into deiodinized plastic bottles and 2 mL of these samples were aliquoted to deiodinized eppendorf tubes. Results. Median urinary iodine concentration (UIC) was 95.5 μg/L for pregnant women and 245 μg/L for their infants. Frequency of iodine deficiency was observed as 63.3% (n=114) (<150 μg/L) and 24.4% (n=44) (<100 μg/L) in mothers and their infants, respectively. UIC of the infants whose mothers used iodized salt was significantly higher than the one whose mothers used rocksalt (p=0.030). Conclusions. It was stated in our study that UIC of pregnants was lower than the target limit (<150 μg/L), suggested by World Health Organisation (WHO) and iodine deficiency in pregnants is still a problem in our city located in the centre of Turkey. Iodine deficiency was observed in 24.4% of the infants and this prevalence suggests us that iodine deficiency is still an important health problem in infants.

Context. Four major modifiable behavioral risk factors are considered responsible for the current burden of the non-communicable diseases: tobacco use, physical inactivity, unhealthy diet and excessive alcohol consumption. Limited data on the lifestyle habits in Romanian population is currently available. Objective. To assess the eating patterns and physical activity habits and other lifestyle components in various age groups in the population included in the ORO study. Design. ORO was a cross-sectional, epidemiologic, multicenter non-interventional study conducted from January 2014 until August 2014 in 8 study centers spread in the main historical regions of Romania Results. Eating 3 meals/day every day was more frequently reported in the 60-79 years and ≥ 80 years age groups (53.0% and 51.7%) than in the 18-39 years and 40- 59 years age groups (26.8% and 35.8%), p <0.001. The frequency of eating breakfast every day increased with age from 43.5% in the youngest age group to 79.3% in the oldest one (p <0.001). Intense and moderate leisure-time physical activity was more frequent among participants in the 18- 39 years age group. Leisure time physical activities were associated with younger age groups, male sex, rural area, higher educational level and non-smoking status. Regular breakfast and regular consumption of 3 meals/day was associated with older age group, male sex and non-smoking status. Conclusions. Our analysis showed a high frequency of unhealthy lifestyle habits among the younger age groups as compared to the older ones, with the highest frequency of these unhealthy behavior reported in the 18-39 years age group.

Context. Thyrotoxicosis is an important cause of secondary osteoporosis, but the extent of bone loss and its\r\nreversibility with therapy have not been clearly determined yet.\r\nObjective. We assessed the impact of thyrotoxicosis on bone mineral density (BMD) and the recovery of bone loss with\r\ntherapy. We also tested, in this context, the hypothesis that low TSH levels, even within reference range, increase fracture risk.\r\nDesign, Subjects and Methods. In this retrospective study we compared 78 women with thyrotoxicosis and osteopenia /\r\nosteoporosis (TX ? study group), with 82 age matched, euthyroid women with primary osteopenia /osteoporosis (C-control group). All patients had a baseline and at least one follow-up assessment of lumbar spine BMD by dual-emission X-ray absorptiometry (DXA) and thyroid function (thyrotropin ? TSH and free thyroxine ? fT4, measured by electrochemiluminescence immunoassay).\r\nResults. Mean BMD and T scores were similar at baseline (0.764 g/cm2, -2.50 SD in the TX group 0.747 g/cm2, -2.59 SD\r\nin C group); 17 thyrotoxic patients and 17 patients with primary osteoporosis had previous fractures. Both groups showed a significant BMD increase with therapy, over a similar period of time (TX ? mean 10.38 months; C ? 10.74 months). BMD gain was significantly higher in the study\r\ngroup (p = 0.04). In hyperthyroid patients, the best predictor for bone density increase was the TSH raise, while in controls the main determinant was treatment duration.\r\nConclusions. In comparison to primary osteoporosis, bone loss recovery rate with appropriate therapy is higher in\r\nthyrotoxicosis, confirming its contribution to the pathogenesis of osteoporosis.