ACTA ENDOCRINOLOGICA (BUC)

Overview of necessity of universal screening as the tool for adequate diagnosis of GDM in 2016. Identifying of gestational diabetes mellitus (GDM) overpasses the medical discussion of utility, both for the mother and child, both for the short term and long term possible complications.

Context. Non-psychogenic polydipsia-induced hyponatremia is a rare clinical finding. The effects of severe hyponatremia on the electrical activity of the heart in this setting are far from clear. Case report. Resting ECG and 24-h ambulatory ECG monitoring performed in an 80-year-old hypertensive female accusing nonspecific symptoms of confusion, lethargy, disorientation, nausea, and palpitations, demonstrated significant intraatrial and atrioventricular conduction disorders and numerous atrial tachyarrhythmia episodes. Laboratory analysis revealed severe hyponatremia (108 mEq/L) as only significant disorder. Extensive endocrine, neurological, cardiology, and pulmonary examinations excluded the most common causes of hyponatremia, including the inappropriate antidiuretic hormone secretion syndrome. Careful history revealed excessive voluntary water intake of up to 6 L/day and low sodium intake, associated with long-term thiazidelike diuretic treatment. Correction of sodium levels was associated with complete resolution of both atrial arrhythmias and conduction disorders. Conclusions. This report presents the first case of severe hyponatremia caused by combined non-psychogenic polydipsia and thiazide-like diuretic use complicated with reversible cardiac conduction disorders and atrial arrhythmias. The close temporal relationship between the fully reversible cardiac electric abnormalities and severe hyponatremia strongly indicates hyponatremia as key feature in the pathogenesis of these electric abnormalities.

Aim. Alpha-lipoic acid (ALA) is a potent naturally occurring antioxidant and in the\r\npast years several studies suggested the fact that ALA can have positive effects on glucose\r\nmetabolism. We intended to evaluate in an open-label, non-randomized study, in usual\r\nambulatory settings, the effect intravenous ALA infusion on fructosamine level, in patients\r\nwith type 2 diabetes and painful peripheral diabetic neuropathy.\r\nPatients and methods. 28 consecutive patients with type 2 diabetes and painful\r\nperipheral diabetic neuropathy, treated with 10 daily infusions of 600 mg ALA in 300 ml of\r\nnormal saline, were included in the study. Fructosamine was measured with a colorimetric\r\nmethod. For the analysis of the results we have used the non-parametric Wilcoxon Signed\r\nRanks test.\r\nResults. There were 15 women and the mean (? SD) age and duration of diabetes were\r\n59.39 (? 7.92) and 9.46 ? 6.19 yr respectively. Mean (?SD) HbA1c at enrolment was 7.77\r\n? 1.18 %. The mean (?SD) value of fructosamine decreased significantly from 568.14\r\n(?190.67) &#956;mol/L to 467.10 (?126.98) &#956;mol/L (p < 0.0001). The mean decrease between the\r\nfirst and second measurement was 17.8%, 101.03 (?132.17) &#956;mol/L in absolute term.\r\nConclusions. Decrease in fructosamine concentration can be described at least as a\r\n&#8220;positive side effect&#8221; of ALA used for the treatment of the painful peripheral diabetic neuropathy.\r\nAs far as we know there is only one study that used fructosamine as a criterion for evaluating the\r\nsafety and tolerability of orally administred ALA in patients with type 2 diabetes.

Background. Langerhans cell histiocytosis (LCH) is a rare group of neoplastic diseases resulting from Langerhans dendritic cells. The most common site (80%) is bones. Thyroid gland involvement is exceedingly rare and usually expected to be seen as a part of multisystemic disease. Case Report. We present a 45 year old male patient operated due to multinodular goiter and neck pain, and diagnosed with LCH in his postoperative pathologic examination. As a result of the systemic screening performed after the pathological diagnosis, the disease was interestingly localized to the thyroid gland. Systemic involvement did not develop in the two-year follow-up of the patient who did not receive additional chemotherapy treatment. Conclusion. It is difficult to diagnose LCH in the thyroid gland before surgery. Although surgical treatment with or without chemotherapy is recommended, surgery is not recommended alone since it is generally systemic involvement. However, in primary thyroid LCH cases limited to the thyroid gland, we recommend that only total thyroidectomy treatment should be kept in mind.

Neuroendocrine carcinoma (NEC) of the larynx is the most frequent neuroendocrine neoplasm of the head and neck and the most common nonsquamous carcinoma of the larynx. It usually occurs in the supraglottic area, in smoking men. We report a case of a 58-year-old woman with no history of smoking who presented with an atypical carcinoid, arising in the right piriform sinus of the larynx. During the 5-year follow-up, the patient developed metastases in the lymph nodes, palatine tonsils, parotid glands, breasts and skin. For this reason the patient underwent several surgical procedures, radiotherapy and eventually was qualified for chemotherapy. Our case shows that NEC of the larynx can have an atypical presentation. The diagnosis requires careful pathological evaluation with immunohistochemistry and a wide spectrum of imaging. The serum concentration of chromogranin A seems to be not useful in the diagnosis and follow-up of laryngeal NEC.

Resistance to thyroid hormone (RTH) is an inherited disease transmitted in an autosomal dominant manner. The diagnosis is suspected when peripheral thyroid hormones are increased contrasting with normal or increased levels of thyroid stimulating hormone. Usually, people harboring the rare syndrome have few or no symptoms. However, in some patients signs of hyperthyroidism may be the revealing anomalies as in the following case: A 75 year-old woman was referred to our department for a benign adrenal incidentaloma. In her medical history she was treated for systemic hypertension and diabetes mellitus for 15 years. Clinical examination did not show any sign of adrenal secretion, but discovered rapid irregular cardiac rhythm with some hyperthyroidism features such as increased sweating and upper limbs and jaw tremor. Electrocardiogram showed atrial fibrillation. Hormonal assessment confirmed hyperthyroidism as FT4 levels were high (mean value: 30.2pmol/L (n= 9–23)), contrasting with non-suppressed TSH levels (13.8μU/mL (n = 0.2 – 4)). Cerebral magnetic resonance imaging was normal. Genetic testing revealed a new heterozygous mutation on exon 10 in the THRβ gene (c.1366T>G) compatible with RTH syndrome. Screening of her children showed the same hormonal profile in five out of ten. These results confirmed RTH and the familial character.

Background. McCune-Albright syndrome (MAS) is a sporadic disease characterized by polyostotic fibrous dysplasia (FD), café au lait skin lesions and a variety of endocrine or non-endocrine dysfunctions. Case presentation. We present the case of a 33 years old woman diagnosed with MAS in 2011. She presented precocious puberty at the age of five, multiple long bone fractures, but no café-au-lait spots were identified. The thyroid investigation tests revealed a toxic multinodular goiter. The thyroid scintigraphy showed an increased uptake in the superior third of the right lobe. The X-rays and bone scintigraphy revealed polyostotic FD. The patient was previously diagnosed with transmission hypoacusia, explicable in the setting of bony auditory canal deformity. The assessment of phospho-calcium balance showed a hyperphosphaturic hypophosphatemia. The liver enzymes levels were also increased, especially GGT. Conclusion. The sporadic mosaic nature of the disease means that it is an uncommon disease with a variable expression. Each case is unique, and the approach that was appropriate in one of the cases is likely not to be the best in another.

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As men are aging, their testosterone levels decline, while the morbidity of atherosclerosis (AS) rises in accordance\r\nwith their age. Recent studies indicate that inflammation contributes to atherosclerosis. Whether hypogonadism in old men is associated with inflammation deserves to be\r\ninvestigated.\r\nBackground. To examine the relationship between free testosterone (FT) and inflammatory cytokines such as\r\npregnancy-associated plasma protein A (PAPP-A), interleukin-6 (IL-6), vascular cell adhesion molecule-1 (VCAM-1), intracellular adhesion factor-1 (ICAM-1) in old men with\r\nacute coronary syndrome (ACS).\r\nMethods. Serum was collected from 107 men aged 60-86 years. Among them, 52 were patients with ACS. The relationships\r\nbetween FT and PAPP-A, IL-6, VCAM-1 and ICAM-1 were examined respectively.\r\nResults. Levels of weight, body mass index, total cholesterol, low density lipoprotein cholesterol, triglyceride, PAPPA, IL-6, VCAM-1 and ICAM-1 of old male\r\nACS patients were higher than those of controls; FT and high density lipoprotein cholesterol levels were lower than those of controls. FT level was inversely associated with PAPP-A, IL-6, VCAM-1 and ICAM-1.\r\nConclusions. FT level is inversely associated with inflammatory cytokines such as PAPP-A, IL-6, VCAM-1 and\r\nICAM-1 in old men with ACS. This might imply that low testosterone is associated with inflammation in old men with ACS.