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ACTA ENDOCRINOLOGICA (BUC)
The International Journal of Romanian Society of Endocrinology / Registered in 1938in Web of Science Master Journal List
Acta Endocrinologica(Bucharest) is live in PubMed Central
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Case Report
Ursu HI, Purice M, Belgun M, Suciu I, Ioan D
Down syndrome and Turner syndrome associated with Graves' disease: two case reports and a review of the literatureActa Endo (Buc) 2008 4(4): 471-476 doi: 10.4183/aeb.2008.471
AbstractAbout 15-20% of adults with Down?s syndrome have autoimmune hypothyroidism. Among patients with Down?s syndrome, prevalence of Graves disease (1-2%) may not be increased compared with the general population. About 15% of the patients with Turner?s syndrome have autoimmune hypothyroidism. Until 2006, only 15 cases of Graves disease have been reported among patients with Turner?s syndrome. We present two adult patients with chromosomial disorders (Down?s syndrome, Turner?s syndrome) with Graves? disease without clinical Graves ophthalmopathy. Clinical picture of thyrotoxicosis was oligosymptomatic in the patient with Down?s syndrome, probably because Down?s syndrome represents a syndrome of accelerated ageing. Both were pretreated with antithyroid drugs before radioiodine therapy. Both patients developed postradioiodine hypothyroidism: after 8 months in the case with Turner?s syndrome and after 11 years in the patient with Down?s syndrome. Adults with these two chromosomial disorders should be screened annually for autoimmune thyroid dysfunction. -
Case Report
Niculescu DA, Purice M, Lichiardopol R, Hortopan D, Dumitrascu A, Coculescu M
Reversal of impaired fasting glucose with long-acting somatostatin analogs in active acromegaly - a report of two casesActa Endo (Buc) 2007 3(4): 471-482 doi: 10.4183/aeb.2007.471
AbstractGlucose intolerance (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] or diabetes mellitus) due to insulin resistance is a frequent complication of acromegaly due to excessive growth hormone (GH) production. Long-acting somatostatin analogs are known to reduce the GH and IGF-1 serum levels, and to inhibit at the same time the pancreas insulin release. The effect upon acromegalic patients who express IFG before therapy is controversial. We here present two male patients, 66 and 36 years old, with active acromegaly and IFG who were submitted to a treatment with long-acting somatostatin analog lanreotide. After being diagnosed with active acromegaly with high nadir serum GH levels along oral glucose tolerance test (OGTT), i.e. 149 ng/mL and 43 ng/mL respectively, the patients underwent complex therapy (surgery and radiotherapy) which reduced the GH serum levels (20.7 ng/mL and 3.5 ng/mL respectively) without curing the disease. The patients developed IFG with fasting serum glucose levels of 113 mg/dL and 101 mg/dL, respectively. The treatment with the long-acting somatostatin analog lanreotide (30 mg i.m., every two weeks) decreased the GH serum levels close to normal limits (1.5 ng/mL and 1.6, ng/mL respectively). The treatment with lanreotide normalised the fasting serum glucose levels (91 mg/dL and 81 mg/dL, respectively) together with a reduction of serum insulin levels from 14.2 mU/mL to 8.7 mU/mL and from 25.4 mU/mL to 11.5 mU/mL, respectively (HOMA decreased form 3.96 to 1.97 and 6.33 to 2.3, respectively). We discuss the mechanisms by which lanreotide can improve glucose tolerance in patients with active acromegaly despite lowering the serum insulin levels through a direct effect on insulin secretion. -
Images in Endocrinology
Poiana C, Carsote M
Abdominal wall endometriosisActa Endo (Buc) 2006 2(4): 471-471 doi: 10.4183/aeb.2006.471
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Endocrine Care
Muntean V, Domsa I, Ghervan C, Valea A, Fabian O
Is subtotal thyroidectomy an obsolete indication for the management of benign multinodular goiter?Acta Endo (Buc) 2009 5(4): 471-488 doi: 10.4183/aeb.2009.471
AbstractIntroduction. In our department the standard surgical procedure for multinodular\r\ngoiter used to be subtotal resection. Over the years, total thyroidectomy has progressively\r\nreplaced subtotal resections and is performed in most of our patients at present.\r\nPatients and Methods. In a prospective cohort, observational study, we assessed\r\nthe immediate surgical outcome in 742 consecutive patients with multinodular goiter\r\n(MNG), admitted for surgery and operated in our hospital. Of all patients, 664 were women\r\n(89.5%) and 78 men (11.5%), aged 15 to 85 years, mean (?SD) of 48 ?13.8 years. Pathology\r\nwas done on frozen and permanent sections. The complications directly related to surgery\r\nin subtotal thyroidectomy (STT) were compared to total thyroidectomy (TT) or near-total\r\nthyroidectomy (NTT) patients: temporary hypoparathyroidism, temporary RLN injury,\r\npermanent hypoparathyroidism and permanent RLN injury. The χ2 test (95% confidence\r\ninterval) was used and values of p<0.05 were considered significant.\r\nResults. There were no significant differences among the patients with SST for\r\nMNG, NTT or TT , and TT for recurrent MNG or completion thyroidectomy, with respect\r\nto temporary and permanent RLN injury. Significant differences were found for temporary\r\nhypoparathyroidism in STT for MNG (9 out of 361 patients, 2.45%) and NTT or TT for\r\nMNG (21 out of 266 cases, 7.89%) (p<0.01) and between STT for MNG (9 out of 361 cases,\r\n2.45%) and TT for recurrent MNG for completion thyroidectomy (8 out of 45 cases,\r\n17.77%) (p<0.01) and no difference between NTT or TT for MNG (21 out of 266 cases,\r\n7.89%) and TT for recurrent MNG or completion thyroidectomy (8 out of 45 cases, 17.77%)\r\n(p=0.11). We registered no permanent hypoparathyroidism in our patients.\r\nConclusions. Total thyroidectomy is now the preferred option for the management\r\nof patients with bilateral benign MNG. However, TT is associated with a considerable rate\r\nof complications, higher than of STT. In patients with bilateral MNG and no malignancy,\r\nSTT remains in our opinion, a valuable option. -
Endocrine Care
Ozler S, Oztas E, Guler BG, Alci M, Caglar AT, Danisman N
Are the Factors Affecting Adverse Pregnancy Outcomes Different in Obese Gestational Diabetes Pregnant Women Receiving Diet or Insulin Treatment?Acta Endo (Buc) 2019 15(4): 472-481 doi: 10.4183/aeb.2019.472
AbstractContext. We aimed to examine the factors affecting adverse gestational outcome in gestational diabetes (GDM) patients, who were grouped as obese and normal- weight, having only-diet, or insulin treatments. Subjects and Methods. The study included 373 patients, treated with diet or insulin. These patients were sub-grouped as obese and non-obese, and examined retrospectively. The variables affecting adverse gestational outcome in obese GDM patients having dietary and/ or insulin treatments were detected with multiple regression analysis. Results. The weight gained during pregnancy in the GDM group having insulin treatment was more than the one in only-diet treated GDM group (p=0.004). Pre-pregnancy body mass index, the weight gained during pregnancy, hemoglobin A1C levels in the second and third trimesters, caesarian rates were higher in the insulin-treated obese patients than in the other groups (p<0.001). The odds ratio for fasting blood glucose level in insulin-treated obese GDM group was 1.081 (95% CI =1.004 - 1.163) (p=0.039); and it was 0.982 (95% CI =0.924 - 1.002) (p=0.048) for the weight gained during pregnancy, in only-diet treated obese GDM patients. Conclusion. The control of weight gained during pregnancy, and of fasting blood glucose levels in obese patients having GDM, is important to decrease adverse gestational outcome. -
Endocrine Care
Altun R, Gokcay Canpolat A, Demir O, Erdogan MF
The Course of Autoimmune Thyroiditis in WomenActa Endo (Buc) 2021 17(4): 472-478 doi: 10.4183/aeb.2021.472
AbstractContext. Although, many studies have been made on the clinical course of autoimmune thyroiditis, this study focused on women and the factors effecting the natural course such as Selenium. Objective. The study aimed to determine Hashimoto’s thyroiditis (HT) clinical course in adults and the factors that could affect it. Design. The study was in a retrospective manner between 2010-2018. Subjects and Methods. 101 patients with HT were followed for 60.7±32.7 months. Biochemical and ultrasonographic data were collected. We investigated whether the age at diagnosis, family history, smoking habits, levothyroxine replacement therapy, and serum selenium (Se) levels influenced the disease course. Results. No relationship was observed between age and thyroid functions, thyroid volumes (TV), and autoantibody (Ab) levels at diagnosis. Ab levels were irrelevant with TV, echogenicity, and nodularity at diagnosis. However, initial TSH levels were significantly associated with anti-TPO levels (p=0.028, r=0.218). In the untreated group, thyroid functions seemed to be stable. TV decreased significantly in both treated and untreated patients (p<0.001). The decrease in TV was significantly higher in the treatment group (p=0.002). In euthyroid and subclinical hypothyroid patients, levothyroxine therapy did not affect the decrease in TV. Ab levels remained stable in untreated patients, but anti-TPO levels significantly decreased in treated patients (p<0.001). Smoking seemed to increase only anti-Tg levels (p=0.009). Family history was not associated with any of the studied parameters. Serum Se level was negatively correlated only with thyroid echostructure and only in treated patients. TV showed a “Gaussian distribution” in all patients at the diagnosis and at the end, independent of levothyroxine treatment. Conclusions. Most euthyroid patients remained euthyroid during five years of follow-up. The decrease in TV was significantly prominent with LT4 treatment. Importantly, TV followed a normal distribution instead of the bimodal distribution that is classically described. -
General Endocrinology
Sayiner ZA, Okyar B, Kisacik B, Akarsu E, Özkaya M, Araz M
DPP-4 Inhibitors Increase the Incidence of Arthritis/Arthralgia but do Not Affect AutoimmunityActa Endo (Buc) 2018 14(4): 473-476 doi: 10.4183/aeb.2018.473
AbstractAims. In August 2015, FDA published a black box declaring that DPP-4 inhibitors may cause severe joint pains. The impact on autoimmunity marker positivity of these drugs has not been comprehensively evaluated. We compared the incidence of arthritis/arthralgia in patients with T2DM who were using DPP-4 inhibitors and patients who were not using. Methods. A number of 93 DPP-4 inhibitor users and 107 non-users were included into the study. Arthritis/ arthralgia were found in 41 of 93 (44.1%) DPP-4 inhibitor users and in 19 of 107 (17.8%) non-users (p<0.05). Results. No inflammatory rheumatological condition was identified in 27 of 41 (65.9%) patients in DPP-4 inhibitor user group as well as in 13 of 19 (68.4%) patients in non-user group (p>0.05). After adjusting for gender the incidence for arthritis/arthralgia was significantly increased in the DPP-4 inhibitor user group (p value for any DPP-inhibitor <0.05). There was 3.77 times increased risk for arthritis/arthralgia in the DPP-4 inhibitor using group (p value= 0.001) and this risk increases 2.43 times for each year of DPP-4 inhibitor usage. Conclusions. Arthritis/arthralgia were more common among T2DM patients who were using DPP-4 inhibitors compared to non-users, but the seropositivity did not differ between DPP-4 inhibitor users and non-users. -
Notes & Comments
Mihai R, Bridge H, Sadler G
Perioperative management of phaeochromocytomasActa Endo (Buc) 2006 2(4): 473-479 doi: 10.4183/aeb.2006.473
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Case Report
Ionescu R, Opris D
Severe osteoporosis with vertebral fractures in a young woman with Behcet's diseaseActa Endo (Buc) 2005 1(4): 473-480 doi: 10.4183/aeb.2005.473
AbstractWe describe a case of severe osteoporosis with vertebral fractures in a 30-year-old male with very active Beh?et?s disease treated for nine months with high doses of Prednisone. He was admitted to our department because of classical manifestations of the autoimmune disorder (bipolar aphthous) and also for acute mechanical back pain developed after a minor fall. The X-ray evaluation revealed a spinal fracture confirmed by the CT scan. The DXA evaluation revealed a T-score of -3.4 with an identical Z-score. The patient was diagnosed with severe secondary (glucocorticoid induced) osteoporosis with vertebral fracture and active Beh?et disease. -
Case Report
Chentli F, Kalafate N
Nasal Bleeding Due to Huge ProlactinomasActa Endo (Buc) 2013 9(3): 473-478 doi: 10.4183/aeb.2013.473
AbstractProlactinomas are the largest pituitary tumours (PT) in males, but huge ones (defined arbitrarily as ≥ 8 cm in height) are exceptional. They are usually diagnosed after impotency, headaches and visual troubles. Other manifestations such as memory troubles, unconsciousness, meningitis, epilepsy, psychiatric disorders, and exophthalmos are unusual. We aimed to report two cases diagnosed after epistaxis. Case 1. A man, aged 38, suffering from chronic nasal bleeding and impotency was diagnosed with a huge prolactinoma [90x90x80 mm, PRL=3737 ng/mL (n<15)] invading the nasal cavity. Nasal biopsy confirmed PT with positivity to PRL antibodies. After dopamine agonists intake, PRL and tumour size were significantly reduced and nasal bleeding disappeared.Case 2. A male aged 29 was referred for a huge PT [PRL= 2586 ng/mL, tumour= 130x80x60 mm] diagnosed after epistaxis. Nasal endoscopy showed a bleeding greyish tumour whose immunostaining confirmed PT. Dopamine agonists stopped epistaxis after PT tumour reduction. Conclusion. Both cases suffered from epistaxis secondary to huge prolactinomas invading the nasal cavity. So, chronic nasal bleeding should be kept in mind as a possible sign of PT. Nasal biopsy should be kept in mind for diagnosis confirmation. Nasal invasion by PT can induce suppurative meningitis which is a life threatening condition, fortunately not observed in our cases.