ACTA ENDOCRINOLOGICA (BUC)

Context. Atypical antipsychotics (AAs) are the first-line treatments for schizophrenia, schizoaffective disorder and bipolar disorder. However, they are now extensively utilized as off label in a myriad of diseases despite their frequently serious metabolic side-effects and hyperprolactinemia. Objective. The purpose of our study was to observe long-term (one year) prolactin level change in first episode schizophrenia patients treated with one of the four AAs: olanzapine, quetiapine, amisulpride, ziprasidone. Design. This study is an analysis of the prolactin level associated with the atypical antipsychotics used in European First Episode Schizophrenia Trial (EUFEST) study. Subjects and Methods. Seventy-three first episode schizophrenia patients from the 113 patients, randomized to one of the four AAs treatment arms. Prolactin level was obtained at baseline, 6 and 12 months for all the four AAs. Analyses have been done for each antipsychotic separately for each sex. Results. For the male patients neither of the four antipsychotics have been associated with a statistically significant increase of prolactin level in the entire study (p>0.05). In case of the female patients, treatment with olanzapine (p=.021) and ziprasidone (p=.005) has been associated with a decrease of prolactin level in one year compared with baseline. Conclusions. In both men and women, the administration of these four AAs is not associated with the increase of prolactin levels, moreover, in women’s case, there is a reduction of prolactin values at administration of Olanzapine and Ziprasidone. These results are optimistic, suggesting that long term administration of these antipsychotics is safe regarding prolactin level.

Graves’ disease is an autoimmune disorder characterized by various degrees of thyroid gland, eye and skin affection. We present the case of a 36 years old woman diagnosed with Graves’ disease and infiltrative ophthalmopathy class IV according to Werner classification, non-responsive to Methylprednisolone antiinflammatory therapy and to irradiation. From anamnesis we mention Graves’ disease’s debut approximately one year ago, manifested by thyrotoxicosis features without evident ophthalmopathy. Antithyroid drug therapy was started at debut and maintained for eleven months. One month after antithyroid drug therapy cessation, the patient developed diplopia, periorbital edema, and proptosis. At that moment we decided to initiate intravenous Methylprednisolone therapy using a total dose of 3 grams, followed by oral corticotherapy in association with antithyroid drug therapy. One month later, when bilateral fat tissue hernia appeared in the external orbital angle, we decided to add orbital radiotherapy. In the absence of any evident clinical improvement, immunosuppressive treatment with Cyclosporine 5 mg/kg/day was chosen. Consequently, ,we obtained a significant reduction of eye proptosis, 4 mm at the right eye, and 3 mm at the left eye, a significant reduction of bilateral orbital fat tissue hernia, and no more diplopia.

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) has been a rarely recognized condition. As the prescription of\r\noral bisphosphonates is universalized and the number of people treated with bisphosphonates is increasing, an accurate understanding and proper management of BRONJ are required.\r\nAim. Our aim was to describe the clinical features, treatments and prognosis of patients with oral bisphosphonate-related osteonecrosis of the jaws.\r\nMaterials and Methods. In our study BRONJ is reported in 20 consecutive patients who received BP therapy for osteoporosis with different drug schedules. The length of therapy was 7-73 months before osteonecrosis was observed; in 16 patients BRONJ involved the mandible and in 4 the maxilla. Systemic co-morbidities were present in seven patients, namely, rheumatoid arthritis (20), diabetes mellitus type 2 (10%) and chronic anemia (5%).\r\nResults. Nine of the 14 patients who did not suspend BP therapy demonstrated decreased pain and a clinically significant improvement in function. By using the authors? case series of 20 patients, which are reported in the article and the authors? clinical orientation to evaluation and treatment of oral bisphosphonate-related\r\nosteonecrosis of the jaws are presented.

Introduction. The presence of Hürthle cells (HC) in fine needle thyroid biopsy (FNAB) is a real concern for a cytologist and also for an endocrinologist. We aimed to demonstrate if the presence of HC is associated with specific cytological features in FNAB results. Material and Methods. This retrospective study analyzed 89 patients diagnosed with thyroid nodules, with FNAB; were two groups of patients: the study group A (HC+) (22 patients) with HC and control group B (HC-) (67 patients) with no HC; for both groups we analyzed the presence of 9 cytomorphologic features: overall cellularity, background colloid, lymphocyte infiltration, chronic inflammation, large nucleoli, small nucleoli, syncytial infiltration, nuclear pleomorphism/atypia, cellular pleomorphism. Results. We found no statistical differences between age and gender. Nodules with diameter greater than 2 cm were present, more frequently in the group without HC, 43 (64.18%). The presence of HC is correlated with cellular pleomorphism (p=0.042) and nuclear pleomorphism (p < 0.0001) with no correlation between the other investigated parameters. The presence of colloid was correlated with the absence of HC (p= 0.014). In group with HC was a positive correlation with cellular pleomorphism and fibrosis. In the presence of fibrosis, HC was correlated with nuclear pleomorphism (p=0.03). In the group with HC without fibrosis there are more characteristic the sets with positive nuclear pleomorphism, positive large nucleoli and negative small nucleoli (p= 0.002). Conclusions. The presence of HC in FNAB results is associated with colloid in small amounts, associated with nodules smaller than 2 cm, correlated with cellular pleomorphism and nuclear pleomorphism. Fibrosis can be a protective feature against malignancy because cellular parameters were not significantly associated with HC except the cellular pleomorphism.

Streptococcus pneumoniae generally causes pneumonia or meningitis. The psoas abscess and osteomyelitis is mainly caused by Staphylococcus aureus. We report here on a patient with type 2 diabetes mellitus who had a psoas abscess and foot ulcer caused by Streptococcus pneumoniae after acupuncture\r\nand moxibustion.

Objective. We analyzed the possible correlation between glycemic variability and psychological disorders such as depression, anxiety disorder, and low self-esteem, in diabetic patients. These correlations are relevant, as they consume a large number of resources. Their better understanding can increase the effectiveness of incident reduction techniques and could provide better management and cost reduction of care. Methods. We compared the relationships between the glycemic variability (for a period of 10 days prior to completing the depression questionnaire) and the results of two standardized questionnaires: Hamilton anxiety scale - HRSA (group 1: 500 patients), Rosenberg self-esteem test (group 2: 490 patients) and Beck depression inventory (both groups). Results. A statistically significant correlation was identified between the glycemic oscillation and depression as well as both anxiety and low self-esteem. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients. In conclusion, psychometric tests could be an important instrument in the management of diabetic patients.

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Background. Dehydroepiandrosterone sulphate (DHEA-S) is a major steroid product of adrenal glands and an important neurosteroid, but due to only slight androgenic activities pathology of DHEA-S secretion it was rarely described until now. Aim. To report a case of DHEA-S and testosterone secreting adrenal tumour with clinical manifestations of suddenly appeared epileptic seizures, amenorrhea, hirsutism, weight gain and decreased sexual activity before operation, and up to 12 months observation after surgical removal of the tumour. Methods. Presentation of clinical case with comments. Results. Epileptic seizures, amenorrhea, weight gain and hirsutism suddenly appeared in a 38-year-old fertile woman. A right adrenal tumour was detected. Blood levels of DHEA-S and testosterone were very high. Surgical removal of the adenoma (confirmed histologically) was performed what conditioned decrease of DHEA-S, testosterone and other hormones in 2-24 hours for the level of adrenal insufficiency. After a month all the hormones returned to normal level and were maintained at this level for 12 months after operation, excepting aldosterone, which increased gradually. Menses reappeared in six weeks after a short period of hot flashes and perspirations. Seizures did not appear in 12 months. Sexual activity was lowered one month before and after the operation, and it was maximal 6-12 months after operation. Conclusions. We report a case with complete recovery of a 38-year-old woman, presented with epileptic seizures, amenorrhea, hirsutism, weight gain and decrease of sexual activity, before and after surgical removal of DHEA-S and testosterone secreting adrenal tumour.

This paper reviews the class of mineralocorticoid receptor (MR) modulators, especially new nonsteroidal antagonists. MR is a nuclear receptor expressed in many tissues and cell types. Aldosterone, the most important mineralocorticoid hormone and MR agonist, has many unfavorable effects, especially on the heart, blood vessels, and kidneys, by promoting fibrosis and tissue remodelling. Classical synthetic MR antagonists (spironolactone, eplerenone) have proven useful in clinical practice through their antihypertensive effects in resistant forms, and through benefits on morbidity and mortality in heart failure with reduced ejection fraction. These benefits are associated with important side effects, hyperkalemia being the main limitation. In the latest years, a new generation of MR modulators with a nonsteroidal structure has emerged. These compounds are more selective than classical MR antagonists, with much higher affinity for the MR than for the glucocorticoid, androgen, or progesterone receptors. Recent clinical and experimental observations suggest that nonsteroidal MR antagonists, especially finerenone, have proven superior renoprotective properties, antiproteinuric efficacy, inhibition of inflammation and heart fibrosis in animal models, without sharing the side effects of steroidal MR antagonists. Nonsteroidal MR modulators represent an interesting new therapeutic approach for the prevention and progression of chronic kidney disease and for patients with heart failure and renal disease. Despite these promising data, there are still many issues to be clarified and it is necessary to accumulate solid evidence from studies on larger numbers of patients and from head-to-head clinical trials.

Context. Children having gonadal tumors and disorder of sex differentiation (DSD) are rare. Objective. To investigate the presentation of DSD children with malignant gonadal tumors. Methods. A retrospective study from 2010- 2020, that evaluated 17 children with DSD, including 13 females, eight months to 16 years, with congenital adrenal hyperplasia, 5-alpha reductase deficiency, androgen insensitivity syndrome, Turner, Sywer, and Klinefelter syndromes. Results. Ten children had malignant gonadal tumor; nine had germ cell tumors and one person granulosa cell tumors, while seven children with non-malignant tumor had gonadoblastoma, cystadenoma (five children), and cysts. Systemic malformations, obesity, elevated tumor markers, and psychosocial issues were observed in 90%, 90%, 70%, and 50% of children with malignancy unlike 28.6%, 42.9%, 14.35%, and 57.1% children without malignancy respectively. Most (9/10) children >12 years, had psychosocial issues, unlike 0/7 children ≤12 years. From 8/17 children presenting with symptoms suggestive of tumor, 75% had malignancy, while from 9/17 children with DSD presentation, 44% had malignant tumors. Malignancy was observed in 3/10 children between eight months to age six, while 7/10 children had stage 1-2 tumors. We reported a child, identified as female, aged 13 years, with partial androgen insensivity syndrome (PAIS) 46,XY, and testicular papillary serous cystadenoma with genomic variant AR NM_000044.4:c.2750del. p.(F917Sfs*27) chromosome Xq12, never published in people with PAIS nor population databases (GnomAD). Conclusion. DSD diagnosis raises numerous challenges. People with DSD have increased risk of malignancy, especially when obesity and, systemic malformations are present; also, psychosocial issues in these children are associated with postpubertal age.