ACTA ENDOCRINOLOGICA (BUC)

Background. Drug induced thrombocytopenia is mostly related with nonsteroidal\r\nanti-inflammatory drugs (NSAID), anticonvulsants, sulfonamides, diuretics, cinchona\r\nalkaloid derivatives, penicillamine and gold salts. Oral sulfonylureas such as glibenclamide,\r\nchlorpropamide and glimepiride are known to induce thrombocytopenia.\r\nCase report. We report a 42 year old female admitted to emergency department with\r\na complaint of hematochesia. She has been using oral gliclazide for three years. Laboratory\r\nresults revealed bicytopenia: haemoglobin=8.9 g/dL (N=12.3-15.3), white blood count\r\n(WBC)=12100/μL (N=4400-11300), platelet count=4000/μL (N=150000-450000). All\r\nexaminations to etiology of thrombocytopenia were negative including autoimmune,\r\ninfectious (viral-bacterial) and haematological diseases. Colonoscopic examination showed\r\n50% construction of the lumen in the first 15 cm segment of the colon by an ulcerovegetant\r\nmass. Pathological examination was reported as adenocarcinoma. Thrombocyte levels\r\nincreased on the 4th day after stopping gliclazid treatment.\r\nConclusions. It is the first case of gliclazid induced thrombocytopenia in literature. So\r\nwe recommended that platelet count should be regularly checked in all patients receiving\r\nsulfonylurea drugs including gliclazid.

Psychosis following steroid replacement in Sheehan's syndrome is rarely encountered. We present the clinical course of two patients who developed severe psychosis after starting them on low dose prednisolone. Psychosis subsided after either stopping or decreasing the dose together with use of antipsychotic medications. Glucocorticoids restarted a week later in low doses were well tolerated. Both the patients were reviewed after three months and were psychosis free.

Context. Hepatitis C and diabetes represent important health problems globally. The new-onset diabetes after transplantation is a particular entity that appears due to the use of immunosuppression among transplanted patients. Objective. We aim to describe the clinical and biological aspects of severe hyperglycemia in a kidney transplant recipient undergoing Interferon-free therapy for chronic hepatitis C, discussing the interference of different factors with the glucose metabolism. Design. The occurrence of diabetes in a patient with history of renal transplantation and Interferon-free treated hepatitis C was studied from both clinical and paraclinical points of view. Subjects and methods. When presenting to the hospital, extensive blood tests were performed on the patient, revealing significant hyperglycemia and an elevated level of blood tacrolimus. Creatinine clearance was calculated. ECG presented T-wave alterations. Intensive insulin protocol was applied, the case being managed in a multidisciplinary approach. Results. Blood glucose and tacrolimus were slowly normalized, under therapy. The antiviral treatment was continued, with the achievement of sustained virologic response. Conclusions. Diabetes mellitus can have many causes, hepatitis C and transplantation both having an impact on glucose metabolism. The association of the three entities should be carefully managed, due to its enhancing effect on morbidity and mortality.

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Background. The concept of NE differentiation in prostate carcinoma has two major aspects: prostate tumors with\r\nprimary NE differentiation and NE differentiation occurred during hormonal therapy for prostate adenocarcinoma, with\r\nthe extreme case of tumor dedifferentiation into a NE hormone resistant carcinoma.\r\nMaterial and method. The patient, 62 years old, with a history of poorly differentiated prostate adenocarcinoma,\r\nhormonally treated with the decrease and then constant maintenance of serum PSA level to 0.01 ng/mL was admitted in the hospital, 8 years after prostate tumor diagnosis, and 3 years after ceasing of hormone therapy, with multiple bone and liver metastases of unknown primary source.\r\nResults. The serum levels of CgA, NSE, CEA, CA19.9, serotonin were elevated. The histopathological examination\r\nof the needle biopsy fragment from a liver metastatic lesion revealed small cell neuroendocrine carcinoma. Despite the\r\nprompt chemotherapy, the disease has progressed, with the occurrence of brain metastases and the patient?s death\r\n6 months after detection of the metastatic disease.\r\nConclusions. The present case confirms the diagnostic difficulties in llymetastatic undifferentiated small cells\r\ntumors, and on the other hand, draws attention to the possibility of NE dedifferentiation as a result of hormone\r\ndeprivation in patients with prostate cancer.

Thyroid cancer, the most frequent endocrine malignancy, is in most patients a treatable disease, with excellent outcome and cure rate. However, a few patients present with rapidly progressive metastatic differentiated thyroid cancer which loses the radioiodine uptake capacity. These rare cases are prone to a rapid evolution and poor prognosis. Medullary thyroid cancer is a neuroendocrine tumor occurring sporadically or as part of endocrine tumor syndromes, genetic tests being part of standard clinical evaluation. Current knowledge of tumor biology in thyroid cancer allowed development of a new class of drugs, thyrosine kinase inhibitors (TKI). Their use in clinical trials allowed the development of more specific drugs, increasingly effective and with less adverse reactions, interfering with multiple thyrosine kinase enzymes. Improvement of the progression free survival, decrease of tumor volume and tumor markers, as well as patients with stable disease on TKI are strong arguments for including patients in clinical trials. Currently, only four TKI are approved by FDA: sorafenib and lenvatinib for DTC; vandetanib and cabozantinib for MTC. In this paper we present this new class of drugs used in the treatment of aggressive thyroid cancer.

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Researches on ageing phenomenon offer significant information regarding the consequences of stressors on immune system that affects longevity in the elderly. Immunosenescence has become the most common immunodeficiency state in humans, occurring in over 30% of community - dwelling elderly, and greater than 90% of elderly who are ill, taking medication, or residing in longterm care facilities. Immunosenescence may reflect tandem changes in neuroendocrine responses. There are several agingrelated changes in cortisol, DHEA and catecholamines, which are considered to set up a “vicious cycle of endocrinosenescence and immuno-senescence”. The low-level, chronic increase in innate, inflammatory response observed in older adults ultimately results in tissue damage and disease; the key inflammatory mediators in this process are CRP, nuclear factor (NF)-kB, IL-1-beta, IL-6, TNF-alpha, cyclooxygenase-2 (COX-2), and inducible nitric oxide (NO) synthase. Further, glucocorticoid inhibition of IL-6 production was observed to be lower in older compared to younger men following psychological stress. There are individual differences that protect aged people from stressors and strains, and it will be important to identify biological mechanisms of protection and those at risk who might benefit from early behavioral interventions.

Background. Phosphaturic mesenchymal tumor (PMT) is a recently described concept\r\nunifying the mesenchymal tumor associated with oncogenic osteomalacia. Most of the cases of\r\nPMT occur in the extremities and appendicular skeleton. PMT occurring in the paranasal\r\nsinuses is extremely rare with only a few cases reported in the available literature.\r\nCase. A 51-year-old man presented with a long history of bone pains. Biochemical\r\nand radiologic investigations, including skeletal survey showed features of osteomalacia.\r\nPositron emission tomography (PET) scan showed a small tumor in the left nasal cavity,\r\nethmoid and sphenoid sinuses. Histopathological examination of the excised tumor showed\r\nfeatures of a phosphaturic mesenchymal tumor- mixed connective tissue variant. Excision\r\nof the tumor was associated with marked improvement in the biochemical parameters and\r\nremarkable clinical relief.\r\nConclusion. Phosphaturic mesenchymal tumor is a rare cause of osteomalacia and is\r\nusually associated with small tumors, which escape detection for long periods. Its occurrence in\r\nthe paranasal sinuses needs to be kept in mind and evaluated to allow for timely detection of the\r\ntumor with subsequent surgical excision and clinico-biochemical relief.