ACTA ENDOCRINOLOGICA (BUC)

Context. Predictive equations estimate total fat mass obtained from multiple-site ultrasound measurements; however, the predictive equation of total fat mass has not been investigated solely from abdominal subcutaneous fat thickness. Objective. To develop regression-based prediction equations using abdominal subcutaneous fat thickness for predicting fat mass, and to explore the validity of these predictive equations. Design. Cross-sectional study. Subjects and Methods. Twenty-seven males and eighteen females were randomly divided into two groups as the model prediction and the validation. Total body fat mass was determined by dual-energy X-ray absorptiometry. The linear regression analysis was used to predict equations for total body fat mass from abdominal subcutaneous fat thickness acquired by ultrasound. Then, these predictive equations were tested on the validation group. Lin’s concordance correlation coefficient (CCC) was used as a further measure of agreement. Results. When fat mass prediction equations were tested on the validation groups, measured- and estimated-total fat masses in males (p=0.9) and females (p=0.5) were found similar. A good level of agreement between measurements in males (CCC=0.84) and females (CCC=0.76) was attained. Conclusion. The abdominal subcutaneous fat thickness obtained from a single region by ultrasound might provide a non-invasive and quick evaluation.

Context. Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. It is also a growing problem worldwide and is associated with many maternal and fetal complications during and after pregnancy. Objective. This study aimed to investigate the neonatal and maternal complications of gestational diabetes in the Iranian population of pregnant women. Design. This prospective cohort study was carried out on the health assessment data of pregnant women in the age range of 18-45 years who were referred to health centers affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2019 to September 2020. Subjects and Methods. Overall, 2,500 pregnant women with GDM and 7,700 healthy pregnant women were enrolled in the GDM and healthy groups, respectively. Individuals’ data were recorded in an electronic health record system (SINA System) and were later collected and analyzed. Results. Significant between-group differences were observed in terms of cesarean delivery risk, hypertension, fetal macrosomia, preeclampsia, preterm birth, fetal birth weight, and neonatal icterus in GDM and non-GDM groups. However, no significant differences were found in terms of stillbirth, and low birth weight between the two groups. Based on the logistic regression model, GDM significantly increased the risk of cesarean delivery, fetal macrosomia, and neonatal icterus. Conclusions. The fetal macrosomia leading to the cesarean delivery, and neonatal icterus were determined as the significant complications of GDM in the Iranian population. These results can provide valuable insight into healthcare planning.

Context. Sodium Glucose Co-Transporter-2 inhibitors (SGLT2i) are oral antidiabetic agents that can be used with insulin in the treatment of type 2 diabetes mellitus, known for cardiovascular and renal benefits. Dapagliflozin and empagliflozin are available in Turkey and we aimed to evaluate real-life data of using these two molecules with other oral antidiabetic drugs (OAD) or insulin. Subjects and methods. 119 patients (59 women, 60 men) files who had started SGLT2i between 2017-2019 were examined retrospectively until 6 months after the treatment change. Patients’ weight, body mass index (BMI), insulin doses, fasting blood glucose, HbA1c, lipid profile, spot urine albumin/creatinine ratio, e-GFR values, ALT, AST, uric acid levels were evaluated at baseline, 3 months and 6 months. Results. 41.2% of patients were using dapagliflozin and 58.8% were using empagliflozin. After 6 months of follow-up, HbA1c decreased from 8.27% to 7.45% (p<0.001). Daily total insulin dose decreased from 84.75 to 75.58 U/day in 3 months (p<0.004). Weight and BMI decreased significantly at 6 months. ALT, AST decreased significantly in patients using insulin (p 0.001 and 0.007), whereas spot urine microalbumin/creatinine ratio decreased at 3 and 6 months (p 0.005 and 0.020). A significant decrease was also observed in uric acid levels (p: 0.026). Conclusions. Dapagliflozin and empagliflozin have beneficial effects on decreasing glycemic parameters, weight, transaminases, uric acid and microalbuminuria in the real life environment. We also observed that SGLT2i and insulin combination is as safe and effective as combination with OAD.

Background. Early detection of coronary plaques in patients with diabetes mellitus (DM) could play a major role in improving the evolution of these patients, targeting a therapeutic intervention in early stages when the chances to reduce the progression of the disease are higher. Aim of the study was to evaluate the presence of coronary lesions and analyze the plaque morphology in patients with type 2 DM using multislice 64 computed tomography coronary angiography (MSCT), and to assess the cardiovascular risk expressed by calcium scoring (CS) in these patients. Methods. The study included 37 patients with type 2 DM. Mean age was 67.38 years (±19.62). In all cases MSCT was performed, CS was calculated and morphology of coronary plaques was analysed. Results. Coronary artery disease was present in 86.48% cases. CS was <100 in 6 patients (16.2%), between 100 and 400 in 7 patients (18.9%) and >400 in 24 cases (64.8%). Coronary plaques were classified as non-calcified in 142 segments, mixed in 78 segments and calcified in 114 segments. In 40.12% of lesions the plaques were nonobstructive, in 44.91% obstructive, and in 14.91% severely obstructive. Conclusions. In patients with type II DM there is a high incidence of coronary lesions and vascular calcification, which could represent an indicator of the severity of coronary artery disease even in asymptomatic diabetic patients. CS calculated with MSCT is increased in these patients, representing a marker of high cardiovascular risk.

Introduction. This study evaluates the clinical efficacy of androgen replacement therapy with the new long-acting intramuscular (i.m.) testosterone undecanoate (T.U.) in comparison to oral T.U. in adult men with hypogonadotropic hypogonadism.\r\nPatients and methods. In 41 patients with central hypogonadism (30 with pituitary tumors or craniopharyngiomas, 11 with non-tumor hypogonadism), aged 20-62 years, we evaluated, before and after androgen replacement therapy, morning serum total testosterone\r\n(T), hemoglobin, hematocrit, cholesterol, triglycerides (measured with commercial kits in venous blood sampled at 8.00-9.30 a.m) and the sexual dysfunction (SD) by questions on libido, frequency and quality of erections.\r\nResults. In group A, including 28 patients treated with oral T.U. median dose 120 mg/day (range 80-160) in 3 divided doses, for 4-60 (median 14) months, T rose from 0.37 ? 0.40 ng/mL (mean ? standard deviation) to 1.43 ? 1.36 ng/mL (p<0.01), reaching normal levels only in 4 patients (14%). In group B, including 20 patients treated with 1000 mg i.m. T.U. at 12 weeks intervals, for 1-12 (median 6) months, T rose from 0.88 ? 0.83 ng/mL to 5.88 ? 3.50 ng/ml (p<0.01). T was low in 1 patient (5%) and above normal in 6 patients (30%). A subgroup (C) of 7 patients was switched from oral to i.m.T.U. T was higher after i.m. than after oral T.U in group B vs. A and within subgroup C (p < 0.01). SD improved in 7/16 patients (43.7 %) on oral T.U. and in 11/12 patients (91.6%) on i.m. T.U (p < 0.05). Hematocrit increased significantly from baseline in both groups, while serum cholesterol and triglycerides did not change significantly on either T.U. treatment.\r\nConclusions. Clinical efficacy, judged by normal morning T and sexual dysfunction improvement, was reached in over 90% of patients with central hypogonadism after i.m.T.U. and in less than half after oral T.U.

Context. Vitamin D is essential for skeletal and nonskeletal health and prolonged deficiency results in infantile rickets and adult osteomalacia. The aim of this study is to\r\ndetermine 25(OH) VitD and iPTH status in pregnancy and to evaluate the effects of monthly 100.000 IU dose of vitamin D\r\nsupplementation.\r\nMaterials and Methods. In a double blind trial of vitamin D supplementation in pregnant Iranian women, vitamin D3\r\n(cholecalciferol , 100/00 IU/month) was administered to 25 women and placebo to 25 controls during the last trimester. The two groups had similar distributions of maternal age, height, gravity, weight and age of gestation. Hydroxycholcalciferol and iPTH were measured in mothers at 27 weeks and at delivery. Cord blood was used to assess the\r\nsame parameters.\r\nResults. Comparing the data final maternal 25 - hydroxyvitamin D levels were significantly higher in the supplemented group versus control group (61.45?30 ng/mL versus 29.4?16 ng/mL); P &#8804; 0.001.Cord 25 - hydroxyvitamin D levels were significantly higher in supplementation group in\r\ncomparison to control group (52 ? 40.5 ng/mLversus 36?21.3 ng/mL); P<0.005.\r\nConclusion. Administration of 100/000 IU/monthly of vitamin D3 in the last trimester significantly increased 25(OH) VitD to high normal concentration. However, even with supplementation, only of mother and of newborn had serum\r\n25(OH) VitD greater than 30 ng/mL a small percentage of women and babies were vitamin D sufficient. According to data of study we propose 100/000 IU monthly is safe for pregnant women.

Introduction. Radiation-induced hypothyroidism is a well-recognized entity that occurs after an interval of 15- 21 months. However, in the treatment of locally advanced Head and neck Squamous cell carcinoma (HNSCC), thyroidsparing techniques are infrequently employed. Aims. To evaluate the dosimetric and early clinical outcomes of thyroid-sparing SIB-VMAT technique (Simultaneous Integrated Boost - Volumetric Modulated Arc Radiotherapy) in patients of locally advanced HNSCC. Methods. In this two-arm prospective pilot study, patients in the study group received radiotherapy by SIBVMAT technique with a thyroid constraint to a dose of 70 Gy to the gross disease and 59.4 Gy to nodal and subclinical disease in 33 fractions over 6 ½ weeks with concurrent cisplatin. V50Gy<75% was the thyroid constraint used. The control group was treated with the same dose and technique but without using a thyroid gland constraint. The dosevolume parameters of the thyroid gland, PTV (Planning Target Volume) along with thyroid profile were analyzed. Results. Twenty-six patients were recruited. Thyroid V50Gy of the study group (65.33 ±6.63 %) was significantly lower than that of control group (80.35 ±13.40 %) (p=0.003). Tumor dose parameters of both groups were compared and revealed no significant difference. At 18 months follow-up, the incidence of any degree of hypothyroidism was 46.15% in the study group and 23.07% in the control group (p=0.216) Conclusion. In locally advanced HNSCC, it is feasible to spare the thyroid gland without compromising the tumour coverage. This has the potential to reduce the frequency of radiation-induced hypothyroidism.

Context. Ovarian failure leading to delayed puberty and infertility is a cardinal sign in patients with Turner syndrome (TS). Objective. We reviewed the pattern of puberty in a group of Irish patients with TS. Design. This was a prospective observational study conducted at the National Children’s Hospital, Dublin, Ireland. Subjects and Methods. All patients aged 12–19 years and attending the paediatric endocrinology service with a confirmed diagnosis of TS were enrolled. Eligible patients underwent puberty assessment using Tanner staging and had 3 ml of blood taken for measuring luteinising hormone (LH), follicle-stimulating hormone (FSH) and oestradiol. Results. Out of 65 patients with TS identified from the medical and laboratory records, 42 aged 12 to 19 years were enrolled. Clinical assessment of puberty using Tanner staging revealed that 21 patients (50%) had spontaneous puberty (breast stage 2–5). Fourteen individuals out of 23 with mosaicism experienced spontaneous puberty (61.9%) compared with 7 out of 19 (36.8%) carrying a 45,X karyotype (P = 0.10). Of the 21 patients who had spontaneous puberty, 9 (43%) achieved menarche ; 6 of them were mosaic while the other 3 had 45 X karyotype (P = 0.33). The mean age of spontaneous menarche was 13.9 ± 1.97 years (range 10.9–18.9). One patient with spontaneous puberty achieved two successful pregnancies. Conclusions. Spontaneous puberty occurred in half of TS patients in this cohort and among these, 43% achieved spontaneous menarche. Prevalence of both spontaneous puberty and menarche were higher in mosaic patients compared to those with 45X karyotype.

Context. Estimation of osteoporotic hip fracture incidence and Romanian FRAX model were based on nationally reported hospital ICD 10 coding admissions of all hip fractures (without a validation process). Objective. We aimed to calculate, based on individual hospital charts analysis, the incidence of osteoporotic hip fracture in the main urban area of Romania and compare it with data reported to the National Institute of Public Health (NIPH). Design. We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest and surrounding Ilfov County (11.8% of Romania population). Subjects and Methods. All ICD 10 fracture and event/fall codes were validated against the charts. We calculated the age and sex adjusted incidence of osteoporotic hip fracture and used the national reported hip fracture data base for comparison. Results. There were 2203 hip fractures of which 1997 (90.65%) were fragility fractures. The crude incidence of low-energy hip fractures was 171/100,000 (225/100,000 in women, 103/100,000 in men). The incidence rose with age to a maximum rate of 1902/100,000 in women >85 years. The NIPH-reported incidence of hip fracture was 181/100,000 for the region of interest and 176/100,000 at the national level. Conclusion. The incidence of osteoporotic hip fracture was lower than the incidence based on hip fractures reported codes in the national database, but the incidence of fragility fractures calculated by our group was higher than the incidence reported in previous national studies. Nationwide studies are warranted.

Purpose. To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. Methods. Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. Results. Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). Conclusion. Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.