ACTA ENDOCRINOLOGICA (BUC)

Context. Pakistan is considered to be severely iodine deficient with 70% population at risk of iodine deficiency. Objectives. This study was designed to determine the prevalence of goiter and status of iodine in district Charsadda, Pakistan. Design. The study was carried out using the 30 cluster approach. Subject and Methods. From each cluster, 40 school going children were randomly selected with equal number of male and female children making a total of 1210. A total of 202 pregnant women were sampled casually from different health units and hospitals of the districts. For goiter determination palpation, for urinary iodine wet digestion and for salt iodine rapid spot test kits were used. Results. The prevalence of goiter in school children was 10.9% (10.2% in boys and 11.5% in girls). In pregnant women the goiter prevalence was found to be 20.7% (16.6% in 1st trimester, 19% in 2nd trimester and 25% in 3rd trimester). The median urinary iodine concentration of school children and pregnant women was 89.9μg/L and 89.8μg/L respectively. Estimation of iodine content in salt illustrates that 70% households were consuming non-iodized salt. Conclusions. This study suggests mild iodine deficiency in the district Charsadda of Pakistan. Regular iodine prophylaxis is needed in the area.

Introduction. Surgery has lost a lot of ground as the main therapy of most prolactinomas as it is clear from the current guidelines in most prolactin secreting adenomas, even in the setting of optic compression. However, we believe that surgery is still an important part in the treatment of this type of adenomas. This study is aimed to define what is the role of pituitary surgery in the current setup of prolactinoma management. Material and methods. In this retrospective, single-center study we analyzed 12 consecutive patients who underwent primary endoscopic transsphenoidal surgery for prolactinomas, between 2013 and 2022. Surgical indication, previous dopamine agonist (DA) treatment, remission rates, surgical complications, pituitary function and imagistic appearance are presented. Results. Of the 12 patients included, 4 had giant PRL and 8 macroadenomas, while 9 of them had previous DA treatment. The main surgical indication was pituitary apoplexy in 5 patients followed by CSF leak after DA treatment, 3 cases, and DA resistance in 3 cases. The main surgical complications were transitory diabetes insipidus in 7 cases. Normalization of prolactin levels was achieved in 2 patients. Conclusions. Surgical intervention should be strongly considered in all patients with neurologic symptoms referable to the lesion, resistance to medical therapy, other treatment failure or with complications after DA treatment. The endoscopic endonasal surgery offers good surgical outcomes with low rates of surgical complications and should remain an open option for specific cases.

Context. Clinical studies demonstrated erythrocyte deformability (ED) is impaired in diabetic patients and described the correlations between HbA1c and ED. Few studies further investigated what an exact elevated HbA1c level linked to the impairment of ED in diabetes. Objective. This study was to determine a cut-off point of HbA1c level leading to the impairment of ED in patients with diabetes. Design. This was a retrospective observational study. ROC curve analysis was used to determine an optimal cut-off value of HbA1c for the increasing HSRV. Subjects and Methods. In this study, 300 type 2 diabetic patients were enrolled. The whole blood viscosity was measured. High shear reductive viscosity (HSRV) was used to indirectly estimate ED. Based on the obtained cut-off value and glycemic control criteria for HbA1c, we divided all the cases into different groups to further confirm the accuracy of the cut-off value. Results. In 300 patients, ROC curve illustrated that 9.05% was the optimal cut-off value as a predictor of the increasing HSRV. And higher odds ratio (OR) for significant decrease in ED was seen in the patients with HbA1c >9.05% compared to those with HbA1c≤9.05% (OR: 3.78, 95% CI: 2.08-6.87). HSRV increased significantly in patients with HbA1c level >9.05% in comparison to patients with HbA1c levels <6.5% between 6.5 and 8.0% and between 8.0 and 9.05%. Conclusion. ED decreased significantly in diabetic patients as soon as HbA1c level was higher than 9.05%.

Introduction. Obesity was considered to protect against osteoporosis. Recent studies indicate the opposite.\r\nThe study aimed to see if adipose tissue has a protective effect on bone mass and if adipocytokines can explain the\r\nrelationship between obesity and osteoporosis.\r\nSubjects and methods We designed a study enrolling 83\r\npostmenopausal women, aged over 60, without diagnosed or treated osteoporosis and no secondary osteoporosis. We formed 3 groups- group 1- osteoporosis and metabolic syndrome (MetSyn), group 2- osteoporosis, group 3- MetSyn.\r\nWe evaluated the hematological, biochemical profile, bone turnover markers and adipocytokines. DXA of the spine and\r\nthe hip (left) was performed on all the enrolled women. Insulin resistance was appreciated using HOMA index. Metsyn\r\nwas defined using the International Diabetes Federation?s criteria.Results were statistically analyzed using SPSS program, version 15.\r\nResults. All groups were vitamin D insufficient with lower vitamin D, osteocalcin and adiponectin levels in the\r\ngroups with MetSyn and higher leptin levels. BMI correlated positively with spine BMD, while leptin correlated positively with hip BMD, pointing out to the protective effect of obesity against osteoporosis due to leptin?s involvement.\r\nConclusion. Obesity seems to have a protective effect against osteoporosis, probably due to leptin.

Context. We assessed the association between the severity of COVID-19 and the thyroid function, and the relationship of thyroid hormones with inflammatory markers in COVID-19 patients. Subjects and methods. This observational study contained 95 COVID-19 patients. The covariates of interest included the thyroid-stimulating hormone (TSH) and the total form of thyroid hormones thyroxine and triiodothyronine. Furthermore, the inflammatory markers including C-reactive protein, erythrocyte sedimentation rate, lactate dehydrogenase (LDH), and lymphocyte were measured. To analyze the data, the t-test, the nonparametric test for comparing the medians, and the Spearman correlation were used. Results. The median (interquartile range) of ages was equal to 53 (41-66) years old, including 54 men (56.8 %). As the severity of COVID-19 progressed from moderate to severe, increasing, though non-significant, trends of thyroid dysfunction were observed, the most remarkable for TSH. The only significant association between thyroid hormones and inflammatory markers was a Spearman correlation of -0.28 between TSH and LDH. Moreover, a direct association was found between the severity of COVID-19 and the LDH levels (p-value<0.001). Conclusions. A direct relation between the severity of COVID-19 and the LDH level and a reverse association between the LDH level and the thyroid hormone, TSH was obtained. Key

Objective. To investigate the significance of DHEAS assessment in males of different ages. Methods. Retrospective cohort study of patients investigated in two large academic centres. Results. The data of DHEAS assessment of 3533 patients (3013 females and 520 males) was analysed. DHEAS was 1.6 – 13.5 times more frequently investigated in women than in men. A peak of DHEAS evaluation test for women was at 25 years old and distribution was uniform in males over decades, excepting being lower in 0-9 and 75+ages. In the age group 10-24 years, DHEAS levels were higher in females. After 45 years, DHEAS was higher in men than in women. Analysis of 510 case records showed low DHEAS levels in boys (0-9 years) and in men aged 65 – 84+. Higher DHEAS levels were detected as a peak at 30 years old, but never after 55 years. In individuals with low DHEAS levels prevailed congenital adrenal hyperplasia (32%), adrenal tumours (30%) and primary or secondary adrenal insufficiency (19%). High DHEAS levels prevailed in patients with arterial hypertension (26%), overweightobesity -(19%), non-toxic goiter (17%) and alopecia (9%). In the normal DHEAS miscellaneous diagnoses were met most frequently – 40%. Disorders exceeding 5% were non-toxic goiter (19%), adrenal tumours – 17%, overweight/obesity – 16% and arterial hypertension– 8%. In 71 women and 124 men adrenal neoplasms were detected. Higher frequency of these was observed in women in their 30s. A peak of adrenal neoplasms in men was at their 70s. This gender difference was not conditioned by earlier attempts to seek medical care by women. A significant correlation of DHEAS, weight, body mass index and systolic blood pressure with diastolic blood pressure was found. Conclusion. Our study permits to determine which DHEAS secretion and clinical pattern might be associated in males of different ages.

Background. Although thyroid nodules are a common finding in the general population, determining the clinically important nodules is essential. We investigated thyroid nodules or cysts by thyroid ultrasonography (US) in patients with β-thalassemia major (β-TM) and intermedia (β- TI). We also report a β-TI patient who was diagnosed with thyroid cancer six months before our screening. Methods. In this cross-sectional study, 178 patients with β-thalassemias referred to the Thalassemia Clinic in a tertiary hospital affiliated to Shiraz University of Medical Sciences were investigated, from January to June 2016, by US. Results. Thyroid nodules or cysts were detected in 11 patients [total: 6.17 %; 8 patients with β-TM (8.2%) and 3 patients with β-TI (3.7%)]. All nodules were < 1 cm in diameter and were not suspicious of malignancy. All patients, after 1 year of thyroid US follow-up, did not show any significant change in favor of malignancy. Conclusion. Based on our results, the frequency of thyroid nodules was similar to what was reported in the general population. However, a long-term follow-up of these patients is recommended because of the potential carcinogenic effects of iron and hepatitis C infection (HCV). To achieve more precise information, collaborative multicenter studies should be considered.

Context. Nesfatin-1 is a novel peptide with both central and peripheral anorexigenic regulatory properties. Besides its effects on food intake, few studies have suggested a possible role for this peptide in the pathogenesis of diabetes mellitus type 2. Objective. To compare serum levels of nesfatin-1 between healthy, normal-weight persons and three groups including healthy underweight, healthy obese and diabetic subjects. Design. Prospective, case-control study, performed between January 2015 and January 2016. Subjects and Methods. Fasting levels in serum nesfatin-1 were measured in 30 healthy, normal-weight individuals (controls), 30 healthy underweight persons, 30 healthy obese persons, and 30 patients with newly diagnosed diabetes type 2 using standard enzyme-linked immunosorbent assay (ELISA) kits. Results. The mean serum nesfatin-1 level was significantly higher in controls (2.61 ng/mL) compared to that in obese (1.13 ng/mL) and diabetic (0.99 ng/mL) patients; and significantly lower than that in the underweight group (3.50 ng/mL). The obese and diabetic groups were comparable in this regard. No significant association was found between serum nesfatin-1 level and age, sex, or body mass index. Conclusions. Serum nesfatin-1 is possibly associated with weight-related abnormalities in otherwise healthy subjects and diabetes type 2. Obesity and diabetes type 2 may share a common pathologic point in this regard.

Background. Previous sleep studies suggest that type 2 diabetes mellitus is associated with poor quality of sleep and sleep disorders. Aim. To evaluate sleep parameters and diurnal preference in type 2 diabetic patients, using a questionnaire. Methods. Ninety seven patients (aged 55.8±8.3, sex ratio 1:1), previously diagnosed with type 2 diabetes mellitus, together with 102 controls (aged 47.1±10.5, sex ratio 1:1), without diabetes, completed a questionnaire containing the Romanian translation of the Composite Scale of Morningness, the Sleep Disorders Questionnaire, the Pittsburgh Sleep Quality Index, the Pittsburgh Insomnia Rating Scale, the Multidimensional Fatigue Inventory, the Epworth Sleepiness Scale, the Alcohol Use Disorders Identification Test and the Beck Depression Inventory II (BDI). The study was cross-sectional, as we included subjects from outpatient and inpatient facilities. The recruitment process was based on handing invitation letters to patients consulting their physician, as well as to their acquaintances, using the snowball sampling. Participation was voluntary and anonymous. Results. Insomnia was more often reported in diabetic patients: 32 (33.0%) vs. 16 (15.7%) controls, a difference that was highly significant (P<0.001). Diabetic patients used to wake up at approximately the same hour as controls did; nevertheless they went to bed earlier (22:14 ± 0:57 vs. 22:32 ± 1:03), needed more minutes to fall asleep (28.84 ± 21.01 vs. 24.32 ± 23.45) and slept less than controls (7.01 ± 1.56 vs. 7.23 ± 1.18). Statistically significant differences between patients and controls were found regarding the Pittsburgh Sleep Quality Index (P=0.005), the Pittsburgh Insomnia Rating Scale (P<0.001) and the Multidimensional Fatigue Inventory (P=0.001) scores. Eighteen (18.5%) patients also met the criteria for a depressive disorder. No significant differences between patients and controls were found as related to their chronotype (P=0.32) Conclusion. Poor sleep, but not diurnal preference, was linked with the presence of type 2 diabetes mellitus.