ACTA ENDOCRINOLOGICA (BUC)

Context. Subacute thyroiditis (SAT) is a transient inflammatory disease that occurs often after an upper respiratory tract infection. Permanent hypothyroidism ratio is reported in 5-26% of the SAT patients. Objective. In this study, we tried to compare the treatment options on permanent hypothyroidism in our SAT patients. Design. It is a retrospective study. The medical records of SAT patients between 2010 and 2015 were analysed. Subjects and Methods. The medical records of 81 patients were analysed for demographic data, laboratory and clinical course, treatment and 1 year outcome. 81 patients were classified in steroid (n=29), nonsteroidal antiinflammatory drugs (NSAID) (n=33) and steroid+NSAID (n=19) groups. Results. Male/female ratio was similar and female domination was demonstrated in all groups. In the steroid and NSAID groups the pretreatment thyroid function tests were diagnosed as hyperthyroidism. In the steroid+NSAID group they were not diagnosed as hyperthyroidism in the beginning. In all groups the thyroid function tests were all in normal levels (p˃0.05) one year later. In all groups the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were increased in the pretreatment period and decreased with the treatment. In total, right lobe involvement of thyroiditis was more detected (40/81 (49%)) (p=0.018). Permanent hypothyroidism observed in steroid, NSAID, and steroid+NSAID groups were 7/29 (24%), 5/33 (15%), 3/19 (16%) respectively (p˃0.05). Conclusion. In this study, treatment drug option did not affect the permanent hypothyroidism one year after in our SAT patients.

Context. Clinically „silent“ pheochromocytomas are very rare tumors. Objective. We present a patient with incidentally discovered, asymptomatic benign pheochromocytoma and discuss its presentation and management. Conclusion. Considering the increasing incidence of adrenal incidentalomas and, therefore, pheochromocytomas too, every incidentally found adrenal mass has to be carefully examined regardless of its clinical presentation in order to prevent fatal oversight of possible secreting nature and/or malignant potential of the lesion and to ensure an adequate curable treatment.

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Prolonged target gland failure causes pituitary hyperplasia, but rarely, secondary hyperplasias develop into autonomous neoplasms. We report herein a rare example of gonadotroph adenoma arising in a patient with prolonged hypogonadism due to Klinefelter syndrome. A pituitary macroadenoma with suprasellar extension was discovered incidentally by magnetic resonance imaging (MRI), in search for the cause of chronic saliva retention. His pre-operative serum concentrations of both luteinizing hormone (LH) and mostly follicle-stimulating hormone (FSH) were distinctly higher than normal, as expected, but the levels decreased after complete removal of the tumor, suggesting partial secretion of gonadotropins by the tumor. The surgically removed tissue showed a typical pituitary adenoma with distinct immunoreactivity for FSH (intense, homogeneous) and LH (scattered). In the fragmented parts of adjacent gland tissue, no hormone producing cell hyperplasia or presence of gonadal deficiency cells were detectable. In conclusion, our case is the description of a rare example of gonadotropin producing pituitary adenoma (FSH and LH) with increased serum levels of both gonadotropins in a patient with untreated Klinefelter syndrome.

Background. Atypical antipsychotics proved efficacy in monotherapy and more so in\r\nassociation with mood stabilizers, but choosing the atypical antipsychotic requires special\r\ncautions due to metabolic adverse effects. The aim: to verify if Quetiapine-valproate\r\ncombination improves rapidly acute depressive symptoms and has a good endocrinemetabolic\r\ntolerability. Case presentation. A 49 years male, bipolar patient, admitted for a\r\nmajor depressive episode. The patient also has type 2 DM for which he takes oral antidiabetics.\r\nWhen inpatient, he had persistent hyperglycemia (>250mg/dL). DM&#8217;s\r\ncomplications (poly-neuropathy, retinopathy and right bundle-branch block). Diabetic status\r\noriented us to choose quetiapine (600 mg/day) for both antidepressive effect and its safe\r\nmetabolic profile associated with valproate (1000 mg/day). Antidiabetic medication was\r\nadjusted following the clinical outcome. Instruments. for depression we used Montgomery-\r\nAsberg Rating Scale (MARS), for mania Young Mania Rating Scale (YMRS), Clinical\r\nGlobal Impression for Bipolar Disorder (CGI-BP), for diabetes (glycemia, HbA1c,\r\nglycosuria, body weight, adverse events and relapse were followed-up for 6 months. The\r\nevaluations were performed weekly during hospitalization (6 weeks) and then monthly, for\r\n6 months quetiapine together with valproate therapy led to remission of depressive\r\nsymptoms (MADRS <50% vs. baseline). At the same time DM was compensated with\r\nglimpirid and metformin (glycemia < 120mg/dL). These results maintained till the end of\r\nthe follow-up period. Conclusion. Quetiapine associated to valproate in acute and chronic\r\nmanagement of bipolar depression proved to be efficient and well tolerated, along 6 months,\r\nin patient with type 2 diabetes.

Using mathematical and clinical trial pharmacokinetics for Cabergoline (a dopaminergic agonist used in hyperprolactinaemia and long-term treatment of nonfunctioning tumours), a new ?hyperfractionation? effect is proven. This effect leads to higher steady state plasma concentrations of drug by fractionating multiple dose regimens in more frequent doses of smaller individual amounts. We generalize this effect by formulating a general mathematical condition for any drug to benefit from hyperfractionation. The effect is important in the long-term treatment of non-functioning tumours as one tries to achieve higher steady state plasma concentrations by using small individual doses in order to insure tolerability. This effect is more complex than the accumulation effect known in pharmacokinetics as a one parameter effect (frequency). Hyperfractionation is a two parameter effect for multiple dose regimens (frequency, dose amount).

Background. The aim of this study was to assess the awareness of the USA and world population about osteoporosis, taking into account seasonal variations and economic conditions. Methods. The term “osteoporosis” was searched using Google Trends between January 1, 2004 and September 12, 2024. Cosinor analysis was used to test the effect of seasonality on relative search volumes (RSV) for osteoporosis searches in the USA and worldwide. LOESS (Locally Estimated Scatterplot Smoothing) was used to decompose a time series into its seasonal component, trend component, and residual component. We also analysed RSV values in US states according to income levels. Results. It is seen that RSV values in the USA and the world have been in a decreasing trend from 2004 to 2014, but after 2015, they have been in an increasing trend. According to the results of the cosinor analysis, RSV values in the US and worldwide are highest in the fall months and lowest in the summer months. Significant differences were found in search trends between seasons in both the US and the world (p<0.05). There is no statistically significant difference in RSV values by income level worldwide and in the USA (p>0.05). Conclusion. Osteoporosis appears to be a global health problem and a major focus of attention, both in the US and around the world. Health strategies to increase osteoporosis awareness can be planned to address different income groups, taking into account regional and seasonal effects.

Introduction. The prevalence of obesity has reached alarming levels in the European Union, including in Romania. Data on the prevalence of obesity is only available at the national populational level, but this may hide the increased levels in disadvantaged groups. The purpose of this study was to evaluate the prevalence of overweight and obesity in the Roma population in Southern Romania. Material and method. This cross-sectional, epidemiological, non-interventional study was conducted from March 2014 to May 2017 in several settlements from Calarasi County. Screening procedures included interviews about medical history, lifestyle, anthropometric and clinical measurements and fasting capillary glucose. Results. The study population consisted of 1120 adult subjects, of which 735 Roma. In Roma population group, the prevalence of underweight, normal weight, overweight and obesity was 4.5% (n=33), 25% (n=184), 25.3% (n=186) and 45.2% (n=332) respectively. In Romanian Caucasians group, the prevalence of underweight, normal weight, overweight and obesity was 2.3% (n=9), 20% (n=77), 33.8% (n=130) and 43.9% (n=169) respectively. Among the Romanian Caucasians significant predictors of obesity were a sedentary lifestyle and current smoking. The odds of being obese in Roma population were higher in sedentary lifestyle persons and lower in current smokers, with primary education, and in those living in rural settlements. The family history of obesity had a significant association with obesity only in Roma population. Conclusions. Our results confirm the need to implement prevention programs in high-risk populations due to the double burden of malnutrition, lack of medical education and preventive healthcare, low socio-economic level.

Context. The links between obesity and thyroid function or thyroid volume in children are still controversial with limited available data. Objective. This study aimed to examine thyroid function and volume in obese Turkish school-age children in comparison to normal-weight children. Design. Cross-sectional study. Subjects and Methods. One hundred obese children (47 boys, 53 girls; mean age 10.34±2.79 years) with a body mass index (BMI) above 95th percentile, and 100 normal-weight children (42 boys, 58 girls; 10.34±2.79 years) were included. The study parameters were BMI z score (Z-BMI), body surface area (BSA), thyroid volume, free thyroxine (fT4) and thyroid stimulating hormone (TSH) levels. Results. The mean TSH and fT4 levels did not show a significant difference between obese and normal-weight children (p>0.05). The mean thyroid volume was higher in obese children (6.46±5.84 and 4.64±1.44, respectively; p=0.043). fT4 correlated negatively with Z-BMI in both normal-weight and obese children (r=-0.285, p=0.004 and r=-0.289, p=0.004, respectively). Thyroid volume, on the other hand, correlated positively with Z-BMI, again in both normal-weight and obese children (r=0.657, p<0.001 and r=0.444, p<0.001, respectively). Similar associations were found for BSA. Conclusions. Thyroid volume correlated positively and fT4 correlated negatively with Z-BMI and BSA, in both obese and normal-weight school-age children, whereas TSH appears to be independent of these parameters.