ACTA ENDOCRINOLOGICA (BUC)

Uncontrolled chronic gout can lead to deposition of monosodium urate crystals, better known as tophi. Such depositions can involve several organ systems, including unusual locations such as the vertebrae. Nevertheless, certain complications, such as hypercalcemia, can arise because of tophi. Despite an aggressive intervention, hypercalcemia might not resolve spontaneously, as long as an ongoing inflammatory process secondary to gouty tophi is taking place. Herein, we present the case of a 62-year-old man with a long history of gouty tophi who presented for back pain and was found to have spinal cord involvement with PTH-independent hypercalcemia which only resolved with pegloticase therapy.

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Aims. To provide growth references for school-aged children in western Romania, to compare them with other national and\r\ninternational growth charts and evaluate the prevalence of overweight and obesity.\r\nMethods. A total of 3731 children, aged 7-19 years, from Timis county, were examined by medical students, between\r\nFebruary 2010-June 2011. Growth references for height, weight, and body mass index (BMI) were constructed with LMS method and LMSChartMaker software. The Romanian 3rd, 50th and 95th percentile for height and BMI were compared with national and international growth references. The prevalence of overweight and obesity was determined with IOTF definition.\r\nResults. Crude and smoothed percentiles for weight, height and BMI were shown for this population. The comparison\r\nprovided data regarding the variation of growth models in different populations. Our results demonstrated a high prevalence of overweight (18.2%) and obesity (7.2%) in our\r\npopulation, higher in boys versus girls.\r\nConclusions. Our study constructed growth references for a Romanian population. The comparison with other growth references reflected the regional differences in growth\r\npatterns between populations.

Accumulating evidence indicates that induction of inducible nitric oxide (NO) synthase and the subsequent NO production may be involved in the pathogenesis of insulin resistance. However the role of NO on insulin action of glucose uptake in skeletal muscle is not clearly understood. We hypothesized that NO does not impair insulin action of glucose uptake in skeletal muscle. To test this hypothesis, isolated rat epitrochlearis muscles were incubated in the presence or absence of sodium nitroprusside (SNP), a NO donor, with or without insulin, followed by measurement of glucose uptake. A low concentration of SNP (0.1 mM) did not stimulate glucose uptake, whereas a high concentration of SNP (10 mM) caused a large increase in glucose uptake in the absence of insulin (basal: 1.08?0.13; 0.1mM SNP: 1.32?0.11; 10 mM SNP:3.85?0.32 μmol/ml/20 min) When muscles were incubated in the presence of 0.1 mM SNP with insulin, the glucose uptake was not significantly different than that induced by insulin alone (insulin: 3.54?0.34; insulin+0.1mM SNP: 4.42?0.37 μmol/ml/20 min). In the presence of 10 mM SNP with insulin, the combined effect on glucose uptake was greater than that induced by insulin alone (insulin+10mM SNP: 6.32 ? 0.31 μmol/ml/20 min). The calculation of net increase of insulinstimulated glucose uptake (SNP+insulin minus SNP alone) clearly demonstrated that insulin action of glucose uptake was not impaired by SNP. Furthermore, wortmannin did not inhibit SNPstimulated glucose uptake and NG-monomethyl-L-arginine, a NO synthase (NOS) inhibitor, also did not block insulin-stimulated glucose uptake, indicating no interaction between NO signaling and insulin signaling in glucose uptake mechanisms. These results strongly suggest that NO does not induce insulin resistance of glucose uptake in isolated rat epitrochlearis muscle.

Context. DEXA is recommended for osteoporosis screening. However, the rate of screening with DEXA is very low. Therefore, methods that can be used more easily and cost effectively are needed. Objective. The objective of this study is to develop a clinical risk assessment tool of osteoporosis (OSTEORISKAPP) by using syndromic approach. Design. A methodological study was performed. Subjects and Methods. Three hundred and fiftysix participants who are above 50 years old are participants of study and take history and physical examination. Positive likelihood ratio (LR), pre and post test probability, is calculated. A logistic regression analysis and a ROC analysis are made with the model constructed by those criteria. Results. Eighteen different clinical risk indices are diagnosed. According to LR, 4 of these criteria are minimally effective, 11 of them are weakly effective and 3 of them are medium effective criteria According to results of logistic regression analysis, back pain, waist pain, and usage of cortisone for more than 3 months, vertebra tenderness in physical examination, having dorsal kyphosis and being obese are turned out to be statistically significant in 89.9% confidence interval. AUC is found to be 0.948 and diagnostic test is found to have perfect distinction ability. Conclusion. Syndromic diagnostic criteria that will be used for osteoporosis screening of population and that is cost effective, no need to refer, practical, reliable and has tried to be developed.

Objectives. The aim of this study was to evaluate serum levels of interleukin (IL)-8 in pre- and postmenopausal women and in patients with surgically-induced menopause, and the relationship between IL-8 and vasomotor symptoms. Material and Method. 175 women were enrolled and were divided into 5 groups (I – Fertile women; II – Pre- and perimenopausal women; III – Postmenopausal women; IV – Surgically-induced menopause; V – Chronic inflammation). Multiplex cytokine kits were used to evaluate serum levels of interleukin-8. We determined the serum levels of the follicle stimulating hormone, of the luteinizing hormone, 17β-estradiol, progesterone, dehydroepiandrosterone and dehydroepiandrosterone sulfate using sandwich ELISA. The severity of the vasomotor symptoms was evaluated according to FDA guidelines. Results. Serum concentration of IL-8 in women with natural menopause (233.0±226.5 pg/ml; p<0.001) and in women with surgically-induced menopause (148.0±162.0 pg/ml; p=0.045) is significantly higher than in women of reproductive age (84.88±82.32 pg/ml). Serum levels of IL-8 in premenopausal women, postmenopausal women, and in women with surgically-induced menopause, respectively, with severe and moderate hot flashes, on one hand (174.8±90.94 pg/ml, 369.3±194.2 pg/ml, respectively 274.1±146.3 pg/ml), is significantly higher than in women without vasomotor symptoms or with mild hot flashes, on the other hand (19.97±22.15 pg/ml, 28.66±35.72 pg/ml, respectively 28.94±37.68 pg/ml; p<0.001). Serum levels of IL-8 are significantly higher in women of reproductive age with chronic inflammatory pathology (152.3±121.0 pg/ml) than in women without such pathology (84.88±82.32 pg/ml; p=0.02). Conclusions. IL-8 is significantly higher in postmenopausal women with vasomotor symptoms than in women without vasomotor symptoms. In the postmenopausal group, the serum levels of IL-8 are similar to those in women with chronic inflammatory pathology. IL-8 could be a key factor in occurrence of hot flashes in menopause and could be associated with peripheral vasodilatation in these women.

Context. Urolithiasis and obesity are now public health problems with an increased incidence worldwide. Management of urolithiasis in patients with morbid obesity is usually associated with higher morbidity and mortality compared to non-obese patients. ESWL is a nonsurgical procedure for the treatment of lithiasis. In obese patients the ESWL efficacy is influenced by the skin-to-stone distance or poorer detection of the calculus because of the fatty tissue. Objective. To highlight the overweight or obese lithiasic patient profile that could be best treated by ESWL. Subjects and Methods. We evaluated ESWL results in 1393 patients with kidney or ureteral stones between 5 and 20 mm. They were divided into 4 groups according to the BMI: Group A-overweight (BMI=25-30 kg/ m2); Group B-grade I obesity (BMI=30-35 kg/m2); Group C-grade II obesity (BMI=35-40 kg/m2) and a control group of normal weight (BMI=18-25 kg/m2). Results. Patients with a higher BMI required a greater number of ESWL sessions. A statistically significant greater number of patients with a waist circumference of >102 cm required more than 2 SWL sessions (p=0.007). Location of the stones in the pelvic ureter had the highest rate of success for obese patients (p=0.00001). The ESWL success rate in overweight and obese patients can be negatively influenced by BMI, abdominal circumference over 102 cm, and hardness of calculi reflected in the radiopacity on KUB. Conclusions. In patients with grade II obesity, pyelocaliceal calculus and increased hardness, other urological alternatives to lithiasis should be considered from the beginning.

Context. Oral anti-diabetic drugs (OADs) are leading option for treatment of type 2 diabetes (T2D). However, availability of OADs are limited in the presence of renal impairment (RI). Objective. In this study, we examined the efficacy of repaglinide, which is mainly metabolized and excreted via non-renal route, in patients with T2D and severe RI that consists mainly of chronic kidney disease (CKD) stage 4. Design, Subjects and Methods. This was an open label, single arm, interventional study by repaglinide monotherapy. The primary efficacy end point was HbA1c change from baseline to week 12. Results. Repaglinide treatment significantly reduced HbA1c levels from 7.7 ± 0.7% to 6.1 ± 0.3% (p<0.001) in 9 patients with severe RI (mean estimated glomerular filtration rate was 26.4 ± 7.5 mL/min/1.73m2). Focusing on 4 patients who received DPP-4 inhibitor monotherapy at enrolment, switching to repaglinide also significantly improved HbA1c levels. No hypoglycemic symptoms or severe hypoglycemia was reported in patients who completed the period of 12 weeks. Conclusions. We demonstrated the efficacy of repaglinide in patients with T2D and severe RI. In case that DPP-4 inhibitors are not enough to achieve targeted range of glycemic control, repaglinide is another good candidate.

Paragangliomas are rare neuroendocrine slowgrowing tumors, often asymptomatic, that originate from embryonic neural crest cell. In the head and neck area, the most common location is the carotid body, followed, with decreasing frequency, in jugular, tympanic and vagal sites. Bilateral carotid body tumors are extremely rare. Aim. To present the most important features of carotid body paragangliomas, illustrating the clinical characteristics, associated with a thorough analysis of the diagnostic imaging elements, but also the current therapeutic strategies, with respective anatomical, surgical considerations and potential complications that can occur. Surgical resection is the main line of treatment. The complex anatomy of the cervical region and the close relationships of carotid body paragangliomas with carotid vessels and cranial nerves, as well as its intense vascularization makes the surgical intervention a real challenge even for an experienced surgeon. Discussion. Starts from a bilateral carotid paraganglioma in a 35-year-old male, with painless lateral neck swelling, accidentally discovered by his barber about two years ago. Diagnosis was suspected on the basis of history, clinical and radiological findings. “Wait and scan” strategy plus endocrinologic assessment for MEN syndromes were considered the optimal therapeutic approach in this case.