ACTA ENDOCRINOLOGICA (BUC)

Introduction. Clinical or subclinical hypothyroidism dictates the severity of depressive episodes and more frequently overlaps psychotic phenomenology. There are also major depressive episodes resistant to treatment in patients with euthyroidism, in which supplementation of antidepressant medication with thyroid hormones is beneficial. Material. Systematization of meta-analyses from perspectives: hypothyroidism and depression, autoimmune and depression pathology, gestational and puerperal pathology in association with hormonal and dispositional changes, presentation of therapeutic schemes. Results. Hypothyroidism is more commonly comorbid with major depression in women. It associates the need for hospitalizations, psychotic phenomenology, resistance to treatment, somatic comorbidities. Autoimmune pathology is associated with depression and requires thorough investigation. A possible genetic candidate for thyroid dysfunction is the DIO1 gene. FT4 may be a predictor, but the combination of FT4 + TBG measured during the prenatal period has a higher prognostic power for a future depressive episode. Conclusion. The article presents psychiatric medication schemes that combine antidepressants and antipsychotics of various classes with other enhancers, an important role going back to step three, which includes thyroid hormones, mainly T3. The doses used are smaller than the amount of endogenous production of T3 daily, with a small risk of inducing clinical hyperthyroidism.

Introduction. Infertility is a very discussed problem in many endocrinological and gynecological courses and congresses. In a rapidly revolving environment women tend to postpone pregnancy to have security in their financial life and career. We discuss primary and secondary infertility and the hormonal results in women that presented for a desire to conceive with their partner. Infertility is considered to have many causes and annual follow-up is important, especially in women with no children and a stable partner.Hormonal parameters are often not recommended until late after 30 years of age, in women who adress routine consultations and should be considered much early on in their reproductive life, especially in women with familly history of premature menopause. Conclusions. There is still a lot to research in the field of ovarian response and poor ovarian reserve, but promising studies are being made in the present and near future.

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Context. Vitamin D, a fat-soluble prohormone, is synthesized in response to sunlight and plays several roles in the body. Objectives. To determine Vitamin D status among healthy, young female medical students studying at King Saud University, Riyadh, Saudi Arabia, and to study the effects of nutritional and environmental factors on Vitamin D level. Study design. It is a prospective, observational, cross-sectional study conducted between December 2012 and March 2013. Subjects and methods. One hundred and seventy eight healthy medical students participated in the study. Each subject completed a questionnaire about vitamin D deficiency and attitude towards related environmental and nutritional factors, including duration of sunlight exposure, and vitamin D supplements. Serum levels of 25-hydroxyvitamin D, parathyroid hormone, calcium, phosphorus, and alkaline phosphatase were obtained.Results. The mean serum vitamin D level of the study group was 41.41±29.31 mmol/L (normal 75–250 mmol/L). Out of 178 participants, 126 (70.8%) were vitamin D deficient (<50 mmol/L), 29 (16.3%) had insufficient vitamin D (50–75 mmol/L), and 23 (12.9%) had normal vitamin D level (>75 mmol/L), with mean serum levels of 25.52±10.89, 62.84±7.04 and 101.41±9.1 mmol/L, respectively. In comparison between vitamin D deficient and nondeficient groups, daily milk consumption (P < 0.001), use of vitamin D supplements (P < 0.0001), and frequency of sun exposure for ≥ 5 days/week (P < 0.006) were significantly higher in the nondeficient group. Conclusion. Prevalence of vitamin D deficiency among female medical students in Riyadh is high and may be attributed to nutritional, social and environmental factors.

Background and Purpose. Fibroblast growth factor 21 (FGF21) has recently been identified as a metabolic regulator, but its physiological role is still not completely known. The aim of this study was to evaluate serum FGF21 levels in an Iranian population with type 2 diabetes. Materials and Methods. This cross-sectional study was conducted in patients with type 2 diabetes. All patients were evaluated for fasting serum levels of glucose, glycated hemoglobin (HbA1c), lipids, urea and creatinine. Participants were divided into two groups with poorly-controlled and wellcontrolled diabetes based on their HbA1c levels. Healthy nondiabetic subjects (matched with patients in terms of age, sex and body mass index [BMI]) were also recruited as control group. Serum FGF21 concentrations were determined in all subjects using ELISA. Results. Of the evaluated 141 subjects, 49 (34.8%) were categorized as having well-controlled diabetes, 66 (46.8%) had poorly-controlled diabetes, and there were 26 subjects in the normal control group. Mean serum FGF-21 concentration was 337.89±283.67 ng/L in the diabetic group and 237.25±43.22 ng/mL in the non-diabetic group (p<0.001). Mean serum FGF21 level was 237.25 ± 43.22 ng/mL in the control group, 309.81 ± 301.68 ng/mL in the well-controlled diabetic group, and 358.73 ± 269.98 ng/mL in the poorly controlled diabetic group. Serum FGF21 level in the poorly controlled diabetic group was significantly higher than that in the well-controlled diabetic and the healthy control groups (p=0.02) but there was no significant difference between the well-controlled and healthy groups. There was no significant association between serum FGF21 levels with lipid levels, presence of diabetic complications and BMI (p > 0.05). Conclusions. The present results suggested an association between elevated serum levels of FGF21 and poor control of diabetes. Future studies are warranted to elucidate the prognostic role of these elevated levels of FGF21 in diabetic subjects.

Context. For control of blood glucose in diabetic patients on enteral feeding either insulin infusion or multiple insulin injections are used. However, both of these\r\nmethods necessitate a very close follow-up and are not easy to apply during home care.\r\nObjective. In this study we aimed to see whether insulin glargine once daily is proper for glucose regulation in enterally fed diabetic patients.\r\nDESIGN: Insulin glargine is given to enterally fed diabetic patients and they are followed up for three months.\r\nSubjects and methods. Thirteen diabetic stroke patients with PEG are involved in the study. Treatment of these patients is switched from insulin infusion or multiple insulin injections to once daily insulin glargine and they are followed up for 3 months.\r\nResults. Mean blood glucose values are improved with once daily insulin glargine regimen. HbA1c decreased from 7.2% ? 1.5 5. to 6.7% ? 0.8 with insulin glargine. Daily insulin requirement of the patients is significantly decreased as well. A significant decrease in the hypoglycemic episodes is\r\ndetected with glargine (p<0,0001).\r\nConclusion. Insulin glargine once daily is a safe and effective regimen for diabetic patients with PEG.

As the kits used in routine for assessment of human growth hormone (hGH) status in CSF are originally designed for the serum and plasma, the specifications and limitations imposed by some environmental factor are important to be known. The aim of study was to\r\ninvestigate the influence of different protein concentrations on an immunometric assay to design a suitable and reproducible method for hGH measurement in different matrices, particularly in CSF-like environment.\r\nMaterial and methods. Experiments were performed using an in-house protocol for the determination of hGH by Time Resolved Immunofluorometric method. Standard curves were prepared in different biological matrices (sheep, human or fetal calf serums and CSFlike matrix). The concentrations of albumin and gamma-globulins were the variable parameters. The gold standard was the standard curve in sheep serum.\r\nResults. Constantly high background signal values were obtained at different albumin concentrations, in the absence of IgG, indicating intense non-specific binding and a low sensitivity. This fact allows accurate hGH measurement at over 5-10 ng/ml. Using a reaction environment enriched in IgG with a standard albumin concentration, background signal decreases while increasing IgG concentration. The highest sensibility is obtained for 5 g/l and 2.5 g/l IgG environments, allowing the sample signal to be measured accurately at hGH concentrations of 0.2 ng/ml or 0.5 ng/ml respectivly. This is observed in all biological matrices used.\r\nConclusions. The variation of protein concentration influences hGH determination. A standard curve with high sensibility for low values and a reduction in the influences of the reaction environment by minimising non-specific binding were obtained by enriching the environment with IgG.

Background. The association between high blood pressure and hypokalemia is usually caused by primary or secondary hyperaldosteronism. Recent studies indicate that\r\nprimary hyperaldosteronism is a much more common cause of hypertension than had been previously demonstrated. Arterial hypertension is often present in hypothyroid patients, but almost never associated with hypokalemia.\r\nCase report. We report the case of a 69 years old male admitted for shortness of breath, inferior limbs edema and fatigue. From his medical history we mention: essential\r\narterial hypertension (for about 25 years), ischaemic coronary artery disease (for 20 years), for which he underwent PTCA (two years ago), atrial fibrillation electrically converted to sinus rhythm (a year a ago). Despite taking four antihypertensive drugs his blood pressure was far from being controlled. Blood analysis revealed an important hypopotasemia (K 2.4mmol/l) and consequently the loop diuretic was replaced with a potassium-sparing diuretic. The measured proved to be unsuccessful and potassium supplements had to be\r\nadded, but with modest results (K 2.94mmol/l). Further specific investigations revealed almost normal levels of aldosteron, low renin, normal cortisol. Associated was a high Thyroid-stimulating hormone (TSH). Computer tomografy (CT) showed bilateral suprarenal glands adenomas.\r\nConsidering the laboratory findings, we interpret the case as a primary hyperaldosteronism and a successful treatment with spironolactone was initiated.

Bronchial carcinoid tumours (typical and atypical carcinoid) are endobronchial tumours that can benefit from both local endobronchial treatment and surgical treatment. Given their relatively good prognosis compared to the other two forms of pulmonary neuroendocrine tumours, there is a current concern about the implications of lymph node involvement as well as the identification of new prognostic factors to shape the treatment of these patients in the future.

Context. Female adnexal tumors of probable Wolffian origin (FATWO) represent very rare borderline ovarian tumors with low malignant potential. Only 15 cases of malignant FATWO are described in the current literature, among which, only 5 are reported as being recurrent. Objective. Due to the rare presentation of the recurrence of the malignant FATWO and the few cases reported in the scientific database, there are no clear therapy recommendations. This paper should help practitioners to choose the best therapy approach. Design. This paper presents the 6th case of malignant recurrent FATWO and will compare all the cases available in the literature. Subjects and Methods. We present a review of the literature comparing the therapeutic approaches and outcomes of all the five cases of recurrent malignant FATWOs. Also, we introduce the case of a stage III Wolffian origin adnexal tumor with multiple recurrences appeared after 6 years of disease free interval. Results. Our case presents the longest survival reported in the literature and underwent most surgical procedures of the recurrences and more than 4 lines of chemotherapy regimens. Conclusions. This paper shows possible therapeutic approaches to be used as example by the practitioners according to the drug availability in their centers.