ACTA ENDOCRINOLOGICA (BUC)

Context. Diabetes mellitus is a well known risk factor for COVID-19 patients. However, There is limited data to investigate the association between prediabetes and COVID-19. Objective. We aimed to evaluate the effect of prediabetes and mechanical ventilation on the course of COVID-19 and determine whether patients who recover from COVID-19 infection show changes in cardiac function and laboratory findings during follow-up. Patients and Methods. This study included 87 adult patients who were diagnosed with COVID-19 according to the WHO definition and were admitted for inpatient treatment between April 2021 and August 2021. They were classified into 3 groups, normoglycemia (n=40), prediabetes (n=25), and diabetes (n=22), and then divided into groups according to need for mechanical ventilation. Statistical analyses were performed to compare laboratory, echocardiographic findings and COVID-19 outcomes among the groups. Results. The need of mechanical ventilation was significantly higher in both diabetes and prediabetes groups than the normoglycemic group. Patients with diabetes and prediabetes had significantly higher LV E/Em (p=0.003, p=0.045) and RV MPI (p=0.032, p=0.021) and significantly shorter PAT (p=0.001, p=0.036) and significantly longer RV IVRT (p=0.021, p=0.017), respectively, compared to the normoglycemia group. Patients who required mechanical ventilation had significantly higher CRP (p=0.043), troponin (p<0.001), ferritin (p<0.001), HBA1C (P<0.001), glucose (p=0.019), monocytes (p<0.001), and monocytes-HDL ratio (MHR) (p<0.001) and significantly lower levels of HDL-C (p<0.001). Glucose, HDL-C, troponin, MPV, NLR, PLR level and RV and E/Em were found independently associated with the RVMPI Conclusion. Prediabetes was associated with more impaired LV and RV diastolic functions compared to normoglycemic patients, comparable to those seen in diabetes. Our observations suggest that prediabetes should be considered as diabetes in the risk stratification of patients with COVID-19.

Objective. We analyzed the correlation between glycemic variability and psychological problems such as depression, anxiety disorder, and low self-esteem in pregnant and non-pregnant (excluding gestational diabetes) patients with diabetes. Besides its originality, this study might contribute to better / earlier diagnosis of these psychological conditions, with a special interest in pregnant diabetic women. Better management and cost reduction of care could be a consequence. Methods. We compared diabetic pregnant and non-pregnant women from the perspective of the glycemic variability (for a period of 15 days prior inclusion in the study) and their results on the standardized questionnaires: Beck depression inventory, Hamilton anxiety scale – HRSA, Rosenberg self-esteem test. Results and Conclusions. A statistically significant correlation was identified in both groups between the glycemic oscillation and depression, anxiety, and low selfesteem. Diabetic pregnant women had a higher statistical significance for the correlation between the glycemic oscillation and depression, as well as between the glycemic oscillation and anxiety than non-pregnant diabetic patients. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients.

Context. Polycystic ovarian syndrome is the most common endocrine disorder in women of reproductive age. Objective. The purpose of the present study is to investigate the role of progesterone on survival, in vitro growth and in vitro maturation of follicles and the maturation of oocytes derived from mouse polycystic ovary. Subjects and Methods. To induce polycystic ovary (PCO) female NMRI mice 21 days old were injected daily with testosterone enanthate 1 mg/100g body weight dissolved in sesame oil for 4 weeks (PCO group), while non- PCO group were injected only with vehicle. Follicles were derived from both groups and cultured in MEM-α medium either with progesterone or without progesterone. Sizes of follicles were measured in days 1, 3, 6, 9 and 12. After 12 days follicles were transferred to mature medium, follicles from two groups were cultured for 24 and 48 h and the in vitro maturation of oocytes was assessed. Results. In PCO groups with progesterone, survival and in vitro growth of follicles, significantly increased as compared with PCO groups without progesterone (p<0.05). The in vitro maturation rate in PCO group with progesterone was significantly higher than in those not treated by progesterone (p<0.05). Conclusions. This study demonstrated that progesterone can improve survival, in vitro growth and in vitro maturation of follicles derived from mouse polycystic ovary.

-

Introduction. Pheochromocytoma is a rare clinical finding during pregnancy. Due to the variable clinical presentation it may be mistaken for preeclampsia or primary hypertension. The early antenatal diagnosis is crucial, because it reduces possible maternal and fetal complications. Pheochromocytomas are usually benign, but may also present as or develop into a malignancy. Malignancy requires evidence of metastases at non-chromaffin sites distant from that of the primary tumor. Large tumor size and malignant disease are not necessarily associated. Case. The patient, a 39 years old multipara presented at 30 weeks of gestation with labile hypertension, headache and palpitations. She had a 6 years history of chronic hypertension controlled during the pregnancy with methyldopa. Using this treatment blood pressure was maintained at 140/100 mmHg. Further biochemical and radiological investigations confirmed the diagnosis of pheochromocytoma. The patient was invasively monitored and treated with alpha-adrenoblockers. Childbirth was performed by elective cesarean section at 34 weeks with simultaneous right-sided adrenalectomy. Postoperative period was uneventful. Histological examination of 12 cm encapsulated tumor revealed trabecular type pheochromocytma with focal capsular invasion. Although the usual criteria for malignancy, such as mitotic activity, nuclear pleomorphism, are not suitable to discern benign from malignant pheochromocytomas, we considered this large tumor presumably malignant in order to provide systematic longterm follow-up. Postoperative biochemical and imagistic screening was planned to detect and treat local recurrence or metastatic tumors. Conclusions. A multidisciplinary team to diagnose and treat pheochromocytoma during pregnancy is mandatory. Careful postoperative monitoring of recurrent disease is necessary indefinitely.

Aims: Prolonged exposure to a glucocorticoid excess leads to cognitive impairment in experimental animals as well as humans. The present study tries to identify the cognitive deficits in patients with Cushing’s syndrome and to evaluate the possible residual deficits in patients after treatment. Materials and methods: 19 patients (women) with a history of chronic endogenous hypercortisolemia were investigated for etiology using clinical and biochemical criteria. Cognitive functions were evaluated using a battery of psychometric tests: the Rey Auditory Verbal Learning Test (RAVLT), the BCR2 battery for general intellectual potential and the Prague test, for divided attention and resistance to psychic fatigue. The patients were divided into two groups (before surgical treatment– Cushing and after surgical treatment – postCushing) without differences in age or duration of studies between groups (p = ns). The controls were considered to belong to the general population for which the psychometric tests were standardized. Results: Both groups showed an altered pattern of incremental learning - scores below standard in the last two trials of the RAVLT (one sample t test, one tailed, p<0.05), and the total score (p<0.05 for PostCushing, p=0.07 for Cushing); both had very low total scores in the battery for intellectual potential. The PostCushing scores were significantly better than those of the Cushing group for only one nonverbal test (complex perceptual analysis), p<0.02. There appears to be no significant effect of cortisol exposure on distributive attention; there is however an alteration in the resistance to psychic fatigue. Daily average cortisol exposure was positively correlated with the number of errors in learning for both groups (r=0.65, p=0.058 for Cushing; r=0.85, p<0.005 for PostCushing) Duration of illness was negatively correlated with the total learning score in the PostCushing group (r=-0.68, p<0.05). For the Cushing group there was a strong negative correlation between the duration of illness, general performance (r=-0.81, p<0.05) and verbal scores (r=-0.77, p<0.07).

Context and objective. The new insights in the pathogenesis of osteoarthritis (OA) reveal the implications of adipocytokines. This study aims to analyze the correlations between the serum value of adiponectin and the clinical rehabilitation effects in patients diagnosed with knee OA, admitted and treated in the complex balneal resort of Techirghiol lake. Subjects and methods. The prospective randomized clinical study included 23 patients in the study group, diagnosed with knee OA according to ACR criteria, and a matching control group of 23 subjects. Serum level of adiponectin (using ELISA technique), uric acid, triglycerides, cholesterol, HDLcholesterol and clinical response using a visual analog scale (VAS) were evaluated in all patients on their admission day and after 10 days of balneal treatment. Control group benefited from the same procedures except for cold mud therapy and mineral water baths. Results. Plasma adiponectin levels (23.73±6.44 ng/dL) were statistically higher (p<0.05) in the study group compared to the control group (18.15±6.49 ng/dL). The mean VAS in both groups was decreased (p<0.005) compared to the initial moment. Conclusions. Cold peloidotherapy combined with physical therapy and balneal factors induces serum adiponectin elevation and improves knee pain in OA. Therapeutic properties of Techirghiol mud still need further research.

Introduction. Patients with breast cancer are treated after surgery by radiation and\r\nchemotherapy, potentially nephrotoxic. Patients with tumor estrogen-positive receptors are then\r\ntreated with Tamoxifen with a possible renoprotective effect. Aim. To assess the effects of\r\nradiation and chemotherapy and of Tamoxifen on renal function in patients with breast cancer.\r\nPatients and Methods. We undertook a retrospective observational study on 76 breast\r\ncancer patients during 2002-2006. Depending on the estrogen receptor status of the tumour\r\nthey were divided into group A (estrogen positive) with 50 patients, mean age: 57.64?9.34,\r\ntreated with Tamoxifen and group B (estrogen negative), 26 patients, mean age: 50?9.83\r\nwho did not receive Tamoxifen. Both groups underwent surgical tumor resection, radiation\r\nand chemotherapy. The TNM status of the tumours was similar in both groups. (2/3 stages\r\nI and II and 1/3 stages III and IV). We followed up the GFR (MDRD 4) before radiation and\r\nchemotherapy and after this treatment. Thereafter, we followed up the GFR in group A at 1,\r\n2 and 3 years of Tamoxifen and in group B at 1, 2 and 3 years of radiation and\r\nchemotherapy. Statistical analysis was performed using OpenEpi 2.3. software.\r\nResults. In group A the GFR declined not significantly after radiation and chemotherapy\r\nand at 1 year of Tamoxifen. At 2 ys of Tamoxifen, in the 18 surviving patients the GFR\r\nincreased from 61.13?17.53 mL/min to 66.56?16.3 mL/min (p=0.009). At 3 y of Tamoxifen,\r\nthe 12 surviving patients showed a preservation of the GFR. In group B the GFR declined from\r\n88.14?14.63 mL/min (baseline) to 80.01?20.62 mL/min (p=0.0001) after radiation and\r\nchemotherapy. At 1 y after radiation and chemotherapy the GFR declined to 78.21?17.65\r\nmL/min (p<0.001). At 2 y after radiation and chemotherapy in the 18 surviving patients the\r\nGFR declined to 70.94?13.39 mL/min (p<0.001 as compared to baseline). At 3 y in the 8\r\nsurviving patients the GFR declined to 61.36?9.17 mL/min (p=0.001 as compared to baseline).\r\nConclusions. Patients undergoing treatment with Tamoxifen (group A) showed a\r\npreservation of their renal function. In patients undergoing radiation and chemotherapy\r\nalone (group B) we noticed a decline of the Glomerular Filtration Rate.