ACTA ENDOCRINOLOGICA (BUC)

Abstract Purpose. Primary hyperparathyroidism (PHP) is a prevalent endocrine disorder requiring surgical treatment. The rise of minimally invasive parathyroidectomy as the favored surgical approach emphasizes the significance of localization studies. This study aims to explore clinical and laboratory profiles of PHP patients and evaluate the efficacy of diverse localization methods in a substantial patient cohort. Methods. We analyzed clinical features, biochemical parameters, and imaging outcomes for localization, as well as postoperative histopathological findings in 327 diagnosed PHP patients who underwent surgery. Initial localization methods, which included ultrasonography (US), US-guided Parathormone (PTH) washout analysis, and 99mTechnetium- Sestamibi/123Iodine Scintigraphy (MIBI-SPECT/CT), were applied to all patients. Advanced techniques like Four-Dimensional Computed Tomography (4D-CT) and 18F-Fluorocholine Positron Emission Tomography (18F-FCH PET/CT) were used for cases where initial methods failed and/ or for secondary intervention. Results. Minimally invasive surgery accounted for 74% (n=241) of cases. Histopathological analysis revealed single adenoma in 94.5% (n=309) patients, hyperplasia in 5.2% (n=17), and cancer in 0.3% (n=1). Adenoma volume showed a significant positive correlation with serum calcium and parathyroid hormone (PTH) levels (p<0.001). 82 and 26 cases required 4D-CT and 18F-FCH PET/CT respectively, for localization. Positive predictive values (PPV) for imaging modalities were: US (84.56%), US-guided PTHwashout analysis (87.30%), MIBI-SPECT/CT (92.1%), 4DCT (81.94%), and 18F-FCH PET/CT (95.83%). Conclusion. Serum calcium and PTH levels estimate adenoma size. Initial localization studies (i.e.US, PTH washout and, MIBI-SPECT/CT) effectively localized most adenomas. 4D-CT showed notable efficacy, and 18F-FCH PET/CT had the highest PPV for adenoma localization when the initial studies failed.

Objectives. The objective of this retrospective study was to evaluate weight gain at 3 months following insulin therapy initiation and to determine if it is due to fat or fat free tissue. Methods. Fifty-eight patients with T2DM and initiation of insulin therapy were evaluated. Body composition was assessed with InBody720 device (Biospace, Korea) before and 3 months after the initiation of insulin therapy. Results. The insulin therapy was initiated with basal insulin in 84.48% of the cases. The initial dose of insulin was 22.76±12.89 units/day and increased at 3 months to 30.81±18.49 units/day (p<0.001). The initial HbA1c was 9.86±2.02% and decreased to 7.58±1.19% (p<0.001). The body weight increased from 87.01±17.37 kg to 88.04±16.64 kg (p=0.026). The fat body mass and the percent of fat decreased with no statistical significance; the intracellular and extracellular body water increased significantly (intracellular: 26.30±5.96 vs. 27.26±6.16; extracellular: 16.61±3.63 vs. 17.03±3.84; p<0.001). Conclusion. During the first 3 months after initiation of insulin therapy a modest weight gain due to increase in the body water after restoration of the metabolic balance was observed.

-

Context. Polycystic ovary syndrome (PCOS) or disease (PCOD) is one of the most common causes of female infertility. Objective. The objective of this study was to find out the influence of insulin on LH, testosterone and SHBG in diffrent PCOS categories. Experimental design. A total of 800 women who were subjected to infertility treatment at infertility clinics were selected. About 60 healthy females with regular menstrual cycles were considered as control. The data were collected from hospital records using subject’s consent. Results. Relationship of insulin to LH and testosterone was positive and significant (p<0.05) in the entire PCOS group and in five PCOS subcategories with increased LH rise (i.e. 1.3, 2, 3, 4 & 5 times of LH rise in relation to FSH levels in each group respectively). The correlation pattern showed an increasing trend from lower to increased rise of LH compared to FSH. The relationship between insulin and SHBG was negative and significant (p<0.05) in all PCOS subcategories, except for the group having similar LH and FSH levels and also in another group with FSH levels higher than LH levels. A strong positive correlation was established between insulin and SHBG in normal subjects. The percentage of negative correlation was strong in PCOD subcategories with elevated rises of LH. Conclusion. This study established the influence of insulin on other marker hormones (LH, testosterone an SHBG) in various PCOS categories in view of their percentage of relationship.

Context. Injury and functional disorders in pituitary gland after COVID-19 still need elucidation. Objective. To investigate pituitary functions, particularly hypothalamic pituitary adrenal (HPA) axis after COVID-19 infection. Methods. This study was conducted at a university hospital between May and October 2021. Patients who had COVID-19, were enrolled as study group, three months after recovery. Participants who do not have COVID-19 diagnosis, with similar characteristics were included as control group. Blood samples were taken on the morning at 08 AM. Adrenal stimulation test was performed with 1 μg of ACTH (Synacthen). Results. The study group included 50 patients and control group was 49 cases. One (2%) out of the 50 patients with 8 a.m. serum cortisol below 5 μg/dL. Low serum ACTH levels were detected in 7 (14%) participants in patient group. Stimulation with 1 μg of ACTH (Synacthen) test was performed for 2 (4%) of 50 patients with serum cortisol below 10 μg/dL. Both patients achieved a peak cortisol of over 12.5 μg/dL after stimulation. Standard deviation (SD) score for insulin like growh factor-1 (IGF-1) was lower than –2 SD for age and gender in 7 (14%) patients. TSH levels was mildly increased in five (10%) patients. There was no significant difference in baseline pituitary hormone levels in study and control groups. Conclusion. Basal pituitary hormone levels and HPA axes were found to be preserved and competently functioning in patients who experienced mild/moderate COVID-19. However, symptoms observed after COVID-19 episode were evident in substantial amount of patients in this study and these symptoms were not associated with changes in pituitary gland function.

Context. The detrimental effects of hyperinsulinemia on human ovaries during follicular development process have been shown in various studies, particularly in women with polycystic ovary syndrome. To our knowledge there is no study regarding the effect of insulin resistance (IR) on the intrauterine insemination (IUI) success in women with unexplained infertility (UEI). Objective. To evaluate the effects of IR on the occurrence of pregnancy among infertile women undergoing ovulation induction (OI) with IUI for UEI. Design. Prospective cohort study. Subjects and Methods. 173 patients who met the criteria for UEI and under the age of 35 were included in this study. All women underwent OI with IUI and, subsequently, they were divided into two groups based on the presence of pregnancy. Data reviewed for analysis were demographic, clinical, and laboratory features. Results. There were 37 (21.4%) cycles with pregnancy and 136 (78.6%) cycles without pregnancy. Median infertility duration was significantly lower in the pregnant group when compared with non-pregnants (p=0.018). The mean number of previous cycles per patient was also lower in this group (p=0.028). No significant differences were found between the groups in terms of other variables. Levels of insulin, fasting glucose and HOMA-IR were also similar between the two groups. Conclusions. IR calculated by using HOMA-IR index has no positive or negative effect on the occurrence of pregnancy in women undergoing OI therapy with IUI for UEI.

Context. Foetal asphyxia, a frequent birth complication, detrimentally impacts the immature brain, resulting in neuronal damage, uncontrolled seizure activity and long-term neurological deficits. Oxytocin, a neurohormone mediating important materno-foetal interactions and parturition, has been previously suggested to modulate the immature brain’s excitability, playing a neuroprotective role. Our aim was to investigate the effects of exogenous oxytocin administration on seizure burden and acute brain injury in a perinatal model of asphyxia in rats. Animals and methods. Asphyxia was modelled by exposing immature rats to a 90-minute episode of low oxygen (9% O2) and high CO2 (20% CO2). Control rats were kept in ambient room-air for the same time interval. In a third group of experiments, oxytocin (0.02 UI/g body weight) was nasally administered 30 minutes before the asphyxia episode. Seizure burden was assessed by the cumulative number of loss of righting reflex (LRR) over a two-hour postexposure period. Acute brain injury was assessed through hippocampal S-100 beta, a biomarker of cellular injury, 24-hours after exposure. Results. Asphyxia increased both LRR and hippocampal S-100 beta protein compared to controls, and these effects were significantly reduced by oxytocin administration. Conclusion. Oxytocin treatment decreased both seizure burden and hippocampal injury, supporting a potential neuroprotective role for oxytocin in perinatal asphyxia.

Objective. To investigate clinicopathologic feature, diagnosis and differential diagnosis of gangliocytic paraganglioma (GP). Methods. Clinical data, histologic findings of one GP case in our hospital were reported and we reviewed the published literature on GP. Results. GP is composed of three types of cells: spindle cells, ganglion-like cells, and epithelioid cells. Several kinds of antibodies were used to evaluate and identify tumor cells immunohistochemically. Epithelioid cells showed positive results with antibodies for NSE , CgA, Syn, Ck and negative results with antibodies for S-100 protein, CD117.Spindle cells showed positive results with antibodies for S-100 protein, CD34 and negative results with antibodies for CD117, NSE, CgA, Syn, CK. Ganglion-like cells showed positive results with antibodies for NSE, CgA, Syn, CD117 and negative results with antibodies for S-100 protein and CK . In some cases, metastatic spread to regional lymph nodes or recurrence has been reported. Conclusions. GP is a rare true neuroendocrine tumor of potential metastatic capacity.

This study was performed to search the effect of a fiber rich dietary product on anthropometric measurements and some biochemical parameters of obese adult women. A total of 25 adult women (12 were in study and 13 were in control group, all randomly selected) volunteered in this study. At the beginning of the study, height, weight, waist and hip circumferences of all women were measured, and blood samples were collected for fasting blood glucose (FBG), insulin, triglycerides (TG), total cholesterol, HDL-C, LDL-C, VLDL-C levels. Patients having endocrine and metabolic disturbances and who need to use anti-obesity medications were not enrolled. A low calorie weight losing diet consisting of 50-55% carbohydrate, 15-20% protein and <30% fat was given to all cases, but women in the study group were given a specific dietary product rich in apple and wheat fiber as an exchange of one slice of bread every day. Patients were checked monthly with respect to their weight loss and diet adhesion during the three months of treatment period. Although biochemical parameters did not show any significant differences between the two groups at the beginning of the study, FBG and insulin levels were significantly lower in the study group than in the control group at the end of the treatment period. There were also significant decreases in insulin, triglyceride, total cholesterol and VLDL-C levels in the study group after 3 months of treatment, but not in the control group. Women in both groups lost weight, and their waist and hip circumferences decreased significantly. This concludes that the fiber rich, fat, sugar and salt free dietary product could be a useful dietary treatment not only in obesity, but also in dislipidemia and insulin resistant states.

Background. Intraabdominal obesity is considered a low level chronic proinflammatory state. The adipocyte is the central element that integrates multiple metabolic and endocrine signals.\r\nObjectives. This study monitors the metabolic effects of the administration of melatonin or melatonin associated with estrogen in surgically castrated female rats.\r\nMaterial and method. Experiments were performed in white female Wistar rats, with a weight of 160-200 g. At 14 days postovariectomy, a time period required for the postoperative validation of ovarian failure, with the experimental induction of artificial\r\nmenopause in the studied animals, estrogen replacement treatment and combined treatment of estrogen and melatonin were initiated. The duration of the administered treatment, with the products and the doses recommended for veterinary use, was of 12 consecutive weeks.\r\nResults. Food consumption (p=0.60), glycemia (p=0.053) and TG (p=0.34) did not significantly differ between the groups. The comparison of weight and intra-retroperitoneal\r\nfat between the groups in the last week showed that groups which did not receive estrogen had a significantly higher weight and higher intra-retroperitoneal fat than groups to which estrogen was administered (p<0.001). Groups which received estrogen associated with melatonin had a lower weight and a lower intra-retroperitoneal fat compared to groups, which received estrogen alone (p<0.001). Melatonin administred alone (without estrogens)does not show any effects on weight or lipid metabolism in ovarectomised rats.\r\nConclusion. In ovarectomised rats, the associated administration of estrogen and melatonin is correlated with: a less important increase in the body weight, under the conditions of unchanged food consumption, a decrease in intra-retroperitoneal fat, a decrease in total cholesterol, an increase in HDL-cholesterol levels.