Acta Endocrinologica-Bucharest最新文献

Contex: Detection of parathyroid incidentalomas (PTIs) by ultrasonography (US) generally depends on clinical experience and it can be usually confused with perithyroidal lymph nodes.

Objective: We aimed to evaluate the role of US for the detection of PTIs and define clinicopathologic features of PTIs detected during routine neck US.

Design: In this retrospective study, we studied PTIs in a multidisciplinary clinical approach of nuclear medicine and general surgery clinics.

Subjects and methods: US indications and reports of 41275 were reviewed retrospectively. Of these patients, PTI was suspected in 66 (0.16%) patients. Those with a pathology-confirmed diagnosis after surgery formed Group PCD and those without a pathology-confirmed diagnosis and operation Group NPCD. These groups were compared statistically according to demographic data, laboratory tests, imaging results and postoperative findings.

Results: The diagnosis of PTI was confirmed pathologically in 31 operated patients. Other pathologies rather than PTI on US were multinodular goiter, thyroiditis, thyroid nodule and perithyroidal lymph node. PTH and calcium levels were significantly higher in PCD Group;anti-TPO and anti-TG levels were significantly higher in NPCD Group.

Conclusions: Lesions suspected of PTI on US should be followed-up with further evaluation by laboratory tests and imaging methods and a multidisciplinary working environment should be established.

Introduction: Diabetes mellitus, a chronic metabolic disorder stemming from pancreatic dysfunction, is surging in India, notably among those aged 60 and above. The escalating disease prevalence in this demographic necessitates heightened medication use, escalating the risk of Adverse Drug Reactions (ADRs). This underscores the vital role of ADR monitoring to curtail potential harm.

Method: A 12-month cross-sectional, prospective, observational study engaged 200 participants from the geriatric Outpatient Department (OPD). Diabetic patients in the geriatric OPD, willing to participate, underwent face-to-face evaluations using a structured questionnaire focused on adverse reactions to anti-diabetic medications. The study also included a Knowledge, Attitude, and Practice (KAP) assessment.

Results: Of the 200 patients, 57% were male, 43% female. Thirteen participants (7 male, 6 female) reported ADR encounters during therapy, predominantly categorized as mild in causality and severity. KAP assessments unveiled a robust understanding of ADRs, primarily shaped by physicians and reinforced by pharmacists. Anticipation of ADR occurrence was noted in 70% of respondents, linked to non-compliance and lifestyle factors.

Conclusion: Educating caregivers about the critical importance of monitoring medication adherence among the elderly is imperative. Cultivating an attitude of reporting even minor ADRs to appropriate authorities is essential for harm prevention.

Context: Studies indicate a decrease in spatial memory across species as they age. Moreover, consistent administration of Gonadotropin-releasing hormone (GnRH) improves learning abilities in older rats that have undergone gonadectomy.

Objective: The aim of this study was to investigate the effects of the GnRH agonist, leuprolide acetate (LA) on spatial memory in aged intact male rats and the expression of proteins associated with hippocampal plasticity.

Subjects and methods: Aged male rats were injected with LA or saline every three days for nine weeks to assess the effects of LA on spatial memory. The aged rats were trained in the Morris Water Maze for four days, and the evaluation took place on the fifth day. Additionally, the Y-maze test was used to investigate short-term spatial memory. The expression of spinophilin and microtubule-associated protein 2 (MAP2) in the hippocampus was measured.

Results: Behavioral tests revealed that LA improves spatial memory in aged rats. Additionally, we observed increased expression of spinophilin and MAP2 in the hippocampus of aged male rats following LA treatment. Based on these results, the administration of LA holds is a potential treatment for restoring cognitive function in aged individuals.

Context: In patients undergoing thyroidectomy for malignant disease, lower quality of life scores were observed in the early postoperative period compared to those undergoing thyroidectomy for benign causes.

Objective: Thyroid gland diseases are commonly encountered in society. This study presents health-related quality of life differences in thyroidectomies performed for benign and malignant diseases and the factors affecting this.

Design: Patients who underwent thyroidectomy for thyroid disease between January 2021 and January 2022 were evaluated prospectively.

Subjects and methods: The SF 36 questionnaire was applied and interpreted at the 1^st and 6^th months after thyroidectomy in patients over the age of 18 who did not have a history of previous thyroid surgery.

Results: The study included a total of 228 patients. Among them, 171 (75%) were female (male/female: 57/171). Multinodular goiter in benign cases and papillary carcinoma in malignant cases were predominant (68.3% and 90.6%, respectively). SF-36 scores were found to be worse in the malignant group.

Conclusion: In patients undergoing thyroidectomy for malignant disease, lower quality of life scores were observed in the early postoperative period compared to those undergoing thyroidectomy for benign causes.

Denosumab,a monoclonal IgG2 antibody directed against RANK-L,is used as a neoadjuvant therapy for inoperable or metastatic giant cell tumor of bone. Many side effects like as hypocalcemia during treatment and rarely severe hypercalcemia especially in children after discontinuation of denosumab occurred. The unpredictable onset and recurrent episodes of severe hypercalcemia increase the duration of hospitalization and the risk of complications. Persistent hypercalcemia and difficulties in management have prompted the search for different more effective therapeutic options.

Objectives: To share our experience with the use of oral bisphosphonate in acute and long-term therapy of severe hypercalcemia following high-dose denosumab therapy and to review the literature on this subject.

Case: We report the management of a case of severe hypercalcemia that developed 4 months after the completion of 18-month denosumab treatment in a 9-year-old girl who was followed up with a giant cell bone tumor for 6 years. Based on an evaluation aiming to determine etiology, hypercalcemia was considered as "rebound-linked" upon denosumab discontinuation. Severe hypercalcemia attacks recurring with an interval of 2 weeks were treated with IV bisphosphonate, but when mild hypercalcemia developed again, treatment with 70 mg per week of oral bisphosphonate was planned. After the second dose of alendronate, the calcium level always remained below 10.5 mg/dl. In the 14-month follow-up, no hypercalcemia attack was observed again.

Results: Rebound hypercalcemia can occur as an unpredictable recurrent episode at any time after denosumab cessation. Thus, the patient should be closely monitored especially in childhood due to rapid bone cycle. In long-term follow-up, oral biphosphonates can be used effectively to reduce hospitalization time and the management of especially life-threatening recurrent attacks.

Background: Sweet's syndrome (SS) or acute febrile neutrophilic dermatosis is a dermatological illness that can be described by tender erythematous plaques or nodules and acute onset fever. The etiology is multifactorial and is not fully understood. SS is separated in three subclasses: classical, malignancy-associated, and drug-induced. It was shown that this syndrome can reveal an underlying hematological or solid malignancy.

Case presentation: We report the case of a 55-year-old female patient referred to the Urology department for management of pheochromocytoma in the right adrenal gland, revealed by abdominal imaging in another medical unit during the evaluation and diagnosis of multiple mucocutaneous lesions, characterized by erythematous-violaceous plaques and nodules, and painful aphthous ulcers of the tongue. The eruption of each lesion was preceded by low-grade fever and chills. The hormonal profile highlighted the presence of elevated normetanephrines. We performed 3D laparoscopic transperitoneal right adrenalectomy after preoperative treatment with alpha blocker therapy. The clinical outcome was favourable, given that the cutaneous lesions started to heal after the surgery.

Conclusions: Sweet's syndrome in association with pheochromocytoma is a very rare condition, only few cases were described in literature to our knowledge. The multidisciplinary collaboration is extremely important in the management of such cases.

Objective: Few prognostic analyses have been conducted for papillary thyroid cancer (PTC) patients with preablative stimulated Tg >10 ng/mL. We investigated the therapeutic responses and prognosis of these patients after the initial radioiodine (RAI) therapy.

Methods: We retrospectively assessed 256 patients with PTC who underwent RAI remnant ablation after total thyroidectomy, and all presTg levels were >10 ng/mL. We assessed therapeutic responses and influencing factors 6-12 months after the initial RAI therapy. The Kaplan-Meier method was used to analyze progression-free survival (PFS).

Results: After initial RAI therapy, excellent (ER), indeterminate (IDR), biochemically incomplete (BIR), and structurally incomplete (SIR) responses were identified in 5.1% (13/256), 22.6% (58/256), 46.9% (120/256), and 25.4% (65/256) of the patients, respectively. Among them, incomplete response (IR [BIR+SIR]), accounting for 72.3% of the responses. Univariate and multivariate analyses showed that presTg (OR=1.047, 95% CI 1.027-1.066, p=0.000), sex (OR=3.356, 95% CI 1.613-6.986, p=0.001), and tumor size (OR=1.431, 95% CI 1.050-1.951, p=0.023) were independent risk factors for IR. ROC analysis identified presTg levels and tumor size cutoffs of 24.4 mg/mL and 2.3 cm, respectively, for predicting IR. The PFS was significantly shorter in the SIR group than in the ER, IDR, and BIR groups (p=0.020). At the last follow-up, the number of patients with SIR decreased significantly (65 to 44 cases).

Conclusions: PresTg level, tumor size, and male sex were predictive of IR, and patients with initial SIR showed the poorest prognosis. Individualized interventions can improve the prognosis of patients with an initial SIR.

Parathyroid cancer is an uncommon endocrine malignancy. It has slow clinical course and low malignancy potential. It represents 1% of primary hyperparathyroidism. It results with more agrressive biological behaviour and severe clinical condition than benign reasons. Extended resection in the first operation is essential for PC treatment and decreases local recurrence that is observed in high frequency. Palliative surgery should be considered in patients with unresectable tumor. Immunotherapy and recent interventional radiological procedures are considered for patients that are unfit to surgery. Effect of adjuvant chemotherapy and radiotherapy is limited however recent immunization studies are promising. Parathyroid cancer epidemiology, staging system, diagnosis and advancements in treatment are considered according to recent literature in this review.

Background: Diabetes mellitus has been associated with many different musculoskeletal system problems.

Objective: This study aims to show the prevalence of musculoskeletal disorders in patients with diabetes and to reveal their relationship to the metabolic parameters and microvascular complications.

Methods: Seven hundred two diabetic patients who consecutively applied to our clinic between March 2017 and February 2018 were included in this prospective cross-sectional study. The relationship of the musculoskeletal disorders including carpal tunnel syndrome, Dupuytren's contracture, adhesive capsulitis, flexor tenosynovitis, limited joint mobility syndrome, Charcot arthropathy, diabetic foot and gout to the patients' age, gender, type of diabetes, duration of diabetes, metabolic parameters, and microvascular complications were evaluated.

Results: Musculoskeletal system disorders were detected in 45.9% (n = 322) of the 702 diabetic patients evaluated in our study. The most common disorders were carpal tunnel syndrome 17.7% (n = 124), Dupuytren's contracture 14.4% (n = 101), and adhesive capsulitis 13.8% (n = 97). A statistically significant relationship of the HbA1c level with Dupuytren's contracture, carpal tunnel syndrome, and adhesive capsulitis was detected (p<0.05).

Conclusions: Patients' age, duration of diabetes, HbA1c level, and presence of microvascular complications are associated with musculoskeletal disorders in this population.

Context: Osteonecrosis (ON) is bone death caused by inadequate blood supply and its optimal management remains uncertain.

Objective: We describe the outcomes of BP (pamidronate) treatment in our patients.

Design: Data regarding clinical, laboratory, magnetic resonance imaging (MRI) studies, and bone mineral density measurements (BMD) were recorded before and one year after treatment (reevaluation). The severity of the clinical picture was assessed using the criteria of the common terminology criteria for adverse events (CTCAE).

Subjects and methods: There were four female patients (patient 1, acute lymphoblastic leukemia; patient 2, immune thrombocytopenic purpura; patients 3 and 4, systemic lupus erythematosus) .All of them had been treated with high-dose prednisolone. Clinical picture of all patients were consistent with grade 3 according to CTCAE(: severe symptoms, limiting self-care ).

Results: ON lesions were multifocal in the lower limbs in all of them and none of them had any fractures. All of them had been treated with high-dose glucocorticoid. Patients were treated with pamidronate (1 mg/kg/day, with maximum dose of 60 mg/day, for two days, quarterly). At the time of re-evaluation(one year after treatment), the lesions were stable on MRI, and their clinical condition was consistent with grade 1 according to CTCAE(asymptomatic). No side effects related to the use of bisphosphonates were observed except for increased BMD (SD score of 2.9) in one of the patients.

Conclusions: Pamidronate may be an effective treatment for the improvement of functional impairment and pain among patients with severe osteonecrosis (ON) lesions.