Acta Endocrinologica-Bucharest最新文献

Background: The most serious complication of central neck dissection (CND) is inadvertent parathyroidectomy. There is no definitive method for intraoperative diagnosis of this complication.

Method: We studied on CND indicated 17 thyroid cancer patients (14 female, 3 male, age range: 21-67, mean age: 43.4). The excised CND material was kept in 50 ml of normal saline for 30 minutes. A 2 ml sample was taken from this fluid and sent to biochemistry for rapid parathyroid hormone (PTH) measurement.

Results: PTH values were <10pg/mL in 14 patients. PTH values of three patients were very high (112pg/mL, 167pg/mL, 210pg/mL respectively). When the excised tissue in these patients was evaluated intraoperatively with loop glasses, one parathyroid tissue was found in each of the three cases and these were autotransplanted intramuscularly. After this procedure we kept CND tissue material again in another normal saline of 50mL in 30 minutes and PTH was measured. The values came back as <10pg/mL. No parathyroid gland was found in any case in the postoperative routine histopathological evaluation. No patient had symptoms of hypocalcemia during the eight-weeks postoperative follow-up.

Conclusion: Inadvertent parathyroidectomy due to CND is a serious complication. This complication can be prevented with the simple method we recommend here.

Context: Intraoperative parathyroid hormone (IO PTH) monitoring has determinative role in surgery for tertiary hyperparathyroidism (tHPT).

Objective: We tried to find out whether the extent of surgery to be performed can be dedicated via IO PTH monitoring in tHPT.

Design: Renal transplantation (RTX) recipients who had been operated and followed up because of tHPT between 9/2014 and 5/2021 at our institution were retrospectively analysed.

Subjects and methods: We analysed the pre-operative and postoperative data of 41 patients with tHPT.

Results: Considering IO PTH monitoring; 70% and more decrease of the hormone level leaded us favourable results (89% surgical success) regardless of the PTX method (p<0.05). We obtained the same surgical success rate (75%) in patients in whom monitoring was done and was not done. We observed high success ratios (100%) in the latter group via subtotal PTX and total PTX plus autotransplantation (AT) (p<0.05).

Conclusions: In surgery for tHPT, IO PTH monitoring should be maintained. When we observe 70% or more decline in the hormone level, we can decide to finish the operation regardless of the surgical technique. If hormone level decrease is below 70%, we have to continue exploration.

Introduction: Primary hyperparathyroidism (PHPT) is a prevalent endocrine condition that presents with significant clinical symptoms. Ectopic adenomas commonly occur in the tracheo-esophageal groove, thymus, intrathyroidal, and mediastinum. While mediastinal ectopic adenomas are frequently observed, pericardial ectopic adenomas are only documented in case reports in the literature.

Case report: We present a 65-year-old female patient who had persistent PHPT and underwent re-sternotomy and excision of a pericardial ectopic parathyroid adenoma. The typical treatment for PHPT has generally been conventional bilateral neck exploration without preoperative imaging. Conventional bilateral neck exploration has decreased in popularity because of the rise in the minimally invasive parathyroidectomy (MIP) procedure. The use of MIP is prevalent in surgical procedures, and it is crucial to have precise preoperative localization. Due to the ectopic localization of certain parathyroid adenomas, they are regarded as an important cause of the failure of primary surgery. Hence, particularly when dealing with persistent and recurrent PHPT, modern imaging techniques like 4D CT enhance the efficacy of surgical interventions. Therefore, particularly in cases of ectopic parathyroid adenomas located in the mediastinum, it is important to consider the possibility that if the adenoma cannot be found after surgery, it may be located in the pericardial region.

This review provides a comprehensive analysis of drugs approved by the U.S. Food and Drug Administration (USFDA) for managing diabetes mellitus (DM) from 2013 to 2022, including emerging treatments from phase 3 clinical trials during this period. By combining data from approved drugs and promising contenders, we provide insights into the changing landscape of DM care. A thorough examination of phase 3 clinical studies that focused on treatments for diabetes mellitus (DM), utilizing data collected from ClinicalTrials.gov. Furthermore, we made sure to only include trials with documented outcomes in our analysis. Our study uncovers a wide range of innovative compounds in phase 3 trials, aiming at DM through diverse action mechanisms.

Renovascular disease and primary hyperaldosteronism are among the leading causes of high blood pressure in young adults. Collaboration between cardiologists and endocrinologists is crucial in addressing the underlying causes of resistant hypertension. In this article, we provide updated information on the clinical context in which renal artery stenosis is suspected, and the appropriate investigation methods for confirmation. The decision to revascularize is based on the etiology of the stenosis, patient age, and comorbidities. In brief, we aimed to provide a cardiologist's perspective on a significant contributor to secondary hypertension.

Context: In this study we compared daily calorie restriction, and intermittent calorie restriction in overweight and class 1 obese patients. Findings are these diets correct metabolic parameters and intermittent calorie restriction diet regimen increases muscle strength.

Aim: We investigated the effects on metabolic, anthropometric values and muscle in Intermittent Fasting (IF) and Continuous Calorie Restriction (CCR) groups in adult overweight and class 1 obese patients.

Material and methods: The patients were randomly divided into 3 groups: IF group (n=23), CCR group (n=21), and control group (n=22). Fat mass, and basal metabolic rate were recorded. Fat-Free Mass Index (FFMI) was calculated. Handgrip strength was measured. Walking speed test was performed. The 'International Physical Activity Questionnaire' was administered to the patients. Weight, body mass index, fat mass, muscle mass, FFMI, waist circumference, right and left arm circumference, right and left calf circumference values decreased significantly and similarly compared to the beginning at the end of 6 months in the IF and CCR groups (p<0.05). A statistically significant increase was found in hand grip strength test measurements in the IF groups.

Conclusions: IF and CCR diets enhance metabolic functions while reducing muscle mass. Despite this decrease, the IF diet increases muscular strength.

Objective: Obesity is a metabolic condition characterized by increased body fat mass. Increased prevalence of nonalcoholic steatohepatitis (NASH) and increased atherogenicity are closely associated with morbidity and mortality in obesity patients. In this study, we investigated the effect of orlistat, a gastrointestinal lipase inhibitor, on atherogenicity-related and NASH-related indexes in obese patients.

Material and methods: This retrospective study was completed with a total of 139 class III obesity patients with NASH who were admitted to our hospital, creating an orlistat treatment group and a control group. NASH-related indices and atherogenicity indices were calculated at the beginning of the study. These parameters were repeated in the 12^th week of the study. Statistical analyzes were performed on the entire patient population and in groups classified according to body mass index (BMI) (BMI <40 kg/m² and BMI ≥40 kg/m²).

Results: As a result of our 12-week study, in addition to the improvement in glycemic parameters and lipid profile, atherogenic indexes (Triglyceride-Glucose index and Triglyceride-Glucose-BMI index) and NASH-related indices (Nonalcoholic Fatty Liver Disease Fibrosis Score, Fibrosis-4 Index, Aspartate aminotransferase-Platelet Ratio Index) superior improvements were achieved compared to the control group (p<0.001). These improvements were similar in groups separated by BMI (p>0.05).

Conclusion: In addition to its proven body weight loss effect, Orlistat may be beneficial in the treatment of atherogenicity and steatohepatitis.

Background: Managing pheochromocytoma during pregnancy presents significant challenges due to the absence of well-established guidelines. Early detection during prenatal care, together with timely medical and surgical interventions, is crucial for achieving favorable maternal and fetal outcomes.

Case presentation: This report presents the case of a 35-year-old nulliparous woman with bilateral pheochromocytoma who became pregnant between the first and second stages of adrenalectomy. Preoperative management included α-adrenergic blockade and hydration, which was successfully implemented despite the patient being normotensive. The patient underwent a cortical-sparing tumor resection during the second trimester without complications and subsequently delivered a healthy full-term infant through normal labor.

Conclusion: This case demonstrates that preoperative α-adrenergic blockade remains the recommended approach for managing pheochromocytoma during pregnancy, even in normotensive patients. Additionally, laparoscopic cortical-sparing adrenalectomy appears to be an effective surgical option for minimizing the risk of long-term adrenal insufficiency in cases of bilateral lesions.

Introduction: Diagnosing Cushing Syndrome (CS) remains challenging due to its diverse symptoms and the complexity of its subtypes. This study aimed to optimize diagnostic cut-off values for differentiating CS subtypes using the 1 mg dexamethasone suppression test (DST) in a cohort of 237 patients.

Materials and methods: Retrospective data from patients diagnosed with non-functional adrenal adenomas (NFA), mild autonomous cortisol secretion (MACS), adrenal CS, and pituitary CS at the Dokuz Eylül University Endocrinology and Metabolism Clinic (2005-2016) were analyzed. Sensitivity and specificity of morning cortisol levels after DST were evaluated using receiver operating characteristic (ROC) curve analysis.

Results: The analysis identified optimal morning cortisol cut-off levels: 2.14 μg/dL (59.04 nmol/L) for MACS, 2.3 μg/dL (63.4 nmol/L) for adrenal CS, and 2.33 μg/dL (64.28 nmol/L) for pituitary CS.

Conclusion: These optimized thresholds demonstrated high sensitivity and specificity, significantly improving diagnostic precision over the conventional threshold of 1.8 μg/dL (50 nmol/L). The findings underscore the importance of tailored cut-off values to address subtype-specific diagnostic challenges, reducing delays and mitigating long-term complications. Personalized diagnostic approaches, incorporating patient demographics and disease-specific characteristics, are essential for enhancing diagnostic accuracy and facilitating timely interventions.

Objective: Osteoporosis is a complex disease and its development is influenced by genetic, epigenetic, metabolic, and environmental factors. However, specific genetic factors associated with osteoporosis are not fully understood. The aim of this study was to identify genetic risk factors for osteoporosis.

Methods: This study included 86 females with osteoporosis and 47 healthy females. We analyzed rs1800587, rs16944, rs1799814, rs4988321, rs2228570, and rs35211496 variations in IL1A, IL1B, CYP1A1, LRP5, VDR, and RANK, respectively, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis.

Results: Our analysis revealed that the CT and TT genotype for rs1800587 in IL1A was associated with higher bone mineral density in the lumbar spine, trochanter, Ward's triangle, and femoral neck (p=0.020, p=0.021, p=0.015, and p=0.013, respectively). The rs1800587 variation in IL1A was associated with a reduced risk of osteoporosis in both dominant and codominant inheritance models (CC vs. CT, p=0.016 and CC vs. CT/TT, p=0.035, respectively). However, we did not identify any statistically significant differences in either genotype or allele frequencies between the control group and the patients with osteoporosis for the other genetic variations examined.

Conclusion: Our findings suggest that the rs1800587 variation in IL1A gene is associated with a significantly decreased risk of osteoporosis in the Turkish population.