Acta Endocrinologica-Bucharest最新文献

Denosumab,a monoclonal IgG2 antibody,is used as neoadjuvant therapy for giant cell bone tumors, particularly in inoperable or metastatic cases. It targets the receptor activator of nuclear factor kappa-β ligand (RANKL),which is overexpressed in tumor stromal cells.However,denosumab treatment can lead to side effects such as hypocalcemia during treatment and rarely but malignant hypercalcemia after discontinuation. The unpredictable onset time and persistent course of hypercalcemia attacks increase the duration of hospitalization and the risk of complications.

Case: A 9-year-old girl with a giant cell bone tumor was treated with denosumab for diffuse tumor recurrence. Severe hypercalcemia occurred four months after completing therapy. Evaluation suggested "rebound-linked" hypercalcemia following denosumab discontinuation. IV bisphosphonate treatment normalized calcium levels initially, but hypercalcemia recurred, requiring repeated IV bisphosphonate administration. Oral alendronate was used weekly to prevent further attacks, resulting in stable calcium levels during follow-up.

Results: Rebound hypercalcemia, as an unpredictable recurrent episode at any time, is a potential complication of denosumab cessation, and requires close monitoring post-treatment. Children may be at higher risk due to their rapid bone cycle. In long-term follow-up, IV and oral biphosphonates can be used effectively in the management of especially life-threatening recurrent attacks.

Objective: In our study, we aimed to evaluate thyroid nodule ultrasound findings, nodule frequency and malignancy risk according to the ultrasonographic classification systems [(American Thyroid Association-2015 (ATA) and American College of Radiology - Thyroid Imaging Reporting and Data System (ACR-TIRADS)] in obese and non-obese subjects.

Materials and methods: 111 obese subjects and 111 non-obese age- and sex-matched control subjects were included in the study.The malignancy risk of the identified nodules was evaluated using ultrasonographic classification systems. Fine neddle aspiration biopsy (FNAB) was performed on the nodules according to ultrasonographic malignancy risk, and cytopathological evaluation was performed according to the Bethesda system.

Results: We did not find any difference between the groups in terms of age, sex, thyroid stimulating hormone (TSH) levels and thyroid volumes.We detected thyroid nodules in 36 (32.4%) of 111 subjects in the obese group and 22 (19.8%) of 111 subjects in the control group. Compared with controls, the prevalence of nodules was higher in obese subjects (p=0.046).There was no difference in the malignancy risk of nodules in obese subjects compared to non-obese subjects according to both ultrasonographic classification systems.

Conclusion: We have determined that the frequency of thyroid nodules is higher in obese patients than in non-obese subjects.However, we did not find any difference between the two groups in terms of malignancy risk of thyroid nodules according to ultrasonographic classification systems.

Background: Up to this point, individual or population-based approaches for treating and preventing obesity have not yielded lasting success. We assessed the impact of orlistat with or without metformin on anthropometric and laboratory measurements as well as cardiovascular risk factors in patients suffering from severe obesity.

Methods: A total of 116 patients with morbid obesity, consisting of 105 females and 11 males, were involved in the study. Of these, 30 patients (29 females and 1 male) underwent treatment with orlistat, while 86 patients (70 females and 10 males) were given a combination of orlistat and metformin. The effects of orlistat treatment, either 360 mg/day alone or orlistat plus metformin at a dose of 1700 mg/day, were retrospectively examined in patients who had been compliant with therapy for at least three months and had also made adjustments to their diet and lifestyle.

Results: The mean age in the orlistat group was 46.26 ± 11.30 years, and 43.13 ± 11.37 years in the orlistat plus metformin group. Significant reductions in weight, body mass index (BMI), waist circumference (WC), systolic blood pressure (BP), total cholesterol, LDL-cholesterol, and carotid intima media thickness (CIMT) resulted from three months of orlistat treatment (p < 0.01). The combination of orlistat and metformin produced substantial reductions in weight, BMI, WC, systolic BP, diastolic BP, CIMT, fasting blood glucose, total cholesterol levels, homeostatic model assessment for insulin resistance (HOMA-IR), and HbA1c levels (p < 0.01). The groups showed comparable weight, BMI, and WC. Neither group experienced notable side effects.

Conclusions: Treatments with orlistat and orlistat in combination with metformin led to a significant reduction in body weight. Similar body weight changes were observed between the groups, whereas the alterations in fasting plasma glucose, HOMA-IR, and HbA1c levels were greater with orlistat combined with metformin treatment.

Context: Pheochromocytomas are very rare but important and potentially life-threatening sources of ectopic ACTH secretion (EAS), and the diagnosis of Cushing's syndrome due to adrenocorticotropic hormone (ACTH)-producing pheochromocytoma needs a high index of suspicion.

Case presentation: Herein, we present a rare case of catastrophic Cushing 's syndrome due ACTH-producing pheochromocytoma in a 59-year-old woman, which was characterized by severe hypercortisolism, markedly elevated ACTH levels and rapidly progressed and persisting metabolic derangements, and complete resolution of symptoms and signs after adrenalectomy, despite no biochemical evidence of pheochromocytoma and the coexisting adrenal cortical adenoma. The timely recognition of findings sufficient to raise the suspicion of an ACTH-producing pheochromocytoma is crucial to plan surgical resection of the adrenal mass which is the only curative option enabling quick recovery with complete amelioration of symptoms and signs and restoration of organ functions.

Conclusions: In this regard, our case highlights the likelihood of severe hypercortisolism even in the absence of typical Cushingoid features, and the consideration of suspected diagnosis of ACTH-releasing pheochromocytoma even in the absence of biochemical evidence on catecholamine hypersecretion when workup is suggestive of an ectopic source along with an adrenal mass on imaging.

Objective: This study examined the glycemic control among adult patients with type 2 diabetes mellitus (T2DM) and their ongoing antidiabetic therapy focusing on potential differences in attaintment of glycemic control associated with the use of specific antidiabetic regimens (ADR).

Design: This was a cross sectional study conducted between September 2019 and March 2020 at a tertiary hospital, department of Internal Medicine.

Subjects and methods: Patients with T2DM who had a diagnosis of T2DM for at least one year and used their prescribed ADR for at least 3 months were included in the study. Glycated hemoglobin (HbA1c) was used for evaluation of glycemic control.

Results: A total of 500 patients aged 59.4 (±10.2) years, with 9.9 (±6.7) years of diabetes duration (54% women, BMI: 29.6±5.1kg/m²) were analysed. The mean HbA1c was 8.3% (±1.9) and 34.2% of patients had a HbA1c level ≤7 %. 12%, 20% and 15.4% of diabetic patients were prescribed one, two or more than three antidiabetic drugs, 6.4% were on glucagon-like peptide 1 receptor agonists (GLP-1RA) only and 46% received insulin. Education level (OR=0.79; 95 % CI 0.66-0.94 p=0.009) and use of GLP-1RA (OR=0.19; 95 % CI 0.07-0.51 p=0.001) were associated with improved glycemic control while longer diabetes duration (OR=1.06; 95 % CI 1.02-1.11 p=0.004), use of basal insulin (OR=2.91; 95 % CI 1.70-6.88 p=0.010) and basal-prandial regiments (OR=2.49; CI 1.54-5.38 p=0.020) were associated with HbA1c >7%.

Conclusions: Despite the introduction of novel drugs in the treatment of T2DM a majority of our patients fail to reach therapeutic goals.

Context: The first study delves into the postpartum diabetes screening during the postpartum 3^rd month period and exploration of non-compliance reasons.

Objective: The primary aim of this study is to examine the adherence to postpartum diabetes screening recommendations among women with gestational diabetes in Turkey.

Design: A cross-sectional study was conducted on 783 postpartum women diagnosed with gestational diabetes.

Materials and methods: Participants were categorized into three groups based on their screening behavior. Group 1 did not undergo any postpartum screening, Group 2 only underwent fasting plasma glucose (FPG) or HbA1c tests, and Group 3 only underwent oral glucose tolerance tests (OGTT). Data on demographic characteristics and reasons for non-compliance were collected.

Results: Only 3.45% of women complied while 55.81% did not undergo any screening. Adherence was significantly higher among primigravid women. Statistically significant differences were observed based on education level, GDM treatment method, and information received during pregnancy or postpartum (p<0.001). The most common reason for non-compliance was normal FPG values observed post-delivery.

Conclusion: This study emphasizes the crucial need for enhanced education and information provision to high-risk women diagnosed with gestational diabetes, both during pregnancy and the postpartum period, particularly during their hospital stay.

Context: Chronic unpredictable mild stress (CUMS) has been widely shown to impact neurological disorders. Recently, growing evidence suggests that CUMS may also contribute to the development of metabolic conditions such as diabetes mellitus.

Objective: This study aimed to investigate blood glucose levels and histopathological and immunohistochemical changes in the endocrine pancreas in an experimental rat model of CUMS, as well as the potential protective effects of vortioxetine (VOR) treatment.

Subjects and methods: A total of 28 rats were divided into four groups. The CUMS group was exposed to random stressors once daily for six weeks. Rats in the VOR and CUMS+VOR groups received VOR treatment. The VOR and control groups were housed separately, without exposure to CUMS. At the end of the experiment, blood and pancreatic tissue samples were collected from all rats.

Results: Blood glucose levels were elevated in the CUMS group compared to the other groups. Histopathological analysis revealed a reduction in insulin, amylin, and insulin receptor expression, along with a slight increase in glucagon expression and a small number of necrotic cells in the CUMS group. VOR treatment improved all these parameters.

Conclusions: Our findings suggested that CUMS may contribute to endocrine pancreatic damage resembling diabetes mellitus, while VOR treatment may mitigate this effect.

Increased body mass index (BMI) is considered a risk factor for breast cancer. Moreover, it is associated with an unfavorable prognosis of the disease. Overweight and obesity are a global public health problem.

Objective: We aimed to describe the risk factor of high BMI in breast cancer patients through an observational study of patients diagnosed with mammary neoplasm.

Patients and methods: The study was performed on a sample of 172 women with breast cancer with a mean age of 58.8 (±SD) years and a control sample of 217 women without breast cancer with a mean age of 54 (±SD) years. Data collection was performed by questionnaires and by anthropometric measurements, during 2017-2021. Statistical analysis used numerical descriptive methods: mean, standard deviation, etc. and graphical methods.

Results: The sample of women with breast cancer compared to the control sample showed differences in BMI (26.27 vs. 24.45 kg/m²), p=0.001.

Conclusion: Obesity is a risk factor for breast cancer. This risk factor for breast cancer could be altered by the quality of the diet and by the adoption of an active lifestyle.

Objective: To analyze the clinical value of dissection parathyroidectomy (DP) in patients with chronic kidney disease (CKD) complicated by refractory secondary hyperparathyroidism (HPT).

Subjects and methods: Patients with CKD complicated by refractory secondary HPT were included as the research subjects. Among them, 42 patients who received DP were assigned as the study group, while another 42 patients who underwent conventional total parathyroidectomy were assigned as the control group.

Results: The average operative time and postoperative average length of hospital stay of the study group were lower than those of the control group (P<0.05). The study group showed lower levels of parathyroid hormone (PTH) compared to the control group 1 day postoperatively, 7 days postoperatively, 6 months postoperatively, and 12 months postoperatively (P<0.05). The study group exhibited lower serum calcium levels than the control group 1 day postoperatively, 7 days postoperatively, 1 month postoperatively, and 6 months postoperatively (P<0.05). Additionally, the study group demonstrated lower serum phosphorus levels compared to the control group 1 day postoperatively, 7 days postoperatively, and 6 months postoperatively (P<0.05).

Conclusions: The application of DP in patients with CKD complicated by refractory secondary HPT holds definite clinical value.

Context: Epilepsy and osteoporosis are closely related. The detrimental effect on bone by older generation of antiepileptic drugs (AEDs) is well known, but newer AEDs can also cause a decline in bone health.

Objective: To provide a review on the impact of AEDs on bone mineral density, fractures and bone turnover markers and to analyze the effect of bone active treatments in epileptic patients.

Methods: Medline (PubMed) and EMBASE were searched for studies about AEDs and bone health. The PRISMA statement was used.

Results: Chronic use of AEDs is associated with alterations in bone metabolism, low bone mineral density values, and increased risk of fractures. These effects appear to be more associated to the use of enzyme-inducing AEDs. Supplements with vitamin D and bone active treatments may have benefits in terms of bone mineral density gain and of mortality risk. More studies are required to determine the impact of non-enzyme-inducing AEDs on bone health and to gather useful information about the management of osteoporosis therapy in epileptic patients.

Conclusion: Chronic AED use has a significant impact on bone health; it is therefore necessary to evaluate in such individuals the claim to vitamin D and calcium supplements and bone active treatments.