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Introduction. Precocious puberty is a common endocrine disorder in pediatric patients, leading to important changes in growth patterns. Case presentation. We present the case of a patient with precocious puberty and accelerated bone maturation, evaluated in several medical centers. A 9-year-and-11-month-old female patient was evaluated for premature thelarche, adrenarche and menarche starting at the age of 7. On clinical examination, height was 143 cm, 0.9 SD above the age and sex median, with 37.91% excess weight. She also presented with acne, cervical posterior acanthosis nigricans, hirsutism and Tanner puberty development stage B3/P4. The endocrine profile showed pubertal values for FSH (Follicle-Stimulating Hormone), LH (Luteinizing Hormone) and estradiol, before and after the Diphereline test, hyperprolactinemia (of 38.6 ng/mL, normal: 2-18.9 ng/mL) and high levels of 17-OH Progesterone (of 2.60 ng/mL, normal: 0.2-0.9 ng/mL). The Synactene® test excluded 21-hydroxylase deficiency. Knee X-rays showed a tendency for premature growth plate fusion and bone age advancement of 3.1 years. Gynecological examination and pelvic ultrasound showed normal ovarian morphology and volume, according to chronological age and a 17-mm endometrium. Hypothalamic-pituitary MRI (Magnetic Resonance Imaging) excluded the presence of a local lesion. Conclusions. In the absence of therapeutic intervention, accelerated skeletal development due to precocious puberty initially leads to high stature compared to the patient’s age group, followed by premature closure of the growth plates and low final height.

Introduction. Pineal tumors are an inhomogeneous group of lesions with pineal origin, characterized by various degrees of hypothalamic-pituitary dysfunction. Case presentation. We present the case of a patient with pineal germinoma and hypogonadotropic hypogonadism who was evaluated in several medical centers. A 31-year-old male patient with a history of primary hypothyroidism and pineal germinoma, for which he underwent surgery, radiation and chemotherapy, was admitted for frontal-temporal headache, nausea and moderate intensity asthenia. Clinical examination revealed normal weight, normal blood pressure, left eye strabismus, pale skin, diminished facial and body hair, bilateral gynecomastia. The endocrine profile showed adequate thyroid hormone replacement, low normal basal cortisol levels (5.88 µg/dL, normal 5-25 µg/dL), low IGF-1 (Insulin-like Growth Factor) (93.2 pg/mL, normal 115-307 pg/mL), low gonadotrophins, testosterone (0.57 ng/mL, normal 1.3-8.53 ng/mL) and estradiol (

Introduction. We present different particular aspects of the thyroid ultrasound in patients who were first referred to an endocrinologist after a gynaecological check-up. Case series presentation. A 73-year-old woman was admitted for a routine gynaecological and general exam, after a thyroid nodule was incidentally detected. Ultrasonography showed a macronodule of 3.1 cm, that was treated by surgery. A 53-year-old woman presented for hot flashes in association with high blood pressure episodes. Hyperthyroidism was not confirmed, but a conglomerate of thyroid nodules of 2.2 cm was detected. The fine needle aspiration excluded a malignancy. A 66-year old woman, presenting for bone assessment, was incidentally detected with a large multinodular goitre. The left lobe has multiple nodules including TIRADS4 conglomerate. A 43-year-old woman, with bilateral mammary cysts, normal TSH, increased prolactin, presented at thyroid ultrasound a left lobe of 5.4 cm, with a conglomerate of 3.3 cm. The fine needle aspiration showed Hürthle cells and the patient was referred to surgery, which confirmed the diagnosis of follicular adenoma. A 41-year-old female, with a history of subtotal hysterectomy for uterine fibroma, presented for intermittent palpitations. TSH value was normal, but ultrasonography showed a mildly increased right lobe of 4.3 cm, with multiple bilateral micronodular masses. Conclusions. The thyroid ultrasound represents a very practical diagnostic method in daily gynaecological endocrinology. The detection of a nodule may be related to routine menopausal evaluation, may be associated with clinical examination for bone menopausal status or may be associated to thyroid function assessment if hot flushes mimic hyperthyroidism.

Acromegaly is a complex disorder caused by growth hormone excess mostly due to a pituitary adenoma. Surgery represents the first option but rate of long time success is almost 50% thus the patients need other therapies. Apart from radiation, medical therapy panel includes previously used long-acting formulas of first-generation somatostatin analogues like ocreotide or lanreotide and, moreover, pasireotide LAR which is a recently introduced second-generation analogue. Non responders to prior medication, proved a good response to this as pointed by C2305 extension trial or PAOLA study. The rate of overresponse to pasireotide may be explained by a different receptor target: mostly on somatostatin receptor type 5 opposite to type 2 as it acts first-generation compounds. The tolerance of pasireotide LAR is good; the safety profile includes the awareness of hyperglycaemia risk. The cross-road that follows the lack of acromegaly control after a patient was treated with somatostatin analogue of first generation is currently more complex since pasireotide LAR became a feasible option.

Cushing’s disease is a rare pathology characterized by excess production of adrenocorticotropic hormone (ACTH) secondary to a pituitary adenoma which stimulates adrenal cortisol secretion. The main consequences are the metabolic and cardiovascular complications, as well as osteoporosis and infection predisposition, which increase mortality in untreated patients. The first case presentation is about a patient with Cushing’s disease, surgically treated and cured, without any need for substitution or signs of pituitary-adrenal axis failure. The second case is a patient diagnosed with Cushing’s disease, with multiple complications, with clinical and hormonal relapse after selective adenomectomy and resistant to medical therapy, who is scheduled for reintervention. The third presentation is about a patient known with osteoporosis, diagnosed with Cushing’s disease based on the clinical appearance with bilateral adrenal adenomas, with left suprarenalectomy and pituitary gamma knife radiotherapy. We aim to introduce a pictorial assay consisting of a series of three cases, different from detection, management and outcome

Chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) is the most common cause of hypothyroidism which may associate weight increase and changes in serum lipid levels. There is still controversy over the link between obesity and autoimmune hypothyroidism. The paper aims to assess obesity and lipid metabolism in patients with Hashimoto’s thyroiditis, and to establish a correlation between TSH (thyroid-stimulating hormone), FT4 (free thyroxine) levels, and the titer of antithyroid antibodies.