Search

We aimed to provide an updated narrative review with respect to the RET pathogenic variants and their implications at the clinical and molecular level in the diagnosis of medullary thyroid cancer (MTC)/multiple endocrine neoplasia (MEN) type 2, particularly with respect to the presence of cutaneous lichen amyloidosis (CLA). We searched English-language, in extenso original articles with no timeline nor study design restriction that were published on PubMed. A traditional interplay stands for CLA and MTC in MEN2 (not MEN3) confirmation. While the connection has been reported for more than three decades, there is still a large gap in understanding and addressing it. The majority of patients with MEN2A-CLA have RET pathogenic variants at codon 634; hence, it suggests an involvement of this specific cysteine residue in both disorders (most data agree that one-third of C634-positive subjects have CLA, but the ranges are between 9% and 50%). Females seem more prone to MEN2-CLA than males. Non-C634 germline RET pathogenic variants included (at a low level of statistical evidence) the following: RET V804M mutation in exon 14 for MTC-CLA (CLA at upper back); RET S891A mutation in exon 15 binding OSMR variant G513D (familial MTC and CLA comprising the lower legs to thighs, upper back, shoulders, arms, and forearms); and C611Y (CLA at interscapular region), respectively. Typically, CLA is detected at an early age (from childhood until young adulthood) before the actual MTC identification unless RET screening protocols are already applied. The time frame between CLA diagnosis and the identification of RET pathogenic variants was between 5 and 60 years according to one study. The same RET mutation in one family is not necessarily associated with the same CLA presentation. In MTC/MEN2 subjects, the most affected CLA area was the scapular region of the upper back. Alternatively, another hypothesis highlighted the fact that CLA is secondary to long-term prurit/notalgia paresthetica (NP) in MTC/MEN2. OSMR p. G513D may play a role in modifying the evolutionary processes of CLA in subjects co-harboring RET mutations (further studies are necessary to sustain this aspect). Awareness in CLA-positive patients is essential, including the decision of RET testing in selected cases. [ABSTRACT FROM AUTHOR]

Non-functioning adrenal incidentalomas (NFAIs) have been placed in relationship with a higher risk of glucose profile anomalies, while the full-blown typical picture of Cushing's syndrome (CS) and associated secondary (glucocorticoid-induced) diabetes mellitus is not explicitly confirmed in this instance. Our objective was to highlight the most recent data concerning the glucose profile, particularly, type 2 diabetes mellitus (T2DM) in NFAIs with/without mild autonomous cortisol secretion (MACS). This was a comprehensive review of the literature; the search was conducted according to various combinations of key terms. We included English-published, original studies across a 5-year window of publication time (from January 2020 until 1 April 2024) on PubMed. We excluded case reports, reviews, studies on T1DM or secondary diabetes, and experimental data. We identified 37 studies of various designs (14 retrospective studies as well 13 cross-sectional, 4 cohorts, 3 prospective, and 2 case–control studies) that analysed 17,391 individuals, with a female-to-male ratio of 1.47 (aged between 14 and 96 years). T2DM prevalence in MACS (affecting 10 to 30% of NFAIs) ranged from 12% to 44%. The highest T2DM prevalence in NFAI was 45.2% in one study. MACS versus (non-MACS) NFAIs (n = 16) showed an increased risk of T2DM and even of prediabetes or higher fasting plasma glucose or HbA1c (no unanimous results). T2DM prevalence was analysed in NFAI (N = 1243, female-to-male ratio of 1.11, mean age of 60.42) versus (non-tumour) controls (N = 1548, female-to-male ratio of 0.91, average age of 60.22) amid four studies, and two of them were confirmatory with respect to a higher rate in NFAIs. Four studies included a sub-group of CS compared to NFAI/MACS, and two of them did not confirm an increased rate of glucose profile anomalies in CS versus NFAIs/ACS. The longest period of follow-up with concern to the glycaemic profile was 10.5 years, and one cohort showed a significant increase in the T2DM rate at 17.9% compared to the baseline value of 0.03%. Additionally, inconsistent data from six studies enrolling 1039 individuals that underwent adrenalectomy (N = 674) and conservative management (N = 365) pinpointed the impact of the surgery in NFAIs. The regulation of the glucose metabolism after adrenalectomy versus baseline versus conservative management (n = 3) was improved. To our knowledge, this comprehensive review included one of the largest recent analyses in the field of glucose profile amid the confirmation of MACS/NFAI. In light of the rising incidence of NFAI/AIs due to easier access to imagery scans and endocrine evaluation across the spectrum of modern medicine, it is critical to assess if these patients have an increased frequency of cardio-metabolic disorders that worsen their overall comorbidity and mortality profile, including via the confirmation of T2DM. [ABSTRACT FROM AUTHOR]

Introduction. Current studies support the implication of metabolic changes associated with type 2 diabetes in altering bone metabolism, structure and resistance.

Copyright of Obstetrică şi Ginecologie is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Our aim is to update the topic of adrenal tumours (ATs) in congenital adrenal hyperplasia (CAH) based on a multidisciplinary, clinical perspective via an endocrine approach. This narrative review is based on a PubMed search of full-length, English articles between January 2014 and July 2023. We included 52 original papers: 9 studies, 8 case series, and 35 single case reports. Firstly, we introduce a case-based analysis of 59 CAH-ATs cases with four types of enzymatic defects (CYP21A2, CYP17A1, CYP17B1, and HSD3B2). Secondarily, we analysed prevalence studies; their sample size varied from 53 to 26,000 individuals. AT prevalence among CAH was of 13.3–20%. CAH prevalence among individuals with previous imaging diagnosis of AT was of 0.3–3.6%. Overall, this 10-year, sample-based analysis represents one of the most complex studies in the area of CAH-ATs so far. These masses should be taken into consideration. They may reach impressive sizes of up to 30–40 cm, with compressive effects. Adrenalectomy was chosen based on an individual multidisciplinary decision. Many tumours are detected in subjects with a poor disease control, or they represent the first step toward CAH identification. We noted a left lateralization with a less clear pathogenic explanation. The most frequent tumour remains myelolipoma. The risk of adrenocortical carcinoma should not be overlooked. Noting the increasing prevalence of adrenal incidentalomas, CAH testing might be indicated to identify non-classical forms of CAH. [ABSTRACT FROM AUTHOR]

Our objective is to present an exceptional case of a patient diagnosed with Paget's disease of the bone (PDB) while being confirmed with Lynch syndrome (LS). A 44-year-old woman was admitted for progressive pain in the left forearm 2 years ago, and was partially relieved since admission by non-steroidal anti-inflammatory drugs. Suggestive imaging findings and increased blood bone turnover markers helped the diagnosis of PDB. She was offered zoledronate 5 mg. She had two more episodes of relapse, and a decision of new medication was taken within the following years (a second dose of zoledronate, as well as denosumab 60 mg). Her family history showed PDB (mother) and colorectal cancer (father). Whole exome sequencing was performed according to the manufacturer's standard procedure (Ion AmpliSeq™ Exome RDY S5 Kit). A heterozygous pathogenic variant in the SQSTM1 gene (c.1175C>T, p.Pro392Leu) was confirmed, consistent with the diagnosis of PDB. Additionally, a heterozygous pathogenic variant of MSH2 gene (c.2634+1G>T) was associated with LS. The patient's first-degree relatives (her brother, one of her two sisters, and her only daughter) underwent specific genetic screening and found negative results, except for her daughter, who tested positive for both pathogenic variants while being clinically asymptomatic. The phenotype influence of either mutation is still an open issue. To our current knowledge, no similar case has been published before. Both genetic defects that led to the two conditions appeared highly transmissible in the patient's family. The patient might have an increased risk of osteosarcoma and chondrosarcoma, both due to PDB and LS, and a review of the literature was introduced in this particular matter. The phenotypic expression of the daughter remains uncertain and is yet to be a lifelong follow-up as the second patient harbouring this unique combination of gene anomalies. [ABSTRACT FROM AUTHOR]

A deficient vitamin D status has been associated with various diseases but its correlation with different types of cancer remains of interest. Thyroid cancer is the most frequent endocrine malignancy and despite the fact that differentiated thyroid carcinoma (DTC) has an excellent survival rate (>90% 10-year survival), persistent and recurrent disease is still an issue nowadays. Epidemiological studies confirmed lower levels of vitamin D in patients with DTC and correlation of 25-hydroxy vitamin D3 [25(OH)D3] status with clinicopathologic features and poor prognosis, being considered a biomarker for aggressiveness. Vitamin D, through it active form 1α,25-dihydoxyvitamin D3 [1,25(OH)2D3] and its receptor (VDR) exerts genetic changes to both healthy and neoplastic cells thus controlling their proliferation, differentiation and apoptosis. Also, vitamin D binding protein (DBP) has been recently discovered to have many different biological functions. This review is an update on molecular mechanisms of vitamin D signaling and its association with thyroid cancer prevention, treatment and prognosis. [ABSTRACT FROM AUTHOR]

This is a review of full-length articles strictly concerning subacute thyroiditis (SAT) in relation to the SARS-CoV-2 virus infection (SVI) and COVID-19 vaccine (COV) that were published between the 1st of March 2020 and the 21st of March 2022 in PubMed-indexed journals. A total of 161 cases were reported as follows: 81 cases of SAT–SVI (2 retrospective studies, 5 case series, and 29 case reports), 80 respective cases of SAT–COV (1 longitudinal study, 14 case series, 17 case reports; also, 1 prospective study included 12 patients, with 6 patients in each category). To our knowledge, this represents the largest cohort of reported cases until the present time. SAT–SVI was detected in adults aged between 18 and 85 years, mostly in middle-aged females. SAT–COVID-19 timing classifies SAT as viral (synchronous with infection, which is an original feature of SATs that usually follow a viral infection) and post-viral (during the recovery period or after infection, usually within 6 to 8 weeks, up to a maximum 24 weeks). The clinical spectrum has two patterns: either that accompanying a severe COVID-19 infection with multi-organ spreading (most frequent with lung involvement) or as an asymptomatic infection, with SAT being the single manifestation or the first presentation. Either way, SAT may remain unrecognized. Some data suggest that more intense neck pain, more frequent fever, and more frequent hypothyroidism at 3 months are identified when compared with non-SAT–SVI, but other authors have identified similar presentations and outcomes. Post-COVID-19 fatigue may be due to residual post-SAT hypothyroidism. The practical importance of SAT–SVI derives from the fact that thyroid hormone anomalies aggravate the general status of severe infections (particular concerns being tachycardia/arrhythmias, cardiac insufficiency, and ischemic events). If misdiagnosed, SAT results in unnecessary treatment with anti-thyroid drugs or even antibiotics for fever of unknown cause. Once recognized, SAT does not seem to require a particular approach when compared with non-COVID-19 cases, including the need for glucocorticoid therapy and the rate of permanent hypothyroidism. A complete resolution of thyroid hormone anomalies and inflammation is expected, except for cases with persistent hypothyroidism. SAT–COV follows within a few hours to a few weeks, with an average of 2 weeks (no particular pattern is related to the first or second vaccine dose). Pathogenesis includes molecular mimicry and immunoinflammatory anomalies, and some have suggested that this is part of ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvants). An alternative hypothesis to vaccine-related increased autoimmunity is vaccine-induced hyperviscosity; however, this is supported by incomplete evidence. From what we know so far concerning the risk factors, a prior episode of non-SVI–SAT is not associated with a higher risk of SAT–COV, nor is a previous history of coronavirus infection by itself. Post-vaccine SAT usually has a less severe presentation and a good outcome. Generally, the female sex is prone to developing any type of SAT. HLA susceptibility is probably related to both new types of SATs. The current low level of statistical evidence is expected to change in the future. Practitioners should be aware of SAT–COV, which does not restrict immunization protocols in any case. [ABSTRACT FROM AUTHOR]

Background: Vitamin D status and renal function are well-known independent predictors of serum parathyroid hormone (PTH) levels. We aimed to describe the combined effects of 25-hydroxy vitamin D (25(OH)D), glomerular filtration rate (GFR) and age on serum PTH levels across the whole clinical spectrum. Methods: We retrieved from our endocrinology center database all PTH measurement between 2012 and 2020 for which a simultaneous measurement of serum 25(OH)D, calcium and creatinine was available. Age, sex and diagnosis were available for all subjects. Intact PTH was measured using the same electrochemiluminescence assay. Results: There were 6,444 adults and 701 children without a diagnosis of hyper- or hypoparathyroidism or abnormal serum calcium levels. In adults with 25(OH)D≥12 ng/mL multiple regression models showed that serum PTH was negatively correlated with both 25(OH)D and GFR. Regression (-0.68 and -1.59 vs. -0.45 and -0.22 respectively), partial correlation (-0.16 and -0.35 vs. -0.12 and -0.10 respectively) and determination coefficients (0.14 vs. 0.031) were higher in CKD than in normal renal function. In subjects with 25(OH)D<12 ng/mL, GFR was the only significant predictor in those with CKD (β-coefficient=-2.5, r=-0.55) and 25(OH)D was the only significant predictor in those with normal renal function (β-coefficient=-2.05, r=-0.11). Increasing age was associated with higher PTH levels only in those with normal renal function and 25(OH)D≥12 ng/mL. Conclusions: We showed that declining vitamin D and renal function have additive effects on serum PTH in subjects without vitamin D deficiency. In vitamin D deficient subjects this dependency is stronger but is not additive anymore. [ABSTRACT FROM AUTHOR]

Ectopic Cushing syndrome or ectopic ACTH (Adrenocorticotropic Hormone) syndrome, a rare but severe condition, is due to a non-pituitary ACTH excess or exceptionally a non-hypothalamic CRH (Corticotropin - Releasing Hormone) hyper-production, usually due to a neoplasia which may be of endocrine or nonendocrine origin. Our objective is to introduce a brief literature regarding ectopic Cushing syndrome based on five micro-chapters: clinical evaluation, lab tests, imaging assays, therapy options and as discussions – the current limits of the topic. This actually comes with a twist in every aspect since a lot of data are yet to be clarify about this complex medical entity. Clinical presentation may be suggestive for Cushing syndrome but a few characteristics are more frequently seen as hyperpigmentation, rapid onset up even becoming an endocrine emergency, male preponderance, potential weight loss instead of weight gain, as oppose to Cushing disease or adrenal Cushing syndrome. Hypokalaemia is a hallmark of this particular situation. Additional tests are necessary to identify the source of ACTH excess and this twist is necessary in addition to traditional suppression tests for glucocorticoid axes. Some authors describe another twist in recognition of syndrome presentation: that actually there are two subtypes – one caused by a very aggressive tumour with rapid evolution and another with a lent slope of clinical features appearance caused by a occult neoplasm. Another twist is the fact that, in cases without a clear tumour origin, bilateral adrenal removal is actually necessary until adequate identification of source is done (if ever). Overall, a complex multidisciplinary team is necessary, the prompt recognition and therapy is life saving and numerous limits of both diagnosis and management are still a matter of debate [ABSTRACT FROM AUTHOR]

Differentiated thyroid cancer of papillary type have an increasing incidence on women of reproductive age but also in menopause, possible related to new triggers that act as endocrine disruptors which are more or less described until this moment or possible related to the increased accessibility to thyroid ultrasound. The incidence of non-medullary thyroid cancer in women is 3 times higher than in males so the influence of estrogens seems rational. Yet, some meta-analyses did not confirm a direct link with estrogens exposure during reproductive years. Thyroid cancer is also diagnosed in menopause which is a low estrogens status thus other risk factors should be taken into consideration; among these obesity and smoking are frequently incriminated. We aim to introduce a two cases series of adult females with differentiated thyroid carcinoma which was diagnosed from an initial routine ultrasound. [ABSTRACT FROM AUTHOR]

Copyright of Internal Medicine / Medicină Internă is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Although adenomectomy remains the first-line treatment in Cushing's disease, it is not always curative for most patients. Sooner or later persistent or recurrent disease can be found in some cases.Case report: A 13-year-old girl was admitted for weight gain, menstrual disturbances, and transient headache. Hormonal profile confirmed the clinical suspicion of Cushing's disease. Pituitary MRI highlighted a microadenoma of 5.2 mm resected through transsphenoidal adenomectomy. No complications were registered during the procedure. After a 7 days hospitalization, the patient was discharged without any medications. Periodic evaluations confirmed the disease's remission that was maintained for a period of 2 years. During this period, the patient received only thyroxine and progesterone treatment. Two years after surgery, the adrenal hormone profile confirmed the recurrence of the disease. According to the patient's age, ketoconazole and carbergoline treatment was instituted without any significant improvement. Because no obvious tumor mass has been revealed on the pituitary MRI, pasireotide treatment was introduced at the age of 18. An obvious improvement in the hormonal profile was achieved after three months of treatment. Cushing's disease control requires therapeutic alternatives consistent with the patient's age and the complications of the disease. Pasireotide treatment may be a good choice for adult patients with recurrent disease after transsphenoidal adenomectomy. [ABSTRACT FROM AUTHOR]

Introduction. Paget’s disease of the bone is a skeleton condition affecting bone remodelling of unknown cause. Bone formation and resorption, as parts of bone turnover which are normally coupled in healthy skeleton, in this condition are disconnected. We aim to introduce an adult male case with the condition which is also diagnosed with a multinodular goitre. This is a case report. This is a 60-year old male who is a former smoker and recently accused intermittent mild loss of hearing at left ear. Whole body bone scintigram (20mCi, Tc99m) showed increased uptake of the radiotracer with high bone affinity at parietal and occipital parts of the skull. Accidental multinodular goitre is diagnosed with a large cystic macronodule. Fine needle aspiration showed BETHESDA 2 with modest risk of haemorrhage and indication of surgery. 6 months after a dose of 5 mg zolendronic acid the bone markers were not increased and subsequent follow-up is necessary. Conclusion. Early diagnosis of Paget’s bone disease improves the potential risk of complications; however, distant potential complications need lifelong periodic check-up. The synchronous diagnosis of multinodular goitre with dominant cystic macronodule seems accidental in this male case. [ABSTRACT FROM AUTHOR]

This is a 67-year old male who was referred for autoimmune myxedema after prior presentation in different departments. This real life case introduces the discussion related to relationship TSH and specific thyroid antibodies against thyroid. Despite relative high frequency, autoimmune thyroiditis may be under diagnosed until myxedema is recognised, challenging various differential diagnoses, as in our case. Male are rarer affected than women. Overall, the levels of thyroid antibodies are not correlated with TSH; neither they predict the pattern of response to levothyroxine substitution. [ABSTRACT FROM AUTHOR]

Adults and children who were exposed to head and/or neck radiotherapy for different cancers associate a life time higher risk than general population for a heterogeneous panel of secondary conditions like thyroid nodules, cancer and radiation induced primary hypothyroidism. We introduce an adult female case who was diagnosed and treated for Hodgkin lymphoma type IIB and one year after she presented non-autoimmune thyroiditis and high TSH. Hypothyroidism was substituted for 29 years; the ultrasound pattern remained hypoechoic with a relatively small gland and also associated radiation induced lung fibrosis. [ABSTRACT FROM AUTHOR]

The subtrochanteric fracture occurs on the femur bone at 5 to 7.5 cm below the lesser trochanter. Its uniqueness consists of the fact that it occurs at the junction between cortical bone and trabecular bone and also the various muscle attachments that displace the fractured ends making the end treatment difficult. We introduce a cases series of such situation. We treated our patients with intra-medullar nailing with or without cerclage cables and on all 3 presented cases one year follow up was excellent. We strive for the perfect implant, but for now we have yet to discover if cerclage cables on all intra-medullar nailing would be beneficial or the open method and the fracture hematoma evacuation is more of a disadvantage. The functional outcome of the patients was excellent using all three surgical methods. The most important aspect remains the recovery time and the patient's quality of life after the intervention. Therefore, the surgical strategy should be individualized for improving the outcome. [ABSTRACT FROM AUTHOR]

Riedel's thyroiditis is a fibrous invasive type of chronic thyroiditis with a benign pattern which is characterized by a dense fibrotic and inflammatory process that invades the thyroid gland and adjacent structures of the neck Our purpose is to introduce such a rare case with challenges of rapid diagnosis associating severe local complications which required thyroid surgery. A 71-yearold female patient was admitted because of developing a neck mass in association with dysphagia and weight loss. Thyroid enlargement, especially of the right lobe, had a woody consistency. Ultrasound showed an asymmetric enlargement, with absent vascular flow. Normal thyroid function associated positive anti-thyroperoxidase antibodies. The diagnosis of Hashimoto's thyroiditis was confirmed but the clinical evaluation (a large compressive goiter) raised the suspicion of a thyroid malignancy. Fine needle aspiration provided unsatisfactory tissue sample because of the fibrous consistency. Due to the persistent aggravating compressive symptoms emergency thyroidectomy was performed. The pathologic report showed: chronic Hashimoto thyroiditis with an extensive fibrous tissue transformation of the right lobe, chronic inflammatory and sclerosing pattern suggestive for Riedel's thyroiditis. The postoperative evolution had no complications, levothyroxine substitution was initiated, and the pain and dysphagia completely disappeared. Clinical presentation of Riedel's thyroiditis, a rare thyroid condition, mimics practically any other thyroid pathologies, especially sub-acute thyroiditis and malignancy. The differential diagnosis is essential for the treatment plan since missing the diagnosis may be fatal. Atypical cases which rapidly developing compressive symptoms require lifesaving surgery. [ABSTRACT FROM AUTHOR]

Summary : We measured serum vitamin D in 8024 Romanian subjects and found a marked seasonal variation with highest levels in September and lowest levels in March. The seasonal variation (early autumn vs. early spring) persisted in all age and sex groups. The prevalence of vitamin D deficiency was very high. Purpose: Romania is located in Eastern Europe, roughly between 44°N and 48°N latitude. Seasonal variation of serum vitamin D in Romanian subjects is unknown. We assessed the seasonal variation of 25-hydroxy vitamin D [25(OH)D] in Romanian population. Methods: We retrieved from our endocrinology center database all 25(OH)D measurements between 2012 and 2016. We also evaluated age, sex, diagnosis, and date of blood sampling. The 25(OH)D was measured by two different chemiluminescence or electrochemiluminescence assays. Results: There were 8024 subjects (median age 50 (37, 62); 1429 men (17.8%)) without a diagnosis of low bone mass (osteopenia or osteoporosis). The median serum 25(OH)D was 18.6 (12.7, 25.4) ng/mL. Of the subjects, 0.73, 14.4, 55.6, and 86.1% had a serum 25(OH)D level below 4, 10, 20, and 30 ng/mL, respectively. Serum 25(OH)D showed a marked seasonal variation with highest levels in September (24.1 [18.3, 30.3] ng/mL) and lowest levels in March (13.5 [9.4, 19.6] ng/mL) ( p < 0.001). The seasonal variation (early autumn vs. early spring) persisted in all age and sex groups and was maximal for 21-40 years of age (26.5 (20.8, 33.1) vs. 12.9 (9.7, 17.9) ng/mL) and minimal for >65 years of age (18.6 (13.0, 27.2) vs. 12.7 (7.8, 19.7) ng/mL). Men and women showed similar amplitude of serum 25(OH)D variation. Conclusion: The prevalence of vitamin D deficiency is high, particularly in the elderly. The data show a strong seasonal variation of serum 25(OH)D in all subgroups of our Romanian population with highest levels in September and lowest levels in March. [ABSTRACT FROM AUTHOR]

Ultrasound is an extremely useful tool of thyroid investigation showing different aspects from previously unknown nodules to high-risk lesions requiring immediate surgery. We aim to introduce a pictorial assay of a series cases from two tertiary Romanian centres of endocrinology underling different scenarios from detection to management. All female patients associated normal thyroid function and lack thyroid antibodies while thyroid ultrasound proved essential in detection and follow-up the thyroid condition. Case 1 is a 49-year old subject admitted after an episode of palpitations and detected with a left thyroid nodule of 4.9 by 2.7 by 4.9 cm with inhomogeneous pattern and relatively regular shape requiring surgery. Case 2 is a 63-year old patient accusing dizziness and requiring Doppler ultrasound for carotid arteries that incidentally pointed a thyroid nodule. Ultrasound confirmed a right lobe nodule of 1.1 by 0.6 by 1 cm in association with another small thyroid nodule of 0.8 by 0.6 by 0.6 cm having egg shell peripheral calcifications. Fine needle aspiration was indicated and follicular aspects were identified. Case 3 is a 56-year old female admitted for menopausal osteopenia and routine ultrasound found a hypo-echoic nodule of 2.5 cm at right lobe. Case 4 is a 67-year female who was actually post-operatory confirmed with pT3aN1M0 papillary cancer starting from a first ultrasound evaluation of the thyroid. Case 5 is a 23-year old patient with a nodule detected by ultrasound three years ago and currently appreciated with a considerable increase even BETHESDA 2 was found initially through fine needle aspiration. Conclusion. As pointed by present series of cases, thyroid ultrasound represents an essential method in the hands of endocrinologists. [ABSTRACT FROM AUTHOR]

Endocrine morbidities are a vast panel of conditions; the most frequent diseases in daily endocrine practice are typically thyroid nodules or primary osteoporosis. We aim to introduce two cases who underlined a hematologic malignancy in association with apparently low risk endocrine conditions involving thyroid, respective osteoporosis field. A 24-year female is admitted for anterior cervical lumps which she self-detected one month ago. Normal thyroid blood assays are associated with neck ultrasound anomalies as: 2 thyroid nodules of 0.5/0.3 cm, respective of 0.5/0.2 cm; 5 left cervical lumps (largest at supraclavicle level of 1.5/ 0.7/1.5 cm); 4 right lateral cervical lymph nodes; multiple similar lesions were also revealed at others neck areas - largest at submandible level of 1.3/0.9/1.2 cm (right), respective 1.1/0.9/2.4 cm (left). Evaluation at oto-rhino- laringology, infectious disease was unrevealing; diagnosis of stage IIA Hodgkin lymphoma was established starting from ganglion biopsy. This is 78-year female, admitted for evaluation of bone loss under densumab for the latest year after a decade history of bisphosphonates. Secondary causes of osteoporosis or hypovitaminosis D were ruled out; computed tomography detected a small adrenal incidentaloma, whole body bone scintigrame did not reveal metastasis while flow cytometry of peripheral lymphocytes identified B monoclonal lymphocytosis/chronic lymphatic leukaemia with B cell starting from a mild elevation of white blood cells in routine hemogram. Behind classical endocrine conditions as goitre or osteoporosis, severe diagnosis might be found in situations as associated cervical nodes involvement, respective non-response to specific anti-osteoporotic therapy if active case finding strategies in a multidisciplinary manner are performed. [ABSTRACT FROM AUTHOR]

Background and aim. The cysts may potentially affect any organ; adrenals cysts are rare. This is a review of the literature regarding adrenal cysts, focusing on children and young adults. General data. Three major types have been described: pure cysts (endothelial, epithelial, and hemorrhagic or pseudocyst), parasitic (as hydatid) cysts and cystic part of a tumour (most frequent are neuroblastoma, ganglioneuroma, pheocromocytoma, and teratoma). The complications are: bleeding, local pressure effects; infection; rupture (including post-traumatic); arterial hypertension due to renal vessels compression. Adrenal hemorrhage represents a particular condition associating precipitating factors such as: coagulation defects as Factor IX or X deficiency, von Willebrand disease, thrombocytopenia; antiphospholipid syndrome; previous therapy with clopidogrel or corticosteroids; the rupture of a prior tumour. At birth, the most suggestive features are abdominal palpable mass, anemia, and persistent jaundice. Adrenal insufficiency may be found especially in premature delivery. The hemorrhage is mostly self-limiting. Antenatal ultrasound diagnosis of a cyst does not always predict the exact pathology result. The most important differential diagnosis of adrenal hemorrhage/hemorrhagic cyst is cystic neuroblastoma which is highly suggestive in the presence of distant metastases and abnormal catecholamine profile. The major clue to differentiate the two conditions is the fact that the tumor is stable or increases over time while the adrenal hemorrhage is expected to remit within one to two weeks. Conclusion. Pediatric adrenal cysts vary from simple cysts with a benign behavior to neoplasia-related lesions displaying severe prognosis as seen in cystic neuroblastoma. A multidisciplinary team is required for their management which is conservative as close follow-up or it makes necessary different surgical procedures in cases with large masses or if a malignancy suspicion is presented. Recently, laparoscopic approach is regarded as a safe procedure by some authors but generally, open surgery is more frequent used compare to adults; in most cases the preservation of normal gland is advisable. [ABSTRACT FROM AUTHOR]

Introduction. Metabolic complications (MC) may be caused by an active adrenal tumor (AT) as Conn's, Cushing's syndrome; however a secondary site of a previous carcinoma may involve adrenals. Objective. We present endocrine panel of a menopausal woman with MC and cancer to whom differential diagnosis need to be clarified in front of a newly discovered AT. Material and method. Hormonal assays are detailed. Results. In 2015, a 64-year-old female is admitted for accidentally discovered AT (of 2.89/3.6/3.2 cm). In 2011 she was diagnosed with endometrial carcinoma and total hysterectomy with bilateral anexectomy was done with local radiotherapy added. She associated high-risk MC as: type 2 diabetes mellitus, high blood pressure, hyperlipemia, chronic ischemic heart disease, persistent atrial fibrillation, hyperuricemia, and an episode of stroke (complicated with left hemiplegy). On admission, the serum sodium and potassium were normal while the endocrine profile revealed non-secretor profile: plasma metanephrines = 10 pg/mL (Normal: 10-90 pg/mL), plasma normetanephrines=20 pg/mL (Normal: 15-180 pg/mL), plasma baseline ACTH=8.04 pg/mL (Normal: 3-66pg/mL), baseline morning plasma cortisol = 14.97 pg/dL (Normal: 6.2-11.9 pg/dL), morning plasma cortisol after dexametasone suppression test =3 pg/dL (Normal: <1.8 pg/mL), chromogranin A = 20 ng/mL (Normal: 20-125 ng/mL). The patient was followed for one more year, and clinical, hormonal and imagery aspects were status quo. Conclusion. Adrenal incidentaloma may represent a challenge if metabolic complications are already diagnosed and a secretorpattern might be involved, and if a prior cancer is treated, the adrenal mass raises the question of a secondary spreading. [ABSTRACT FROM AUTHOR]

Introduction. Menopause involves skeletal losses, which may be accelerated by breast cancer and associated therapy, as aromatase inhibitors. Case presentation. A 67-year old Caucasian female underwent 2 years ago a right mastectomy for breast cancer (invasive ductal carcinoma of mucinous type; 85-90% positive reaction of estrogen receptor). Synchronously, she presented, at computer tomography, a left adrenal hyperplasia, stationary during follow-up. Tamoxifen was continued for two years, then a switch to anastrozole was done for the last four months. On admission, the assays showed a non-secretor adrenal pattern, with negative neuroendocrine markers, including serum serotonin. Bone profile pointed mild hypercalcemia with normal parathormone levels, as well as bone turnover markers and 25-hydroxyvitamin D (negative imagery scan for bone metastases). Dual-Energy X-Ray Absorptiometry (DXA) revealed osteopenia with a mid deterioration of Trabecular Bone Score (TBS) at 1220. Further continuation of aromatase inhibitor is recommended, in association with vitamin D supplementation and monthly oral risendronate, good hydration and serial calcium assays. Conclusion. Modern approach of menopausal breast cancer with aromatase inhibitors increases the speed of age-related bone loss, while detailed imagery may find otherwise unknown artefacts as non-tumour enlargement of adrenal glands. Whether neuroendocrine markers like 5-hydroxytryptamine will find a place in this particular context, apart from traditional bone indices, is still difficult to establish. [ABSTRACT FROM AUTHOR]

We introduce an original study referring to Romanian population treated with teriparatide (TPT), an anabolic drug for severe menopausal, glucocorticoid and male hypogonadism-related osteoporosis. Primary end point is to analyze the parameters of persons who fulfilled the national criteria of TPT regarding co-morbidities and bone profile. Secondary end point is to reveal the skeleton indices 12 months after TPT (20 μg/day subcutaneous). Informed written consent was signed between July 2015 and June 2016. Out of 21 patients with a mean age of 66.76 years (yrs), except for 2 men, there were menopausal females with av. 21.47 yrs since menopause. 57% had a history of superior digestive condition, another 57% had a chronic thyroid disease and 29% had a non-thyroid autoimmune morbidity. 17 patients were pre-exposed to anti-osteoporotic drugs 4.23+/-3.49 yrs. Number of prevalent fractures was: 3.75+/-2.17 (median 3; min 1, max 9). 42% (N=9) of subjects were followed for 1 year: no new fracture was registered; each patient had at least one DXA site with a BMD (Bone Mineral Density) increase (mean T-score increase of the most affected region was of 0.56+/-0.2 SD); osteocalcin statistically significant elevated from 18.87+/4.22 ng/mL to 42.8+/-16.3 ng/mL (p<0.0005) while CrossLaps went from 0.46+/-0.22 ng/mL to 0.65+/-0.3 ng/mL (p=0.15). Early drop-offs were registered in 2 patients. Based on this original study, patients with severe osteoporosis having a burden of many years of prior therapy or fragility fractures became candidates for TPT. After 12 months, the anabolic window was revealed by high bone remodelling blood markers, especially for osteocalcin. [ABSTRACT FROM AUTHOR]

Primary hyperaldosteronism (PH) caused by an aldosterone producing adrenal tumour is cured after adrenalectomy. However, long term follow-up is needed focusing on arterial hypertension and metabolic complications. A 69-year-old male was confirmed with PH at the age of 62. At that moment he had an 18-year history of high blood pressure (maximum 200/100 mmHg) in association with diabetes mellitus and hyperlipidemia. He developed hypopotassemia requiring spironolactone. No hypoaldosteronism was registered but a normalization of adrenal endocrine profile. While the patient was first evaluated for PH at the age of 62, a routine thyroid check-up showed multinodular enlargement with a large cyst on the right lobe. Six years later, the patient has moderate high blood pressure values controlled under daily 80 mg of telmisartan. This is a 49-year-old female with irrelevant family history who became hypertensive at the age of 37. At the age of 42, while she was investigated for performing a cholecystectomy, a left adrenal tumour of 1.2/0.9/0.9 cm was discovered at CT. Three years later she was investigated for secondary hypertension after associating mild hypopotassemia. A tumour production of aldosterone was linked with the adrenal mass. Currently, 4 years after the adrenal excision, biochemistry and endocrine panel is normal with residual high blood pressure controlled with low doses of calcium and beta adrenergic blockers. Surgery for adrenals in primary hyperaldosteronism is one elegant option which may cure the condition. A high index of suspicion and a systematic approach are useful in identifying and proving the diagnosis. Association with other endocrine disorders diversify the clinical appearance. Delaying the diagnosis and adrenalectomy decreases the chance of high blood pressure remission after adrenal removal. [ABSTRACT FROM AUTHOR]

Acromegaly is a rare chronic, progressive disease caused by the increased secretion of growth hormone (GH) and subsequently insulin-like growth factor 1 (IGF-1). Benign thyroid overgrowth is a common phenomenon in this pathology, but some studies revealed that acromegaly is associated with an increase in the prevalence of malignant thyroid nodules. We present two cases of acromegaly associated with papillary thyroid carcinoma. A 69-year-old female accused at the age of 43 headache, enlarged hands and feet, secondary amenorrhea. The investigations revealed high IGF-1 and GH levels and a pituitary GH producing macroadenoma. 19 years after transsphenoidal adenomectomy, a multinodular goiter with areas of calcifications and intra and perinodular vascularization were discovered. Total thyroidectomy was performed and histopathology highlighted a papillary thyroid carcinoma. A 53-year-old male was admitted at the age of 45 with intense headache, dizziness, sexual dysfunction and a multinodular goiter. Clinical signs of acromegaly were correlated to the presence of an intra-sellar tumor with extension to the optic chiasm. Transsphenoidal adenomectomy was first decided and it was followed by conventional radiotherapy, somatostatin analogue and GH blocker afterwards. For multinodular goiter a fine needle aspiration showed the need of total thyroidectomy which was further performed and a minimally invasive papillary microcarcinoma was confirmed. The relationship between acromegaly and thyroid carcinoma could be related to the stimulatory effects of long-lasting excess of IGF-1 and GH on TSH induced thyroid cellular growth. Therefore, it is necessary to carry out effective treatment and periodic thyroid ultrasound examination in patients with acromegaly; usually thyroidectomy follows hypophysectomy to achieve GH control first. [ABSTRACT FROM AUTHOR]

Renal hyperparathyroidism (HPTH) is first treated with vitamin D supplements and later parathyrodectomy is required; usually total removal of the four glands with self-transplantation and rarely partial resection is performed. We introduce a case of end-stage renal disease (ESRD) with very high parathormone (PTH) levels long-time after total parathyroidectomy without autoimplant, lacking the evidence of anatomical parathyroid presence. A 59-year-old female with ESRD since the age of 38 and hemodyalisis performed until the present day. The vitamin D supplementation was not adequate thus 8 years ago PTH was found increased (of 2070 pg/mL, normal: 15-65pg/mL), requiring surgery (total parathyroidectomy). Patient experienced low PTH values immediately after surgery. Further vitamin D and calcium supplements were offered and the values of total calcium remained low-normal while PTH assays were no longer done until recently. Currently, an elevated PTH of 1622 pg/mL with normal total calcium and severe vitamin D deficiency was found confirming once again renal HPTH. The imagistic tests did not reveal suggestive parathyroid masses at cervical and mediastinal computer tomography, both by using 99mTc PERTECHNETATE and SESTAMIBI parathyroid scintigraphy. Anterior cervical ultrasound suggested two right remnants of 4 mm, probably parathyroids. The best treatment for this moment is the adequate correction of vitamin D deficiency so daily oral vitamin D3 1000 UI, calcitriol 0.75 µg, and calcium carbonate 1500 mg were started. Three months later PTH decreased at 900pg/mL. If PTH might have a good response to the medication, surgery may be delayed. Moreover, the lack of adequate parathyroid masses identification will increase the surgical approach difficulty requiring intra-operatory localisation on a patient already associating multiple comorbidities. [ABSTRACT FROM AUTHOR]

Currently, transcranial hypophysectomy is infrequently used since the trans-sphenoidal approach is very effective and less invasive. Prolactinomas represent one of the rarest indications for pituitary surgery due to the spectacular effects of dopamine agonists as cabergoline. A 66-year-old female presented at age of 52 with headache, low blood pressure. The investigations revealed panhypopituitarism, high prolactin and a large pituitary mass with obstructive hydrocephalus at the left lateral ventricle. Transcranial surgery was performed through a right approach without complications. The pathological report confirmed a pituitary adenoma with intense cellular pleomorphism. A 29-year-old male was admitted at the age of 28 for severe headache, multiple episodes of vomiting, and hypotension. Pituitary insufficiency and hyperprolactinemia were correlated to the presence of an intrasellar tumor of 2/2 cm with extension to the right cavernous sinus, optic chiasm. The pathological report confirmed a pituitary adenoma. Transcranial pituitary surgery represents an option only in selected large macroprolactinomas. After procedure, a good outcome is expected despite the potential secondary eye field defects or pituitary insufficiency which needs medication. Sometime the panhypopituitarism caused first by the tumor itself persists after surgery (as in our first case) or it is corrected (as adrenal insufficiency in the second case). The presence of a residual prolactin producing tumor requires long term specific therapy with dopamine agonists. [ABSTRACT FROM AUTHOR]

Vitamin D represents a complex endocrine system with multifunctional levels of action, including during pregnancy. This is a short review of literature based on PubMed research. Vitamin D is linked to numerous divergent normal and abnormal functions of the human body. This becomes crucial during pregnancy. Specific metabolism during this period of time includes the role of placenta as provider of additional calcitriol resources. The excess of calcitriol is sustained by adequate levels of maternal 25-hydroxyvitamin D. Different conditions as gestational diabetes have been linked to maternal hypovitaminosis D. Vitamin D also prepares neonates immune system. Vitamin D represents a strong player during pregnancy from mothers and child's as well point of view. [ABSTRACT FROM AUTHOR]

The surgical approach in the pituitary secreting or non-secreting tumours had a complex development during the last century up to the microscopic transsphenoidal or endoscopic techniques. This is a mini-review of endocrine features in adenomas requiring their remove starting from a case presentation. A 54-year-old female is admitted for endocrine evaluation because of her medical history. At the age of 45 she presented secondary amenorrhea, mild right eye proptosis, and persistent diffuse headache. A pituitary adenoma of 21 by 19 mm was found. Selective transnasal trasnsphenoidal hypophysectomy was performed. The surgery went well without any incidents. The patient was hospitalised for 14 days. She was released without hypopituitarism, or diabetes insipidus. The immunohistochemistry report showed a weak reaction for GH but the adenoma was considered non-functioning. In 2015 severe headache was progressively seen and it became mostly unresponsive to usual analgesic medication so amitriptylin, and gabapentin were introduced in order to control the pain. MRI showed a right pituitary tumour of 12 by 19 by 13 cm with right cavernous sinus invasion. A second selective pituitary surgery was recommended but the patient still delays it. Hypophysectomy represent the first line of treatment in all the hormonally active pituitary masses (except for the majority of prolactionomas) and in non-secretor macroadenomas. Close endocrine and imagery check-up is indicated at diagnosis and later on even in cases with complete neurosurgical remove, as seen in this case, because the risk of relapse is presented even after a few years. Repeating the surgical procedure is advisable due to compression and local invasion risks, as well as the risk of hypopituitarism. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism (PHPT) is a frequent endocrine disorder that can only be cured by a surgical procedure that is parathyroidectomy. The main causes are usually solitary benign adenoma (80-85%), diffuse or nodular hyperplasia (10-15%), or parathyroid carcinoma (<1%). Out of the known localization techniques, ultrasonography, nuclear scintigraphy and computer tomography (CT scan) are most commonly used [1]. The aim of this study is to evaluate the sensibility of ultrasonography by comparison to scintigraphy and CT scan for the preoperative localization of parathyroid adenoma in patients with biochemically confirmed primary hyperparathyroidism. Localization studies were correlated with intraoperative findings, histopathological outcomes. In a retrospective study we analyzed 60 patients out of 245 patients who had undergone parathyroidectomy for PHPT between 2012-2013 in the Surgery Department of the National Institute of Endocrinology, Bucharest. Preoperative evaluation included imaging explorations (ultrasonography, scintigraphy and cervical CT scan) and therapeutic success was confirmed by histopathological result and the evolution of hormonal and biochemical tests. Intraoperative exploration revealed a single adenoma in 59 patients and one double adenoma. Thyroid disease was associated in 27 (45%) patients [ABSTRACT FROM AUTHOR]

Introduction The field of Cushing syndrome is a various area; there are still subjects incompletely clarified as the subclinical pattern as well as cortisol producing bilateral adrenal tumours. Case presentation The paper presents a 67-year old male case previously known with metabolic complications. He had an abdominal ultrasound done for unspecific complains and multiple gallbladder stones together with a right adrenal tumour were found. Later the computer tomography revealed bilateral adrenal tumours of almost 1.5 centimetres diameters (right larger than left) and a morning plasma cortisol level of 2.58 micrograms/ decilitre after low dose of dexametasone suppression test confirming the subclinical Cushing syndrome. After 6 months the endocrine and imagery profile was similar but the gallbladder patter aggravated so surgery was performed (together with right adrenalectomy) by a laparoscopic procedure. The blood pressure profile improved after surgery. Conclusion Subclinical Cushing syndrome diagnosis is challenging especially if metabolic complications or bilateral adrenal tumours are presented. Based on our observations in this case unilateral adrenalectomy improved the metabolic pattern [ABSTRACT FROM AUTHOR]

Introduction Cushing's disease is a complex endocrine disorder characterized by excessive glucocorticoid secretion caused by an ACTH-secreting pituitary adenoma. Hyperandrogenism and menstrual disorders such as amenorrhea and oligomenorrhea complete the clinical picture of Cushing's syndrome. Infertility is relatively common, involving complex pathogenetic mechanisms, which differ depending on the cause of hypercortisolism. Case presentation We present the case of a female patient diagnosed with Cushing's disease during the investigations carried out to assess infertility. After transsphenoidal adenomectomy, the patient underwent treatment with pasireotide and dopamine agonists, achieving normalization of gonadotropin and estradiol levels. Conclusion Current guidelines recommended transsphenoidal adenomectomy as first-line therapy in an attempt to correct hypercortisolism and restore fertility in patients with Cushing's disease. In case of relapse pasireotide and dopamine agonists can be effective in normalizing the hormonal profile [ABSTRACT FROM AUTHOR]

Introduction Cushing's disease is a rare endocrine disorder characterized by persistent hypercortisolism due to excessive, autonomous ACTH secretion by a pituitary adenoma. Transsphenoidal adenomectomy is the main therapeutic option in Cushing's disease. When imaging studies are unable to demonstrate an obvious pituitary mass complete tumor resection is difficult and often encumbered by risk of relapse. Medical therapy is a second-line option or the first-line treatment for patients with high surgical risk, incomplete surgical resection or relapse. Rarely classic clinical manifestations limit the selection of medical therapy for Cushing's disease. Case presentation We present the case of a male patient with Cushing's disease complicated with diabetes mellitus and severe hepatocytolisis syndrome with no visible pituitary adenoma on MRI studies. In the absence of technical equipment petrosal sinus sampling could not be performed in order to improve surgery outcome Conclusion The presence of unbalanced diabetes and severe hepatocytolisis syndrome made it impossible to use steroidogenesis inhibitors (mitotane, ketoconazole, metyrapone, etomidate) or inhibitors of ACTH secretion as pasireotide that represent a new option in achieving control of hypercortisolism [ABSTRACT FROM AUTHOR]

Introduction The Rathke cyst represents an unusual benign tumour derived from Rathke's cleft remnants. The diagnosis is potential seen at any age. The most frequent signs are mostly mass effects as headache, visual field defects and hypopituitarism. Case presentation 30-year old female is admitted for persistent headache that was later associated with secondary amenorrhea and visual field defects for the last two years. The clinical data are consistent with high levels of serum prolactin, gonadotropes deficiency, as well as central hypothyroidism. The magnetic resonance imagery found a pituitary tumour of 2.7 centimetres with extrapituitary extension up to the optic chiasm. Surgery was performed in order to remove the tumour. The pathologic report confirmed a Rathke's cleft cyst. Diabetes insipidus associated with panhypopituitarism was diagnosed and treated after the procedure. Close follow-up is necessary. Conclusion This case highlights the fact that headache sometimes embraces a severe neoplasia diagnosis and that the iatrogenic complications after surgery are lifelong care demanding [ABSTRACT FROM AUTHOR]

Introduction Prolactinomas without galactorhhea may be considered menopause or not diagnosed. This is a cases series. Case1. 76-year female with menopause at age of 52 was discovered at 66 yrs with high prolactin and a pituitary micro-nodule. Bromocriptin was continued for 6 years then switched to cabergoline with constant imagery. The patient did not display at all galactorrhea. Osteoporosis was diagnosed at age of 66 with previous 2 fragility fractures. Case2. 45-year female is known with secondary amenorrhea (without galactorrhea) for the last 7 years being considered menopause. She experienced headaches thus a MRI was performed and found a pituitary tumour of 1.5cm. Low FSH with increased prolactin was revealed. Cabergoline was started. Within 2 months the menses resumed and headache mildly improved. After 3 months prolactin normalised under weekly 2 mg of cabergoline. Periodical prolactin control is necessary as well as a pituitary scan at 6 months. Case3. 39-year female had a 3 yrs history of secondary amenorrhea. A prolactin of 117ng/mL and a microprolactinoma of 0.77cm were found. Cabergoline was started and progressively increased up to 1.5mg per week. The prolactin quickly normalised up to 8ng/mL within 4 months. She was followed for 2 years and the imagery found a tumour reduction to 0.44cm. Conclusion Prolactinomas associate a great variety of clinical presentations. They interfere with menopause by mimicking it in cases without galactorrhea. Also a newly diagnosed prolactinoma during menopause needs long term therapy and followed-up for especially for bone safety. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency is a global health problem, its role as an immune modulator being recently emphasized. Recent studies are increasingly suggesting that vitamin D plays a significant role in reducing the incidence and progression of autoimmune diseases. Furthermore, it was reported that patients with Hashimoto's thyroiditis, an autoimmune thyroid disease had lower vitamin D levels [1]. We initiated a prospective study, for a period of 6 months with a study group represented by 160 patients admitted to the National Institute of Endocrinology 'CI Parhon' in the period 2013 -2014. Patients were divided into 3 groups: 121 patients without thyroid pathology, 22 patients diagnosed with chronic autoimmune thyroiditis, who received 2000 IU cholecalciferol daily, 17 patients diagnosed with chronic autoimmune thyroiditis, which did not receive cholecalciferol. We found that patients with chronic thyroiditis have a poor vitamin D status with ATPO values negatively correlating with 25 (OH) vitamin D levels. Treatment with cholecalciferol not only improves vitamin D status but also lowers antithyroid antibodies titres. Keywords: vitamin D deficiency, chronic [ABSTRACT FROM AUTHOR]