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Simple Summary: Pituitary neuroendocrine tumors (PitNETs) comprise a large panel of histological types and usually require a multidisciplinary team for diagnosis and management. The most common are clinically and biochemically non-functioning PitNETs, and among them are incidentally found masses of pituitary incidentalomas (PIs), which have an increasing rate of detection currently. PIs are diagnosed in 10% of the population (up to 40% in some studies), and they may be confirmed at any age, mostly by computed tomography (CT) or magnetic resonance imaging (MRI). The rate of PIs growth varies from 5% to 50% depending on the tumor size, but micro-adenomas generally have a lower rate of enlargement. Long-term follow-up is advised, yet standard protocols are not homogenous. Overall, forestalling the tumor's spontaneous evolution is still an open issue. Non-functioning (NF) accidentally detected PitNETs (PIs) are common findings of CT/MRI scans currently. Data concerning their behavior vary, and some PIs will potentially experience a size change over time that might become clinically relevant. Objective: We aimed to evaluate CT-related PIs diameters following 3 aspects: a cross-sectional analysis based on the age' groups at first PI diagnosis and on the gender distribution and a longitudinal analysis in PIs with <0.5 cm versus ≥0.5 cm as the largest diameter at baseline. Methods: A retrospective, real-life, multi-centric study in adults with NF micro-PIs was performed. Results: 208 subjects (92.79% females) were included (average age 43.18 ± 12.58 y). The mean largest diameter (between transversal and longitudinal diameters) was 0.55 ± 0.16cm, and 44.71% of the PIs were located on the right part of the pituitary gland. The patients were divided into 10 age-groups (21 to 70 y), and no difference was observed between the mean largest diameters of these groups (p = 0.693). Females and males had a similar age at PIs diagnosis (p = 0.353), transverse diameter (p = 0.910), longitudinal diameter (p = 0.229), and PI location (p = 0.368). Serial CT scans (2 to 4 per patient) included a median (Q1–Q3) of 20 (12–36) months for the second CT scan, 58 (36–84) for the third CT scan, 78 (53–118) for the fourth CT scan, and a total follow-up between baseline and last CT scan of 40 (13–72) months. The initial largest diameter correlated with the diameter change between the baseline and the last CT (r = −0.575, p = 0.000). The largest PI diameter was similar between each serial CT scan (p = 0.840). According to the cut-off value of 0.5 cm diameter (for initial largest tumor diameter), group A (N = 78, 37.50%, <0.5 cm) and group B (N = 130, 62. 50%; ≥0.5 cm) had similar age at baseline (43.83 ± 12.72 versus 42.79 ± 12.54 y, p = 0.565) and PIs locations (right, left, median). The largest PI diameter remained smaller in group A versus B amid the second CT scan (p = 0.000) and the last CT scan (p = 0.009). The largest diameter change from the first to the last CT scan showed an increase in group A (median of +0.10 cm, p = 0.000) and a decrease in group B (median of −0.01 cm, p = 0.002); this diameter change was different in group A versus B (p = 0.000). The cumulative probability of tumor-growth-free survival showed different survival functions (log rank p = 0.000): group A exhibited a more gradual decrease versus B; at 60 months, the cumulative probability was 0.32 ± 0.08 for group A versus 0.75 ± 0.07 for B. During follow-up, all PIs remained NF, and no hypopituitarism was noted (as limits, we mention that dynamic hypopituitarism testing was selectively performed). Conclusions: NF micro-PIs in adults showed a similar age and sex distribution. During follow-up, PIs with a largest diameter < 0.5 cm increased after a median of 40 months but remained <1 cm, while in PIs with ≥0.5 cm, the largest diameter decreased. This highlights a lower predictability in tumor behavior than expected, particularly in larger micro-PIs that, overall, remained without relevant clinical implications after surveillance. [ABSTRACT FROM AUTHOR]

Background. Incidentalomas have an increasing incidence all over the world due to a larger access to imaging assessments, and endocrine incidentalomas make no exception in this matter, including pituitary incidentalomas (PIs). Objective. Our objective was to analyse the dynamic changes amid a second computed tomography (CT) scan after adult patients were initially confirmed with a PI (non-functioning micro-adenoma). Methods. This was a multi-centric, longitudinal, retrospective study in adults (aged between 20 and 70 y) amid real-world data collection. We excluded patients who experienced baseline pituitary hormonal excess or deficiency or those with tumours larger than 1 cm. Results. A total of 117 adults were included (94.02% females) with a mean age of 43.86 ± 11.99 years, followed between 6 and 156 months with a median (M) of 40 months (Q1 Q3: 13.50, 72.00). At the time of PI diagnosis, the transverse diameter had a mean value of 0.53 ± 0.16 cm, the longitudinal mean diameter was 0.41 ± 0.13 cm, and the largest diameter was 0.55 ± 0.16 cm. No PI became functioning during follow-up, neither associated hypopituitarism nor increased >1 cm diameter. A total of 46/117 (39.32%) patients had a larger diameter during follow-up (increase group = IG) versus a non-increase group (non-IG; N = 71, 60.68%) that included the subjects with stationary or decreased diameters. IG had lower initial transverse, longitudinal, and largest diameter versus non-IG: 0.45 ± 0.12 versus 0.57 ± 0.17 (p < 0.0001), 0.36 ± 0.11 versus 0.43 ± 0.13 (p = 0.004), respectively, 0.46 ± 0.12 versus 0.6 ± 0.16 (p < 0.0001). IG versus non-IG had a larger period of surveillance: M (Q1, Q3) of 48 (24, 84) versus 32.5 (12, 72) months (p = 0.045) and showed similar age, pituitary hormone profile, and tumour lateralisation at baseline and displayed a median diameter change of +0.14 cm versus −0.03 cm (p < 0.0001). To conclude, a rather high percent of patients might experience PI diameter increase during a longer period of follow-up, including those with a smaller initial size, while the age at diagnosis does not predict the tumour growth. This might help practitioners with further long-term surveillance protocols. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) causes specific hormonal disturbances, such as variations in leptin and testosterone levels and function. These disturbances can promote errors in signaling interaction and cellular information processing and can be implicated in the pathogenesis of atherosclerosis. This study investigates the factors that affect leptin in CKD patients and examines how leptin is related to markers of vascular disease. We conducted a cross-sectional study of 162 patients with CKD in pre-dialysis and dialysis stages. We recorded clinical and laboratory data, including leptin, testosterone, and subclinical atherosclerosis markers like brachial–ankle pulse wave velocity (ba PWV) in pre-dialysis CKD patients and flow-mediated vasodilation (FMD) and nitroglycerin-mediated vasodilation (NMD) in hemodialysis (HD) patients. Leptin was significantly correlated with testosterone in CKD pre-dialysis stages (p < 0.001) and also in HD (p = 0.026), with adipose tissue mass in pre-dialysis stages (p < 0.001), and also in HD (p < 0.001). In women HD patients, leptin correlated with NMD (p = 0.039; r = −0.379); in all HD patients, leptin correlated with C reactive protein (p = 0.007; r = 0.28) and parathormone (p = 0.039; r = −0.220). Our research emphasizes the connection between leptin, adipose tissue, and testosterone in all stages of CKD. Leptin was associated with NMD in HD women and correlated with inflammatory syndrome and parathyroid hormone in all HD patients. [ABSTRACT FROM AUTHOR]

Petrified ear (PE), an exceptional entity, stands for the calcification ± ossification of auricular cartilage (CAC/OAC); its pathogenic traits are still an open matter. Endocrine panel represents one of the most important; yet, no standard protocol of assessments is available. Our objective was to highlight most recent PE data and associated endocrine (versus non-endocrine) ailments in terms of presentation, imagery tools, hormonal assessments, biopsy, outcome, pathogenic features. This was a comprehensive review via PubMed search (January 2000–March 2024). A total of 75 PE subjects included: 46 case reports/series (N = 49) and two imagery-based retrospective studies (N = 26) with CAC/OAC prevalence of 7–23% (N = 251) amid routine head/temporal bone CT scans. Endocrine PE (EPE): N = 23, male/female ratio = 10.5; average age = 56.78, ranges: 22–79; non-EPE cohort: N = 26; male/female ratio = 1.88, mean age = 49.44; ranges: 18–75 (+a single pediatric case).The longest post-diagnosis follow-up was of 6–7 years. The diagnosis of PE and endocrine anomalies was synchronous or not (time gap of 10–20 years). A novel case in point (calcified EPE amid autoimmune poly-endocrine syndrome type 2 with a 10-year post-diagnosis documented follow-up) was introduced. We re-analyzed EPE and re-classified another five subjects as such. Hence, the final EPE cohort (N = 50) showed: adrenal insufficiency was the most frequent endocrine condition (36%) followed by hypopituitarism (22%) and hypothyroidism (18%); 39% of the patients with adrenal failure had Addison's disease; primary type represented 72% of all cases with hypothyroidism; an endocrine autoimmune (any type) component was diagnosed in 18%. We propose the term of "endocrine petrified ear" and a workflow algorithm to assess the potential hormonal/metabolic background in PE. [ABSTRACT FROM AUTHOR]

Pro-B amino-terminal natriuretic peptide (NT-proBNP) is a diagnostic marker for heart failure (HF), a severe complication of chronic kidney disease (CKD). However, its significance in CKD is not clear, as other factors, such as renal function, may also have an impact. Recent studies have shown that ghrelin treatment is effective in HF in the general population, but the impact of ghrelin on cardiac function in CKD patients is still unknown. Our study aimed to investigate the factors associated with NT-proBNP in pre-dialysis CKD patients and to evaluate the correlation between NT-proBNP and ghrelin and acyl-ghrelin, molecules determined using ELISA methods. In a cross-sectional observational study, we included 80 patients with pre-dialysis CKD, with a mean age of 68 years and 50% men. The median values for NT-proBNP were 351.8 pg/mL, for acyl ghrelin 16.39 pg/mL, and for ghrelin 543.32 pg/mL. NT-proBNP was correlated with ghrelin (p = 0.034, r = 0.24), acyl-ghrelin (p = 0.033, r = −0.24), estimated glomerular filtration rate (p = 0.027, r = −0.25), serum urea (p = 0.006, r = 0.31), and ferritin (p = 0.041, r = 0.28). In multivariate analysis, ghrelin (p = 0.040) and blood urea (p = 0.040) remained significant predictors for NT-proBNP levels. NT-proBNP was a significant predictor for acyl-ghrelin (p = 0.036). In conclusion, in pre-dialysis CKD patients, a high value of NT-proBNP was associated with a high value of total ghrelin and a low value of acyl-ghrelin. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVD) are the first cause of chronic kidney disease (CKD) mortality. For personalized improved medicine, detecting correctable markers of CVD can be considered a priority. The aim of this study was the evaluation of the impact of nutritional, hormonal and inflammatory markers on brachial-ankle Pulse Wave Velocity (PWV) in pre-dialysis CKD patients. A cross-sectional observational study was conducted on 68 pre-dialysis CKD patients (median age of 69 years, 41.2% with diabetes mellitus, 52.9% male). Laboratory data were collected, including levels of prolactin, triiodothyronine, TGF α, IL-6, and IL-1β. The high values of brachial-ankle PWV were associated with reduced muscle mass (p = 0.001, r = −0.44), low levels of total cholesterol (p = 0.04, r = −0.26), triglycerides (p = 0.03, r = −0.31), triiodothyronine (p = 0.04, r = −0.24), and prolactin (p = 0.02, r = −0.27). High PWV was associated with advanced age (p < 0.001, r = 0.19). In the multivariate analysis, reduced muscle mass (p = 0.018), low levels of triiodothyronine (p = 0.002), and triglycerides (p = 0.049) were significant predictors of PWV, but age (p < 0.001) remained an important factor. In conclusion, reduced triiodothyronine together with markers of malnutrition and age were associated with PWV in pre-dialysis CKD patients. [ABSTRACT FROM AUTHOR]

DNA damage repair pathways, including mismatch repair (MMR) genes, are prone to carcinoma development in certain patients. The assessment of the MMR system is widely recognized as part of strategies concerning solid tumors (defective MMR cancers), especially MMR proteins (through immunohistochemistry), and molecular assays for microsatellite instability (MSI). We aim to highlight the status of MMR genes–proteins (including MSI) in the relationship with ACC (adrenocortical carcinoma) according to current knowledge. This is a narrative review. We included PubMed-accessed, full-length English papers published between January 2012 and March 2023. We searched studies on ACC patients for whom MMR status was assessed, respectively subjects harboring MMR germline mutations, namely Lynch syndrome (LS), who were diagnosed with ACC. MMR system assessments in ACCs involve a low level of statistical evidence. Generally, there are two main types of endocrine insights: 1. the role of MMR status as a prognostic marker in different endocrine malignancies (including ACC)—which is the topic of the present work, and 2. establishing the indication of immune checkpoint inhibitors (ICPIs) in selective, mostly highly aggressive, non-responsive to standard care forms upon MMR evaluation (which belongs to the larger chapter of immunotherapy in ACCs). Our one-decade, sample-case study (which, to our knowledge, it is the most comprehensive of its kind) identified 11 original articles (from 1 patient to 634 subjects per study diagnosed with either ACC or LS). We identified four studies published in 2013 and 2020 and two in 2021, three cohorts and two retrospective studies (the publication from 2013 includes a retrospective and a cohort distinct section). Among these four studies, patients already confirmed to have LS (N = 643, respective 135) were found to be associated with ACC (N = 3, respective 2), resulting in a prevalence of 0.0046%, with a respective of 1.4% being confirmed (despite not having a large amount of similar data outside these two studies). Studies on ACC patients (N = 364, respective 36 pediatric individuals, and 94 subjects with ACC) showed that 13.7% had different MMR gene anomalies, with a respective of 8.57% (non-germline mutations), while 3.2% had MMR germline mutations (N = 3/94 cases). Two case series included one family, with a respective four persons with LS, and each article introduced one case with LS-ACC. Another five case reports (between 2018 and 2021) revealed an additional five subjects (one case per paper) diagnosed with LS and ACC (female to male ratio of 4 to 1; aged between 44 and 68). Interesting genetic testing involved children with TP53-positive ACC and further MMR anomalies or an MSH2 gene-positive subject with LS with a concurrent germline RET mutation. The first report of LS-ACC referred for PD-1 blockade was published in 2018. Nevertheless, the use of ICPI in ACCs (as similarly seen in metastatic pheochromocytoma) is still limited. Pan-cancer and multi-omics analysis in adults with ACC, in order to classify the candidates for immunotherapy, had heterogeneous results, and integrating an MMR system in this larger and challenging picture is still an open issue. Whether individuals diagnosed with LS should undergo surveillance for ACC has not yet been proven. An assessment of tumor-related MMR/MSI status in ACC might be helpful. Further algorithms for diagnostics and therapy, also taking into consideration innovative biomarkers as MMR-MSI, are necessary. [ABSTRACT FROM AUTHOR]

Early diagnosis of pregnancy- and lactation-associated osteoporosis (PLO) is mandatory for a good outcome. Standard care is not a matter of conventional guidelines, rather it requires an individualized strategy while true overall incidence and pathogeny remain open issues. This is a narrative review based on full-length English articles, published between January 2021 and March 2023 and accessed via PubMed (no traumatic fractures or secondary osteoporosis are included). Our case-sample-based analysis included 836 females with PLO (the largest cohort based on published cases so far) through 12 studies and 24 single case reports. Except for one survey, these involved retrospective cohorts of small size (6–10 females/study) to medium size (23–47 women/study), and large cohorts with >50 subjects per study (a maximum of 379). Age of diagnosis: from 24 to 40 years for case reports (most subjects being over 30 and primigravida), while original studies indicated an average age between 31 and 34.18 years. Type of fractures underlined a most frequent vertebral phenotype (a mean of 2 to 5.8 vertebral fractures per patient) versus a most severe non-vertebral phenotype (hip and femoral neck fractures mostly requiring surgery). Potential contributors varied: smoking (1/3–1/2 of subjects), family history of osteoporosis (1/3), heparin and glucocorticoid use in pregnancy, low body mass index (majority of cases), hypovitaminosis D; and (with a low level of statistical significance) anti-psychotic medication, gestational diabetes, lupus, thrombophilia, anemia, in vitro fertilization (1/3 in one study), twin pregnancy, tocolysis with MgSO4, and postpartum thyroiditis. Most remarkably, up to 50% of PLO patients harbor mutations of LRP5, WNT1, and COL1A1/A2 (more damaged form with potential benefits from osteoanabolic drugs); gene testing might become the new norm in PLO. The low index of clinical suspicion should be supported by performing magnetic resonance imaging (gold standard in pregnancy) with DXA (in lactation). Low bone mineral density is expected (Z-score varying from −2.2 SD to −4 SD, unless normal which does not exclude PLO). Bone turnover markers might be useful in individuals with normal DXA, in pregnancy when DXA cannot be performed, and in following the response to anti-osteoporosis drugs. Alternatively, microarchitecture damage might be reflected by DXA-trabecular bone score and high-resolution peripheral quantitative computed tomography. Specific medical interventions are currently focused on teriparatide (TPT) use (3 studies; n = 99 females treated with TPT and an additional subgroup of 18 patients from the gene-analysis-based study, thus a total of 117 females) which seems to be the therapy of choice as reflected by these new data: 6–24 months, 20 µg/day, no sequential therapy needed; case selection based on high fracture risk is necessary). The first case using romosozumab was reported in 2022. PAO/LAO remains a challenging condition which is a battle for the wellbeing of two individuals, on one hand, considering maternal-fetal outcomes and taking care of the offspring, but it is a battle for a multidisciplinary team, on the other hand, since a standardized approach is lacking. [ABSTRACT FROM AUTHOR]

This document is a certificate of publication for an article titled "Mineral metabolism assays and osteoporotic fracture risk evaluation in menopausal population diagnosed with adrenal incidentalomas: a sub-analysis of PRECES study." The article is authored by Alexandra-Ioana Trandafir, Mihaela Stanciu, Ana Valea, Oana-Claudia Sima, Claudiu Nistor, Mădălina Gabriela Iliescu, Ileana Ciobanu, Florina Ligia Popa, and Mara Carsote. It was published in the Balneo & PRM Research Journal in June 2024. The article focuses on evaluating the risk of osteoporotic fractures in menopausal individuals diagnosed with adrenal incidentalomas through mineral metabolism assays. The certificate includes the website of the journal and information about the editorial board. [Extracted from the article]

Vitiligo, the discoloration of the skin, has different autoimmune mechanisms reflected by many biomarkers as shown by skin histology, staining for CD4 and CD8 T lymphocytes, chemokine ligand 9 or circulating cytokines such as interleukin (IL)-1 beta, interferon (IFN)-gamma, transforming growth factor (TGF)-beta, antibodies, markers of oxidative stress, chemokines, and others. In this narrative review, we aim to overview vitiligo in relationship with chronic autoimmune thyroiditis. Regarding vitiligo, more than 50 different genetic loci have been associated with this disease, and the heritability is high. There is a 20% risk of an environmental connection which may also act as a trigger; moreover, the association with human leukocyte antigen (HLA) expression is well recognized. The specific lesions display CD8+ tissue-resident memory T cells as continuous key activators of melanocytes. The association with chronic thyroiditis is based on common autoimmune background and excessive reactive oxygen species that destroy melanocytes and thyrocytes (oxidative stress hypothesis) with thyroxine and melanin as target molecules, thus sharing a common origin: tyrosine. Moreover, common epigenetic anomalies or mutations of the Forkhead transcription factor D3 (FOXD3) have been described. Since vitiligo affects up to 1-2% of the population worldwide and 34% of patients have positive thyroid antibodies, apart from common autoimmunity background and oxidative stress toxicity, the association is clinically relevant for different practitioners. [ABSTRACT FROM AUTHOR]

We aimed at assessing the interaction between visceral adipose tissue (VAT), insulin resistance (IR), circulating levels of monocyte chemoattractant protein-1 (MCP-1) and malondialdehyde (MDA) and the thyroid parameters in obese subjects. Methods. Obese subjects without thyroid pathologies or diseases associated with systemic inflammation and OS were recruited. Insulinemia, visceral fat thickness, metabolic and thyroid parameters were assayed. Circulating levels of MCP-1 and MDA were used to quantify inflammation and OS. Results. A number of 160 obese subjects were included. The MCP-1 level increased with the degree of obesity and HOMA-IR. MCP 1 was positively associated with antithyroperoxidase antibody (TPOab) levels and the frequency of Hashimoto's thyroiditis (HT). The MDA level was positively correlated with the degree of obesity, aspartate aminotransferase and MCP-1. MDA was an independent predictor for the occurrence of hypothyroidism. IR patients showed higher fT3 levels and a positive association between insulin and TPOab levels. Conclusions. Systemic inflammation increased with VAT, IR and OS and was correlated with the frequency and the severity of HT, suggesting that, in obesity, MCP-1 could be part of the etiopathogenesis of autoimmune thyroiditis. MDA was an independent risk factor for hypothyroidism; therefore, redox imbalance associated with obesity can produce cell damage and thyroid dysfunction. FT3 is increased in IR patients, thus being a marker for the severity of metabolic impairment. [ABSTRACT FROM AUTHOR]

Introduction. As opposed to secreting tumours, non-functioning pituitary adenomas are usually diagnosed at a later stage, when they are large enough to cause symptoms due to mass effect rather than because their associated endocrine dysfunction. We aim to introduce a case report with limited therapy options. Case presentation. We present the case of a 69 year-old male patient with a history of stroke, atrial fibrillation and type 2 diabetes, who was initially admitted to the neurology department three years ago for frontal headaches and visual disturbances. The MRI (magnetic resonance imaging) exam revealed a 15.4/26.7/19.5 mm sellar mass, with suprasellar and parasellar extension, minimal optic chiasm compression and pituitary stalk deviation. Initial pituitary hormone profile showed central hypogonadism and mild hyperprolactinemia. The patient underwent neurosurgery evaluation but at that point transsphenoidal surgery was contraindicated due to severe cardiovascular comorbidities and the patient was referred to the endocrinology department for further follow-up, where he presented a year later, after worsening of symptoms. The MRI revealed tumour enlargement (18.5/28/24.6 mm) and stationary hormonal profile. The diagnosis of nonfunctioning pituitary macroadenoma was once again confirmed, cabergoline was initiated as adjuvant therapy since surgery was still contraindicated because high cardiovascular risk. Stereotactic radiation was not an option due to tumour proximity to the optic chiasm, therefore the patient underwent conventional radiotherapy. Evaluation after 3 months showed stationary clinical picture while MRI scan 3 months revealed a mild tumour growth (4 mm in all diameters). Further cabergoline therapy 2 mg/week was prescribed and the patient needs carefull monitorization for worsening of symptoms and hypopituitarism. Conclusion. Surgery is the mainstay of therapy in case of large nonfunctioning pituitary macroadenomas. If contraindicated, the available options include radiotherapy and medical therapy like cabergoline, with varying results, mostly suboptimal. [ABSTRACT FROM AUTHOR]

Hereditary syndromes underlying neuroendocrine tumours are extremely heterogeneous and, despite the genetic background, their recognition may actually be done later in life in many cases. Our purpose is to introduce a case of neurofibromatosis type 1 -related pheocromocytoma on a patient within his six decade of life after multiple cardiovascular complications. A 53-year old male is admitted for loss of appetite with weight loss, decreased exercise tolerance, transient occipital headache, night sweats. His medical history revealed arterial hypertension, right carotid artery ischemic stroke, and a recently non-STEMI myocardial infarction diagnosed two months ago. The pathological family history illustrated mother and a brother prematurely dying of myocardial infarction (no date of skin anomalies). Clinical examination reveals café-au-lait spots, axillary freckles, skin neurofibromas and a large plexiform neurofibroma in the right thigh. Evaluation of the adrenal gland revealed highly elevated values of urinary metanephrines and normetanephrines. Computed tomography showed a left adrenal gland tumour of 31/39 mm. Thus neurofibromatosis type 1 in addition to a left pheocromocytoma was confirmed. A cardiologic examination before surgery was re-done. Given previous pathological history (cardiovascular events like stroke and nonSTEMI infarction) adrenalectomy was delayed for the moment in addition to second antiplatelet agent and the alpha blocker medication in increasing doses. The adrenal tumour removal is planned to be done as soon as cardiovascular risk is acceptable. The importance of endocrine check is seen in young patients with severe cardiovascular and neurological acute conditions that are actually caused by a hormonal excess like found in pheocromocytoma. Nevertheless, the spectrum of tumours associated with neurofibromatosis type 1 is heterogeneous and screening protocols are still a matter of debate. Delayed diagnosis worsts the overall prognosis [ABSTRACT FROM AUTHOR]

TBS (Trabecular Bone Score) is the latest tool for clinicians to evaluate bone micro-architecture based on a pixel greyscale, which is provided by lumbar dual-energy X-ray absorptiometry (DXA). Its use enhances fracture prediction in addition to DXA-BMD (Bone Mineral Density). This is independent of fracture risk assessment (FRAX) and DXA results. We present a narrative review regarding the connection between TBS and Glucocorticoids (GC), either as a drug used for different conditions or as a tumor-produced endogenous excess. TBS is a better discriminator for GC-induced vertebral fractures compared to DXA-BMD. This aspect is similarly available for patients with osteoporosis diagnosed by DXA. TBS is inversely correlated with the cumulative dose of GC (systemic or inhaled), with disease duration, and positively correlated with respiratory function in patients with asthma. Low TBS values are found in females with a T-score at the hip within the osteoporosis range, with diabetes mellitus, or who use GC. Lumbar TBS is a screening tool in menopausal women with type 2 diabetes mellitus. TBS is an independent parameter that provides information regarding skeleton deterioration in diabetic patients receiving GC therapy in a manner complementary to DXA-BMD. TBS might become an essential step regarding the adrenalectomy decision in patients with adrenal incidentaloma in whom autonomous cortisol secretion might damage bone micro-architecture. TBS currently represents a standard tool of fracture risk evaluation in patients receiving GC therapy or with endogenous Cushing's syndrome, a tool easy to be applied by different practitioners since GCs are largely used. [ABSTRACT FROM AUTHOR]

Glucagonoma is a hormonally active rare pancreatic neuroendocrine tumour causing an excess of glucagon. This is a narrative review based on a multidisciplinary approach of the tumour. Typically associated dermatosis is necrolytic migratory erythema (NME) which is most frequently seen at disease onset. Insulin-dependent diabetes mellitus, depression, diarrhoea, deep vein thrombosis are also identified, as parts of so-called 'D' syndrome. Early diagnosis is life saving due to potential aggressive profile and high risk of liver metastasis. NME as paraneoplastic syndrome may be present for months and even years until adequate recognition and therapy; it is remitted after successful pancreatic surgery. Thus the level of practitioners' awareness is essential. If surgery is not curative, debulking techniques may improve the clinical aspects and even the outcome in association with other procedures such as embolization of hepatic metastasis; ablation of radiofrequency type; medical therapy including chemotherapy, targeted therapy with mTOR inhibitors such as everolimus, PRRT (peptide receptor radiotherapy), and somatostatin analogues (including combinations of medical treatments). Increased awareness of the condition involves multidisciplinary practitioners. [ABSTRACT FROM AUTHOR]

Somatostatinoma is a tumour mainly originating from pancreas or duodenum; overall with an incidence of 1/40 million persons. We introduce a narrative review of literature of somatostatinoma including the relationship with neurofibromatosis type 1. Clinical presentation includes: Diabetes mellitus, cholelithiasis, steatorrhea, abdominal pain, and obstructive jaundice while papillary tumour may cause acute pancreatitis. The neoplasia may develop completely asymptomatic or it is detected as an incidental finding during an imaging or a surgical procedure. It may be sporadic or associated to genetic backgrounds especially for duodenal localisation as neurofibromatosis type 1 (NF1 gene with malfunction of RAS/MAPK pathway) or Pacak-Zhuang syndrome (EPAS1 gene encoding HIF). Surgery represents the central approach if feasible but the prognostic depends on location, and grading as indicated by WHO 2017 classification of neuroendocrine tumours. Previously known as Von Recklinghausen disease, neurofibromatosis type 1, the most frequent neurocutaneous syndrome, is an autosomal dominant disorder including: Café-au-lait spot, skin fold freckling on flexural zones, and neurofibromas as well as tumours such as gliomas of optic nerve, gastrointestinal stromal tumours (GISTs), iris hamartomas and brain tumours. Duodenal somatostatinoma is associated with the syndrome which actually involves more often a duodenal tumour of GIST type than a somatostatin secreting neoplasia. Other neuroendocrine tumours are reported: Gastrointestinal NENs at the level of rectum or jejunum and pheocromocytoma. Overall, one quarter of subjects have gastrointestinal tumours of different types. Somatostatinoma, when not located on pancreas but in duodenoum, may be registered in subjects with neurofibromatosis type 1 most probably in addition to other tumours. Overall, this type of neuroendocrine tumour with a challenging presentation has a poor prognosis unless adequate radical surgery is promptly offered to the patient. [ABSTRACT FROM AUTHOR]

Scar is part of wound healing and hypertrophic aspects as well as keloids are pathological formation of a scar. Their appearance is seen post-operatory, post-trauma and the consequences are more than cosmetic depending on location, for instance at joins functional impotence is associated. A scar formation involves activation of matrix enzymes, matrix response, local inflammation and fibroblast intervention as well as local cytokines and growth factors action. Our purpose is to introduce to cases of females who developed hypertrophic scars after thyroidectomy in addition to local swelling as revealed by neck ultrasound. The paper is two cases series report. The hormonal assays and ultrasound aspects are provided. A 30-year female with Basedow disease had one month after thyroidectmy TRAb of 2.4 U/l while TSH was 1 of under daily 100 ìg of levothyroxine. The subject presented a post-operatory hypertrophic scar in addition to the following ultrasound aspect: right area with an inhomogeneous structure of 1/1.2/4 cm, left area of 1.4/1.7/4 cm, with multiple images with posterior echo and intense local edema. This is a 44-year female referred for total thyroidectomy (for large goiter). The subject did not develop any peri-operatory complication. The histological report showed chronic autoimmune thyoiditis background of focal type in addition to nodules of colloidal and cystic adenomatosis with hyperplasic epithelium. One month later TSH was normal under levothyroxine. The subject presented a post-operatory hypertrophic scar in addition to ultrasound aspect of edema in association with inflammatory lymph nodes at lateral cervical level of 0.6/0.2 cm maximum diameter. It is still a matter of debate to classify the high risk patients for developing post-thyroidectomy scars. [ABSTRACT FROM AUTHOR]

Hypoparathyroidism is a rare condition associating autoimmune, genetic, post-operatory (most frequent) or idiopathic causes. Low calcium causes neuromuscular irritability of chronic or acute type like muscle crample, paresthesia, tingling, cardiac rhythm anomalies, seizures, etc. Despite calcium and active vitamin D replacement, acute complications are frequently seen and generally a reduced quality of life is registered since pathogenic medication like parathormone drug substitution is not currently available in daily practice. Other complications are due to overtreatment with calcium and vitamin D like kidney stones and associated urinary infections and hypercalciuria while increased calcium-phosphor product causes calcifilaxia of different locations causing complications like skin necrosis, brain calcifications with seizures, etc. We introduce a case of hypoparathyoidism in association with other co- morbiditis and a brief discussion around the case related to bone mineral density anomalies or usefulness in general panel of investigations in this particular topic. This is a 43-year old non-smoking male coming from non-endemic area that had a small lesion of skin necrosis at left hand. He has autoimmune thyroiditis and on admission low values of calcium and PTH 2 pg/ml (normal 15-65 pg/ml) are consistent for the diagnosis of hypoparathyroidsm, probably of autoimmune cause. Central DXA shows high BMD at each site. He was offered calcium and vitamin D replacements with a mild clinical improvement. This case of autoimmune hypoparathyroidism associated with Hashimoto's thyroiditis highlights the idea of high DXA-BMD due to cortical and trabecular effects of PTH deficiency. [ABSTRACT FROM AUTHOR]

Neuroendocrine neoplasia (NEN), priory known as neuroendocrine tumours represent the modern approach of traditionally named "carcinoid" tumours. We shortly introduce benign and malign dermatological aspects that are linked to NEN field. This is a multidisciplinary perspective. The paper is a mini-review. 30 articles are included as references. NEN represents 2% of all cancers, being considered orphan disease. Skin and soft tissue are exceptional sites of NEN, the majority are actually secondary spreading of NEN of other locations. Little data have been published related to the topic. Some cases reports showed invasion of dermis and subcutis, probably more frequent in older adults. The entity has been named low-grade neuroendocrine carcinoma of the skin, also named primary cutaneous carcinoid tumour. As seen in NEN diagnosis, the immunohistochemistry is essential like chromogranin A, synaptophysin, neuron specific enolase which are classical neuroendocrine markers and non-neuroendocrine parameters are useful for differential diagnosis like estrogens, androgens and progesterone receptors, GATA3, carcinoembryonic antigen. Merkel cell carcinoma represents the high grade NEN. It has a poor prognosis, with a 30% risk of local metastasis. The risk factors are either viral infection like Merkel cell polyomavirus, either long time exposure to ultraviolet light. The prognostic is similar between the two factors. Surgical removal is the first line therapy and adjuvant treatment is radiotherapy and chemotherapy. Skin NEN represents an exceptional finding of aggressive profile. Their prompt recognition may help the prognosis. [ABSTRACT FROM AUTHOR]

Skin metastases are not typical. Malignancies like mammary cancer (most frequent in females) and pulmonary neoplasia (most frequent in males) represent the majority and exceptional findings are in those originating from thyroid, prostate, ovaries and oesophagus, usually in advanced, generally disseminated stages, with a poor prognosis. It may be found more often in elderly patients. We aim to present some practical aspects of skin metastases in thyroid cancer that originates from follicular thyroid epithelium. This is a brief literature review. The level of evidence is poor since most data is provided from cases reports. Cutaneous malignant lumps are rarely the first sign of disease, mostly associating a cancer relapse. The location varies from neck and head (majority) to exceptional sites as chest wall and of variable rate for scalp. Underling neck muscle or Meckel's cave metastasis may be associated. The lesion is usually a lump of medium to small size, sometimes of papular appearance, without local pain (but depends on the site); it may associate erythema. The diagnosis is difficult unless an index of suspicion is positive (in which case whole body radioiodine scintigram may be useful). Biopsy and histological report are essential for diagnosis especially in cases without an evident connection to a prior/synchronous thyroid malignancy. Knowing the exceptional prevalence, the need for awareness in this particular topic is connected with a multidisciplinary daily practice. [ABSTRACT FROM AUTHOR]

Breast fibroadenoma is a benign tumour that is mostly asymptomatic thus it may be detected as an incidentaloma. Typically they are diagnosed in women of reproductive age and they reduce the dimensions during menopause because of estrogens deficiency that is why in menopause are rare. The mass is elastic, mobile and it contains an epithelial part and a stromal component (so called fibroepithelial tumours). Here is the case of a 70-year old female who had done a mammogram for the first time and she was found with such a lesion of 1.5 cm. She also is confirmed with osteopenia, most probable unrelated to the breast tumour. Menopausal fibroadenoma, even at low risk of malignancy requires a good multidisciplinary team of decision. Because of the differential diagnosis with breast cancer the positive diagnostic is based on ultrasound, mammogram and even biopsy. Menopausal fibroadenoma, even at low risk of malignancy requires a good multidisciplinary team of decision. Because of the differential diagnosis with breast cancer the positive diagnostic is based on ultrasound, mammogram and even biopsy. Due to low aggressive profile, the follow-up is, however, the most rational approach. [ABSTRACT FROM AUTHOR]

Introduction. High prolactin may cause central hypogonadism including osteoporosis and breast secretion but also rare manifestations like increased androgens in females or galactocele. A part from high prolactin - related large cystic incidental mammary findings, the breast cysts may be associated with infections, local trauma and hemorrhage of priory benign cystic disease or solid tumors. Method. We introduce different clinical aspects of breast nodules with benign appearance, either symptomatic like painful large cyst with local inflammation elements or asymptomatic as an incidental finding. This is a cases series from a multidisciplinary perspective. Cases data. The patients' age is between 43 and 62 years. The youngest female presented a large left cyst after a potential local trauma with local inflammation signs which were released after liquid evacuation. The oldest patient had bilateral mammary micro-cysts with a good prognostic as incidental finding. Conclusion. Benign breast lesions of adult females may associate local skin changes as redness and increased temperature or they may be completely asymptomatic, being detected as incidental findings. Regardless the scenario, the index of malignancy suspicion is always necessary because of heterogeneous presentation and increased incidence of mammary cancer. [ABSTRACT FROM AUTHOR]

We introduce dermatological aspects from an endocrine point of view related to pituitary tumours that display active secretor activity. This is a short literature review. 40 papers are cited including narrative reviews and original studies. Acromegaly: GH overproduction causes the thickening of the skin and swelling of the soft tissues in addition to the enlargement of extremities (like nose, hands, feet, jaw), coarsening of facial features (as front head and naso-labial folds), excessive sweating, exaggerate skin wrinkles, oily skin, and acrochordons. Cushing's disease: cortisol overproduction has a severe protein catabolic effect at skin with collagen network disruption while immune effect of hypercortisolemia induces chronic skin infections and difficulties in wound healing. In females, consecutive androgens excess induces acne, hirsutism, and androgens-related alopecia. The classical phenotype includes: fragile skin or skin atrophy, red/purple striae, easy bruising, facial plethora. Skin changes represent the window to pituitary tumours for clinicians of different specialities, therefore contributing to final diagnosis of endocrinopathies. [ABSTRACT FROM AUTHOR]

Adrenal carcinoma is a complex orphan disease with a very poor prognosis. The evolution is rapid and in cases with suggestive symptoms the diagnosis may be established earlier in order to improve the outcome. One third of the patients are negative for a clear hormonal expression or they have an atypical presentation. We introduce an adult patient diagnosed with adrenal carcinoma and a rapid lethal outcome who initially presented with pale skin and non-specific abdominal pain. A multidisciplinary team is essential for adequate diagnosis and prompt intervention. Severe bleeding at the level of the adrenal carcinoma causing symptomatic anaemia is a rare event. The prognosis in adrenocortical carcinoma is severe and the presence of humoral hypercalcemia represents a sign of short survival time. [ABSTRACT FROM AUTHOR]

Our aim is to describe a case of a menopausal woman who started with dermatomyositis and then became a patient at endocrinology because of complicated glucocorticoid osteoporosis. This is a 63-year old female who suddenly started to accuse intense muscle pain associated with redness of the skin. She was confirmed with dermatomyositis and offered high doses of oral metilprednisolone. The thyroid ultrasound showed micronodular background and a small nodule of 0.7 cm without clinical relevance with an increase of antibodies thyroperoxidase antibody and normal thyroid function. Bone turnover markers were within normal in addition to decrease of serum 25-hydroxyvitamin D of 20 ng/ml. DXA (Dual-Energy X-Ray Absorptiometry) showed ostepenia based on a minimum T-score of -2.4 SD. The patient was offered high doses of cholecalciferol 2,000 UI per day and 500 mg of calcium daily in addition to weekly alendronate due to the high risk of fracture because of the glucocorticoid doses. 6 months later she suffered and accidental fall and a hip fracture was confirmed and required surgery. Further on the therapy was switched to zolendronic acid one injection per year. The dermatological and muscle progressively improved thus the doses of corticoids were reduced. As particular observation the presence of autoimmune thyroid condition may increase the risk of a second autoimmune disease like dermatomyositis, also the specific antibodies panel was negative. A multidisciplinary team needs to be involved in associated therapy for dermatomyositis and complications of glucocorticoids use. [ABSTRACT FROM AUTHOR]

Striae rubrae or red striae are found in different circumstances like pregnancy, weight gain and Cushing's syndrome regardless of endogenous or exogenous type. This type of skin lesion is commonly found in general population and usually does not underline a severe condition. The histological aspect that involves the stretch marks is the destruction of the dermal fibbers and their local network. The fibbers have receptors for glucocorticoids. A secondary epidermal anomaly is also seen. In benign scenarios the prevention with topic applications is still a matter of debate while therapy lasers of different types might help. In cases with pathological glucocorticoids excess the removal of the source improves the skin lesions yet not completely, they become white. We aim to introduce two cases of Cushing's disease of different origins to whom impressive red striae were positive from the presentation. Red striae may be the hallmark of Cushing's syndrome in association with different cardio- metabolic and/or bone complications. Despite the remission of the glucocorticoid excess the skin lesions are not completely reversible. [ABSTRACT FROM AUTHOR]

Introduction: Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures. Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant. Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse. [ABSTRACT FROM AUTHOR]

Obesity is associated with multiple complications like cardiovascular, oncologic, including skin infections potentially with a more severe evolution than in subjects with normal weight. We aim is to introduce two cases of females who initially presented with skin infections associating obesity and two different types of endocrine tumours; both of them underwent bariatric surgery. One case of a young female who had acne and menses anomalies was confirmed with macroprolactinoma and treated with cabergoline with menses control. For obesity she had bariatric surgery with weight and acne control but associating long term hypovitaminosis D. The second case is a menopausal woman with metabolic syndrome and different persistent skin infections in association with features of cardio-metabolic anomalies which were confirmed as adrenal Cushing's syndrome and referred for unilateral adrenalectomy. The improvement of mentioned parameters was not associated with obesity control so bariatric surgery was done. She suffered a shoulder fracture and she was confirmed with osteoporosis (a lumbar T-score of -3.3 SD). The values of 25-hydroxyvitamin D remained normal only under oral replacement with vitamin D supplements and zolendronic acid was added. Obesity underlines heterogeneous aspects including dermatological, metabolic, cardiovascular and endocrine conditions; some of them are dramatically improved after bariatric surgery, yet not hipovitaminosis D and osteoporosis especially in menopausal women. The prolactin excess, Cushing's disease or just obesity itself may cause repeated skin infections or acne. [ABSTRACT FROM AUTHOR]

Pituitary non-functioning adenomas may be detected based on pituitary insufficiency, eye field complications or headache, etc, so called pituitary mass syndrome. We introduce a series of three cases of non-functioning pituitary macroadenoma with a different management based on local anatomy of the tumour and complications, as well as the tumour speed of growth. Non-functioning macroadenoma, even rare, require lifetime follow-up and a rigorous multidisciplinary decision of intervention. [ABSTRACT FROM AUTHOR]

This is a case report of a female with transitory erythema who was found with thrombocytosis caused by a pheocromocytoma. The skin changes were not accompanied by typical manifestations of an adrenergic crisis although she had high blood pressure episodes without skin colour changes. Both the erythema and the arterial hypertension controlled after the adrenal tumour was removed. Pheocromocytoma associates not only the excessive production of metanephrines and normetanephrines but also other factors like interleukins (for instance, IL-6, causing a general inflammatory syndrome including reactive thrombocytosis) eritropoietin or parathormone related peptide. Thrombocytosis is extremely rare associated with cathecolamines producing tumour and it may become a supplementary contributor to cardiovascular risk. [ABSTRACT FROM AUTHOR]

Hypopituitarism is the main complication of nonfunctioning pituitary macroadenomas. A 64-yearold patient was admitted for marked asthenia, generalized muscle contractions, acroparesthesia and lumbar pain. Clinical examination revealed grade I obesity, discrete eyelid edema, negative Chwosteckand Trousseau signs. Hormonal profile showed the presence of somathotropic pituitary insufficiency, low testosterone levels (of 1.3 ng/mL, normal: 1.68-7.58ng/mL), gonadotropin and prolactin levels within the normal range, normal values for TSH (Thyroid Stimulated Hormone) and FT4 (Free Thyroxine). On admission, low serum and urinary cortisol values were obtained, with an appropriate response after the Synacthen test. The MRI (Magnetic Resonance Investigation) examination revealed a pituitary macroadenoma of 20/21/21 mm, compressing the optic chiasm and thalamus, with bilateral 180-degree involvement of the internal carotid artery. The ophthalmological examination described a lower scotoma in the left eye, without amputation of the visual field. Thyroid and glucocorticoid hormone replacement therapy was recommended, along with neurosurgical intervention. In pituitary macroadenomas, the close proximity to the optic chiasm and carotid arteries limits the curative therapeutic potential and increases the risk of postoperative complications. [ABSTRACT FROM AUTHOR]

The aim of this article is to study the possible relation of serum vitamin D concentrations to body mass index (BMI), visceral fat thickness (VFT), insulin resistance (IR), inflammation (serum monocyte chemoattractant protein-1 - MCP-1) and thyroid parameters in obese patients. A total of 158 non-diabetic, obese patients aged 19-68 without a history of thyroid pathology were recruited. Biochemical markers, insulin, 25-OH vitamin D, thyroid parameters (TSH, FT3, FT4, TPO antibodies, TG antibodies) and VFT were measured. Serum MCP-1 evaluated the inflammation. A HOMA-IR cut-off value of 2.5 defined IR. Most patients had severe (70.3%) or moderate (25.3%) vitamin D deficiency. Vitamin D level was negatively associated with BMI (p = .043) and during the cold season with VFT (p = .009). Vitamin D deficiency correlated with Hashimoto's thyroiditis prevalence during the warm season (p = .047) and was a risk factor for its occurrence (p = .021). At 15 ng/mL cut-off value, vitamin D was negatively correlated with MCP-1 (p = .0006). Also, MCP-1 was positive correlated with HOMA- IR (p = .042), TPO-Ab levels (p = .011) and with Hashimoto's thyroiditis (p = .027). MCP-1 was a risk factor for vitamin D deficiency (p < .0001). Our study supports a bidirectional interaction between vitamin D and systemic inflammation in obese patients. Moreover, systemic inflammation is related to the severity and frequency of Hashimoto's thyroiditis. Vitamin D deficiency is the single independent factor associated with Hashimoto's thyroiditis in obese patients. [ABSTRACT FROM AUTHOR]

Non-functioning pituitary adenoma is one of the most common endocrine tumour with a benign pattern in the majority of cases. We present the case of a 69 years old female admitted on endocrinology department for visual field defects, dizziness, memory disorder, bradylalia, bradypsychia. During medical examination, the patient presented a sincopal event, with abundant sweating and temporo-spatial disorientation. Magnetic Resonance Imaging revealed a pituitary macroadenoma of 23/33.3/37 mm with two spherical lesions overlapped ("snow man" shape), with mass effect on the cavernous sinuses extending to the posterior wall of the left sphenoid sinus. Visual field examination showed significant narrowing to both eyes. The hormonal profile revealed gonadotropic insufficiency and low Insulin-like Growth Factor 1 with normal prolactin and cortisol levels. Thyroid hormonal evaluation highlighted primary hypothyroidism due autoimmune thyroiditis. Two weeks later, adenomectomy was performed by supraorbital craniotomy. After discharge, she received the thyroid hormone replacement therapy initiated preoperatively and specific therapy for associated pathology: diabetes mellitus type 2, osteoporosis, and hyperlipidemia. Pituitary surgery is the first line treatment for the majority of patients with symptomatic endocrine-inactive adenomas. Further multidisciplinary close check-up is periodically recomended. [ABSTRACT FROM AUTHOR]

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]

Primary hyperparathyroidism (HPTH) is a common endocrine disorder characterized by multiple organic events secondary to hypercalcemia, including renal insufficiency. We introduce a case of primary HPTH diagnosed after presentation for recent-onset of renal insufficiency. A 60-year old male with no prior medical history was initially diagnosed with renal failure in the context of progressive malaise, nausea, recent onset of moderate blood pressure. Beside low glomerular filtration rate (eGFR of 15 mL/mim/1.73m2), biochemical evaluation showed hypercalcemia of 14.4 mg/dL (normal: 8.8-10.6 mg/dL), ionic calcium of 7.27 mg/dL (normal: 4.4-5.4 mg/dL), hypercalciuria of 343 mg/24h, normal:<300 mg/24h. Examinations performed for secondary causes of hypercalcemia have revealed increased value of parathyroid hormone (PTH) of 881.2 pg/mL (normal: 12-88 pg/mL). Thyroid ultrasound and cervico-mediastinal computed tomography highlighted an inhomogeneous hypoechoic lesion on the posterior side of the left lobe, with intrathoracic extension, measuring 3.54/4.94/5.4cm with left parathyroid adenoma significance. The hormonal profile excluded multiple endocrine neoplasia syndrome (MEN). After improvement of biochemical parameters by adequate hydration and diuretic treatment, left parathyroidectomy was performed. One month later, normal PTH, calcium total, ionic calcium, and improvement of renal function have been achieved. Long-term follow-up by a multidisciplinary team was recommended. [ABSTRACT FROM AUTHOR]

Osteoporosis represents a worldwide problem due to under diagnosis, and under treatment. The major complications are fragility fractures as vertebral, etc. some of them requiring orthopedic and neurosurgical procedures. We introduce a case of a female adult who was first referred for spine surgery because of osteoporosis complications and then she was followed for a few years based on background skeleton condition. This is a 70-year old subject admitted for a new vertebral fracture assessment and therapy adjustment. She had 3 spine surgeries for multiple vertebral fractures (thoracic 7, 8, 9,10, and 12) during the last 5 years; she was intermittently treated with specific anti-osteoporotic drugs. On admission, the patient has severe kyphosis and secondary walk difficulties; intermittent non-specific lumbar pain. The mineral metabolism indicated no anomaly. DXA confirmed low T-score with reduced values compare to prior analysis. X-Ray assays at spine levels showed diffuse demineralization, multiple metallic implants at the level of thoracic vertebras T7, 8, 9, 10, 12 and another new one at T7, round kyphosis, increased physiological lordosis; osteophytosis including at hip joint. The patient was offered a yearly intravenous injection of zolendronic acid 5 mg in addition to 2000 Units of cholecalciferol and 800 units of calcium per day. Another spine surgery was considered unnecessary for the moment, but close follow-up is useful, including the management regarding therapy and lifestyle intervention for severe osteoporosis. The management of a patient with osteoporotic spine fracture is a complex and dynamic equation requiring a multidisciplinary team and life time follow-up. [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]

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]

The autoimmune background as found in chronic thyroiditis (CT), also known as Hashimoto's thyroiditis or autoimmune lymphocytic thyroiditis, does not represent an indication of surgery but the discovery of macro-nodules may represent a risk for thyroid cancer, thus thyroidectomy becomes an important tool of approach. Environmental triggers, less or more described up to this moment, are a contributor to higher prevalence of CT and to the shift through more frequent cases of papillary thyroid cancers (PTC) rather than follicular type. This is a mini-review of literature focused on the association between CT and differentiated thyroid cancer, especially PTC. The research used as key words all the mentioned synonyms used for CT. A number of 62 references are selected, since 2004 (while 45 of them are published between 2015 and 2017), and 53 of them are accessible via PubMed database. The CT - PTC relationship may be described at different levels: PTC is presented more frequently than follicular thyroid cancer in relationship with iodine supplements including cases with autoimmune background; 2. CT is involved in multifocal PTC but this histological pattern may not be more aggressive than generally expected because lymph nodes are somehow blocked by the immune process and protected by lymph nodes metastasis from primary thyroid source of PTC so the risk of recurrence and aggressive profile is not higher than seen in CT-free subjects. Team approach is essential for many aspects as the detection of CT and the selection of those rare cases that need thyroidectomy. The association between CT and PTC is actually more frequent that expected, especially for micro-PTC subtype. Overall, the survival of PTC patients does not seem to be influenced by CT if surgery is correctly applied despite a risk of multifocal intra- and not extra-thyroid spreading of malignancy. [ABSTRACT FROM AUTHOR]

Medullar thyroid cancer (MTC) may be sporadic or familial, either linked with pheocromocytoma (PHEO) and primary hyperparathyrodism (PHP), as seen in type 2A MEN (Multiple Endocrine Neoplasia) syndrome, either isolated. This is a 56-year old female known with mild arterial hypertension controlled under therapy, having a daughter with type 2A MEN syndrome (PHEO, MTC, PHP). Mild hypercalcemia and high parathormone were consistent for PHP, while calcitonin was 20 times above the upper normal limit for MTC. The PHEO tests were negative. Anterior cervical ultrasound confirmed a 2.7 cm thyroid nodule, local lymph nodes, and enlargement of inferior and superior left prarathyroids. After total thyroidectomy with bilateral neck dissection and excision of the left inferior and superior parathyroid glands, MTC and parathyroid hyperplasia was confirmed. Calcitonin decreased to 5 times above the normal level. Further close follow-up and therapy of residual MTC is needed. MEN 2A Syndrome may embrace various clinical presentations with more or less aggressive tumours, sometimes allowing a long time survival without neoplasia confirmation or incomplete phenotype until advanced age. [ABSTRACT FROM AUTHOR]

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Introduction. Scleroderma induces heterogeneous skin changes due to collagen anomalies including facial. The recommended therapy is. among others, topic cortisol derived products so an issue of diagnosis differential regarding the etiological type of Cushing's syndrome (CS) is raised if a patient develops a suggestive phenotype. Case presentation. This is a 64-year female presenting since the last few months red face, high blood pressure. central obesity. She has a 6-year history of scleroderma, intermittently treated with local corticotherapy. On admission, she associated metabolic disturbances as lipid profile anomalies, high uric acid, insulin resistance and increased number of white blood cells (which were not connected with a relapse of scleroderma, neither to an inflammatory syndrome). Low baseline plasma ACTH and morning serum cortisol level (not high yet detectable) with abnormal diurnal rhythm suggested an adrenal source of CS. A 3 cm right adrenal tumor was found on computer tomography and later removed through a classical intervention. Two weeks after, the patient voluntarily reduced her prednisone dose causing an adrenal crisis which required re-admission as an emergency. After discharge daily oral adrenal replacement therapy is needed for the moment. Conclusions. Scleroderma, especially with skin involvement, and some of associated therapies may mask an endogenous CS as adrenal tumor derivate thus delaying the adequate diagnosis and therapy. Patient's education regarding a potential life threatening condition as chronic adrenal insufficiency is necessary since post-operatory recovery of adrenal function is expected within 6 to 24 months. [ABSTRACT FROM AUTHOR]

The field of neuroendocrine tumours (NETs) is complex and dynamic, recently becoming a hot spot on publications area. We aim at presenting new frames of NETs approach. This is a narrative review using an English literature PubMed research (publications only from 2016). The main stream of NETs management includes somatostatin analogs with good effects on carcinoid syndrome and proliferation rate; peptide receptor radionuclide therapy (NETTER-1 study). New products as peripheral tryptophan hydroxylase oral inhibitors (TELESTAR study) are opening promising doors. RADIANT-4 results were recently published; everolimus becoming an essential line therapy especially for pancreas. Surgical approach of NETs remains important. T invasion. The indications of performing surgery for metastasis are mostly unchanged and this decision must be taken under multi-disciplinary considerations. Despite recent progress, there are still many missing pieces of the puzzle represented by NETs domain. [ABSTRACT FROM AUTHOR]