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Copyright of Ginecologia.ro 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.)

Copyright of Ginecologia.ro 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.)

Copyright of Ginecologia.ro 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.)

Copyright of Ginecologia.ro 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.)

Copyright of Ginecologia.ro 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.)

Copyright of Ginecologia.ro 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.)

Copyright of Jurnalul Pediatrului is the property of Romanian Society of Pediatric Surgery 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.)

Breast cancer has a worldwide increasing incidence and once the diagnosis is done a screening is performed using method like ultrasound, computed tomography etc in order to assess disease spreading, according to the mammary malignancy's stage. During this type of evaluation, a thyroid condition might be detected. Generally, 50-70% of adult population has a thyroid nodule of different dimensions, usually with a very low clinical relevance and a very good prognosis. If the pathogenic correlation between a thyroid nodule and the breast tumour is indeed sustained this is still a matter of debate. Our purpose is to introduce a series of subjects associating non-syndromic mammary cancer and thyroid nodules of various types. The use of thyroid ultrasound in patients with mammary cancer is mandatory. Most of thyroid nodules are incidental but some thyroid pathologies may actually be linked to breast malignancy. [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]

Ultrasound is the first step to detect an abdominal tumour at the level of adrenal. The most common scenario is related to the pelvic and abdominal ultrasound. This kind of tumour is more frequently seen in menopausal women than in premenopausal ones. We introduce a case of a menopausal woman accidentally detected at ultrasound with an adrenal mass starting from a routine gynaecological control. The use of ultrasound on adrenal masses is related to their detection and follow-up in cases when surgery is not necessary. [ABSTRACT FROM AUTHOR]

Introduction: Epicardial adipose tissue is an ectopic fat storage at the heart surface in direct contact with the coronary arteries. It is considered a metabolically active tissue, being a local source of pro-inflammatory factors that contribute to the pathogenesis of coronary artery disease. The AIM of our study was to establish correlations between echocardiographic assessment of epicardial adipose tissue and anthropometric and ultrasound measurements of the central and peripheral fat depots. Method: The study was conducted on 22 patients with or without coronaropathy. Epicardial adipose tissue was measured using Aloka Prosound α 10 machine with a 3.5-7.5 MHz variable-frequency transducer and subcutaneous and visceral fat with Esaote Megas GPX machine and 3.5-7.5 MHz variable frequency transducer. Results: Epicardial adipose tissue measured by echocardiography is correlated with waist circumference (p < 0.05), visceral adipose tissue thickness measured by ultrasonography (US) and is not correlated with body mass index (p = 0.315), hip and thigh circumference or subcutaneous fat thickness measured by US. Conclusions: Our study confirms that US assessment of epicardial fat correlates with anthropometric and US measurements of the central fat, representing an indirect but reliable marker of the visceral fat. [ABSTRACT FROM AUTHOR]

Premenstrual syndrome (PMS), including the severe subtype premenstrual dysphoric disorder (PMDD), DSM-5 category, represents a challenging combination of hormonal, environmental and neuroendocrine dysfunctions with menstrual cycle-related pattern. Controversies around the role of daily stress and associated anomalies of hypothalamic-pituitary-adrenal axis are related to the fact that stress is all the time, not just a fluctuating element. This is a narrative review on PMS/PMDD and cortisol profile. 46 articles are cited (between 2009 and 2020). PMD/PMDD underlines multiple imbalances and anomalies of the cortisol levels or its secretory pattern may be a few of them, despite the fact that multiple controversies are still present and most of studies are of limited statistical power. Women with PMS may have higher levels of cortisol in relationship to stress independently of the cycle phase, also a delay of CAR (cortisol awakening response) peak and a delayed cortisol slope during day time. It does not seem that CAR pattern is related to the phases of menstrual cycle. CAR anomalies may be associated with pain perception disturbances in PMS females. The most modern area of interest is related to allopregnanolone, a progesterone metabolite with neuroactive profile. The diurnal serum baseline cortisol and the values of cortisol after dexamethasone suppression test may be similar between patients with PMS and without, but the females with PMS that have higher allopregnanolone associate blunted values of cortisol during the night versus control (without PMS) and versus women with low allopregnanolone levels, thus proving a suboptimal response to stress. Allopregnanolone modules GABA receptors on a paradoxical manner inducing anxiety and irritability during luteal phase on women with a specific predisposal configuration of GABA receptor as those confirmed with PMDD. Overall, PMS/PMDD impairs the quality of life, thus the more we understand about its pathogeny, the easier it gets to control it. [ABSTRACT FROM AUTHOR]

Hot flashes (HF), transitory episodes of erythema, heat sensation, anxiety followed by chills, are described in carcinoid syndrome, mastocytosis, medullary thyroid cancer, hyperthyroidism, pheochromocytoma, alcohol consumption, side effects of drugs, and infections. They are pivotal among menopause-related vasomotor symptoms beside genitourinary syndrome in addition to sleep disturbances (40-60% of females), and metabolic changes. HF affect 70% of women (20% of them have a severe impairment of life quality); they last for 4-7 years, starting 4-6 years before last menstruation. The main HF cause is ovarian-derivate estrogen deprivation which activates complex endocrine and neuroendocrine mechanisms involving noradrenaline, 5-hydroxytriptamine (5-HT), calcitonin gen-related peptide, orexin, kisspeptin, neurokinin B, and epigenetic elements like modulation of tachykinin receptor 3, accelerated epigenetic aging (as found in Women's Health Initiative Observational Study), expression of central serotonin transporters. Estrogen deficiency uncouples the negative feedback with preoptic area of hypothalamus, responsible for thermoregulation by inducing an exacerbated vasodilatory response to a small increase of body temperature. TRPV1 (transient receptor potential vanilloid 1) in preoptic hypothalamic area may play a role by NE-α2ADR (norepinephrine- activated α2-adrenergic receptors) activation. Higher expression of serotonin transporter SLC6A4 causes a lack of 5-HT at synapsis which is a trigger for presynaptic 5-HT receptor feedback, thus a release of serotonin amount prevents hot flashes. Kisspeptin and neurokinin B which are co-expressed in infundibular nucleus of hypothalamus are involved in central thermoregulation and gonadotropin releasing hormone anomalies. The NKR3 (neurokinin 3 receptor) antagonist receptor improves HF. Understanding the pivotal role of central neurotransmitters in hot flashes is the basis of new therapeutically researches because otherwise estrogen replacement has a long list of side effects, and it is contraindicated in breast cancer-related hypogonadism. [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]

Dyke-Davidoff-Masson syndrome (DDMS) represents a severe disease that is caused by brain anomalies of different mechanisms early in life during fetal period or within first years after birth. This is a brief point of view of DDMS through an endocrine perspective. In DDMS, low TSH (thyroid stimulating hormone) hypothyroidism is part of a variable cocktail of endocrine anomalies like pituitary insufficiency that actually seem less relevant opposite to massive neurological damage which marks the clinical picture. Overall, the most spectacular anomaly and the most specific in DMMS is the imaging aspect of the brain hemiatrophy. The syndrome itself, even with a very low prevalence in general population (the level of statistical evidence is case report or series), has a heterogeneous presentation and a large area of clinical combo involving not only neurological field. On the other hand, cerebral hemiatrophy (also a rare neuroimaging finding) may have other causes, either acquired or congenital. Seizures induced by brain damage may be presented long before the imaging recognition of the syndrome is actually done. The endocrine disturbances vary and they may be subtle like central hypothyroidism or life threatening like adrenal crisis due to secondary adrenal insufficiency. Overall, DDMS represents a complex challenge from severe neurological deterioration to neuro-imagery features centered on the brain hemiatrophy to skin and bone anomalies as well as endocrine disorders which are either deficiency of pituitary hormones or diabetes mellitus and autoimmune thyroiditis. Early recognition is useful for long term prognosis, a multidisciplinary approach is essential. Underlying causes and specific clusters of classification are still running under a large shadow of unknown data. [ABSTRACT FROM AUTHOR]

Introduction. Skin is deeply affected by aging as all the organs do, including endocrine glands and neuroendocrine circuits. The anomalies of aging are connected to the internal aspects including hormonal panel mostly vitamin D status and glucocorticoid axes integrity, melatonin networking, thyroid function, and catecholamines/ serotonin release), state of health/illness, genetic background and bio-neuroendocrine/neurotransmitters pathways as well as immune defence. Moreover, external environment elements like sun exposure, radiations, pollution, physical, chemical and biological agents are consistent with internal mentioned aspects. Our purpose is to provide a mini-review regarding neuroendocrine and endocrine perspective of skin aging. Particular aspects on glucocorticoids, vitamin D and 5-hydroxytryptamine are pointed out. This is a narrative type of review. Skin is situated at the crossroad between intrinsic and extrinsic aging and the neuroendocrine approach is essential for understanding its time dependent changes. [ABSTRACT FROM AUTHOR]

We introduce a case of a menopausal woman newly diagnosed with primary osteoporosis who has been detected with a forearm lump. A 57-year old female is confirmed with osteoporosis at DXA. The patient developed within 10 days a painful lump with local redness at dorso-medial part of left forearm. Apparently no local trauma was identified. Neither had she a general infection or any other condition in the mean time. The ultrasound identified a hypoechoic area of 4 by 1.3 by 4 cm, with positive Doppler signal. A local infection was considered and she was offered antibiotics for 10 days. However, since the patient also accused bone pain, she was re-referred for an endocrine assessment. The hormonal panel was consistent with the first assays. Also a mild inflammatory syndrome was detected based on erythrocytes sedimentation rate of 31 mm/1-hour (normal: < 25 mm/1-h) and C reactive protein of 1.4 mg/dl (normal: < 1 ng/ml). An X - Ray of the region was done and showed no anomaly. The bone whole body scintigram was negative at forearm but a fracture rib at the level of 9th left rib was identified and considered osteoporotic. A computed tomography showed the subcutaneous localisation of the lump with small calcifications and no bone involvement. Paget's disease of the bone was excluded based on normal bone turnover markers and negative bone scintigram. The proximity with a bone disease diagnosis needs to differentiate a subcutaneous lesion from a potential bone deformity caused by a metabolic bone condition. [ABSTRACT FROM AUTHOR]

Introduction. Adrenal incidentaloma is a more frequent diagnosis during the last decades since the relative access to abdominal ultrasound, computed tomography or magnetic resonance imagery is higher. Aim. Our aim is to focus on the relationship between bone status (BS) in patients diagnosed and confirmed with adrenal incidentaloma. Method. This is a mini-review of the literature. Most of the included papers were published during the last 5 years. The main research tool is PubMed database. General data. BS is affected in adrenal incidentaloma mainly through persistent autonomous cortisol production which is called (even lately the term is not encouraged) "subclinical Cushing's syndrome" with a prevalence of 0.2 up to 2% in unselected series of adult people. TBS (Trabecular Bone Score) in both men and women is negatively correlated with plasma cortisol after 1 mg dexamethasone suppression test. There is 2.2% decrease of TBS if subclinical Cushing's syndrome is confirmed opposite to clear non-functioning pattern of the adrenal incidenaloma. Bone mineral density based on DXA at central sites (lumbar spine and femoral neck) was similar between the subject with unilateral and bilateral incidentaloma. The presence of subliclinical hypercortisolism is positively correlated with a higher risk of osteoporosis and fragility fractures Recently the term of "high risk" patients with adrenal incidentaloma has been introduced in order to describe the subgroup with autonomous cortisol secretion that has an increased risk of cardiovascular morbidities, infections and fractures (even independently of DXA - bone mineral density. Conclusion. The main contributor to BS, as well as to the cardiometabolic damage, remains the autonomous cortisol secretion in adrenal incidentaloma with a potential improvement after adrenalectomy and without a specific anti-osteoporotic medication in this particular situation. [ABSTRACT FROM AUTHOR]

Introduction. ACTH (adrenocorticotropic hormone) is a key regulator of adrenal production involving cortisol as an essential hormone for life. The melanin is a pigment which is produced by melanocytes at the level of melanosomes (the melanogenesis). Both MSH and ACTH are generated by the cleavage of POMC (proopiomelanocortin) after CRF (corticotropin-releasing factor) stimulation and then MSH acts on the skin causing hyperpigmentation. Aim. To introduce clinical data of literature that link hyperpigmentation with ACTH excess. Three main topics are introduced: Addison's disease, ectopic Cushing's syndrome, and Nelson's syndrome. Method. This is a short overview of literature including papers that have been mostly published within last 5 years. General data. Hyperpigmentation in relationship to ACTH includes its high levels in addition to low cortisol in Addison's disease and Nelson's syndrome and high non-suppressible cortisol in ectopic Cushing's disease. ACTH has a pituitary origin in first two situations and malignancy in the third one. A pituitary tumour is found in cases with Nelson's syndrome. An autoimmune background may be associated with Addison's disease. An iatrogenic component is brought by Nelson's syndrome. All three situations are severe and life threatening of different scenarios. Conclusion. Hyperpigmentation may be the clue to connect dermatology to endocrine pathologies and ACTH massive release by a pituitary or a non-pituitary origin involves a complex panel of conditions. [ABSTRACT FROM AUTHOR]

Renal failure is associated with numerous complications including cardiovascular, dermatological, neurological, surgical and endocrine. Hypovitaminosis D induces secondary hyperparathyroidism and long term effects are represented by autonomous stimulation of the parathyroid glands (tertiary hyperparathyroidism). Fail of PTH (parathyroid hormone) levels control through vitamin D replacement makes necessary a surgical intervention because of the risk of chronic complications in addition to the general morbidities caused by chronic kidney disease including osteoporosis. Our aim is to present a case of an adult woman with a very long history of renal failure complicated with tertiary hyperparathyroidism and osteoporosis. The clue of the case is the difficult localisation of PTH source after total parathyroidectomy was previously done in order to remove it and timing of re-intervention. There is a challenge to adequately locate the parathyroid remnants after a prior glands removal and a skilled surgeon is still the best "tool". However, the risk of surgery in a cases with multiple complications is very high so it is preferable a pre-operatory localisation. The neck ultrasound is the most accessible tool offering a good accuracy if there is no mediastinal localisation and also the combination with parathyroid scintigram increases the rate of detection. [ABSTRACT FROM AUTHOR]

Vitamin D in menopause is essential for skeleton and metabolic involvement. Our purpose is to introduce the level of evidence regarding menopause - related hypovitaminosis D through a brief review of papers published on PubMed in 2016. The correlation between low vitamin D and risk of falls is a traditional observation. Lack of vitamin D remains one of the major contributors to osteoporotic fractures which have an annual incidence of 8.9 million worldwide. Yale FIT trial referring to menopausal cancer survivors after 12 months of aerobic physical exercise confirmed the bone loss under aromatase inhibitors opposite to tamoxifen is significant, a bone loss that is lower if vitamin D ranges are low. Arzoxifene Generations Trial followed for 5 years menopausal women treated only with vitamin D and calcium and found a fracture risk increase by 46% for each unit of lumbar T-score that decreases. A meta-analysis of 34 studies on 11,090 patients treated with ibandronate showed that hypovitaminosis D at baseline is a predictor of bone mineral density improvement only at lumbar spine. Another study revealed that 77% of menopausal females have 25-hydoxyvitamin D (25OH D) less than 30 ng/mL while a negative correlation between 25-OH D and waist circumference was found knowing that android fat disposition in women with hipovitaminosis D is a hallmark of metabolic syndrome. Overall, in 2016, PubMed published papers regarding vitamin D in menopause still reflect its deficiency and associated metabolic risk. [ABSTRACT FROM AUTHOR]

Introduction. Thyroidectomy is currently a rather simple procedure with various indications, regardless total or subtotal/near total, based on conventional approach or modern like robotic (trans-axillary and axillobreast robotic). We aim to introduce a few scenarios in daily endocrine practice based on a pictorial essay. This is a cases series. Case 1 is a 59-year old female with recent subclinical thyrotoxicosis with an extremely large multinodular goitre who was confirmed benign by the pathological report was provided after. Case 2 is a 70-year old female who self detected through palpation a large left thyroid macronodule with suspected ultrasound features. However, she still delays thyroidectomy. Case 3 is a 51-year old female also with compressive symptoms due multinodular goitre and a dominant left lobe nodule who was referred to surgery. Case 4 is a 59-year female treated with thiamazole for 12 years presents a large multinodular goitre which was referred to surgery. Conclusion. Different scenarios are ending with the idea of thyroidectomy from compressive local symptoms, to curative option for a potential malignancy etc. [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]

Plummer disease of the thyroid represents a traditional condition causing primary hyperthyroidism. Our aim is to introduce a short overview regarding the use of the term "Plummer adenoma" of the thyroid and to report a case with traditional diagnosis. In terms of method this is a case report and a historical data report using as references PubMed and online sites of general endocrine and historical information. This is a 43-year old female who had 2 months ago a mild episode of vertigo, followed by intermittent sweating and weight loss (2 kilos within 2 months). Hyperthyroidism is confirmed based on suppressed TSH. Thyroid scintigrame was performed using as thyroid tracer Tc99 Perthechnetate which revealed thyroid with normal anatomy with a "hot" autonomous nodule at the level of right thyroid lobe. Thyroid ultrasound showed a right lobe of 2.4 by 3.2 by 3.5 cm and a left lobe of 1.1 by 0.8 by 3.6 cm. Right lobe has a macronodule of 3.5 by 2.1 by 2.8 cm which entirely occupies the lobe; it has an inhomogeneous pattern, with microcalcifications and tracheal effect to the opposite site. The patient was offered daily thiamazole and a low dose of beta blockers; follow-up is necessary; then the indication of thyroidectomy will be done because of thyroid dimensions and nodule aspect in association with tracheal effect. Plummer toxic nodule of the thyroid represents a classical endocrine condition which requires thyroid scintigrame to be adequately identified even the management is not distinctive from other forms of primary hyperthyroidism. [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]

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. 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]

Introduction. 5-hydroxytryptamin (serotonin) represents a monoamine with different functions. Central neurotransmitter is related to mood, food and energy regulation and indirect positive effects on bone mass via leptin and sympathetic system. Gut-derived 5-hydroxytryptamine directly influences the skeleton through Wnt/Lrp5/beta catenin signalling with opposite actions to the central pool. Method. This is a mini-review regarding serotonin- related bone changes. Results and discussions. All the bone cells have receptors for 5-hydroxytryptamine while skeleton may have an intrinsic ability to locally generate it. The monoamine displays paracrine and autocrine actions, some incompletely described. One practical point is the potential bone loss in clinical situations with serotonin excess as seen in carcinoid syndrome. Up to this moment, non-bone metastatic neuroendocrine tumours are not listed as cause of secondary osteoporosis. Another practical aspect is the use of circulating 5-hydroxytryptamine as bone turnover marker surrogate for assessing the future fragility fracture probability. Despite some correlations with classical bone remodelling markers, no clear cut conclusion has been established yet. Conclusion. 5-hydroxytryptamine displays complex effects on skeleton status, whether direct, indirect or local but there are data still unknown thus future need to connect the dots in this particular inter-disciplinary field. [ABSTRACT FROM AUTHOR]

Menopause comes with different changes including estrogen deficiency - related qualitative and quantitative progressive skeleton deterioration. The physiological process turns to pathology, respective osteopenia and osteoporosis at central DXA (Dual-Energy X-Ray Absorptiometry) or low lumbar - DXA derived TBS (Trabecular Bone Score) or increased 10-year probability of major osteoporotic/hip fractures provided by FRAX. We aim to briefly introduce the methods of menopausal fracture risk assessment if back pain is presented from an endocrine point of view. This is a vignette type of manuscript focusing on imagery tools. A 60-year old smoker woman with 10 years since menopause and prior corticotherapy accuses persistent back pain for a few weeks, with mild to medium intensity and responsive to small doses of pain medication. Profile plain X-Ray showed no vertebral fractures. FRAX estimated risk was low. Lumbar DXA (GE Lunar Prodigy) showed osteopenia (a T-score of -1.9 SD) while TBS showed a deterioration of lumbar micro-architecture based on a value of 1,199. Further recommendations of stop smoking, healthy diet, physical exercise, vitamin D and calcium supplementation are necessary. Retesting using DXA is not necessary sooner than 2 years or even longer. Related to back pain, rheumatologic and balneology support and intervention are required for spondylarthrosis. For daily practice, the approach of bone health and estimation of future fragility fractures in menopause combines gold standard DXA to most modern instrument TBS together with easy accessible online algorithms as FRAX. These do not display individual medical decision and adequate use of guidelines. [ABSTRACT FROM AUTHOR]

Introduction. Multiple myeloma represents a malignant skeleton condition, been considered the most frequent bone malignancy of primary type in people older than 70 years. Myeloma causes a particular deterioration of bone via bone loss which can be localized or diffuse. The skeletal anomalies may include osteoporosis and vertebral fractures as first sign of the condition which need to be differentiated from others types of osteoporosis. This is a case presentation. This is a 56-year old female who was diagnosed with a lumbar fracture 5 months ago and considered osteoporosis treated with alendronate. Bone pain continued in addition to hypoanabolic syndrome. Second opinion showed hypercalcemia with suppressed parathomone and high bone resorption marker CrossLaps in association with mild anaemia, highly increased ESR (erythrocyte sedimentation rate), and newly discovered renal failure, and large ostolytic lesions at computed tomography. A bone biopsy was necessary and confirmed multiple myeloma. Conclusion. Severe diagnosis like malignant bone conditions may be first diagnosed as osteoporosis. [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]

Glucocorticoid (GC) therapy and orbital radiotherapy represent the classic medical management of Graves' ophthalmopathy, either used separately or in association. Because of the lack of response for classic therapy, in some patients new immunosuppressive methods have been tried, one of them is cyclosporine, an selective immunomodulatory drug. This study has proposed to compare short time administration of cyclosporine with administration of iv methylprednisolone and combined therapy (methylprednisolone - orbital radiotherapy). In this comparative and prospective study we followed 127 patients with Graves' ophthalmopathy divided in 4 groups, treated with iv methylprednisolone, associated therapy (GC+RxT), cyclosporine and a control group. All patients were concomitantly treated with oral antithyroid drugs. At 0, 3 and 6 months, the patients were subjected to Hertel exophthalmometry, orbital ultrasonography, TSHR antibody and thyroid-peroxidase antibody assessment and to clinical activity score (CAS) calculation. Comparing the means of each parameter assessed in all 4 groups, a significant decrease of exophthalmy and of extraocular muscle thickness was observed in each group, with a better effect of cyclosporine comparing to iv methylprednisolone, but with a lower effect of cyclosporine comparing to combined therapy. CAS improved significantly in all patients. Cyclosporine has a poorly effect on TRAb and ATPO in contrast with GC or combined therapy. [ABSTRACT FROM AUTHOR]

Introduction. Bariatric surgery, regardless the type of approach, has aggressively extended nowadays. The procedure saves lives due to substantial improvement of severe cardio-metabolic co-morbidities but the influence of nutritional status might not be completely harmless including bone and muscle changes. Our purpose is to introduce data regarding skeleton after bariatric surgery. This is a narrative mini-review including papers from PubMed. A selection of 33 papers has been done. General data. Longitudinal better than cross-sectional studies confirmed an annual rate of losing bone mineral density at lumbar and femoral neck of 3-10% starting with first year after surgery and continuing within the third year; low vitamin D and calcium absorption with associated secondary hyperparathyroidism is described; others anomalies include elevated bone remodelling markers, damage of bone microarchitecture, fracture healing disturbances and sarcopenia. Conclusion. Overall, despite spectacular results after bariatric surgery, the bone and muscle are expected to suffer a level of deterioration which should be taken into account for assuring an adequate quality of life and an immediate and distant good post-operatory prognosis. [ABSTRACT FROM AUTHOR]

The field of osteoporosis, especially of primary type, tidily connected with estrogen deprivation and aging, is complex and dynamic. Bone turnover markers (BTM) have been and still are a hot spot on this panorama, because no straight cut lines are found yet. We aim to briefly introduce the current status of BTM, as a short commentary. BTM have a high inter- and intra- individual variation, they are rather expensive for daily practice, they are not necessary to diagnose osteoporosis. Low or normal levels do not necessary mean that a person will not suffer fragility fracture while a higher level is associated with an increased fracture risk. Moreover, BTM seem better players for clinical studies to point out the efficacy of anti-osteoporotic drugs rather than helping each patient's decision. BTM prematurely detect remodelling variations before DXA. No algorithm or calculation model of fracture prediction has incorporated yet BTM, most probably due to heterogeneity of reports. Traditional BTM are alkaline phosphates, osteocalcin, and collagen- derived fragments. New BTM, that proved useful, are represented by P1NP. Atypical BTM like osteoprotegerin, sclerostin, and serotonin are still far from daily practitioners' assessment. Regardless classical or modern, the way that BTM represent a reflection of skeleton health is still an emerging subject. [ABSTRACT FROM AUTHOR]

Serotonin is a brain neurotransmitter, a local gut-produced pro-kinetic agent and a platelets-released monoamine with haemostasis role. We focus on revealing the serotonin interferences with menopause mainly related to climacteric syndrome and bone health. This is a short commentary type of manuscript, centred on English language PubMed research. Serotonin is connected to the hypothalamic thresholds for temperature regulation in vasomotor symptoms, that is why drugs that elevate the serotonin synaptic plaque exposure like SSRI (serotonin selective reuptake inhibitors) are indicated. Serotonin is also linked to bone field, but its testing into the blood has not been unanimously found to be correlated with bone mineral density or menopausal bone remodelling markers. Conditions with age-related onset, as carcinoid tumours, bring a serotonin excess, but not necessary a bone loss. From climacteric syndrome to bone regulation and to pathological domain of neuroendocrine neoplasia, serotonin plays a complex role on menopause’s field. [ABSTRACT FROM AUTHOR]

This is a narrative review focusing on neuroendocrine neoplasia (NEN) and bone status, in terms of metastases and osteoporosis/fractures. One fifth of NEN have skeletal dissemination, this affinity being regulated by intrinsic tumor factors such as the C-X-C chemokine receptor 4 (CXCR4). Bone colonization impairs the patient quality of life, representing a surrogate of reduced survival. Patients with NEN without bone metastases may exhibit low bone mineral density, perhaps carcinoid-related osteoporosis, yet not a standardized cause of osteoporosis. Case-finding strategies to address bone health in NEN with a good prognosis are lacking. Contributors to fractures in NEN subjects may include: menopausal status and advanced age, different drugs, induced hypogonadism, malnutrition, malabsorption (due to intestinal resection, carcinoid syndrome), hypovitaminosis D, impaired glucose profile (due to excessive hormones such as glucagon, somatostatinoma or use of somatostatin analogues), various corticoid regimes, and high risk of fall due to sarcopenia. Pheocromocytoma/paraganglioma involve bone through malignant forms (bone is an elective site) and potential secondary osteoporosis due to excessive hormonal content and increased sympathetic activity which is a key player of bone microarchitecture/quality as reflected by low Trabecular Bone Score. Glucocorticoid osteoporosis is related to NEN-associated ectopic Cushing syndrome. Currently, there are a lack of studies to emphasis that excessive gut-derivate serotonin in NENs with carcinoid syndrome is a specific activator of bone loss thus a contributor to carcinoid-related osteoporosis. [ABSTRACT FROM AUTHOR]

Anorexia nervosa is an eating disorder characterized by restrictive eating and an intense fear of gaining weight. It is a disease with an increasing incidence during the last few decades, and represents a complex psychiatric condition which includes secondary amenorrhea, nutritional and metabolic damage, and impaired endocrine panel up to bone loss as well as cardiac, gastrointestinal and hematological complications. This is a narrative review which includes an update on this eating disorder from the perspective of an endocrine panel of anomalies, especially of the skeleton, considering the pressure of the recent global COVID-19 pandemic changes. Practically affecting every organ, anorexia nervosa needs to be taken into consideration during the pandemic period because of the higher risk of relapse due to new living conditions, social distancing, self-isolation, changes in food access, more intense use of social media platforms, disruption of daily habits, and more difficult access to healthcare practitioners. The lack of physical activity in addition to vitamin D deficiency related to low sun exposure or to the use of facial masks may also be connected to further bone damage related to this disease. [ABSTRACT FROM AUTHOR]

In patients who were not previously diagnosed with any thyroid conditions, the scenario of COVID-19-related anomalies of the hypothalamus-pituitary-thyroid axes may include either: A process of central thyroid stimulating hormone (TSH) disturbances via virus-related hypophysitis; an atypical type of subacute thyroiditis which is connected to the virus spread or to excessive cytokine production including a destructive process with irreversible damage of the gland or low T3 (triiodothyronine) syndrome (so called non-thyroid illness syndrome) which is not specifically related to the COVID-19 infection, but which is associated with a very severe illness status. Our objective here was to briefly review thyroid changes due to the COVID-19 infection. Ongoing assessment of the effects of the COVID-19 pandemic will reveal more information on coronavirus-induced thyroid conditions. Routine thyroid assays performed in patients with severe infection/at acute phase of COVID-19 are encouraged in order to detect thyrotoxicosis. After recovery, thyroid function should be assessed to identify potential hypothyroidism. There remain unanswered questions related to the prognostic value of interleukin-6 in infected patients, especially in cases with cytokine storm, and the necessity of thyroid hormone replacement in subjects with hypophysitis-related central hypothyroidism. [ABSTRACT FROM AUTHOR]

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.

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.

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.

Brown tumors, an exceptional bone complication of severe primary (PHP) or renal (secondary) hyperparathyroidism (RHP), are caused by long-standing, elevated parathormone (PTH)-induced osteoclast activation causing multinucleated giant cell conglomerates with hemosiderin deposits in addition to the local production of cytokines and growth factors. We aim to present an adult case series including two females displaying this complication as part of a multidisciplinary complex panel in high PTH-related ailments. The approach was different since they had distinct medical backgrounds and posed a wide area of challenges amid real-life settings, namely, a 38-year-old lady with PHP and long-term uncontrolled hypercalcemia (with a history of pregnancy-associated PHP, the removal of a cystic jaw tumor, as well as a family and personal positive diagnosis of polycystic kidney disease, probably a PHP-jaw tumor syndrome), as well as, a 26-year-old woman with congenital single kidney and chronic renal disease-associated RHP who was poorly controlled under dialysis and developed severe anemia and episodes of metabolic acidosis (including one presentation that required emergency hemodialysis and was complicated with convulsive seizures, followed by resuscitated respiratory arrest). Both subjects displayed a severe picture of PHP/RHP with PTH levels of >1000 pg/mL and >2000 pg/mL and elevated serum bone turnover markers. Additionally, they had multiple brown tumors at the level of the ribs and pelvis (asymptomatically) and the spine, skull, and pelvis (complicated with a spontaneous cervical fracture). As an endocrine approach, the control of the underlying parathyroid disease was provided via surgery in PHP (for the postparathyroidectomy hungry bone syndrome) via medical intervention (with vitamin D analogs) in RHP. Additionally, in this case, since the diagnosis was not clear, a multidisciplinary decision to perform a biopsy was taken (which proved inconclusive), and the resection of the skull tumor to confirm the histological traits. This series highlights the importance of addressing the entire multidisciplinary panel of co-morbidities for a better outcome in patients with PHP/RHP-related brown tumors. However, in the instance of real-life medicine, poor compliance and reduced adherence to recommendations might impair the overall health status. Thus, sometimes, a direct approach at the level of cystic lesion is taken into consideration; this stands for a narrow frame of decision, and it is a matter of personalized decision. As seen here, brown tumors represent the hidden face of PHP/RHP, primarily the complex and severe forms, and awareness is essential even in the modern era.

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.

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.

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.

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.

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.