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

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

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

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

Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95–99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation. [ABSTRACT FROM AUTHOR]

We aim to present an adult female confirmed with severe hypothyroidism due to Hashimoto's autoimmune thyroiditis that was associated with hyperprolactinemia which, combined, led to secondary amenorrhea. Additionally, hypercholesterolemia, anemia and vitamin D deficiency were confirmed, and the patient's electrocardiogram showed flattened T waves. The value of TSH (thyroid stimulating hormone) was unexpectedly high, approximately 100 times upper the normal limit. The patient experienced a progression of clinical manifestations within one year, while she did not seek for medical care. This unexpected severity of thyroid hormones deficiency is rarely found nowadays due to active screening protocols and easy access to thyroid assessment; however, in young individuals, the clinical tolerance to myxedema-associated issues is higher than seen in seniors, thus a delay of diagnosis might be found. Whether this impacts the overall reproductive potential in young females mostly depends on the compliance to lifelong hormonal replacement and surveillance of adequate serum hormonal levels, including during pregnancy. [ABSTRACT FROM AUTHOR]

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

Renal cancer (RC) – associated increased calcium is rather frequent among cases of kidney neoplasia; it may be the first sign of presentation that allows the detection of the malignancy; typically representing a poor prognostic factor. Weight loss is part of the panel underling hypercalcemia - related signs, but also of the malignancy – associated phenotype. We aim to introduce a male case who was admitted for a clinical picture (including weight loss) correlated with alarming high calcium levels; the biochemistry anomaly was actually a paraneoplasic syndrome due to RC. When admitted as emergency, the assays revealed hypercalcemia of 16.9 mg/dl (normal levels between 8.4 and 10.2 mg/dl) with low PTH (Parathormone) and high CrossLaps as bone turnover marker of resorption. Intravenous contrast computed tomography showed a large left retroperitoneal tumor (involving the kidney and adrenal gland) with iodophil pattern, and post-contrast heterogeneous structure of 8.06/11.09 cm (axial), 10.58/12.16 cm (coronal - reconstruction), 9.12/10.59 cm (sagittal - reconstruction), also associating a mixt structure and micro-calcifications as well as hypodense areas. Whole body bone scintigrame did not show metastasis. The calcium levels were controlled under subcutaneous denosumab 60 mg in addition to IV fluids replacement; then the patient was referred to nephrectomy; postoperatory confirmation confirmed a clear cell renal cell carcinoma (T4N1Mx). A normalization of calcium and PTH levels was found immediately after surgery. Unintentional weight loss might become a valuable tool in order to assess a routine biochemistry panel that will detect hypercalcemia. Low PTH represents the next step in order to further look for a tumor. Symptomatic control of hypercalcemia in addition to targeted approach of originating tumor are essential to improve the outcome. [ABSTRACT FROM AUTHOR]

This is a narrative review of literature. We focus on the issue of identifying a parathyroid adenoma without anomalies of function (non-functioning parathyroid adenoma) which is incidentally detected or not, via routine neck ultrasound or through advanced imaging techniques which are mostly performed for other conditions (like assessment of a non-parathyroid oncological condition or emergencies – related neck exploration). The traditional diagnostic of primary hyperparathyroidism is exclusively a biological one based on high calcium and parathormone (PTH), and only a second step of assessment actually involves the localization procedures. However, the detection of a parathyroid tumor does not necessarily mean that it is associated with an over-secretion of PTH. Ultrasound is usually followed by Tc Sestamibi scintigram and/or computed tomography is order to refer the patient to parathyroidectomy in cases with biological confirmation of primary or renal hyperparathyroidism; yet, in cases with non-functioning profile, there is no clear indication of further imaging exploration. In conclusion, the identification of a parathyroid adenoma is rarely associated with a normal parathyroid function and this entity, which most probably is an incidentaloma, is not a subject of particular guidelines yet. Whether it is necessary to continue with other imaging techniques as typically seen in primary hyperparathyroidism is still an open issue, and so is the panel of indications to perform its surgical removal instead of serial follow-up. [ABSTRACT FROM AUTHOR]

Thyroid domain amid COVID-19 era has been involved in many ways, either in terms of patients with prior thyroid conditions who become COVID-19 positives, or coronavirus-induced de novo thyroid anomalies. This article represents a literature update on thyroid cancer (TC). The PubMed-based research includes a publication timeline regarding the first two years of pandemic (2020-2021). The general scientific interest on TC according to online research decreased during the first half of 2020 and got to the pre-pandemic level by the end of 2020. At the beginning of the pandemic, there was a delay in approaching the thyroid conditions, while telemedicine became a most useful tool, as seen in others areas of medicine. Post - 2020 lockdown medical presentation was associated with a more aggressive behavior of TC when compare to pre-pandemic data. Ongoing debates surround the topic of higher risk of COVID-19 infection in patients with a prior diagnostic of a thyroid malignancy in terms of having a higher risk of contracting the infection or an increased risk of developing a more severe form. There is not clear answer up to this point. Recent assets concerning TC field (non-COVID-19 data) that are released for the last two years concern the understanding of thyroid cancer genetics, the approach of shift from differentiated to anaplastic carcinoma, as well as evidence regarding new players in the oncological endocrinology like tyrosine kinase inhibitors for advanced forms of radioiodine refractory TC. For what we know so far, by the end of the second pandemic year, the patients with TC do not represent a fragile population when facing COVID-19 infection itself. However, the delay of adequate therapy amid restrictions is reflected in more severe malignancy behavior, while general concerns about the virus and pandemics increase the level of psychological and social stress. Case finding strategies to detect high risk patients as those on tyrosine kinase inhibitors with potential lung complications are needed. [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]

Vitamin D is a fat soluble vitamin and a steroid hormone with endocrine, paracrine and autocrine actions. The two major forms are vitamin D2 (ergocalcifeol) and vitamin D3 (cholecalciferol), the active hormone being calcitriol. The importance of vitamin D and its metabolites lies in the key role in calcium homeostasis and bone metabolism but vitamin D also has extraskeletal effects, still incompletely understood. Vitamin D receptor (VDR) is ubiquitous in the body, the presence of VDR in multiple tissues suggesting a more general role of calcitriol. Vitamin D can regulate many cellular functions such as cell proliferation, differentiation, and apoptosis. Calcitriol exerts immunomodulating and antiproliferative effects and plays a potential role in the prevention and therapy of various cancers (breast, colorectal, prostate, thyroid), autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis and type 1 diabetes, thyroid autoimmunity), obesity and also in cardiovascular, renal, maternal-fetal pathologies. Conclusions. The current studies bring increasingly more evidence about the benefits of vitamin D supplementation in extraskeletal pathology although there is no agreed protocol in this regard. However, these patients should be considered for adequate intake of vitamin D for the prevention, improving the evolution and the prognosis of their disease. [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]

Primary hyperparathyroidism (PHPT), an endocrine condition caused by a parathyroid adenoma (PTA) in 80-85% of the cases, has shifted in the modern era to a mildly symptomatic phenotype due to the prompt recognition of hypercalcemia and to a minimally invasive surgical approach which has a curative potential. Clinical complications of PHTH are either related to high calcium or parathyroid hormone [also parathormone (PTH)] or both, while the originating tumor typically is small, without local mass effects. A distinct entity is represented by giant PTA (GPTA) which is considered at a weight of more than 3 (3.5) grams. The present article is a review of the literature involving practical points of non-syndromic PHPT-related GPTA. Most authors agree that pre-operatory calcium and PTH are higher in GPTA vs. non-GPTA. However, the clinical presentation of PHPT may be less severe, probably due to local mass effects that bring the patient to an early medical evaluation. Age distribution, sex ratio, rate of successful pre-operatory location do not differ from non-giant PTA. Hypovitaminosis D is more frequent in PTA of higher dimensions. Post-operative hypocalcemia, but not recurrent/persistent PHPT, is expected, even hungry bone disease. A higher rate of atypia is described although the tumor is mostly benign. Unusual presentations such as cystic transformation, initial diagnosis during pregnancy or auto-infarction have been reported. The ectopic localization of PTA presented in almost 15% of all cases may also be found in GPTA. What are the exact cutoffs for defining GPTA is still an open issue. [ABSTRACT FROM AUTHOR]

Bilateral adrenal hemorrhage represents a challenging condition which requires multi-modal intervention. Our aim to systematically review the published cased diagnosed with this condition. The method we used is based on PubMed database research. The papers are published between 2005 and 2020. We included articles that follow the subsections: idiopathic type, hemorrhage in patients with adrenal tumors, in subjects with hematologic diseases, with autoimmune/systemic conditions, in COVID-19 positive patients, in subjects using anticoagulants, respective in pregnant females [ABSTRACT FROM AUTHOR]

Hemoptysis as first sign of a thyroid differentiated cancer represents an atypical behavior of a cervical mass, usually associating lung metastasis or direct tracheal invasion. Late presentation (for instance, due to COVID-19 pandemic circumstances) associates a poor prognosis. This is a case report. We aim to introduce a 70-year old female case who was admitted for an atypical cervical mass associating hemoptysis as onset; the diagnostic of metastatic papillary thyroid cancer was established; the delay of hospital admission did not allow a radical intervention with curative purpose. The lady was admitted as an emergency for an endocrine checkup of a progressively growing cervical mass in addition to hemoptysis that developed a few weeks before. Specific blood endocrine panel confirmed the normal thyroid function with negative thyroid autoimmunity. Anterior cervical ultrasound showed intensely hypoechoic, inhomogeneous, large structure, with macro-calcifications (TIRADS 5). Fine needle aspiration cytology exam revealed a papillary carcinoma of thyroid, consistent with Bethesda 6 score. Computed tomography detected a voluminous thyroid tumor process of 92 by 58 by 89 mm. The superior, middle and inferior left later-cervical lymph nodes which are located posterior to the later-cervical vascular package, have maximum diameters of approximately 30/34 mm (axial) and 54 mm (vertical). Multiple micro-nodules of oval form in both lungs have diameters up to 29 mm (probably secondary lesions). Osteolytic tumor lesion at the level of the lateral arch of the vertebral body thoracic T 1 and the head of the left first rib extends to the level of the left foramen from the spaces cervical C7 to thoracic T1, respective between thoracic T1 and T2, with maximum diameters of 23/32 mm. CT also showed brain metastasis, as a iodophil, inhomogeneous, well-contoured tumor that is located on the right frontal precentral gyrus, with maximum diameters of 10/13 mm (axially) and 13 mm (vertically) and small areas of perilesional edema. Further adjuvant therapy was refused by the patient; palliative tracheostomy is needed. Atypically aggressive presentation of well differentiated thyroid cancer of papillary type might be associated with delayed presentation; whether this comes as direct consequence of pandemic era is still a matter of debate. [ABSTRACT FROM AUTHOR]

We introduce a case report of an adult male diagnosed with non-syndromic pheochromocytoma with a first pathological post-operatory report of malignant type with further re-considerations during follow-up for a 6-year period of time. This is 46 - year old male admitted for: post-adrenalectomy status reassessment. In 2013 he was diagnosed with high blood pressure requiring a complex regime of anti-hypertensive drugs to control it. In 2015 he was referred for an endocrine check-up which revealed a pheochromocytoma (noradrenaline type). Computed tomography imaging of the abdomen showed a right adrenal tumour of 28/38 mm, a mass that was clearly contoured, with heterogeneous pattern, and with moderate caption of intravenous contrast. Laparoscopic right adrenalectomy is performed with normalization of high pre-operatory normetanephrines and a dose reduction of anti-hypertensive medication which was still necessary. Pathological report suggested a malignant pheochromocytoma; the initial PASS score of 8 was later re-calculated, and a GAPP score of 5 was achieved showing a moderately differentiated tumour. No genetic backup was identified. Within the first year after tumour removal, the patient suffered a stroke, proving the higher cardiovascular risk than general population even after hormonal imbalance is restored. Lifelong surveillance is the rule. [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]

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]

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]

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]

Vitamin D is a fat-soluble vitamin and a presteroid hormone synthesized in the dermis under UVB rays. In terms of its endocrine functions, it has an important role in mineral homeostasis. Besides these effects, recent studies have found a series of non-calciotropic actions of vitamin D: modulation of autoimmune processes, promoting secretion and insulin action, pulmonary development, inhibition of malignant cells proliferation in various cancers, implications in maternal-fetal pathology. Recent studies have identified the association of vitamin D deficiency in pregnancy with a series of maternal complications (preeclampsia, bacterial vaginosis, gestational diabetes, increased risk of cesarean delivery) and fetal complications (affecting skeletal development and tooth enamel, impaired fetal growth). Also, newborns from mothers with vitamin D deficiency have an increased risk of tetany, hypocalcemia, with or without seizures and an increased susceptibility to respiratory diseases (asthma, bronchiolitis RSV). Conclusions: There is no current consensus on routine screening of vitamin D deficiency in pregnancy, nor the required dosage for vitamin D supplementation in pregnant women. All pregnant women should have a balanced diet and get vitamin D as part of prenatal vitamins. Their purpose is to increase the availability of calcidiol to the fetus and newborn with a beneficial role over the classic effects of vitamin D and possibly over the non-calciotropic ones. [ABSTRACT FROM AUTHOR]

We aim to address incomplete procedures of adrenalectomy for pheochromocytoma (PHEO) on a bases of a mini-review. Dopamine, adrenaline and noradrenaline – secretor tumors are rare in general population, representing a neuroendocrine neoplasia with a strong genetic driving force and uncertain profile concerning a malignant behavior which may be less or more predicted based on initial post-operative report. There is no linear correlation with the post-operative recurrence in terms of clinical presentation, timing and prognostic. The first laparoscopic – based PHEO removal was done in 1992; and since then, the open procedure was replaced in majority of cases by the new gold standard – laparoscopic adrenalectomy; a current conversion rate is of 5%; alpha and beta - blockade is mandatory for preoperative management since an adrenergic crisis might be triggered by higher intraabdominal pressure during laparoscopy; bilateral PHEO may be addressed through one time procedure; minimally invasive technique is done trans-peritoneal or retroperitoneal; robotic – assisted laparoscopic procedure is the next logical step from traditional laparoscopy; in children, minimally invasive procedure is less likely to be used as in adults. Partial adrenalectomy (in terms of cortical - sparing technique) should be rarely performed for unilateral PHEO; its potential utility is for cases with non-feasible total removal due to tumor anatomy (like advanced local disease) or bilateral adrenal involvement in hereditary syndromes (like MEN 2A, VHL), especially in children and young adults to overcome the need of life long glucocorticoid replacement due to chronic adrenal insufficiency. A meta-analysis focusing on recurrence after total adrenalectomy revealed a 3% ratio after 2 years in PHEO. The percent for partial procedure is more than 10% depending on study. In conclusion, a particular aspect in PHEO management is the recurrence after an adrenalectomy, typically after a partial procedure. Unless bilateral involvement or a clear diagnostic of a hereditary syndrome involving bilateral PHEO, partial adrenalectomy should be limited. [ABSTRACT FROM AUTHOR]

We introduce an adult male case report with a history of osteogenesis imperfecta related fractures without specific medication against osteoporosis until the age of 50 years; however, within the first year he was offered anti-osteoporotic medication, he suffered a fall and a consecutive fracture was registered despite improved of bone mineral density parameters at DXA (dual-energy x-ray absorptiometry), proving the importance of life style intervention to minimize the dramatic impact on bone fragility due to a genetic condition. Despite the fact that the risk of fracture on a subject with a genetic condition that directly impacts the bone status represents a game changer, the everyday circumstantial situations that cause an increased risk of fall represent strong players that need to be taken into consideration as part of patients’ education. [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]

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]

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]