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Tumorile neuroendocrine (NET) sunt mult mai frecvente în ultimele decade. Unul din intrumentele majore de evaluare în această patologie este reprezentat de dozarea markerilor neuroendocrini precum cromogranina A, serotonina, acidul 5-hidroxi indolacetic urinar şi enolaza neuronal specifică. Aceştia se schimbă cu progresia tumorală, indiferent de terapie. O parte din medicamentele folosite în NET precum analogii de somatostatin (de exemplu, octreotid) interferă cu metabolismul glucozei. Obiectiv. Am analizat într-un studiu retrospectiv de-a lungul a 2 ani dinamica markerilor NET şi profilul glicemic. Material si metode.Toţi pacienţii au avut cel puţin o evaluare pe an. Rezultate. 9 pacienţi au fost incluşi (5 femei şi 4 bărbaţi), cu o vârstă medie de 57,33 de ani. Perioada de tratament anterior cu octreotid a fost de 18 +/- 14,69 de luni. Doza de octreotid a variat de la 20 la 50 mg lunar. Glicemia s-a modificat nesemnificativ de la bază după 2 ani. Nu s-a înregistrat nici un caz nou de diabet. O pacientă a necesitat insulină pentru diabetul preexistent (dar între timp s-a adaugat şi terapie cu interferon) Cromogranina A a avut valori mari sustinute pentru toate cele 9 cazuri, sugerând progresia bolii. Enolaza neuronal specifică a crescut semnificativ iar serotonina serică şi 5HIIA au crescut considerabil în 2 cazuri cu simptome severe de sindrom carcinoid. Concluzie. Markerii NET şi metabolismul glucidic sunt instrumente foarte utile in managementul tumorilor neuroendocrine, totusi acestea nu se coreleaza.

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Copyright of Farmacia is the property of Societatea de Stiinte Farmaceutice Romania 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.)

The thyroid cancer had an increasing frequency during the last decades mostly related to better and accessible detection methods. The papillary type has the major epidemiologic impact. We present a case with mixed symptoms before surgery, a rare combination of both thyrotoxicosis and thyroid malignancy and an unusual pathologic report in a 56-year-old female known with total hysterectomy at age of 42, diagnosed with toxic goiter 2 years ago and under intermittent therapy with thiamazol. She presented for unspecific hot flashes and palpitation at gynaecology and she was referred for endocrine evaluation that revealed unspecific cervical compression complains, and a large goiter. The Thyroid-Stimulating Hormone was normal under thiamazol and so were the thyroid antibodies and calcitonin. The computed tomography pointed an isthmus and left lobe nodule of maximum 7.28 cm with mass effect on trachea. Total thyroidectomy was performed without any significant complications. The patient was hospitalised for 4 days (less than 48 hours postoperatively). The pathological report showed a papillary thyroid cancer (stage III) with oxyphil variant and an insular and solid pattern component. A high proliferative index is detected by vessels invasion and a ki-67 of 15 %. She received radioiodine therapy and then she started suppression levothyroxine treatment. The insular and oxyphilic pattern as well as the large tumour size of 6 cm suggest a severe prognosis. On the other hand, it is still a matter of debate whether non-autoimmune hyperthyroidism and solid pathologic features subscribe to the hypothesis of an aggressive cancer phenotype. Lifelong follow up is needed. [ABSTRACT FROM AUTHOR]

Objectives. Previous research has shown that Cushing's syndrome has been linked with higher incidence of cognitive impairment. The beneficial effects of exercise on cognitive function have been demonstrated in clinical studies. This study will test the hypothesis that aerobic exercise leads to improved cognitive function in patients with Cushing's syndrome. Material and Method. 16 patients with Cushing's syndrome (10 with iatrogenic syndrome, 2 with adrenal and 4 with pituitary adenoma) and mild or moderate cognitive impairment were recruited for this study. The mental state examination were evaluated by Folstein test-30-point questionnaire test that is used to screen for cognitive impairment. Training consisted of exercise (such as cycling or fast walking) 5days/week for approximately 30 min/day. The efficacy were evaluated at six months of aerobic exercise treatment. Results. The subjects were between 42 and 58 years age and an evolution of the Cushing's syndrome between 2 and 6 years. Patients were screened initially with a questionnaire detailing their medical history, concomitant medications, smoking status, alcohol consumption. Baseline score of the Folstein test were 20±2.1 points. 10 patients present mild (19-24 points) and 6 patients moderate (10-18 points) cognitive impairment. At the end of six months, the mean score of the Folstein test was improved (20,3±2.1 vs 21.4±3.3, p<0.05).Conclusion. In our study the Folstein score can be corrected significantly by aerobic exercise in patients with Cushing's syndrome. [ABSTRACT FROM AUTHOR]

Primary osteoporosis is a common age-related disease characterized by an imbalance in bone homeostasis, increasing the risk of fractures. Twin and family studies have shown that bone mineral density (BMD) variance is in part genetically determined and osteoporotic fractures have also a heritable component. Over the last years, a series of genome-wide association studies (GWAS) and meta-analysises evidenced several loci associated with BMD at genome-wide significance, clustering within the RANK-RANKL-OPG and WNT signaling pathways but also in the mesenchymal stem cell differentiation or endochondral ossification systems. Some of these BMDassociated loci were also significantly associated with risk of fracture, including 17q21.31 (SOST), 11q13.2 (LRP5), 10q21.1 (DKK1), 1p36.12 (WNT4) and 7q31.31 (WNT16), whereas SNPs in genes of the RANK-RANKLOPG pathway (TNFRSF11A, TNFSF11, TNFRSF11B) were associated with BMD only. These data provide key insights into the pathophysiological mechanisms of the disease and may contribute to the identification of new drug targets for the treatment of osteoporosis, beyond previously available therapy. [ABSTRACT FROM AUTHOR]

With the advent of high resolution imaging procedures (CT, MRI), incidentally discovered adrenal masses have become a common clinical problem. In the majority of cases these lesions are nonfunctioning benign adenomas. Less numerous are functioning tumors (pheochromocytomas or those secreting cortizol, aldosterone or sex steroids) which can modify the lipidic and glycemic profile in organism. In this context tumor size, hormonal secretion are important including in establishing the necessity of surgery. [ABSTRACT FROM AUTHOR]

The forearm DXA is additional in current practice, except for primary hyperparathyroidism cases. A transversal, observational study was performed between 2010 and 2013, including women in menopause. The excluding criteria were previous anti-osteoporosis drugs or diagnosis of primary hyperparathyroidism. The bone turnover markers were assessed, as well as central DXA of the 4 central sites. The absolute risk of fracture based on Romanian FRAX was calculated. The age at evaluation was 61.25 years. The bone markers were: alkaline phosphatase 60.89 +/- 40.29 U/l, CrossLaps 0.48 +/- 0.25 ng/ml, osteocalcin 18.45 +/- 7.27 ng/ml. The bone mineral density varies with DXA site. The FRAX probability of major fractures for 10 years is higher than for hip (4.11 versus 0.98%). The WHO groups based on minimum T score were: osteoporosis - 18.75%, osteopenia - 37.5% and normal DXA - 43.75%. The forearm DXA identified the diagnosis as well as central DXA groups (the WHO groups) in 100% of cases with osteoporosis; 66.66% of cases with osteopenia, and 100% of cases with DXA normal. The forearm evaluation is useful in cases when central DXA is not availed, under normal values of the parathormon. [ABSTRACT FROM AUTHOR]

Silent disease, less known than in women, osteoporosis in men is an important public health problem which is increasing in significance. The pathogenesis of this entity is extremely heterogeneous. The gold standard for osteoporosis diagnosis is the DXA scan which measure BMD in the spine or hip. Treatment consists both of non-pharmacological (lifestyle factors, calcium and vitamin D supplementation) and pharmacological (most commonly bisphosphonates) approaches. This article analyses the risk factors in the development of osteoporosis in men, the means of diagnosis and treatment of this clinical entity that is often underdiagnosed, undertreated or insufficiently search. [ABSTRACT FROM AUTHOR]

Hypercalcemia develops when increased amounts of calcium enters the extracellular fluid. This can occur due to intensification of bone resorption, reducing renal elimination of calcium ora combination of the two. Rarely, excessive absorption at the intestinal level is the first event în the pathogenesisof a hypercalcemic syndrome. Calcium homeostasis is important for many essential physiological processes such as muscle contraction, neuronal activation and coagulation. Because of this, a complex system in which parathyroid hormone and vitamin D are key elements acts on bone, kidney and intestinal tract to prevent and correct excessive increase or decrease of serum calcium level. When these elements of control are dysfunctional or exceeded hypercalcemia may occur. In terms of etiology, primary hyperparathyroidism and paraneoplastic hypercalcemia represents most cases, with the first diagnosis being established most often în ambulatory and the second în hospitalized patients. Besides these cases, hypercalcemia can occur în many other diseases, such as inflammatory, endocrine or genetic disorders or can complicate some medical treatments. [ABSTRACT FROM AUTHOR]

The auto-immune diseases of thyroid represent a variant and challenging field with an increasing interest during the last years. We present some aspects related to the autoimmune underlying mechanism, but also the clinical implications in pathogeny and current clinical practice not only in endocrinology, but also in internal medicine, rheumatology, or gynecology. [ABSTRACT FROM AUTHOR]

Aim of the study. The study follows the correlation between tumor size, catecholamine secretion and Chromogranine A value, the correlation of high blood pressure with catecolamine secretion and postsurgery evolution of high blood pressure in order to improve the therapeutic approaches and prognostic in pheocromocytomas. Matherial and methods. We have included 35 patients which had been diagnosed with pheocromocytomas in C.I. Parhon Institute. All patients had plasma and urinary metanephrines (MN) and normetanephrines (NMN), Chromogranine A (Cg A), adrenal CT, plasma and urinary cortisol, the 1 mg Dexametasone suppression test overnight. Blood presure was measured and patients with high blood pressure had aldosterone/rennin ratio. All patients had surgery in Emergency Hospital Floreasca Bucharest and they had been followed after 2-4 weeks postsurgery for plasma and urinary MN and NMN, blood pressure, Chromogranin A. Results. Median value of Cg A was bigger in pheocromocytomas greater than 5 cm compared with those smaller than 5 cm. Plasma MN and NMN value was not correlated with tumor size or with high blood pressure. Postsurgery some of the patients had high blood pressure and their age was bigger than the age of patients without high blood pressure. Conclusion. Chromogranin A value was correlated with tumor size. Catecholamine secretion was not correlated with tumor size or high blood pressure. Postsurgery some of the patients had high blood pressure and their age was bigger than the age of patients without high blood pressure. [ABSTRACT FROM AUTHOR]

Osteoporosis is a systemic bone disease în which both a reduction în bone mass and an alteration of the normal architecture occur, the combined result being an increased risk of fracture, particularly at the spine, hip and forearm. Primarily affecting postmenopausal women and elderly men, osteoporosis has gained epidemic proportions and with increasing life expectancy în developed countries the incidence of fragility fractures is exceeding that of breast cancer and is coming close to that of cardiovascular diseases. Since the recognition of this disease many treatment options have been found, some of which are currently widely used, with demonstrated effects on reducing the incidence of fractures. Bisphosphonates are currently the most widely used class of drugs worldwide. It has been shown that their antiresorbtive effect is protective against fractures, which exceeds the strict increase în DMO as assessed by DXA. However, the mechanism of action, which involves significant suppression of bone metabolism, given the prolonged duration of treatment, raises concerns about patient safety with such drugs. Increased risk for atypical fractures (subtrochanteric) and dental complications (osteonecrosis of the jaw) are additional arguments that we haven't found yet the ideal drug for the treatment of osteoporosis. Therefore, new therapies for treatment of osteoporosis should bring us closer to this goal. Strontium ranelate's presumtive mechanism of action involves decoupling bone formation from bone resorbtion, with the possibility of net bone accumulation Anabolic therapies, unlike antiresorbtive ones, have the effect of active accumulation of bone mass by stimulating osteoblasts. Teriparatide, the only approved drug în this group, proved to be effective în the prevention of new fractures in high-risk patients. Denosumab, a human monoclonal antibody which inhibits osteoclast activation mediated through RANK-ligand, became first biologic therapy approved for the treatment of osteoporosis. In addition, current research that evaluates the effectiveness of modulators of calcium sensor on stimulation of endogenous pulsatile secretion of PTH, of anti-sclerostin and anti-dikkopf1 antibodies and of integrin antagonists and cathepsin-K inhibitors open up the possibility of new therapeutic approaches. The role of intracellular VEGF in osteoblast differentiation from mesenchymal stem cell to osteoblast is also currently being investigated. [ABSTRACT FROM AUTHOR]

Introduction. The bone assessment with less expensive methods as quantitative ultrasound (QUS) is useful in menopausal women since life expectancy increased, meaning more years since menopause and a higher fragility fracture risk. Thus, the correlation with the golden standard DXA is important. Material and method. We enrolled women in menopause who were not previously treated for osteoporosis, neither for osteoporotic fractures. We did not include the patients with secondary osteoporosis. Anamnesis, Body Mass Index (BMI), left heel QUS (GE Achilles), and central DXA (GE Lunar Prodigy) were performed. Results. Out of 267 patients, 111 had normal DXA, with a mean age of 54 years, and 156 women had ostepenia, with a mean age of 58 years. The univariate correlation coefficient stiffness index (QUS) and lumbar DXA was statistically significant for the entire population, including applying the correction for age, BMI, and years in menopause, and excluding the patients with self-declared fragility fractures. (r between 0.29 and 0.36, p < 0.005). The analyses on each sub-group pointed significant results in women with normal DXA without fractures (p = 0.26, p = 0.008), orosteopenia (r= 0.17, p = 0,04). Conclusion. Based on our observations, we encourage the use of QUS in selected groups of women in menopause. [ABSTRACT FROM AUTHOR]

Introduction. Type 2 Diabetes Mellitus (T2DM) induces changes in bone health by increasing the fracture risk but not throughout currently measurable anomalies as Bone Mineral Density (BMD) changes but throughout qualitative disturbances of the cortical bone structure, the glycosylation of bone matrix proteins and consecutive decreased bone turnover markers. Aim. We analyzed the bone parameters in menopausal women with or without T2DM. Material and methods. This is a transversal study in menopausal women (for at least 1 year post-menopause), aged between 40 and 80 years who were not previously treated with anti-resorbtives or hormonal replacement therapy. Body Mass Index (BMI), central DXA, 25-OH vitamin D levels, and bone turnover markers were performed. Results. 310 women were included: group 1 with T2DM - 64p and group 2 (control) without T2DM -- 246p. Mean age and BMI were not statistically significant (SS) different between groups (59 yrs, respectiv 31.42 kg/m2 vs. 30.19 kg/m2 in control group). Fractures percent was 6.25% in group 1 and 9,7% in group 2. Lumbar and femoral neck BMD (higher in diabetics) were not SS different unlike total hip BMD (1.9 g/cm2 vs. 0.95 g/cm2, p=0.01). Mean 25-OH vitamin D was low but similar between the two groups. Bone turnover markers were SS lower in diabetics: osteocalcin 19.29 ng/ml vs. 23.24 ng/mL (p=0.01) and CrossLaps: 0.36 ng/mL vs. 0.48 ng/mL (p=0.04). Conclusions. Based on our observations BMD is higher in menopausal women with diabetes with statistically significant results in hip while the bone turnover markers are statistically significant lower in diabetics. No differences were found in 25-OH vitamin D levels and overall prevalence of fractures was lower in diabetic patients. The relationship between type 2 diabetes mellitus and bone is .complex, many of the observations being provided during the last years but there are still a lot of aspects incompletely known. [ABSTRACT FROM AUTHOR]

We present a transversal study in 306 anti-osteoporotic free medication, postmenopausal women, who were analyzed based on DXA. The 153 patients with osteopenia were statistically significant different from those 103 with normal DXA by following parameters: body mass index, bone formation marker serum osteocalcin, bone resorbtion marker serum CrossLaps. The heel quantitative ultrasound (QUS) analyze by two devices Achilles and Sonost Chrono 3000 revealed differences between the Stiffness index values between osteopenia and each of the other two groups. [ABSTRACT FROM AUTHOR]

Thyroid metastasis is atypical. We present a 70-year-old female case that was first diagnosed as gastric cancer after surgical approach. Two years later a thyroidectomy was performed and the immunohistochemistry (IHC) profile revealed a neuroendocrine tumor (NET): poorly differentiated neuroendocrine carcinoma (with small cells), with positive reaction for SYN, CROMO, negative for calcitonin, TTF1 and thyreoglobulin. The Ki-67 index was 25%. Considering the unusual metastasis, the IHC exam of the stomach tumor was performed pointing the same features as the thyroid findings. This proved that the thyroid tumor was a metastasis from a primary gastric neoplasia. This is an unusual case of NET because of the thyroid involvement. Nevertheless, the IHC exam played the major role in elucidating the diagnosis and the prognosis of the case.