Endocrine disruptors (ED) are exogenous agents that interfere with the normal function of the endocrine system and they are considered environmental chemicals with estrogen-like and/or anti-androgenic activity with important impact on the reproductive axis. They act via nuclear receptors, non-nuclear steroid receptors, nonsteroidal receptors, orphan receptors, and different enzyme pathways involved in the biosynthesis and/or metabolism of steroids. The molecules identified as ED and sources of exposure are diverse and vary worldwide, including from natural chemicals found in human and animal food (the main source) up to synthetic chemicals, such as as solvents, plasticizers, pesticides, fungicides, pharmaceuticals etc. ED are incriminated in the occurrence of malignant tumors, birth defects, attention deficit disorders, cognitive impairment, brain development, deformations of the body (including limbs), disturbance of sexual development, menstrual irregularity, precocious puberty, feminizing or masculinizing effects, abortion, not least obesity and decreased fertility. The principles of action are still studied and controversial, therefore, it is difficult to determine the minimum level at which adverse effect occurs and further studies are required.
Introduction. Current studies support the implication of metabolic changes associated with type 2 diabetes in altering bone metabolism, structure and resistance. Objective. We conducted a cross-sectional study on postmenopausal women aimed to analyze the differences in metabolic and bone profile in patients with and without type 2 diabetes Methods. We analyzed the metabolic and bone profile in postmenopausal women with and without type 2 diabetes (T2DM). Clinical, metabolic, hormonal parameters, along with lumbar, hip and femoral bone mineral density (BMD) and trabecular bone score (TBS) were evaluated. Results. 56 women with T2DM(63.57±8.97 years) and 83 non-T2DM (60.21±8.77 years) were included. T2DM patients presented a higher value of body mass index (BMI) and BMD vs. control group (p = 0.001; p = 0.03-lumbar level, p = 0.07-femoral neck and p = 0.001-total hip). Also, BMI correlated positively with lumbar-BMD and glycated hemoglobin (HbA1c) (r = 0.348, p = 0.01; r = 0.269, p = 0.04), correlation maintained even after age and estimated glomerular filtration rate (eGFR) adjustment (r = 0.383, p = 0.005; r = 0.237, p = 0.08). Diabetic patients recorded lower levels of 25(OH)D(p = 0.05), bone markers (p ≤ 0.05) and TBS(p = 0.07). For the entire patient group we found a negative correlation between HbA1c level and bone markers: r = -0.358, p = 0.0005-osteocalcin, r = -0.40, p = 0.0005-P1NP, r = -0.258, p = 0.005-crosslaps. Conclusions. Our results indicate the presence of altered bone microarchitecture in T2DZ patients according to the TBS score, combined with lower levels of bone markers, with a statistically significant negative correlation between HbA1c level and bone markers.
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. Contents 1. Introduction 2. Aim 3. Giant parathyroid adenoma: Concept around the size considerations 4. Pre-operative biological correlates 5. Relationship with vitamin D status 6. Histological issues 7. Ectopic PTA of large dimensions 8. Risk of post-operative hypocalcemia 9. Future considerations 10. Conclusions
Thyroid carcinoma is the most common endocrine cancer representing 1-1.5% of all cancers diagnosed annually. Differentiated thyroid carcinoma (DTC) with the 2 main subtypes, papillary (PTC) and follicular (FTC), is the most common. DTC incidence has increased significantly in recent years, mainly due to increased and early use of imaging techniques (thyroid ultrasonography) and fine needle biopsy of thyroid nodules. Although after radical treatment, DTC is considered to be curable, histologic and clinical presentation is very diverse, the recurrence rate being 10-30%, while 5% of patients are resistant to conventional therapy, and some are even incurable. In recent years, there has been progress in terms of describing genetic changes in thyroid carcinoma, genetic testing providing important information that may influence therapeutic decision. The practical importance of these genetic mutations (for example, BRAF V600E, RAS, etc.) and their roles in tumorigenesis, the clinical features, treatment and prognosis of thyroid carcinoma is still controversial and incompletely elucidated.The increase knowledge of molecular pathogenesis and tumorigenesis in thyroid cancer lead to the emergence of new therapies with targeted antitumor effect and minimal toxicity. Patient selection should be made taking into account the risk stratification and tangible benefits, molecular tests being expensive and inaccessible.
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.
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