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  • Author: Carmen Emanuela Georgescu x
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Severe hepatocytolisis syndrome - a challenge in medical therapy of Cushing’s disease


Introduction Cushing’s disease is a rare endocrine disorder characterized by persistent hypercortisolism due to excessive, autonomous ACTH secretion by a pituitary adenoma. Transsphenoidal adenomectomy is the main therapeutic option in Cushing’s disease. When imaging studies are unable to demonstrate an obvious pituitary mass complete tumor resection is difficult and often encumbered by risk of relapse. Medical therapy is a second-line option or the first-line treatment for patients with high surgical risk, incomplete surgical resection or relapse. Rarely classic clinical manifestations limit the selection of medical therapy for Cushing’s disease. Case presentation We present the case of a male patient with Cushing’s disease complicated with diabetes mellitus and severe hepatocytolisis syndrome with no visible pituitary adenoma on MRI studies. In the absence of technical equipment petrosal sinus sampling could not be performed in order to improve surgery outcome

Conclusion The presence of unbalanced diabetes and severe hepatocytolisis syndrome made it impossible to use steroidogenesis inhibitors (mitotane, ketoconazole, metyrapone, etomidate) or inhibitors of ACTH secretion as pasireotide that represent a new option in achieving control of hypercortisolism

Open access
Changes in Bone Mineral Density in Young Adults with Type 1 Diabetes Mellitus


Background and aims: Type 1 diabetes mellitus (T1DM) represents a secondary cause of osteoporosis. Our aim was to determine bone mineral density (BMD) changes in a group of young Romanian adults with T1DM and to analyze the factors related to this disease that could have had an impact on bone mass. Material and Methods: Fifty-two young patients with T1DM were compared to 37 healthy volunteers matched for body mass index (BMI). All subjects had their BMD measured at the hip and lumbar spine. Results: We found no statistically significant differences in BMD between T1DM patients and controls (p=0.618 for lumbar spine, p=0.974 for femoral neck and p=0.883 for total hip). Multiple linear regression models detected BMI (p =0.043), smoking (p=0.001) and milk intake (p=0.004 for lumbar spine) as significant BMD determinants. In contrast, no associations were found between BMD and metabolic control, daily insulin dose or presence of diabetic retinopathy and/or neuropathy. Long diabetes duration was negatively associated with BMD in femoral neck (p=0.012). Conclusions: Although we couldn’t find differences between BMD in T1DM patients and controls, the link between diabetes duration and BMD that we found suggests that even young patients with long standing T1DM should have their BMD measured

Open access