Mara Carsote, Adina Ghemigian, Ana Valea, Anda Dumitrascu, Corina Chirita and Catalina Poiana
Introduction The field of Cushing syndrome is a various area; there are still subjects incompletely clarified as the subclinical pattern as well as cortisol producing bilateral adrenal tumours.
Case presentation The paper presents a 67-year old male case previously known with metabolic complications. He had an abdominal ultrasound done for unspecific complains and multiple gallbladder stones together with a right adrenal tumour were found. Later the computer tomography revealed bilateral adrenal tumours of almost 1.5 centimetres diameters (right larger than left) and a morning plasma cortisol level of 2.58 micrograms/ decilitre after low dose of dexametasone suppression test confirming the subclinical Cushing syndrome. After 6 months the endocrine and imagery profile was similar but the gallbladder patter aggravated so surgery was performed (together with right adrenalectomy) by a laparoscopic procedure. The blood pressure profile improved after surgery.
Conclusion Subclinical Cushing syndrome diagnosis is challenging especially if metabolic complications or bilateral adrenal tumours are presented. Based on our observations in this case unilateral adrenalectomy improved the metabolic pattern
Ana Valea, Alexandra Marcusan, Mara Carsote, Adina Ghemigian, Cristina Ghervan and C. Dumitrache
Introduction The Rathke cyst represents an unusual benign tumour derived from Rathke’s cleft remnants. The diagnosis is potential seen at any age. The most frequent signs are mostly mass effects as headache, visual field defects and hypopituitarism.
Case presentation 30-year old female is admitted for persistent headache that was later associated with secondary amenorrhea and visual field defects for the last two years. The clinical data are consistent with high levels of serum prolactin, gonadotropes deficiency, as well as central hypothyroidism. The magnetic resonance imagery found a pituitary tumour of 2.7 centimetres with extrapituitary extension up to the optic chiasm. Surgery was performed in order to remove the tumour. The pathologic report confirmed a Rathke’s cleft cyst. Diabetes insipidus associated with panhypopituitarism was diagnosed and treated after the procedure. Close follow-up is necessary.
Conclusion This case highlights the fact that headache sometimes embraces a severe neoplasia diagnosis and that the iatrogenic complications after surgery are lifelong care demanding
The neuroendocrine tumors (NETs) are more frequent during the last decades. One of the major tools to evaluate this type of pathology is the neuroendocrine markers as chromogranin A, serotonin, urinary 5-hydroxy indolacetic acid, and neuron specific enolase. They change related to the disease progression, regardless therapy. Some of the drugs that are used for NETs as somatostatin analogs (for example octreotide) might interfere with glucose metabolism. Objectives. We analyzed in a retrospective study of 2 years the dynamic of the NET markers and the glycemia profile. Material and Methods. All the patients had at least one assay per year. Results. 9 patients were included (5 women and 4 men), with a mean age of 57.33 years. They were treated before the study with octreotide for 18 +/- 14.69 months. The dose of octreotide varied from 20 to 50 mg, monthly. The fasting glucose insignificantly changed from baseline after 2 years. No new case of diabetes was registered. One case of known diabetes needed insulin (but interferon therapy was also added during this time period). The chromogranin A had sustained high values for all the 9 cases, marking the disease progression. The neuron specific enolase significantly increased, and the serum serotonin as well as the 5HIIA was much higher in 2 cases with aggressive carcinoid symptoms. Conclusion. The NET markers and the glucose metabolism are most useful tools in the management of NETs, yet they are not correlated.
Ana Valea, Andra Morar, D.P. Dumitru, Mara Carsote, Adina Ghemigian and C. Dumitrache
Introduction Cushing’s disease is a complex endocrine disorder characterized by excessive glucocorticoid secretion caused by an ACTH-secreting pituitary adenoma. Hyperandrogenism and menstrual disorders such as amenorrhea and oligomenorrhea complete the clinical picture of Cushing’s syndrome. Infertility is relatively common, involving complex pathogenetic mechanisms, which differ depending on the cause of hypercortisolism.
Case presentation We present the case of a female patient diagnosed with Cushing’s disease during the investigations carried out to assess infertility. After transsphenoidal adenomectomy, the patient underwent treatment with pasireotide and dopamine agonists, achieving normalization of gonadotropin and estradiol levels.
Conclusion Current guidelines recommended transsphenoidal adenomectomy as first-line therapy in an attempt to correct hypercortisolism and restore fertility in patients with Cushing’s disease. In case of relapse pasireotide and dopamine agonists can be effective in normalizing the hormonal profile
Mara Carsote, Ana Valea, Anda Dumitrascu, Cristina Capatina, Diana Paun, Catalina Poiana and Adina Ghemigian
Introduction Prolactinomas without galactorhhea may be considered menopause or not diagnosed. This is a cases series.
Case1. 76-year female with menopause at age of 52 was discovered at 66 yrs with high prolactin and a pituitary micro-nodule. Bromocriptin was continued for 6 years then switched to cabergoline with constant imagery. The patient did not display at all galactorrhea. Osteoporosis was diagnosed at age of 66 with previous 2 fragility fractures.
Case2. 45-year female is known with secondary amenorrhea (without galactorrhea) for the last 7 years being considered menopause. She experienced headaches thus a MRI was performed and found a pituitary tumour of 1.5cm. Low FSH with increased prolactin was revealed. Cabergoline was started. Within 2 months the menses resumed and headache mildly improved. After 3 months prolactin normalised under weekly 2 mg of cabergoline. Periodical prolactin control is necessary as well as a pituitary scan at 6 months.
Case3. 39-year female had a 3 yrs history of secondary amenorrhea. A prolactin of 117ng/mL and a microprolactinoma of 0.77cm were found. Cabergoline was started and progressively increased up to 1.5mg per week. The prolactin quickly normalised up to 8ng/mL within 4 months. She was followed for 2 years and the imagery found a tumour reduction to 0.44cm.
Conclusion Prolactinomas associate a great variety of clinical presentations. They interfere with menopause by mimicking it in cases without galactorrhea. Also a newly diagnosed prolactinoma during menopause needs long term therapy and followed-up for especially for bone safety.
Ana Valea, Mara Carsote, Adina Ghemigian, Andra Morar, D.P. Dumitru and Carmen Emanuela Georgescu
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
Nicoleta Dumitru, Mara Carsote, Andra Cocolos, Eugenia Petrova, Maria Olaru, Andra Caragheorgheopol, Constantin Dumitrache and Adina Ghemigian
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.