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  • Author: Rucsandra Dănciulescu Miulescu x
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Abstract

Hypothyroidism is a pathologic condition generated by the thyroid hormone deficiency. The American Thyroid Association advises for the screening of hypothyroidism beginning at 35 years and thereafter every 5 years in people at high risk for this condition: females older than 60 years, pregnant women, patients with other autoimmune disease or patients with a history of neck irradiation. In pregnant women, hypothyroidism can been associated with adverse effect for both mother and child. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ recommends the treatment of maternal overt hypothyroidism: females with a thyrotropin (TSH) level higher than the trimester-specific reference interval and decreased free thyroxine (FT4), and females for which TSH level is higher than 10.0 mIU/L, irrespective of the FT4 value, with administration of oral levothyroxine. The goal of treatment of maternal overt hypothyroidism is to bring back the serum TSH values to the reference range specific for the pregnancy trimester. The Guidelines of the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ recommends treatment of pregnancy associated subclinical hypothyroidism with the following levothyroxine doses: „1.20 μg/kg/day for TSH≤4.2 mU/l, 1.42 μg/kg/day for TSH >4.2-10 and 2.33 μg/kg/day for overt hypothyroidism“. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ and the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ do not recommend the treatment of isolated hypothyroxinemia in pregnancy.

Abstract

Women with gestational diabetes mellitus (GDM) have an increased lifetime risk of developing type 2 diabetes mellitus (T2DM). GDM has a substantial impact on maternal and foetal short and long-term health. Risk factors for GDM may be genetic or nongenetic and have been analysed in numerous studies. Researches in recent years allowed the identification of other risk factors for GDM except for those already known. Knowledge and identification of all risk factors for GDM allows the elaboration of a prevention strategy of T2DM, it may influence the screening, diagnosis, and, subsequently, treatment modalities for this disease.

Abstract

Insulinoma are insulin-secreting tumors of pancreatic origin that generates hypoglycemia by excessive secretion of insulin. Insulinoma is a rare disease ant the most tumors are benign, solitary and occur at intrapancreatic sites.

Case report. A 42-year old Caucasian women was hospitalized at the “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases Bucharest in April 2019 after an episode of hypoglycaemia remitted after intravenous glucose administration. Patient accused for about two weeks anxiety phenomena. At the time of admission in the hospital the patient was conscious in a good general condition. Paraclinical investigations revealed basal blood glucose 29 mg/dl, fasting insulin serum 87.7 µU/ml and pancreatic C-peptide-7.90 ng/ml. During hospitalization under strict glycaemic monitoring, the patient presented frequent asymptomatic hypoglycemic episodes that was remitted after intravenous glucose administration. Nuclear magnetic resonance highlighted a nodular lesion of the pancreas and in May 2019 the tumor resection was practiced. After surgery the blood glucose ranged between 86 mg/dl and 116 mg/dl. To mention that patient has a family history of diabetes and she’s obese.

Conclusion. This case suggests that lack symptoms of hypoglycaemia may be present in patients with insulinoma. Diagnostic of insulinoma requires high clinical suspicions, accurate biochemical investigations and imaging techniques for the localization of the tumor and may represent a challenge in certain situations.

Abstract

Background and Aims. Previous studies have shown that aging is an important risk factor for insulin resistance and type 2 diabetes. The beneficial effects of exercise on glucose metabolism are well known. Our goal was to examine whether physical activity improves insulin levels in older individuals. Material and Methods. Plasma glucose and insulin were measured in fasting state and 2 h after a 75-g oral glucose tolerance test in young lean, sedentary, non-diabetic subjects (n=34, age 25±2 years, body mass index- BMI 24.4±0.7 kg/m2) and older, lean, sedentary, non-diabetic subjects (n=36, age 75±3 years, BMI 24.8±0.4 kg/m2), before and after 8 weeks of aerobic exercise. Training consisted of exercise (such as cycling or fast walking) 5 days/week for approximately 30 min/day. Results. Fasting plasma insulin and 2-h serum insulin levels at baseline were significantly higher in older than young subjects (11.6 μU/ml vs 10.0 μU/ml, p=0.0001, 46.3 μU/ml vs 34.0 μU/ml, p=0.0001). Fasting and 2h plasma insulin levels were reduced after 8 weeks of aerobic exercise in older subjects, with no change in body weight. Conclusion. In our study the hyperinsulinemia associated with aging can be blunted significantly by aerobic exercise in older individuals independent of any changes in body composition

Abstract

Background and aims: Insulin-like Growth Factors (IGF-1) plays as mediator between metabolic syndrome (MetS), oxidative stress and breast cancer (BrCa) progression. The objective of this study was to examine the relationships between IGF-1 serum levels and metabolic profile biomarkers in a population group of BrCa patients.

Material and methods: 126 Syrian women with breast lesions were assigned in 3 study groups: I. Malignant breast tumor group, II. Benign breast tumor group and a Normal (control) group. The following biochemical parameters were measured: IGF-1, HDL-cholesterol, LDL-cholesterol, triglycerides (TG) and glucose.

Results: The mean levels of serum IGF- 1 in patients with breast cancer was significantly higher than those with benign tumors but we did not find any correlation between IGF-1 serum levels and tumor stage or lymph nodes metastases. Total cholesterol and LDL-cholesterol levels, along with TG were significantly higher in patients with BrCa versus benign and normal subjects.

Conclusion: Results support the link of metabolic dysregulation and oxidative stress in BrCa progression as elevation of serum IGF-1 levels in BrCa patients are associated with metabolic syndrome markers which eventually adds more risk in cancer progression.

Abstract

Background and Aims. Previous studies have shown that hypochromia is a common finding in patients with chronic diseases. The aim of our study was to estimate the anthropometric and metabolic characteristics of patients with type 2 diabetes mellitus (T2DM) and hypochromia. Material and Methods. 30 patients with T2DM were recruited for this study. Patient demographics, relevant concomitant illnesses and medical history were recorded. Anthropometric, biochemical parameters (fasting plasma glucose - FPG, glycated hemoglobin -HbA1c, glomerular filtration rate - GFR) and morphology of blood smear were assessed. Patients diagnosed with diabetes and hypochromia constituted the study group and patients with type T2DM but without hypochromia constituted the control group. Results. The study showed no statistically significant differences on anthropometric and metabolic characteristics of patients with diabetes and hypochromia, compared with controls. Conclusions. We observed a high prevalence of hypochromia in diabetic patients (46.66%). Our findings suggest the need of screening for routine hematological tests in patients with T2DM.

Abstract

Introduction: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are part of the routine blood tests and are usually used to assess liver or cardiac status. The most common disturbances are the mildly risen levels which are correlated with hepatic dysfunction and entail a wide variety of etiologies: viral, toxic, drug or are lifestyle related.

Case report: Routine blood tests revealed high AST and ALT levels in an otherwise healthy 40-years-old male. After a series of supplementary tests the cause remained undetermined, so more attention was paid to the patient’s daily routine. Recently he started an intense training program which led to extensive muscle damage causing an elevation of plasma transaminases’ levels.

Discussion: When dealing with a rise in AST and ALT levels in asymptomatic patients, physicians must carefully consider all aspects, from family and personal history, infectious diseases or toxins to medication and lifestyle, in order to avoid unnecessary tests and incorrect diagnoses or treatments.

Abstract

Objectives. Prostate-specific antigen (PSA) is the most used and validated marker of prostate cancer risk. The aim of this study was to assess PSA levels during treatment with testosteronum undecanoat in patients with type 2 diabetes (T2DM). Material and Methods. We evaluated 38 T2DM patients aged between 48 and 61 years with confirmed hypogonadism. 1000 mg testosterone undecanoate was injected intramuscular every 10 to 14 weeks. Total testosterone and PSA levels were assessed at baseline and after 6, 12, 24 months of treatment. Results. The average age was 55.03 ± 2.40 years and 3 patients (7.89%) had a family history of prostate cancer. Treatment with testosterone undecanoate generated significant changes in serum total testosterone (482.29±50.78 ng/dl vs. 246.66±51.50 ng/dl, p < 0.001) but not in serum PSA levels (2.11±.0.49 ng/ml vs. 2.09±0.47 ng/ml, p - NS). Conclusion. Testosterone replacement therapy may normalize serum androgen levels but appears to have little effect on PSA levels.