Issue 2 (April – June)152 – HORMONES (Archive)

Laparoscopic surgery for pancreatic insulinomas: an update

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Chrysanthi Aggeli, Alexander M. Nixon,Ioannis Karoumpalis, Gregory Kaltsas, George N. Zografos

Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity …

Cardiovascular safety of type 2 diabetes medications: Review of existing literature and clinical implications

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Sílvia Paredes, Claudia Matta-Coelho, Ana Margarida Monteiro, Alice Brás, Olinda Marques, Marta Alves, Laura Ribeiro

Type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD) and the cardiovascular effect of antidiabetic drugs are today critical medical issues, with the prevalence of T2DM in particular showing a steep increase worldwide, mainly due to unhealthy lifestyle habits. T2DM in association with obesity and other cardiovascular risk factors, results in the development of CVD, the leading cause of morbidity and mortality in patients with T2DM …

Effects of ghrelin in energy balance and body weight homeostasis

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Laura Mihalache, Andreea Gherasim, Otilia Niță, Maria Christina Ungureanu, Sergiu Serghei Pădureanu, Radu Sebastian Gavril, Lidia Iuliana Arhire

Ghrelin is a gut peptide composed of 28 amino acids mostly secreted in the gastric fundus mucosa. It was isolated and described in 1999 by Kojima et al. and only three years later its specific receptor, GHSR1a, was also identified. Ghrelin, the endogenous ligand for the GH secretagogue receptor, is the only peripheral orexigenic hormone that activates the receptors to be found especially in the appetite center (hypothalamus and pituitary gland) …

Comparison of color-Doppler and qualitative and quantitative strain-elastography for differentiation of thyroid nodules in daily practice

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Manuela Götzberger, Susanne Krueger, Roland Gärtner, Martin Reincke, Matthias Pichler, Gerald Assmann, Thomas Mussack, Michael Zimmermann, Veit Gülberg

OBJECTIVE: Strain-elastography provides a new ultrasound-based method that can offer information about the stiffness of thyroid nodules as an indicator of malignancy. The aim of our study was to compare the utility of color-Doppler and strain-elastography in differentiating between benign and malignant nodules. DESIGN AND METHODS: 77 thyroid nodules (70 benign and 7 malignant) from 70 unselected patients (48 female/22 male, mean age 49.7±14.3 years) were evaluated with color-Doppler …

Vitamin D levels in a large Mediterranean cohort: reconsidering normal cut-off values

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Marianna Katrinaki, Marilena Kampa, Andrew Margioris, Elias Castanas, Niki Malliaraki

OBJECTIVE: The determination of the normal range of 25-hydroxyvitamin D [25-(OH)D], though currently based on suppression of PTH levels, still remains a controversial issue. The 25-(OH)D levels exhibit gender and seasonal variability, the latter attributed in part to changes of insolation. DESIGN: The aim of this cross-sectional study was to estimate the levels of 25-(OH)D on the island of Crete …

Beneficial effect of dose escalation and surgical debulking in patients with acromegaly treated with somatostatin analogs in a Romanian tertiary care center

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Monica Livia Gheorghiu, Simona Găloiu, Mădălina Vintilă, Mariana Purice, Dan Hortopan, Anda Dumitraşcu, Mihail Coculescu, Cătălina Poiană

BACKGROUND: Somatostatin analogs (SSA) are now considered standard therapy for acromegaly, as primary or adjunctive treatment after pituitary surgery. OBJECTIVE: To evaluate the efficacy of SSA and the effect of dose escalation in non-operated patients with acromegaly as compared to patients treated after pituitary surgery in a Romanian tertiary care center …

Genetic screening of non-classic CAH females with hyperandrogenemia identifies a novel CYP11B1 gene mutation

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Christos Shammas, Stefania Byrou, Marie M. Phelan, Meropi Toumba, Charilaos Stylianou, Nicos Skordis, Vassos Neocleous, Leonidas A. Phylactou

OBJECTIVE: Congenital adrenal hyperplasia (CAH) is an endocrine autosomal recessive disorder with various symptoms of diverse severity. Mild hyperandrogenemia is the most commonclinical feature in non-classic CAH patients and 95% of the cases are identified by mutations in the CYP21A2 gene. In the present study, the second most common cause for non-classic CAH (NC-CAH), 11β-hydroxylase deficiency due to mutations in the CYP11B1 gene, is investigated …

The gonadotroph origin of null cell adenomas

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George Kontogeorgos, Eleni Thodou

OBJECTIVE: The term “null cell” adenoma was first proposed in 1980 to designate pituitary adenomas lacking clinical, biochemical and morphological markers to disclose their cell origin. DESIGN: The aim of this study was to investigate the presence of α- and β-gonadotropin subunits in clinically nonfunctioning pituitary tumors …

Salivary testosterone responses to a physical and psychological stimulus and subsequent effects on physical performance in healthy adults

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Blair T. Crewther, Liam P. Kilduff, Charlie Finn, Phil Scott, Christian J. Cook

OBJECTIVE: To address the rapid influence of testosterone (T) on neuromuscular performance, we compared the T and physical performance responses of adults exposed to a physical and psychological stimulus. DESIGN: A group of healthy men (n=12) and women (n=14) each completed three treatments using a randomised, crossover design: exercise involving five × ten-second cycle sprints, viewing a video clip with aggressive content and a control session …

Which is the best predictor of thyroid cancer: thyrotropin, thyroglobulin or their ratio?

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Pinar Yazici, Mehmet Mihmanli, Emre Bozkurt, Feyza Yener Ozturk, Mehmet Uludag

OBJECTIVE: Since documented incidence of thyroid cancer has been rising over time, in part due to incidental small papillary cancer, several studies have been carried out to investigate the role of possible serum markers of thyroid cancer prior to surgery. DESIGN: Prospective cohort study. AIM: To investigate the role of thyroglobulin (Tg), thyrotropin (TSH) and the TSH:Tg, Tg:TSH ratio in the preoperative diagnosis of thyroid cancer …

Clinical impact of strict criteria for selectivity and lateralization in adrenal vein sampling

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Alessandro Gasparetto, John F. Angle, Pasha Darvishi, Colbey W. Freeman, Ray G. Norby, Robert M. Carey

INTRODUCTION: Selectivity index (SI) and lateralization index (LI) thresholds determine the adequacy of adrenal vein sampling (AVS) and the degree of lateralization. The purpose of this study was investigate the clinical outcome of patients whose adrenal vein sampling was interpreted using “strict criteria” …

Pasireotide for malignant insulinoma

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Amit Tirosh, Salomon M. Stemmer, Evgeny Solomonov, Eldad Elnekave, Wolfgang Saeger, Yelena Ravkin, Kobi Nir, Yeela Talmor, Ilan Shimon

Malignant insulinoma usually has a poor prognosis, as no efficient medical treatment is available. The somatostatin analogs octreotide and lanreotide have limited ability to control the hypoglycemic events. Pasireotide is a multi-receptor targeted somatostatin-analog with improved affinity for SSTR5. There is to date no reported treatment experience with this drug in such tumors …

Delayed diagnosis of disorder of sex development (DSD) due to P450 oxidoreductase (POR) deficiency

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Vasiliki Koika, Anastasia K. Armeni, Neoklis A. Georgopoulos

CASE PRESENTATION: A 36-year old man, operated on for cryptorchidism at the age of 8 years, was referred to the Outpatient Clinic of Reproductive Endocrinology for investigation of infertility. Clinical examination revealed ambiguous genitalia: penis 4-5 cm, testicular volume 2-3 ml, hypospadias, hypertrophic foreskin and scrotum bifida. Mild hypertension was confirmed. No skeletal malformations were detected …

Adrenal malignant melanoma masquerading as a pheochromocytoma in a patient with a history of a multifocal papillary and medullary thyroid carcinoma

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Maria E. Barmpari, Christos Savvidis, Anastasia D. Dede, Haridimos Markogiannakis, Christina Dikoglou, Paraskevi Xekouki, Constantine A. Stratakis, Andreas Manouras, Sofia Malaktari-Skarantavou

Objective: Adrenal masses usually represent benign and nonfunctional adrenal adenomas; however, primary or metastatic malignancy should also be considered. Discovery of an adrenal mass needs further evaluation in order to exclude malignancy and hormonal secretion. We present a rare case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. Case report: A 61-year-old male farmer was referred for evaluation …

A complicated case of primary hypophysitis with bilateral intracavernous carotid artery occlusion

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Pinelopi Katsiveli, Maria Sfakiotaki, Nikolaos Voulgaris, Labrini Papanastasiou, Theodora Kounadi, Konstantinos Lymperopoulos, George Piaditis

Primary hypophysitis (PH) is a rare clinical entity characterized by inflammatory infiltration of the pituitary gland with various degrees of pituitary dysfunction. OBJECTIVE: To present a complicated case of aggressive PH with bilateral cavernous sinuses infiltration, successfully treated with azathioprine after failure of corticosteroid treatment. METHODS AND RESULTS: A 48-year-old woman presented with episodes of recurrent headache …

A case of dyskeratosis congenita associated with hypothyroidism and hypogonadism

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Nilufer Ozdemir Kutbay, Banu Sarer Yurekli, Zehra Erdemir, Emin Karaca, Idil Unal, Banu Yaman, Ferda Ozkinay, Fusun Saygili

Dyskeratosis congenita is a very rare multisystemic disorder and it can be accompanied by different endocrinological pathologies. We would like to draw attention to this rare disease by reporting a case diagnosed as dyskeratosis congenita. More specifically, a 30-year-old male patient was referred with the findings of micropenis and atrophic testicles …

A novel CYP11B1 mutation in a Turkish patient with 11β-hydroxylase deficiency: An association with the severe hypokalemia leading to rhabdomyolysis

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Banu Sarer Yurekli, Nilufer Ozdemir Kutbay, Huseyin Onay, Ilgin Yildirim Simsir, Gokcen Unal Kocabas, Mehmet Erdogan, Sevki Cetinkalp, Gokhan Ozgen, Fusun Saygili

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder caused by the loss of one of five steroidogenic enzymes affecting cortisol synthesis. Deficiency of 21-hydroxylase is the most common cause of CAH, accounting for more than 90% of all cases; it is followed in frequency by 11β-hydroxylase deficiency (11βOHD), reported to be between 3% and 5% of cases …

A case of multiple immune toxicities from Ipilimumab and pembrolizumab treatment

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Malik Asif Humayun, Ruth Poole

Monoclonal antibodies have revolutionized the management of complex and challenging human diseases such as malignancies as well as haematological, rheumatologic and other autoimmune conditions over the last three decades. At the same time, they are associated with a significant degree of immune-mediated disorders, and endocrinopathies are no exception …