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Catalina POIANA

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Articles signed on MÆDICA, JCM:

Testicular Regression Syndrome and Severe Psychiatric Disorder – a Rare Association Preventing the Optimal Management of the Endocrine Condition

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MÆDICA - a Journal of Clinical Medicine | Vol. 13, nr. 4, 2018
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Testicular Regression Syndrome and Severe Psychiatric Disorder – a Rare Association Preventing the Optimal Management of the Endocrine Condition

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ABSTRACT

Introduction: Bilateral testicular regression syndrome (TRS) is a very rare condition characterized by the absence of testicular tissue in a genotypic male.
Case report: A 39 years old male with TRS (diagnosed at age 8, during investigation for bilateral cryptorchidism) associating paranoid schizophrenia (diagnosed at the age of 14) is described. The patient received parenteral androgen replacement only for a few months in the pubertal period. After puberty, the psychiatric team strongly advised against the androgen replacement which was stopped and not resumed ever since. At presentation the patient has no subjective complaints but clear signs of hypogonadism. The psychiatric status was stable under neuroleptics. Topical androgen replacement was recommended but it aggravated the psychotic aggressive features so it was stopped.
Conclusion: We present the case of a patient with TRS associating, from early adolescence, a severe psychiatric pathology with aggressive characteristics, which constantly precluded adequate testosterone replacement.
Keywords: testicular regression, vanishing testes, schizophrenia, hypogonadism, replacement

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Overall Survival of Patients with Aggressive Thyroid Cancer on Fine-Needle Aspiration Biopsy Examination. A Tertiary Romanian Center Experience

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MÆDICA - a Journal of Clinical Medicine | Vol. 10, nr. 3, 2015 CNCSIS - CMR - B+ OBBCSSR

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Overall Survival of Patients with Aggressive Thyroid Cancer on Fine-Needle Aspiration Biopsy Examination. A Tertiary Romanian Center Experience

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Aim: Anaplastic thyroid carcinoma (ATC), poorly differentiated thyroid carcinoma (PTDC) and lymphoma are aggressive forms of neoplasia. Although all carry a poor prognosis there is an important heterogeneity of overall survival (OS) between individual patients. The decision of total thyroidectomy is often based on fine-needle aspiration biopsy (FNAB) which has important limitations in this setting. Our aim was to assess the OS of aggressive thyroid cancer diagnosed on FNAB in a single university center.

Methods: We retrospectively reviewed all the ATC, PDTC and lymphoma cases diagnosed on FNAB during 2007-2013 (15 cases). All FNAB examinations were performed by the same specialized pathologist. Data on demographics, laboratory tests, imaging studies, FNAB/pathology reports, treatment and survival time were recorded. All patients had serum calcitonin levels under 5 pg/mL. Five patients had total thyroidectomy.

Results: The OS was 2.2 (0.6, 18.5) months. The survival rate at 3 and 12 months was 46.6% and 33.3% respectively. There were no significant differences between ATC and PDTC/lymphoma patients for age, TSH, largest tumoral diameter and cervical lymph involvement. Patients with ATC (8 cases) had a median OS of 0.8 months, significantly shorter than 6 months for patients with PDTC/lymphoma (7 cases). Patients treated with total thyroidectomy had a median OS of 20 months compared with 1.87 months for patients without surgical intervention (p=0.06).

Conclusion: The differences between groups and the heterogeneity of individual cases suggest that a diagnosis of aggressive thyroid cancer on FNAB should not preclude the surgical intervention. The decision to operate should be based on accurate imaging rather than on discouraging FNAB result.

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Screening for Secondary Endocrine Hypertension in Young Patients

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MÆDICA - a Journal of Clinical Medicine | Vol. 8 (11), no. 2 2013

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Screening for Secondary Endocrine Hypertension in Young Patients

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Background: Secondary endocrine hypertension accounts for 5-12% of hypertension’s causes. In selected patients (type 2 diabetes mellitus, sleep apnea syndrome with resistant hypertension, sudden deterioration in hypertension control), prevalence could be higher. Objectives: To present etiology of endocrine secondary hypertension in a series of patients younger than 40 years at hypertension’s onset. Material and methods: Medical records of 80 patients (39M/41F), aged 30.1 ± 8.2 years (range: 12- 40 years), with maximum systolic blood pressure=190.4 ± 29.2 mm Hg, range: 145-300 mm Hg, maximum diastolic blood pressure=107.7 ± 16.9 mm Hg, range: 80-170 mm Hg) referred by cardiologists for endocrine hypertension screening were retrospectively reviewed. Cardiac and renal causes of secondary hypertension were previously excluded. In all patients, plasma catecholamines were measured by ELISA and plasma cortisol by immunochemiluminescence. Orthostatic aldosterone (ELISA) and direct renin (chemiluminescence) were measured in 48 patients. Results: Secondary endocrine hypertension was confirmed in 16 out of 80 patients (20%). Primary hyperaldosteronism was diagnosed in 7 (4M/3F) out of 48 screened patients (14.6%). i.e. 8.75% from whole group: 5 patients with adrenal tumors (3 left/2 right), 2 patients with bilateral adrenal hyperplasia; all patients were hypokalemic at diagnostic (average nadir K+ levels = 2.5 ± 0.5 mmol/L); four patients were hypokalaemic on diuretic therapy (indapamidum); other 3 patients were hypokalaemic in the absence of diuretic therapy. Cushing’s syndrome was diagnosed in 6 patients (7.5%): subclinical Cushing due to 4 cm right adrenal tumour – n = 1, overt ACTH-independent Cushing’s syndrome due to: macronodular adrenal hyperplasia associated with primary hyperparathyroidism – n = 1; due to adrenal carcinoma – n = 1; due to adrenal adenomas – n = 2; Cushing’s disease – n = 1). Pheochromocytomas were diagnosed in 3 patients (3.75%). Conclusion: Primary hyperaldosteronism was the most frequent cause of secondary endocrine hypertension in our series, followed by Cushing’s syndrome and pheochromocytomas. Screening of young hypertensive patients for secondary causes, especially primary hyperaldosteronism, is mandatory.

Keywords: secondary hypertension, primary hyperaldosteronism, hypercortisolism, pheochromocytoma, screening

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Vitamin D Deficiency in Postmenopausal Women – Biological Correlates

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MÆDICA - a Journal of Clinical Medicine | Vol. 9, nr. 4, 2014

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Vitamin D Deficiency in Postmenopausal Women – Biological Correlates

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ABSTRACT

Introduction: Low vitamin D (VD) is associated with secondary hyperparathyroidism and both contribute to deleterious consequences (reduced bone mineral density (BMD), risk of fractures and falls).

Objective: To study the VD status and biological correlates in a group of postmenopausal women.

Material and methods: We studied 123 postmenopausal women evaluated in the C.I.Parhon National Institute of Endocrinology, the Pituitary and Neuroendocrine Diseases department. All cases had been reffered for the evaluation of BMD by the general practitioner. The evaluation included serum measurements of total and ionised calcium, phosphorus, alkaline phosphatase (ALP), 25 hydroxi vitaminD (25OHD), parathyroid hormone (PTH), osteocalcin, betacrosslaps. Central DXA osteodensitometry was performed.

Results: 91.9% of cases had 25OHD serum levels below 30 ng/ml (74.8% had VD deficiency, 17.1% VD insufficiency). Only 8.1% had sufficient VD levels. A history of fragility fractures was present in 45.83% of the osteoporotic patients, 27.27% of the osteopenic ones and 15.15% of the women with normal BMD.

32 women (26%) were on VD supplementation at the time of evaluation. Among these subjects, the 25OHD level was significantly higher in those with prior fragility fractures (p=0.018) and osteoporosis (p=0.008).

25OHD concentration negatively correlated with PTH, alkaline phosphatase (ALP) and osteocalcin. The bone markers evaluated had a significant inverse correlation with the radius BMD, T and Z scores (p=0.004).

27.17% of the cases with VD deficiency had secondary hyperparathyroidism. The 25OHD concentration was significantly lower in these cases (p=0.000).

Conclusions: VD insufficiency is widely prevalent but still under-recognized and under-treated, possibly leading to secondary hyperparathyroidism. The compliance to VD supplementation is lower in subjects without osteoporosis or fragility fractures. Primary prevention measures should be more actively implemented.

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