Articole semnate de acelasi autor in Revista Medicala Romana:

Recognizing endogenous Cushing’s syndrome after therapy for scleroderma

REVISTA MEDICALA ROMANA - Romanian Medical Journal, Vol. LXIII, Nr. 4, An 2016

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

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Promoting Global Health

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Ana Valea, Dan Nicolae Paduraru, Adriana Elena Nica, Maria Iuliana Oprisor, Adina Ghemigian and Mara Carsote

REZUMAT

Introduction. Scleroderma induces heterogeneous skin changes due to collagen anomalies, including facial. The recommended therapy is, among others, topic cortisol derived products, so an issue of diagnosis differential regarding the etiological type of Cushing’s syndrome (CS) is raised if a patient develops a suggestive phenotype.
Case presentation. This is a 64-year female presenting (since the last few months) red face, high blood pressure, central obesity. She has a 6-year history of scleroderma, intermittently treated with local corticotherapy. On admission, she associated metabolic disturbances as lipid profile anomalies, high uric acid, insulin resistance and increased number of white blood cells (which were not connected with a relapse of scleroderma, neither to an inflammatory syndrome). Low baseline plasma ACTH and morning serum cortisol level (not high, yet detectable) with abnormal diurnal rhythm suggested an adrenal source of CS. A 3 cm right adrenal tumor was found on computer tomography and later removed through a classical intervention. Two weeks after, the patient voluntarily reduced her prednisone dose causing an adrenal crisis which required re-admission as an emergency. After discharge, daily oral adrenal replacement therapy is needed for the moment.
Conclusions. Scleroderma, especially with skin involvement, and some of associated therapies may mask an endogenous CS as adrenal tumor derivate, thus delaying the adequate diagnosis and therapy. Patient’s
education regarding a potential life threatening condition as chronic adrenal insufficiency is necessary since post-operatory recovery of adrenal function is expected within 6 to 24 months.

Cuvinte cheie: Cushing’s syndrome, adrenal tumor, scleroderma

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Ana Valea

Bariatric surgery and osteoporosis

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Mara Carsote, Razvan Petrescu, Adriana Elena Nica, Adina Ghemigian, Dan Nicolae Paduraru and Ana Valea

ABSTRACT

Introduction. Bariatric surgery, regardless the type of approach, has aggressively extended nowadays. The procedure saves lives due to substantial improvement of severe cardio-metabolic co-morbidities, but the influence of nutritional status might not be completely harmless including bone and muscle changes. Our purpose is to introduce data regarding skeleton after bariatric surgery. This is a narrative mini-review including papers from PubMed. A selection of 33 papers has been done.
General data. Longitudinal better than cross-sectional studies confirmed an annual rate of losing bone mineral density at lumbar and femoral neck of 3-10% starting with first year after surgery and continuing within the third year; low vitamin D and calcium absorption with associated secondary hyperparathyroidism is described; others anomalies include elevated bone remodelling markers, damage of bone microarchitecture, fracture healing disturbances and sarcopenia.
Conclusion. Overall, despite spectacular results after bariatric surgery, the bone and muscle are expected to suffer a level of deterioration, which should be taken into account for assuring an adequate quality of life and an immediate and distant good post-operatory prognosis.

Keywords: bariatric surgery, osteoporosis, bone

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Mara Carsote

5-Hydroxytryptamine and skeleton status

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Mara Carsote, Dan Nicolae Paduraru, Adriana Elena Nica, Ana Valea and Adina Ghemigian

ABSTRACT

Introduction. 5-hydroxytryptamin (serotonin) represents a monoamine with different functions. Central neurotransmitter is related to mood, food and energy regulation and indirect positive effects on bone mass via leptin and sympathetic system. Gut-derived 5-hydroxytryptamine directly influences the skeleton through Wnt/Lrp5/beta catenin signalling with opposite actions to the central pool.
Method. This is a mini-review regarding serotonin- related bone changes.
Results and discussions. All the bone cells have receptors for 5-hydroxytryptamine while skeleton may have an intrinsic ability to locally generate it. The monoamine displays paracrine and autocrine actions, some incompletely described. One practical point is the potential bone loss in clinical situations with serotonin excess, as seen in carcinoid syndrome. Up to this moment, non-bone metastatic neuroendocrine tumours are not listed as a cause of secondary osteoporosis. Another practical aspect is the use of circulating 5-hydroxytryptamine as bone turnover marker surrogate for assessing the future fragility fracture probability. Despite some correlations with classical bone remodelling markers, no clear cut conclusion has been established yet.
Conclusion. 5-hydroxytryptamine displays complex effects on skeleton status, whether direct, indirect or local, but there are data still unknown, thus future need to connect the dots in this particular inter-disciplinary field.

Keywords: 5-hydroxytryptamine, bone, osteoporosis

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Mara Carsote