Issue 1/2019

The incidence of neuroendocrine tumors (NETs) is increasing annually by 5,8%, mainly due to improved diagnostic methods. In 2013 primary epidemiological information was collected on the frequency of neuroendocrine tumors in Bulgaria. The initial information included 127 patients with NETs from the regions of Sofia, Varna and Pleven. Tumors were 98% localized in the gastrointestinal tract. Primarily the small intestine, rectum, appendix were mainly affected while the colon, stomach and pancreas were less affected.

Primary amenorrhea is defined as absence of menarche by the age of 15 years in the presence of pubertal development. In the absence, however, of pubertal signs, the condition can be diagnosed as early as 13 years of age. Behind primary amenorrhea there are often serious diseases the most common being gonadal dysgenesis in particular Turner syndrome. About 10% of girls with Turner syndrome have a karyotype with Y chromosome which changes their therapeutic behavior. The presence of Y-chromosomal material in standard cytogenetic analysis, combined with intra-abdominal gonads, whether functional or not, increases the risk of gonadal tumors. This risk varies in the different diseases, but gonadectomy is recommended in all of them, at different ages, depending on the endocrine role of gonads during puberty.

Insulin resistance and cardiovascular diseases as well as the risk factors that lead to their occurrence like atherosclerotic changes, dyslipidemia, obesity, are the main components of metabolic syndrome. Different methods for insulin sensitivity estimation exist which are widely used in epidemiological studies and in clinical practice. However, most of them do not reflect the metabolic disturbances of an individual. That is why new indices emerge in practice that estimate insulin resistance and cardiovascular risk using easily accessible anthropometric and functional parameters.

The biological activity of thyroid hormones (TН) at the tissue level is determined by two important processes: 1) the activity of T4-deiodinase systems converting Т4 to bioactive T3; 2) the transmembrane transport of TH in the target cells depending on the expression of the tissue-specific peripheral transporters (MCT8, MCT-10, OATP1C1). Decreased FT4 and FT3 transport has been demonstrated in a wide range of conditions -insulin resistance, diabetes, obesity, dyslipidemias, chronic and acute stress, severe infectious and autoimmune diseases, sepsis, heart failure, low calorie diets, starvation and depression.

Subclinical Cushing’s syndrome (SCS) in patients with adrenal adenomas refers to the presence of chronic mild to moderate cortisol hypersecretion without specific signs and symptoms of classical Cushing`s syndrome which leads to serious diagnostic and therapeutic difficulties. Because of the lack of pathognomonic signs active screening for SCS should be carried out among patients with adrenal incidentalomas, metabolic syndrome, arterial hypertension, diabetes mellitus, dyslipidemia and osteoporosis. The effects of glucocorticoids on carbohydrate profile, blood pressure, lipid metabolism and bone are unfavorable and lead not only to deterioration in quality of life but also to increased morbidity and mortality.

The beginning of the scientific and practical development of thyroidology in Bulgaria dates back to 1951 when the first Department and Clinic of Endocrinology was opened at the Institute for Specialization and Improvement of Physicians (ISUL) under the Professorship of Head Prof. Dr Ivan G. Penchev (1904 – 1974). The national scientific group for study of endemic goiter was established in 1953 by the Ministry of Health under the leadership of Prof. I. Penchev. A number of distinguished clinicians were involved in the group including Dr V. Varbanov, Dr T. Staykov, Dr G. Papazov as well as others specialists. Laboratories for basal metabolic rate (BMR), serum protein-bound iodine (PBI) and Pathomorphology were created. Radio-isotopic thyroid diagnostics were used such as thyroid – 131-uptake, T3-supression (Werner test) and thyroid scintigraphy. The treatment applied at that time included antithyroid agents (Thionamides, PTU and Potassium iodide – Sol. Lugoli 5%) in patients with thyrotoxicos, bovin Thyroid extract (tabl. Thyroidea siccata) for hypothyroid patients’ surgery of nodular goiter (subtotal and total thyroidectomy) and 131-Iodine for the management of patients with metastatic thyroid carcinomas.