A deficient vitamin D status has been associated with various diseases but its correlation with different types of cancer remains of interest. Thyroid cancer is the most frequent endocrine malignancy and despite the fact that differentiated thyroid carcinoma (DTC) has an excellent survival rate (>90% 10-year survival), persistent and recurrent disease is still an issue nowadays. Epidemiological studies confirmed lower levels of vitamin D in patients with DTC and correlation of 25-hydroxy vitamin D3 [25(OH)D3] status with clinicopathologic features and poor prognosis, being considered a biomarker for aggressiveness.Vitamin D, through it active form 1α,25-dihydoxyvitamin D3 [1,25(OH)2D3] and its receptor (VDR) exerts genetic changes to both healthy and neoplastic cells thus controlling their proliferation, differentiation and apoptosis. Also, vitamin D binding protein (DBP) has been recently discovered to have many different biological functions. This review is an update on molecular mechanisms of vitamin D signaling and its association with thyroid cancer prevention, treatment and prognosis.

Thyroid cancer is the most frequent endocrine cancer representing 1-1.5% of all cancers. Approximately 90% of these are differentiated thyroid carcinomas (DTC) with a favorable prognosis and cure rate. DTC has recently witnessed an increase in incidence with a relatively stable mortality rate, mostly due to intensive screening. Despite being considered indolent and the 10-year survival rate being above 90%, local or distant recurrence can be observed in up to 20% of cases. Mutations in BRAF, RET, RAS, NTRK1, PAX8-PPARG are commonly found in DTC but studies show that genetic alterations with apparently no correlation to DTC might improve or aggravate prognosis.
Vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms is consider to be one of these factors, due to the fact that it exerts immunological and antineoplastic functions throught its antiproliferative and prodifferentiating actions. FokI gene polymorphism has been associated with later stage and negative prognosis in different studies.
Also, polymorphisms of genes involved in folate metabolism (MTHFR, MTR, RFC1) may be incriminated in carcinogenesis, folate being an extremely important factor in DNA synthesis.
Studies suggest that through correction and avoidance of incriminated neoplastic agents, thyroid cancer incidence, evolution and prognosis might improve significantly. For this to be possible we need to be aware of the molecular pathways these environmental factors use to exert their carcinogenic effects.

The importance of burnout amongst medical staff was highlighted by various papers, showing that this issue implies job demands and job resources. The current challenge of SARS-CoV-2 pandemic also raised many concerns about its impact on healthcare sector. A new survey after 4 years from the previous study of the Bucharest College of Physicians is coming with new data, containing the effect of COVID-19 on the psychological wellbeing of its members.
The increasing of burnout was found in all categories, and the most frequently solutions claimed by the respondents were related to decreasing of workload and bureaucracy, and an important number of physicians identify the need for specialized psychological assistance.
The COVID-19 pandemic period exacerbated the system related factors that contribute to the phenomenon of burnout.

Since its fi rst description in 1980 by Freudenberger, the phenomenon of burnout has been studied intensively by many scholars in the past decades and stakeholders are getting more and more aware of the problematic burnout poses in the professional fi eld, as well as the healthcare threat it poses. It is well known today that when it comes to the fi eld of healthcare workers, burnout plays a signifi cant role in regards to physicians’ well-being. The Bucharest College of Physicians wanted to evaluate this phenomenon amongst doctors working in Romania’s capital city and launched a survey addressing its’ members. The study revealed a rather high number of physicians suffering from at least one kind of burnout. The numbers were highest in the fi eld of personal and professional burnout – 55% and 52% of respondents respectively. In regards to burnout caused by the nature of their work (working with patients), a still high number of 36% of respondents showed signs of burnout. Participants in the study named the increasing number of bureaucratic tasks as one of the major stressors at the job and suggested that by eliminating some bureaucracy, one could improve their level of stress on the job. The results of the study conducted by the Bucharest College of Physicians fall in line with other studies regarding healthcare workers around the globe. The alarmingly high numbers of burnout cases and increased levels of stress should signal stakeholders in the healthcare system to take action in order to improve physicians’ well-being.

Craniopharyngiomas are rare tumors developed in the area of the sella turcica and especially the suprasellar region. Despite their benign histological nature they are locally aggressive and surgical intervention is a major challenge due to the risk of damaging critical neural and vascular neighbouring structures. Objective: To study the postsurgical evolution of craniopharyngioma in adults after total or partial surgical resection. Material and methods: We performed a retrospective review of adult craniopharyngioma patients evaluated and followed up in the Pituitary Diseases Department of the National Institute of Endocrinology in Bucharest between 1998 and 2018. Results: A total of 60 patients (39.62±15.6 years-old) diagnosed with craniopharyngioma were included. All underwent initial surgery (68.3 % transcranial, 31.7% transsphenoidal approach). Gross total resection (GTR) was achieved in 21 cases (35%), in all the others partial resection was obtained (non-GTR). Immediate non-threatening postsurgical complications were anosmia (in 2 cases), cerebrospinal fluid-CSF leak (3 cases), subdural hematoma (2 cases). After surgery 13 cases (21.66%) had cognitive impairment (2 with GTR, 11 with non-GTR), 14 (23.3%) had hypothalamic syndrome (diurnal sleepiness, appetite and memory dysfunction- present in 1 case with GTR, 13 with non-GTR), 27 cases (45%) reported lethargy (7 GTR, 20 non-GTR), 24 (40%) complained of headaches (6 GTR, 18 nonGTR). All these complications were signifi cantly more frequent in cases with incomplete tumor resection compared to those with GTR: p= 0.000; 0.000; 0.036 and 0.009, respectively. Conclusions: Craniopharyngioma as well as its treatment are associated with very significant morbidity. Aggressive surgical resection with the aim of GTR is possible in a signifi cant percentage of cases and if it is carefully considered in view of the surgically perceived risk of neurologic injury it is associated with lower postsurgical morbidity.

Pituitary adenomas are benign neoplasms originating in the anterior pituitary cells, that represent 15-20% of all intracranial tumors. Pituitary adenomas (PA) can be secreting (producing growth hormone-GH, prolactin-PRL, adrenocor-ticotropic hormone-ACTH or, very rarely gonadotro-pins-FSH and LH or thyrotropic hormone TSH) or non-secreting (NPA). [...]

Metabolic syndrome (MetS), type 2 diabetes, and consequent cardiovascular complications are serious healthcare problems worldwide [1,2]. The prevalence of MetS or its components around the world is variable in different ethnic populations [3,4], and this can be explained by interactions between susceptibility genes specifically expressed in certain ethnic groups and environmental factors [5]. Nonetheless, the number of people aff ected by these conditions is continuously increasing at a global level [4,6] and along with it the mortality and morbidity of populations [7,8]. Cardiovascular disease (CVD) is the main cause of mortality in people suffering from MetS and/or diabetes [9]. The research in this field is ongoing, in the attempt to elucidate the pathophysiological mechanisms and pathways involved in MetS, and to find reliable biomarkers for diagnosis and disease prognosis, as well as therapeutic targets. [...]

Pheochromocytomas (Pheos) and paragangliomas (Pgls) are rare neuroendocrine tumors, with the same embriologic origin. Based on WHO classification, chromaffin tumors of the adrenal medulla are called Pheos, whereas tumors arising from extra-adrenal chromaffi n cells, along the autonomous nervous chains, are named Pgls [1]. Furthermore, there are two types of Pgls according to their homologous nervous chain: sympathetic and parasympathetic tumors. Sympathetic Pgls are developing from the pre- and paravertebral sympathetic ganglia (ex: Pgls of the thorax, mediastinum, abdomen) and from the connective tissue within the pelvic organs (ex:urinary bladder Pgl). They release dopamine or norepinephrine (NE) because they lack phenylethanolamine N-methyltransferase (PNMT), the enzyme in charge of transforming NE into epinephrine (E), that is specific to adrenal medulla. [...]

Pituitary adenomas (PAs) are the most frequent cause of cranial tumors [1,2], benign by histology but with high morbidity caused by their complications – hypersecretion of pituitary hormones but also compression of surrounding structures thus affecting the visual field or causing pituitary deficiency. Their etiology, although intensely studied in the last 30 years, is still largely unknown. The natural evolution and the response to current treatment options of PAs (surgery, medication and radiotherapy) are very variable, influenced by various factors, some identified and some still to be found. Early diagnose and treatment is associated with better prognosis thus identifications of patients at risk for developing a PA and targeted follow-up would result in a better management of the disease [...]

Renal osteodystrophy is almost universally found in patients with end-stage renal disease (ESRD). Although bone biopsy is the gold standard for assessment of bone status it is infrequently used.
Guidelines (KDIGO, 2009) recommend the use of dual-energy X-ray absorptiometry (DXA), as a method for measuring bone quantity, in all dialysis patients who either have had fractures or have risk factors for osteoporosis but state against routine use of DXA for bone mineral density (BMD) measurement. This is because low BMD measured by DXA was consistently associated with an increased risk of low trauma fractures in general population but in patients with ESRD studies produced conflicting results (Inaba et al., 2005
Jamal et al., 2002
Kaji et al., 2002
Urena et al., 2003
Yamaguchi et al., 1996). There are many causes of this heterogeneity including secondary hyperparathyroidism, presence of low bone turnover disease, osteomalacia, site of BMD measurement or fracture assessment (clinical vs. radiological).