Primary adrenal insufficiency (Addison’s disease) is a condition that is characterized by a lack of adrenal hormones - cortisol and aldosterone. The most common symptoms are fatigue and lack of ...energy, weakness, loss of appetite, and increased thirst. Additionally, darkening of the skin can occur. Inmost cases, Addison’s disease has an autoimmune etiology, but in some cases, it can be caused by infections, adrenal hemorrhage, and medications that disrupt the steroidogenesis pathway.
Purpose
The aim of this study was to review therapeutic outcomes of the medical treatment of patients with acromegaly based on real-world data from the Croatian Acromegaly Registry.
Methods
In this ...retrospective study we investigated 163 patients (101 female, 62 male, age at diagnosis 47.2 ± 13.4 years) treated between 1990 and 2020, of which 53 were treated medically (32.5%). The duration of follow-up was 115.8 ± 304.4 months. The remission rate after the pituitary surgery was achieved in 66.5% (
n
= 105/158; 5 patients refused surgery). Patients who did not achieve disease remission or had a relapse during follow-up (
n
= 2), underwent reoperation (
n
= 18/60, 30%) and/or radiotherapy (
n
= 33/60, 55%) and/or medical treatment (
n
= 53/60, 88.3%). One patient refused further treatment after the failure of the first pituitary surgery.
Results
Out of 53 patients treated with medical therapy, monotherapy was used in 34 (64.2%) and combination therapy in 19 (35.8%) patients. Remission (IGF-I < 1.2 upper limit of normal, ULN) was achieved in 51 patients (96.2%). Out of 53 patients, 21 (39.6%) were treated with first-generation somatostatin receptor ligand (SRL-1) monotherapy, 10 (18.9%) with dopamine agonist (DA) monotherapy, one (1.9%) with pegvisomant monotherapy, 13 (24.4%) with a combination of SRL-1 and DA, three (5.7%) with a combination of SRL-1, DA and pegvisomant, two (3.8%) with a combination of second-generation somatostatin receptor ligand (SRL-2), DA and pegvisomant and in one (1.9%) temozolomide was added on top of SRL-1 and DA. Two patients currently have active disease, both on SRL-1 monotherapy, of whom one is non-adherent to the treatment. Radiotherapy was applied to 27 (50.9%) patients on medical therapy.
Conclusion
Our results indicate that almost all patients with active acromegaly after pituitary surgery can achieve biochemical control with medical treatment.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Pituitary apoplexy is a clinical syndrome occurring as a consequence of fulminant expansion of pituitary tumor due to massive infarction, necrosis, and hemorrhage. Its association with head injury is ...rare and only few reports are available. Shear forces on stalk and arterial vasospasm have been proposed to be the possible reasons. The clinical picture is characterized by sudden onset headache, visual symptoms, multiple cranial nerves involvement, meningismus, altered mental status, and hormonal dysfunction. Transsphenoidal decompression is the standard treatment but suprasellar and widespread extension of hematoma may need intracranial approach. We are reporting a rare association of head injury with pituitary apoplexy, where endonasal surgery proved to be a simple useful approach to evacuate contiguous intra-cerebral hematoma with excision of apoplectic pituitary adenoma. PUBLICATION ABSTRACT
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Diabetes mellitus (DM) can lead to the development of macro- and microvascular complications. Homocysteine (Hcy) may play a role in the development of cardiovascular (CV) diseases (CVDs). The role of ...Hcy in the development of the vascular complications associated with DM is not clearly defined. Despite a strong initial assumption regarding the importance of Hcy in DM and its complications, over time “enthusiasm has waned” because several studies showed unconvincing and occasionally contradictory results. A universal conclusion is not easy to draw given the diversity of studies (e.g. number of patients, design, folic acid and vitamin B status, ethnic differences, genetic background). For some complications, most results encourages further investigation. Impaired renal function is a major independent determinant of high total Hcy (tHcy) levels. However, the role of hyperhomocysteinaemia (HHcy) in the development of diabetic kidney disease (DKD) has yet to be determined. Hcy-lowering therapies can significantly decrease Hcy levels but their effects on CVD risk reduction are conflicting. Further studies are needed to determine the influence of Hcy-lowering therapy on CVD risk reduction, especially in patients with DM.
•Homocysteine metabolism may be modulated by insulin and glucose.•The regulation of enzymes involved in homocysteine metabolism in diabetes is complex.•Homocysteine as a risk factor in diabetes requires reassessment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Inflammatory bowel diseases are a group of chronic inflammatory conditions that affect gastrointestinal tract due to inapt and continuous immune activation in response to a myriad of predisposing ...factors (most notably genetics, environmental impact and gut microbiota composition). It has been shown that vitamin D status can also play a role in the disease pathogenesis, as its deficiency is commonly observed in two major forms of inflammatory bowel diseases - Crohn's disease and ulcerative colitis. Mounting evidence supports the concept of intricate relationship between gut dysbiosis and vitamin D metabolism, while suboptimal levels of this vitamin have been linked to increased clinical disease relapse rates, inadequate response to drugs, as well as decreased quality of life in patients with Crohn's disease and ulcerative colitis. Consequently, the pertinent question is whether increased vitamin D supplementation and (on a population level) food fortification may bring significant benefit to the affected individuals. In this short review we discuss the synthesis, functions, status and food sources of vitamin D, appraise biotechnological facets of vitamin D status analysis and food fortification, and concentrate on novel developments in the field that describe its influence on intestinal microbiota and inflammatory bowel disease.
The aim was to determine which adult type 1 diabetic patient receiving multiple daily injection therapy is the most appropriate candidate for insulin pump therapy, while taking into consideration ...limited insulin pump affordability in Croatia. A total of 145 type 1 diabetic patients (52% diagnosed in adult age) were monitored at the Department of Endocrinology, Clinical Department of Internal Medicine, Zagreb University Hospital Center from 2009 to 2014. Twenty-one patients started insulin pump therapy in adulthood (seven men and 14 women, median age 27). Five patients had chronic complications (retinopathy in two, polyneuropathy in one, and both nephropathy and retinopathy in two patients). The median HbA1c at the initiation of pump therapy was 6.95% versus 6.5% after 1 year of pump therapy. Patients were stratified according to indications for insulin pump therapy (frequent and/or severe hypoglycemia, specific lifestyle, having not reached glycemic goals despite adherence/labile diabetes, and preconception). Patients could meet more than one criterion. Initially, the occurrence of hypoglycemia was analyzed by 6-day continuous glucose monitoring, while re-evaluation was done after collecting history data at 1 year ± 3 months. Initially, all patients had a median of 5 hypoglycemias/6 days (30% nocturnal) versus 1 hypoglycemia/6 days (without nocturnal) after 1 year. The Wilcoxon signed-rank test yielded a statistically significant difference in hypoglycemic events, nocturnal hypoglycemia and HbA1c. Patients commencing insulin pump therapy due to hypoglycemia initially had median HbA1c of 6.7% with 7 hypoglycemia/6 days (50% nocturnal). After one year, median HbA1c was 6% with 1 hypoglycemia/6 days (without nocturnal). In conclusion, the main indication for insulin pump therapy in adults is the frequency of hypoglycemia, especially nocturnal ones.
Osteoporotični prijelomi kuka i kralježaka povezani su s povećanjem mortaliteta od 10 do 20 % u žena i muškaraca. Mnoga su ispitivanja pokazala da je nizak BMD povezan s visokim rizikom prijeloma. ...Međutim, kako se veliki broj prijeloma događa kod osoba s T-scoreom boljim od –2,5, liječenje koje bi se temeljilo samo na BMD-u izostavilo bi mnoge bolesnike koji imaju visok rizik prijeloma i profitirali bi od liječenja. Stoga je evaluacija kliničkih čimbenika rizika prijeloma važna u odluci o liječenju. U kliničkom radu najčešće koristimo FRAX (engl. Fracture Risk Assessment Tool) kalkulator rizika za procjenu rizika prijeloma. Međutim, potrebno je uvijek uzeti u obzir ograničenja FRAX-a. Isto tako kliničari trebaju biti svjesni potencijalnih pogrešaka u snimanju i interpretaciji denzitometrijskog nalaza kako bi se izbjegle greške u dijagnosticiranju i praćenju bolesnika s osteoporozom. U dijagnosticiranju i odluci o terapiji također je potrebno uzeti u obzir dob i spol bolesnika te lijekove koji utječu na metabolizam kosti.
Osteoporozu karakteriziraju niska koštana masa, poremećaj mikroarhitekture kosti i fragilnost skeleta koji rezultiraju smanjenom jačinom kosti i povišenim rizikom prijeloma. Mjerenje koštane ...mineralne gustoće (BMD-a) korištenjem denzitometrije kosti standard je u dijagnostici osteoporoze. Denzitometrija je dobro dijagnostičko sredstvo, ali klinički čimbenici rizika također značajno utječu na rizik od prijeloma kod pojedinih bolesnika. Stoga se danas preporučuje da odluka o liječenju osteoporoze uključuje razmatranja o vjerojatnosti prijeloma. Rezultati BMD-a trebaju se kombinirati s ostalim kliničkim čimbenicima za rizik prijeloma kako bi se pravilno procijenio rizik te donijela odluka o terapiji. Osim denzitometrijom, klinička dijagnoza osteoporoze može se postaviti kod visokog rizika prijeloma procijenjenog prema FRAX-u (engl. Fracture Risk Assessment Tool) specifičnim za pojedinu zemljopisnu regiju/državu. Također, klinička dijagnoza osteoporoze može se postaviti kod prijeloma kuka, kralježaka, podlaktice, nadlaktice, rebara i zdjelice koji se javljaju spontano ili nakon minimalne traume, neovisno o BMD-u. Nakon što se postavi dijagnoza osteoporoze, potrebno je učiniti obradu radi isključenja sekundarnih uzroka osteoporoze.
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