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Somatostatin is a hormone with broad spectrum of physiological effects. Somatostatin and its analogues are employed in the diagnosis and treatment of various clinical conditions. The article reviews the use of somatostatine and somatostatine analogues in the clinical medicine. It also comprises the overview of the basic therapeutical and diagnostic indications for somatostatine and its analogues and the theoretical basis of their use.

The technologic advancement of imaging techniques especially computed tomography (CT) and magnetic resonance (MRI) is associated with an increasing number of incidentally discovered sellar masses. The endocrinologists are facing the problem to distinguish between benign and clinically often insignificant non-functioning pituitary adenomas (pituitary incidentalomas) and other pituitary or sellar and parasellar masses, which require further therapy. This paper gives an overview about different types of pituitary or sellar and parasellar masses, their aetiology and basic symptoms arising from either endocrine disturbances or as a result of mass effect of an enlarging tissue. Further, the paper shortly characterises most common pituitary and non-pituitary sellar masses that are necessary to distinguish. Finally, the basic diagnostic approach to the patients with sellar and parasellar masses is described.

Background: The system of IGF-I and its binding proteins is a complex system with many physiological functions including metabolic regulations. Present study was aimed to describe changes of its particular components in patients with type 1 and type 2 diabetic patients and patients with obesity., Methods and Results: We examined 21 patients with obesity, 13 patients with type 2 and 22 with type 1 diabetes in comparison with 16 age matched healthy controls. We performed clinical examination and estimation of serum concentrations of IGF-I, free-IGF-I, IGFBP-1, -2, -3 and -6, insulin, C-peptide and fasting glucose. Patients with obesity featured by decreased IGF-I (p < 0.05), free-IGF-I (p < 0.05), IGFBP-1 (p < 0.01) and IGFBP-3 (p < 0.05) serum levels. Type 2 diabetes were associated with a decline of IGF-I (p < 0.05) and IGFBP-2 (p < 0.05) serum levels. Type 1 diabetes was characterised by typical decrease in IGF-I (p < 0.05), free-IGF-I (p < 0.01) and IGFBP-3 (p < 0.01) serum levels as well as by increase in IGFBP-1 (p < 0.01) serum levels. Type 2 diabetic patients had lover IGFBP-2 and higher IGFBP-1 and IGFBP-6 levels than obese subjects., Conclusions: The study showed a changes in the system of IGF-1 and its binding proteins associated with studied metabolic diseases that confirm active participations of this system in carbohydrate metabolism regulation.

Background: The role of IGF-I/IGFBP's system in the pathogenesis of diabetic vascular complications is widely discussed in the literature. We studied the influence of this system on microvasculature in patients with type 1 diabetes with respect to the effect of IGFBP-1., Methods and Results: 17 patients with type 1 diabetes were included in the study. We examined IGF-I, IGFBP-1 and IGFBP-3 serum levels, parameters of compensation of diabetes and basic values of lipid metabolism. The function of microvasculature was examined using the laser-Doppler system Periflux. We didn't found any relation between the total IGF-I serum levels, parameters of lipid metabolism or level of diabetes compensation and the degree of impairment of the function of microcirculation. IGFBP-1 serum levels positively correlated with the peak perfusion in thermal hyperaemia (r = 0.39; p < 0.03). IGFBP-3 serum levels did not affect the function of microcirculation., Conclusion: We can conclude that the activity of IGF-I/IGFBP's system belongs to factors contributing to the development of diabetic microangiopathy in type 1 diabetes. IGFBP-1 as the modulator of IGF-I activity plays probably protective role against the progression of microangiopathy. These results correspond with observations of some other authors.

Background: The aim of the treatment of acromegaly is to normalise the hormonal activity. Besides the surgical and radiation treatment, medical therapy can be used. The project was set to determine the value of combined therapy with lanreotide and terguride in patients with active acromegaly., Methods and Results: Nine patients previously treated with lanreotide for at least one year without normalisation of hormonal activity were included in the study. Terguride was added to lanreotide for one month. The combined treatment brought about reduction of growth hormone (GH) levels, however, with marginal significance only. GH-BP, IGF-I and IGFBP-3 serum levels were not changed significantly. Considering the individual cases, the combined treatment resulted in normalisation of GH levels in one patient and that of IGF-I in another one. Substantial decrease of GH levels (> 50%) was found in three patients and that of IGF-I (> 20%) in another one patient., Conclusions: The combined treatment of acromegaly appears to be more effective than monotherapy with lanreotide only in a subset of acromegalic patients.

Background: Osteoporosis is one of the most serious consequences of Cushing's syndrome. Only a small number of longitudinal observations on bone mineral density (BMD) in patients with treated Cushing's syndrome have been reported so far. To evaluate changes in bone mass in patients with Cushing's syndrome after surgical cure of the disease, BMD was evaluated cross-sectionally., Methods and Results: BMD (DPX-L, Lunar) was measured in the lumbar spine and femoral neck (i.e. in skeletal areas with high proportion of trabecular and cortical bone, respectively) in 72 patients after successful surgical cure of Cushing's syndrome (8 men, 34 women before menopause and 30 women after menopause who were not on hormone replacement therapy). No other drug's interfering with skeletal metabolism were used. The reference group consisted of young healthy Czech women and/or men. The mean lumbar spine and femoral neck BMD increased to normal values within 3 and 5 years after surgery, respectively. In women after menopause, however, the significant positive relationship between BMD and time after surgery was negatively influenced by time after menopause. It is likely that several other factors contributed to the increase in bone mass in the patients (cure of hypercortisolism, recovery from hypogonadism and restoration of muscle strength)., Conclusions: After surgical cure of Cushing's syndrome in premenopausal women and in men, BMD rapidly and substantially increases. The recovery is negatively affected by estrogen deficiency in postmenopause.

Background: Differential diagnosis of the etiology of ACTH-dependent hypercortisolism is very difficult in some cases. The uncertainty, whether there is a central or ectopic etiology, is also strengthened by the fact that even nuclear magnetic resonance (MR) sometimes does not prove the pituitary adenoma. A more precise differential diagnosis under these conditions has been made, over the last years, by selective determination of ACTH levels bilaterally in sinus petrosi inferiores (SPI) and by their comparison with the level in peripheral blood. The confirmation of central etiology makes a decision about neurosurgical intervention easier. This intervention, due to the present microsurgery technique, makes it possible to detect otherwise undetectable microadenoma and enables its selective excision with maintaining healthy hypophysis tissue and all its functions., Methods and Results: In the last two years the authors indicated 11 patients (10 women, one man at the age of 17-54 years, mean age 33.5 year) with proved ACTH-dependent hypercortisolism to the determination of ACTH in SPI. Their CT or NMR examination did not prove a hypophysis tumour unequivocally. Only in one female patient the catheterization was not possible for anomalous vascular bed with aplasia of internal jugular vein on the left and hypoplasia of internal jugular vein on the right. In 8 patients the determination of the ratio of ACTH levels between SPI and periphery (7.78 +/- 1.54, mean +/- S.E.) has shown that even the basal levels indicated central etiology of hypercortisolism. This has been confirmed by the ratio of the values of ACTH after stimulation with corticotrophin releasing hormone (CRH). The diagnosis was confirmed in all patients by surgery, by histology and post-operation course. In two female patients the ratio of basal levels of ACTH, SPI/periphery did not prove useful for the diagnosis of the Cushing's disease. In the first patient the CRH stimulation was not yet performed routinely and the ratio of basal levels of ACTH, SPI/periphery gave a false negative result, as shown by the finding of adenoma of hypophysis during the operation. The operation was indicated on the basis of hormonal examinations and repeated MR with a finding of suspected microadenoma and the diagnosis was then confirmed by further clinical development. The determination of the levels of ACTH after CRH stimulation would give more precision in this case, as shown by analysis of the results of large cohorts in literature, which we perform at present as well. In the other patient the CRH stimulation test was done, changing the ratio from 1.1 to 5.7 and thus confirmed central etiology of the Cushing's syndrome. In agreement with literature this method did not contribute to lateral localization of the tumour., Conclusions: The determination of basal levels of ACTH in SPI and levels after CRH stimulation enables to differentiate between central and ectopic overproduction of ACTH in the ACTH-dependent Cushing's syndrome.