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Izlaganje na skupu MICC 2022 na temu vrednovanja u znanosti i visokom obrazovanju s osvrtom za prosudbu kvalitete nastavnog procesa

Background: Chronic Graft-versus-Host disease (cGvHD) is the leading cause of late non- relapse morbidity and mortality following allogeneic hematopoietic stem cell transplantation (alloHSCT). Metabolic bone disease is frequently seen after alloHSCT and is related to vitamin D deficiency and to GvHD – especially corticosteroids therapy and gastrointestinal (GIT) involvement. Elevated parathyroid hormone levels (PTH>6 pmol/L) were noticed alongside vitamin D deficiency presumably causing excessive bone resorption. However, high PTH level could be also a marker of systemic inflammation in cGvHD. In this study we investigated an association of cGvHD and vitamin D with PTH levels among long-term alloHSCT survivors. Methods: Data were collected on a prospective cross-sectional study protocol in patients who underwent alloHSCT and were evaluated by the institutional multidisciplinary cGvHD team from 6/2013 to 11/2019. Laboratory tests and detailed history were obtained, and patients with cGvHD were evaluated according to NIH 2005 criteria. Exclusion criteria were active acute GvHD, and for non-cGvHD group of patients also ongoing immunosuppressive treatment. Results: Study population consisted of 89 alloHSCT survivors (46% female), median age 48 (11-72) years, median of 672 (77-9478) days after alloHSCT. 62 (69.7%) had cGvHD and were evaluated at median of 376 (0-8869) days after the diagnosis was established. Majority of cGvHD patients had severe (38.7%) or moderate (38.7%) NIH global score, 41.9% had active cGvHD by clinician impression, and 58.1% were receiving systemic immunosuppression (41.6% of them corticosteroids). Median number of organs involved by cGvHD was 3, and most frequently involved organs were skin (58.0%), eyes (53.2%), and mouth (51.6%). GIT was involved in 11.3% of the patients. There was significantly more patients with history of acute GvHD (p

Zadnjih desetak godina došlo je do značajnih promjena u zdravstvenom zbrinjavanju bolesnika s incidentalomima nadbubrežne žlijezde koje su rezultirale novim preporukama za dijagnostiku i liječenje ovih bolesnika napravljenim u suradnji Europskoga endokrinološkog društva i Europske mreže za istraživanje tumora nadbubrežne žlijezde. Na temelju navedenih preporuka i višegodišnjega vlastitog iskustva Referentni centar Ministarstva zdravstva Republike Hrvatske za bolesti nadbubrežne žlijezde predlaže izmjene i dopune preporuka za dijagnostiku i liječenje ovih bolesnika objavljenih u Liječničkom vjesniku 2010. godine., In the last decade, the clinical care of patients with adrenal incidentaloma has been significantly changed which prompted the European Society of Endocrinology and European Network for the Study of Adrenal Tumors to develop an updated clinical practice guideline for the management of these patients. In accordance with the aforementioned recommendations and based on its own experience, the Croatian Referral Center for adrenal gland disorders provides an update of the previous guideline for the clinical management of patients with adrenal incidentaloma published in Liječnički vjesnik in 2010.

Novi dijagnostički i terapijski pristup monogenskom dijabetesu (MODY) uključuje analizu genskih i biokemijskih biljega posebice mutacija u genima nuklearnih faktora HNF1A, HNF4A, HNF1B i glukokinaze GCK. Identifikacijom mutacija HNF1A- MODY, HNF4A- MODY, GCKY-MODY i HNF1B-MODY stratificiraju se ispitanici u dobro definirane podtipove dijabetesa MODY. Najčešće genske patogene varijante (HNF1A-MODY, HNF4A-MODY, HNF1B- MODY) vezane su uz disfunkciju beta stanica pankreasa i mikrovaskularne komplikacije (retinopatija, nefropatija, neuropatija), te kardio- cerebrovaskularne bolesti. Dob postavljanja dijagnoze je određena lokacijom patoloških mutacija u genu. Rijeđe mutacije otkrivene su u genima INS, INSR, PPARG, ABCC8, KCNJ11, LMNA, TRMT10A, WFS1, NEUROD1 i m.3243A>G. U osoba s MODY u zemljama s razvijenom preciznom medicinom provode se DNA analize sa svrhom individualizacije terapije niskom dozom sulfoniluree gdje je bitan genotip HNF1Ai HNF4A, te terapije inzulinom gdje važnu ulogu ima HNF1B. Kod bolesnika s GCK-MODY stabilna je funkcija beta stanica s blagom hiperglikemijom i terapija nije potrebna. Sekvenciranje gena omogućava dijagnozu sve većem broju pacijenata u Hrvatskoj u KBC-u Zagreb gdje se provodi molekularna dijagnostika prema međunarodnim smjernicama od 2017. godine, te se postavlja dijagnoza koristeći biokemijske pretrage (profil GUK-a, OGTT, C-peptid, inzulin, HbA1c, protutijela ICA, GAD, IA2) i genske biljege. Progresija ove autosomno dominantne bolesti je spora, dugo asiptomatska, a često se dijagnosticira u mlađih osoba s hiperglikemijom tijekom bolesti. Precizna klasifikacija dijabetesa i liječenja na temelju genotipa dio su precizne medicine u razvijenom svijetu. Translacijska istraživanja mutacija u pojedinim populacijama polučuju korisne spoznaje o pojavnosti bolesti, etiologiji, ranom otkrivanju i liječenju pojedinih podtipova dijabetesa, onemogućuje da slučajevi ostaju neprepoznati, te koriste za registar bolesnika. Precizna medicina podiže kvalitetu života pacijenata s monogenskim dijabetesom i smanjuje troškove liječenja.

Introduction: Insulinoma is a neuroendocrine tumor derived from pancreatic β cells. Studies of clinical characteristics and therapeutic outcome of insulinoma are relatively rare because of its infrequent prevalence. The aim of this survey was to present clinical characteristics of insulinoma and to determine the success rate of different diagnostic methods in localization of insulinoma. Subjects and methods: Using hospital database we analyzed clinical course of all patients with insulinoma (N=9) who were treated at the Clinical Hospital Center Zagreb from 2010 – 2015. Results: The study group comprised 9 patients (2 men) with average age of diagnosis 49 years (range 28 to 71 years). All of them were diagnosed with insulinoma by biochemical findings of endogenous hyperinsulinemia. Average size of the tumor was 1, 69 cm. Each patient underwent surgical treatment. Two of them have a distal pancreatosplenectomy done, while other seven patents underwent an enucleation of the insulinoma. Results of diagnostic methods comparison: Abdominal ultrasound was performed in two of eight of our patients (there was no data for one patient). In both cases the result was negative. Endoscopic ultrasound was performed in six of our patients. The localization of insulinoma was confirmed in two patients and four of them had negative result. Computer tomography (CT) was performed in eight of our patients. In five of them, insulinoma was localized successfully while in three patients the result was negative. Magnetic resonance (MR) was performed in four of our patients. In all four cases, the result was positive. Selective arterial calcium stimulation was performed in six of our patients. It was positive in all cases. Conclusion: Although limited by small sample size, our results suggest that MR is the most sensitive imaging procedure for the localization of insulinoma. In the case of negative MRI, more invasive test such as selective arterial calcium stimulation is the most appropriate test.

Accurate assessment of the hypothalamic–pituitary–adrenal (HPA) axis is important for the appropriate management of patients with pituitary tumours after transsphenoidal surgery. The aim of our study was to evaluate the clinical relevance of the early postoperative basal cortisol level in assessing postoperative HPA axis function. We performed a retrospective analysis of 68 patients (male:female=36:32, age 59.5 years, range 21–77) treated by transsphenoidal surgery between September 2011 and October 2014 at our centre of neuroendocrinology (44 nonfunctioning pituitary adenoma, 15 somatotrophinomas, five symptomatic Rathke’s cleft cysts bigger than 15 mm, three craniopharyngeomas, and one macroprolactinoma resistant to medical therapy). Patients with Cushing’s disease were excluded as well as patients with preoperative HPA insufficiency. Early postoperative basal cortisol levels (measured on the second postoperative day) and a Synacthen stimulation test (performed 10–12 weeks after the operation with a peak cortisol level of >550 nmol/l considered as normal response) were analyzed to assess HPA axis function during follow-up. We found that basal cortisol level of ≥249.5 nmol/l measured on the second day after the operation is a sensitive and accurate predictor of normal postoperative HPA axis function, with a sensitivity of 87.8%, and a specificity of 52.6%. Our data suggest that early postoperative cortisol level of ≥249.5 nmol/l predicts distant, normal postoperative HPA axis function following transsphenoidal surgery

Teriparatid je jedini odobreni osteoanabolik, a uz mineralnu gustoću kostiju, treba uzeti i ostale elemente čvrstoće kosti u obzir u dijagnostici i liječenju osteoporoze.

Višak hormona rasta u akromegaliji stimulira rast raznih tkiva, a budući da miociti posjeduju receptore za hormon rasta i IGF-1, njihov višak u akromegaliji dovodi do razvoja specifične akromegalijske kardiomiopatije. Prvi stupanj akromegalijske kardiomiopatije susreće se u mladih bolesnika s kratkim trajanjem bolesti, a karakterizira ga hiperkinetska lijeva klijetka, porast kontraktilnosti i minutnog volumena te smanjen periferni vaskularni otpor. Drugi stupanj obuhvaća koncentričnu ili ekscentričnu hipertrofiju lijeve klijetke, poremećaj dijastoličke funkcije u mirovanju te oslabljenu srčanu funkciju tijekom opterećenja. Ako ostane neliječena, akromegalija može dovesti do posljednjeg stadija kardiomiopatije: bolesti srčanih zalistaka te oslabljene sistoličke i dijastoličke funkcije s niskim minutnim volumenom i u mirovanju, što može uzrokovati kongestivno zatajivanje srca. Uz razvoj specifične kardiomiopatije, čimbenici rizika udruženi s akromegalijom poput arterijske hipertenzije, dislipoproteinemije, šećerne bolesti i periferne inzulinske rezistencije dovode do činjenice da je zahvaćenost kardiovaskularnog sustava među glavnim uzrocima povećanog morbiditeta i mortaliteta u akromegaliji.

CILJ: prikazati klinička obilježja i rezultate liječenja bolesnika s karcinomom kore nadbubrežne žlijezde (ACC). ISPITANICI: od 1.1.2005. do 1.9.2013. godine u našem je centru liječeno 18 bolesnika s ACC (5 M, 13 Ž, medijan 44 godine, raspon 17-74). Procjena stupnja proširenosti tumora napravljena je prema ENS@T (European Network Study of Adrenal Tumors) kriterijima, a svi bolesnici su uključeni u Europski registar bolesnika s ACC. Do siječnja 2011. godine svi bolesnici su nakon kirurške resekcije tumora adjuvantno liječeni mitotanom, a nakon toga samo oni koji su imali indeks Ki-67>10%. Od ožujka 2010. bolesnicima se određivala koncentracija mitotana u sklopu Lysosafe programa. Sveukupno je 14/18 bolesnika liječeno mitotanom, od toga 11 adjuvantno. Jedna bolesnica je uz mitotan primala i kemoterapiju (etopozid, doksorubicin, cisplatina). REZULTATI: u 13/18 bolesnika ACC je dijagnosticiran kao incidentalom nadbubrežne žlijezde, a u 5/18 zbog simptoma hipersekrecije hormona. Dvanaest bolesnika je imalo funkcionalni tumor s pojačanom sekrecijom jednog ili više hormona (androgeni=6, kortizol=4, 17-OHP=2, aldosteron=2, estradiol=1). Medijan veličine tumora bio je 92 mm (raspon 45-160 mm). Proširenost tumora u trenutku dijagnoze: stadij I= 1, stadij II= 9, stadij III= 6 i stadij IV= 2 bolesnika. U 17/18 bolesnika učinjena je R0 resekcija (11/18 otvoreni pristup ; 7/18 laparoskopski). Proliferacijski indeks Ki67 bio je >10% kod 11/18 bolesnika (medijan 16%, raspon 1–65%), visoki mitotski indeks (≥ 9/50HPF) imalo ih je 8/18, a medijan bodovanja po Weiss-u iznosio je 6 (raspon 3–8). Vrijeme proteklo između dijagnoze i operacije bilo je 40, 7±15, 8 dana, a od operacije do primjene mitotana 48, 8±27, 6 dana. Svi bolesnici uključeni u Lysosafe program postigli su ciljanu koncentraciju mitotana (>14 mg/L). Medijan vremena praćenja bio je 19 mjeseci (raspon 1-102). Dvije bolesnice su umrle ; jedna zbog proširene bolesti, kod druge uzrok smrti nije bio povezan s ACC. Kod jednog bolesnika učinjena je operacija lokalnog recidiva, a kod jedne bolesnice resekcija solitarne metastaze na plućima u dva navrata. Kod ostalih bolesnika nije došlo do progresije bolesti. ZAKLJUČAK: ACC je rijedak tumor koji je potrebno zbrinjavati isključivo u specijaliziranim centrima koji imaju veliko iskustvo u liječenju ove bolesti. Radikalna resekcija tumora uz primjenu mitotana kod bolesnika s visokim rizikom progresije bolesti temelj su uspješnog liječenja.

Uvod: Feokromocitomi se odlikuju visokim vrijednostima Hounsfieldovih jedinica (HJ) na nativnoj kompjutorskoj tomografiji (CT). Istraživanje je provedeno s ciljem ispitivanja prediktivne vrijednost CT-a u osoba s vrijednostima HJ10, od kojih je 13 bolesnika (18, 3%) imalo kirurški i histološki potvrđenu dijagnozu feokromocitoma. Zaključak: Biokemijski probir za feokromocitom nije potreban u bolesnika s incidentalomom nadbubrežne žlijezde i vrijednosti HJ

The working group of the Croatian Society of Endocrinology met in September 2011 to discuss the diagnostic and therapeutic dilemmas in patients with acromegaly. The group comprised 9 pituitary specialists including endocrinologists, neurosurgeons, and medical biochemistry specialist. After a critical analysis of published scientific papers the group has developed guidelines for the diagnosis and treatment of acromegaly.

Radna skupina Hrvatskoga endokrinološkog društva sastala se u rujnu 2011. godine radi rasprave o dijagnostičkim i terapijskim dilemama kod bolesnika s akromegalijom. U skupini je bilo 9 supspecijalista iz područja bolesti hipofize, uključujući endokrinologe, neurokirurge i specijalista medicinske biokemije. Nakon kritičke analize publiciranih znanstvenih radova skupina je donijela smjernice za dijagnostiku i liječenje akromegalije.

The aim of this study was to review the outcome of acromegaly treatment, as well as co-morbidity and mortality in a series of patients with acromegaly attending a single center in the last 10 yr. In that period, 53 patients were treated for acromegaly. Transsphenoidal operation was applied as the first-line therapy in 94.3% of patients and it led to disease remission in 59.2% of them. The remission criteria included a nadir GH

Cilj ovog istraživanja bio je ispitivanje mineralne gustoće kosti u bolesnika s prekomjernim lučenjem hormona rasta, te prospektivno praćenje vrijednosti biljega koštane pregradnje prije i nakon izlječenja bolesti. Dodatni cilj istraživanja bio je praćenje pridruženih bolesti i uspjeha liječenja tih bolesnika. U istraživanje je uključeno 53 bolesnika liječenih u Zavodu za endokrinologiju KBC Zagreb zbog prekomjernog lučenja hormona rasta uzrokovanog somatotropinomom u periodu od 2000. do 2010. godine. U cilju procjene mineralne gustoće i metabolizma kosti ispitanicima je učinjeno mjerenje mineralne gustoće kosti pomoću DXA (n=43 ispitanika) i kvantitativnog ultrazvuka petne kosti (n=36 ispitanika) te mjerenje biljega koštane pregradnje (osteokalcin, koštana alkalna fosfataza, β-crosslaps) prije početka liječenja (n=37 ispitanika) i 6 mjeseci nakon postizanja remisije bolesti (n=28 ispitanika). U bolesnika s akromegalijom su nađene statistički značajno više vrijednosti biljega koštane pregradnje nego u zdravih pojedinaca (osteokalcin: p=0,003; koštana alkalna fosfataza: p

Incidentalomi nadbubre`ne `lijezde jesu tumori otkriveni tijekom dijagnosti~ke evaluacije nekoga drugog klini~kog stanja. Tehnolo{; ; ki napredak radiolo{; ; kih ure|aja i njihova sve ve}; ; a upotreba u svakodnevnoj klini~koj praksi doveli su do ~e{; ; }; ; eg otkrivanja ovih tumora ~ine}; ; i njihovu dijagnostiku i lije~enje jednim od najva`nijih izazova moderne endokrinologije. Radi racionalnog pristupa ovim bolesnicima radna skupina koju su ~inili vode}; ; i hrvatski stru~njaci iz podru~ja bolesti nadbubre`ne `lijezde, na temelju relevantne znanstvene literature i postoje}; ; ih smjernica europskih i svjetskih dru{; ; tava, donijela je preporuke za dijagnostiku i lije~enje incidentaloma nadbubre`ne `lijezde.

Cilj ovog istraživanja bio je ispitivanje mineralne gustoće kosti u bolesnika s prekomjernim lučenjem hormona rasta, te prospektivno praćenje vrijednosti biljega koštane pregradnje prije i nakon izlječenja bolesti. Dodatni cilj istraživanja bio je praćenje pridruženih bolesti i uspjeha liječenja tih bolesnika. U istraživanje je uključeno 53 bolesnika liječenih u Zavodu za endokrinologiju KBC Zagreb zbog prekomjernog lučenja hormona rasta uzrokovanog somatotropinomom u periodu od 2000. do 2010. godine. U cilju procjene mineralne gustoće i metabolizma kosti ispitanicima je učinjeno mjerenje mineralne gustoće kosti pomoću DXA (n=43 ispitanika) i kvantitativnog ultrazvuka petne kosti (n=36 ispitanika) te mjerenje biljega koštane pregradnje (osteokalcin, koštana alkalna fosfataza, β-crosslaps) prije početka liječenja (n=37 ispitanika) i 6 mjeseci nakon postizanja remisije bolesti (n=28 ispitanika). U bolesnika s akromegalijom su nađene statistički značajno više vrijednosti biljega koštane pregradnje nego u zdravih pojedinaca (osteokalcin: p=0,003; koštana alkalna fosfataza: p, The aim of this study was to investigate the bone mineral density in patients with hypersecretion of growth hormone caused by somatotropinoma, as well as to measure the bone turnover markers before and 6 months after the treatment of disease. Additional purpose of the study was to detect the prevalence of comorbidities in patients with acromegaly and to evaluate the results of the acromegaly treatment. The study comprised 53 patients diagnosed and treated for acromegaly at Division of Endocrinology, University Hospital Centre Zagreb in the period from year 2000 to 2010. Analysis of bone mineral density was done by DXA (n=43 patients) and by quantitative ultrasound of the heel (n=36 patients). Bone turnover markers were analysed before the acromegaly treatment (n=37 patients) and six months after the disease remission achievement (n=28 patients). Bone turnover markers were significantly higher in patients with acromegaly than in the control group (osteocalcin, p=0,003; bone alkaline phosphatase, p

46-godišnja bolesnica je hospitalizirana sa slikom floridne hipertireoze (T3 6, 2 nmol/l T4 240 nmol/L TSH manji od 0, 05 mU/L), hipertenzijom (izmjeren RR 200/120 mmHg), tahikardijom (EKG sinus 129/min) i općim lošim stanjem. UZV-om vrata pokazala se difuzno promijenjena uvećana struma sa pozitivnim nalazom antitijela, klinički izraženom oftalmopatijom. Bolesnica navodi da je u zadnjih 3-4 mjeseca počela gubiti na težini, primijetila je tremor ruku i povremeno lupanje srca. Međutim, nekoliko dana prije prijema u bolnicu primijetila je povremeno kočenje donjih ekstremiteta, naočito nakon sna. Pri prijemu iz laboratorijskih nalaza dominira niska vrijednost kalija od 2, 4 mmol/L. Uz uvedenu nadoknadu kalija iv. (kalijev klorid), neselektivnog beta blokatora, peroralnog tireostatika te ostalu standardnu suprotivnu terapiju dolazi do povlačenja neuromuskularnih tegoba. Učinjen EMNG nakon provedene terapije nije pokazao osobitosti, a po smirivanju hipertireoze nije bila potrebna antihieprtenzivna terapija. Radi se o tireotoksičnoj periodičkoj paralizi, bolesti nepoznatog uzroka koja je karakterizirana progresivnom slabosti mišića praćene hipokalijemijom u hipertireozi. Mogući uzrok je unutarstanični pomak kalija nastao povećanom osjetljivošću Na+/K+–ATP-aze stanične membrane koja je inače stimulirana inzulinom i beta adrenegičkom stimulacijom. U stanjima viška hormona štitnjače povećana je osjetljivost na adrenergički stimulus čime se objašnjava hipokalijemija. Bolest se najčešće javlja u mladih muškaraca orijentalnog porijekla. Ovo je drugi dosada opisani slučaju tireotoksične periodične paralize u Hrvatskoj, prvi puta dijagnosticirane u 24-godišnjeg muškarca (J. Morović-Vergles i sur: Tireotoksična periodična paraliza: prikaz slučaja. Acta clin Croat 2002). U našem slučaju rijetka bolesti javila se u etničkom okruženju kod kojeg se njena pojava ne očekuje, ali i u spolu koji nije tipičan za navedenu bolest

Prikaz bolesnice s inzulinomom

The majority of adrenal incidentalomas (AI), adrenal masses discovered incidentally during diagnostic investigation of non-adrenal disorders, are benign and non-functional. Interestingly, no studies with ambulatory blood pressure monitoring (ABPM) in patients with AI have been published so far. In this case-control study, we analyzed ABPM data of 57 patients with AI (12 men, 45 women) and 103 patients with essential hypertension (EH) (60 men, 63 women). ABPM was performed using a SpaceLabs 90207 device. Classification and interpretation of ABPM data were done according to the ESH/ECS guidelines. Average daytime values were higher in the EH than in the AI group (136 ± 9/87 ± 10 vs. 133 ± 21/80 ± 15), as well as blood pressure load (BPL) for systolic and diastolic BP (46.5 ± 30.6 vs. 37.9 ± 30.2 ; 41.6 ± 32.0 vs. 26.4 ± 31.4 mmHg, respectively). On the contrary, average nighttime values were higher in the AI than in the EH group (125 ± 21/73 ± 14 vs. 119 ± 13/71 ± 11). There were no differences in nighttime BPL between EH and AI. In the AI group, BPL was higher during nighttime than during daytime for both systolic and diastolic BP (47.0 ± 32.3 vs. 37.9 ± 30.2 ; 29.6 ± 31.0 vs. 26.4 ± 31.4, respectively). No differences in BP variability were observed between EH study suggest that further investigations are needed before any final conclusion could be made.

The majority of adrenal incidentalomas (AI), adrenal masses discovered incidentally during diagnostic investigation of non-adrenal disorders, are benign and non-functional. However, not so many studies on clinical characteristics of patients with AI have been published so far, and our aim was to analyze data in our group of patients. In this case-control study, we analyzed the clinical characteristics of 57 patients with AI (12 males, 45 females) and compared to data of 103 patients with essential hypertension (EH) (60 males, 63 females) referred to our hospital. All patients underwent clinical examination, blood pressure (BP) measurements, and hormonal testing. Imaging techniques were performed as well. Patients were not taking antihypertensive drugs during the examination.

Increased arterial stiffness has been shown to predict cardiovascular mortality. Recently, ambulatory arterial stiffness index was proposed as a new method.

Background: Due to chronic GH and IGF-I excess, a specific cardiomyopathy associated with ventricular hypertrophy and diastolic dysfunction develops in patients with acromegaly. The first stage of acromegalic cardiomyopathy is characterized by a visually hyperkinetic left ventricle (LV) but normal ejection fraction (EF) and may be difficult to discern from LV remodelling taking place in arterial hypertension. We sought to analyze the potential difference in LV contractility among these two patient groups with a similar grade of hypertrophic remodelling. Methods: 37 patients with acromegaly (50.1 ± 10.5 years, 20 female/17 male) and normal EF were compared to 15 patients with arterial hypertension (52.7±16.6 years, 7 female/8 male, normal EF). 32 healthy sex- and age matched volunteers served as a control group. Patients in all three groups underwent a complete echocardiographic exam. LV mass was calculated and indexed by body surface area to obtain the LV mass index (LVMI). The outflow velocity time integral (VTI) and ejection time (ET) were measured from PW Doppler traces of left ventricular outflow. ET was indexed by heart cycle duration (R-R) to obtain the relative ET duration (ET/R-R). Aortic root size (Ao), LV stroke volume (SV) and cardiac output (CO) were calculated as previously described. Results: Acromegaly: mean disease duration was 6.5±6.0 years, LVMI=95±24 g/m², SV = 158±60 mL, Ao = 3.4±0.5 cm, ET/R-R = 0.33±0.03 s. A correlation was found between LVMI and ET/R-R (R=0.34 ; p=0.07) and LVMI and VTI (R=0.58 ; p= 0.002). Hypertension group: LVMI=93±13 g/m², SV = 87±16 mL, Ao = 3.1±0.2 cm, ET/R-R = 0.36±0.03 s. Control group: LVMI = 77±12 g/m², SV = 84±20 mL, Ao = 2.8±0.4 cm. ET/R-R = 0.34±0.04 s. No correlation between LVMI and ET/R-R nor LVMI and VTI was found in the hypertensive or control group. Conclusion: A comparable degree of LVH was found in acromegaly and the hypertensive group, both significantly higher compared to normals. Unlike in hypertension, in the acromegalic hearts this was associated with an increase in outflow together with a shorter relative ejection time suggesting the presence of increased contractility. Additionally, the aortic diameter was increased both in acromegaly and hypertension, although significantly higher in acromegaly. Thus, unlike hypertensive heart disease, acromegalic heart disease at an early stage is associated with a hypertrophic and hypercontractile LV without an additional increase in afterload, leading to a higher grade of aortic dilatation.

Idiopathic osteoporosis in males is influenced predominantly by low peak bone mass as a feature under a strong genetic control. Among a number of candidate genes, a-estrogen receptor (ERa) and CYP19 genes are of particular interest due to important role of estrogen in pathophysiology of osteoporosis. In the present study we examined the association of certain allelic combinations of ERa gene thymine– adenine (TA) polymorphism and aromatase gene TTTA polymorphism on bone mineral density (BMD) in young men. The study sample consisted of 92 unrelated healthy male volunteers, aged 21– 35. In each subject, lumbar spine and proximal femur BMD, parameters of bone turnover and 25-OHD level were measured. Two ERa (TA)n alleles, allele 19 and allele 21, were found to be associated with lower BMD. The presence of allele 19 was associated with significantly lower lumbar spine (P = 0.006) and trochanter (P = 0.02) BMD while the subjects positive for allele 21 had significantly lower lumbar spine (P = 0.04), trochanter (P = 0.02) and total hip (P = 0.03) BMD. Men with CYP19 (TTTA)7-3/Era (TA)19 allele combination had significantly lower lumbar spine BMD (P = 0.02) and those with CYP19 (TTTA)7-3/ ERa (TA)21 allele combination had significantly lower BMD for all three measurements, i.e. lumbar spine (P = 0.02), femoral neck (P = 0.02) and total hip (P = 0.008). These particular combinations of high-risk alleles were associated with lower median lumbar spine, femoral neck and total hip BMD than either of the allele alone suggesting that negative effect of two risk alleles on peak bone mass add up.

Hypercoagulability is a commonly described complication in patients with Cushing's syndrome. Recent clinical studies have indicated various abnormalities of coagulation and fibrinolysis parameters which may be related to that phenomenon. The aim of this study was to investigate the mechanisms underlying the hypercoagulable state in patients with Cushing's syndrome. Research methods and procedures A wide range of serum markers involved in the processes of blood coagulation and fibrinolysis was measured in a group of 33 patients with Cushing's syndrome and 31 healthy controls. No participant was taking medication which could influence the result or had known diseases, except hypertension and diabetes, which could affect blood coagulation or fibrinolysis parameters. Results Patients with Cushing's syndrome had higher levels of clotting factors II (P = 0.003), V (P < 0.001), VIII (P < 0.001), IX (P < 0.001), XI (P < 0.001) and XII (P = 0.019), protein C (P < 0.001), protein S (P < 0.001), C1-inhibitor (P < 0.001) and plasminogen activator inhibitor-1 (PAI-1) (P = 0.004). The activity of fibrinolytic markers, plasminogen (P < 0.001), antithrombin (P < 0.001) and antithrombin antigen (P = 0.001) was also increased in the patient group. Conclusion The study has demonstrated hypercoagulability in patients with Cushing's syndrome manifest as increased prothrombotic activity and compensatory activation of the fibrinolytic system. We propose the introduction of thromboprophylaxis in the preoperative and early postoperative periods, combined with a close follow-up in order to prevent possible thromboembolic events in patients with Cushing's syndrome.

Debljina je kronična bolest povezana s povećanim rizikom duboke venske tromboze i kardiovaskularne bolesti. Poremećaji sustava zgrušavanja i fibrinolize mogu povećati rizik oba incidenta. U debelih osoba poznati su neki poremećaji sustava zgrušavanja i fibrinolize, ali još uvijek nije jasan cijeli patogenetski mehanizam koji u debelih osoba vodi k nastanku ovih komplikacija. Cilj našeg ispitivanja bio je ispitati povezanost indeksa tjelesne mase (BMI) s razinom čimbenika zgušavanja u plazmi (PV, APTV, fibrinogen, antitrombin, antitrombin AG, F II, F V, F VII, F VIII, F IX, F XI, F XII, protein C, protein S koag., C1 inhibitor, PAI, Tr. V, plazminogen) kod zdravih ispitanika. Ispitivanje smo proveli u 31 ispitanika (12 muškaraca i 19 žena) prosječne dobi 48, 7 &plusmn ; 14, 1 godina. Ispitanici su podijeljeni u tri kategorije ovisno o BMI-u (30 kg/m2) te su između kategorija za muškarce i žene uspoređeni čimbenici zgrušavanja u plazmi. Razlike čimbenika zgrušavanja između kategorija ovisnih o BMI-u analizirali smo testom za analizu varijance (ANOVA), s korištenjem Games-Howell post-hoc testa, zbog nejednake veličine uzorka. Rezultati su pokazali statistički značajnu povezanost BMI, F5 i plazminogena kod žena te agregacije trombocita s ADP-om, F5 i plazminogena u muškaraca. Rezultati ovog ispitivanja upućuju na mogući utjecaj BMI na faktore zgrušavnja. Potrebna su daljnja ispitivanja na većem broju ispitanika da bi se moglo razlučiti je li ovaj utjecaj spolno i dobno specifičan.

Debljina je povezana s povećanim rizikom malignih bolesti. Rjeđe je ispitivan utjecaj na razvoj benignih tumora i endokrinih tumora. Nađena je povezanost debljine i adenoma kolona, fibroma kože i uterusa, lejomioma uterusa. Cilj našeg ispitivanja bio je ustanoviti postoji li povezanost indeksa tjelesne mase (BMI) i veličine slučajno nađenih tumora kore nadbubrežnih žlijezda (incidentaloma). U istraživanje su uključena 23 bolesnika (10 muškaraca, 13 žena). Prosječna dob bolesnika iznosila je 59, 9 + 10, 3 godina. Podaci su statistički obrađeni Mann-Whitney i t-testom, ovisno o raspodjeli podataka. U korelaciji BMI-a i veličine incidentaloma korišten je Pearsonov test. Nije nađena korelacija BMI i veličine incidentaloma nadbubrežnih žlijezda. Usporedbom BMI-a, opsega struka, bokova, omjera struk-bokovi, leptina i adiponektina i veličine incidentaloma nije nađena povezanost. Potrebna su daljnja ispitivanja u cilju razjašnjenja spolne i dobne specifičnosti ovog odnosa i boljeg upoznavanja patogenetskog mehanizma.

Cilj rada bio je odrediti postoji li povezanost između indeksa tjelesne mase i veličine slučajno nađenih tumora nadbubrežne žlijezde - incidentaloma. Nije nađena povezanost tih dviju varijabli.

70-yr-old women was referred to our department because of osteoporosis. She was previously followed by a hematologist for 1 year because of unexplained erythrocytosis with normal platelt and leukocyte count. Endocrinological evaluation showed preserved circadian rhythm of cortisol secretion, and the reverse rhythm of ACTH, with slightly elevated 24-h urinary free cortisol level. The overnight dexamethason suppression test showed inadequate cortisol suppression. MR disclosed a pituitary tumor. Transsphenoid tumor ablation was carried out. Pathohistology and immunohystochemistry revealed corticotropinoma. Six month after operation patient had erythrocytes count within normal limits.

Cilj istraživanja bio je odrediti referentne vrijednosti parametara kvantitativnog ultrazvuka petne kosti i na osnovi njih procijeniti učestalost osteoporoze u muškaraca u Hrvatskoj. U istraživanje su, u sedam istraživačkih centara (Zagreb, Ivanić Grad, Koprivnica, Šibenik, Pula, Slavonski Brod, Vukovar), uključena 1002 muškarca, dobi od 20 do 99 godina. Svim ispitanicima izmjerena je petna kost uređajem Sahara, a određivani su brzina ultrazvučnog vala (SOS), slabljenje ultrazvučnog vala pri prolasku kroz kost (BUA) i indeks kvantitativnog ultrazvuka (QUI). Vrijednosti svih parametara kvantitativnog ultrazvuka značajno su se smanjivale s dobi (p

Heart involvement in acromegaly is mostly recognized by the presence of LV hypertrophy (LVH), often accompanied by diastolic dysfunction (DD). Although it is known that patients (pts) with active disease have more pronounced LVH than pts in remission, the impact of pituitary adenoma size might also be important. We sought to analyze the degree of LVH and DD in acromegaly with regard to adenoma size. The diagnosis of acromegaly was based on clinical characteristics, failure to suppress serum GH level below 1 µ g/L after a glucose tolerance test and a high serum IGF1 level. 32 pts with acromegaly (49± 11 years) and normal systolic function were distributed in 2 groups by adenoma size (measured from MRI images of the hypothalamo-pituitary region). MACRO: 11 pts with macroadenoma (>10 mm in diameter) ; MICRO: 21 pts with microadenoma (