Search

SARS-CoV2 infection can lead to severe cytokine storm especially in obese patients. Ghrelin acts not only as an appetite regulator but can also play a key role in the immune reaction. Leptin, secreted mainly by the white adipose tissue, can act as a pro-inflammatory cytokine. The crucial question is whether or not the cytokine storm in COVID-19 patients with obesity is linked to adipokine dysregulation. The aim of this study was to assess ghrelin and leptin concentrations in patients 6 months after SARS-CoV2 infection in comparison to a control group considering the influence of sex. The study group included 53 patients with a history of COVID-19 and 87 healthy subjects in the control group. Leptin and ghrelin concentrations as well as hormonal and biochemical parameters were measured. A significantly higher ghrelin concentration was observed in the COVID-19 group in comparison to the control group, with a statistically significant impact of sex on the relationship between COVID-19 and ghrelin concentration, which was lower in the males. No statistically significant differences in leptin concentration were observed between the groups. A significant negative correlation was observed between ghrelin and testosterone and morning cortisol levels in the COVID-19 group. The current study showed that ghrelin levels were significantly higher in patients 6 months after a mild course of SARS-CoV2 infection. To confirm the hypothetical protective role of ghrelin in the inflammatory process, it would be necessary to compare serum ghrelin levels between patients after mild and severe courses of COVID-19. Due to the small sample size and the lack of patients with a severe course of COVID-19, these observations need further investigation. There were no differences in leptin concentrations between the COVID-19 patients and the control group.

Streszczenie Badanie i poznawanie skomplikowanych mechanizmów molekularnych i immunologicznych procesów nowotworowych umożliwia wprowadzanie nowych terapii przeciwnowotworowych. W leczeniu chorych na nowotwory coraz częściej stosuje się terapie celowane molekularnie inhibitorami kinaz tyrozynowych i inhibitorami mTOR oraz immunoterapię z użyciem inhibitorów punktów kontrolnych CTLA-4 (cytotoxic T-cell antigen-4) i PD-1/PD-L1 (programmed death receptor 1/programmed death ligand 1). Nowe leki przeciwnowotworowe zajmują miejsce konwencjonalnej chemioterapii i znalazły już zastosowanie w zwalczaniu wielu nowotworów m.in. raka tarczycy, wątrobowokomórkowego, niedrobnokomórkowego raka płuca, nerki, pęcherza moczowego, czerniaka, raka piersi, ostrej i przewlekłej białaczki szpikowej. Stosowanie tych leków jest mniej toksyczne od klasycznej chemioterapii, ale może wywoływać działania niepożądane ze strony układu pokarmowego, sercowo-naczyniowego, oddechowego, skóry, a także powikłania endokrynologiczne. Większość działań niepożądanych nowych terapii przeciwnowotworowych to zaburzenia łagodne i umiarkowane, ale zdarzają się również ciężkie i zagrażające życiu. Endokrynopatie są jednymi z częstszych działań niepożądanych omawianych metod leczenia. Mogą dotyczyć wielu gruczołów wydzielania wewnętrznego (przysadka, tarczyca, przytarczyce, nadnercza, trzustka) i wywoływać zarówno przemijające jak i trwałe zaburzenia. W artykule wykorzystano informacje z bazy PubMedu o endokrynologicznych powikłaniach nowych terapii przeciwnowotworowych.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in developed countries. This condition includes benign non-alcoholic fatty liver disease and non-alcoholic steatohepatitis with possible fibrosis leading to cirrhosis and hepatocellular carcinoma. Association of NAFLD and polycystic ovary syndrome (PCOS) has been widely discussed. Women with PCOS are prone to develop NAFLD more often. PCOS is one of the most common endocrine disorders among reproductive-age women, characterized by an excess of androgens, anovulation, and polycystic ovary on ultrasound. Obesity, dyslipidemia and insulin resistance (IR) are frequently observed in women with PCOS, being also important factors predisposing to the development of NAFLD. IR may stimulate theca cells to excessive production of androgens, inhibits the production of sex hormone-binding globulin in the liver, which contributes to the increase of the bioactive form of testosterone. Hyperandrogenemia also plays an important role in NAFLD pathogenesis and progression. Androgen excess promotes visceral fat accumulation, development of dyslipidemia, IR, and contributes to low-grade inflammation. The pathophysiological associations between PCOS and NAFLD are not fully understood although it seems reasonable to screen PCOS women for the presence of NAFLD.

Background/aim Morphological features, combined with Ki-67 proliferative index, remain the standard for discriminating benign and malignant adrenocortical tumors. The aim of this study was to evaluate the role of minichromosome maintenance proteins MCM-3, MCM-5, MCM-7, and Ki-67 as proliferative markers in adrenocortical tumors. Materials and methods Specimens of 81 adrenocortical adenomas and 3 adrenocortical carcinomas were stained with antibodies against MCM-3, 5, 7 and Ki-67. Results Malignant tumors were characterized by a greater size (p=0.017), volume (p=0.017), and higher levels of Ki-67 (p=0.005), MCM-3 (p=0.005), MCM-7 (p=0.008), but not MCM-5 (p=0.069). The markers' levels were independent from the tumors' size and volume, the patient's age and hormonal status. ROC curves showed Ki-67 (AUC 0.984), MCM-3 (AUC 0.984), and MCM-7 (AUC 0.950), but not MCM-5 (AUC 0.820) to be reliable markers. Conclusion Ki-67, MCM-3, and MCM-7, but not MCM-5 are reliable proliferative and diagnostic markers in discerning benign and malignant adrenocortical tumors.

IntroductionPatients are qualified for an adrenalectomy due to endocrine or oncologic reasons. Final histopathological diagnoses include a wide spectrum of more than a dozen entities. The aim of this study was to compare preoperative and postoperative diagnoses of patients undergoing adrenalectomy to determine the level of diagnostic accuracy, as well as sex and age of patients.Material and methodsA group of 214 patients (230 specimens in total) operated on in a single center was studied and their demographic and pathological data were investigated.ResultsThe majority of diagnoses were characterized by both high positive predictive value and sensitivity, excluding pheochromocytoma (60.0% and 67.7%, respectively) and adrenal cyst (100% and 37.5%, respectively). Patients operated on due to Cushing’s syndrome were statistically significantly more often females (p = 0.009), while those with metastases (diagnosed both pre- and postoperatively) were more often males (both p = 0.001). Patients qualified due to non-functioning tumors were older than those with Cushing’s or Conn’s syndrome (p = 0.044 and p = 0.002, respectively).ConclusionsThe lowest diagnostic accuracy is observed in cases of pheochromocytoma and adrenal cyst. Meticulous preparation of the patient for hormonal tests, including discontinuation of certain medications, is essential for obtaining accurate results. The diagnosis of Cushing’s syndrome is more prevalent in females, while metastasis syndrome is more prevalent in males. Adrenocortical carcinoma may initially be diagnosed as a non-functioning tumor (1.6% of such cases) or a recurrence of a previously resected tumor, which should always raise a suspicion of a malignant neoplasm.

Wstep: Szerokie zastosowanie badan obrazowych klatki piersiowej i jamy brzusznej skutkuje coraz czestszym przypadkowym rozpoznawaniem zmian w nadnerczach. Cel: Celem pracy byla analiza dostepnej wiedzy dotyczącej postepowania w incydentaloma nadnerczy u doroslych w celu przygotowania praktycznych zalecen. Sposob przygotowania: Grupa robocza stworzona z ekspertow zgromadzonych w Polskim Towarzystwie Endokrynologicznym przeanalizowala jakośc dostepnych danych i po dyskusji podsumowala wyniki analizy w postaci przygotowanych zalecen. Ocena obrazowa i hormonalna: Jednofazowa tomografia komputerowa (CT) nadnerczy moze byc zalecana jako badanie w początkowej ocenie zmiany pozwalające odroznic gruczolaki od innych zmian nie bedących gruczolakami („nie-gruczolaki”). W przypadku gestości zmiany g 10 jednostek Hounsfielda zaleca sie wykonanie badania CT z oceną wyplukiwania środka cieniującego lub rezonansu magneproftycznego. U wszystkich chorych z incydentaloma nadnerczy, niezaleznie od obrazu klinicznego oraz chorob wspolistniejących, zaleca sie ocene hormonalną w kierunku guza chromochlonnego oraz hiperkortyzolemii. Badania w kierunku pierwotnego hiperaldosteronizmu są wskazane u pacjentow z rozpoznanym nadciśnieniem tetniczym lub hipokaliemią. Leczenie: Leczenie operacyjne powinno byc zastosowane u chorych z incydentaloma nadnercza o charakterystyce obrazowej mogącej odpowiadac nowotworom zlośliwym (wskazania onkologiczne) lub potwierdzonej czynności hormonalnej (wskazania endokrynologiczne). Podstawową metodą leczenia operacyjnego jest laparoskopowa adrenalektomia. Pacjenci z podejrzeniem guza chromochlonnego bezwzglednie wymagają przygotowania farmakologicznego do operacji. U chorych niezakwalifikowanych do operacji, badania kontrolne (obrazowe i laboratoryjne), nalezy ustalac indywidualnie, biorąc pod uwage, miedzy innymi wielkośc, obraz i dynamike wzrostu guza, objawy kliniczne, wyniki badan hormonalnych oraz choroby wspolistniejące. (Endokrynol Pol 2016; 67 (2): 234–258)

Introduction: Statins belong to the most commonly used medicines worldwide. They affect cholesterol synthesis and thus they may suppress steroidogenesis. Our aim was to evaluate whether the use of statins is associated with the concentration of sex hormones. Material and methods/Results: In a population sample of men (n = 237) we found that subjects receiving statins had significantly lower concentrations of: total testosterone (14.9 vs. 16.35 nmol/L, p = 0.008 after correction for body mass), free testosterone (32 vs. 39 pmol/L, p = 0.004), calculated free testosterone (0.32 vs. 0.36 nmol/L, p < 0.001) and bioavailable testosterone (6.10 vs. 7.56 nmol/L, p < 0.001) than age-matched controls. Conclusions: We conclude that the use of statins may have an impact on the diagnosis of age-related testosterone deficiency in men. (Endokrynol Pol 2014; 65 (6): 464–468)

Wstep: Osoby z zespolem metabolicznej otylości z prawidlową masa ciala (MONW), mimo prawidlowego wskaźnika masy ciala (BMI), są narazone na powiklania typowe dla otylości. Moze to wynikac z subklinicznego stanu zapalnego, wynikającego z nadmiernego gromadzenia tkanki tluszczowej brzusznej. Celem pracy byla ocena związku pomiedzy nagromadzeniem tkanki tluszczowej, szczegolnie okolicy brzusznej, a stezeniem wybranych cytokin prozapalnych — interleukiny 6, 18 i bialka C-reaktywnego (CRP), biorących udzial w aterogenezie. Material i metody: Badaniem objeto 342 osoby (218 kobiet, 124 mezczyzn w wieku 20–40 lat, z BMI > 27 kg/m2), mieszkancow Wroclawia. Grupe podzielono ze wzgledu na wartośc wskaźnika insulinooporności (HOMA): 90 osob — grupa MONW ( HOMA < 1.69), 252 osoby — grupa kontrolna. Oceniono parametry antropometryczne, stezenia IL-6, IL-18, CRP, glukozy, insuliny oraz wskaźniki insulinowrazliwości i insulinooporności. Wyniki: Stezenie CRP bylo istotnie wyzsze w grupie kobiet MONW niz kontrolnej (3,26 vs. 1,97, p = 0,03). Stezenia IL-6 i IL-18 nie roznily sie pomiedzy grupami, zarowno u kobiet, jak i u mezczyzn. Dodatnią korelacje zanotowano miedzy stezeniem IL-6 a wskaźnikiem centralizacji tluszczu u kobiet. Stwierdzono dodatnią korelacje miedzy stezeniem CRP a BMI, wskaźnikiem talia– biodra, obwodem talii u obu plci. U kobiet istniala takze dodatnia korelacja miedzy CRP a wskaźnikami HOMA i FIRI i ujemna ze wskaźnikiem QUICKI. Wnioski: Zwiekszone gromadzenie tluszczu okolicy brzusznej u zdrowych, mlodych osob, wiąze sie z podwyzszonym stezeniem CRP. (Endokrynol Pol 2014; 65 (6): 449–455)

Summary Background MRCP is the method of choice in diagnosing pathologies of the biliary system. One of them is bile fistulae. They are uncommon but tend to cause many diagnostic problems. The possible way to improve MRCP is using it with intravenous injection of hepatobiliary-specific contrast agents. As it is eliminated via the hepatobiliary system, it can be visualized in the bile ducts and may help to reveal disorders undetected by a standard MRCP. Case Report We report a case of a 36-year-old woman with leakage in the biliary system which led to creation of a subcutaneous bile reservoir. By means of a regular MRCP protocol it was impossible to reveal any disorders of the biliary system and thus a decision to inject Gd-EOB-DTPA was taken. As a result, a fistula with its opening in the fundus of the gall bladder was revealed. Patient was qualified for treatment with somatostatin analogues in order to stop bile secretion. Conclusions The Gd-EOB-DTPA in combination with regular T2-weighted MRCP may be helpful in detecting anomalies of the biliary system. Although a high price of the procedure restricts its accessibility, such advantages as lower risk of complications, lower costs of hospitalization, and less traumatic nature make it a technique that may take precedence over ERCP in ambiguous cases.

A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma.To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations.Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations.Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia.Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases.

Obesity is defined as the excess of body fat and results from interactions between genes and the environment. The factors contributing to obesity are unsuitable nutrition and food overproduction, poor physical activity, mental stress, psychoemotional disorders, and metabolic and hormonal disturbances [1].

Wstep: Osoby z zespolem metabolicznej otylości z prawidlową masa ciala (MONW), mimo prawidlowego wskaźnika masy ciala (BMI), są narazone na powiklania typowe dla otylości. Moze to wynikac z subklinicznego stanu zapalnego, wynikającego z nadmiernego gromadzenia tkanki tluszczowej brzusznej. Celem pracy byla ocena związku pomiedzy nagromadzeniem tkanki tluszczowej, szczegolnie okolicy brzusznej, a stezeniem wybranych cytokin prozapalnych — interleukiny 6, 18 i bialka C-reaktywnego (CRP), biorących udzial w aterogenezie. Material i metody: Badaniem objeto 342 osoby (218 kobiet, 124 mezczyzn w wieku 20–40 lat, z BMI > 27 kg/m2), mieszkancow Wroclawia. Grupe podzielono ze wzgledu na wartośc wskaźnika insulinooporności (HOMA): 90 osob — grupa MONW ( HOMA < 1.69), 252 osoby — grupa kontrolna. Oceniono parametry antropometryczne, stezenia IL-6, IL-18, CRP, glukozy, insuliny oraz wskaźniki insulinowrazliwości i insulinooporności. Wyniki: Stezenie CRP bylo istotnie wyzsze w grupie kobiet MONW niz kontrolnej (3,26 vs. 1,97, p = 0,03). Stezenia IL-6 i IL-18 nie roznily sie pomiedzy grupami, zarowno u kobiet, jak i u mezczyzn. Dodatnią korelacje zanotowano miedzy stezeniem IL-6 a wskaźnikiem centralizacji tluszczu u kobiet. Stwierdzono dodatnią korelacje miedzy stezeniem CRP a BMI, wskaźnikiem talia– biodra, obwodem talii u obu plci. U kobiet istniala takze dodatnia korelacja miedzy CRP a wskaźnikami HOMA i FIRI i ujemna ze wskaźnikiem QUICKI. Wnioski: Zwiekszone gromadzenie tluszczu okolicy brzusznej u zdrowych, mlodych osob, wiąze sie z podwyzszonym stezeniem CRP. (Endokrynol Pol 2014; 65 (6): 449–455)

Statins belong to the most commonly used medicines worldwide. They affect cholesterol synthesis and thus they may suppress steroidogenesis. Our aim was to evaluate whether the use of statins is associated with the concentration of sex hormones.Material and methods/Results: In a population sample of men (n = 237) we found that subjects receiving statins had significantly lower concentrations of: total testosterone (14.9 vs. 16.35 nmol/L, p = 0.008 after correction for body mass), free testosterone (32 vs. 39 pmol/L, p = 0.004), calculated free testosterone (0.32 vs. 0.36 nmol/L, p0.001) and bioavailable testosterone (6.10 vs. 7.56 nmol/L, p0.001) than age-matched controls.We conclude that the use of statins may have an impact on the diagnosis of age-related testosterone deficiency in men.

Cushing's syndrome (also known as hypercortisolemia) is rare in pregnant women due to the menstrual disturbances and infertility in women with hypercortisolism. A diagnosis of pathological hypercortisolism in pregnant women is often difficult as some symptoms of the disease may be associated with a complicated pregnancy. Hypercortisolemia leads to serious complications for mother and foetus, and is associated with premature labour and high foetal mortality. Hormonal and radiological diagnostics in pregnancy are limited. The results of hormonal measurements and dynamic tests are difficult to interpret due to the physiological changes in the hypothalamo-pituitaryadrenal axis connected with pregnancy. The optimal time and method of treatment should be chosen cautiously case by case because of the possibility of maternal and foetal complications. In this paper, we present a case of Cushing's syndrome secondary to adrenal adenoma in which the diagnosis was made in the 22(nd) week of pregnancy. Due to the advanced gestational status and mild symptoms of hypercortisolism, only symptomatic treatment was introduced. The patient was under continuous obstetric and endocrinological care. At 35 weeks of gestation, the pregnancy was terminated by emergency caesarean section because of premature detachment of the placenta. A male infant weighing 2,450 g was delivered; neither adrenal insufficiency in the child nor hypercortisolemia complications in the mother were observed.

Homozygosity for interleukin-6 (IL-6) 174G_C promoter polymorphism has recently been associated with indices of metabolic syndrome; however, this problem has not been investigated in non-obese subjects. The aim of this study was to explore the relation between abdominal fat distribution and some inflammatory risk factors of atheromatosis and IL-6 174G_C gene polymorphism in non-obese healthy subjects.Relationships were investigated between anthropometric variables, i.e. weight, height, BMI, waist circumference (WC), waist-to-hip ratio (WHR), body fat distribution (DXA), serum CRP and IL-6, insulin sensitivity/resistance indices, and IL-6 174G_C gene polymorphism, in healthy non-obese Polish subjects: 232 women (age 31.4 +/- 5.5 years) and 199 men (age 30.3 +/- 6.0 years).The genetic study revealed that the CC genotype was observed in 15.56% of subjects, the CG genotype in 52.74%, and the GG genotype in 31.7%. IL-6 and CRP concentration did not differ among the genotypes. There were also no differences regarding BMI and WHR. The only differences among genotypes, observed only in men, were those concerning total fat (CC had higher fat content than CG and GG); the difference being statistically significant between CC and GG (p0.05), and gynoidal fat deposit (CC had higher gynoidal fat deposit than CG and GG); the difference being statistically significant between CC and GG (p0.025) and between CC and CG (p0.05). Biochemical parameters and insulin sensitivity did not differ among the genotypes.These data show that IL-6 174G_C polymorphism is not associated with features describing metabolic syndrome in nonobese healthy subjects.

Pheochromocytoma is rare tumor with a highly variable clinical presentation. This report provides clinical picture, efficiency of diagnostics and treatment of pheochromocytoma in 8-years in the endocrinological center in Wroclaw.The records of 37 patients with pheochromocytoma were identified, who were treated in 2000-2007 in the Department of Endocrinology, Diabetology and Isotope Treatment in Wroclaw. There were 23 women (age 23-75 year) and 14 men (age 17-74). We studied frequency of clinical signs, usefulness of diagnostic methods and efficacy of treatment.The duration of the clinical history ranged from 2 months to 16 years. The most frequent symptoms were: hypertension paroxysmal and constant, palpitations, headache, sweating and anxiety. The most sensitive diagnostic method was increased concentration of urinary metanephrine in 24-hour urine. Computed tomography was the most widely used method for tumor localization. Adrenal pheochromocytoma was detecting by CT in all patients, predominated in right adrenal, in 1 case in urinary bladder. Surgery caused remission of hypertension in 59%, improvement in 26.8%, and no changes in 13.9% of patients. Malignancy was reported in 2 cases, 1 woman died after surgery. MEN 2A occur in 21.6%.The diagnosis of pheochromocytma is usually made after long duration of the disease. The study confirms that clinical presentation of pheochromocytoma is variable and nonspecific, this finding makes the diagnosis very difficult. The most typical symptom is paroxysmal hypertension, which is present only in 40%, other symptoms are nonspecific. The measurement of 24-hour urinary metanephrines was the best indicator. CT was almost always successful in localizing the tumor. Patients with pheochromocytoma should be consider for other endocrine diseases especially medullary carcinoma, primary hyperparathyroidism and other component of MEN 2A.

Vitamin D could have a direct effect on adipocyte differentiation and metabolism and might be involved in glucose regulation of insulin secretion. In recent years several polymorphisms in the gene encoding the vitamin D receptor (VDR), which are potent to alter the activity of VDR protein, have been described. The present study aimed to investigate the prevalence of the VDR BsmI polymorphism and its association with anthropometric and biochemical features of metabolic syndrome in postmenopausal women.We studied 351 randomly selected healthy postmenopausal women, with mean age of 55.43 +/- 2.75 years and mean body mass index (BMI) of 27.5 +/- 4.78 kg/m2, to evaluate the frequency of BsmI polymorphism (by restriction fragment length polymorphism-polymerase chain reaction) in the VDR gene and to find out whether there is an association between this polymorphism and BMI, total fat volume and visceral fat (as determined by total body dual-energy X-ray absorptiometry), blood pressure, lipid profile (total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides) glucose and fasting insulin in the whole group, as well as subgroups of obese and non-obese women.The prevalence of BsmI genotypes in the study group was 51.0% Bb, 37.3% bb and 11.7% BB. Genotype distribution did not differ from that expected under Hardy-Weinberg equilibrium conditions (chi2 = 2.95, p = 0.22). Apart from LDL-C levels (F = 3.46, p = 0.032), there were no significant differences in anthropometric or metabolic parameters between genotypes.The BsmI polymorphism in the VDR gene does not seem to predispose to obesity and insulin resistance, but the BB genotype is connected with an unfavorable lipid profile.

Dehydroepiandrosterone (DHEA) is postulated to have antiatherogenic properties, but the possible mechanism of this action is unclear. The aim of this study was to determine the influence of endogenous DHEA-S on the levels of some factors playing significant roles in atherogenesis.In a group of 40 premenopausal women, relationships between endogenous DHEA-S and serum lipids and the apolipoproteins A1 (apoA1) and B (apoB), serum lipid peroxide (LPO), and total antioxidant system (TAS) concentrations as markers of the serum antioxidant-prooxidant balance were measured as well as clinical and biochemical parameters playing roles in atheromatosis such as the type of obesity and the serum glucose, insulin, insulin-like growth factor (IGF-1) and homocysteine (HCY) concentrations.Statistical analysis revealed significant correlation (p0.05) between serum DHEA-S level and the serum concentrations of: HDL(2)-C (r=0.53), HDL(2)-C/HDL(3)-C (r=0.58), TG (r=0.35), IGF-1 (r=0.39), and HCY (r=-0.44). There was no statistically significant correlation between DHEA-S level and other biochemical and clinical parameters (age, BMI, WHR) found in this study.Despite unfavorable correlation between DHEA-S and TG concentration, the results of this study indicate a potential antiatherogenic action of DHEA which may occur through various mechanisms: by increasing HDL(2)-C and the HDL(2)-C/HDL(3)-C ratio, which has an atheroprotective effect, by elevating the serum IGF-1 concentration, or by decreasing the HCY level. These preliminary results, however, require further investigation.

Hipercortisolemia in pregnancy occurs rarely because of menstrual disturbances and infertility in subjects with Cushing syndrome. The diagnosis of pathological hipercorisolemia in pregnant women is often difficult because some symptoms of the disease may be associated with complicated pregnancy. Hipercortisolemia causes weight gain, especially trunk obesity with thin extremities, arterial hypertension, glucose intolerance, purple-blue skin striae and hirsutism. Hormonal and radiological diagnostic in pregnancy is limited. Results of hormonal estimations and of dynamic tests are difficult to interpret because of physiological changes in the hypothalamo-pituitary-adrenal axis connected with pregnancy. Interpretation of magnetic resonance imaging of pituitary gland should include hypertrophy of pituitary gland connected with pregnancy. The choice of optimal time and method of treatment should be cautious and individualized because of the possibility of maternal and fetal complications.