Patients with Active Acromegaly are at High Risk of 25(OH)D Deficiency

Acromegaly is a chronic disease characterized by hypersecretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Electrolyte disturbances such as hypercalcemia and hyperphosphatemia are reported in patients with this disorder. There is limited data on vitamin D status in subjects with acromegaly. The aim of the study was to determine calcium, inorganic phosphate, magnesium, alkaline phosphatase and 25(OH)D levels with regard to the activity of the disease. We also studied correlations of 25(OH)D and IGF-1, GH, body mass, body mass index and age. A study group consisted of 55 acromegalic patients, and was divided into three subgroups: active acromegaly (AA), well-controlled acromegaly (WCA), cured acromegaly (CA). We enrolled 29 healthy subjects to a control group (CG). Vitamin D deficiency was recorded in all AA patients, 13 WCA patients (92.86%), 10 CA patients (62.5%) and 13 controls (54.17%). The highest 25(OH)D levels were found in the CG group and the lowest in the AA group (p=0.012). The dose of octreotide did not influence serum 25(OH)D levels. A significant positive correlation between IGF-1 and 25(OH)D levels was observed in the AA group (r=0.58, p=0.024). Inorganic phosphate levels were the highest in the AA group. In conclusion, active acromegalic patients have lower 25(OH)D levels in comparison with the control group and are at higher risk of vitamin D deficiency

Potential influence of sewer heat recovery on in-sewer processes

Heat recovery from combined sewers has a significant potential for practical renewable energy provision as sources of heat demand and sewer pipes are spread across urban areas. Sewers are continuously recharged with relatively hot wastewater, as well as interacting with heat sources from surrounding air and soil. However, the potential effects of modifying sewage temperature on in-sewer processes have received little attention. The deposition of fats, oils and greases (FOGs) and hydrogen sulphide formation are biochemical processes and are thus influenced by temperature. This paper utilises a case study approach to simulate anticipated temperature reductions in a sewer network due to heat recovery. A laboratory investigation into the formation of FOG deposits at temperatures varying between 5 °C and 20 °C provided mixed results, with only a weak temperature influence, highlighting the need for more research to fully understand the influence of the wastewater composition as well as temperature on FOG deposit formation. A separate modelling investigation into the formation of hydrogen sulphide when inflow temperature is varied between 5 °C and 20 °C showed considerable reductions in hydrogen sulphide formation. Hence, heat extraction from sewers could be a promising method for managing some in-sewer processes, combined with traditional methods such as chemical dosing

Effective Therapy of Insulinoma by Using Long-Acting Somatostatin Analogue. A Case Report and Literature Review

AbstractWe are reporting a case of 68-year-old woman with insulinoma, after a non-successful tumor surgery and a long-term diazoxide treatment. She had a lot of hypoglycemia cases, and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in the diameter, in the head of the pancreas. The patient did not agree for the repeated insulinoma surgery. Furthermore, we found a lesion in the left adrenal gland (14 mm in the diameter) and in the right lung (8 mm in the diameter). Pheochromocytoma was diagnosed on the basis of hypertension, elevated levels of normetanephrine in the 24-h urine collection, and an elevated level of norepinephrine in a plasma sample. After the left adrenal gland removal we observed lower blood pressure. Since we had revealed the presence of somatostatin receptors by the somatostatin receptors scintigraphy, we decided to control hypoglycemia by a monthly subcutaneous administration of the long-acting lanreotide. Because of higher glucose levels (300–400 mg/dl) we started an intense insulin therapy. Nowadays, the patient feels better, she has lost 20 kg of her body weight, and we have observed normal blood glucose levels during the long-term lanreotide treatment. We have noticed neither side effects nor hypoglycemic episodes and we have reduced the dose of insulin. The presented case can be an evidence of the effective treatment of the pancreatic neuroendocrine tumor of insulinoma type, with somatostatin analogue.</jats:p

Utility of baseline serum phosphorus levels for predicting remission in acromegaly patients

Purpose High GH and IGF I levels increase tubular phosphate reabsorption in patients with acromegaly. We aimed to investigate the utility of serum phosphorus levels as an indicator for predicting chance of remission in acromegaly patients