Total testosterone to dihydrotestosterone ratio assessed by LC-MS/MS predicts a worse metabolic profile not only in PCOS patients

Objectives: Total testosterone/dihydrotestosterone ratio (TT/DHT) was found to determine metabolic risk in polycystic ovary syndrome (PCOS). The aim of this study was to analyze whether (TT/DHT) may be helpful in predicting metabolic risk not only in PCOS patients but also in healthy women. Material and methods: Total testosterone (TT), dihydrotestosterone (DHT), androstendione and dehydroepiandrosterone sulphate (DHEA-S) were measured by LC-MS/MS in 36 women with PCOS and in 29 age-matched controls without clinical hyperandrogenism. In all participants, anthropometric data, lipids, adipose tissue percent (%fat), HOMA-IR were also assessed. Results: The studied groups were not different in terms of age, BMI, waist circumference, %fat and HOMA-IR. In the patients group, mean TT and androstendione levels were significantly higher as compared to controls (1.4 nmol/L vs. 1.0 nmol/L, P < 0.001) and (6.6 nmol/L vs. 4.9 nmol/L, P < 0.01), respectively. In the patients group, mean TT/DHT ratio was significantly higher compared to controls (3.6 vs. 2.7, P < 0.01) and correlated with BMI (r = 0.37, P < 0.05), waist circumference (r = 0.44, P < 0.01), %fat (r = 0.30, P < 0.05), as well as with insulin levels (r = 0.38, P < 0.05) and HOMA-IR (r = 0.44, P < 0.05). The association between TT/DHT ratio and unfavorable metabolic parameters was also seen in controls. Conclusion: Total testosterone/dihydrotestosterone ratio assessed by LC-MS/MS correlates with a worse metabolic profile not only in PCOS patients, but also in healthy women

Total testosterone to dihydrotestosterone ratio assessed by LC-MS/MS predicts a worse metabolic profile not only in PCOS patients

Objectives: Total testosterone/dihydrotestosterone ratio (TT/DHT) was found to determine metabolic risk in polycystic ovary syndrome (PCOS). The aim of this study was to analyze whether (TT/DHT) may be helpful in predicting metabolic risk not only in PCOS patients but also in healthy women. Material and methods: Total testosterone (TT), dihydrotestosterone (DHT), androstendione and dehydroepiandrosterone sulphate (DHEA-S) were measured by LC-MS/MS in 36 women with PCOS and in 29 age-matched controls without clinical hyperandrogenism. In all participants, anthropometric data, lipids, adipose tissue percent (%fat), HOMA-IR were also assessed. Results: The studied groups were not different in terms of age, BMI, waist circumference, %fat and HOMA-IR. In the patients group, mean TT and androstendione levels were significantly higher as compared to controls (1.4 nmol/L vs. 1.0 nmol/L, P < 0.001) and (6.6 nmol/L vs. 4.9 nmol/L, P < 0.01), respectively. In the patients group, mean TT/DHT ratio was significantly higher compared to controls (3.6 vs. 2.7, P < 0.01) and correlated with BMI (r = 0.37, P < 0.05), waist circumference (r = 0.44, P < 0.01), %fat (r = 0.30, P < 0.05), as well as with insulin levels (r = 0.38, P < 0.05) and HOMA-IR (r = 0.44, P < 0.05). The association between TT/DHT ratio and unfavorable metabolic parameters was also seen in controls. Conclusion: Total testosterone/dihydrotestosterone ratio assessed by LC-MS/MS correlates with a worse metabolic profile not only in PCOS patients, but also in healthy women

Should we routinely assess hypothalamic–pituitary–adrenal axis in pediatric patients with Prader–Willi syndrome?

BackgroundIt has been reported that central adrenal insufficiency (CAI) in pediatric patients (pts) with Prader–Willi syndrome (PWS) may be a potential cause of their sudden death. In addition, the risk of CAI may increase during treatment with recombinant human growth hormone (rhGH).ObjectiveTo prevent both over- and undertreatment with hydrocortisone, we evaluated the prevalence of CAI in a large multicenter cohort of pediatric pts with PWS analyzing adrenal response in the low-dose ACTH test (LDAT) and/or the glucagon stimulation test (GST) and reviewing the literature.MethodsA total of 46 pts with PWS were enrolled to the study, including 34 treated with rhGH with a median dose of 0.21 mg/kg/week. LDAT was performed in 46 pts, and GST was carried out in 13 pts. Both tests were conducted in 11 pts. The tests began at 8:00 a.m. Hormones were measured by radioimmunoassays. Serum cortisol response &gt;181.2 ng/mL (500 nmol/L) in LDAT and &gt;199.3 ng/mL (550 nmol/L) in GST was considered a normal response. Additionally, cortisol response delta (the difference between baseline and baseline) &gt;90 ng/mL and doubling/tripling of baseline cortisol were considered indicators of normal adrenal reserve.ResultsThree GSTs were not diagnostic (no hypoglycemia obtained). LDAT results suggested CAI in four pts, but in two out of four pts, and CAI was excluded in GST. GST results suggested CAI in only one patient, but it was excluded in LDAT. Therefore, CAI was diagnosed in 2/46 pts (4.3%), 1 treated and 1 untreated with rhGH, with the highest cortisol values of 162 and 175 ng/dL, but only in one test. However, in one of them, the cortisol delta response was &gt;90 ng/mL and peak cortisol was more than tripled from baseline. Finally, CAI was diagnosed in one patient treated with rhGH (2.2%).ConclusionWe present low prevalence of CAI in pediatric pts with PWS according to the latest literature. Therefore, we do not recommend to routinely screen the function of the hypothalamic–pituitary–adrenal axis (HPAA) in all pts with PWS, both treated and untreated with rhGH. According to a review of the literature, signs and symptoms or low morning ACTH levels suggestive of CAI require urgent and appropriate diagnosis of HPAA by stimulation test. Our data indicate that the diagnosis of CAI should be confirmed by at least two tests to prevent overtreatment with hydrocortisone

The Enzymatic Activity of Type 1 Iodothyronine Deiodinase (D1) is Low in Liver Hemangioma: A Preliminary Study

Type 1 iodothyronine deiodinase (D1) is a crucial enzyme which converts the prohormone thyroxine (T4) into active tri-iodothyronine (T3). There has been strong evidence that the metabolism of thyroid hormones is disturbed in some neoplastic tissues such as thyroid, renal, and breast cancer. However, there are few available data about D1 enzyme activity in benign tumors such as hemangioma, which is the most common primary liver tumor. Hence this study aimed to determine the enzymatic activity of D1 in hemangiomas in relation to healthy liver tissue. Seven tumors and healthy control tissues were obtained from patients who had liver resection due to hemangioma. The activity was assessed by measurement of radioactive iodine released by deiodination catalyzed by D1. It was found that D1 activity was significantly lower in the hemagiomas than in the healthy surrounding tissue (p = 0.0017). The results indicated that thyroid hormones play important roles not only in the regulation of cell metabolism, but also in cell growth, division, and apoptosis. The active form T3 acts through its nuclear receptors and influences the up- and down-regulation of target genes. Healthy liver tissue expresses a high level of D1, but disturbed D1 activity may result in changes in the local concentration of T3 which may impair gene transcription. These finding demonstrate a low enzymatic activity of D1 in liver hemangioma and suggest an as yet unknown role of thyroid hormones in this type of benign liver tumor

Adrenal incidentaloma in adults — management recommendations by the Polish Society of Endocrinology

  Wstęp: Szerokie zastosowanie badań obrazowych klatki piersiowej i jamy brzusznej skutkuje coraz częstszym przypadkowym rozpoznawaniem zmian w nadnerczach. Cel: Celem pracy była analiza dostępnej wiedzy dotyczącej postępowania w incydentaloma nadnerczy u dorosłych w celu przygotowania praktycznych zaleceń. Sposób przygotowania: Grupa robocza stworzona z ekspertów zgromadzonych w Polskim Towarzystwie Endokrynologicznym przeanalizowała jakość dostępnych danych i po dyskusji podsumowała wyniki analizy w postaci przygotowanych zaleceń. Ocena obrazowa i hormonalna: Jednofazowa tomografia komputerowa (CT) nadnerczy może być zalecana jako badanie w początkowej ocenie zmiany pozwalające odróżnić gruczolaki od innych zmian nie będących gruczolakami („nie-gruczolaki”). W przypadku gęstości zmiany &amp;gt; 10 jednostek Hounsfielda zaleca się wykonanie badania CT z oceną wypłukiwania środka cieniującego lub rezonansu magneproftycznego. U wszystkich chorych z incydentaloma nadnerczy, niezależnie od obrazu klinicznego oraz chorób współistniejących, zaleca się ocenę hormonalną w kierunku guza chromochłonnego oraz hiperkortyzolemii. Badania w kierunku pierwotnego hiperaldosteronizmu są wskazane u pacjentów z rozpoznanym nadciśnieniem tętniczym lub hipokaliemią. Leczenie: Leczenie operacyjne powinno być zastosowane u chorych z incydentaloma nadnercza o charakterystyce obrazowej mogącej odpowiadać nowotworom złośliwym (wskazania onkologiczne) lub potwierdzonej czynności hormonalnej (wskazania endokrynologiczne). Podstawową metodą leczenia operacyjnego jest laparoskopowa adrenalektomia. Pacjenci z podejrzeniem guza chromochłonnego bezwzględnie wymagają przygotowania farmakologicznego do operacji. U chorych niezakwalifikowanych do operacji, badania kontrolne (obrazowe i laboratoryjne), należy ustalać indywidualnie, biorąc pod uwagę, między innymi wielkość, obraz i dynamikę wzrostu guza, objawy kliniczne, wyniki badań hormonalnych oraz choroby współistniejące. (Endokrynol Pol 2016; 67 (2): 234–258)    Introduction: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma. Aim: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations. Methods: 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. Imaging and hormonal assessment: 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 density &amp;gt; 10 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. Treatment: 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. (Endokrynol Pol 2016; 67 (2): 234–258)

Ocular surface and contact lenses

W pracy podsumowano problematykę zaburzeń powierzchni oka u użytkowników soczewek kontaktowych. Zaprezentowano klasyfikację i patogenezę zespołu suchego oka ze szczególnym uwzględnieniem postrzegania zagadnienia przez kandydatów i użytkowników soczewek kontaktowych oraz zasad postępowania i rozwiązywania problemów. Omówiono także popularne indeksy i kwestionariusze stosowane jako kryteria diagnostyczne. Wskaźnik zaburzeń powierzchni oka (OSDI, Ocular Surface Disease Index), stworzony do diagnostyki i oceny nasilenia ZSO, charakteryzuje się dobrą korelacją z testami klinicznymi i biologicznymi oraz specjalnymi implikacjami wykorzystania w badaniach klinicznych i praktyce kontaktologicznej. Według DEWS w codziennej praktyce sekwencja stosowanych testów diagnostycznych powinna zawierać: • wywiad kliniczny (historię choroby) • kwestionariusz dotyczący występujących objawów • czas przerwania filmu łzowego z fluoresceiną (FTBUT) • ocenę barwienia powierzchni oka fluoresceiną z zastosowaniem filtra żółtego w oparciu o skalę stopniującą • test Schirmera I ze znieczuleniem lub bez znieczulenia i/lub test Schirmera II ze stymulacją jamy nosowej • ocenę morfologii brzegów powiek oraz gruczołów Meiboma • ocenę wydzieliny (ekspresja) gruczołów Meiboma. Pozostałe dostępne testy mogą zostać indywidualnie dołączone do schematu w zależności od dostępności, możliwości wykonania oraz celu badania.The aim of this paper is to summarize ocular surface problems within contact lens wearers. The author present classification and pathogenesis of dry eye syndrome and pay attention to the importance of this problem in case of contact lens candidates and contact lens wearers. An appropriate attitude how to manage this problem is also described. The paper discusses the most popular indexes and questionnaires with particular emphasis on Ocular Surface Disease Index (OSDI), as well as the correlation of results from clinical trials with those from biological ones, and their practical implementation as far as use of contact lenses and clinical studies are concerned. Dry Eye Work Shop (DEWS) to screen, diagnose and monitor dry eye disease. A practical sequence of tests: • clinical history • fluorescein BUT • ocular surface staining grading with fluorescein/yellow filter • Schirmer I test without anesthetic, or I with anesthetic, and/or Schirmer II with nasal stimulation • lid and meibomian morphology • meibomian expression • other test may be added according to availability

Contact lens practice in the times of coronavirus

Wysoce zakaźny wirus SARS-CoV-2, który może powodować ciężką chorobę układu oddechowego znaną jako COVID-19, jest obecnie krytycznym wyzwaniem dla praktyki kontaktologicznej: optometrycznej i okulistycznej. Pandemia ewoluuje, a jej wpływ na zdrowie publiczne jest znaczący oraz progresywny i będzie skutkować ogromnymi zmianami gospodarczymi i społecznymi. W czasach koronawirusa praktyka kontaktologiczna niewątpliwie staje się trudniejsza. Należy przestrzegać zasad bezpieczeństwa oraz postawić na personalizację procedur oraz oferowanych rozwiązań korekcji wad wzroku i terapii widzenia. Warto podkreślić, że badanie okulistyczne i optometryczne przeprowadzone zgodnie z zasadami epidemiologicznymi nie jest obarczone zwiększonym ryzykiem zakażenia SARS-CoV-2.The highly contagious virus SARS-CoV-2 that causes the serious respiratory disease COVID-19 has posed a tremendous challenge to our daily optometric and ophthalmologic contact lens practice. The pandemic is still evolving. Its impact on public health has been significant and intensified and will result in significant economic and social changes. In the time of coronavirus, contactology is undoubtedly becoming more difficult. We should focus on both safety and the personalization of procedures and solutions that are offered to correct vision defects. Nevertheless, we should remember that ophthalmologic and optometric tests that are performed in accordance with epidemiological guidelines are not associated with a higher risk of SARS-CoV-2 infection

The Choice of Soybean Cultivar Alters the Underyielding of Protein and Oil under Drought Conditions in Central Poland

The popularization of soybean cultivation in Central Poland is progressing due to the European Soy Declaration signed by 13 member states in Brussels on 17 July 2017. Hence, this research was initiated under the European Innovation Partnership on phenotyping soybean cultivars in two regions, i.e., Kuyavian-Pomeranian and Greater Poland for integrated systems. The aim of this study was to determine soybean potential in the agrotechnical and agroclimatic conditions, with the selection of the most suitable cultivars for tillage and no-tillage cultivation in the region of Central Poland. Strict field research was carried out in six locations from 2018–2020 on 20 cultivars selected in terms of their earliness of maturation to the climatic conditions. On the basis of meteorological data, it was found that half of the plantations suffered from drought stress, as evidenced by the hydrothermal coefficients (K) for the growing season of soybean K R = 0.67; p K and the vegetation period days (VPD) as the predictors of the soybean yield was determined by the regression equation Y(yield) = 21.8 + 12.0 X(K) + 0.20 X(VPD). A significant multivariate relationship (R = 0.43; p K and the protein content, quantified with the regression equation Y(protein) = 32.6 + 0.25 X(Yield) + 0.28 X(K). In the no-tillage system of cultivation, the seed yield of soybean constantly increased with increasing K (+32.3% between dry/relatively dry and optimal periods, +22.4% between optimal and humid periods), while in the tillage system, the yield increased by 22.1% only when K rose from optimal to humid. In the seasons with optimum and humid conditions, no-tilled soybean produced more oil, in comparison to the season of dry conditions, and the opposite trend was found with the greater oil content in the tillage system. Meanwhile, a higher protein content was observed in the tillage system under humid conditions. All soybean cultivars were grouped according to the cluster analysis (k-means) with ANOVA in terms of vegetation period in days, seed yield, oil, and protein content for tillage and no-tillage cultivation. The study confirmed that soybean might be considered in the future as a profitable crop in Central Poland and create perspective for a low-input source of protein and oil

Algorytmy postępowania z pacjentem krótkowzrocznym – interpretacja danych diagnostyczno-terapeutycznych wraz z analizą prospektywną

Praca badawcza poświęcona świadomości osób miopijnych w dziedzinie krótkowzroczności oraz analizie roli specjalistów w budowaniu wiedzy pacjentów. Przedstawiono w niej epidemiologię oraz czynniki ryzyka rozwoju i progresji miopii, ze szczególnym uwzględnieniem zmian spowodowanych przez pandemię COVID-19. Przybliżono schemat postępowania, zaproponowany przez The International Myopia Institute (IMI), który obejmuje regularne wizyty optometryczne i okulistyczne, a także szereg badań diagnostycznych. W ramach pracy dokonano analizy świadomości pacjentów krótkowzrocznych na temat miopii. W tym celu przeprowadzono ankietę, zawierającą pytania dotyczące częstości konsultacji optometrycznych i okulistycznych, znajomości różnych metod korekcji wady wzroku oraz świadomości konieczności podejmowania działań profilaktycznych

Diagnostyka ektazji rogówki w nowoczesnym centrum okulistycznym. Standardy badań a rola optometrysty

Stożek rogówki to dwustronna i asymetryczna choroba degeneracyjna, która polega na postępującym ścieńczeniu oraz uwypukleniu rogówki, prowadząc tym samym do powstawania nieregularnego astygmatyzmu oraz znacznych zaburzeń ostrości wzroku. Stożek rogówki zwykle rozwija się w drugiej bądź trzeciej dekadzie życia i jego progresji nie da się przewidzieć. Schorzenie dotyczy wszystkich grup etnicznych i obu płci. Powszechność występowania oraz wskaźniki zapadalności na stożek rogówki mogą różnić się w zależności od położenia geograficznego oraz wieku występowania. Szczególną uwagę chciałabym poświęcić czynnikom etiologicznym, patogenezie oraz epidemiologii powstawania tej dystrofii