Disorders of carbohydrate metabolism and their relationship with the prevalence of cancer in patients with acromegaly – authors’ own observations

Background . Acromegaly is a rare chronic disease with an excessive secretion of growth hormone, which leads to characteristic changes in appearance, organ and metabolic complications and neoplasms, which are a significant cause of shortened survival time. One of the most common consequences of acromegaly is disturbed carbohydrate metabolism. Objectives . The aim of this study was to assess the prevalence of disorders of carbohydrate tolerance and their relationship with the prevalence of malignant tumours in subjects with acromegaly. Material and methods. The study group comprised 69 patients with confirmed acromegaly (26 M, 43 F), aged 26–83 (mean 58.9 ± 11.0). Medical histories and the results of laboratory tests – plasma fasting glucose and oral glucose tolerance test, as well as the results of imaging and histopathological examinations performed in cases of suspected cancer lesions were analyzed. Results Disorders of carbohydrate tolerance were confirmed in a total of 46 patients (66.7%). 23 patients (33.3%) had normal glucose tolerance. Diabetes was diagnosed in 22 patients (31.9%), while prediabetes was diagnosed in 24 (34.8%) patients. In the analyzed group there were 6 cases of cancers, including 5 patients with concomitant diabetes, which represented a value significantly higher (p = 0.01) compared to patients without diabetes. The sixth case of cancer was detected in a woman with IGT . In patients with normal glucose tolerance there was no case of cancer. Conclusions . Among patients with acromegaly, disorders of carbohydrate tolerance occur in more than half of the cases, which confirms the need for active screening in this group of patients, in which a significant role is played by General Practitioners. General Practitioners should also consider the possibility of acromegaly in the differential diagnosis of glucose tolerance disorders detected in their patients. All patients with acromegaly, especially with concomitant diabetes or prediabetes, should be screened for cancers

Thyroid diseases in patients with acromegaly — own observations

Wstęp. Nadmiar hormonu wzrostu (GH) w przebiegu akromegalii prowadzi do charakterystycznych zmian wyglądu zewnętrznego, jak też rozwoju powikłań narządowych i metabolicznych oraz nowotworów. Jednym z najczęstszych następstw jest powiększenie tarczycy, a zwłaszcza wole guzowate. Cel pracy. Ocena częstości występowania chorób tarczycy u chorych na akromegalię. Materiał i metody. Badaną grupę stanowiło 62 chorych (23 M, 39 K), w wieku 25–82 lata. Analizowano dokumentację medyczną, wyniki badań obrazowych i hormonalnych tarczycy oraz obecność przeciwciał. Wyniki. Patologię tarczycy wykryto u 48 chorych (77,42%), w tym u 89,74% spośród 39 kobiet i u 56,52% spośród 23 mężczyzn. Najczęściej rozpoznawano wole guzowate z eutyreozą (50%). Wole guzowate nadczynne stwierdzono u 19,35%. Przewlekłe autoimmunologiczne zapalenie tarczycy i wole proste wykryto w pojedynczych przypadkach. Nie potwierdzono żadnego przypadku raka tarczycy. Wnioski. Patologia tarczycy jest bardzo częstym objawem akromegalii i może dotyczyć zarówno zmian w jej morfologii, jak i czynności. Każdy chory w chwili rozpoznania akromegalii powinien przejść wnikliwą diagnostykę tyreologiczną i być objęty odpowiednim leczeniem lub obserwacją, w czym duża rola lekarza podstawowej opieki zdrowotnej (POZ). W każdym przypadku należy dążyć do wykluczenia raka tarczycy.Introduction. Excess of growth hormone (GH) in acromegaly leads to characteristic changes in appearance, as well as the development of metabolic disorders and increased risk of cancer. One of the most common consequences of the disease is the enlargement of the thyroid gland, especially nodular goiter. Aim of the study. Evaluate the prevalence of various diseases of the thyroid in patients with acromegaly. Material and methods. The study group covered 62 patients (23 M, 39 F), aged 25–82 years. We analyzed the medical histories, results of imaging and hormonal studies and the presence of antibodies. Results. Thyroid pathology was detected in 48 patients (77.42%), including 89.74% out of 39 female and 56.52% out of 23 male. Most often we observed euthyroid nodular goiter (50%). Toxic nodular goiter was found in 19.35%. Chronic autoimmune thyroiditis and simple goiter were detected in few cases. There wasn’t any case of thyroid cancer. Conclusions. The pathology of the thyroid is a very common symptom of acromegaly and may involve changes in the morphology and function. At the moment of the diagnosis of acromegaly each patient should undergo a thyroid evaluation and should be treated or followed not only by a specialist but also by GP. In any case, efforts should be made to exclude thyroid cancer

Similarities and differences in clinical picture of incidentally discovered adrenal tumors with latent hormonal activity

Wstęp. Przypadkowo wykryte guzy nadnerczy (AI) są jednymi z najczęściej rozpoznawanych u ludzi. Aktywność hormonalną wykazuje około 10–15% z nich. Cel pracy. Ustalenie różnic w obrazie klinicznym guzów nadnerczy zależnie od rodzaju ich aktywności hormonalnej. Materiał i metody. W badaniu przeprowadzono retrospektywną analizę obrazu klinicznego, badań hormonalnych i obrazowych 396 chorych leczonych w latach 2011–2014. Wyniki. Utajoną aktywność hormonalną wykazano u 42 chorych (10,6%; 31 K, 11 M). U połowy rozpoznano utajony zespół Cushinga, u 29% (12 chorych) zespół Conna i u 21% (9 chorych) — guz chromochłonny (pheochromocytoma). Najwyższe średnie wieku i indeksu masy ciała (BMI) stwierdzono u chorych z utajonym zespołem Cushinga, najniższe z guzem chromochłonnym. Nadciśnienie tętnicze występowało u 92% chorych z subklinicznym zespołem Conna. U chorych z zespołem Cushinga i guzem chromochłonnym częstość nadciśnienia wynosiła odpowiednio 76% i 78%. Zaburzenia tolerancji glukozy występowały u 38% chorych z hiperkortyzolemią i po 33% w pozostałych dwóch grupach. Osiemdziesiąt procent aktywnych hormonalnie guzów nadnerczy wykryto za pomocą tomografii komputerowej (TK.) Największe rozmiary osiągały guzy chromochłonne (42,9 ± 29,5 mm), najmniejsze w zespole Conna (19,3 ± 8,7 mm). Większość zmian (47,6%) lokalizowała się w lewym nadnerczu, zmiany obustronne występowały u pięciu chorych (11,9%). Wniosek. Chorzy z guzami nadnerczy i utajoną aktywnością hormonalną różnili się wielkością guza, wiekiem, masą ciała, częstością otyłości i nadciśnienia, nie różnili się natomiast częstością występowania nietolerancji glukozy.Introduction. Incidentally discovered adrenal tumors (AI) are among the most commonly diagnosed in people. Only about 10–15% of AI show latent hormonal activity. Aim of the study. Determine the differences in clinical picture of hormonally active AI depending on the nature of their hormonal activity. Material and methods. Covered 396 patients treated in the years 2011–2014. Retrospective analysis of the clinical picture, hormonal and imaging studies. Results. Subclinical hormonal activity was confirmed in 42 patients (10.6%; 31 F, 11 M). Half of them were diagnosed with latent Cushing’s syndrome, 29% (12 patients) with Conn’s syndrome and 21% (9 patients) with pheochromocytoma. The highest average age and BMI characterized patients with Cushing’s syndrome, the lowest patients with pheochromocytoma. Hypertension was found in 92% of patients with latent Conn’s syndrome. In patients with Cushing’s syndrome and pheochromocytoma incidence of hypertension was respectively 76% and 78%. Glucose intolerance was certified in 38% of patients with hypercortisolemia and in 33% in the other two groups. 80% of hormonally active AI were detected in CT. The largest tumor’ dimension (42.9 ± 29.5 mm) was found in patients with pheochromocytoma, the smallest (19.3 ± 8.7 mm) in Conn’s syndrome. Most of the changes (47.6%) were localized in left adrenal gland, bilateral tumors occurred in 5 patients (11.9%). Conclusion. Patients with AI and latent hormonal activity, differed in tumor size, age, BMI, incidence of obesity and hypertension but did not differ in the prevalence of glucose intolerance

Nadwaga i otyłość a niedoczynność tarczycy = Overweight and obesity in hypothyroidism

Szwajkosz Katarzyna, Zwolak Agnieszka, Dudzińska Marta, Świrska Joanna, Oszywa-Chabros Anna, Wawryniuk Agnieszka, Łuczyk Robert, Daniluk Jadwiga. Nadwaga i otyłość a niedoczynność tarczycy = Overweight and obesity in hypothyroidism. Journal of Education, Health and Sport. 2016;6(7):419-428. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.58447 http://ojs.ukw.edu.pl/index.php/johs/article/view/3707 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 15.06.2016. Revised 09.07.2016. Accepted: 21.07.2016. Nadwaga i otyłość a niedoczynność tarczycy Overweight and obesity in hypothyroidism Katarzyna Szwajkosz1, Agnieszka Zwolak1,2, Marta Dudzińska1, Joanna Świrska1,2, Anna Oszywa-Chabros1, Agnieszka Wawryniuk1, Robert Łuczyk1, Jadwiga Daniluk1,3 1Katedra Interny z Zakładem Pielęgniarstwa Internistycznego, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie 1Department of Internal Medicine with the Department of Internal Nursing, Faculty of Sciences Health, Medical University of Lublin 2Katedra i Klinika Endokrynologii, Uniwersytet Medyczny w Lublinie 2Department of Endocrinology, Medical University of Lublin 3Katedra Zdrowia, Państwowa Szkoła Wyższa im. Papieża Jana Pawła II w Białej Podlaskiej 3Department of Health, the National School of the name of Pope John Paul II of Biala Podlaska Korespondencja: Katarzyna Szwajkosz Katedra Interny z Zakładem Pielęgniarstwa Internistycznego, Wydział Nauk o Zdrowiu, Uniwersytet Medyczny w Lublinie ul. Jaczewskiego 8, 20-954 Lublin tel. 81 742 58 25 [email protected] Streszczenie Wstęp. Niedoczynność tarczycy, najczęściej będąca skutkiem przewlekłego autoimmunologicznego zapalenia, jest jedną z najczęstszych patologii gruczołu tarczowego i dotyczy około 2% populacji. Niedobór hormonów tarczycy manifestuje się zwykle zmniejszeniem napędu życiowego, stanami depresyjnymi, pogorszeniem sprawności intelektualnej, nietolerancją niższych temperatur. Patologia ta wiąże się ze zwiększonym ryzykiem nadwagi lub otyłości, wtórnie do zwolnionego metabolizmu, a także jest czynnikiem sprzyjającym hiperlipidemii, co wiąże się ze wzrostem ryzyka sercowo-naczyniowego. Celem pracy była ocena występowania nadwagi i otyłości w grupie pacjentów z niedoczynnością tarczycy. Materiał i metody. W badaniu wzięło udział 101 pacjentów (77K, 24M, w wieku średnio 43 lat) z rozpoznaną niedoczynnością tarczycy. W toku badań zastosowano metodę sondażu diagnostycznego z wykorzystaniem autorskiego kwestionariusza ankiety oraz metodę pomiaru parametrów antropometrycznych, w tym BMI, obwodu talii i bioder. Wyniki. Wśród badanych pacjentów nadwagę (BMI 25-29,9) miało 39,6% badanych, otyłość I stopnia (BMI 30-34,9) 26,7% pacjentów, otyłość II stopnia (BMI 35-29,9)- 10,9%. Wartości BMI≥40 cechujące otyłość III stopnia stwierdzono u 2% badanych. Średnia wartość BMI wyniosła 28,9, przy czym pacjenci w wieku 18-25 lat istotnie częściej cechowali się prawidłową masą ciała niż badani w grupie wiekowej ≥65 lat (p=0,0003), podobnie pacjenci wieku 26-40 lat w porównaniu z badanymi ≥65 lat (p=0,001). Wnioski. Nadwaga i otyłość dotyczą większości pacjentów z niedoczynnością tarczycy, a ryzyko to rośnie wraz z wiekiem. Wartym rozważenia jest aktywna diagnostyka w kierunku chorób tarczycy wśród pacjentów z nadwagą i otyłością, także w warunkach podstawowej opieki zdrowotnej. Podjęcie prób aktywnego edukowania pacjentów z już zdiagnozowaną niedoczynnością tarczycy z towarzysząca nadwagą i otyłością do zmiany zachowań behawioralnych stanowi wyraz profilaktyki chorób sercowo-naczyniowych. Słowa kluczowe: otyłość, nadwaga, niedoczynność tarczycy, ryzyko sercowo-naczyniowe. Summary Introduction: Hypothyroidism is usually caused by chronic autoimmune inflammation of the thyroid gland. It is one of the most common disorders of the thyroid concerning approximately 2% of the adult population. This disorder is related to higher risk of overweight and obesity due to decreased total body metabolism. Furthermore, it predisposes to dyslipidaemia thus increases the risk of cardiovascular disease. Aim: The aim of the study was to evaluate the prevalence of overweight and obesity in patients with hypothyroidism. Material and methods: 101 patients (77F, 24M, with an average age 43years) with diagnosed hypothyroidism were enrolled into the study. A method of proprietary questionnaire was used with measurement of anthropometric parameters. Results: In the examined group of patients, 39,6% were overweight (BMI 25,0-29,9), first degree obesity (BMI: 30,0-34,9) was present in 26,7%; 10,9% of the patients had 2 nd degree obesity. 2% of the examined patients had third degree obesity with BMI ≥40 kg/m2. Mean BMI value was 28,9, whereas patients aged 18-25 years and patients aged 26-40 years had significantly more often normal body mass than patients aged 65 years and older (p=0,0003 and p<0,0001 respectively). Conclusion: Overweight and obesity concern the majority of patients with hypothyroidism and this risk is increasing with patients’ age. Therefore, it is worth considering evaluating routinely, also in General Practitioner’s office, thyroid function particularly in patients who are overweight or obese. Recognition and treatment of hypothyroidism combined with non-pharmacological actions in overweight and obese patients will be a form of cardiovascular diseases prophylaxis. Key words: overweight, obesity, hypothyroidism, cardiovascular risk

Disorders of carbohydrate metabolism and their relationship with the prevalence of cancer in patients with acromegaly – authors’ own observations

Background . Acromegaly is a rare chronic disease with an excessive secretion of growth hormone, which leads to characteristic changes in appearance, organ and metabolic complications and neoplasms, which are a significant cause of shortened survival time. One of the most common consequences of acromegaly is disturbed carbohydrate metabolism. Objectives . The aim of this study was to assess the prevalence of disorders of carbohydrate tolerance and their relationship with the prevalence of malignant tumours in subjects with acromegaly. Material and methods. The study group comprised 69 patients with confirmed acromegaly (26 M, 43 F), aged 26–83 (mean 58.9 ± 11.0). Medical histories and the results of laboratory tests – plasma fasting glucose and oral glucose tolerance test, as well as the results of imaging and histopathological examinations performed in cases of suspected cancer lesions were analyzed. Results Disorders of carbohydrate tolerance were confirmed in a total of 46 patients (66.7%). 23 patients (33.3%) had normal glucose tolerance. Diabetes was diagnosed in 22 patients (31.9%), while prediabetes was diagnosed in 24 (34.8%) patients. In the analyzed group there were 6 cases of cancers, including 5 patients with concomitant diabetes, which represented a value significantly higher (p = 0.01) compared to patients without diabetes. The sixth case of cancer was detected in a woman with IGT . In patients with normal glucose tolerance there was no case of cancer. Conclusions . Among patients with acromegaly, disorders of carbohydrate tolerance occur in more than half of the cases, which confirms the need for active screening in this group of patients, in which a significant role is played by General Practitioners. General Practitioners should also consider the possibility of acromegaly in the differential diagnosis of glucose tolerance disorders detected in their patients. All patients with acromegaly, especially with concomitant diabetes or prediabetes, should be screened for cancers

Screening colonoscopy tests in acromegaly patients – authors’ observations

Background . The prevalence of adenomas which cause acromegaly is estimated at 50–70 mln people. They secrete excess of growth hormone and increase the risk of benign and malignant tumours. Intestinal tumours are considered the most common types of lesion. In order to diagnose them early, a colonoscopic examination should be performed every 2–3 years. Objectives. The aim of the study was to estimate the frequency of the performed colonoscopies in acromegaly patients, and to assess their applicability in the detection of neoplastic lesions of the colon. Material and methods . The study involved 69 patients with acromegaly (26 M, 43 F), aged 26–83 years (mean 58.9 ± 11.0). The authors analyzed medical records and the results of additional tests. Results . Colonoscopy was performed in 30 patients (43.5% of cases), was well tolerated and without serious complications. 70% of colonoscopies revealed polyps of the colon and 6.7% revealed colon carcinoma. In 9 patients (30% of conducted studies) colonoscopy examination showed no pathological changes. Only in 4 cases the test was performed more than once. Conclusions . Current recommendations regarding colonoscopic examinations in all acromegaly patients are implemented in less than half of the cases. Recommendations relating to colonoscopy being repeated every 2–3 years are followed occasionally. Colonoscopy is a diagnostic test of great significance. In 70% of cases it enables the detection and removal of pathological lesions of the colon. As a low-invasive, safe and well-tolerated examination it should be performed in all patients. GPs should make acromegaly patients aware of the importance of colonoscopy and refer them for periodic follow-up examinations

Depression, anxiety and stress in patients with acromegaly — own observations

Wstęp. Akromegalia prowadzi do niekorzystnych zmian wyglądu, powikłań metabolicznych oraz podwyższonego ryzyka nowotworów. Świadomość choroby i jej konsekwencji może być źródłem poważnych problemów natury psychicznej pogarszających jakość życia. Cel pracy. Ocena częstości występowania i nasilenia depresji, lęku oraz stresu u chorych na akromegalię. Materiał i metody. Ocenę zaburzeń przeprowadzono przy użyciu skali depresji, lęku i stresu (DASS) w grupie chorych na akromegalię (15M, 29K). Wyniki. Występowanie przynajmniej jednego z zaburzeń stwierdzono u 56,8% chorych, nieistotnie częściej u kobiet niż u mężczyzn. Najczęstszym zaburzeniem był lęk, kolejnym depresja i stres. Równoczesne występowanie lęku, depresji i stresu podawało 27,3% badanych. Wnioski. Akromegalia w ponad połowie przypadków prowadzi do zaburzeń emocjonalnych. Ich występowanie należy uwzględniać w ocenie skuteczności leczenia i dążyć do usunięcia na drodze psycho- lub farmakoterapii. Autorzy sugerują konieczność wstępnej oceny wszystkich pacjentów z akromegalią pod kątem występowania zaburzeń nastroju przez lekarza POZ.Introduction. Acromegaly leads to progressive changes in the appearance and metabolic complications and causes increased risk of cancer. Awareness of the disease and its consequences can be a source of serious psychological problems deteriorating quality of life. Aim of the study. Evaluation of the prevalence and the severity of depression, anxiety and stress in patients with acromegaly. Material and methods. 44 patients (15 M; 29 F). The evaluation was performed with the use of depression, anxiety and stress scale (DASS). Results. The presence of at least one of the disorders were found in 56.8% of patients, insignificantly more often in female than in male. The most common disorder was anxiety, then a depression and stress. The simultaneous occurrence of anxiety, depression and stress was found in 27.3%. Conclusions. Acromegaly in more than half of the cases leads to emotional disorders. Their presence should be taken into account in assessing the effectiveness of the treatment. These disorders should be treated using psycho or pharmacotherapy. The authors suggest the need for a preliminary evaluation of all patients with acromegaly for the occurrence of mood disorders by GP

The role of the primary care outpatient clinic in the promotion of healthy nutrition – preliminary reports

Background. Understanding the principles of prophylaxis, and awareness of the importance of proper nutrition in maintaining wellbeing should be a part of every doctor–patient relationship. Objectives . An evaluation of the sources of knowledge and access to information about healthy nutrition in primary care outpatient clinics. Material and methods . The study comprised 222 subjects (150 women and 72 men) aged 18–87 years (median 47.5). The study used a self-prepared questionnaire. Results . 97.7% of the patients (n = 217) were aware of the impact of diet on health, of which only 9.9% (n = 22) knew the rules of healthy nutrition well, 55.4% (n = 123) had knowledge at a medium level, and 31.1% (n = 69) at a low level. Dietary mistakes were more frequently reported by men (p = 0.001), and lack of time (38.2%; n = 85) and knowledge (29.3%; n = 65) were reported as the main reasons. The Internet (64.9%; n = 144) is the main source of knowledge about healthy nutrition. It is used mainly by younger people (78.9% < 50 years; n = 97 vs. 47.5% ≥ 50 years; n = 47; p < 0.001). People ≥ 50 years prefer to talk with a doctor (22.2%; n = 22 vs. 4.9%; n = 6; p < 0.001). Patients expect to get dietary education in their primary care outpatient clinic in the form of leaflets (58.6%; n = 130), posters (25.7%; n = 57), conversation with a doctor (36.9%; n = 82), and consultation with a nutritionist (33.3%; n = 74). Significantly more women want to get information directly from a doctor (p = 0.01). Conclusions . The primary care outpatient clinic is an important source of information on healthy nutrition. Patients expect access to information in the form of leaflets and medical or dietary consultations conducted in a family doctor’s practice. We should consider the implementation of educational programmes on the principles of healthy nutrition in primary care outpatient clinics