Oś przysadka–gonady–tarczyca i oś laktotropowa u chorych w stanie krytycznym

  Introduction: The normal circadian rhythm of hormones in critical patients becomes chaotic causing some hormones to increase and others to decrease abnormally. The goal of this study is to evaluate hormonal changes in severely ill patients and to investigate the relationship between hormonal changes and mortality and morbidity. Material and methods: We enrolled 20 patients (10 F/10 M). Blood samples were collected on day 0, day 5, and day 10. If a patient was discharged before these defined days, a sample was drawn on that day. Twenty healthy controls were included. Results: Female patients had lower LH, FSH, and fT3 and higher PRL and cortisol levels than controls on admission to the intensive care unit (ICU) (pLH = 0.021, pFSH:0.001, pfT3 = 0.021, pPRL = 0.042, pCortisol <0.001, respectively). Men had significantly low testosterone and fT3, and high PRL and cortisol levels on ICU admission (pT = 0.01, pfT3 = 0.043, pPRL = 0.005, pCortisol < 0.001, respectively). The lowest levels of gonadotropins in both genders and testosterone in men were measured on day 5. Cortisol levels decreased in the patients discharged from the ICU (p = 0.01). FSH levels increased in recovered women (pFSH = 0.043). The mortality rate was 30%. There were correlations between admission TSH and NIMV duration (p = 0.006), fT3 and APACHE II (p = 0.001), and PRL and mortality (p = 0.044). Positive correlations between E2 and APACHE II (p = 0.003) in females, and PRL and APACHE II (p = 0.022) in males were also displayed. Conclusions: Critically ill patients develop significant changes in neuroendocrine axes. Alterations in hormones correlate with the disease severity and mortality. (Endokrynol Pol 2016; 67 (3): 305–312)    Wstęp: Prawidłowy rytm dobowy wydzielania hormonów u chorych w stanie krytycznym staje się chaotyczny — wydzielanie jednych hormonów nadmiernie się zwiększa, natomiast innych maleje. Badanie przeprowadzono w celu oceny zmian stężeń hormonów u osób ciężko chorych oraz zbadanie zależności między zmianami stężeń hormonów a śmiertelnością I chorobowością. Materiał i metody: Do badania włączono 20 chorych (10 K/10 M). Próbki krwi pobierano w dniach 0, 5 i 10. Jeśli pacjent został wypisany przed tymi dniami, próbkę pobierano w dniu wypisu. Utworzono również grupę kontrolną złożoną z 20 zdrowych osób. Wyniki: U kobiet stwierdzono niższe stężenia LH, FSH i fT3 oraz wyższe stężenia PRL i kortyzolu przy przyjęciu na oddział intensywnej opieki medycznej (OIOM) niż u osób z grupy kontrolnej (odpowiednio pLH = 0,021; pFSH = 0,001; pfT3 = 0,021; pPRL = 0,042; pCortisol < 0,001). U mężczyzn w chwili przyjęcia na OIOM stężenia testosteron i fT3 były istotnie niższe, a stężenia PRL i kortyzolu wyższe niż w grupie kontrolnej (odpowiednio pT = 0,01; pfT3 = 0,043; pPRL = 0,005; pCortisol < 0,001). Najniższe stężenie gonadotropin u obu płci, a testosteron u mężczyzn zmierzono w dniu 5. Stężenia kortyzolu zmniejszyły się u chorych wypisanych z OIOM-u (p = 0,01). Stężenia FSH zwiększyły się u kobiet, których stan się poprawił (pFSH = 0,043). Odsetek zgonów wynosił 30%. Występowały korelacje między stężeniem TSH przy przyjęciu na OIOM a czasem stosowania nieinwazyjnej wentylacji mechanicznej (p = 0,006), fT3 i oceną w skali APACHE II (p = 0,001) oraz między stężeniem PRL a śmiertelnością (p = 0,044). Stwierdzono także dodatnie korelacje między stężeniem E2 a oceną w skali APACHE II (p = 0,003) u kobiet oraz między stężeniem PRL a ocean w skali APACHE II (p = 0,022) u mężczyzn. Wnioski: U chorych w stanie krytycznym występują istotne zaburzenia osi neuroendokrynnych. Zmiany stężeń hormonów korelują z ciężkością choroby I śmiertelnością. (Endokrynol Pol 2016; 67 (3): 305–312)

Empagliflozin-induced ketoacidosis in a patient presenting with new-onset type 2 diabetes mellitus due to indolent pancreatic cancer

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Previous, simultaneous, or subsequent occurrence of malignant tumours in patients with primary hyperparathyroidism: a closer look at the single-tertiary-centre cases

Introduction: Our aims were to explore the relationship between primary hyperparathyroidism (pHPT) and malignant tumour development, to determine the frequency and the time of occurrence of malignant tumours in patients with pHPT, and to evaluate the characteristics of pHPT in these patients. Material and methods: This retrospective cohort study included consecutive individuals who were diagnosed with pHPT aged 18 years or older in a university hospital during a 7-year period. A total of 198 patients with pHPT were reviewed retrospectively. Demographic, clinical, biochemical, radiologic findings, and histopathological diagnosis were collected from the electronic medical records of the hospital system. Results: The mean age of the study population was 58 ± 13 years and was predominantly female (female/male: 162/36). There were 42 (21.2%) patients with malignant tumours. Five (12%) out of 42 patients had metachronous double malignancies. The most common 2 concurrent malignancies were breast (36.1%) and thyroid (17.0%). Sixty-eight per cent of the malignant tumours occurred before the diagnosis of pHPT. A higher percentage (87.5%) of simultaneous tumours was seen in the thyroid gland. No statistically significant differences were observed between patients with and without malignant tumours in terms of demographic, clinical, biochemical, radiological, and histopathological features. The median follow-up duration was 24 months after parathyroid surgery. Conclusion: The results of this study revealed that pHPT was associated with various tumour types. The frequency of malignant tumours was 21.2%. Breast and thyroid cancers were the most common 2 cancers coexisting with pHPT. A large percentage of malignant tumours occurred before the diagnosis of pHPT. A higher percentage of simultaneous tumours was seen in the thyroid gland. pHPT patients with and without malignant tumours seemed to have similar characteristics

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity