Lipid profile disorders in diabetes mellitus type 2 coexisting with hypertension, CAD and obesity

WSTĘP. Obecnie cukrzycę uważa się za chorobę cywilizacyjną. Jednym z najważniejszych powikłań cukrzycy jest wczesny rozwój choroby niedokrwiennej serca (CAD, coronary artery disease). Początek i przebieg izolowanej CAD znacząco różni się w porównaniu z CAD u chorych leczonych dodatkowo z powodu cukrzycy. Inną chorobą związaną z cukrzycą jest nadciśnienie tętnicze. W insulinoniezależnej cukrzycy, nadciśnienie tętnicze wiąże się z otyłością centralną, insulinoopornością, wysokim stężeniem insuliny we krwi i zaburzeniami lipidowymi. Wszystkie te objawy tworzą obraz zespołu metabolicznego. MATERIAŁ I METODY. Badaniem objęto 113 osób: 46 mężczyzn i 67 kobiet w wieku 61 ± 35 lat leczonych z powodu cukrzycy typu 2 z współistniejącą chorobą niedokrwienną serca, nadciśnieniem tętniczym oraz otyłością. Analizowano wybrane parametry metaboliczne w odniesieniu do płci, wieku i współistnienia nadciśnienia tętniczego, CAD oraz wskaźnika masy ciała (BMI, body mass index). WYNIKI. W badanej grupie chorych znamiennie częściej CAD występowała u kobiet, natomiast nadciśnienie tętnicze w obu grupach występowało jednakowo często. W grupie kobiet częściej niż u mężczyzn CAD współistniała z cukrzycą typu 2. Wyższe wartości BMI częściej odnotowano u kobiet niż u mężczyzn. W grupie mężczyzn chorujących na CAD wartości BMI były wyższe w porównaniu z mężczyznami, u których choroba ta nie wystąpiła. U kobiet wartości BMI były porównywalne, niezależne od CAD. W grupie kobiet stwierdzono wyższe niż u mężczyzn stężenia cholesterolu frakcji HDL i frakcji LDL. WNIOSKI. Wiek to najistotniejszy czynnik ryzyka CAD. Podwyższone stężenie glukozy na czczo wpływa na zmniejszenie stężenia cholesterolu frakcji HDL u kobiet, a u mężczyzn na zwiększenie stężenia cholesterolu frakcji LDL. Większe ryzyko wystąpienia nadciśnienia tętniczego u chorych na cukrzycę typu 2 zależny od hipercholesterolemii.INTRODUCTION. Diabetes is one of the most common metabolic diseases. One of the most relevant complication of diabetes is early development of coronary artery disease (CAD). The onset and the progress of CAD is different in patients with and without diabetes. Another illness connected with diabetes is hypertension. In insulin- non depended diabetes, hypertension is connected with central obesity, insulin resistance, high level of insulin in blood and lipid disorders. All those symptoms together are called metabolic syndrome. MATERIAL AND METHODS. In 113 patients, 46 male and 67 female, correlations between individual metabolic disorders in diabetes type 2 (lipid disorders: total cholesterol, LDL-cholesterol, HDL-cholesterol; triglyceride; fasting glucose) were analysed. RESULTS. Research concerns connections between metabolic disorders and CAD, hypertension and obesity, illnesses which are closely connected with diabetes (depending on age and sex). CONCLUSIONS. Age is the most important risk factor of CAD in patients with diabetes type 2. It was observed, that increased level of fasting glucose and high value of BMI have significant influence on a reduction of HDL-cholesterol level, which is independent risk factor of CAD development. Hypercholesterolaemic patients with diabetes type 2 are at the risk of increased hypertension

fT3:fT4 ratio in Graves’ disease : correlation with TRAb level, goiter size and age of onset

Introduction: Graves’ Disease (GD) is an autoimmune hyperthyroidism occurring mostly in young women. The main pathogenic role of the disease is attributed to TSH receptor antibodies (TRAb), which stimulate the thyroid gland to increase production of the most active thyroid hormone- triiodothyronine (T3). High level of TRAb and a large goiter size are commonly known as poor prognostic factors for the disease and are used to predict relapse. The aim: The purpose of our study was to check the correlation between fT3:fT4 ratio with TRAb concentration, total volume of thyroid and age of GD onset. Materials and Methods: 114 patients with onset or relapse of GD were analyzed. Those after thyroidectomy or radioiodine therapy were not taken into analysis. The data was retrospectively retrieved from the hospital’s records consisting of patients’ sex, age, level of TRAb, fT3, fT4 and thyroid volume on ultrasonography. The association between fT3:fT4 and TRAb concentration, thyroid volume and age was evaluated using Pearson correlation coefficient. Results: The group was predominated by women (19.3% men, 80.7% women). The average age was 47.0. The analysis revealed positive correlation between: 1) fT3:fT4 ratio and total volume of thyroid (correla-tion ratio: 0.37; p <0.05) 2) fT3:fT4 ratio and level of TRAb (correlation ratio: 0.26; p <0.05) 3) negative correlation between fT3:fT4 ratio and patient’s age (correlation ratio: -0.14; p = 0.144.Conclusions: Positive correlations between fT3:fT4 ratio and TRAb level and total volume of thyroid (poor predictors of GD) may confirm that high level of fT3 can also be a prognostic factor for GD severity

Ectopic ACTH syndrome of different origin-Diagnostic approach and clinical outcome : experience of one Clinical Centre

PurposeEctopic Cushing Syndrome (EAS) is a rare condition responsible for about 5-20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production-especially neuroendocrine tumors with other neoplasms.MethodsTwenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed.ResultsHalf of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia.ConclusionEAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients

A rare case of aggressive, hereditary paraganglioma associated with a pathogenic variant in SDHD

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Nieinsulinowa hipoglikemia trzustkowa u dorosłych — przegląd genetyki

  Hyperinsulinaemic hypoglycaemia (HH) is also classically referred to as “nesidioblastosis”. Heterogeneous clinical manifestation of the disease causes risk of late diagnosis or even misdiagnosis. In infants and children, it can lead to serious and permanent damage to the central nervous system, which leads to the manifesting mental retardation. HH is characterised by unregulated insulin secretion from pancreatic β-cells. This effect has been correlated with nine genes: ABCC8, KCNJ11, GCK, GLUD-1, HADH1, SLC16A1, HNF4A, HNF1A, and UCP2. Mutations in these genes were found in approximately 48% of cases. The genetic background of the remaining cases is unknown. Understanding the genetic basis of familial hyperinsulinism has changed the early look at the disease. It has allowed for the differentiation of specific types of the disease. Depending on which of the nine disease-associated loci bears a pathogenic mutation, they differ in phenotype and pattern of inheritance. This review provides a brief overview of the genetic mechanisms of HH and its possible clinical presentations. (Endokrynol Pol 2015; 66 (4): 344–354)    Hipogligemia hiperinsulinemiczna (HH) określana jest również terminem „nesidioblastoza”. Różnorodna kliniczna manifestacja choroby powoduje ryzyko późnej diagnozy, a nawet braku rozpoznania. U niemowląt i dzieci nesidioblastoza prowadzić może do ciężkich i trwałych uszkodzeń centralnego systemu nerwowego, manifestujących się w postaci niedorozwoju umysłowego. Hipogligemia hiperinsulinemiczna charakteryzuje się nieuregulowanym wydzielaniem insuliny przez komórki β trzustki. Efekt ten powiązany został z dziewięcioma genami: ABCC8, KCNJ11, GCK, GLUD-1, HADH1, SLC16A1, HNF4A, HNF1A i UCP2. Mutacje występujące w wymienionych genach znajdowane są u 48% chorych. Genetyczne podłoże pozostałych przypadków pozostaje nieznane. Zrozumienie genetycznej przyczyny rodzinnej postaci hiperisnulinizmu zmieniło sposób, w jaki postrzegano chorobę. Pozwoliło na wyróżnienie poszczególnych jej typów. W zależność od tego, w którym z dziewięciu zasocjowanych z chorobą loci występuje patogenna mutacja, typy różnią się fenotypem i sposobem dziedziczenia. Praca stanowi krótki przegląd genetycznych patomechanizmów choroby obserwowanych w HH oraz ich możliwych prezentacji klinicznych. (Endokrynol Pol 2015; 66 (4): 344–354)

Glucagon-like peptide-1 receptor imaging with [Lys^{40}(Ahx-HYNIC-^{99m}Tc/EDDA)NH_2]-Exendin-4 for the diagnosis of recurrence or dissemination of medullary thyroid cancer : a preliminary report

Introduction. Epidemiological studies on medullary thyroid cancer (MTC) have shown that neither a change in stage at diagnosis nor improvement in survival has occurred during the past 30 years. In patients with detectable serum calcitonin and no clinically apparent disease, a careful search for local recurrence, and nodal or distant metastases, should be performed. Conventional imaging modalities will not show any disease until basal serum calcitonin is at least 150 pg/mL. The objective of the study was to present the first experience with labelled glucagon-like peptide-1 (GLP-1) analogue [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 in the visualisation of MTC in humans. Material and Method. Four patients aged 22–74 years (two with sporadic and two with MEN2 syndrome-related disseminated MTC) were enrolled in the study. In all patients, GLP-1 receptor imaging was performed. Results. High-quality images were obtained in all patients. All previously known MTC lesions have been confirmed in GLP-1 scintigraphy. Moreover, one additional liver lesion was detected in sporadic MTC male patient. Conclusions. GLP-1 receptor imaging with [Lys40(Ahx-HYNIC-99mTc/EDDA)NH2]-exendin-4 is able to detect MTC lesions. GLP-1 scintigraphy can serve as a confirmatory test in MTC patients, in whom other imaging procedures are inconsistent