Dehydroepiandrosterone Sulfate and Arterial Hypertension

Dehydroepiandrosterone sulfate (DHEAS) is a steroid molecule whose function and mechanism of action in the human body are still inadequately researched. A potential protective function for the cardiovascular system can be explained by activation of nitric oxide production, impact on endothelial and mitochondrial function, and inhibition of proinflammatory cytokine production (IL-6 and TNF-α). Some research shows the beneficial effects of DHEA/DHEAS on many bodily functions, especially in the cardiovascular and the neurological systems. However, we need to be careful with interpretation of the results because of different criteria used for defining arterial hypertension, the race that was observed, and reproductive status of women, as these factors can change the conclusion. Due to a lack of evidence, DHEAS supplementation is still not recommended. We need multicentric prospective and randomized studies on DHEAS to examine its potential impact on blood pressure regulation and cardiovascular risk

Medical students\u27 attitudes towards terminology of obesity

Introduction: Obesity, one of the most common health problems encountered in medicine with implications in various other health issues, is nowadays omnipresent. Terminology describing diagnosis of obesity might be considered rude or offensive. Since perception of obese people is sometimes associated with negative attitudes and stereotypes, proper terminology used by physicians is crucial

Exercise heart rate recovery in obesity

Introduction: Obesity is an epidemic that carries significant cardiovascular (CV) burden. Autonomic dysfunction, characterized by reduced vagal tone and sympathetic overactivity, has been found in diabetes, hypertension, heart failure, metabolic syndrome, and other conditions. Heart rate decrease after exercise, or heart rate recovery (HRR) reflects cardiac autonomic activity. Decreased HRR is a powerful predictor of CV disease, CV and all-cause mortality.1-3 Patients and Methods: A total of 54 obese patients (24% male, 76% female), age 22-66 (mean 47 year), BMI 29.4-53.3 (mean 40.3 kg/m2), were enrolled in a multidisciplinary weight management program. Treadmill testing was done initially and after 6-month follow-up. Standard Bruce protocol was used to assess exercise capacity and passive HRR (15 sec, 3 and 6 min into the recovery period, as per institutional protocol). Control group was composed of age- and sex-matched non-obese subjects. Results: Obese subjects had significantly slower HRR (HRR0:15 6.1 vs. 9.1 BPM, HRR3:00 57.8 vs. 66.6 BPM, HRR6:00 63.3 vs. 72.7 BPM; p=0.0216, 0.0006, 0.0004, respectively). Exercise capacity was also significantly lower in comparison to control (6.7 vs. 8.6 METs; p=0.000001), with reduced exercise time (6.0 vs. 8.2 min; p=0.000001). Sixteen subjects that reached 6-month follow-up lost 5.4 kg on average. Exercise capacity increased mildly (6.4 to 7.1 METs; NS), as well as total exercise time (5.6 to 6.6 min; NS). Discussion and Conclusion: Physiological HRR kinetics follows exponential decay function. Rapid first phase, mediated by vagal reactivation is followed by a gradual HRR decline, dominated by sympathetic withdrawal. We found significantly slower HRR over different time-points in the obese, which reflects autonomic imbalance. Functional aerobic capacity was also significantly reduced. Somewhat improved functional capacity and dynamics of HRR after weight loss did not reach statistical power. To conclude, we found evidence of significantly impaired cardiac autonomic function in obese subjects, together with reduced functional capacity. As the study is ongoing, we hope to demonstrate sustained effect of exercise and diet on autonomic function. Potential benefit on mortality and CV risk reduction should encourage patients and health care providers to manage obesity more vigorously

Estradiol impact on hypertension profile in obese patients

Introduction: Obesity is a well-known risk factor for developing hypertension. Prehypertensive patients (with an average 24h monitored blood pressure between 120/85 and 139/89mmHg) rarely get physician’s attention despite their differences from non-hypertensive patients.1,2 Patients and Methods: We enrolled 42 obese female patients (age range from 26 to 69 years) from a multidisciplinary weight management program (BMI range 30 to 49.9 kg/m2). Firstly, because of estradiol levels, patients were divided into two groups, younger than 50 years (A) and older (B). Due to the average values of patient’s ambulatory monitored blood pressure, patients were additionally put into three groups (1 = below 120/85mmHg, 2 = between 120/85 to 139/89mmHg 3 = above 140/90mmHg). Systolic dipping profile, estradiol levels, and average nocturnal heart rate were also checked. Results: Prehypertensive obese patients older than 50 years (B) had higher nocturnal heart rate (58.50 vs. 70.25/min; p<0.05). Even though differences were found in younger patients, they were not statistically significant. Systolic dipping profile was different and age-dependent (Non-dippers A: 44.00%; B 82.35%; p=0.02). The number of non-dippers in the younger group was highest in group 2 (66% vs. 20% in group 1; p=0.03) while there were no differences in the older group. The prehypertensive group had very similar results to hypertensive patients. Estradiol levels (Figure 1) were age independently lower in non-dippers (A: 185.5 vs. 201.07, NS; B: 71.9 vs. 87.0, NS) and also in hypertensive patients (A: 111.0 vs 192.6 pmol/L, p=0.21; B: 59.0 vs. 98.0 pmol/L). Conclusion: Our results showed that estradiol levels seem to be protective in terms of blood pressure stability, systolic dipping profile and nocturnal heart rate probably due to its impact on autonomic nerve system functionality. Because of a small number of patients further investigation is needed to prove the statistical significance of this statement

Maligni limfomi štitnjače

Primary thyroid lymphoma is a rare disease that accounts for about 5% of all thyroid neoplasms. It shows a female predominance, especially in women with a pre-existing Hashimoto.s disease. During a 15-year period, 11 patients were diagnosed with primary thyroid lymphoma at Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital. There were no records on associated Hashimoto.s thyroiditis in any of them, which is inconsistent with the international literature reporting on such association in 40%-80% of cases. Painless neck edema was the most common physical symptom for patient presentation. The diagnosis was based on fine needle aspiration cytology, while the spread of disease to other organ systems was ruled out by other studies (computed tomography, ultrasonography and gallium scintigraphy). However, it should be noted that diffuse or nodular lymphoma cannot always be classified only by aspiration cytology. The World Health Organization classification was used. Today, it has been generally accepted that thyroid lymphomas belong to a group of lymphomas associated with mucosa-associated lymphoid tissue (MALT). The most common form of nonHodgkin\u27s lymphoma (NHL) of the thyroid was B-cell phenotype lymphoma with a high malignancy grade. All patients were treated with chemotherapy according to the CHOP protocol (cyclophosphamide, doxorubicin, vincristine, prednisone). Eight patients underwent surgical treatment, three of them for compressive syndrome, followed by radiotherapy. The follow-up of patients with primary thyroid lymphoma revealed high disease aggressiveness and short survival, while complete remission was only occasionally recorded.Primarni limfomi štitnjače su rijetka bolest, a pojavljuju se u oko 5% slučajeva svih neoplazma štitnjače. Češće se javljaju kod žena, osobito onih s prethodno postojećom Hashimotovom bolešću. U Zavodu za hematologiju Kliničke bolnice "Sestre milosrdnice" u 15-godišnjem razdoblju dijagnosticirano je 11 bolesnika s primarnim limfomom štitnjače. Ni za jednog bolesnika, međutim, nije se znalo da boluje od pridruženog Hashimotovog tiroiditisa, što se ne uklapa u podatke iz svjetske znanstvene literature koji govore o 40%-80%. Najčešći simptom koji je doveo bolesnika na pregled liječniku bila je bezbolna oteklina vrata. Dijagnoza je postavljena putem aspiracijske citopunkcije, a ostalim pretragama (CT, UZV, scintigrafija tijela radiogalijem) isključena je proširenost bolesti u druge organske sustave (staging). Treba, međutim, napomenuti kako isključivo citopunkcijom nije uvijek moguće klasificirati difuzni i nodularni limfom. Klasifikacija je provedena prema Svjetskoj zdravstvenoj organizaciji. Danas je općenito prihvaćeno mišljenje da limfomi štitnjače pripadaju skupini limfoma pridruženih mukoznom limfatičnom tkivu (MALT, mucosa associated lymphoid tissue). Najčešći oblik ne-Hodgkinovog limfoma (NHL) štitnjače bio je B stanični fenotip visokog stupnja malignosti. Svi bolesnici su liječeni kemoterapijom po shemi CHOP (ciklofosfamid, doksorubicin, vinkristin, prednizon), a kod 8 bolesnika je primijenjen kirurški zahvat, od toga kod troje zbog kompresivnog sindroma, a potom je provedena radioterapija. Praćenjem bolesnika s primarnim limfomom štitnjače uočena je velika agresivnost bolesti i kratko preživljavanje, ali su rjeđe moguće i potpune remisije

Panhipopituitarizam u 45-godišnje bolesnice: prikaz slučaja

A case of a 45-year-old woman with untreated panhypopituitarism is presented. Hypopituitarism is a rare disorder consisting of multiple deficiencies of hormones originating from the adenohypophysis. It is divided into primary and secondary. Primary disorders manifest at the pituitary level, whereas secondary hypopituitarism implies hypothalamic affection. Partial or total loss of all pituitary hormones is called panhypopituitarism. Hypopituitarism can be slow and insidious or severe and life-threatening. The expression of symptoms largely depends on the patient\u27s age and the hormones involved. The leading symptom is growth retardation when the disorder develops in childhood or puberty. Sometimes years may elapse without accurate diagnosis, as in the case described. To date, only a few cases of untreated hypopituitarism have been published. In our patient, clinical examination revealed short stature and weak osteomuscular constitution, primary amenorrhea and lack of development of secondary sex characteristics. The patient\u27s clinical history revealed signs of hypopituitarism from childhood, which had been untreated until she presented to our clinic. The results of complete testing showed the lack of all pituitary hormones and antidiuretic hormone, which was consistent with panhypopituitarism, including central diabetes insipidus.Prikazuje se slučaj 45-godišnje bolesnice s neliječenim panhipopituitarizmom. Hipopituitarizam je rijedak poremećaj koji obilježava manjak više hormona prednjega režnja hipofize. Može biti primaran ili sekundaran. Primarni poremećaji nastaju na razini hipofize, dok su sekundarni na razini hipotalamusa. Djelomičan ili potpun manjak svih hormona hipofize naziva se panhipopituitarizam. Tijek hipopituitarizma može biti spor i podmukao ili nagao i životno ugrožavajući. Izražajnost simptoma ovisi prvenstveno o dobi bolesnika te zahvaćenim hormonima. Vodeći simptom je zaostajanje u rastu, kada bolest zahvati bolesnika u djetinjstvu ili pubertetu. Ponekad može proći niz godina bez potpune dijagnoze, kao što je opisano i u naše bolesnice. Do danas je objavljeno svega nekoliko slučajeva neliječenog hipopituitarizma. Kliničkim pregledom naše bolesnice nađen je nizak rast i slaba osteomuskularna građa, primarna amenoreja i nerazvijene sekundarne spolne značajke. Anamnestički podaci otkrivaju sliku hipopituitarizma od dječje dobi, ali bolesnica nije liječena do dolaska u našu kliniku. Rezultati sveobuhvatne obrade pokazali su manjak svih hormona hipofize i antidiuretičnog hormona, što govori u prilog panhipopituitarizma, uključujući i centralni dijabetes insipidus