Pituitarni apsces neuobičajenog kliničkog tijeka

The aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of inflammatory markers. The presence of expansile sellar lesion, showing restricted diffusion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confirmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fibrotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic inflammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic inflammatory changes with granulation tissue proliferation, mimicking macroadenoma.Cilj rada je prikaz neuobičajenog kliničkog tijeka i magnetsko-rezonantnih (MR) karakteristika pituitarnog apscesa. Bolesnik je bio 59-godišnji muškarac s groznicom, poliurijom, polidipsijom i gubitkom tjelesne mase u posljednja dva mjeseca. Osnovni endokrinološki testovi ukazali su na poremećaj funkcije adenohipofize, udružen s centralnim insipidnim dijabetesom i povišenom razinom upalnih biljega. Pregled pomoću MR je otkrio ekspanzivnu leziju u selarnoj regiji sa znacima restrikcije difuzije, nalaz kompatibilan s pituitarnim apscesom. Nakon primjene antibiotika tijekom sljedećih nekoliko tjedana došlo je do regresije apscesa, a odgovarajuće nadomještanje hormona postignuto je primjenom L-tiroksina, hidrokortizona, testosterona i dezmopresina. Sedamnaest mjeseci kasnije uočeno je pogoršanje kliničkog stanja s opetovanim pituitarnim apscesom, što je potvrđeno pomoću MR. Nakon primijenjene terapije došlo je do ponovne regresije apscesa. Međutim, kontrolni pregled pomoću MR tri godine nakon prvog otkrio je prisustvo pituitarnog tumora s obilježjima makroadenoma, zbog čega je provedena kirurška intervencija. Patohistološka analiza je dokazala prisustvo fibroze udružene s granulacijskim tkivom, rijetkim staničnim elementima, karakteristično za kroničnu upalu. U literaturi ne postoje studije koje prikazuju kroničnu evoluciju pituitarnog apscesa s kroničnim upalnim promjenama koje oponašaju makroadenom

The quality of life in patients with diabetes mellitus type 2

Background/Aim. Through its various activities, World Health Organization (WHO) contributed to increasing the understanding of the concept of quality of life. People with diabetes have a lower quality of life than people without chronic illnesses. The aim of this study was to examine the differences in the quality of life, related to health, in patients with diabetes mellitus (DM) type 2 by age, gender and type of therapy. Methods. We performed a cross-sectional study at the outpatient department of the Clinical Center in Novi Sad and the Health Center Ruma - General Practice. The group consisted of 90 patients with DM type 2, 41 men and 49 women. The age of respondents was from 40 to 80 years and they were classifed into four groups according to the ten-year age intervals. We applied WHO Quality of life questinnaire - BREF 100 composed of four domains: physical health, psychological health, social relationships and environment. The general questionnaire asks questions about socio-demographic data, duration of diabetes, the last value of blood glucose and glycosylated hemoglobin, training for self-control and its implementation, informing patients about their disease, therapy and its impact on daily activities and the presence of comorbidity. In statistical analysis the following tests were used: Student’s t-test, Ftest, ANOVA (one way). Results. The average duration of DM type 2 was 11.2 ± 9.2 years. Most of the patients (76%) were trained to self-control and 91% received enough information about their disease. Oral hypoglycemic preparations were used by 49%, insulin by 21%, and oral drugs and insulin by 29% patients while 1% were on a special regime of a diet therapy. Daily activities were performed without difficulties by over 29%, with some difficulties by 41% and 30% of patients who could not perform daily activities. The patients with DM type 2 had significantly lower scors in all 4 domains of quality of life (physical health, psychological health, social relations, environment). The biggest influence was on physical domains (51.31). Education level had an impact on physical and psychological domains. Comorbidity was found in 83% of the respondents. The most common were: arterial hypertension (63%), chronic cardiovascular disease (46%), neuropathy (23%), impaired vision 24%, elevated blood lipids (39%) and amputation of toes or feet (2.2%). The average value HbA1C in the group with comorbidity was 8.47% and in the group without comorbidity 6.46%. The subjects with comorbidity had low quality of life assessment in relation to the group without comorbidity: the domain of physical health (45.64 vs 79.66), psychological health (50.3 vs 76.86), social relations (52.97 vs 75.46) and environment (52.7 vs 75.06). Conclusion. Diabetes mellitus type 2 has negative influence on the quality of life. It contributes to the presence of comorbidity. The occurrence of comorbidity was associated with higher glucosylated HbA1C values. There was no difference in the assessment of quality of life regarding gender, age, or the type of therapy used. The quality of life was assessed as low in patients with comorbidity. However, certain personality characteristics play a decisive role in self-evaluation

Autoimmune thyroid diseases in patients with chronic hepatitis C treated by pegylated interferon-alpha and ribavirin: A prospective study

Introduction/Objective. Despite sufficiently explained pathogenesis, today autoimmune thyroid diseases (AITD) are recognized as one of extra-hepatic manifestations of systemic hepatitis C virus infection. The aim of the present study was to determine clinical characteristics and to estimate the success of pegylated interferon-α2a plus ribavirin (pegIFN-α2a + RBV) therapy in patients with AITD as an extrahepatic manifestation of chronic hepatitis C infection (CHC). Methods. This prospective study included 91 CHC patients treated with pegIFN-α2a + RBV from 2010 to 2012 (39 women and 52 men, mean age 41.6 Ѓ} 11.9). The study group (group A) consisted of 31 patients with CHC and AITD. Control group (group B) consisted of 60 patients with CHC without AITD. We analyzed clinical, biochemical, virological, and histopathological markers of CHC, as well as response and side effects of pegIFN-α2a + RBV therapy. Results. There was a statistically significant difference in sex (p = 0.011), age (p = 0.001), AST level (p = 0.013), level of gamma globulins (p < 0.001), level of IgM (p = 0.007), IgG (p < 0.001), in the success of therapy of CHC with pegIFN-α2a + RBV between the groups. Odds ratio (OR) for unfavorable outcome in group A was 4.200 [95% confidence interval (CI): 1.545–11.417]. In final multivariate logistic regression analysis in group A, the only factor predicting sustained virological response was patients’ age (OR = 0.781; 95% CI: 0.603–0.959). The main side effects in group A were interferon induced thyroiditis (IIT) (41.9% vs. 3.3%; p < 0.001) and anemia, which was the only reason for dose reduction of ribavirin (29% vs. 6.7%; p = 0.027). Conclusion. Patients with AITD as an extra-hepatic manifestation of CHC achieve poorer virological response and their antiviral therapy is inevitably followed by a manifestation of adverse effects, predominantly solvable IITs and anemia

Osteoporosis reversibility in a patient with celiac disease and primary autoimmune hypothyroidism on gluten free diet: A case report

Introduction. Secondary osteoporosis occurs in many diseases. Celiac disease-induced osteoporosis is the consequence of secondary hyperparathyroidism. Biochemical bone markers show predominance of bone resorption, thus making the bisphosphonates the first line therapy option. Intestinal mucosal changes are reversible on gluten-free diet. Osteoporosis reversibility is also possible, provided postmenopausal osteoporosis risk factors independent from celiac disease are not present. Case report. We presented a postmenopausal woman with at least a 10-year history of celiac disease prior to diagnosis, which had overt secondary hyperparathyroidism with insufficient status of vitamin D and a significant bone mass reduction. At the time of diagnosis of celiac disease the patient was receiving 250 g of levothyroxine daily without achieving optimal substitution. Three years after the initiation of gluten-free diet the patient was without any signs and symptoms of the disease. All laboratory findings were within normal range. It was decided to treat the underlying disease and to supplement calcium and vitamin D without the initiation of bisphosponate therapy. Conclusion. Osteoporosis regression justified this therapeutic approach. The presence of primary autoimmune hypothyroidism makes this case specific, since the inability for optimal substitution therapy with a high daily dose of levothyroxine provoked the suspicion of celiac disease

Metabolic aspects of adult patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease and it encompasses a spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved in the occurrence of NAFLD and its progression are probably due to a metabolic profile expressed within the context of a genetic predisposition and is associated with a higher energy intake. The metabolic syndrome (MS) is a cluster of metabolic alterations associated with an increased risk for the development of cardiovascular diseases and diabetes. NAFLD patients have more than one feature of the MS, and now they are considered the hepatic components of the MS. Several scientific advances in understanding the association between NAFLD and MS have identified insulin resistance (IR) as the key aspect in the pathophysiology of both diseases. In the multi parallel hits theory of NAFLD pathogenesis, IR was described to be central in the predisposition of hepatocytes to be susceptible to other multiple pathogenetic factors. The recent knowledge gained from these advances can be applied clinically in the prevention and management of NAFLD and its associated metabolic changes. The present review analyses the current literature and highlights the new evidence on the metabolic aspects in the adult patients with NAFLD

Pituitary abscess with unusual clinical course

The aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of inflammatory markers. The presence of expansile sellar lesion, showing restricted diffusion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confirmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fibrotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic inflammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic inflammatory changes with granulation tissue proliferation, mimicking macroadenoma

The influence of hyperprolactinemia on coagulation parameters in females with prolactinomas

Introduction. Currently there is little information on the effects of prolactin (PRL) on the coagulation and fibrinolytic systems. Objective. The aim of this study was to evaluate the effects of hypeprolactinemia on the parameters of the hemostatic system and activation of the coagulation system. Methods. We studied PRL levels, body mass index (BMI), values of activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), D-dimer level, von Willebrand factor antigen (vWFAg) and fibrinogen in 15 young female patients with microprolactinomas before and after therapy and in 15 healthy female controls. Results. As expected, pretreatment PRL levels were significantly higher in patients than in controls (140.90±42.87 vs. 12.53±4.05 ng/ml; p<0.001). PT, although still in the normal range, was prolonged in patients with hyperprolactinemia as compared to the control group (13.53±1.39 vs. 12.65±0.53 s; p=0.03) and normalized after therapy (12.69±0.65 vs. 12.65±0.53 s; p=0.88). TT, although in normal range, was significantly shorter in the hypeprolactinemic patients than in the controls (14.34±4.52 vs. 17.21±1.35 s; p<0.025) and after treatment remained significantly shorter than in the controls (15.17±1.55 vs. 17.21±1.35 s; p<0.0001). D-dimer values before treatment in the patients with hyperproplactinemia were above the normal range (239.47±107.93 vs. 131.27±50.64 ng/ml, p=0.002) and decreased to normal values after therapy (239.47±107.93 vs. 146.60±39.15 ng/ml; p<0.001). D-dimer levels correlated with PRL (r=0.30) and the change in serum D-dimer values significantly correlated with the change in PRL levels during therapy (r=0.62). aPTT, vWFAg and fibrinogen were similar in patients and controls. Conclusion. In our study, increased thrombin generation that resulted in elevated D-dimer levels may be one of the contributing factors to the prethrombotic state in patients with hyperprolactinemia. [Projekat Ministarstva nauke Republike Srbije, br. 175033 i br. 174016