Incretin System: New Pharmacological Target in Obese Women with Polycystic Ovary Syndrome

Introduction: Obesity is highly prevalent in polycystic ovary syndrome (PCOS). It aggravates adverse features of the syndrome. Weight management by lifestyle intervention is often insufficient. We reviewed studies addressing the use of agents mediating through incretin system in obese PCOS

Efficacy of GLP-1 RA Approved for Weight Management in Patients With or Without Diabetes: A Narrative Review

The approval of once daily liraglutide, 3.0 mg, and once weekly semaglutide, 2.4 mg, for chronic weight management provides a novel effective strategy against obesity. The reliable models that might predict weight reducing potential at the individual level have not been identified yet. However, the coexistence of diabetes has been consistently related with less effective response than in people without this comorbidity. We aimed to review the efficacy of GLP-1 RAs approved for weight management in individuals with and without diabetes and discuss some potential mechanisms for consistently observed differences in efficacy between these two populations. The mean weight loss difference between GLP-1 RAs and placebo as add-on to lifestyle intervention in patients with diabetes was 4% to 6.2% compared to 6.1 to 17.4% in people without diabetes. Semaglutide compared to liraglutide resulted in greater weight loss. Some hypothetical explanations for the weaker anti-obesity response for both GLP-1 RAs in people with diabetes include the background medications that promote weight gain, the fear of hypoglycaemia inherently related to the treatment of diabetes, a decrease in glycosuria and subsequently less weight loss in diabetics, an altered microbiota in patients with obesity and diabetes and a genetic background that predispose to weight gain in patients with diabetes. Moreover, people with diabetes may have had obesity for longer and may be less adherent to exercise, which seems to potentiate the effects of GLP-1 RA. Emerging multimodal approaches combining peptides targeting receptors at different levels might therefore be of additional benefit particularly in patients with diabetes

Interplay between Oxidative Stress and Chronic Inflammation in PCOS: The Role of Genetic Variability in PCOS Risk and Treatment Responses

PCOS is often accompanied by insulin resistance, which is associated with the pathogenesis of the syndrome and increases the risk of developing the metabolic syndrome, type 2 diabetes, and cardiovascular complications. All these processes are characterized by chronic inflammation, which may be associated with an increased formation of reactive oxygen species and activation of inflammatory pathways that may further aggravate the function of pancreatic beta-cells. It has been shown that PCOS treatment improves metabolic indexes, while at the same time lowering inflammatory indicators. This chapter summarizes the latest findings about the role of oxidative stress and chronic inflammation in pathogenesis of PCOS. It also provides information on genetic variability in these pathways that may lead to interindividual differences in the risk for PCOS-related metabolic complications. Furthermore, genetic variability in these pathways may influence response to different treatment options in PCOS patients

Impact of COVID-19 Pandemic on Disease Control Status and Quality of Life of Patients with Acromegaly

Background and Objectives: Despite the best efforts of healthcare workers and the deployment of alternative healthcare delivery solutions through telemedicine, the pandemic has disrupted standard care for patients with chronic conditions. The long-lasting pandemic has also had a profound impact on the quality of life (QoL) of the majority of patients with chronic illnesses. The management of rare diseases has been particularly challenging. We aimed to evaluate the impacts that the long-lasting pandemic had on the disease control status and QoL in patients with acromegaly. Materials and Methods: Our prospective study included 34 patients from a national referral centre. The baseline SAGIT and AcroQoL results were obtained in October 2020 during the lockdown period of the SARS-CoV2 pandemic. The follow-up results were assessed during the summer of 2022 in a period without any public health restrictions. All the patients were additionally evaluated for their attitude towards preventative public health measures against SARS-CoV2 spread and required mask wearing during the pandemic. Results: By comparing assessments in 2020 during the lockdown period and 2022 post-lockdown, we observed some improvement in SAGIT subscores T and I, most likely reflecting treatment changes in a small number of patients. The global SAGIT score remained stable. QoL measurement by AcroQoL did not demonstrate any changes. There was a negative correlation between SAGIT subscore S and the AcroQoL results. We also noted that the group of patients with the most negative attitude toward public health measurements for preventing SARS-CoV2 spread had higher AcroQoL results than others. Conclusion: Our results showcase that the SARS-CoV2 pandemic, lasting over two years, did not impact the disease control status and QoL in patients with acromegaly. The cohort continued to be well controlled and without changes in QoL. We measured a relatively favourable attitude towards the public health measures to prevent the spread of SARS-CoV2; in particular, patients who had a lower QoL had more positive attitudes towards these measures

Strokovna stališča Združenja endokrinologov Slovenije o obravnavi glukokortikoidne osteoporoze

Zdravljenje z glukokortikoidi je najpogostejši vzrok sekundarne osteoporoze. Za glukokortikoidno osteoporozo je značilno zelo hitro zmanjšanje mineralne kostne gostote z naglim zvišanjem tveganja za osteoporozne zlome, zato priporočamo ob uvedbi glukokortikoida oceniti bolnikovo tveganje za zlom in mu svetovati glede zdravega načina življenja ter vnosa kalcija, vitamina D in beljakovin. Če je indicirano, uvedemo tudi eno od zdravil za zaščito kosti, s čimer povečamo mineralno kostno gostoto in zmanjšamo tveganje za zlome vretenc. Večinoma predpišemo bisfosfonate, bolj ogroženim bolnikom, ki so zlome že utrpeli, lahko tudi teriparatid

Individualizacija magistralnog hormonskog liječenja kod bolesnice s kemoterapijom induciranom prijevremenom insuficijencijom jajnika i smanjenom jetrenom funkcijom: prikaz slučaja

Although the use of commercially manufactured hormone therapy (HT) to treat menopausal symptoms has declined during the past 12 years, the use of custom compounded HT seems to have increased. A 39-year-old woman with refractory anemia sustained premature ovarian insufficiency following allogeneic stem cell transplantation. After systemic biologic treatment (azacitidine) and corticosteroid therapy, besides extreme climacteric symptoms (Green Climacteric Scale, 59) and impaired quality of life, she also had elevated liver enzymes. Therefore, she was not a candidate for oral HT. Treatment was started with 17-beta estradiol patch 0.5 mg (Climara) together with micronized progesterone intravaginally, 2x100 mg (Utrogestan) for 3 months. She was not satisfied, so the custom compound HT started with 17-beta estradiol 0.5 mg gel 2x/day and micronized progesterone in liposomal gel 100 mg/daily. She was much better but she complained of low libido, decreased sex drive and emotional instability, so 1% testosterone gel was added. Now she was completely satisfied, Green Climacteric Scale was 8 and liver enzymes were normal. In conclusion, custom compound HT has the possibility of tailoring and adjusting therapy to the individual need, which has been the everlasting goal in menopause medicine and should be a good option for special clinical cases.Premda je upotreba komercijalno pripravljene hormonske terapije u liječenju klimakteričnih simptoma u posljednjih 12 godina u padu, čini se da je upotreba magistralnih hormonskih pripravaka u porastu. Žena u dobi od 39 godina s refraktornom anemijom doživjela je prijevremenu insuficijenciju jajnika nakon transplantacije matičnih stanica. Nakon sistemskog biološkog liječenja azacitidinom i kortikosteroidima, uz izrazite klimakterične tegobe (Greenov indeks 59) i smanjenu kvalitetu života imala je povišene jetrene enzime. Zbog toga nije bila kandidat za oralnu hormonsku terapiju. Započeto je liječenje 17-beta estradiolom u obliku naljepka od 0,5 mg (Climara) zajedno s mikroniziranim progesteronom intravaginalno 2x100 mg (Utrogestan) kroz 3 mjeseca. Nije bila zadovoljna terapijom pa su joj propisani magistralno pripravljeni hormoni. Započelo se s primjenom 17-beta estradiola u obliku 0,5 mg gela 2x/dan i mikroniziranog progesterona u liposomalnom gelu 100 mg/dnevno. Bolje se je osjećala, ali još uvijek se žalila na smanjeni libido i emocionalnu nestabilnost pa je dodan 1% testosteron. Sad je bila potpuno zadovoljna terapijom, Greenova klimakterijska ljestvica bila je 8, a jetreni enzimi su se normalizirali. U zaključku, magistralni hormonski pripravci pružaju mogućnost titracije i prilagođavanja terapije individualnim potrebama, što je stalni cilj u menopauzalnoj medicini i mogao bi biti dobra mogućnost za posebne slučajeve

Natural history of nonfunctioning adrenal incidentalomas: a 10-year longitudinal follow-up study

Most data on the natural history of nonfunctioning adrenal incidentalomas (NFAI) are provided by follow-ups up to 5 years. We conducted a 10.5 (9.1–11.9)-year prospective follow-up study of NFAI in 67 participants (20 (29.9%) males, 47 (70.1%) females) of mean age 57.9 (52.3–63.9) years and BMI 27.42 (24.07–30.56) kg/m2). We also evaluated the associations between baseline BMI and changes of NFAIs’ characteristics at follow-up. Progression to mild autonomous cortisol excess (MACE) was observed in 15 (22 %) patients, with 14 of them having post overnight dexamethasone suppression test (ODST) cortisol between 50 and138 nmol/L and only one > 138 nmol/L. The progression rate was significantly higher in overweight and obese than in normal-weig ht subjects. Patients that developed MACE had a significantly higher baseline mean cortisol after 1 mg ODST. Tumor enlargement ≥10 mm occurred in 8.9% of patients. In comparison with reports of shorter observational periods, we observed a higher growth rate ≥ 10 mm and higher progression rate from NFAI to MACE, particularly in overweight and obese subjects. All tumors had persistent radiological characteristics typical for adrenal adenoma. We concluded that the duration of the follow-up period is an important factor in characterizing the natural history of NFAI. Higher baseline BMI and higher baseline cortisol after ODST might predict the long-term likelihood of progression in hormonal activity. The magnitudes of observed progressions in growth or hormonal activity were clinically ins ignificant. Our long-term follow-up, therefore, clearly supports the general view that a long-term monitoring of patients with NFAI is not necessary

Terminologija klinične prehrane: Motnje prehranjenosti in s prehranjenostjo povezana stanja

Izhodišča: Prehransko stanje posameznika uvrščamo med ključne dejavnike njegovega zdravja. Za učinkovito individualno in multidisciplinarno obravnavo stanj, povezanih s prehranskim stanjem posameznika, moramo dobro poznati terminologijo klinične prehrane. Ker je klinična prehrana kot medicinska stroka razvita tudi pri nas, v tujini pa so tovrstni terminološki dokumenti že na voljo, želimo tudi v Sloveniji na podlagi konsenza oblikovati enotno terminologijo. Metode: Prispevek je osnovan na podlagi eksplicitnega terminološkega dogovora. K sodelovanju smo povabili obsežno skupino relevantnih slovenskih strokovnjakov s kliničnih, predkliničnih in drugih področij, ki so povezana z dejavnostjo klinične prehrane v medicini, pri oblikovanju pa je sodeloval tudi terminolog s področja medicine. Kot izhodišče smo izbrali terminološke smernice Evropskega združenja za klinično prehrano in presnovo ter ob njih upoštevali najnovejša strokovna priporočila za posamezne pojme. Avtorji so bili v stiku prek osebnih srečanj in elektronske pošte. Pri končnem oblikovanju konsenza je sodelovalo 42 avtorjev iz 19 slovenskih ustanov. Rezultati: Predstavljamo temeljne pojme, terminološke definicije in pripadajoče slovenske termine s področja klinične prehrane. Opredelili smo osnovne motnje prehranjenosti – podhranjenost, prekomerno hranjenost, neravnovesje mikrohranil in sindrom ponovnega hranjenja. Poleg tega smo opredelili tudi s prehranjenostjo povezana stanja – sarkopenijo in krhkost. Osnovne pojme smo podprli s kliničnim kontekstom, v katerem nastopajo. Zaključki: Poenoteno razumevanje osnovnih patoloških stanj, ki jih obravnava klinična prehrana, je izhodišče za nadaljnji razvoj stroke, poleg tega pa je podlaga tudi za prehransko obravnavo in učinkovito prehransko oskrbo

Terminologija klinične prehrane: Prehranska obravnava – presejanje prehranske ogroženosti in prehranski pregled

Izhodišča: Pomembno vlogo pri prehranski obravnavi imata tako presejanje prehranske ogroženosti kot prehranski pregled, na podlagi katerega lahko postavimo diagnozo motnje prehranjenosti ali s prehranjenostjo povezane motnje. Ocena posameznikovega prehranskega stanja, ki jo pridobimo s prehransko obravnavo, je namreč ključna za načrtovanje učinkovite prehranske oskrbe. Za razvoj področja je pomembno, da so vsi termini, ki se uporabljajo pri kliničnem delu, usklajeni. Taki terminološki dokumenti v mednarodnem prostoru že obstajajo, smiselni pa so tudi za slovenščino in naše okolje. Metode: Prispevek temelji na eksplicitnem terminološkem dogovoru skupine 42 relevantnih slovenskih strokovnjakov iz 19 slovenskih ustanov. Osnova oblikovanja terminoloških smernic je terminološki dokument Evropskega združenja za klinično prehrano in presnovo, pri čemer so bili upoštevani tudi novejši izsledki klinične prehrane. Rezultati: Predstavljeni so slovenski termini in terminološke definicije s področja klinične prehrane. Opredeljeni so osnovni pojmi s področja prehranske obravnave, ki je praviloma del medicinske obravnave. Predstavljena sta pojma prehranska ogroženost in presejanje prehranske ogroženosti, ob čemer so navedeni tudi različni presejalni testi za presejanje prehranskih motenj in s prehranjenostjo povezanih stanj. Podrobno so opredeljeni tudi prehranski pregled in njegovi sestavni deli. Zaključki: Tako presejanje prehranske ogroženosti kot prehranski pregled sta bistvena za diagnostično obravnavo v okviru klinične prehrane, poenoteno razumevanje terminologije pa omogoča primerno prepoznavo patoloških stanj pri bolnikih in pripravo ustreznega načrta prehranskih ukrepov