Osteoporoza pri moških – pomen hipogonadizma

Osteoporoza je sistemska bolezen kosti z znižano mineralno kostno gostoto in spremenjeno mikroarhitekturo kostnine, kar vodi do zlomov ob majhni sili. Čeprav pogosteje prizadene ženske, imajo moški zaradi osteoporoze več zapletov in višjo umrljivost po zlomih. Pri moških diagnozo osteoporoze večkrat postavimo šele po zlomu. Pogosteje je sekundarna, med najpomembnejšimi sekundarnimi vzroki je hipogonadizem, ki je prav tako podcenjeno, premalo prepoznano ter preredko diagnosticirano in zdravljeno stanje. Zdravljenje osteoporoze pri moških je kompleksno, vključuje nefarmakološke in farmakološke ukrepe. Cilj zdravljenja je preprečevanje zlomov. Nadomestno zdravljenje s testosteronom poleg pozitivnih učinkov na skelet pri hipogonadnih moških izboljša tudi kakovost življenja. Neposrednih dokazov, da bi zdravljenje s testosteronom zmanjšalo tveganje za osteoporozne zlome, zaenkrat ni. Pred uvedbo testosterona skupaj z bolnikom skrbno pretehtamo koristi in tveganja. Bisfosfonati, denosumab in teriparatid izboljšajo mineralno kostno gostoto in zmanjšajo tveganje za zlome vretenc. Učinkoviti so tudi pri moških z osteoporozo in s hipogonadizmom

The Molecular Electrostatic Potential as a Determinant of Receptor-Drug Recognition

The validity of the concept of the molecular electrostatic . potential and its applicability in rationalizing drug-receptor interactions are discussed on hand of examples covering the qualitative aspects. The computational methods are briefly reviewed with respect to economy and quality of results

Ab Initio MO Study of Hydrogen Bonded Complex: Noradrenaline - Formic Acid

The ioruic complex ethanolammoni:um-carboxylate serves as a model of the interaction between the noradrenaUne side chain and anionic sites in the biophase. Proton transfer properties amd the influence of water on this process were investigated using an ab initi<o MO method. In all cases considered the pro1tlon transfer from the side chain nitrogen to the carboxylate oxygen is ener. getically preferable and inclusion of a water hydration shell by the addition of 2 or 4 water molecules is not sufficient to stabilize the ionic form. The degree of covalency of hyd.rogen bonds was estimated to be rather large by considering MO energy levels, Mulliken population analysis and molecular electron density difference plots

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

Addison’s disease in patients with an unidentified panhypopituitary condition following observed atypical meningeoma (primary description)

Obsevanje je utečen in uspešen način zdravljenja možganskih tumorjev, vendar moramo vedeti, da ima poleg akutnih neželenih učinkov lahko tudi pozne posledice, ki se pokažejo šele leta po končanem zdravljenju. Med največkrat na ta način okvarjenimi organi so endokrine žleze, predvsem hipotalamus in hipofiza. Na podlagi kliničnega primera želimo pokazati, da bolniki po obsevanju glave nujno potrebujejo tudi redno endokrinološko testiranje in po potrebi ustrezno hormonsko nadomestno zdravljenje.Radiotherapy is a proven and successful way of treating brain tumors. One should be aware, however, of its acute side effects as well as late consequences, often only apparent years after concluded treatment. The endocrine glands, primarily the hypothalamus and pituitary gland, are the most commonly affected organs. We present a clinical case to illustrate that, after irradiation of the head, patients should have periodic endocrinological testing and adequate hormonal substitution, when necessary

The Molecular Electrostatic Potential as a Determinant of Receptor-Drug Recognition

The validity of the concept of the molecular electrostatic . potential and its applicability in rationalizing drug-receptor interactions are discussed on hand of examples covering the qualitative aspects. The computational methods are briefly reviewed with respect to economy and quality of results

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

Poti in stranpoti v diagnostiki primarnega aldosteronizma

Predstavljamo bolnika s tumorjem leve nadledvičnice, ki je bil vrsto let obravnavan zaradi odporne hipertenzije in hipokaliemije. Potrjen je bil izrazit primarni aldosteronizem, vendar kljub večkratnim poskusom s selektivno kateterizacijo nadledvičnih ven enostranske bolezni nismo uspeli dokazati. Z antagonisti mineralokortikoidnih receptorjev bolezni nismo uspeli obvladati, trdne osnove za operativno zdravljenje pa tudi ni bilo. Klinične in laboratorijske značilnosti bolnika so govorile za enostransko bolezen, zato smo ga napotili še na PET CT z 11-C-metomidatom v Veliko Britanijo. Tako smo dokazali enostransko bolezen in bolnika ozdravili z levostransko laparoskopsko adrenalektomijo

Addisonska kriza pri bolnici z neprepoznavnim panhipopituitarizmom po obsevanju atipičnega meningeoma

Radiotherapy is a proven and successful way of treating brain tumors. One should be aware, however, of its acute side effects as well as late consequences, often only apparent years after concluded treatment. The endocrine glands, primarily the hypothalamus and pituitary gland, are the most commonly affected organs. We present a clinical case to illustrate that, after irradiation of the head, patients should have periodic endocrinological testing and adequate hormonal substitution, when necessary.Obsevanje je utečen in uspešen način zdravljenja možganskih tumorjev, vendar moramo vedeti, da ima poleg akutnih neželenih učinkov lahko tudi pozne posledice, ki se pokažejo šele leta po končanem zdravljenju. Med največkrat na ta način okvarjenimi organi so endokrine žleze, predvsem hipotalamus in hipofiza. Na podlagi kliničnega primera želimo pokazati, da bolniki po obsevanju glave nujno potrebujejo tudi redno endokrinološko testiranje in po potrebi ustrezno hormonsko nadomestno zdravljenje