Petrographic Characteristics of Extrusive Rocks from Hruskovec, Mt. Kalnik, NW Croatia

Spilites, altered diabases and meta-basalts from Hruskovec quarry on Mt. Kalnik form part of a complex sequence of extrusive rocks. They are the result of several successive extrusions of basaltic lava within Upper Cretaceous sediments of heterogeneous petrographic composition. The mineral composition and the numerous textural variations are the results of different cooling histories. Intense spilitization was caused by descendent (sea water) and ascendent (juvenile) solutions. Products of the hydrothermal alteration are the result of very low to low-grade metamorphism. The contacts of the extrusives with surrounding sediments suggest an Upper Cretaceous age for the volcanism. The rocks resemble the extrusives found in other parts of Mt. Kalnik, as well as the extrusives from the wider area of NW Croatia and the rocks found in ophiolitic complexes of the Internal Dinarides

Prikaz bolesnika s ektopičnom sekrecijom ACTH i znacima Cushingova sindroma

Ectopic ACTH secretion was the first paraneoplastic endocrine syndrome described in the literature. The most common tumors associated with ectopic ACTH production are small-cell lung cancer and atypical carcinoids. High cortisol levels have also been described in patients with adenocarcinoma and large-cell carcinoma of the lung, other carcinoid tumors, thymoma, neural crest tumors, medullary carcinoma of the thyroid, and bronchial adenomas. Patients rarely live long enough for frank Cushing’s syndrome to develop. A 30-year-old male is described, who was admitted to endocrinology ward for clinical features of Cushing’s syndrome. Outpatient examination showed high levels of plasma cortisol on several occasions, without suppression of night dexamethasone test. Laboratory tests performed during his hospital stay showed an increased level of serum cortisol without suppression of night dexamethasone test, increased level of ACTH, and decreased testosterone level, increased 17 OHCS in urine. CT scan of adrenal and pituitary glands, and chest x-ray were normal. The patient was discharged with an appointment made for surgical exploration of the pituitary gland. Transnasal selective partial hypophysectomy was performed, however, excisional biopsy showed no microadenoma while the symptoms persisted postoperatively. The patient received TCT hypophysis in a maximal dose, and elevated ACTH level was found to persist after 37 days of treatment. One year later, the patient was readmitted for persistent cushinoid appearance. After complete investigations for ectopic ACTH secreting tumor, chest x-ray showed an infraclavicular, circular, sharply demarcated inhomogeneous lesion of the left lung, 2x3 cm in size. Three months later, lobectomy was performed and pathohistologic examination pointed to a carcinoid (argentaffinoma). During hospitalization, the symptoms of Cushing’s syndrome regressed. In conclusion, CRH test which usually distinguishes between hyperadrenocorticism associated with ectopic ACTH secretion and hypersecreting adrenal tumors is sometimes misleading because of the large overlap in normal and abnormal responses. In this case, chest or abdominal CT scan or MRI should be performed, because these are the most common sites of ectopic ACTH secreting tumors.Prvi paraneoplastični endokrini sindrom opisan u literaturi bila je ektopična sekrecija ACTH. Najčešći tumori udruženi s ektopičnom sekrecijom ACTH su mikrocelularni karcinom pluća i atipični karcinoidi. Visoke razine kortizola opisane su i u bolesnika s adenokarcinomom i karcinomom velikih stanica pluća, karcinoidima, timomom, tumorima neuralnog grebena, medularnim karcinomom štitnjače i bronhalnim adenomom. Bolesnici rijetko žive dovoljno dugo da razviju manifestan Cushingov sindrom. Opisan je slučaj 30-godišnjeg muškarca koji je primljen na odjel s kliničkim znacima Cushingova sindroma. Ambulantno ispitivanje pokazalo je u više navrata visoke razine kortizola koji se nije snižavao u kratkom deksametazonskom testu. Tijekom boravka u bolnici je uz već navedeno uočena visoka razina ACTH, sniženi testosteron i povišen 17 OHCS u mokraći. CT nadbubrežnih žlijezda i Rtg snimka prsnog koša bili su uredni. Bolesnik je otpušten uz dogovor za kiruršku eksploraciju hipofize, te je učinjena transnazalna djelomična hipofizektomija. Ekscizijska biopsija nije pokazala znakove tumora, a klinički znaci Cushingova sindroma ustrajali su nakon operacije. Bolesnik je podvrgnut radioterapiji hipofize u maksimalnoj dozi, međutim, vrijednosti ACTH su još uvijek bile povišene. Nakon godinu dana bolesnik je ponovno primljen na odjel zbog ustrajnih znakova Cushingova sindroma. Nakon potpune obrade u smislu traženja ektopične sekrecije ACTH, snimka prsnoga koša pokazala je infraklavikularno oštro ograničenu, nehomogenu sjenu u plućima, veličine 2x3 cm. Tri mjeseca kasnije učinjena je lobektomija, a patohistološki nalaz je ukazao na karcinoid (argentafinom). Tijekom hospitalizacije simptomi Cushingova sindroma su se povukli. U zaključku, CRH test koji obično razlikuje hiperadrenokorticizam udružen s ektopičnom sekrecijom ACTH i hipersekreciju iz adrenalnih tumora, ponekad je neprikladan zbog značajnog preklapanja u normalnom i abnormalnom odgovoru. U tom slučaju, nužan je detaljan pregled prsnoga koša i trbuha, budući da su to najčešća sijela tumora koji ektopično izlučuju ACTH

Depressive Disorder as Possible Risk Factor of Osteoporosis

Hipothalamo-pituitary-adrenal (HPA) axis is a very complicated control system playing an important role in stress reaction, where glucocorticoids suppress the autonomic (vegetative), endocrine, immunologic and psychic responses to stressful stimuli. We described the marked clinical, physiological, and biochemical connection between osteoporosis and major depressive disorder (MDD). Both conditions are associated with a hyperactive HPA axis and LC/NE system, and hence with increased CRH, cortisol, and catecholamine secretion. There are numerous states or diseases associated with osteoporosis and we were looking for a hypercorticism value as a one of these. Some recent studies demonstrated that earlier history of MDD was associated with marked osteoporosis. In MDD there are two well-documented biochemical abnormalities: hypercortisolism and its resistance to dexamethasone suppression. The present study included 31 MDD patients (19 males and 12 females, mean age 37 1.3, age range 29–41 years), and 17 healthy male volunteers (mean age 39 1.6, age range 34–45 years). In each of our patients 24-hour urinary free cortisol, serum cortisol level at 8 a.m. and 5 p.m., cortisol in dexamethasone suppression test and bone mineral density were measured. We have, therefore, analyzed a group of young men and women with normal menstrual cycles, who were without signs of osteoporosis in the beginning, and who received anti-depressive therapy for many years. Analysis showed that increased levels of cortisol and the occurrence of osteoporosis, that developed as the result of elevated cortisol level. For our workshop we used nonparametric rang-correlation with Spearman’s ro = –0.805, with statistic significant at the 0.01 level (2-tailed). Patients under long-term history of depression could develop a very stronger type of osteoporosis i.e. it is before known that the patients with untreated Cushing syndrome developed hard osteoporosis