Hormoni i starenje

Since the 19th century, there have been sporadic attempts to attribute the changes of aging to one or another endocrine deficit and efforts to reverse these changes by various replacement therapies. This search for a hormonal ‘fountain of youth’ continues today.Još od 19. stoljeća bilo je sporadičnih pokušaja da se promjene u starenju pripišu nekom endokrinom deficitu, kao i nastojanja da se utječe na te promjene različitim nadomjesnim terapijama. Ta potraga za hormonskim ‘izvorom mladosti’ traje do današnjih dana

Neuroendokrini tumor gušterače s izraženim karcinoidnim sindromom: prikaz slučaja

Carcinoid is the most common neuroendocrine tumor. It is primarily localized in the ileum and the appendix, whereas other localizations are rare. Only a small number of the carcinoids present with carcinoid syndrome (flushing, diarrhea), usually after tumor has already metastasized. A case of carcinoid tumor of uncommon localization is reported. A 54-year-old male patient presented for evaluation because of weight loss, flushing and diarrhea. Laboratory value of 5-HIAA was 775.5 mmol/l (normal values up to 72.8) and the pancreatic tumor marker CA 19-9 was increased. Ultrasonographic and magnetic resonance find-Rings localized the tumor in the prepapillary pancreatic region and visualized the spread to the liver. The diagnosis was confirmed by pathohistologic evaluation of a liver biopsy specimen. The patient was treated with Sandostatin (octreotide analog), which led to significant relief of the symptoms, although control 5-HIAA values were not reduced.Iako su karcinoidi rijetki, predstavljaju najčešći tip neuroendokrinih tumora, primarno smještenih u tankom crijevu i apendiksu. Mali broj ovih tumora, nakon što metastazira u jetru, prezentira se simptomima karcinoidnog sindroma (rumenjača, proljevi). Prikazan je karcinoid gušterače, neuobičajene lokalizacije za ovu vrst tumora. Bolesnik u dobi od 54 godine upuaen je u kliniku zbog gubitka na težini, rumenjače i proljeva. Vrijednosti 5-HIAA i CA 19-9 bile su izrazito povišene. Ultrazvučno i magnetskom rezonancom prikazan je tumor predpapilarnog područja te uvećana jetra prožeta višestrukim sekundarizmima, a patohistološki nalaz govorio je u prilog neuroendokrinog tumora tipa karcinoida. S obzirom na proširenost procesa odustalo se od kirurškog liječenja te je započeta terapija Sandostatinom uza značajno kliničko poboljšanje, no bez učinka na 5-HIAA

The role of exercise under hypoxia on glycemia in people with prediabetes/diabetes

Tjelesno vježbanje je temelj prevencije i liječenja šećerne bolesti tipa 2. U zadnje vrijeme sve se više istražuje učinak treninga u hipoksičnim uvjetima u svrhu povećanja učinkovitosti vježbanja. Dosadašnja istraživanja pokazala su veće povoljne efekte na utilizaciju glukoze, osjetljivost tkiva na inzulin te redukciju tjelesne mase, posebno masnog tkiva pri vježbanju u hipoksičnim u odnosu na normoksične uvjete, no još uvijek ne postoji konsenzus o trajanju izloženosti hipoksiji, intenzitetu same hipoksije niti optimalnoj vrsti tjelesne aktivnosti za najučinkovitije rezultate u smislu zdravstvene koristi za osobe s predijabetesom odnosno šećernom bolešću tipa 2 uz izbjegavanje zdravstvenih rizika. Također, nije jasno ima li normobarična hipoksija isti učinak kao i hipobarična, no nije za očekivati da će sve oboljele osobe biti u mogućnosti koristiti prednosti povremene normobarične hipoksije.Physical exercise is an essential component of diabetes prevention and treatment. Lately, there is a growing body of evidence suggesting enhancement of exercise benefits in hypoxic environment. Published studies support better glucose utilization, tissue insulin sensitivity and reduction of body mass, especially fat mass in case of exercise under hypoxic compared to normoxic conditions but there is still no consensus available on duration of exposure, intensity of hypoxia nor optimal type of exercise for best health results in people with prediabetes and type 2 diabetes. Moreover, there is still debate concerning effects of normobaric compared to hypobaric hypoxia, although it is not to expect that all patients with dysglicemia would be able to use the benefits of intermittent normobaric hypoxia

Utjecaj oktreotida na lučenje hormona rasta u bolesnika s akromegalijom

A majority of growth hormone secreting pituitary adenomas respond well to somatostatin and somatostatin analogues. The acute action of octreotide, a synthetic somatostatin analogue, on growth hormone secretion was assessed in 42 patients with clinically and laboratory verified acromegaly. Octreotide was administered subcutaneously in a dose of 50 mg. Blood sampling was performed at 1-hour intervals during 6 hours of testing. The mean basal values of growth hormone (c±SE) was 26.3±4.5 ng/ml (range 6.1-66.6 ng/ml), and of IGF-I 2940±171.7 IU/l (range 2350-4856 IU/l). Reduction in growth hormone values below 5 ng/ml was recorded in 31 (73.8%), suppression by more than 50% in 5 (11.9%) and by more than 45% in 3 (7.1%) patients. Maximal suppression was noticed in the first two hours of testing. In 3 (7.1%) patients, resistance to octreotide with no change in growth hormone values was observed. In conclusion, octreotide reduces growth hormone values in most acromegalic patients. A small proportion of acromegalic patients do not respond well to octreotide, probably due to the lack of somatostatin receptors on tumor cells. We consider the acute octreotide test as a very useful tool in triage of acromegalic patients eligible for medicamentous treatment.Većina adenoma hipofize koji luče hormon rasta zadrže osjetljivost na somatostatin i njegove analoge. Ispitivano je akutno djelovanje oktreotida, sintetskog oktapeptidnog analoga somatostatina, na razinu hormona rasta u 42 bolesnika s klinički i laboratorijski potvrđenom akromegalijom. Oktreotid je primijenjen supkutano u dozi od 50 mg. Uzorci krvi za određivanje hormona rasta uzimani su svakog sata u razdoblju od šest sati. Prosječna bazalna vrijednost hormona rasta bila je 26,3±4,5 c±SE) ng/ml (raspon 6,1-66,6 ng/ml), a IGF-I 2940,2±171,7 IJ/l (raspon 2350-4856 IJ/l). Nakon primjene oktreotida razina hormona rasta u serumu snizila se na normalne vrijednosti (<5 ng/ml) u 31 (73,8%) bolesnika, u 5 (11,9%) bolesnika nastupilo je sniženje za više od 50%, a u 3 (7,1%) za više od 45%. Maksimalno je sniženje u ovih bolesnika uslijedilo jedan do dva sata nakon početka testa. Troje (7,1%) bolesnika pokazalo je rezistenciju na oktreotid. Njihove vrijednosti hormona rasta ostale su gotovo jednake onima u bazalnim uvjetima. Zaključeno je da oktreotid normalizira razinu hormona rasta u većine akromegaličnih bolesnika, međutim, u nekih se ne postiže zadovoljavajući odgovor, vjerojatno zbog malog broja somatostatinskih receptora na membrani tumorskih stanica. Smatramo da je akutni test s oktreotidom koristan u odabiru akromegaličnih bolesnika za konzervativno liječenje analozima somatostatina

Zašto bolesnica s Gravesovom bolešću ostaje eutiroidna/blago hipertiroidna nakon totalne tiroidektomije - uloga antitijela na tirotropinske receptore (TRAb) i vestigalnih ostataka tiroglosalnog trakta

A young female patient suffering from Graves. disease is presented, who raised some diagnostic and therapeutic dilemmas after being diagnosed with subclinical hyperthyroidism following total thyroidectomy. This 20-year-old female patient, carrier of HLA B8 DR3 genes, was referred to our hospital for total thyroidectomy after developing severe leukopenia on both methimazole and propylthiouracil therapy. A high postoperative titer of thyrotropin receptor antibodies and positive scintigraphy finding of the pyramidal lobe and remnant thyroid tissue in the left thyroid lobe led to the administration of radioiodine. Despite further enlargement of the remnant thyroid tissue on post-radioiodine scintiscanning, the patient is currently euthyroid, with normal thyroid-stimulating hormone levels; however, her long-term prognosis remains uncertain.Opisan je slučaj bolesnice operirane zbog hipertireoze na podlozi Gravesove bolesti, u koje se na početno primijenjenu medikamentnu terapiju razvila granulocitopenija. Iako je kod bolesnice bila planirana totalna tireoidektomija, s obzirom na prijeoperacijski neprepoznat lobus piramidalis učinjena je tek djelomična resekcija štitnjače. Poslijeoperacijski se kao posljedica autoimune aktivacije ostatnog tkiva štitnjače antitijelima na tirotropinske receptore (TRAb) razvila hipertireoza, pa je daljnji tijek bolesti još uvijek nesiguran

Relationship between cardiorespiratory fitness, insulin resistance and metabolic health of obese children and adolescents: the role of physical activity

Pretilost je veliki javnozdravstveni problem, a njena incidencija u porastu je u dječjoj i adolescentnoj dobi te povećava kardiometabolički rizik i psihosocijalni komorbiditet u kasnijoj životnoj dobi. Postoje brojni čimbenici rizika za nastanak pretilosti; od genetskih, epigenetskih i okolišnih, a nastanak pretilosti u bliskoj je korelaciji i s inzulinskom rezistencijom, predijabetesom, šećernom bolesti tipa 2 te kardiorespiratornom sposobnosti. Redovita tjelesna aktivnost ima dokazane povoljne učinke na smanjenje i inzulinske rezistencije i povećanje kardiorespiratorne sposobnosti te je samim time važan čimbenik u prevenciji pretilosti, održavanju poželjne tjelesne mase te smanjenju metaboličkih komorbiditeta. Stoga bi uključivanje pretile djece i adolescenata u redovitu tjelesnu aktivnost trebao biti terapijski imperativ.Overweight and obesity is a global health concern, with rising incidence and prevalence among children and adolescents, attributing to cardiometabolic risk and psychosocial comorbidities later in life. Numerous factors influence development of obesity; genetics, epigenetics and environmental being among them. Moreover, obesity is closely related to insulin resistance, prediabetes and type 2 diabetes mellitus, and cardiorespiratory fitness. Regular physical activity has proven beneficial effects on reducing insulin resistance and improving cardiorespiratory fitness and as such is an important means of obesity prevention and attainment of desired weight as well as reduction of metabolic comorbidities. Therefore, inclusion of overweight and obese children and adolescents in regular physical activity should represent a therapeutic imperative