RESUMEN
OBJECTIVE: This work was aimed to evaluate the prevalence of insulin resistance (IR) and metabolic syndrome in a large cohort of 40-60 years old patients with cardiovascular symptoms. METHODS: A total of 500 consecutive males and females referred to coronarography and coronary catheterization, because of spontaneous or after load precordial pain plus denivelisation of ST segment by electrocardiography, were included. Besides standard clinical examinations, ergometry, echocardiography, fundamental laboratory tests, and several other laboratory examinations were also performed, including oral glucose toleration test (OGTT), total and high-density lipoprotein (HDL) cholesterol, triglycerides, apoprotein A1 and B, apolipoprotein (a), uric acid, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), cytokines (tumor necrosis factor α, TNFα, interleukin-1, IL-1, interleukin-6, IL-6), endothelin-1, as well as hormones (insulin, C peptide, leptin, growth hormone, cortisol). RESULTS: In 81.6% of patients, IR syndrome with compensatory hyperinsulinemia was found in a positive correlation with various symptoms of metabolic syndrome, including abdominal obesity, increased body mass index (BMI), dysglycemia, dyslipoproteinemia, coronary stenosis, decreased HDL level, and hypertension. Hirsutism with polycystic ovarian syndrome was found in 52% of examined women with IR. However, a normal coronary angiogram, called as a microvascular form of the angina pectoris (MIV-AP), was found in 14% of predominantly periclimacteric and benign hirsutic females with long-term disorders of menstrual cycle. Since these patients showed the same symptoms as their gender, age, BMI, and degree of coronary stenoses adjusted pairs with the macrovascular form (such as the same levels of several lipids, hormones and obesity measures), our data strongly support the view that MIV-AP might belong to the IR syndrome. CONCLUSIONS: Hyperinsulinemia and high prevalence of various symptoms of metabolic syndrome (MS) were found in high percentage of patients with after load precordial pain who were referred to coronarography. Similarly, in several women, MIV-AP was detected and its affiliation to MS suggested.
Asunto(s)
Angiografía Coronaria , Resistencia a la Insulina , Síndrome Metabólico/diagnóstico por imagen , Síndrome Metabólico/epidemiología , Angina Microvascular/diagnóstico por imagen , Angina Microvascular/epidemiología , Adulto , Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/epidemiología , Estudios de Cohortes , Angiografía Coronaria/estadística & datos numéricos , Femenino , Humanos , Resistencia a la Insulina/fisiología , Masculino , Síndrome Metabólico/complicaciones , Síndrome Metabólico/metabolismo , Angina Microvascular/complicaciones , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/diagnóstico por imagen , Obesidad/epidemiología , Sobrepeso/complicaciones , Sobrepeso/diagnóstico por imagen , Sobrepeso/epidemiología , Prevalencia , Derivación y Consulta/estadística & datos numéricos , Eslovaquia/epidemiologíaRESUMEN
BACKGROUND: The validity of low-dose 1 microg cosyntropin test (LDT) is reported mainly for the assessment of secondary adrenocortical insufficiency (AI). Likewise the hypothalamic-pituitary disorders, early diagnosis of the initial or partial stages of primary AI has an important role. OBJECTIVE: The aim of study was to: 1) establish the normal cut-off level at which the stimulated plasma cortisol (FP) in LDT excludes primary AI; 2) compare the results in elderly subjects to those in younger ones; 3) compare the results between normal and obese subjects; and 4) verify the established cut-off values on the sample of patients suspected to have primary AI. SUBJECTS AND METHODS: 110 subjects (99 women and 11 men, aged 19-80 years, mean 46.2+/-16.1 years, without suspicion for impairment of the hypothalamo-pituitary-adrenal axis were recruited to undergo the LDT in standard conditions. Control group consists of 30 patients (22 women and 8 men, aged 7-58 years, mean 38.4+/-10.6 years) evaluated in whom for suspicion of primary AI as suggested by LDT was confirmed by supplemental investigations (elevated ACTH levels, positive autoantibodies against 21-hydroxylase, mutational analysis of corresponding genes). RESULTS: The mean peak FP level at 30 min (FP (30)) of the subjects was 675+/-85 nmol/L (95% CI=659 to 691 nmol/L), thus reference values expressed as mean+/-2 SD were 505-845 nmol/L. There was a significant negative correlation between basal FP values (FP (0)) (434+/-105 nmol/L) and the absolute FP incremental (FP (Delta)) response varying from 52 to 553 nmol/L (median 230 nmol/L) (r=-0.71; P<0.001). FP (30) was higher in elderly subjects (n=27) in comparison to younger subjects (n=25) (689+/-88 nmol/L vs. 642+/-63 nmol/L, u=2.11, P<0.05) due to higher FP (Delta) (274+/-116 nmol/L vs. 175+/-112 nmol/L; u=4.02, P<0.01) ; FP (30) levels in obese subjects (n=27) did not differ from those with normal BMI (n=33) (694+/-100 nmol/L vs. 667+/-65 nmol/L, u=1.31, P>0.05). We did not find any correlation between body weight or body surface area and FP (0), FP (30) or FP (Delta). Post-stimulation FP (30) levels in the control group varied from 0 to 354 nmol/L with median 64 nmol/L (25 (th) percentile 10 nmol/L; 75 (th) percentile 165 nmol/L) and were entirely distinctive from those of the subjects without adrenal impairment ( P<0.001). CONCLUSIONS: Taking the mean -2 SD result as a threshold, FP value of 500 nmol/L can be consider as cut-off at 30 min in the LDT for defining the intact adrenocortical function, independently of age and body weight, body surface area.
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Enfermedad de Addison/diagnóstico , Cosintropina , Hidrocortisona/sangre , Adulto , Anciano , Anciano de 80 o más Años , Superficie Corporal , Cosintropina/administración & dosificación , Femenino , Humanos , Sistema Hipotálamo-Hipofisario/fisiopatología , Masculino , Persona de Mediana Edad , Sistema Hipófiso-Suprarrenal/fisiopatología , Esteroide 21-Hidroxilasa/sangre , Adulto JovenRESUMEN
This review has summarized the current knowledge of the genetic background of tumors originating from adrenocortical tissue, manifested as a part of inherited or familial syndromes, as well as specific forms of sporadic tumors caused by aberrant expression of G-protein coupled receptors.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/genética , HumanosRESUMEN
It is anticipated that an inherited/familial forms of pheochromocytomas cause approximately 20% of all pheochromocytomas. Therefore, the classic "rule of 10" axioma used to remember the key features of disorder is invalid. Various mutations in several genes have been identified, which underly syndromes with paragangliomas and/or pheochromocytomas. The more candidate genes, the less numbers of patients with apparently sporadic forms of the disorder. This review has summarized the current knowledge of the genetic background of tumors orginating from adrenomedullar and extra-adrenal chromaffin tissue.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/genética , Neoplasia Endocrina Múltiple/genética , Paraganglioma/genética , Médula Suprarrenal , Humanos , Feocromocitoma/genéticaRESUMEN
In the article the authors present the case of a patient with clear cell renal carcinoma, where after nephrectomy local metastases appeared. The treatment of choice was sunitinib. After 20 cycles of therapy heavy hypothyroidism was verified which required substitution by thyroxine. Elevated levels of TSH appeared in up to 70% and hypothyrodism in up to 40% of thus treated patients. Also described is the mechanism of action of sunitinib. There seems to exist a correlation between the "adverse effects" of the drug and a better result of the therapy of cancer, however, prospective studies are absent. Most experts agree that the thyroid function during treatment with sunitinib needs to be monitored.
Asunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Antineoplásicos/efectos adversos , Carcinoma de Células Renales/tratamiento farmacológico , Hipotiroidismo/inducido químicamente , Indoles/efectos adversos , Neoplasias Renales/tratamiento farmacológico , Pirroles/efectos adversos , Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/secundario , Humanos , Indoles/uso terapéutico , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Pirroles/uso terapéutico , SunitinibRESUMEN
Adrenocortical disorders in pregnancy are rare, but unrecognized of them are associated with higher maternal and fetal morbidity. The diagnosis is more complicated because of physiologic changes hormones and frequently lacking normative datas during pregnancy. Therefore increased attention could allow early diagnosis and treatment, that improve prognosis for both the mother and fetus.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales , Complicaciones del Embarazo , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Enfermedades de las Glándulas Suprarrenales/terapia , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/terapiaRESUMEN
Endocrinology and obstetrics have one thing in common--diagnosis and treatment endocrine diseases in gravidity. These are modified by physiological changes in gravidity, often missing data and tests in normal condition and the influence of diagnosis and treatment on the pregnant female and fetus have also to be taken into consideration. If diagnosis of primary aldosteronism is suspected, suprimed plasmatic renin activity is determinant indicator (disregarding arterial hypertension, hypokaliaemia, hyperkaliuresis and proteinuria) as well as ultrasound diagnostics or adrenal gland diagnostics means magnetic resonance imaging. Aldosteron produced adenomas may by treated by adrenalectomy in the second trimester, late diagnosed adenoma and hyperplastic forms are treated by the administration of the respective medicaments.
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Hiperaldosteronismo , Complicaciones del Embarazo , Femenino , Humanos , Hiperaldosteronismo/complicaciones , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/terapia , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/terapiaRESUMEN
In the article authors describe the milestones in history of discoveries of the adrenocortical hormones. Preparation of the adrenal extract cortine was the first experimental contribution. Cortine prolonged life of animals whose adrenals have been removed and had beneficial effects in patients with Addison disease (AD). It was mixture of compounds comprising carbon, hydrogen and oxygen that belong to the steroids. From those deoxycorticosterone had impact on mineral metabolism, substances that Kendall termed as compounds A, B, E, and F influenced metabolism of saccharides and proteins. In 1929 Dr. Hench had observed that the painful symptoms of rheumatoid arthritis (RA) were relieved in a patient who developed jaundice and in 1931 he remarked favourable effects of pregnancy to the course of RA. He suggested that some agent (substance X) was present during jaundice and in pregnancy through that the symptoms of RA were relieved. In 1941 interest concerned to the compound A, however, this was almost ineffective in patients with AD. In 1948 compound E was successfully administered to patients with AD and RA for the first time. Concerning the relation between vitamin E Kendall and Hench gave compound E distinctive name cortisone. Consequently it was confirmed that compound F (hydrocortisone) is the final product of the adrenal cortex. Appreciating the work of the most significant groups was awarding the Nobel Prize to Edward Kendall, Tadeusz Reichstein and Philip Hench in 1950.
Asunto(s)
Corticoesteroides/historia , Endocrinología/historia , Historia del Siglo XX , HumanosRESUMEN
Insulin lispro was compared with regular human insulin with respect to glycaemic control in patients with diabetes mellitus on intensive insulin treatment. Sixty-two patients (55 type 1; 7 type 2) from eight study centres in the Czech Republic, Slovenia and the Slovak Republic participated in a 4-month, open-label, randomized, crossover study. Patients administered insulin lispro immediately before meals or regular human insulin 30 min before meals. A test meal (220-400 kcal), based on local and individual dietary habits and consistent for each patient throughout the study was given at baseline and at the end of each treatment. At each test meal visit HbA1c, fasting blood glucose, 1-hour and 2-hour postprandial blood glucose levels were measured. The level of HbA1c (7.6% +/- 1.5% versus 7.4% +/- 1.5%), incidence of hypoglycaemia (41-66% of patients--versus 39-63%) and daily insulin dose (0.67 +/- 0.11 U/kg versus 0.65 +/- 0.11 U/kg) did not differ between treatment groups at endpoint (insulin lispro versus regular human insulin, respectively). Mean 2-hour postprandial blood glucose excursion for the insulin lispro group (0.0 +/- 3.7 mmol/L) was significantly lower (p = 0.035) when compared with the regular human insulin group (1.3 +/- 3.7 mmol/L) at endpoint. Therapy with insulin lispro was therefore associated with a significant improvement in postprandial blood glucose excursion control when compared with regular human insulin, without an increase in rate of hypoglycaemia.
Asunto(s)
Glucemia/análisis , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/análogos & derivados , Insulina/uso terapéutico , Adulto , Estudios Cruzados , Diabetes Mellitus Tipo 1/sangre , Femenino , Humanos , Insulina Lispro , MasculinoRESUMEN
In the present retrospective study we determined the frequency of glucose intolerance in active untreated acromegaly, and searched for risk factors possibly supporting the emergence of the diabetic condition. Among 43 patients, 8 (19 percent; 95 percent CI: 8-33 percent) had diabetes mellitus and 2 (5 percent; 1-16 percent) impaired glucose tolerance. No impaired fasting glycemia was demonstrable. The frequency of diabetes was on average 4.5 times higher than in the general Slovak population. Ten factors suspected to support progression to glucose intolerance were studied by comparing the frequency of glucose intolerance between patients with present and absent risk factors. A family history of diabetes and arterial hypertension proved to have a significant promoting effect (P<0.05, chi-square test). A significant association with female gender was demonstrated only after pooling our data with literature data. Concomitant prolactin hypersecretion had a nonsignificant promoting effect. In conclusion, the association of active untreated acromegaly with each of the three categories of glucose intolerance (including impaired fasting glycemia, not yet studied in this connection) was defined as a confidence interval, thus permitting a sound comparison with the findings of future studies. Besides a family history of diabetes, female gender and arterial hypertension were defined as additional, not yet described risk factors
Asunto(s)
Humanos , Masculino , Adulto , Anciano , Persona de Mediana Edad , Acromegalia , Diabetes Mellitus , Glucosa , Intolerancia a la Glucosa , Acromegalia , Intervalos de Confianza , Diabetes Mellitus , Ayuno , Prueba de Tolerancia a la Glucosa , Estudios Retrospectivos , Factores de RiesgoRESUMEN
In the present retrospective study we determined the frequency of glucose intolerance in active untreated acromegaly, and searched for risk factors possibly supporting the emergence of the diabetic condition. Among 43 patients, 8 (19%; 95% CI: 8-33%) had diabetes mellitus and 2 (5%; 1-16%) impaired glucose tolerance. No impaired fasting glycemia was demonstrable. The frequency of diabetes was on average 4.5 times higher than in the general Slovak population. Ten factors suspected to support progression to glucose intolerance were studied by comparing the frequency of glucose intolerance between patients with present and absent risk factors. A family history of diabetes and arterial hypertension proved to have a significant promoting effect (P<0.05, chi-square test). A significant association with female gender was demonstrated only after pooling our data with literature data. Concomitant prolactin hypersecretion had a nonsignificant promoting effect. In conclusion, the association of active untreated acromegaly with each of the three categories of glucose intolerance (including impaired fasting glycemia, not yet studied in this connection) was defined as a confidence interval, thus permitting a sound comparison with the findings of future studies. Besides a family history of diabetes, female gender and arterial hypertension were defined as additional, not yet described risk factors.
Asunto(s)
Acromegalia/complicaciones , Complicaciones de la Diabetes , Intolerancia a la Glucosa/complicaciones , Acromegalia/sangre , Adulto , Anciano , Intervalos de Confianza , Diabetes Mellitus/sangre , Ayuno , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Adrenal incidentaloma is an incidentally detected formation on examination of another cause such as visualization of the adrenal glands. From 1996 till December 1999 in the Endocrinological Institute in Lubochna 60 patients with adrenal incidentaloma were examined. In 75% afunctional tumours were involved. In 16.6% (10 patients) the authors recorded an initial impairment of cortisol secretion, in 3.2% (2 patients) impaired aldosterone secretion, similarly in 3.2% (2 patients) a pheochromocytoma and in one patient (1.6%) impaired secretion of 17-hydroxyprogesterone. Functionally active incidentalomas accounted for one quarter of the investigated group.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , 17-alfa-Hidroxiprogesterona/metabolismo , Adolescente , Pruebas de Función de la Corteza Suprarrenal , Hormona Adrenocorticotrópica/metabolismo , Adulto , Anciano , Aldosterona/metabolismo , Niño , Síndrome de Cushing/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Hidrocortisona/metabolismo , Masculino , Persona de Mediana Edad , Feocromocitoma/diagnósticoRESUMEN
BACKGROUND: Information concerning diabetes mellitus associated with primary aldosteronism is scarce. OBJECTIVES: To determine the prevalence of diabetes mellitus in its two main pathogenetic forms of primary aldosteronism and to evaluate its association with several clinical variables. PATIENTS: Fifty in-patients (31 female and 19 male, aged 16-66), diagnosed during the years 1980-1998 as aldosterone producing adenoma (n = 26) or as idiopathic hyperaldosteronism (n = 24). METHODS: Morning fasting plasma glucose was measured by glucoso oxidase method in all patients. In the presence of higher values, confirmatory measurements were performed on the next day. The results were evaluated retrospectively by the diagnostic criteria of American Diabetes Association, 1997. Statistical significance of the association between diabetes mellitus and clinical variables was evaluated by chi-square test. RESULTS: Diabetes mellitus was ascertained in 6 patients out of 50 (12%; interval of 95% confidence 5-24%). Diabetes was accompanied significantly more often with idiopathic hyperaldosteronism (10-47%) than with aldosterone producing adenoma (0-13%). Patients with the family history of diabetes suffered more often (9-76%) from this disease than those without the history (1-19%). Obesity, longer (> 5 years) duration of hypertension and hypokalaemia did not affect the occurrence of diabetes. CONCLUSIONS: The occurrence of diabetes in primary aldosteronism was connected significantly with its idiopathic subtype and positive family history of diabetes. (Tab. 2, Ref. 11.)
Asunto(s)
Complicaciones de la Diabetes , Hiperaldosteronismo/complicaciones , Adolescente , Neoplasias de la Corteza Suprarrenal/complicaciones , Adenoma Corticosuprarrenal/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The authors discuss the relationship between dehydroepiandsoterone, its sulphate conjugate and insulin and ischaemic heart disease in patients with acute myocardial infarction. In the examined group of patients they found lower values of dehydroepiandosterone and its sulphate in men, lower values of dehydroepiandosterone in women as compared with mean values with regard to age and a close inverse correlation of insulin and dehydroepiandrosterone and insulin and dehydroepiandrosterone sulphate. Whether dehydroepiandosterone is the "missing link" of hyperinsulinaemia and arterosclerosis is so far only a theoretical issue.
Asunto(s)
Sulfato de Deshidroepiandrosterona/sangre , Deshidroepiandrosterona/sangre , Insulina/sangre , Infarto del Miocardio/sangre , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
UNLABELLED: After 45 years of successful iodine prophylaxis a total of 6324 subject aged 7 to 70 years from East (72.0%), Central (16.2%) and West Slovakia (11.8%) were examined. The thyroid volume (ThV) by ultrasound was examined in a total of 6045 subjects. Serum level of thyrotropin (TSH) was estimated in 1919 (30.3%) and anti-thyroperoxidase antibodies (anti-TPO) in 2589 (40.9%) subjects. Iodine was estimated in 1983 (31.3%) spot urine samples. The median and 75th percentile of ThV were increasing (respectively) from 3.9 and 5.2 ml (10 yr), 8.2 and 10.2 ml (17 yr), 12.4 and 16.3 ml (31-40 yr) up to 14.1 and 19.9 ml (61-70 yr). The frequency of ultrasound hypoechogenicity as an early sign of autoimmune thyroiditis increased from 3.9% (28/709; 10 yr), 16.3% (66/403; 21-40 yr) and 30.3% (205/665; 41-60 yr) up to 51.0% (48/94; 61-70 yr). Positive anti-TPO level as an other sign of autoimmune thyroiditis was found in 1.6% (11/683; 7-13 yr), 7.3% (47/644; 17-30 yr) and 20.4% (257/1262; 31-70 yr). In the adults 19.0% (268/1409) positive anti-TPO were found. Among 1367 adults 6.2% (N = 85) of TSH levels were higher than 4.0 mU/l and 7.5% (N = 103) were lower than 0.2 mU/l. Among 1504 adults a total of 93 (6.1%) of nodules larger than 10 mm in diameter was found (14 in males and 75 in females). In this study the nature of nodules remained unidentified, since all subjects were referred to additional examinations. Malignant nodules were suspected in 3 females with high serum thyroglobulin level and in one additional female with occasionally found very large nodule. The estimation of urinary iodine showed a majority of values in optimal range (> 100-200 microg/l). CONCLUSIONS: Thyroid volume in about 75% examined subjects of all age groups may be considered as relatively small which is apparently due to 45 years of effective iodine prophylaxis. In spite of that the volume of remaining about 25% thyroids were apparently increased which may be presubambly explained by the effect of mainly genetic, but also environmental factors.
Asunto(s)
Enfermedades de la Tiroides/epidemiología , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Eslovaquia/epidemiología , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/diagnóstico por imagen , Glándula Tiroides/diagnóstico por imagen , UltrasonografíaRESUMEN
Pregnancy in conjunction with primary aldosteronism is an unusual occurrence. We report a 28-year-old woman who presented with mild hypertension and hypokalemia as manifestations of primary aldosteronism caused by an aldosterone-producing adenoma in the left adrenal gland during pregnancy. Although the diagnosis was straightforward, the patient refused to undergo the proposed operation during the second trimester of her pregnancy. She was not admitted to hospital until she developed EPH gestosis in the 27th week of gestation, which had an unfavourable outcome for the infant who died nine days after delivery. The patient underwent a laparoscopic adrenalectomy which resulted in normalization of blood pressure and blood potassium levels. In cases of aldosterone-producing adenoma, surgery in the second trimester is the most appropriate option to avoid a poor obstetric outcome.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/complicaciones , Adenoma Corticosuprarrenal/complicaciones , Hiperaldosteronismo/complicaciones , Preeclampsia/etiología , Complicaciones Neoplásicas del Embarazo , Neoplasias de la Corteza Suprarrenal/cirugía , Adrenalectomía , Adenoma Corticosuprarrenal/cirugía , Adulto , Femenino , Humanos , Hiperaldosteronismo/etiología , Recién Nacido , Enfermedades del Prematuro/etiología , Masculino , Preeclampsia/tratamiento farmacológico , Embarazo , Resultado del Embarazo , Resultado del Tratamiento , Negativa del Paciente al TratamientoRESUMEN
No significant difference has been demonstrated in the altered circadian blood pressure pattern between the pituitary-dependent and adrenal forms of Cushing's syndrome before surgery. The effect of therapy, however, proved to be different. The mesor was normalized in the pituitary-dependent Cushing's syndrome more conspicuously for systolic than for diastolic blood pressure. In Cushing's syndrome due to adrenal adenoma, systolic and diastolic blood pressure mesors have been even significantly "overnormalized" after treatment, being 11 to 27 and 2 to 13 mmHg (95% confidence) lower than corresponding mesors in controls. There was no difference between forms in the effect of treatment on blood pressure amplitudes, which remained significantly lower than in controls. Finally, acrophase patterns were partly normalized after treatment of the pituitary-dependent form only for diastolic blood pressure, while both systolic and diastolic blood pressure acrophases were normalized in the treated adrenal form. In conclusion, complete normalization of the pattern of daily blood pressure profile has not been achieved in either form of the syndrome. This may be one of the reasons for the reduced long-term survival after surgical cure of hypercortisolism, than expected.
Asunto(s)
Presión Sanguínea/fisiología , Ritmo Circadiano , Síndrome de Cushing/fisiopatología , Adolescente , Adulto , Síndrome de Cushing/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo PosoperatorioRESUMEN
No significant difference has been demonstrated in the altered circadian blood pressure pattern between the pituitary-dependent and adrenal forms of Cushing's syndrome before surgery. The effect of therapy, however, proved to be different. The mesor was normalized in the pituitary-dependent Cushing's syndrome more conspicuously for systolic than for diastolic blood pressure. In Cushing's syndrome due to adrenal adenoma, systolic and diastolic blood pressure mesors have been even significantly "overnormalized" after treatment, being 11 to 27 and 2 to 13 mmHg (95 percent confidence) lower than corresponding mesors in controls. There was no difference between forms in the effect of treatment on blood pressure amplitudes, which remained significantly lower than in controls. Finally, acrophase patterns were partly normalized after treatment of the pituitary-dependent form only for diastolic blood pressure, while both systolic and diastolic blood pressure acrophases were normalized in the treated adrenal form. In conclusion, complete normalization of the pattern of daily blood pressure profile has not been achieved in either form of the syndrome. This may be one of the reasons for the reduced long-term survival after surgical cure of hypercortisolism, than expected
Asunto(s)
Femenino , Humanos , Adulto , Persona de Mediana Edad , Adolescente , Presión Sanguínea/fisiología , Ritmo Circadiano , Síndrome de Cushing/fisiopatología , Síndrome de Cushing/cirugía , Disciplina de Cronobiología , Periodo PosoperatorioRESUMEN
Findings pertaining to the diagnosis and treatment of primary aldosteronism are rapidly expanding. In the present work the authors focused attention on the clinical application of some progressive methods. They examined a group of 115 ambulatory patients with arterial hypertension, not suspected of secondary arterial hypertension, in the course of one year. As a screening method of primary aldosteronism they selected the aldosterone renin ratio (ARR). Using this method the authors diagnosed 125 cases of primary aldosteronism, i.e. a 13% prevalence in the examined group. Only in one instance they detected an adenoma by computed tomography (CT), in the remaining patients, i.e. four times, the adenoma was verified by selective catheterization of adrenal veins and assessment of aldosterone and cortisol. The authors did not confirm a more accurate localization of the adenoma by the aldosterone/cortisol ration than when assessing aldosterone only. In two patients adrenalectomy was performed by laparoscopy and this surgical technique, as regards adrenal glands, was implemented for the first time in Slovakia in our department. It has certain advantages over classical adrenalectomy.
Asunto(s)
Hiperaldosteronismo/diagnóstico , Hipertensión/etiología , Humanos , Hiperaldosteronismo/complicaciones , Hiperaldosteronismo/terapiaRESUMEN
OBJECTIVE: To evaluate whether long-term exposure to heavy environmental pollution with polychlorinated biphenyls (PCBs) could result in impairment of thyroid status as evaluated by an epidemiological field survey. METHODS: Thyroid volume (ThV) was measured by ultrasound in 238 employees of a factory (EMP) which previously produced PCBs and 454 adolescents from the surrounding area polluted by PCBs. Controls (C) were 572 adults and 965 adolescents from much less polluted areas. In the 238 EMP and various numbers (shown in parentheses) of adult C the levels of thyroid-stimulating hormone (TSH) (n = 498), thyroxine (n = 498), thyroglobulin (n = 278) and thyroid antibodies (anti-peroxidase (TPO Ab), n= 517; anti-thyroglobulin (Tg Ab), n=455; anti-TSH receptor (TSHR Ab), n=238) were estimated in serum, while only TSH and TPO Ab were measured in 269 and 171 adolescents from polluted and control areas respectively. In several subjects in whom thyroid disease was suspected, total tri-iodothyronine or free thyroxine and tri-iodothyronine were measured. In a total of 362 adults and adolescents the urinary iodine was estimated. RESULTS: Using the Mann-Whitney test, ThV in EMP (mean+/-S.E. = 18.85+/-0.69 ml, median= 17.3 ml, upper quartile=22.9 ml, n=238) was significantly higher (P< 0.001) than that in C (13.47+/-0.48 ml, 11.5 ml, 15.3 ml, n = 486 respectively). Similarly, ThV in adolescents from the polluted area (9.37+/-0.17 ml, 8.9 ml, 11.0 ml, n = 454 respectively) was significantly higher (P< 0.001) than that in C (8.07+/-0.10 ml, 7.6 ml, 9.6 ml, n = 965 respectively). In adults, a significantly increased prevalence of TPO Ab (P<0.05) was found (using the chi-square test) in EMP women of all ages (54/190) vs C women (70/282), in EMP women aged 31-50 years (40/117 vs 70/282 respectively) and those aged 41- 50 years (28/77 vs 54/215 respectively). Compared with C, there was also a higher prevalence of Tg Ab in EMP women aged 31-60 years (36/169 vs 50/342 respectively) and of TSHR Ab (P< 0.001) in the group of EMP men and women (25/238) vs sex- and age-matched C (6/238). No difference between EMP and C was found in the level of thyroxine (mean+/-S.D = 116.1+/-31.2 nmol/l, n = 238 vs 112.2+/-37.0 nmol/l, n = 460 respectively), TSH in the range 0.1-4.5 mU/l(1.56+/-0.86 mUl/l, n = 219 vs 1.51+/-0.84 mU/l, n = 460 respectively), prevalence of TSH >4.5 (14/238 vs 28/498 respectively) and <0.1 mU/l(5/238 vs 10/498 respectively). The prevalence of individuals without any defined clinical or laboratory signs of thyroid disorders among EMP who had worked in the factory for 21-35 years (43/128, 33.6%) was significantly lower than that in twice as many matched C (118/256, 46.1%, P< 0.025) or in EMP who had worked for only 11-20 years (36/73, 49.3%, P< 0.05). In adolescents, no difference was found in the prevalence of TPO Ab or TSH >4.5 mU/l between the polluted (17/269, 6.3%, and 2/243, 0.8% respectively) and C areas (15/171, 8.5% and 4/140, 2.8% respectively). The median values of urinary iodine were in the optimal range (microg per dl/number of cases) and about the same in polluted (12.6/90 and 11.4/55) and C areas (14.1/80, 13.2/82 and 13.4/55). CONCLUSIONS: Since iodine intake in Slovakia is considered sufficient as a result of 45 years of well-monitored iodine prophylaxis, the increased ThVand prevalence of thyroid disorders in the polluted areas presumably results from long-term exposure to toxic substances rather than from a difference in life-long iodine intake. The increased prevalence of some thyroid antibodies may be related to the known immunomodulatory effects of PCBs.