Monika Grymowicz

Extremely elevated activity of serum alkaline phosphatase in gestational diabetes: a case report.

We report a case of a 25-year-old pregnant woman with gestational diabetes and increased activity (25-fold) of placental isozyme of alkaline phosphatase. Abdominal ultrasonographic scan revealed no hepatobiliary disease. After delivery, the alkaline phosphatase level decreased but did not return to the reference range. Similar abnormalities were found in the patients first-degree relatives, which included a mother and a sister.

Alpha-hydroxybutyrate dehydrogenase activity in intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is associated with increased perinatal mortality and morbidity. Alpha‐hydroxybutyrate dehydrogenase (α‐HBDH) is an enzyme that originates in the cytoplasm of hepatocytes and can be detected in the serum. The aim of this study was to determine the characteristics of α‐HBDH activity in ICP.

Eating disorders in older women

Eating disorders (EDs) are disturbances that seriously endanger the physical health and often the lives of sufferers and affect their psychosocial functioning. EDs are usually thought of as problems afflicting teenagers. However, the incidence in older women has increased in recent decades. These cases may represent either late-onset disease or, more likely, a continuation of a lifelong disorder. The DSM-5 classification differentiates 4 categories of eating disorder: anorexia nervosa, bulimia nervosa, binge-eating disorders and other specified feeding and eating disorders. The weight loss and malnutrition resulting from EDs have widespread negative consequences for physical, mental and social health. The main risk factors for developing long-term consequences are the degree of weight loss and the chronicity of the illness. Most of the cardiac, neurological, pulmonary, gastric, haematological and dermatological complications of EDs are reversible with weight restoration. EDs are serious illnesses and they should never be neglected or treated only as a manifestation of the fashion for dieting or a womans wish to achieve an imposed standard feminine figure. Additionally, EDs are associated with high risk of morbidity and mortality. The literature concerning EDs in older, postmenopausal women is very limited. The main aim of this paper is to ascertain the epidemiology and prognosis of EDs in older women, and to review their diagnosis and management.

Successful perinatal outcome in an early onset intrahepatic cholestasis of pregnancy with extremely high serum hepatic function tests

We report a case of a 21-year-old pregnant woman with an early onset of intrahepatic cholestasis of pregnancy with very high aminotransferases activity and bilirubin concentration. Viral and autoimmune hepatitis, and other possible causes of liver function impairment were excluded. Treatment with ursodeoxycholic acid improved biochemical markers. The patient delivered a healthy female neonate by caesarean section. Neonatal and postoperative courses were uneventful.

Calcium–phosphorus–magnesium homeostasis in pregnant women after renal transplantation

Objective: The aim of the study was the assessment of calcium–phosphorus–magnesium homeostasis in pregnant women after renal transplantation. Methods: The study covered 64 pregnant women in the third trimester of gestation including: 33 women after renal transplantation (the study group) and 31 healthy pregnant women (the control group). Women from both groups were at the similar age: 30.8±4.7 vs. 31.3±5.0 years (NS) and at the same gestational age 34.8±2.4 vs. 35.3±2.6 weeks (NS). The mean body mass index (BMI) in the women from the study group before pregnancy was 21.49±2.81 vs. 22.1±3.02 in the control group (NS), BMI before delivery was 25.43±3.05 vs. 26.0±3.35 (NS), the percentage of the BMI increase during pregnancy was 18.7±7.68 vs. 17.65±7.13 (NS) and BMI increase during gestation was 3.93±1.56 vs. 3.90±1.54, respectively (NS). Arterial blood pressure at the time of blood samples collection for biochemical tests was 151.4±26.8/92.5±16.9 in women from the study group comparing to 115.0±6.0/68.0±7.0 mmHg (P<0.001) in the patients from the control group. The maximal blood pressure during pregnancy was 169.2±20.7/102.7±14.0 vs. 118.0±7.0/70.0±8.0 mmHg (P<0.001), respectively. We estimated serum levels of: total Ca, ionized Ca2+, inorganic phosphorus (Pi), Mg, total protein, albumin and blood morphology. Moreover, urine levels of Ca, Pi, Mg and protein were assessed. Results: The pregnant women after renal transplantation presented increases in serum concentrations of total Ca (2.54±0.20 vs. 2.16±0.10 mmol/l; P<0.001) and ionized Ca2+ (1.322±0.104 vs. 1.12±0.07 mmol/l; P<0.001) and the decrease in Pi level (1.013±0.211 vs. 1.10±0.16 mmol/l; P<0.05), total protein (59.3±7.0 vs. 65±5 g/l; P<0.001) and albumin (461.6±65.65 vs. 493.2±59 μmol/l; P<0.05). Moreover, in the study group drop in red blood cells count to 3.71±0.56 vs. 4.01±0.35×1012/l (P<0.02) in the control group was detected. Despite increased volume of 24‐h urine collection in the kidney recipients we observed significantly decreased urine 24‐h calcium excretion 2.47±0.92 vs. 6.72±3.49 mmol (P<0.001) and simultaneous increase in urine Mg excretion 3.422±1.025 vs. 2.18±0.52 mmol/24 h (P<0.001). There was no difference in urine 24‐h Pi excretion between the study and the control group. The pregnant renal transplant recipients presented proteinuria of 1.19±1.9 g/24 h. Conclusions: Women after kidney grafting present vital aberrations in calcium–phosphorus–magnesium homeostasis during pregnancy. The most significant changes are associated with calcium metabolism (high increase in serum Ca levels and impairment of renal elimination of calcium). The observed changes may be influenced by the doses of immunosuppressive agents and disturbed renal function.

Pregnancy course in patients with intrahepatic cholestasis of pregnancy treated with very low doses of ursodeoxycholic acid.

Abstract Objective. Ursodeoxycholic acid (UDCA) has been proposed as the optimal pharmacological treatment for intrahepatic cholestasis of pregnancy (ICP). The lowest effective dosage of UDCA in women with ICP has not been established. The objective is to determine the risk of adverse pregnancy outcomes resulting from ICP and to measure changes in liver function parameters and pruritus severity in ICP patients treated with low doses of UDCA. Material and methods. ICP was diagnosed in 203 patients on the basis of pruritus and elevated liver biochemical parameters. Patients with total bile acids (TBA) ≥10 μmol/l (n = 157) received UDCA (300–450 mg/day; 4–6 mg/kg/day) until delivery. Maternal and fetal outcomes of women with ICP were compared with 100 patients without cholestasis. Patients with ICP were hospitalized for treatment and fetal surveillance. Results. There was no correlation between fetal and neonatal complication rates in ICP patients and biochemical markers of cholestasis. Significant declines in serum TBA (p = 0.003), bilirubin concentration (p = 0.026) and aminotransferase activity (p < 0.001) were observed during treatment with low doses of UDCA. Moreover, severity of pruritus was ameliorated during the 2 weeks of therapy (p = 0.037). A total of 17 patients (10.9%) did not respond to treatment. Conclusions. UDCA at low doses improved biochemical markers and clinical symptoms in almost 90% of ICP patients.

Serum leptin concentration in women of reproductive age with euthyroid autoimmune thyroiditis.

Abstract Introduction: Autoimmune thyroid disease (AITD) with elevated anti-thyroid peroxidase antibody (aTPO) levels appears in 12–25% of all women, apart from thyroid dysfunction. High titers of aTPO are more common in women with polycystic ovary syndrome and endometriosis. Elevated aTPO has been associated with infertility and poorer quality of life among euthyroid women, and may be related to other factors. Objectives: The aim of the study was to measure differences in serum leptin concentration between AITD+ and AITD− patients. Setting, patients and main outcome measures: The sample was comprised of 74 women who were hospitalized in the Department of Gynecological Endocrinology, Medical University of Warsaw. Data collected included age, body mass index (BMI), and serum aTPO, serum thyroid stimulating hormone (TSH), serum fT4, serum follitropin (FSH), serum estradiol and serum leptin. AITD positive status was defined as serum aTPO greater than 5.6 mIU/ml. Results: Serum leptin concentrations were significantly higher in AITD+ patients compared to AITD− patients (17.13 ng/ml [SD 7.66] versus 12.78 ng/ml [SD 7.28]; p < 0.05). No differences by AITD status were found in age, BMI, TSH, FSH, estradiol and fT4. Conclusions: Serum leptin concentrations were higher in patients with AITD than in patients without AITD.

Signs and symptoms, evaluation, and management of genitourinary tract consequences of premature ovarian insufficiency

Premature ovarian insufficiency (POI) occurs in 1% of women under 40 years old. Hypoestrogenism associated with this condition may result in vaginal atrophy and urine incontinence, called genitourinary syndrome. The symptoms include: vaginal dryness, irritation, dyspareunia, and dysuria. There is relative lack of studies on the occurrence and treatment of genitourinary problems in women with POI. Prevalence rates vary from 17 to 54% depending on cause, duration of oestrogen depletion, and the treatment used. Patients with POI gain lower scores in tests measuring vaginal health or sexual function in comparison to healthy peers. Hormonal treatment in premature ovarian insufficiency is recommended until the natural age of menopause. The vaginal route of oestrogen administration is supposed to be the criterion standard in treating genitourinary symptoms. Androgen supplementation is not routinely recommended.

Premature ovarian insufficiency – aetiopathology, epidemiology, and diagnostic evaluation

Premature ovarian insufficiency (POI) is defined as a cessation of ovarian function before the age of 40 years. It is associated with hypoestrogenism and loss of residual follicles, both of which lead to menstrual abnormalities, pregnancy failures, and decreased health-related quality of life. The prevalence of POI is estimated at 1% in the general population. Current European Society of Human Reproduction and Embryology (ESHRE) diagnostic criteria include: amenorrhoea or oligomenorrhoea for at least four months and increased follicle-stimulating hormone (FSH) levels > 25 IU/l measured twice (with a four-week interval). The aetiopathogenesis of the disease in most cases remains unexplained. Nevertheless, in some patients with POI, genetic abnormalities, metabolic disorders, autoimmunity, iatrogenic procedures, infections, or environmental factors have been established as underlying causes of the syndrome.

Premature ovarian insufficiency – hormone replacement therapy and management of long-term consequences

Premature ovarian insufficiency (POI) correlates with increased risk of cardiovascular diseases, osteoporosis, genitourinary syndrome, and other symptoms of prolonged oestrogen deprivation. Properly selected therapy improves the quality of women’s lives and reduces the risk of mortality. There is a wide spectrum of available oestrogen and progestogen formulations restoring proper levels of serum sex steroid hormones. The treatment should be implemented at recognition of the POI and continued to at least the age of natural menopause. Transdermal oestradiol and oral or vaginal progesterone administration provide the most physiological sex steroid replacement therapy. Patients’ views and individual preference according the route, dose, and regimen of hormonal treatment have to be taken into consideration in order to achieve high compliance rates. Women with POI should be managed by a multidisciplinary team, such as a gynaecologist, endocrinologist, dietitian, and psychologist.