Sasa Radenkovic

Optimal surgical treatment for bilateral multinodular goitre

Objective:  In the present study, we compared subtotal thyroidectomy (STT) with total thyroidectomy (TT) in the management of bilateral multinodular goitre.

Localised Langerhans cell histiocytosis of the hypothalamic-pituitary region: case report and literature review

IntroductionLangerhans cell histiocytosis (LCH) localised in the hypothalamic-pituitary region (HPR) is very rare, especially in adults. Diabetes insipidus (DI) is considered to be a hallmark of HPR LCH, while anterior pituitary abnormalities are usually seen as consequences of surgery, radiotherapy or chemotherapy.Case descriptionWe present a patient with localised HPR LCH with dominant anterior pituitary dysfunction and tumour mass effects but without DI. Seven years after surgery and local radiotherapy, she is stable. Control MRI shows no residual tumour growth and thorough physical examination is still without any signs of disease spread.ConclusionsAnterior pituitary deficiency can appear without DI and not only as a consequence of LCH treatment. All patients with LCH should be screened for this endocrine abnormality so that appropriate substitution therapy may be provided.

Expression of prolactin receptors in the duodenum, kidneys and skeletal system during physiological and sulpiride-induced hyperprolactinaemia

Introduction and aimHyperprolactinaemia in pregnancy leads to mild and reversible changes in the maternal skeletal system, and medicamentous hyperprolactinemia causes more detrimental effects. We conducted an experimental study to evaluate differences between Prlr gene expression in the duodenum, vertebrae and kidneys during physiological and medicamentous hyperprolactinaemia, which could influence calcium homeostasis.MethodsExperimental animals (18 weeks old, Wistar female rats) were divided as follows: group P (nine rats that were 3 weeks pregnant), group M (ten rats that were intramuscularly administrated sulpiride (10 mg/kg) twice daily for 3 weeks), and the control group (C, ten age-matched nulliparous rats, 18-week-old). Laboratory investigations included measurements of serum ionized calcium, phosphorus, urinary calcium and phosphorus excretion, osteocalcin (OC), serum procollagen type 1 N-terminal propeptide (P1NP), vitamin D, parathyroid hormone (PTH) and prolactin (PRL). Relative quantification of gene expression for prolactin receptors in the duodenum, vertebrae and kidneys was determined using real-time PCR.ResultsExpression of the Prlr gene was significantly higher in the duodenum (p < 0.001) and lower in vertebrae (p < 0.001) and kidneys (p < 0.01) in rats with physiological hyperprolactinaemia (PHP) than in the control group. Significantly lower Prlr expression in the duodenum was verified (p < 0.001), along with increased Prlr gene expression in vertebrae (p < 0.001) and kidneys (p < 0.01), in rats with medicamentous hyperprolactinaemia (MHP) than in the C group.ConclusionsDownregulation of Prlr gene expression in the duodenum may explain the diminished intestinal calcium absorption in medicamentous hyperprolactinaemia. Prolactin takes calcium from the skeletal system following increased Prlr gene expression in the vertebrae to maintain calcium homeostasis, which increases the harmful effect on bone metabolism compared to that of physiological hyperprolactinaemia.

THE CORRELATION BETW EEN BODY MASS INDEX AND THYROID STIMULATING HORMONE IN EUTHYROID PERSONS

The aim of the study was to determine the correlation between body mass index (BMI), thyroid stimulating hormone (TSH), and thyroid hormones in euthyroid persons. The study included 396 euthyroid participants. The subjects with already established disease of the thyroid function were excluded. In all subjects we measured weight, height and determined BMI. According to BMI values, the subjests were divided into three groups: group A – BMI up to 24.9 (normal weight); group B BMI from 25 to 29.9 (overweight); group C BMI over 30 (obesity). In all subjests we determined serum TSH and free thyroxine (FT4) levels and antibodies to thyroid peroxidase (TPOAb). According to TSH levels, the subjects were divided into two groups: TSH up to 2.5, and TSH higher than 2.5. There is an increase in TSH levels with increasing of BMI. In group C, TSH values were significantly higher than in the groups A and B, and were also higher than the mean values of TSH in all subjects. TSH level in group B were slightly higher compared to the group A but there is no statistically significant difference. TPOAb values increase with increasing of BMI. The mean value of BMI was significantly lower in the group of patients with TSH values lower than 2.5, compared to the mean value of BMI in the group of patients with TSH values higher than 2.5. The relationship of BMI and TSH points to significant positive correlations of two parameters, except in group A. We found a significant degree of positive correlation between BMI and TSH, which remains within the normal range. There are also significant changes in the of TPOAb values. There is no significant changes in the FT4 levels. Acta Medica Medianae 2018;57(1):33-37.

Decreased ultrasound echogenicity as a thyroid hypofunction marker and correlation with autoantibody levels

Background/Aim. The value of ultrasound in functional disorders can be significant. That is why the question arises on the use of ultrasound examination of thyroid gland and its echogenicity as a screening method in early detection of disfunctions, of the gland primarily subclinical and clinical forms of hypothyreoidism. The objective of this paper was to determine antibodies of thyroid peroxidase (anti-TPO) and thyroglobuline antibodies (anti-TG) increase frequency in relation to the character of ultrasound echogenicity as well as to estimate the frequency of subclinically and clinically obvious hypothyreoidism in relation to the changed echogenicity. Methods. Study included 656 patients in outpatient clinic during 2014. All examinees underwent ultrasound examination of thyroid gland, the blood was taken for determination of free thyroxine (FT4), thyroidstimulating hormone (TSH), anti-TPO and anti-TG. The patients were divided into two groups; the group A with normal echogenicity of thyroid gland tissue, and the group B with decreased echogenicity. The group B was divided into two subgroups, B1 with a mildly decreased and B2 with significantly decreased echogenicity. Results. TPO antibody, TSH and TG antibody positivity and their mean values in the group B were significantly higher, as well as in subgroups B1 and B2, in relation to the group A (p < 0.001). In the group A, only 4 (1%) examinees were indicated with subclinical hypothyreoidism. In the group B, the sublinical hypothyreoidism was indicated in 42, while the clinical hypothyreoidism was indicated in 16 examinees. Fifty-eight (25%) examinees suffered from thyroid gland altered function. In the subgroup B1, 16 examinees were indicated with subclinical and 4 with clinical hypothyreoidism. Twenty (11%) examinees suffered from altered thyroid function. In the group B2, the subclinical hypothyreoidism was found in 26 examinees, while the clinical hypothyreoidism was found in 12. Thirty-eight (76%) examinees suffered from altered thyroid function. Conclusion. The ultrasound screening of thyroid gland plays an important role in early detection of thyroid disfunction, i.e., sublinical and clinical hypothyreoidism. Decreased ultrasound echogenicity represents the significant marker of altered thyroid gland function. In these persons we have determined the high percentage of subclinical and clinical hypothyreoidism frequency.

Epileptic seizure as the first sign of hypoparathyroidism

BACKGROUND Hypoparathyroidism refers to a group of disorders in which extracellular calcium levels cannot be maintained within the normal range due to relative or absolute deficiency of parathyroid hormone (PTH). The clinical features of hypoparathyroidism are consistent with hypocalcaemia and, predominantly, neuromuscular dysfunction. Although hypocalcaemia-induced seizures are well documented hypoparathyroidism-induced epilepsy is often misdiagnosed as idiopathic epilepsy. CASE REPORT We reported a 57-year-old woman with new-onset seizure due to hypoparathyroidism. At first, diagnosis of epilepsy was established and the antiepileptic therapy was initiated with gradual increase of the dose. Computerized tomography scan of the head revealed bilateral basal ganglia and cerebellar calcification and many punctiform calcifications between cortical and subcortical parts. During hospitalization, laboratory tests showed hypocalcemia, hyperphosphatemia and low PTH level. Once the diagnosis of hypoparathyroidism was established, a proper treatment with calcium and vitamin D was started, and the patient was discharged from hospital with full seizure control. CONCLUSION Standard evaluation of serum calcium levels in patients with new-onset epileptic seizures should be obligatory part of a diagnostic algoritam to avoid misdiagnosis of idiopathic epilepsy.

Continuous subcutaneous insulin infusion vs. multiple daily injections

BackgroundIntensive insulin therapy should be proposed for most type 1 diabetic patients. It can be achieved by a continuous subcutaneous insulin infusion (CSII) or by multiple daily injections (MDI). Debate remains regarding the optimal delivery of such therapy.AimTo compare the efficacy of glycemic control, hypoglycemia frequency, dose of insulin and weight in the type 1 diabetic patients, after switching from MDI to CSII.MethodsIn this retrospective study we analyzed HbA1c, profiles of blood glucose, weight, dose of insulin and hypoglycemia, 6 months before and 6 months after the initiation of CSII, in 18 patients with type 1 diabetes mellitus.ResultsBlood glucose control is considerably improved during CSII, as measured by HbA1c and mean blood glucose concentrations. Fasting blood glucose, postprandial glucose and also of glycemic variability were significantly lower. The total insulin doses during the CSII period were significantly lower. There was a small non significant increase in weight during CSII. There was a significant decrease in a number of mild hypoglycemic events, a small non significant decrease of asymptomatic hypoglycemia and a small non significant increase of nocturnal hypoglycemia.ConclusionsCSII provides significant improvement of blood glucose control with lower risk for hypoglycemia.