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Journal Article 2006; 27(6): 828-832 PubMed PMID: 17187024 Citation  Keywords:  Acromegaly:blood, Adenoma:blood, Adult, Aged, Aged, 80 and over, Bromocriptine:therapeutic use, Female, Follow-Up Studies, Hormone Antagonists:therapeutic use, Human Growth Hormone:blood, Humans, Insulin-Like Growth Factor I:analysis, Male, Middle Aged, P.   

OBJECTIVES: Acromegaly is a rare disease with increased mortality rate. The aim was to present our centre experience in the diagnosis and treatment of a series of patients suffering from acromegaly.

METHODS: 130 patients (55 men, 75 women) aged 19-84 years presenting with clinical and hormonal features of acromegaly, attending Department of Endocrinology and Out-patient Clinic between 1990 and 2004 were studied. They were analyzed their GH and IGF-1 levels, CT and MRI scans, and they were administered medical therapy, neurosurgery and radiotherapy.

RESULTS: We have observed 106 macro-, 16 microadenomas and 1 case of ectopic GHRH. 115 patients were operated, as cured were recognized 74 of them. Pituitary irradiation was applied to 11 patients, in 4 of them it did not cure the disease. Medical therapy was efficacious in 12% patients treated with bromocriptine, 73% with long-acting lanreotide and 58% with long-acting octreotide. In 7 patients other malignant neoplasm were detected. 11 patients died during the follow-up.

CONCLUSIONS: There is possible underdiagnosis of acromegaly in our region, especially in males. We have observed better diagnostic opportunities in recent years when MRI was available. It was accompanied by better outcome of surgical and pharmacological treatment and better control of the complications of the disease....

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Comparative Study 2006; 27(5): 639-643 PubMed PMID: 17159821 Citation  Keywords:  Acromegaly:blood, Adenoma:complications, Adult, Aged, Colonic Polyps:complications, Colonoscopy:methods, Colorectal Neoplasms:complications, Female, Fluorescence, Growth Hormone:blood, Humans, Insulin-Like Growth Factor I:analysis, Male, Middle Aged, Pitu.   

OBJECTIVES: Acromegalics have an increased risk of colorectal neoplasm. The aim of this study was to establish the association between acromegaly and colorectal lesions.

MATERIALS AND METHODS: The study included 51 patients with active acromegaly: 30 women and 21 men (average age 52.95 +/- 13.49 years). Growth hormone (GH), insulin-like growth factor I (IGF-I), prolactin (PRL), thyreothropin (TSH), thyroxine (FT4) were measured in the serum when patients were hospitalized for their first diagnosis of acromegaly, before starting the treatment. All patients underwent colonoscopy--in the first phase conventional in white light; in the second phase fluorescence colonoscopy. Autofluorescence of colonic mucosa was assessed by illumination with monochromatic light. Green fluorescence is characteristic for normal colonic mucose, whereas red fluorescence occur in pathological lesions. Material to histopathological examination was taken from every pathological colorectal lesion.

RESULTS: Using conventional colonoscopy we detected colonic polyps in 21 acromegalic patients (41.17%). Polyps with red fluorescence were found in 7 (13.7%) acromegalics and with green fluorescence in 16 (31.37%) cases of these patients. Histological diagnoses of colorectal lesions are adenoma, hyperplastic and inflammatic polyps. The number of colorectal polyps was dependent on IGF-I, fT4 and sex.

CONCLUSIONS: Acromegaly is associated with high prevalence of colorectal pathology, mainly hyperplastic polyp and adenoma. There is a relationship between number of colorectal polyps and serum IGF-I levels in acromegaly. Adenomas and hyperplastic polyps were associated with higher levels of IGF-I....

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Journal Article 2006; 27(4): 507-512 PubMed PMID: 16891993 Citation  Keywords:  Adolescent, Anthropometry, C-Peptide:blood, Cerebral Palsy:complications, Child, Child Nutrition Disorders:etiology, Child, Preschool, Energy Metabolism, Female, Growth Disorders:etiology, Human Growth Hormone:blood, Humans, Hydrocortisone:blood, Leptin:b.   

AIM: Children with Cerebral Palsy (CP) are generally undernourished and growth retarded than normal children. The reasons of malnutrition are not only due to poor nutritional status but also nonnutritional factors including negative neurotrophic effects and indirect factor such as immobility, endocrinological abnormalities or spasticity that energy requirements might be contributing factors. Several studies indicated that leptin which is produced by adipocytes, might regulate energy intake and expenditure. The aim of this study is to determine serum leptin levels in children with CP and to investigate the relationship between nutritional status and anthropometric measurements.

METHODS: Forty children with CP and 18 healthy controls were included in this study. The weight, height, body mass index (BMI), upper arm length (UAL) and triceps skinfold thickness (TST) was measured in all children. Serum leptin, growth hormone, C-peptide and cortisol levels were studied. Based on TST measurement CP patients were divided as DSF group (decreased subcutaneous fat) and non-DSF group (nondecreased subcutaneous fat).

RESULTS: UAL were shorter and TST measurements were thinner than control group (p<0.05, p<0.01). Group DSF had lower leptin concentrations compared to Group non-DSF and controls (p<0.001, p<0.001). On the other hand non DSF group had higher leptin levels than controls (p<0.05). There was a positive and significant correlation between leptin and anthropometric measurements, especially TST in children with CP. Serum leptin levels were also lower in non-ambulatory children than ambulatory children with CP (p<0.05).

CONCLUSION: This study has shown that triceps skinfold thickness is better index for the evaluation of nutritional status in children with CP. Serum leptin levels were lower in CP, especially in DSF group. The possible explanation of this finding may not only related with malnutrition, but also immobility related other factors such as bone metabolism and spasticity. We concluded that leptin which regulates energy intake might have a role of nutritional disorders in cerebral palsy. To better understand this relationship further studies are needed....

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Case Reports 2006; 27(1-2): 93-96 PubMed PMID: 16648809 Citation  Keywords:  Adenoma:metabolism, Adrenocorticotropic Hormone:blood, Cell Proliferation, Human Growth Hormone:blood, Humans, Hydrocortisone:blood, Immunohistochemistry, Insulin-Like Growth Factor I:metabolism, Male, Microscopy, Electron, Middle Aged, Pituitary Hormones.   

: Herein, we report the case of a 46-year-old male patient with only one month of double vision. Radiological examination revealed a pituitary tumor. Endocrinological investigations showed no pathological alterations of anterior pituitary function. Neuropathological examinations revealed a pituitary gland adenoma with an elevated proliferation rate (MIB-1 index 4-5 %) as well as an elevated p53 expression leading to the diagnosis of an atypical pituitary adenoma. Interestingly, the tumor exhibited strong basophilia in routine histology and densely secretory granules in electron microscopy (EM). However, no hormone excess was detectable in immunohistochemistry. In contrast to clinical and immunohistochemical observations, EM and routine histology findings implied a hormone production. This discrepancy might be due to a production of unfunctional pre-stages of pituitary gland proteins in this fast growing neoplasm....

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Journal Article 2006; 27(1-2): 183-188 PubMed PMID: 16648806 Citation  Keywords:  Absorptiometry, Photon, Acromegaly:blood, Adult, Aged, Body Mass Index, Bone Density:physiology, Cytokines:blood, Enzyme-Linked Immunosorbent Assay, Female, Human Growth Hormone:blood, Humans, Male, Middle Aged, Sex Characteristics, Testosterone:blood,.   

OBJECTIVES: Elevated cytokines levels were observed as a marker of increased bone resorption in certain diseases. The aim was to assess serum levels of selected cytokines in acromegaly, regarding to different disease's stages, gonadal function, gender and character of BMD change.

METHODS: The study was carried out in 62 patients with acromegaly (40 women, 22 men) aged 26-75 years in various stages of the disease. The controls were 30 healthy, age- and sex-matched subjects. Serum cytokines concentration was assessed using ELISA method.

RESULTS: We have shown higher (p=0.044) concentrations of TGF-beta in male patients with active acromegaly than in cured males. When the influence of all cytokines studied on BMD using multiple regression analysis was carried out, the borderline (p=0.099) statistical significance was achieved (regression coefficient B=0.68271) according to TGF-beta and trochanter major BMD. IL-6 and TNF-alpha were higher (p=0.062, and p=0.098, respectively) in these acromegalic patients, in which gain of trochanter major BMD occurred. IL-1beta levels were lower in patients with ultradistal radius and 1/3 distal radius BMD gain (p=0.007, and p=0.009, respectively). Lower TGF-beta levels (p=0.077) were shown in patients with 1/3 distal radius gain. IL-6 levels were higher in patients with total body BMD gain (p=0.059).

CONCLUSIONS: The relations between TGF-beta and acromegaly activity in men, and trochanter major BMD in both sexes were documented. Concentrations of all cytokines studied correlated with the BMD changes in different bone sites. Noteworthy is homogeneity of the secretory character of cytokines studied according to BMD changes within particular skeleton sites....

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Journal Article 2006; 27(1-2): 153-156 PubMed PMID: 16648801 Citation  Keywords:  Animals, Cells, Cultured, Dose-Response Relationship, Drug, Growth Hormone:metabolism, Male, Neuropeptides:pharmacology, Pituitary Gland:cytology, Radioimmunoassay, Rats, Rats, Inbred WKY,.   

OBJECTIVE: Cortistatin (CST) is a 17-amino acid neuropeptide expressed mainly in the cortex and hippocampus. It is also found in the peripheral tissues such as the stomach, kidney, pancreas and the immune system. Two forms of cortistatin CST-17, CST-29 bind with high affinity all somatostatin (SS) receptor subtypes. It has been reported that a receptor called MrgX(2) is able to selectively bind both CST-17 and CST-14 rather than SS. In human tissues CST-17 and CST-29, rather than SS, also bind ghrelin receptor GHS-r1a. In in vivo experiments CST inhibited GH and insulin secretion.

THE AIM: The aim of this study was to evaluate the effect of cortistatin on GH release in in vitro experiments.

RESEARCH METHODS: CST-14 and SS-14 in doses of 1nMol, 10nMol, and 100nMol were added after 48 hrs of pituitary cell culture, and the medium was collected 30, 60, 120, 240 min thereafter. rGH was measured with RIA kits provided by Linco.

RESULTS: CST-14 stimulated GH release from cultured pituitary cells in a dose dependent manner. The maximum effect of CST-14 was observed after 60 min of incubation. However, SS-14 in doses of 10 nMol and 100 nMol inhibited GH release.

CONCLUSION: A direct stimulating effect of Cortistatin-14 on GH release from cultured pituitary cells was found....

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Journal Article 2006; 27(1-2): 225-230 PubMed PMID: 16648797 Citation  Keywords:  Absorptiometry, Photon, Adolescent, Adult, Aged, Aldehydes:blood, Body Composition:physiology, Body Mass Index, Bone Density:physiology, Female, Glucose Intolerance:physiopathology, Glucose Tolerance Test, Human Growth Hormone:blood, Humans, Lipid Peroxid.   

OBJECTIVES: Growth hormone (GH) deficiency in adults is associated with a higher risk of atherosclerosis and cardiovascular disease. It has recently been suggested that enhanced oxidative stress may be implicated in vascular (and probably other) disturbances, occurring in GH-deficient subjects. The aim of the study was to evaluate serum levels of lipid peroxidation (LPO) products in adult patients with severe GH deficiency during insulin tolerance test (ITT), and to estimate the relationships between LPO and GH, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and other parameters of metabolic processes.

MATERIAL AND METHODS: Twelve adult patients with severe GH deficiency hospitalized in our department and 12 healthy volunteers, matched for sex, age and body mass index (BMI), were enrolled in the study. Peripheral blood was collected during ITT. The concentrations of malondialdehyde + 4-hydroxyalkenals (MDA+4-HDA), as an index of LPO, were measured in blood serum.

RESULTS: Serum LPO level was approximately twice as high in GH-deficient patients as in the controls at each time point of ITT. A positive correlation was found between bone mineral density in the lumbar spine and GH concentration in GH-deficient patients. A positive correlation was found between LPO and BMI in the controls, but no such correlation was observed in GH-deficient patients.

CONCLUSION: The increased LPO in GH-deficient patients may indicate enhanced oxidative stress within the vascular compartment and, possibly, in other tissues, which may contribute to the proatherogenic state and corresponding organ disturbances in GH-deficient patients, independently from conventional risk factors....

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Journal Article 2006; 27(1-2): 149-152 PubMed PMID: 16648787 Citation  Keywords:  Body Height:physiology, Child, Female, Growth:drug effects, Growth Hormone:therapeutic use, Human Growth Hormone:deficiency, Humans, Male, Parents, Prognosis,.   

INTRODUCTION: Parental height is the most important identifiable factor influencing final height (FH) of children with growth hormone (GH) deficiency (GHD), treated with GH.

AIM: Assessment of FH of patients with GHD--classified into familial short stature (FSS) and non-familial short stature (non-FSS) according to parentally adjusted deficit of height.

PATIENTS AND METHODS: The analysis comprised 101 patients (76 boys) with childhood-onset GHD. Final height was compared with patients' height before GH therapy, predicted adult height (PAH) and target height (TH).

RESULTS: Both GH peak in stimulating tests and height standard deviation score (SDS) before the therapy were significantly lower in non-FSS than in FSS. Target height was significantly lower in FSS than in non-FSS. Parentally-adjusted deficit of height was significantly more profound in non-FSS than in FSS. The prognosis of adult height was very similar in both groups of patients, being significantly worse in non-FSS than in FSS while corrected by TH. The absolute FH was similar in FSS and non-FSS, being, however, significantly lower in non-FSS than in FSS while corrected by TH. Improvement of height was significantly better in non-FSS than in FSS. In both groups, FH SDS was significantly better than height SDS before the therapy (H0SDS). In FSS group, PAH was similar to TH, moreover, FH corresponded to both PAH and TH. In non-FSS group FH was significantly higher than PAH, but both FH and PAH were significantly lower than TH.

CONCLUSIONS: 1) Growth hormone therapy was more effective in the patients with non-FSS than in those with FSS. 2) Parentally-adjusted deficit of height is an important prognostic factor of GH therapy effectiveness....

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