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Vujović S, Ivović M, Tančić Gajić M, Marina L, Jovičić SP, Pavlović N, Jovičić ME. Alzheimer’s Disease and Premature Ovarian Insufficiency. Endocrines 2023. [DOI: 10.3390/endocrines4020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Estradiol promotes neuronal growth, transmission, survival, myelinization, plasticity, synaptogenesis, and dendritic branching and it improves cognitive function. Alzheimer’s disease (AD) is characterized by amyloid plaques, neurofibrillary tangles, and the loss of neuronal connection in the brain. Genomic analysis has concluded that hypoestrogenism influences the APOE gene and increases the risk of AD. Premature ovarian insufficiency (POI) is defined as oligo/amenorrhea in women below 40 years of age, low estradiol, and high-gonadotropin levels. Early symptoms and signs of POI must be detected in time in order to prevent subsequent complications, such as Alzheimer’s disease. Meta-analysis has shown favorable effects of estrogen in preventing Alzheimer’s. We measured some of the typical markers of AD in women with POI such as interleukin 6 (IL-6), interleukin 8 (IL-8), tissue necrosis factor α (TNFα), TAU1, TREM2, and amyloid precursor proteins (APP). While FSH, LH, and IL-8 were significantly higher in POI group, compared to controls, testosterone and DHEAS were lower. A significant decrease in IL-6 was found in the POI group during a 6-month therapy, as well as an increase in amyloid precursor proteins. CONCLUSION: Neurological complications of POI, such as declining short-term memory, cognitive function, and dementia, have to be promptly stopped by initiating estro-progestogen therapy in POI. A long-term continuation of the therapy would be strongly advised.
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Affiliation(s)
- Svetlana Vujović
- Faculty of Medicine, National Center for Infertility and Endocrinology of Gender, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, University of Belgrade, 11000 Belgrade, Serbia
| | - Miomira Ivović
- Faculty of Medicine, National Center for Infertility and Endocrinology of Gender, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, University of Belgrade, 11000 Belgrade, Serbia
| | - Milina Tančić Gajić
- Faculty of Medicine, National Center for Infertility and Endocrinology of Gender, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, University of Belgrade, 11000 Belgrade, Serbia
| | - Ljiljana Marina
- Faculty of Medicine, National Center for Infertility and Endocrinology of Gender, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, University of Belgrade, 11000 Belgrade, Serbia
| | - Svetlana Pavlović Jovičić
- Faculty of Medicine, Clinic for Nephrology, University Clinical Center, University of Belgrade, 11000 Belgrade, Serbia
| | - Natalija Pavlović
- Faculty of Medicine, National Center for Infertility and Endocrinology of Gender, Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center, University of Belgrade, 11000 Belgrade, Serbia
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Deutschbein T, Reimondo G, Di Dalmazi G, Bancos I, Patrova J, Vassiliadi DA, Nekić AB, Debono M, Lardo P, Ceccato F, Petramala L, Prete A, Chiodini I, Ivović M, Pazaitou-Panayiotou K, Alexandraki KI, Hanzu FA, Loli P, Yener S, Langton K, Spyroglou A, Kocjan T, Zacharieva S, Valdés N, Ambroziak U, Suzuki M, Detomas M, Puglisi S, Tucci L, Delivanis DA, Margaritopoulos D, Dusek T, Maggio R, Scaroni C, Concistrè A, Ronchi CL, Altieri B, Mosconi C, Diamantopoulos A, Iñiguez-Ariza NM, Vicennati V, Pia A, Kroiss M, Kaltsas G, Chrisoulidou A, Marina LV, Morelli V, Arlt W, Letizia C, Boscaro M, Stigliano A, Kastelan D, Tsagarakis S, Athimulam S, Pagotto U, Maeder U, Falhammar H, Newell-Price J, Terzolo M, Fassnacht M. Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study. Lancet Diabetes Endocrinol 2022; 10:499-508. [PMID: 35533704 PMCID: PMC9679334 DOI: 10.1016/s2213-8587(22)00100-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing). METHODS We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800-0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50-138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants. FINDINGS Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53-68]; median follow-up 7·0 years [IQR 4·7-10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19-1·94) and autonomous cortisol secretion (1·77, 1·20-2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93-9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values <0·001). INTERPRETATION Cortisol autonomy is associated with increased all-cause mortality, particularly in women younger than 65 years. However, until results from randomised interventional trials are available, a conservative therapeutic approach seems to be justified in most patients with adrenal incidentaloma. FUNDING Deutsche Forschungsgemeinschaft, Associazione Italiana per la Ricerca sul Cancro, Università di Torino.
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Affiliation(s)
- Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Medicover Oldenburg MVZ, Oldenburg, Germany
| | - Giuseppe Reimondo
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Guido Di Dalmazi
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | - Irina Bancos
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Jekaterina Patrova
- Department of Clinical Science and Education, Södersjukhuset AB, Karolinska Institutet, Stockholm, Sweden
| | - Dimitra Argyro Vassiliadi
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Anja Barač Nekić
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miguel Debono
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Pina Lardo
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
| | - Luigi Petramala
- Second Hypertension Unit, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Alessandro Prete
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Iacopo Chiodini
- Istituto Auxologico Italiano, IRCCS, University of Milan, Milan, Italy
| | - Miomira Ivović
- Clinic for Endocrinology, Diabetes, and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Krystallenia I Alexandraki
- 1st Department of Propaedeutic and Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Paola Loli
- Department of Endocrinology, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Serkan Yener
- Department of Endocrinology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Katharina Langton
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Dresden, Dresden, Germany
| | - Ariadni Spyroglou
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts-Spital Zürich, Zürich, Switzerland; University Hospital Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tomaz Kocjan
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sabina Zacharieva
- Department of Endocrinology, University Hospital of Endocrinology, Medical University, Sofia, Bulgaria
| | - Nuria Valdés
- Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Hospital Universitario de Cabueñes, Gijón, Spain
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Mari Suzuki
- Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, MD, USA
| | - Mario Detomas
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Soraya Puglisi
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Lorenzo Tucci
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | | | - Dimitris Margaritopoulos
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Tina Dusek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Roberta Maggio
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
| | - Antonio Concistrè
- Second Hypertension Unit, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Cristina Lucia Ronchi
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Barbara Altieri
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany
| | - Cristina Mosconi
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Diagnostic and Interventional Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aristidis Diamantopoulos
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Nicole Marie Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Valentina Vicennati
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | - Anna Pia
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; University Hospital Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gregory Kaltsas
- 1st Department of Propaedeutic and Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ljiljana V Marina
- Clinic for Endocrinology, Diabetes, and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Valentina Morelli
- Istituto Auxologico Italiano, IRCCS, University of Milan, Milan, Italy
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claudio Letizia
- Second Hypertension Unit, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Marco Boscaro
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Padova, Italy
| | - Antonio Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes, and Metabolism, National Expertise Centre for Rare Endocrine Diseases, Evangelismos Hospital, Athens, Greece
| | - Shobana Athimulam
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health System, Detroit, MI, USA
| | - Uberto Pagotto
- Endocrinology and Prevention and Care of Diabetes Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
| | - Uwe Maeder
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - John Newell-Price
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.
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Prete A, Subramanian A, Bancos I, Chortis V, Tsagarakis S, Lang K, Macech M, Delivanis DA, Pupovac ID, Reimondo G, Marina LV, Deutschbein T, Balomenaki M, O'Reilly MW, Gilligan LC, Jenkinson C, Bednarczuk T, Zhang CD, Dusek T, Diamantopoulos A, Asia M, Kondracka A, Li D, Masjkur JR, Quinkler M, Ueland GÅ, Dennedy MC, Beuschlein F, Tabarin A, Fassnacht M, Ivović M, Terzolo M, Kastelan D, Young WF, Manolopoulos KN, Ambroziak U, Vassiliadi DA, Taylor AE, Sitch AJ, Nirantharakumar K, Arlt W. Cardiometabolic Disease Burden and Steroid Excretion in Benign Adrenal Tumors : A Cross-Sectional Multicenter Study. Ann Intern Med 2022; 175:325-334. [PMID: 34978855 DOI: 10.7326/m21-1737] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Benign adrenal tumors are commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion (MACS) is regularly diagnosed, but its effect on cardiometabolic disease in affected persons is ill defined. OBJECTIVE To determine cardiometabolic disease burden and steroid excretion in persons with benign adrenal tumors with and without MACS. DESIGN Cross-sectional study. SETTING 14 endocrine secondary and tertiary care centers (recruitment from 2011 to 2016). PARTICIPANTS 1305 prospectively recruited persons with benign adrenal tumors. MEASUREMENTS Cortisol excess was defined by clinical assessment and the 1-mg overnight dexamethasone-suppression test (serum cortisol: <50 nmol/L, nonfunctioning adrenal tumor [NFAT]; 50 to 138 nmol/L, possible MACS [MACS-1]; >138 nmol/L and absence of typical clinical Cushing syndrome [CS] features, definitive MACS [MACS-2]). Net steroid production was assessed by multisteroid profiling of 24-hour urine by tandem mass spectrometry. RESULTS Of the 1305 participants, 49.7% had NFAT (n = 649; 64.1% women), 34.6% had MACS-1 (n = 451; 67.2% women), 10.7% had MACS-2 (n = 140; 73.6% women), and 5.0% had CS (n = 65; 86.2% women). Prevalence and severity of hypertension were higher in MACS-2 and CS than NFAT (adjusted prevalence ratios [aPRs] for hypertension: MACS-2, 1.15 [95% CI, 1.04 to 1.27], and CS, 1.37 [CI, 1.16 to 1.62]; aPRs for use of ≥3 antihypertensives: MACS-2, 1.31 [CI, 1.02 to 1.68], and CS, 2.22 [CI, 1.62 to 3.05]). Type 2 diabetes was more prevalent in CS than NFAT (aPR, 1.62 [CI, 1.08 to 2.42]) and more likely to require insulin therapy for MACS-2 (aPR, 1.89 [CI, 1.01 to 3.52]) and CS (aPR, 3.06 [CI, 1.60 to 5.85]). Urinary multisteroid profiling revealed an increase in glucocorticoid excretion from NFAT over MACS-1 and MACS-2 to CS, whereas androgen excretion decreased. LIMITATIONS Cross-sectional design; possible selection bias. CONCLUSION A cardiometabolic risk condition, MACS predominantly affects women and warrants regular assessment for hypertension and type 2 diabetes. PRIMARY FUNDING SOURCE Diabetes UK, the European Commission, U.K. Medical Research Council, the U.K. Academy of Medical Sciences, the Wellcome Trust, the U.K. National Institute for Health Research, the U.S. National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research.
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Affiliation(s)
- Alessandro Prete
- The Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.P., V.C., K.L.)
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom (A.S.)
| | - Irina Bancos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom, and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (I.B.)
| | - Vasileios Chortis
- The Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.P., V.C., K.L.)
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Katharina Lang
- The Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.P., V.C., K.L.)
| | - Magdalena Macech
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Ivana D Pupovac
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia (I.D.P., T.D., D.K.)
| | - Giuseppe Reimondo
- Division of Internal Medicine, University of Turin, San Luigi Hospital, Turin, Italy (G.R., M.T.)
| | - Ljiljana V Marina
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (L.V.M., M.I.)
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, and Medicover Oldenburg MVZ, Oldenburg, Germany (T.D.)
| | - Maria Balomenaki
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Michael W O'Reilly
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom, and Department of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Republic of Ireland (M.W.O.)
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Carl Jenkinson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Catherine D Zhang
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Tina Dusek
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia (I.D.P., T.D., D.K.)
| | - Aristidis Diamantopoulos
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Miriam Asia
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (M.A.)
| | - Agnieszka Kondracka
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Dingfeng Li
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Jimmy R Masjkur
- Department of Medicine III and Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany (J.R.M.)
| | | | - Grethe Å Ueland
- Department of Endocrinology, Haukeland University Hospital, Bergen, Norway (G.Å.U.)
| | - M Conall Dennedy
- Department of Endocrinology, University Hospital Galway, Newcastle, Galway, Republic of Ireland (M.C.D.)
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts Spital Zürich (USZ) und Universität Zürich (UZH), Zurich, Switzerland, and Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany (F.B.)
| | - Antoine Tabarin
- Service d'Endocrinologie, Centre Hospitalier Universitaire de Bordeaux, Hôpital du Haut-Lévêque, Pessac, France (A.T.)
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany (M.F.)
| | - Miomira Ivović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia (L.V.M., M.I.)
| | - Massimo Terzolo
- Division of Internal Medicine, University of Turin, San Luigi Hospital, Turin, Italy (G.R., M.T.)
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia (I.D.P., T.D., D.K.)
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (D.A.D., C.D.Z., D.L., W.F.Y.)
| | - Konstantinos N Manolopoulos
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland (M.M., T.B., A.K., U.A.)
| | - Dimitra A Vassiliadi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece (S.T., M.B., A.D., D.A.V.)
| | - Angela E Taylor
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom (L.C.G., C.J., K.N.M., A.E.T.)
| | - Alice J Sitch
- Institute of Applied Health Research, University of Birmingham, and NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (A.J.S.)
| | - Krishnarajah Nirantharakumar
- Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, and Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom (K.N.)
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, and NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (W.A.)
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Šojat AS, Dunjić-Kostić B, Marina LV, Ivović M, Radonjić NV, Kendereški A, Ćirković A, Tančić-Gajić M, Arizanović Z, Mihajlović S, Vujović S. Depression: another cortisol-related comorbidity in patients with adrenal incidentalomas and (possible) autonomous cortisol secretion. J Endocrinol Invest 2021; 44:1935-1945. [PMID: 33528757 DOI: 10.1007/s40618-021-01509-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Hypercortisolism is associated with a high prevalence of depression and impaired health-related quality of life (QoL). According to the available literature, studies examining the depression risk in patients with adrenal incidentalomas (AI), nonfunctioning and the ones with (possible) autonomous cortisol secretion ((P)ACS) are scarce. The aim of this observational, case-control study was to screen patients with nonfunctioning adrenal incidentalomas (NAI) and the ones with (P)ACS for depression and to assess their QoL. METHODS The total studied group consisted of 92 subjects-26 with NAI, 34 with (P)ACS and 32 age-matched healthy controls (HC). To screen for depression, we used the Beck Depression Inventory-II (BDI-II) and to assess the QoL, we used the Short-Form 36 Health Survey (SF-36). RESULTS Patients with (P)ACS had significantly higher BDI-II scores and substantially lower QoL than patients with NAI or HC. Midnight cortisol level was the most significant predictor of BDI-II and SF-36 score. The receiver operating characteristic curve analysis demonstrated that a midnight cortisol value of 86.95 nmol/l had a high sensitivity (82.8%) and high specificity (80%) for detection of mild depression in patients with (P)ACS. CONCLUSION Screening for depression and QoL assessment should become an integral part of clinical evaluation in patients with (P)ACS.
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Affiliation(s)
- A S Šojat
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - B Dunjić-Kostić
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- Clinic for Psychiatry, Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - L V Marina
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia.
| | - M Ivović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - N V Radonjić
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - A Kendereški
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - A Ćirković
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- Institute of Medical Statistics and Informatics, Dr Subotica 15, 11000, Belgrade, Serbia
| | - M Tančić-Gajić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Z Arizanović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - S Mihajlović
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- University Hospital Centre Dr Dragisa Misovic, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - S Vujović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
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Tančić-Gajić M, Vukčević M, Ivović M, Marina LV, Arizanović Z, Soldatović I, Stojanović M, Đogo A, Kendereški A, Vujović S. Obstructive Sleep Apnea Is Associated With Low Testosterone Levels in Severely Obese Men. Front Endocrinol (Lausanne) 2021; 12:622496. [PMID: 34381420 PMCID: PMC8350060 DOI: 10.3389/fendo.2021.622496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background Disrupted sleep affects cardio-metabolic and reproductive health. Obstructive sleep apnea syndrome represents a major complication of obesity and has been associated with gonadal axis activity changes and lower serum testosterone concentration in men. However, there is no consistent opinion on the effect of obstructive sleep apnea on testosterone levels in men. Objective The aim of this study was to determine the influence of obstructive sleep apnea on total and free testosterone levels in severely obese men. Materials and methods The study included 104 severely obese (Body Mass Index (BMI) ≥ 35 kg/m2) men, aged 20 to 60, who underwent anthropometric, blood pressure, fasting plasma glucose, lipid profile, and sex hormone measurements. All participants were subjected to polysomnography. According to apnea-hypopnea index (AHI) patients were divided into 3 groups: <15 (n = 20), 15 - 29.9 (n = 17) and ≥ 30 (n = 67). Results There was a significant difference between AHI groups in age (29.1 ± 7.2, 43.2 ± 13.2, 45.2 ± 10.2 years; p < 0.001), BMI (42.8 ± 5.9, 43.2 ± 5.9, 47.1 ± 7.8 kg/m2; p = 0.023), the prevalence of metabolic syndrome (MetS) (55%, 82.4%, 83.6%, p = 0.017), continuous metabolic syndrome score (siMS) (4.01 ± 1.21, 3.42 ± 0.80, 3.94 ± 1.81, 4.20 ± 1.07; p = 0.038), total testosterone (TT) (16.6 ± 6.1, 15.2 ± 5.3, 11.3 ± 4.44 nmol/l; p < 0.001) and free testosterone (FT) levels (440.4 ± 160.8, 389.6 ± 162.5, 294.5 ± 107.0 pmol/l; p < 0.001). TT level was in a significant negative correlation with AHI, oxygen desaturation index (ODI), BMI, MetS and siMS. Also, FT was in a significant negative correlation with AHI, ODI, BMI, age, MetS and siMS. The multiple regression analysis revealed that both AHI and ODI were in significant correlation with TT and FT after adjustment for age, BMI, siMS score and MetS components. Conclusion Obstructive sleep apnea is associated with low TT and FT levels in severely obese men.
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Affiliation(s)
- Milina Tančić-Gajić
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miodrag Vukčević
- Department of Pulmonology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miomira Ivović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ljiljana V. Marina
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorana Arizanović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Soldatović
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Stojanović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Đogo
- Department of Endocrinology, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Aleksandra Kendereški
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Vujović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Ivović M, Marina LV, Šojat AS, Tančić-Gajić M, Arizanović Z, Kendereški A, Vujović S. Approach to the Patient with Subclinical Cushing's Syndrome. Curr Pharm Des 2021; 26:5584-5590. [PMID: 32787757 DOI: 10.2174/1381612826666200813134328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/08/2020] [Indexed: 01/07/2023]
Abstract
A growing number of patients with adrenal incidentalomas and subclinical Cushing's syndrome (SCS) led to an increasing number of different guidelines, and diagnostic and treatment recommendations. Excess cortisol secretion in patients with SCS is associated with several comorbidities, such as hypertension, dyslipidemia, type 2 diabetes mellitus, and obesity, which in the long-term increase mortality of these patients. Subtle cortisol secretion affects bone health, quality of life and causes depression, but due to the unapparent clinical features, patients with SCS are often at risk between over and under treatment. This narrative review aimed to summarize the latest recommendations on the approach to the patient with subclinical Cushing's syndrome.
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Affiliation(s)
- Miomira Ivović
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Ljiljana V Marina
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Antoan S Šojat
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Milina Tančić-Gajić
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Zorana Arizanović
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Aleksandra Kendereški
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Svetlana Vujović
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
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Cvetković D, Jadžić J, Milovanović P, Djonić D, Djurić M, Ivović M, Nikolić S, Živković V. Comparative Analysis of Femoral Macro- and Micromorphology in Males and Females With and Without Hyperostosis Frontalis Interna: A Cross-Sectional Cadaveric Study. Calcif Tissue Int 2020; 107:464-473. [PMID: 32748007 DOI: 10.1007/s00223-020-00740-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/25/2020] [Indexed: 01/03/2023]
Abstract
We hypothesized that subjects with hyperostosis frontalis interna (HFI), which represents local, endocranial thickening of the frontal bone, would express extra-calvarial manifestations of this condition. Therefore, we compared femoral bone mineral density, geometry, and microarchitecture of males and females with HFI to those without this condition as well as between males and females with HFI. The sample was taken from human donor cadavers, 38 males (19 with and 19 without HFI) and 34 females (17 with and 17 without HFI) that were age-matched within the same sex. The specimens of femoral bones were scanned using microcomputed tomography and dual-energy X-ray absorptiometry (DXA). Parameters of hip structure analysis (HSA) were calculated from data derived from DXA scans. Females with HFI had increased cortical bone volume fraction and their cortical bone was less porous compared to females without HFI. Males with HFI showed microarchitectural differences only with the trabecular bone. They had increased bone volume fraction and decreased trabecular separation compared to males without HFI, although with borderline significance. These microarchitectural changes did not have significant impact on femoral geometry and bone mineral density. The same, still unknown etiological factor behind HFI might be inducing changes at the level of bone microarchitecture at a remote skeletal site (femoral bone), in both sexes. These alterations still do not have the magnitude to induce obvious, straightforward overall increase of bone mineral density measured by DXA. HFI could be a systemic phenomenon that affects both males and females in a similar manner.
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Affiliation(s)
- Danica Cvetković
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska Str., 11000, Belgrade, Serbia
| | - Jelena Jadžić
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Petar Milovanović
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Danijela Djonić
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Marija Djurić
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Miomira Ivović
- Clinic for Endocrinology, Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
| | - Slobodan Nikolić
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska Str., 11000, Belgrade, Serbia
| | - Vladimir Živković
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska Str., 11000, Belgrade, Serbia.
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Brkić M, Vujović S, Ivović M, Tančić Gajić M, Marina L, Franić Ivanišević M, Franić D. THE ROLE OF E2/P RATIO IN THE ETIOLOGY OF FIBROCYSTIC BREAST DISEASE, MASTALGIA AND MASTODYNIA. Acta Clin Croat 2018; 57:756-761. [PMID: 31168213 PMCID: PMC6544108 DOI: 10.20471/acc.2018.57.04.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- The aim of the study was to assess the role of the estradiol and progesterone relationship during the late luteal phase and the occurrence of fibrocystic breast disease (FBD). The concentration of estradiol/progesterone was measured in the group of women with FBD as study group (n=50) and control group of women without FBD (n=40). All women had regular ovulation cycles. Blood samples for estradiol (E2), progesterone (P) and prolactin determination were obtained in the morning at 8 am on days 21 and 24 of menstrual cycle. Significant mastalgia and mastodynia history in women with FBD was obtained with yes or no questionnaire. FBD diagnosis was confirmed with ultrasound (size and number of simple cysts). In the control group, a reduced E2/P ratio was noticed from day 21 to day 24 of the cycle (from 14.8±11.5 pg/mL to 9.1±6.1 pg/mL; p<0.05), which was not recorded in the group of women with FBD (study group). Even the slightest disturbance of the E2/P ratio may contribute to the occurrence of FBD with clinical manifestations of mastalgia and mastodynia.
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Affiliation(s)
| | - Svetlana Vujović
- 1Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 2Department of Endocrinology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia; 3Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; 4Outpatient Clinic of Obstetrics and Gynecology, Rogaška Slatina, Slovenia; 5School of Medicine, University of Maribor, Maribor, Slovenia
| | - Miomira Ivović
- 1Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 2Department of Endocrinology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia; 3Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; 4Outpatient Clinic of Obstetrics and Gynecology, Rogaška Slatina, Slovenia; 5School of Medicine, University of Maribor, Maribor, Slovenia
| | - Milina Tančić Gajić
- 1Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 2Department of Endocrinology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia; 3Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; 4Outpatient Clinic of Obstetrics and Gynecology, Rogaška Slatina, Slovenia; 5School of Medicine, University of Maribor, Maribor, Slovenia
| | - Ljiljana Marina
- 1Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 2Department of Endocrinology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia; 3Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; 4Outpatient Clinic of Obstetrics and Gynecology, Rogaška Slatina, Slovenia; 5School of Medicine, University of Maribor, Maribor, Slovenia
| | - Maja Franić Ivanišević
- 1Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 2Department of Endocrinology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia; 3Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; 4Outpatient Clinic of Obstetrics and Gynecology, Rogaška Slatina, Slovenia; 5School of Medicine, University of Maribor, Maribor, Slovenia
| | - Damir Franić
- 1Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 2Department of Endocrinology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia; 3Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; 4Outpatient Clinic of Obstetrics and Gynecology, Rogaška Slatina, Slovenia; 5School of Medicine, University of Maribor, Maribor, Slovenia
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Marina LV, Ivović M, Tančić-Gajić M, Arizanović Z, Raković D, Milin-Lazović J, Kendereški A, Micić D, Vujović S. Luteinizing hormone and insulin resistance in menopausal patients with adrenal incidentalomas: The cause-effect relationship? Clin Endocrinol (Oxf) 2018; 88:541-548. [PMID: 29288564 DOI: 10.1111/cen.13541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/13/2017] [Accepted: 12/21/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE A high prevalence of insulin resistance (IR) has proven to manifest in patients with adrenal incidentalomas (AI). It has been demonstrated that an increase in IR is related to the size of tumourous masses; additionally, luteinizing hormone (LH)-dependent adrenal pathologies are well documented in patients with LH-responsive adrenal tumours occurring under conditions of physiologically elevated LH. We hypothesized that an association between LH and insulin might play a role in adrenal tumourigenesis and steroidogenesis. DESIGN The aim of our study was to investigate the association between LH and IR; adrenal tumour size (ATS) and IR; LH and cortisol after the 1 mg overnight dexamethasone test (1 mg DST); and ATS and 1 mg DST cortisol in AI patients. This was a case-control study conducted in the Clinic for Endocrinology, Diabetes and Metabolic Diseases in Belgrade, Serbia. The total study group consisted of 105 menopausal women: 75 AI patients [27 with nonfunctional AI (NAI) and 48 with (possible) autonomous cortisol secretion ((P)ACS)] and 30 age-, BMI-, LH- and menopause duration-matched healthy control (HC) women. To estimate IR, we used homeostasis model assessment (HOMA-IR). RESULTS Luteinizing hormone and ATS are in a significant positive correlation with HOMA-IR and 1 mg DST cortisol in menopausal patients with AI and (P)ACS. CONCLUSIONS Our data point to a possible cause-effect relationship between LH and insulin in patients with AI and (P)ACS adding to the body of evidence of their involvement in adrenal tumourigenesis and steroidogenesis.
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Affiliation(s)
- Ljiljana V Marina
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miomira Ivović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milina Tančić-Gajić
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zorana Arizanović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Raković
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Aleksandra Kendereški
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Micić
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Vujović
- Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Franić-Ivanišević M, Franić D, Ivović M, Tančić-Gajić M, Marina L, Barac M, Vujović S. Genetic Etiology of Primary Premature Ovarian Insufficiency. Acta Clin Croat 2017; 55:629-635. [PMID: 29117655 DOI: 10.20471/acc.2016.55.04.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Primary premature ovarian insufficiency (PPOI) is characterized by hypergonadotropic
amenorrhea and hypoestrogenism in women under 40 years of age. PPOI incidence is 1:10,000
in women aged 18-25, 1:1000 in women aged 25-30 and 1:100 in women aged 35-40. In 10%-28% of
cases, PPOI causes primary and in 4%-18% secondary amenorrhea. The process is a consequence of
accelerated oocyte atresia, diminished number of germinated cells, and central nervous system aging.
Specific genes are responsible for the control of oocyte number undergoing the ovulation process and
the time to cessation of the reproductive function. A positive family history of PPOI is found in 15%
of women with PPOI, indicating the existing genetic etiology. Primary POI comprises genetic aberrations
linked to chromosome X (monosomy, trisomy, translocation, deletion) or to autosomal chromosome.
Secondary POI implies surgical removal of ovaries, chemotherapy and radiotherapy, and
infections. Diagnostic criteria include follicle stimulating hormone level >40 IU/L and estradiol level
<50 pmol/L.
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Affiliation(s)
- Maja Franić-Ivanišević
- University Department of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Damir Franić
- Outpatient Clinic for Obstetrics and Gynecology, Rogaška Slatina, Slovenia,School of Medicine, University of Maribor, Maribor, Slovenia
| | - Miomira Ivović
- University Department of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milina Tančić-Gajić
- University Department of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ljiljana Marina
- University Department of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Barac
- University Department of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetlana Vujović
- University Department of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
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Simoncig Netjasov A, Tančić-Gajić M, Ivović M, Marina L, Arizanović Z, Vujović S. Influence of obesity and hormone disturbances on sexuality of women in the menopause. Gynecol Endocrinol 2016; 32:762-766. [PMID: 27871199 DOI: 10.3109/09513590.2016.1161746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess influence of obesity and hormone disturbances on sexuality in the menopause. METHODS The study included 73 menopausal women, who were divided into groups according to body mass index (BMI) ≥ 26.7 kg/m2. Anthropometric characteristics and blood pressure were measured. Blood was taken at 08:00 for hormones. All the participants filled in McCoy Female Sexual Questionnaire for the assessment of sexual life. STATISTICS Student's t-test, correlation, analysis of variance (ANOVA). RESULTS Follicle-stimulating hormone (FSH), luteinizing hormone (LH) and sex hormone-binding globulin (SHBG) were very significantly lower in obese compared to controls. E2 and systolic blood pressure were very significantly, while diastolic blood pressure significantly higher in obese compared to controls. Obese women had significantly decreased frequency of pain during sexual intercourse (3.48 ± 2.64 vs. 4.09 ± 2.81). Influence of age on frequency of sexual intercourse was very significant. Significant influence in interaction between BMI and age on frequency of sexual fantasies as well as significant influence of BMI on satisfaction with partner as lover is also found. CONCLUSION Obesity has influence on different aspects of sexuality in the postmenopausal women. Our results suggest the need of awareness toward obesity and its impact on sexuality in the menopause.
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Affiliation(s)
| | - Milina Tančić-Gajić
- b Clinical Center of Serbia, Institute of Endocrinology, Diabetes and Metabolic Disorders , Dr Subotića 13 , Belgrade , Serbia
| | - Miomira Ivović
- b Clinical Center of Serbia, Institute of Endocrinology, Diabetes and Metabolic Disorders , Dr Subotića 13 , Belgrade , Serbia
| | - Ljiljana Marina
- b Clinical Center of Serbia, Institute of Endocrinology, Diabetes and Metabolic Disorders , Dr Subotića 13 , Belgrade , Serbia
| | - Zorana Arizanović
- b Clinical Center of Serbia, Institute of Endocrinology, Diabetes and Metabolic Disorders , Dr Subotića 13 , Belgrade , Serbia
| | - Svetlana Vujović
- b Clinical Center of Serbia, Institute of Endocrinology, Diabetes and Metabolic Disorders , Dr Subotića 13 , Belgrade , Serbia
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Miletić M, Žarković M, Ćirić J, Nedeljković-Beleslin B, Tančić-Gajić M, Stojanović M, Ivović M, Stojković M, Rajović R, Nišić T, Savić S, Vujović S. Mister XX. Med gl Spec Bol Zlatibor 2016. [DOI: 10.5937/medgla1662028m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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13
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Tančić-Gajić M, Vujović S, Dujmović I, Basta I, Ivović M, Marina LV, Djordjević PB, Micić D. Acquired Hypertrichosis Lanuginosa: Typical Presentation and Unusual Association. Arch Iran Med 2015; 18:450-2. [PMID: 26161711 DOI: 0151807/aim.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Paraneoplastic syndrome might be the first clinical manifestation of malignancy. We present a menopausal female with the acquired hypertrichosis lanuginosa (AHL) as an initial clinical presentation of rectal adenocarcinoma, unusually associated with paraneoplastic cerebellar degeneration (PCD) and disseminated intravascular coagulation (DIC).
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Affiliation(s)
- Milina Tančić-Gajić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia.
| | - Svetlana Vujović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Irena Dujmović
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Ivana Basta
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Miomira Ivović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Ljiljana V Marina
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Predrag B Djordjević
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Dragan Micić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
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Gajić TM, Vujović S, Ivović M, Marina LV, Arizanović Z, Raković D, Micić D. [Complete androgen insensitivity syndrome]. SRP ARK CELOK LEK 2015; 143:214-218. [PMID: 26012135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
SUMMARY INTRODUCTION Androgen insensitivity syndrome (AIS) belongs to disorders of sex development, resulting from complete or partial resistance to the biological actions of androgens in persons who are genetically males (XY) with normally developed testes and age-appropriate for males of serum testosterone concentration. CASE OUTLINE A 21-year-old female patient was admitted at our Clinic further evaluation and treatment of testicular feminization syndrome, which was diagnosed at the age of 16 years.The patient had never menstruated. On physical examination, her external genitalia and breast development appeared as completely normal feminine structures but pubic and axillary hair was absent. Cytogenetic analysis showed a 46 XY karyotype. The values of sex hormones were as in adult males. The multi-sliced computed tomography (MSCT) showed structures on both sides of the pelvic region, suggestive of testes. Bilateral orchiectomy was performed. Hormone replacement therapy was prescribed after gonadectomy. Vaginal dilatation was advised to avoid dyspareunia. CONCLUSION The diagnosis of complete androgen insensitivity is based on clinical findigs, hormonal analysis karyotype, visualization methods and genetic analysis. Bilateral gonadectomy is generally recommended in early adulthood to avoid the risk of testicular malignancy. Vaginal length may be short requiring dilatation in an effort to avoid dyspareunia. Vaginal surgery is rarely indicated for the creation of a functional vagina.
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Vujović S, Popović S, Mrvošević Marojević L, Ivović M, Tančić-Gajić M, Stojanović M, Marina LV, Barać M, Barać B, Kovačević M, Duišin D, Barišić J, Djordjević ML, Micić D. Finger length ratios in Serbian transsexuals. ScientificWorldJournal 2014; 2014:763563. [PMID: 24982993 PMCID: PMC4054789 DOI: 10.1155/2014/763563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/06/2014] [Indexed: 12/05/2022] Open
Abstract
Atypical prenatal hormone exposure could be a factor in the development of transsexualism. There is evidence that the 2nd and 4th digit ratio (2D:4D) associates negatively with prenatal testosterone and positively with estrogens. The aim was to assess the difference in 2D:4D between female to male transsexuals (FMT) and male to female transsexuals (MFT) and controls. We examined 42 MFT, 38 FMT, and 45 control males and 48 control females. Precise measurements were made by X-rays at the ventral surface of both hands from the basal crease of the digit to the tip using vernier calliper. Control male and female patients had larger 2D:4D of the right hand when compared to the left hand. Control male's left hand ratio was lower than in control female's left hand. There was no difference in 2D:4D between MFT and control males. MFT showed similar 2D:4D of the right hand with control women indicating possible influencing factor in embryogenesis and consequently finger length changes. FMT showed the lowest 2D:4D of the left hand when compared to the control males and females. Results of our study go in favour of the biological aetiology of transsexualism.
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Affiliation(s)
- Svetlana Vujović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Srdjan Popović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Ljiljana Mrvošević Marojević
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Miomira Ivović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Milina Tančić-Gajić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Miloš Stojanović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Ljiljana V. Marina
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Marija Barać
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Branko Barać
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
| | - Milena Kovačević
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina
| | - Dragana Duišin
- Clinic for Psychiatry, Clinical Centre of Serbia, Serbia
| | | | | | - Dragan Micić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 13, 11000 Belgrade, Serbia
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Ivović M, Marina LV, Vujović S, Tančić-Gajić M, Stojanović M, Radonjić NV, Gajić M, Soldatović I, Micić D. Nondiabetic patients with either subclinical Cushing's or nonfunctional adrenal incidentalomas have lower insulin sensitivity than healthy controls: clinical implications. Metabolism 2013; 62:786-92. [PMID: 23332445 DOI: 10.1016/j.metabol.2012.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 12/04/2012] [Accepted: 12/09/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to estimate insulin sensitivity (IS) in nondiabetic patients with adrenal incidentalomas (AI): nonfunctional adrenal incidentalomas (NAI) and patients with AI and subclinical Cushing's syndrome (SCS). METHODS Based on the inclusion criteria (normal fasting glucose levels, no previous history of impaired fasting glucose and/or diabetes, and no medications or concomitant relevant diseases) and the exclusion criteria (pheochromocytoma, overt hypercortisolism, hyperaldosteronism, adrenal carcinoma, metastasis of extra-adrenal tumors, extra-adrenal malignancies), 142 subjects were drawn from a series of patients with AI. The subjects were age-, sex- and body mass index (BMI)-matched: 70 with NAI (50 women and 20 men), 37 with AI and SCS (31 women and 6 men) and 35 healthy control (HC) subjects (30 women and 5 men). The oral glucose tolerance test (OGTT) and several indices of insulin sensitivity (IS) were used: homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI), triglycerides and glucose index (TyG), index of whole-body insulin sensitivity (ISI-composite) and glucose to insulin ratio (G/I). RESULTS There was a significant difference in IS between subjects with NAI and HC (HOMA, p=0.049; QUICKI, p=0.036; TyG, p=0.002; ISI-composite, p=0.024) and subjects with SCS and HC (AUC insulin, p=0.01; HOMA, p=0.003; QUICKI, p=0.042; TyG, p=0.008; ISI-composite, p=0.002). There was no difference in the tested indices of IS between subjects with NAI and SCS (p>0.05). However, subjects with SCS had a significantly higher prevalence of impaired glucose tolerance and higher area under the curve for glucose than subjects with NAI (p=0.0174). The linear regression analysis showed that 1 mg-DST cannot be used as a predictor of HOMA (R(2)=0.004, F=0.407, p=0.525). Significant relationship was found between 1 mg-DST and ISI-composite (R(2)=0.042, F=4.981, p=0.028) but this relationship was weak and standard error of estimate was high. The linear regression model also showed that ACTH cannot be used as a predictor of HOMA (R(2)=0.001, F=0.005, p=0.943) or ISI-composite (R(2)=0.015, F=1.819, p=0.187). CONCLUSIONS Insulin resistance is a major cardiovascular risk factor; therefore, the assessment of IS in patients with AI, even nonfunctional, has a valuable place in the endocrine workup of these patients.
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Affiliation(s)
- Miomira Ivović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade
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Vujović S, Ivović M, Tancić-Gajić M, Marina L, Barać M, Arizanović Z, Nenezić A, Ivanisević M, Micić J, Sajić S, Micić D. Premature ovarian failure. SRP ARK CELOK LEK 2012; 140:806-811. [PMID: 23350261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Premature ovarian failure (POF) is the occurrence of hypergonadotropic hypoestrogenic amenorrhea in women under the age of forty years. It is idiopathic in 74-90% patients. Known cases can be divided into primary and secondary POF. In primary POF genetic aberrations can involve the X chromosome (monosomy, trisomy, translocations, deletions) or autosomes. Genetic mechanisms include reduced gene dosage and non-specific chromosome effects impairing meiosis, decreasing the pool of primordial follicles and increasing atresia due to apoptosis or failure of follicle maturation. Autoimmune ovarian damage is caused by alteration of T-cell subsets and T-cell mediated injury, increase of autoantibody producing B-cells, a low number of effector/cytotoxic lymphocyte, which decreases the number and activity of natural killer cells. Bilateral oophorectomy, chemotherapy, radiotherapy and infections cause the secondary POF. Symptoms of POF include irritability, nervousness, loss of libido, depression, lack of concentration, hot flushes, weight gaining, dry skin, vaginal dryness, frequent infections etc.The diagnosis is confirmed by the level of FSH of over 40 IU/L and estradiol below 50 pmol/L in women aged below 40 years. Biochemical and other hormonal analysis (free thyroxin, TSH, prolactin, testosterone), karyotype (<30 years of age), ultrasound of the breasts and pelvis are advisable. Optimal therapy is combined estrogen progestagen therapy given in a sequential rhythm, after excluding absolute contraindications. Testosterone can be added to adnexectomized women and those with a low libido. Sequential estrogen progestagen replacement therapy is the first line therapy for ovulation induction in those looking for pregnancy and after that oocyte donation will be advised. Appropriate estro-progestagen therapy improves the quality of life and prevents complications such as cardiovascular diseases, osteoporosis, stroke etc.
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Tančić-Gajić M, Vujović S, Vukčević M, Ivović M, Drezgić M, Marina L, Stojanović M, Arizanović Z, Nenezić A, Micić D. Effects of alternate fasting or very low calorie diet and low calorie diet on metabolic syndrome in severely obese patients. Hippokratia 2012; 16:335-341. [PMID: 23935313 PMCID: PMC3738608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIM Weight loss improves the metabolic syndrome (MetS) features and related clinical abnormalities in obese subjects. The aim of this study was to assess the effects of a non-surgical therapeutic program on the MetS in severely obese patients. PATIENTS AND METHODS Sixty-four extremely obese patients were involved in the therapeutic program, which consisted of two alternating phases: the three-week therapeutic fasting or semi-fasting in hospital conditions and the low calorie diet with dosed physical activity in outpatient conditions. At the baseline we measured: anthropometric parameters, blood pressure and lipid profile. Subjects underwent an oral glucose tolerance test and insulin resistance/sensitivity was evaluated by the homeostasis model assessment and the oral glucose insulin sensitivity. After weight reduction by at least 10%, all mentioned assessments were repeated. RESULTS None of the patients had significant adverse effects. Forty-one patients aged 43.0±11.5 years completed the study. The mean weight loss was 27 kg or 18% of the initial weight (p<0.01), which was followed by a significant decrease of the insulin resistance, the overall prevalence of MetS (32%) and all MetS parameters, without the significant change in high-density lipoprotein. This weight loss pogram substantially improves the MetS in extremely obese patients. CONCLUSION The tailored alternating either fasting or semi- fasting should be considered as an optional approach to manage extreme obesity and related metabolic abnormality.
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Affiliation(s)
- M Tančić-Gajić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
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Tancić-Gajić M, Vujović S, Ivović M, Stojanović M, Marina L, Barać M, Micić D. Adrenocorticotrophin-dependent hypercortisolism: imaging versus laboratory diagnosis. SRP ARK CELOK LEK 2012; 140:500-504. [PMID: 23092037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Cushing's syndrome results from inappropriate exposure to excessive glucocorticoids. Untreated, it has significant morbidity and mortality. CASE OUTLINE A 38-year-old woman with a typical appearance of Cushing's syndrome was admitted for further evaluation of hypercortisolism. The serum cortisol level was elevated without diurnal rhythm, without adequate suppression of cortisol after 1 mg dexamethasone suppression test. 24-hour urinary-free cortisol level was elevated. Differential diagnostic testing indicated adrenocorticotrophin (ACTH)-dependent lesion of the pituitary origin. Pituitary abnormalities were not observed during repeated MRI scanning. Inferior petrosal sinus sampling (IPSS) was performed: 1) Baseline ratio ACTH inferior petrosal sinus/peripheral was <2; 2) Corticotropin-releasing hormone (CRH) stimulated ratio ACTH inferior petrosal sinus/peripheral was <3; 3) Baseline intersinus ratio of ACTH was <1.4; 4) Increase in inferior petrosal sinus and peripheral ACTH of more than 50 percent above basal level after CRH; 5) Baseline ratio ACTH vena jugularis interna/peripheral was >1.7. Transsphenoidal exploration and removal of the pituitary tumor was performed inducing iatrogenic hypopituitarism. Postoperative morning serum cortisol level was less than 50 nmol/l on adequate replacement therapy with hydrocortisone, levothyroxine and estro-progestagen. CONCLUSION No single test provides absolute distinction, but the combined results of several tests generally provide a correct diagnosis of Cushing's syndrome.
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Affiliation(s)
- Milina Tancić-Gajić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia.
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Penezić Z, Zarković M, Vujović S, Ivović M, Beleslin B, Ciric J, Drezgić M. [The value of corticotropin-releasing hormone (CRH) test for differential diagnosis of Cushing's syndrome]. SRP ARK CELOK LEK 2007; 135:31-7. [PMID: 17503565 DOI: 10.2298/sarh0702031p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Diagnosis and differential diagnosis of Cushing's syndrome (CS) remain considerable challenge in endocrinology. For more than 20 years, CRH has been widely used as differential diagnostic test. Following the CRH administration, the majority of patients with ACTH secreting pituitary adenoma show a significant rise of plasma cortisol and ACTH, whereas those with ectopic ACTH secretion characteristically do not. OBJECTIVE The aim of our study was to assess the value of CRF test for differential diagnosis of CS using the ROC (receiver operating characteristic) curve method. METHOD A total of 30 patients with CS verified by pathological examination and postoperative testing were evaluated. CRH test was performed within diagnostic procedures. ACTH secreting pituitary adenoma was found in 18, ectopic ACTH secretion in 3 and cortisol secreting adrenal adenoma in 9 of all patients with CS. Cortisol and ACTH were determined -15.0, 15, 30, 45, 60, 90 and 120 min. after i.v. administration of 100 microg of ovine CRH. Cortisol and ACTH were determined by commercial RIA. Statistical data processing was done by ROC curve analysis. Due to small number, the patients with ectopic ACTH secretion were excluded from test evaluation by ROC curve method. RESULTS In evaluated subgroups, basal cortisol was (1147.3 +/- 464.3 vs. 1589.8 +/- 296.3 vs. 839.2 +/- 405.6 nmol/L); maximal stimulated cortisol (1680.3 +/- 735.5 vs. 1749.0 +/- 386.6 vs. 906.1 +/- 335.0 nmol/L); and maximal increase as a percent of basal cortisol (49.1 +/- 36.9 vs. 9.0 +/- 7.6 vs. 16.7 +/- 37.3%). Consequently, basal ACTH was (100.9 +/- 85.0 vs. 138.0 +/- 123.7 vs. 4.8 +/- 4.3 pg/mL) and maximal stimulated ACTH (203.8 +/- 160.1 vs. 288.0 +/- 189.5 vs. 7.4 +/- 9.2 pg/mL). For cortisol, determination area under ROC curve was 0.815 +/- 0.083 (CI 95% 0.652-0.978). For cortisol increase cut-off level of 20%, test sensitivity was 83%, with specificity of 78%. For ACTH, determination area under ROC curve was 0.637 +/- 0.142 (CI 95% 0.359-0.916). For ACTH increase cut-off level of 30%, test sensitivity was 70%, with specificity of 57%. CONCLUSION Determination of cortisol and ACTH levels in CRH test remains reliable tool in differential diagnosis of Cushing's syndrome.
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Abstract
INTRODUCTION Frequent use of modern imaging methods (such as ultrasound, CT and MRI) results in high incidence of accidentally discovered adrenal mass. Adrenal incidentalomas are accidentally discovered adrenal tumors by imaging methods without any prior suspicion of adrenal disease. Some studies have shown decreased insulin sensitivity in patients with adrenal incidentaloma. OBJECTIVE The objective of our study was to assess the insulin sensitivity in patients with adrenal incidentalom a. METHOD A total of 22 patients with accidentally discovered adrenal mass confirmed by CT/MRI were evaluated in our study. Average age was 53.31 +/- 26.5 years and average BMI 25.84 +/- 3.65 kg/m2. Control group consisted of 33 healthy subjects. Insulin sensitivity was assessed by short ITT (insulin tolerance test). Blood samples were taken before, 3, 6, 9, 12, 15, 20 and 30 minutes after i.v. bolus of regular insulin (0.05 IU/kg BW). Glycemia was determined by glucose oxidase method. Statistical analysis was done by ANCOVA, using BMI as covariate. RESULTS Our results showed significantly lower insulin sensitivity in patients with adrenal incidentalomas comparing to the control group (4.95 +/- 0.58 vs. 6.62 +/- 0.47, p=0.015). CONCLUSION Our patients with adrenal incidentalomas manifested lower insulin sensitivity what suggested further follow up and assessment of insulin sensitivity during endocrine evaluation of these patients.
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Vujović S, Zidverc J, Stojanović M, Penezić Z, Ivović M, Dukić V, Drezgić M. Drospirenone in the treatment of severe premenstrual cerebral edema in a woman with antiphospholipid syndrome, lateral sinus thrombosis, situs inversus and epileptic seizures. Gynecol Endocrinol 2005; 21:243-7. [PMID: 16373242 DOI: 10.1080/09513590500361853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We report herein the case of 32-year-old woman with situs inversus, thrombophilia, antiphospholipid syndrome and severe premenstrual syndrome (PMS) with cerebral edema and epileptic seizures prior to menstruation. Seven days prior to regular menstruation she developed severe PMS, including headache, blurred vision, epileptic seizures, urinary incontinence, craving for food, depression and irritability. Papilledema was detected. Daily hormone analyses prior to and during menstruation confirmed an ovulatory cycle with extremely high progesterone, prolactin and insulin levels in the late luteal phase. From day 29 to day 31, progesterone and insulin decreased sharply and the estradiol/progesterone ratio changed, leading to epileptic seizures and the peak of her symptoms. Diuretic treatment was administered. All symptoms disappeared during the first few days of menstruation. A novel oral contraceptive, containing ethinyl estradiol and drospirenone, an antimineralocorticoid progestogen, was given during the next cycle and hormone analyses were repeated. All symptoms were reduced significantly and no cerebral edema and epileptic seizures occurred. This is the first report of a woman with severe PMS and cerebral edema being treated successfully with an oral contraceptive containing drospirenone.
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Affiliation(s)
- Svetlana Vujović
- Institute of Endocrinology, Clinical Center of Serbia, Beograd, Serbia and Montenegro.
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Penezić Z, Zarković M, Vujović S, Cirić J, Beleslin B, Ivović M, Pokrajac A, Drezgić M. Gonadotropin pulsatility in Cushing's syndrome compared with polycystic ovary syndrome. Gynecol Endocrinol 2005; 20:150-4. [PMID: 16019354 DOI: 10.1080/09513590400027190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Many of the presenting features in women with Cushing's syndrome (CS) are similar to those observed for patients with polycystic ovary syndrome (PCOS). The aim of this study was to compare gonadotropin pulsatility characteristics in CS and PCOS. We evaluated 32 females divided into three groups. The first group comprised 12 females with clinically and biochemically proven CS, subsequently confirmed by histology (seven with Cushing's syndrome, five with adrenal adenoma). The second group comprised ten females with clinical, endocrine and ultrasonographic parameters for PCOS, while the third group comprised ten healthy females with regular menstrual cycles to serve as controls. Blood samples were taken at 15-min intervals for 6 h in the follicular phase, for determination of luteinizing hormone (LH) and follicle-stimulation hormone (FSH). Pulse analysis was carried out using the PulsDetekt program, and statistical analysis was done using the Kruskal-Wallis test. The following data, presented as median (minimum-maximum), were found for the three groups respectively. Number of LH pulses: 0 (0-5), 7 (3-8) and 3 (2-7); LH pulse amplitude: 2.29 (1.98-3.49), 2.27 (1.15-5.90) and 2.03 (1.02-4.46) mU/l; LH pulse mass: 17.81 (14.82-26.20), 29.85 (8.59-185.82) and 27.57 (7.63-66.69) mU/l x min. Number of FSH pulses: 3 (0-3), 2 (0-5) and 3 (1-5); FSH pulse amplitude: 1.62 (1.29-1.94), 1.49 (1.19-4.40) and 2.02 (1.37-2.52) mU/l; FSH pulse mass: 12.17 (9.64-41.69), 11.18 (8.92-33.02) and 15.16 (10.31-18.93) mU/l x min. Only the number of pulses was compared because other parameters of pulsatile secretion cannot be estimated when no pulses are detected. The difference in number of LH pulses between groups was statistically significant (p < 0.05); however, there was no difference in the number of detected FSH pulses between groups (p > 0.05). Attenuation of pulsatile LH secretion indicating gonadotropin deficiency in the majority of women with CS is mostly due to alterations in serum cortisol levels. Our data also suggest that different mechanisms alter LH pulsatile secretion in CS and PCOS.
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Affiliation(s)
- Zorana Penezić
- Institute of Endocrinology, University of Belgrade, School of Medicine, Belgrade, Serbia and Montenegro.
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Ivović M, Radiojković B, Penezić Z, Stojković M, Tancić M, Vujović S, Bogdanović A, Drezgić M. [Agranulocytosis and acute coronary syndrome in apathetic hyperthyroidism]. SRP ARK CELOK LEK 2003; 131:249-53. [PMID: 14692133 DOI: 10.2298/sarh0306249i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Tissue expose to excessive levels of circulating thyroid hormones results in thyrotoxicosis. In most cases, thyrotoxicosis is due to hyperactivity of the thyroid gland. Cardiovascular and myopathic manifestations are predominant clinical features in most hyperthyroid patients, aged 60 years and older. Some of patients have apathetic hyperthyroidism which presents with weight loss, small goiter, severe depression and without clinical features of increased sympathetic activity [3, 6]. About 50% of patients with cardiovascular manifestations have no evidence of underlying heart disease. Cardiac problems resolve when euthyroid state is established [3]. Three treatment modalities are available in hyperthyroidism, namely medicament therapy, surgery and radioactive iodine. Antithyroid drug therapy complications, can be mild such as rash, which is managed without cessation of therapy by antihistamines administration. On the other hand, very serious complications such as agranulocytosis, necessitate immediate discontinuation of the medication and appropriate treatment. Although extremely rear, it is life-threatening with highly variable recovery time. CASE REPORT A 62-year-old woman with recurrent hyperthyroidism was admitted after treatment of agranulocytosis due to antithyroid drugs in another institution with G-CSF. The patient presented with clinical features of apathetic hyperthyroidism with extremely elevated thyroid hormone levels (total and free T4) and suppressed TSH. Radioactive iodine (5 mCi) was administered after increased thyroid uptake was confirmed. Echocardiography on admission was normal. ECG revealed moderately inverted T waves in standard and V1, V2 precordial leads. Laboratory analysis revealed mild normocytic anemia with normal white blood cell count, hypokaliemia and normal concentration of creatine phosphokinase, lactic dehydrogenase and mildly elevated aspartate transminase in sera. Chest X-ray was consistent with pulmonary emphysema. Because the worsening of ECG changes she was transferred to Coronary unit. The diagnosis of non-Q myocardial infarction was confirmed and treatment with nitrates and beta-adrenergic antagonists was instituted. Four weeks later she became euthyroid and coronarography was performed. Subepicardial coronary arteries were normal (Figure 1). She was dismissed, and still euthyroid three months later. DISCUSSION Agranulocytosis is very rare but very serious complication of antithyroid drug therapy. It can be detected in about 0.1-1% patients during the first three months of treatment. Sudden appearance, heralded by sore throat and fever, prompt physicians to seek white blood cell and differential count [1-3]. Confirmation of diagnosis urges cessation of drug therapy and appropriate antibiotic treatment. Recently, it was reported that recombinant human granulocyte colony-stimulating factor (rhG-CSF) is to be effective in shortening the recovery time in the neutropenic patients undergoing chemotherapy and also in patients with other types of neutropenia [5]. Tamai at al. [7] confirmed positive outcome in 34 patients treated with rhG-CSF compared to corticosteroid treatment. Hematologic laboratory abnormalities disappear 7-10 days after session of therapy. Patients completely recover two to three weeks later. Fatal outcome was also described [1-5]. Thyroid hormones have profound effects on cardiovascular physiology, especially on heart rate, cardiac output and systemic vascular resistance. In patients with hyperthyroidism, cardiac output is much higher than in normal persons. This is the result of direct effect of thyroid hormones on cardiac muscle contractility, heart rate and decrease in systemic vascular resistance. Excessive thyroid hormone secretion increases cardiac Na-K-activated plasma membrane ATP-ase and sarcoplasmic reticulum Ca-activated ATP-ase with resultant in increase myocardial contractility [6, 9]. Sinus tachycardia is the most common rhythm disorder in hyperthyroidism, but paroxysmal tachycardia and atrial fibrillation are not rare. This can be explained by increased heart rate, cardiac output, blood volume, coronary artery flow and peripheral oxygen consumption in thyrotoxicosis [9]. Patients with coronary arteriosclerosis can develop angina pectoris during thyrotoxic stage, which can be explained by imbalance between cardiac demand and supply. Myocardial damage is often in thyrotoxic patients with chronic hart failure, together with myocardial infarction in patients without coronary disease [2,6]. Congestive heart failure and atrial fibrillation are relatively resistant to digitalis treatment because of high metabolic turn over of medication and excessive myocardial irritability in hyperthyroidism [6]. Cardiovascular and myopathic manifestations predominate in older hyperthyroid patients (over 60 years) and some of them can have only few symptoms of hyperthyroidism [1-3]. Thyrotoxic state characterized by fatigue, apathy, extreme weakness, low-grade fever and sometimes congestive heart failure are designated as apathetic hyperthyroidism. Such patients have small goiters, mild tachycardia and often cool and dry skin with few eye signs [6]. Patients with subclinical hyperthyroidism are at increased risk for atrial fibrillation [9]. Unstable angina and non-Q myocardial infarction (non ST elevation) are acute manifestation of coronary artery disease. The acute coronary syndrome of unstable angina, non-Q myocardial infarction and Q-wave myocardial infarction have atherosclerotic lesions of the coronary arteries as a common pathogenic substrate. Erosions or ruptures of unstable atherosclerotic plaque triggered pathophysiologic processes, resulted in thrombus formation at the site of arterial injury. This leads to abrupt reduction or cessation through the affected vessel. Clinical manifestations of unstable angina and non-Q myocardial infarction are similar and diagnosis of non-Q myocardial infarction is made on the basis of elevated serum markers indicative of cardiac necrosis, detected in peripheral circulation. Acute coronary syndrome ranging from unstable angina to myocardial infarction an non-Q myocardial infarction represents increasingly severe manifestations of the same pathophysiologic processes [10,11]. In conclusion, these 62-year-old woman presented with apathetic form of recurrent hyperthyroidism associated with two serious complications, life-threatening agranulocytosis and acute coronary syndrome.
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Affiliation(s)
- Miomira Ivović
- Institute of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade
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25
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Abstract
The species and ecology of sandflies present in the coastal district of Bar, which lies in Montenegro, an endemic focus of visceral leishmaniasis (VL), were investigated in 1996-1999. A mean of 10 cases of VL and a greater number of viral infections (some of which are attributed to pathogens transmitted by sandflies) are diagnosed each year in this district. Phlebotomus papatasi, P. perfiliewi, P. tobbi, P. neglectus and Sergentomyia minuta were collected, P. perfiliewi being recorded for the first time in Montenegro. The ecology and distribution of each of these five species are described and their role, if any, in the transmission of Leishmania to humans is discussed.
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Affiliation(s)
- V Ivović
- Laboratory of Medical Arachno-entomology, Institute for Medical Research, P.O. Box 102, 11129 Belgrade, Yugoslavia.
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