Forearm SXA densitometry in 1,122 Polish women--a cohort study.

INTRODUCTION: The aim of this study was to estimate forearm bone mineral density (BMD) and bone mineral content (BMC) using singleenergy X-ray absorptiometry (SXA) in a group of Polish women that included both pre- and post-menopausal subjects. MATERIAL AND METHODS: The study was carried out in a cohort of 1,122 otherwise healthy women with no history of previous fractures. RESULTS: We showed a gradual decline of BMD and BMC with age, and the presence of suspected correlations of densitometric results with age and selected anthropometric parameters. CONCLUSIONS: Our study confirmed the utility of densitometric screening using forearm SXA measurements. These measurements discriminated clearly between pre- and post-menopausal subjects. Densitometric results correlated negatively with age and age at menopause, but positively with anthropometric indices related to body and skeletal size. Age was the greatest factor in terms of impact on bone loss.

The influence of other than prolactin hormones on bone mineral density in women with hyperprolactinaemia of various origins.

OBJECTIVE: Hyperprolactinaemia may lead to bone loss, both due to hypogonadism and other hormonal disturbances. Aim of the case-control study was the analysis of influences of hormonal profiles associated with hyperprolactinaemia on the bone mineral density (BMD) in women with hyperprolactinaemia of various origin. MATERIAL AND METHODS: The subjects were 32 patients with prolactinoma, 43 ones with functional hyperprolactinaemia and 29 healthy controls. All of them were studied for BMD (lumbar spine, proximal femur, forearm, total body) by dual-energy X-ray absorptiometry and their correlations with hormones levels (prolactin, oestradiol, luteinising hormone, follicle stimulating hormone, sex hormone binding globulin (SHBG), testosterone, dehydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor-1 and intact parathyroid hormone) using Spearman correlation analysis and multiple regression analysis model. RESULTS: Correlation analysis revealed the anabolic influence of PTH on lumbar spine in women with prolactinoma, and on ultradistal radius in functional hyperprolactinaemia. In multiple regression analysis, oestradiol had greatest influence on lumbar spine and total body BMD. Moreover, positive influence of testosterone, SHBG on spine BMD, and of oestradiol, testosterone, SHBG and DHEA-S on total body BMD were observed in patients with prolactinoma. CONCLUSION: Hormonal disturbances associated with hyperprolactinaemia influence BMD more in patients with prolactinoma than in ones with functional hyperprolactinaemia.

Long-term survival and nearly asymptomatic course of carcinoid tumour with multiple metastases (treated by surgery, chemotherapy, (90)Y-DOTATATE, and LAR octreotide analogue): a case report.

Carcinoids are the most common neuroendocrine tumours. They are usually slowly growing, located in the small intestine, secrete serotonin, and are characterized by long survival of patients, so prognosis is generally good. The most frequently encountered clinical presentations of carcinoids are intermittent abdominal pain and carcinoid syndrome (diarrhoea and flushing). Metastases worsen the prognosis and limit the survival of the patients. We report a case of carcinoid tumour with primary focus in the ileum, with an appendix infiltration, in a thirty-two-year-old woman with acute appendicitis symptoms only. Carcinoid was diagnosed postoperatively by histopathological examination. Nowadays, twenty-five years after the surgery, there is evidence of nearly asymptomatic numerous metastases. Only intermittent abdominal pain for about 1-2 years was reported. Partial metastases resection was performed, followed by chemotherapy, (90)Y-DOTATATE and then long-acting release octreotide analogue therapy. In the meantime, severe chronic heart failure (NYHA IV) due to tricuspid combined valvular heart disease and pulmonary hypertension was diagnosed. Combined therapy, typical for chronic heart failure, together with long-acting octreotide analogue highly improved the patient's heart sufficiency and reduced carcinoid syndrome symptoms. The only adverse events of octreotide therapy were hyperbilirubinaemia and itching. Long-term survival is typical for carcinoids, but 30-years survival has not been described in the literature yet.

Additional metabolic effects of adding GH receptor antagonist to long-acting somatostatin analog in patients with active acromegaly.

OBJECTIVE: Somatostatin analogs, dopamine agonists and GH-receptor antagonist--pegvisomant are used in medical therapy of acromegaly. Since pegvisomant has not antitumor effect, the combination of pegvisomant and somatostatin analog could be an attractive option. Aim of study was to assess the effects of pegvisomant and octreotide LAR treatment on GH and IGF-1 levels, and glucose tolerance in acromegaly, and to assess efficacy and tolerability of rapid (after 7 days) pegvisomant dose titration. MATERIAL AND METHODS: Six patients (4 men, 2 women) aged 47.5 years (median) with active acromegaly, after neurosurgery failed, resistant to maximal doses of octreotide, received daily 10-20 mg pegvisomant throughout 2 weeks. They were given octreotide LAR 30 mg monthly for at least 6 months before pegvisomant therapy. Clinical symptoms, GH, IGF-1, fasting glucose and insulin levels were measured on the 0, 8th and 15th day of pegvisomant therapy. On the 8th day pegvisomant dose was titrated based on serum IGF-1 level. RESULTS: IGF-1 levels reduced from 739 at the beginning to 418 ng/ml (medians) on the 15th day of treatment and normalized in one patient. These changes were associated with improvement of glucose metabolism. One diabetic patient could even stop insulin therapy. CONCLUSIONS: Pegvisomant is an attractive adjuvant therapy for controlling acromegaly. Pegvisomant improves insulin sensitivity as well as glucose tolerance. The GH receptor antagonist is good option for patients with active acromegaly coexistent with disturbances of glucose metabolism, especially with diabetes mellitus. Rapid pegvisomant dose increasing to efficient or maximal is well tolerated and effective.

The role of cyclase activating (CAP) and cyclase inhibiting (CIP) parathormone fractions in the assessment of bone metabolism disturbances in women with hyperprolactinemia of various origin.

OBJECTIVES: Hyperprolactinemia could be one of possible causes of bone loss. The reason is thought to be connected with hypogonadism due to PRL excess and the role of other hormones like PTH and PTH-rP. There is no data on the influence of PTH fractions (CAP and CIP) on bone turnover and density in hyperprolactinemia. The aim of the study was to assess the influence of PTH and its fractions on bone metabolism in hyperprolactinemia of various origin. MATERIAL AND METHODS: The study was carried out in 75 women. Group I consisted of 32 women with prolactinoma, group II consisted of 43 women with functional hyperprolactinemia. Both groups were subdivided in patients with hypogonadism and normal gonadal function. The control group consisted of 29 healthy women. In all subjects PRL, PTH and its fractions (CAP, CIP), and bone turnover markers (BAP, ICTP) were studied. BMD measurement was carried out using DXA. RESULTS: In patients with functional hyperprolactinemia i-PTH and CAP levels were lower than in controls. CIP concentrations were lower in patients than in controls. CAP/CIP ratio was higher in patients with prolactinoma than in patients with functional hyperprolactinemia and controls. Higher values of bone turnover markers (BAP, ICTP) in patients groups and subgroups were shown as compared to controls. Some correlations between PTH and its fractions, and BMD and bone turnover were observed. CONCLUSIONS: There is no direct benefit from the assessment of parathormone fractions and CAP/CIP ratio in the prognosis of bone metabolism changes in hyperprolactinemia of various origin.