Ectopic ACTH syndrome of different origin-Diagnostic approach and clinical outcome. Experience of one Clinical Centre.

PURPOSE: Ectopic Cushing Syndrome (EAS) is a rare condition responsible for about 5-20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production-especially neuroendocrine tumors with other neoplasms. METHODS: Twenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed. RESULTS: Half of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia. CONCLUSION: EAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients.

[Different aspects of food consumed by contemporary people]. / Rózne oblicza zywnosci spozywanej przez wspólczesnego czlowieka.

In accordance with the expectations of contemporary people food is to be not only a source of nutritional components but also a mean of realization of new goals. The food is to help in good health and beauty maintaining, in shaping the desired body look, in improving physical condition, in stress reduction, in deleting the process of getting old. The food should prevent from some diseases such as diseases of cardiovascular system, gastrointestinal tract and immunological system. As a result of such needs a few groups of new products of nonconventional food were created: functional food, fortified food, dietary supplements, ergogenic aids for sportsmen, nutraceuticals. The aim of this article is to show both positive and negative aspects of consumption of new generation food, created in order to fulfill human needs and expectations.

[Evaluation of regional cerebral blood flow using 99mTc-ECD SPECT in ethanol dependent patients: pilot study]. / Ocena zaburzen regionalnego przeplywu mózgowego metoda tomografii emisyjnej Pojedynczego Fotonu z uiyciem 99mtc-ECD u pacjentów uzaleinionych od alkoholu: doniesienie wstepne.

UNLABELLED: The depressant actions of ethanol in the brain is known. SPECT is non invasive method to measure the regional cerebral blood flow (rCBF) and to evaluate indirectly the brain metabolism. The aim of the study is to evaluate morphologic and functional status of CNS using 99mTc-ECD SPECT in chronic alcoholics. MATERIAL AND METHODS: Examined group consisted of 18 male alcoholic patients aged from 28 to 52 years (x = 42.1 +/- 5.4) treated at the Ward of Toxicology and Environmental Diseaes (Detoxification Unit). Only patients without prior head injury, CNS inflammatory changes, epilepsy, migraine, diabetes mellitus or other systemic injury were included. Alcohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. The regional cerebral blood flow (rCBF) was measured using 99mTc-ECD SPECT with the double head E.CAM Siemens gamma camera. The reference group, necessary to obtain a normal values for the gamma camera applied, consisted of 31 healthy subjects (33.32 +/- 10.99 y). RESULTS: The mean values of rCBF in all examined region of frontal and temporal lobes, and in basal ganglia bothsided were significantly lower in the group of alcoholic patients than in the control group. No significant difference between rCBF in occipital lobes except the occipital inferior region, and in parietal lobes except the parietal superior region. Symetrical hypoperfusion (rCBF-2SD) in the frontal lobes was stated in 11 (61.1%), in temporal lobes in 4 (22.2%), in parietal and occipital lobes in 3 (16.7%) of the patients examined. In 7 the patients examined rCBF disturbances in basal ganglia were found (bothsided in 4, leftsided in 2, and rightsided in 2 the patients). Focal rCBF changes in the parietal, frontal and temporal lobes localised mostly on the left hemisphere were stated in 27.8% of the alcoholics examined. In concusion, the metabolic disturbances and the brain morphological changes mostly in frontal and temporal lobes due to chronic alcoholism were detected in the pilot study. A further investigation on more numerous group of ethanol dependent patients and monitoring of the changes in alcoholics who maintain a long-term abstinence from alcohol is needed.

Assessment of daily nutrition ratios of opiate-dependent persons before and after 4 years of methadone maintenance treatment.

The aim of the study was the evaluation of the changes in nutritional habits of opiates dependent persons during 4 years of attendance in methadone maintenance treatment conducted by the Department of Toxicology of CMUJ in Kraków. These criteria were fulfilled by 30 persons (23 males and 7 females). They were examined before the methadone treatment and after 4 years of treatment. During Initial and final examinations for each of examined person the 24-hour recall had been performed three times. The information about daily supply of main nutrients (proteins, fats, fatty acids, carbohydrates, dietary fibre, cholesterol), minerals (calcium, iron, phosphorus, zinc, sodium) and vitamins (vitamin A, B1, B2, niacin, C) were obtained. The results were compared with daily norms (N) recommended on the safe level of intake. The normal range was established on the level +/-10% of normal values (+/-10% N). The changes between the results of following examinations were tested by using the t-student test. After 4 years of methadone treatment an increase in energy, vitamins, minerals and main nutritional ingredients intake was noted in women group. In men group a decrease in energy, proteins and carbohydrates intake was noted and fats intake, mainly unsaturated fatty acids, was increased. Vitamins were consumed in lower amounts and among minerals lower consumption in case of iron and sodium was noticed. In comparison with the recommended values in the initial examination in women group too low intake concerned fibre and vit. A, B,, calcium, iron, zinc and magnesium was noticed. In group of men too low intake (below recommended values) of energy, carbohydrates, fiber, vit. B1, B2, C, niacin, calcium and magnesium was noticed. After 4 years of methadone maintenance treatment in group of women too low intake only of vit. B1 and iron was noticed. In group of men it concerned vit. B1, B2, C, niacin and minerals such as calcium, iron, magnesium and zinc.

Nutritional status of the opiate dependent persons after 4 years of methadone maintenance treatment.

The aim of the study was to evaluate the nutritional status of opiate dependent patients before and after 4 years of participation in the methadone maintenance treatment. The examinations were performed in 30 opiates addicted persons (7 women and 23 men). The initial examination (exam 1) was done during the patients qualification for the methadone program, preceding methadone administration and final examination (exam 2) after 4 years of the treatment. In order to estimate the nutritional status body mass, the height, the arm circumference and the thickness of the triceps and subscapular fat-skin folds were measured. On the basis of them the BMI and mid arm muscle circumference (MAMC) were counted. The measurements of the body composition (using the bioimpedance method) were performed. The changes between the results of subsequent examination were tested using the t-Student test. In the examination that took place after 4 years of follow-up, body weight loss in the group of women was observed (mean--1.7 kg). It was followed by the decrease of BMI value (from 20.3 to 19.8 kg/m2). In both examinations the percentage of fatty tissue in general body mass was significantly below recommended values (10.7% in both examinations--the recommended values are 20%-22%). In the group of men an increase in body weight (mean--8.8 kg) and BMI value (from 23.3 to 25.9 kg/m2) was noticed. Arm circumference, muscle arm circumference and fat-skin folds values were increased. The analysis of particular body components showed increased fatty body mass (11.9% in the first and 18.5% in the second examination--the recommended values 16-19%) together with the decrease of lean body mass and body water.

[Nutritional status of opiate-dependent persons before and during methadone maintenance therapy]. / Stan odzywienia osób uzaleznionych od opiatów leczonych substytucyjnie metadonem.

The aim of the study was to evaluate the nutritional status of opiate dependent patients who where classified to participate in the methadone maintenance treatment and to give the answer to the question how the nutritional status of these patients was changing during this programme. We examined 48 persons (12 women aged 21-37 years and 36 men aged 20-46 years). All of them were participants of the methadone maintenance treatment. The patients were examined three times: first time just before the methadone treatment, then after 2 months and third time after 9 months of treatment. The anthropometrics measurement: body weight and height (it allowed us to calculate the BMI), two skin fat folds and the measurements of the body composition (using the bioimpedance method) were performed. The changes between the results of subsequent examination were tested using the t-Student test. As a result of the first examination we showed out that the majority of patients had a proper nutritional status evaluated by BMI. Poor nutritional status has been more often found than excessive nutritional status among examined patients, especially in the group of women. During the nine months of methadone maintenance treatment the statistically significant growth of body weight was observed and it derived from the increasing fat body mass and muscle mass. As a result of that we noticed the diminishing number of underweight people. More of examined people had overweight and in the group of men even obesity.

[Intake of nutrients in daily nutritional ratios by opiate dependent persons during methadone maintenance therapy]. / Podaz skladników odzywczych w dobowych racjach pokarmowych osób uzaleznionych od opiatów leczonych substytucyjnie metadonem.

The aim of the study was the evaluation of the nutritional habits of the opiates dependent persons before and during methadone maintenance treatment. We examined 48 persons (36 males and 12 females) three times: first time before the methadone treatment, then after 2 months of treatment, and third time after 9 months of treatment. During each examination we performed 24-hour recall four times. Collected data were processed by author's software in order to get information about daily supply of main nutrients (proteins, fat, fatty acids, carbohydrates, dietary fibre, cholesterol), minerals (calcium, iron, phosphorus, zinc, sodium) and vitamins (vitamin A, B1, B2, niacin, C). The changes between the results of following examinations were tested by using the t-Student test. The results were compared with daily norms recommended on the safe level of intake for each age and gender group. In the majority of cases the diet of examined persons was quite reach in protein, but we noticed too low daily intake of fats, essential fatty acids, some minerals (calcium, iron, magnesium, zinc) and vitamins B1, B2 and C. After 2 months of methadone treatment the daily intake of fats, saturated fatty acids, essential fatty acids, cholesterol, dietary fibre, some minerals and vitamins decreased in men group, but in the last examination we noticed renewed growth in quantity of those nutrients in daily diet of examined persons. We did not observe it in the group of women.