[Metastatic Pituitary Disorders]. / Metastatické postizení hypofýzy.

BACKGROUND: Pituitary metastases are a rare complication of generalized cancer. Metastases to the pituitary gland occur in only 1% of patients operated on for sellar tumor. The most common presenting symptom in patients with pituitary metastases is diabetes insipidus, whereas this is rare in those with pituitary adenoma. MATERIAL AND METHODS: This publication presents the cases of two patients with pituitary metastases and a systematic review of the literature. English-language publications related to pituitary metastases and published from 1957 to 2016 were identified using the PubMed database. RESULTS: A total of 131 publications containing information about 259 patients (121 female and 138 male; mean age, 57.3 years) were identified. The most often metastasized breast carcinoma (24.6%) and lung carcinoma (23.8%), followed by thyroid carcinoma (11.3%), renal cell carcinoma (7.8%), hepatocellular carcinoma (4.3%), colorectal carcinoma (3.5%), and malignant melanoma (3.5%). The most frequent initial symptoms were manifestations of diabetes insipidus (39.6%), anterior pituitary deficiency (44.9%), perimeter disorders (51.6%), headache (37.6%), cranial nerve palsy (33.5%), and pseudoprolactinemia (16.7%). Radiotherapy (67.8%) and surgical treatment (63.9%) were the most frequently used treatment. CONCLUSION: The average survival time from the onset of metastatic disease was 11.8 months. Surgical therapy alone or in combination with radiation therapy does not prolong survival, but alleviates symptoms and improves quality of life.Key words: pituitary metastasis - diabetes insipidus - hypopituitarism - transsphenoidal surgery The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 13. 1. 2017Accepted: 4. 4. 2017.

OVARIAN GOITER AS A RARE CAUSE OF HYPERTHYROIDISM.

INTRODUCTION: Thyroid tissue ectopically located in the ovary can be reported accidentally after adnexectomy, but as a primary cause of hyperthyroidism this diagnosis is rare. The clinical search for a functional ectopic thyroid tissue requires intense clinical focus and a multidisciplinary approach. CASE DESCRIPTION: This case report demonstrates a patient with a history of Graves' disease who had undergone thyroidectomy combined with postoperative 131I radioablation. Despite the previous treatment, she developed an outburst of hyperthyroidism ten years later. Only very close follow-up enabled us to disclose the right condition. The ovarian source of thyroid hormone production was removed by laparoscopic adnexectomy and a right sided benign ovarian struma was confirmed. CONCLUSION: Most patients treated by thyroidectomy and radioiodine do not require extended periods of follow-up or postoperative investigations, but when the clinical or laboratory signs change, clinicians should be prepared to perform the necessary re-evaluation in order to provide the best care.

ULTRASOUND-GUIDED PERCUTANEOUS ETHANOL INJECTION THERAPY IN A 92 YEAR-OLD PATIENT WITH PARATHYROID ADENOMA AND WITH A HISTORY OF TOTAL THYROIDECTOMY FOR PAPILLARY THYROID CARCINOMA.

Percutaneous Ethanol Injection Therapy (PEIT) of parathyroid adenoma under ultrasound guidance is individually used as an alternative procedure in management of primary hyperparathyroidism in polymorbid elderly patients with increased surgical risk. The treatment is also suitable for patients who already underwent surgery of the thyroid gland, and any other surgery is associated with a higher risk of postsurgical complications. We present a case of a 92-year-old male patient, who underwent thyroidectomy for papillary thyroid carcinoma three years ago. Part of the regular annual follow-up visits was also ultrasonography, which showed a solitary parathyroid adenoma at the site of the removed thyroid gland. Given the underlying condition, polymorbidity and age of the patient, the PEIT method was successfully used in the therapy. The coincidence of adenoma and papillary thyroid carcinoma is also interesting.

[ProVens® in the Therapy of Glaucoma and Ocular Hypertension]. / ProVens® v lécbe glaukomu a ocní hypertenze.

OBJECTIVE: To assess the effect of the ProVens® dietary supplement administration on intraocular pressure in patients with glaucoma and ocular hypertension. MATERIAL AND METHODS: The patients included in the trial were given the ProVens® dietary supplement once daily. One ProVens® tablet contains: 50 mg of maritime pine bark extract, 100 mg of green tea extract, and 3 mg of blueberry extract. The main ProVens® components are proanthocyanins from the bark of the maritime pine tree Pinus pinaster, polyphenols from green tea, and anthocyanins from blueberries. The total number of patients included in the trial was 46. Out of these, 35 patients were monitored for asymptomatic ocular hypertension and 11 patients for open-angle glaucoma treated with prostaglandin analogs. Intraocular pressure was measured by applanation tonometry in the beginning of the trial, after one month, and after three months of their inclusion in the trial, always at the same time of the day. RESULTS: In the group of patients with ocular hypertension, there was a statistically significant reduction in the intraocular pressure from the baseline values of 24.2 ± 2.1 mm Hg to 20.9 ± 2.5 mm Hg within the period of three months (p < 0.0001). In the group of patients with open-angle glaucoma, there was a statistically significant reduction of the intraocular pressure from the baseline values of 18.4 ± 3.2 mm Hg to 17.0 ± 3.1 mm Hg within the period of three months since the beginning of administration of the product (p = 0.022). When comparing both groups, we observed a significantly higher reduction in intraocular pressure (p = 0.0001) in the group of patients with ocular hypertension. In the whole group, no adverse effects were reported during the intake of this dietary supplement. CONCLUSION: Intake of the ProVens® dietary supplement containing proanthocyanins from the bark of the maritime pine tree Pinus pinaster together with a mixture of herbal antioxidants appears to be one of the methods of how to improve the control of intraocular pressure, particularly in patients with ocular hypertension. KEY WORDS: glaucoma, ocular hypertension, ProVens®, proanthocyanins, antioxidants, maritime pine bark extract.

The importance of lipid spectrum changes in women with polycystic ovary syndrome(PCOS).

AIM: of the study was to compare levels of blood lipids, anthropometric characteristics and their relationship in women with PCOS with a group of healthy women. METHODS AND RESULTS: We determined anthropometric indicators (BMI - body mass index, waist measurement, waist/hip ratio), blood lipid levels (total cholesterol TCH, high density cholesterol HDL, low density cholesterol LDL and triglycerides TAG) in a group of women with PCOS and a healthy control group. Levels of evaluated blood lipids in women with PCOS and the healthy control group were within the normal range. Women with PCOS differed statistically significantly from the control group in a higher concentration of triglycerides (control 1.01 ± 0.7 mmol.l-1, PCOS 1.17 ± 0.58). In women with PCOS we proved a positive correlation between BMI, total cholesterol, LDL cholesterol and levels of triglycerides. In women with PCOS waist measurement showed a statistically significant relationship to values of LDL cholesterol, HDL cholesterol and level of triglycerides. CONCLUSIONS: All women with PCOS in our study had very good levels of blood lipoproteins (total cholesterol, LDL and HDL cholesterol, triglycerides) so we are not sure if there is any importance of changes in blood lipid metabolism in these patients (Tab. 1, Fig. 2, Ref. 16).

[Extraocular muscle involvement in patients with thyroid-associated orbitopathy]. / Postizení okohybných svalu u pacientu s endokrinní orbitopatií

AIM: To determine the frequency of extraocular rectus muscle involvement in patients with thyroid-associated orbitopathy (TAO). MATERIALS AND METHODS: A total of 154 orbits of 77 adult patients (53 women and 24 men) with TAO aged from 18 to 81 years (median 49 years) were investigated. Only patients with clear signs of TAO and confirmed thyroid disease who had been referred to the Department of Ophthalmology of the Olomouc University Hospital from May 2007 to December 2012 were included. All patients underwent general ophthalmic examination and ultrasonographic and MRI examinations of the orbit. The largest short and long cross-sectional diameter for every rectus muscle was measured on MRI scans. Spearman correlation analysis was used to determine the correlations between the diameters of rectus muscles and exophthalmos values obtained. RESULTS: A positive moderate correlation (r = 0.514) was shown between the sum of short parameters of all rectus muscles and exophthalmos values. When compared with the normative values and taking gender into account, enlargement of the medial rectus muscle (RM) was found in 55.2 %, of the lateral rectus muscle (RL) in 33.8 %, the inferior rectus muscle (RI) in 57.1 %, and of the superior muscle group (RS) in 59.1 %. In the cases of single-muscle enlargement, the most frequently affected muscle was the RS (48.8 %), followed by the RI (31.7 %) and RM (19.5 %). No case of single-muscle enlargement of the RL was observed. In the cases of two-muscle enlargement, the RS was involved in 64.3 %, the RI and RM in 60.7 %, and the RL in 14.3 %. In the cases of three-muscle enlargement, the most frequently affected muscle was the RM (93.1 %), followed by the RI (86.2 %), RS (69%), and RL (51.7 %). CONCLUSION: Our study found that, in cases with single-muscle enlargement in patients with TAO, the vertical rectus muscles were most likely involved. On the other hand, in cases with multiple-muscle enlargement, the muscle most likely involved was the medial rectus muscle. In addition, the superior muscle group was noted to be affected more frequently than reported in the world literature. Key words: thyroid-associated orbitopathy, extraocular muscles, magnetic resonance imaging.

An update on the genetics of pheochromocytoma.

Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are rare neuroendocrine tumors. About 30% or more of them are thought to be of inherited origin due to germ-line mutations in at least 10 well-characterized genes. There are data linking specific genotypes of these tumors to specific locations, typical biochemical phenotypes or future clinical behaviors. Conversely, clinical features, catecholamine production and immunohistochemistry evaluation can help with the proper order of genetic testing for PHEO and PGL. The identification of a germ-line mutation can lead to an early diagnosis, appropriate treatment, regular surveillance and better prognosis not only for the patient but also for their family members. Moreover, the latest discoveries in molecular pathogenesis of these tumors will provide an important basis for future personalized therapy.

[Efficacy and tolerability of preservative-free tafluprost 0.0015 % in the treatment of glaucoma and ocular hypertension]. / Úcinnost a snásenlivost tafluprostu 0,0015% bez konzervacních látek v lécbe glaukomu a ocní hypertenze.

AIM: The aim of the study was to evaluate the efficacy, safety and local tolerability of preservative-free tafluprost 0.0015% (Taflotan®) in patients with glaucoma and ocular hypertension. MATERIALS AND METHODS: Multicentric, prospective observation study was performed in the Czech Republic from October 2010 to April 2011. A total of 78 centers participated and 754 patients were included. After the doctors decision to start the treatment with Taflotan®, the patients demographic data, previous treatment, intraocular pressure and the reason for switching the medication were recorded. At the follow-up visit after 6-12 weeks, the intraocular pressure, local tolerability (a 5-level scale), the patients and doctors satisfaction (a 4-level scale), and the patients preference were recorded. RESULTS: Altogether, data of 496 patients were evaluated. The majority of them were women (64.9 %). The patients mean age was 58.5 years. The most common diagnosis was primary open angle glaucoma (79.2 %), followed by ocular hypertension (7.3 %), normal tension glaucoma (4.2 %), and pseudoexfoliation glaucoma (3.6 %). In 140 patients, tafluprost 0.0015% was the first antiglaucomatous medication started, 261 patients switched from another monotherapy, and 95 patients were treated with fixed- or nonfixed combinations before starting tafluprost 0.0015%. The most common reason for switching to Taflotan® was local intolerability to the current antiglaucomatous therapy (most often irritation of the eye and hyperemia). The intraocular pressure decreased significantly from 19.9 ± 4.5 mm Hg to 16.3 ± 3.0 mm Hg (p < 0.001). The subjective tolerability of the antiglaucomatous therapy improved rapidly, with 57.4 % of patients rating the tolerability of Taflotan® as "very good" and 34.5 % as "good". In addition, 94.4 % of patients and 96.0 % of ophthalmologists were "very satisfied" or "satisfied" with the treatment. At the final visit, 79.8 % of patients preferred Taflotan® to the previous treatment. CONCLUSION: Taflotan® significantly decreased the intraocular pressure. It was well tolerated even in patients with previous intolerability to another antiglaucomatous therapy, including prostaglandins. The patients and ophthalmologists satisfaction with Taflotan® was high.

Soluble intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1 in asymptomatic dyslipidemic subjects.

AIM: The plasma levels of soluble intercellular cell adhesion molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule-1 (s-VCAM-1) were assessed in clinically asymptomatic subjects to compare them between normolipidemic and various dyslipidemic phenotypes. The associations between soluble cell adhesion molecules (s-CAMs) and risk factors for atherosclerosis, markers of insulin resistance, and the intima-media thickness of the common carotid artery (IMT) were evaluated, too. METHODS: Thwo hundred and thirty-four asymptomatic subjects were divided into four dyslipidemic phenotypes (DLP) according to apolipoprotein B (apoB) and triglycerides (TG): DLP1 (N.=58, apoB<1.2 g/L and TG<1.5 mmol/L), DLP2 (N.=47, apoB<1.2 g/L and TG≥1.5 mmol/L), DLP3 (N.=31, apoB≥1.2 g/L and TG<1.5 mmol/L) and DLP4 (N.=98, apoB≥1.2 g/L and TG≥1.5 mmol/L). DLP1 (normo-apoB /normo-TG) served as a control group. RESULTS: A significant difference in s-ICAM-1 between DLP1 (502.0 [457.1-568.2] ng/mL) and DLP4 (567.9 [502.8-692.1] ng/mL, P<0.001) was found. No significant differences in s-VCAM-1 between DLPs were apparent. S-ICAM-1 was independently predicted by HDL-cholesterol, non-HDL-cholesterol, proinsulin, C-peptide, waist, systolic and diastolic blood pressure. S-VCAM-1 was predicted only by age and systolic blood pressure. Both s-CAMs were detected as independent predictors for IMT, which was significantly increased in DLP 4. CONCLUSION: The elevation of s-ICAM-1 was presented only in patients with simultaneously elevated TG and apoB (DLP4) in comparison with normolipidemic subjects. Patients with DLP 4 had significantly increased IMT, which was independently predicted by levels of s-ICAM-1 and of s-VCAM-1. These findings pointed out DLP4 subjects as individuals with the highest risk for early manifestation of atherosclerosis.

[Problems with interpretation of low levels of thyroidal hormones conditioned by changes in transport proteins]. / Problémy s interpretací nízkých hladin tyreoidálních hormonu podmínené zmenami v transportních proteinech.

In clinical practice, we often observe conditions accompanied by secondary drop of binding proteins that bind, more or less specifically, thyroidal hormones. This is usually considered as normal situation that is often not properly interpreted from clinical point of view. In other words, we tolerate such conditions because we build on values of free hormones FT3 and FT4. However, it is very rare to observe significant decrease or even absence of thyroxin binding globulin (TBG) due to inborn error of metabolism. In such situations, the overall level of thyroidal hormones becomes a part of evaluated laboratory profile. Unusual laboratory constellation is in sharp contrast to the so-called "healthy patient". Due to increased migration of persons, we had an opportunity to take care of a patient of this kind.

[Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) leading to the diagnosis of Wilson's disease]. / Trombotická trombocytopenická purpura--hemolyticko-uremický syndrome (TTP-HUS) vedoucí k diagnóze Wilsonovy choroby.

Authors describe the case of a patient suffering from Thrombotic Thrombocytopenic Purpura--Hemolytic-Uremic syndromee. Any cause of the disease was not found, except signs of liver injury. The etiology of indefinite liver disease that had been diagnosed several years before was examined. Wilson's disease was considered as a final eventuality. The finding of 488 micrograms of copper in the dry liver tissue confirmed the diagnosis of Wilson's disease in the end.

[Effect of portosystemic anastomosis on the degree of splenic inhibition]. / Vliv portosystemické spojky na míru splenického útlumu.

UNLABELLED: Secondary hypersplenism is a well-known complication of portal hypertension. Reduced platelet count is a more alarming sign for the physician than risk for the patient. Improvement of thrombocytopenia is urgent, when portal hypertension with splenomegaly and thrombocytopenia presents with life-threatening haemorrhage from gastroesophageal varices. In this case, treatment aimed at stopping the bleeding may be more beneficial than any intervention on the spleen. In this study, we evaluated long-term effects of an elective distal splenorenal shunt or small diameter H-shunt on splenomegaly and thrombocytopenia in 26 patients with portal hypertension operated for repeated bleeding from oesophageal varices. 25 patients had splenomegaly and 16 patients had thrombocytopenia before shunting. Surgery corrected splenomegaly in 16 patients (64%), platelet counts increased in 13 of 16 patients with thrombocytopenia (81.2%). CONCLUSION: Selective or partial portal decompression is sufficient to alleviate thrombocytopenia and splenomegaly associated with portal hypertension.

[Hyperparathyroidism in clinical practice. Personal experience]. / Hyperparatyreóza v klinické praxi. Vlastní zkusenosti.

The period of six years is discussed by the authors during which 39 patients were confirmed having primary or secondary hyperparathyroidism. All of them finally underwent the surgical procedure. The possibility of immunoreactive PTH measurement has been highly appreciated. Despite that key position of the experienced surgeon remains of the utmost importance.

[The hepatic form of Wilson's disease in young patients]. / Jaterní forma Wilsonovy nemoci u mladých pacientu.

UNLABELLED: Wilson's disease (WD) is a hereditary disorder of the copper metabolism with very varied clinical and biochemical symptoms. Hepatic and neurological forms are the most frequent manifestations of this rare disease. In schoolchildren and adolescents symptoms of liver damage predominate. In a retrospective study 19 patients were evaluated with biochemical signs of hepatopathy manifested before the age of 18 years. The diagnosis of WD was established at the age of 7 to 27 years. One female patient was admitted with fulminant hepatic failure which was treated by acute transplantation of the liver in the Institute of Clinical and Experimental Medicine in Prague. Only 9 of 18 patients with chronic hepatic affection at the time of diagnosis met the Sternlieb diagnostic criteria. These patients had reduced ceruloplasmin levels (0.08-0.18 g/l) and a high copper content in the hepatic dry matter (783 ug/g +/- 323 [SD]). In the remaining 9 patients the ceruloplasmin level was normal, however, in 8 a high copper content of the hepatic dry matter was found (696 ug/g (+)- 352[SD]. The last patient from this group had Kayser-Fleischer's (K-F) ring. It was possible to confirm the high copper content in the hepatic dry matter only after one year's penicillinamine treatment because at the time of the diagnosis poor coagulation did not permit to perform a liver biopsy. There was a statistically significant difference in the copper content of the hepatic dry matter in patients meeting and not meeting Sternlieb's criteria. Statistically significant differences between both groups were found in the plasma copper levels and in the 24-hour urinary copper excretion. Histological examination of the liver under a light microscope revealed findings from minimal changes associated with the presence of glycogen nuclei in hepatocytes to the picture of active chronic hepatitis. In all 19 patients the gene mutation H1069Q was examined and the results were positive in 39.8%. In 3 asymptomatic patients it was present in the homozygous form. CONCLUSION: Early detection of the atypical form of WD remains very difficult. The gold standard is still in all cases assessment of copper in the dry liver tissue. In the near future an important place will be held also by direct DNA analysis although its use is limited not only by the large number of known mutations but also by the financial costs of the method.

[Idiopathic hypoparathyroidism with celiac disease--diagnostic and therapeutic problem]. / Idiopatická hypoparatyreóza s celiakií--diagnostické a lécebné problémy.

A middle-aged woman developed gradually diseases where most probably the common denominator is an autoimmune process. The authors describe the clinical condition persisting for seven years, where hypoparathyroidism was associated with coeliac disease which did not respond to dietary measures. Malabsorption was manifested by a selective block for calcium absorption from the gut. The impaired conversion of vitamin D2 to D3 is of interest; it has obviously a multifactorial etiology. The main problem is the patient's tendency to respond by tachyphylaxis to oral vitamin D administration. The only effective therapeutic procedure apart from those listed is so far parenteral administration of vitamin D3, calcitrol.

[Fulminant liver failure as a sequelae of acute dystrophy of the right hepatic lobe]. / Fulminantní jaterní selhání jako následek akutní dystrofie pravého jaterního laloku.

A 38-year-old female patient developed signs of fulminant hepatic failure, caused by extensive, spontaneous, devastating ischaemia of the right liver lobe. The patient survived the acute attack. During the subsequent eight years hypertrophy of the intact left liver lobe occurred which eventually completely replaced the loss of the dominant right lobe.

[Portosystemic anastomosis at the time of transplantation and TIPS]. / Portosystemická spojka v dobe transplantací a TIPS.

Sclerotherapy has become in the treatment of acute haemorrhage of oesophageal varices the method of first choice. The relapse of haemorrhage within a five-year interval is however too frequent after this treatment. TIPS is a new method which can resolve profuse haemorrhage from varices in patients with a markedly reduced hepatic reserve. The high incidence of stenosis or occlusion (50% during the first six months) however foresees the use this method rather for bridging the interval before definite therapy i.e. transplantation of the liver. Patients with a sufficient functional hepatic reserve and those who are candidates for transplantation can be protected with a very good effect against relapsing haemorrhage by a surgical anastomosis.

[Sarcoidosis of the liver, a granulomatous process with an unclear prognosis]. / Sarkoidóza jater, granulomatózní proces s nejasnou prognózou.

The authors demonstrate on two patients the pitfalls of the diagnosis and prognostic uncertainty of systemic sarcoidosis. The typical pulmonary finding was in the background due to the very extensive and serious affection of the liver.

[Adrenal incidentalomas. Clinical experience]. / Incidentalomy nadledvin. Klinické zkusenosti.

In the course of two years the authors treated 27 patients with incidentally detected adrenal tumours. Detailed morphological and laboratory examination revealed four cases of non-classical late type adrenogenital syndrome (AGS) and two pheochromocytomas. From the submitted paper ensues that it is essential to provide interdisciplinary comprehensive treatment in departments which have sufficient experience with this problem.