Metabolic consequences of recombinant human growth hormone therapy in patients with Turner syndrome.

INTRODUCTION: Turner syndrome (TS) predisposes to metabolic complications. Currently, TS patients are treated with recombinant human growth hormone (rGH) as standard therapy. The long-term effect of this therapy on carbohydrate metabolism remains unclear. Aim of the study: To assess possible metabolic alterations following rGH therapy. MATERIAL AND METHODS: Material and methods: We enrolled 53 TS participants, comprising 37 patients who finished rGH therapy (group 1) and 16 patients who did not receive growth promoting therapy (group 2). Several anthropometric measurements were made. Carbohydrate and lipid metabolism, adipokines, and hs-CRP were assessed basing on laboratory test. The following indices were calculated: HOMA-IR, HOMA-b, QUICKI, and Matsuda. RESULTS: There were no statistically significant differences between the 2 groups in terms of BMI or WHR. There was a statistically significant lower mean percentage of fat tissue in group 1 compared to group 2 (27.46% vs. 31.75%). Insulin resistance and sensitivity indices were not statistically different between groups. Using the Matsuda index, more patients who met criteria of insulin resistance were found in group 2 than in group 1 (56.25% vs. 37.84%); however, this difference was not statistically significant (p = 0.2). No statistically significant differences were found in lipid profile, adipokines, and hsCRP between groups. CONCLUSIONS: rGH therapy leads to a beneficial change in body composition of TS patients despite unchanged BMI. A decrease in body fat persists for several years after finishing rGH treatment; rGH treatment is connected with a trend toward increased insulin sensitivity.

Fasting and postprandial acyl and desacyl ghrelin and the acyl/desacyl ratio in obese patients before and after different types of bariatric surgery.

INTRODUCTION: The mechanism underlying beneficial outcomes of bariatric surgery still remains unclear. Especially little is known about hormonal and metabolic changes induced by the novel bariatric procedure mini gastric bypass (MGB). AIM: To evaluate pre- and post-prandial changes in both ghrelin isoforms in obese patients without diabetes and cardiovascular complications treated with MGB, sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. MATERIAL AND METHODS: From 45 patients initially enrolled in the study, 23 persons completed a one-year follow-up period. Venous blood for acyl and desacyl ghrelin (AG and DAG) as well as other metabolic assays was collected 3 months before and 6 and 12 months after bariatric surgery (MGB, RYGB, SG) - in the fasting state and 2 h after the consumption of a standard 300 kcal-mixed meal (Nutridrink standard, Nutricia). RESULTS: AG and DAG levels (both fasting and prandial) as well as AG/DAG ratio did not change after 6 and 12 months in MGB and RYGB groups. In the SG group we observed a significant decrease in fasting and postprandial DAG levels and consecutively an increase in the fasting AG/DAG ratio after 6 and 12 months. Six months after surgery we observed some differences between carbohydrate metabolism measures in the MGB group (lower HbA1c, HOMA-IR and fasting insulinaemia) in comparison to the rest of the participants, but 12 months after each type of surgery body mass index and indices of carbohydrate and lipid metabolism did not differ. CONCLUSIONS: The results of our study demonstrate that all studied bariatric procedures can successfully reduce overall body weight and suggest also that the mechanisms of weight loss and improvement in carbohydrate and lipid metabolism after all three types of surgery are independent of ghrelin and the acyl/desacyl ghrelin ratio.

Complex interaction between the immune system and adipose tissue (Review).

We review the studies on the links between obesity, the immune system and lifestyle (limited or excessive calorie intake) that provoke changes in the current therapeutic course. There is no doubt that the positive energy balance of the body affects the immune cells, and consequently, the changes intracellular pathways, leading to the disruption of their function. Research suggests that metformin, a drug long used to treat diabetes, and an alternative remedy in the treatment of obesity, increases the activity of 5-adenosinemonophosphate (AMP)-activated kinase (AMPK). Thus, this review comes to the conclusion that alongside traditional methods, such as reducing calorie intake and increasing the energy expenditure of the body, the therapeutic outcome may be improved by implementing drugs affecting the activity of AMPK. In future, other new therapeutic options may be available. The targeting receptors or immunocompetent cells residing in adipose tissue may help to reduce the effects of obesity.

Pseudo-stroke manifestation of multiple myeloma: a report of two cases with literature review.

Multiple myeloma rarely presents with neurological symptoms. We describe two patients with pseudo-stroke manifestation of multiple myeloma. The first patient was a 60-year-old female with the initial presentation of multiple myeloma forming a large skull tumour compressing the brain with resultant symptoms of aphasia, limited logical contact and right upper extremity paresis. The second patient was a 69-year-old female who presented with a partial motor epileptic seizure involving both right limbs with persisting weakness of muscles and speech disturbances due to a skull tumour 4 years after the diagnosis of multiple myeloma. Pseudo-stroke manifestation of multiple myeloma is extremely uncommon, however it can sometimes be observed both as an initial presentation and in the course of long-lasting disease.

Hormonal activity in clinically silent adrenal incidentalomas.

INTRODUCTION: The rapid development of modern imaging techniques, has led to an increase in accidentally discovered adrenal masses without clinically apparent hormonal abnormalities. Such tumours have been termed "incidentalomas". The diagnostic work-up in patients with adrenal incidentalomas is aimed at the determination of hormonal activity of the tumour and identification of patients with potentially malignant tumours. The aim of our study was a retrospective analysis of selected clinical characteristics and hormonal studies in accidentally discovered adrenal tumours. MATERIAL AND METHODS: Fourty hundred sixty-three patients with serendipitously discovered adrenal masses, diagnosed and treated in the Department of Endocrinology and Internal Diseases, Medical University of Gdansk as well as in the affiliated Endocrinology Clinic between 1993 and October of 2009 were included in the analysis. Out of all patients, 245 were referred for adrenalectomy. RESULTS: We found that clinically "silent" tumours often demonstrate subclinical hormonal activity. In our report, increased 24-h urinary excretion of cortisol correlated positively with tumour size (p < 0.001). Moreover, a statistical relationship was demonstrated between tumour size and serum cortisol concentration assessed in the 1 mg dexamethasone suppression test (p < 0.001). Increased values of dehydroepiandrosterone/dehydroepiandrosterone sulphate were more often found in malignant than in benign tumours (p < 0.01). Urinary concentrations of 17-ketosteroids correlate positively with diagnosis of adrenocortical cancer (p = 0.02). CONCLUSIONS: We found that clinically "silent" tumours often demonstrate subclinical hormonal activity (subclinical Cushing syndrome, subclinical pheochromocytoma, low-symptomatic adrenocortical cancer).

Adipose tissue activity in relation to overweight or obesity.

INTRODUCTION: Obesity is associated with a number of diseases resulting from the excessive amount of adipose tissue. The aim of this study was to investigate the correlation between the quantity of adipose tissue and the prevalence of metabolic disturbances, and the concentration of adipokines and proinflammatory cytokines in obese or overweight patients. MATERIAL AND METHODS: Fifty-five middle-aged subjects with body mass index (BMI) > 25 kg/m(2) took part in this study. Twenty-three healthy people with normal BMI formed the control group. Twenty-one people from the study group were on a low-calorie diet. All subjects underwent anthropometric assessment, laboratory investigations, and blood-pressure examination. RESULTS: Patients with obesity or overweight, in comparison to those with normal BMI, showed insulin resistance and a higher concentration of high sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor 1 (PAI-1), and interleukin 6 (Il-6). The concentration of adiponectin was significantly lower in this group. The patients on the low-calorie diet had significantly lower concentrations of leptin when compared to other obese people; moreover, a trend towards decreased hs-CRP concentration was seen. A significant positive correlation between leptin and hs-CRP was observed. The serum concentration of adiponectin was inversely correlated with that of TNF-alpha, IL-6, hs-CRP, and PAI-1. CONCLUSIONS: The results of this study may suggest the beneficial impact of a low-calorie diet on the slowing down of inflammatory processes. The observed negative correlation between the concentrations of adiponectin and inflammatory cytokines may confirm the anti-inflammatory activity of this adipokine.

The serum profile of adipokines in overweight patients with metabolic syndrome.

INTRODUCTION: Obesity is a disease that brings several complications and increases the risk of other diseases like metabolic syndrome, diabetes mellitus type 2, or coronary heart disease. Disturbances in secretion of adipokines caused by obesity have an influence on the development of metabolic complications. The aim of this study was an investigation of adipokines profile in overweight or obese people with metabolic syndrome in comparison to overweight/obese patients without metabolic syndrome. MATERIAL AND METHODS: The studied groups consisted of 38 obese or overweight patients without metabolic syndrome (nonMS) and 17 with recognized metabolic syndrome (MS), according to International Diabetes Federation (IDF) criteria. All individuals underwent anthropometrical and blood-pressure examination as well as biochemical analyses such as: serum concentrations of glucose, insulin, adiponectin, resistin, leptin, TNF-alpha, IL-6, hs-CRP, total cholesterol, HDL, and triglycerides. RESULTS: A significantly lower concentration of adiponectin, and a higher concentration of IL-6, was observed in patients with metabolic syndrome (MS) in comparison to nonMS. Moreover, higher concentrations of hs-CRP and TNF-alpha were observed in patients with metabolic syndrome. CONCLUSIONS: A decreased concentration of adiponectin in obese people is an early predictor of metabolic syndrome. A low adiponectin level could be a marker of high risk of cardiovascular disease in obese patients. (Pol J Endocrinol 2010; 61 (1): 36-41).

[Portal vein thrombosis in patients with thrombophilia--own observations]. / Zakrzepica ukladu zyly wrotnej u chorych z trombofilia-- obserwacje wlasne.

Portal vein thrombosis is one of the main prehepatic causes of portal hypertension. The most frequent causes of thrombosis in this localization, apart from hepatic cirrhosis, are the following: acute inflammatory diseases and abdominal cancers, traumas, proliferative diseases of the hematopoietic system. In recent years attention was given to disorders in hemostasis, such as thrombophilia, in the course of which thrombosis development is particularly common. The authors present 10 patients after an incident of portal vein thrombosis, in which primary hepatic pathology was excluded and tests directed at thrombophilia were performed. In seven patients abnormalities in the examined parameters were found, and what is more, in two cases they had a complex character and involved more than one parameter. In five patients hyperhomocysteinemia was found. Among them, in two patients there was also a decreased protein S activity and in one of them there was also APC-resistance. In the next two patients there were abnormalities in one of the examined parameters - APC-resistance. Hyperhomocysteinemia was found in all patients with idiopathic thrombosis, and in one of them there were concurrent changes in protein S activity and APC-resistance. In patients with the history of portal vein thrombosis diagnostics of thrombophilia should be performed.