Browsing by Author "Stojanović, Miloš (58202803500)"

Introduction Neurofibromatosis type 1 is one of the most common genetically transmitted diseases with a high index of spontaneous mutations and extremely varied and unpredictable clinical manifestations. It is diagnosed by the existence of certain clinical criteria. The presence of numerous localised cutaneous neurofibromas or a plexiform neurofibroma is virtually pathognomonic of neurofibromatosis type 1. The incidence of pheochromocytoma in neurofibromatosis type 1 is 0.1-5.7%. Case Outline A 56-year old female patient was admitted for further evaluation of incidental adrenal tumour previously diagnosed on computerized tomography (CT). She had previously unrecognized neurofibromatosis type 1 and a clinical picture which could remind of pheochromocytoma. None of the catecholamine samples in 24 hr urine indicated functionally active pheochromocytoma. Chromogranin A was moderately increased. Decision for operation was made after performing the image techniques. Adrenal incidentaloma had features of pheochromocytoma on abdominal magnetic resonance imaging (MRI), with positive 131I-MIBG (iodine 131-labelled metaiodobenzylguanidine scintigraphy). After being treated with phenoxybenzamine and propranolol, she was operated on. The pathohistological finding showed the case of left adrenal pheochromocytoma. Conclusion Detailed diagnostic procedure for pheochromocytoma should be performed with patients having neurofibromatosis type 1 and adrenal incidentaloma. Pheochromocytomas are rare tumours with fatal outcome if not duly recognized and cured.

Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications. Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS). Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p<0.001). The metabolic syndrome was significantly less common in the PA group (37.5% vs. 70% in CS+SCS and 65% in NFA+HT group; p=0.015), although there was no significant difference in any of the analysed metabolic parameters between groups. PA group was found to have the most patients with glucose intolerance (81.8%), although the difference was not significant. The mean BMI for all three groups was in the overweight range. Patients with PA had higher microalbuminuria and a higher tendency for cardiovascular, renal and cerebrovascular events, but the difference was not significant. Our results support the importance of the early recognition of primary aldosteronism on the bases of clinical presentation, as well as an increased screening intensity. © 2019 © 2019.

Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications. Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS). Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p<0.001). The metabolic syndrome was significantly less common in the PA group (37.5% vs. 70% in CS+SCS and 65% in NFA+HT group; p=0.015), although there was no significant difference in any of the analysed metabolic parameters between groups. PA group was found to have the most patients with glucose intolerance (81.8%), although the difference was not significant. The mean BMI for all three groups was in the overweight range. Patients with PA had higher microalbuminuria and a higher tendency for cardiovascular, renal and cerebrovascular events, but the difference was not significant. Our results support the importance of the early recognition of primary aldosteronism on the bases of clinical presentation, as well as an increased screening intensity. © 2019 © 2019.

Objective: The aim of the study was to determine whether derangements in insulin pulsatility are related to the presence of insulin resistance or whether these changes occur only in non-insulin-dependent diabetes mellitus (NIDDM). Design and methods: The study included 26 obese, 11 NIDDM and 10 control subjects. The obese group was divided into a low insulin (plasma insulin <20 mU/l, OLI, 14 subjects) and a high insulin (OHI, 12 subjects) group. For pulsatility analysis blood was sampled every 2 min for 90 min. Pulsatility analysis was carried out using the PulsDetekt program. The insulin secretion randomness was quantified using interpulse interval deviation (IpID) and approximate entropy (ApEn). ApEn and ApEn normalized by s.p. of the individual insulin time series (nApEn) were calculated. Lower values of ApEn and IpID indicate more regular secretion. Homeostasis model assessment (HOMA) was used to quantify insulin sensitivity. Results: Insulin pulses were significantly less regular in the OHI and the NIDDM groups compared with the control and the OLI groups (control: ApEn 0,54 ± 0.16, nApEn 0.69 ± 0.19, IpID 2.53 ± 0.99; OLI: ApEn 0.64 ± 0.12, nApEn 0.79 ± 0.15, IpID 2.92 ± 1.09; OHI: ApEn 0.88 ± 0.07, nApEn 0.92 ± 0.07, IpID 3.95 ± 0.84; NIDDM: ApEn 0.92 ± 0.16, nApEn 0.99 ± 0.09, IpID 4.41 ± 0.53; means ± s.p.). There was no difference in the pulse regularity between the OHI and the NIDDM groups. Conclusions: Decrease in insulin sensitivity was correlated with the reduction of insulin secretion regularity. Therefore irregular insulin secretion is related to a reduction in insulin sensitivity, and it is not unique to NIDDM.

Objective: The aim of the study was to determine whether derangements in insulin pulsatility are related to the presence of insulin resistance or whether these changes occur only in non-insulin-dependent diabetes mellitus (NIDDM). Design and methods: The study included 26 obese, 11 NIDDM and 10 control subjects. The obese group was divided into a low insulin (plasma insulin <20 mU/l, OLI, 14 subjects) and a high insulin (OHI, 12 subjects) group. For pulsatility analysis blood was sampled every 2 min for 90 min. Pulsatility analysis was carried out using the PulsDetekt program. The insulin secretion randomness was quantified using interpulse interval deviation (IpID) and approximate entropy (ApEn). ApEn and ApEn normalized by s.p. of the individual insulin time series (nApEn) were calculated. Lower values of ApEn and IpID indicate more regular secretion. Homeostasis model assessment (HOMA) was used to quantify insulin sensitivity. Results: Insulin pulses were significantly less regular in the OHI and the NIDDM groups compared with the control and the OLI groups (control: ApEn 0,54 ± 0.16, nApEn 0.69 ± 0.19, IpID 2.53 ± 0.99; OLI: ApEn 0.64 ± 0.12, nApEn 0.79 ± 0.15, IpID 2.92 ± 1.09; OHI: ApEn 0.88 ± 0.07, nApEn 0.92 ± 0.07, IpID 3.95 ± 0.84; NIDDM: ApEn 0.92 ± 0.16, nApEn 0.99 ± 0.09, IpID 4.41 ± 0.53; means ± s.p.). There was no difference in the pulse regularity between the OHI and the NIDDM groups. Conclusions: Decrease in insulin sensitivity was correlated with the reduction of insulin secretion regularity. Therefore irregular insulin secretion is related to a reduction in insulin sensitivity, and it is not unique to NIDDM.

Introduction/Objective Hot flashes are one of the first clinical symptoms of menopause. The mechanism of hot flashes is still not fully understood. Changes in concentrations of the circulating follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and other hormones can lead to thermoregulatory dysfunction. The aim of this study was to examine the association between dynamic changes in concentrations of sex hormones and the presence of vasomotor symptoms in menopausal women. Methods The study involved 36 women divided into two groups: in the first group there were 24 women with hot flashes, BMI 26.16 ± 3.42 kg/m2; the control group comprised 12 women, BMI 26.82 ± 3.89 kg/m2. Data on the presence of hot flashes were based on medical history data. Venous blood samples were collected for the analyses of FSH, LH, prolactin, estradiol, progesterone, testosterone, sex hormone binding globulin, dehidroepiandrosteron sulfate, thyroid-stimulating hormone, and thyroxin. During the subjective feeling of hot flashes, three blood samples during the day and night were collected to determine the mean levels of FSH, LH, and estradiol in women with hot flashes. Results Women with hot flashes had significantly higher prolactin (389.58 ± 123.69 mIU/L to 258.19 ± 122 mIU/L, p < 0.01) and dehydroepiandrosterone sulfate (3.60 ± 2.49 nmol/L vs. 1.88 ± 1.27 nmol/L, p < 0.05) levels, as well as lower mean values of FSH during hot flashes during the day (69.08 ± 28.84 IU/L vs. 107.18 ± 39.11 IU/L, p < 0.01) and night (60.72 ± 21.89 IU/L vs. 104.57 ± 38.06 IU/L, p < 0.01). Conclusion Women with hot flashes had significantly lower mean FSH levels during hot flashes during the day and night than the control group. © 2018, Serbia Medical Society. All rights reserved.

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 (R2 = 0.004, F = 0.407, p = 0.525). Significant relationship was found between 1 mg-DST and ISI-composite (R2 = 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 (R2 = 0.001, F = 0.005, p = 0.943) or ISI-composite (R2 = 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. © 2013 Elsevier Inc.

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 (R2 = 0.004, F = 0.407, p = 0.525). Significant relationship was found between 1 mg-DST and ISI-composite (R2 = 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 (R2 = 0.001, F = 0.005, p = 0.943) or ISI-composite (R2 = 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. © 2013 Elsevier Inc.

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. © Copyright © 2021 Tančić-Gajić, Vukčević, Ivović, Marina, Arizanović, Soldatović, Stojanović, Đogo, Kendereški and Vujović.

ACTH stimulation is the standard test for assessment of adrenal function. It was suggested that the low dose (1 μg) would be more sensitive for detecting mild secondary adrenal insufficiency than the usual dose of 250 μg. The aim of this study was to find the optimal diagnostic criteria and to compare standard dose test (SDT) with the low dose test (LDT). A group of patients treated with corticosteroids for the 6 months was considered to have hypothalamo-pituitary-adrenal impairment. Studies were performed in 14 corticosteroid-treated and 28 control subjects in random order on 2 consecutive days. Tests were analyzed using the receiver operating characteristic curve method. The best test was cortisol increment at 15 min of the LDT. It was significantly better than the cortisol concentration at 15 min of the SDT, the best test during the SDT (receiver operating characteristic curve area and 95% confidence interval: LDT, 0.997 and 0.956-0.999; SDT, 0.827 and 0.662-0.929; P = 0.0113). For the cortisol increment at 15 min of the LDT at 100% sensitivity, the diagnostic value was 100 mmol/L, and the specificity was 96%. Therefore, the LDT is superior to the standard dose test in the assessment of secondary adrenal insufficiency.

ACTH stimulation is the standard test for assessment of adrenal function. It was suggested that the low dose (1 μg) would be more sensitive for detecting mild secondary adrenal insufficiency than the usual dose of 250 μg. The aim of this study was to find the optimal diagnostic criteria and to compare standard dose test (SDT) with the low dose test (LDT). A group of patients treated with corticosteroids for the 6 months was considered to have hypothalamo-pituitary-adrenal impairment. Studies were performed in 14 corticosteroid-treated and 28 control subjects in random order on 2 consecutive days. Tests were analyzed using the receiver operating characteristic curve method. The best test was cortisol increment at 15 min of the LDT. It was significantly better than the cortisol concentration at 15 min of the SDT, the best test during the SDT (receiver operating characteristic curve area and 95% confidence interval: LDT, 0.997 and 0.956-0.999; SDT, 0.827 and 0.662-0.929; P = 0.0113). For the cortisol increment at 15 min of the LDT at 100% sensitivity, the diagnostic value was 100 mmol/L, and the specificity was 96%. Therefore, the LDT is superior to the standard dose test in the assessment of secondary adrenal insufficiency.

Introduction/Objective Pancreatic cancer may be accompanied by infections caused by various microor-ganisms. It is uncertain wheatear pancreatic infection precedes the development of cancer or vice versa. The aim of this study is to analyze routes of infections from the duodenum through the pancreatic duct to determine what types of microorganisms can get through this duct into the pancreas and nearby tissue. Methods In patients subjected to cephalic duodenopancreatectomy (Whipple procedure) due to ad-enocarcinoma of the ampulla of Vater, the duodenum or head of the pancreas, swabs from duodenal mucosa, pancreatic duct, and pancreatic tissue at the line of the resection were taken. Microscopic slides were prepared directly from the patients’ specimens as well as from colonies on culture plates, and both were Gram stained. Results Candida was present in all three types of swabs (duodenum, pancreatic duct, and tissue), while bacteria, depending on the species (Pseudomonas aeruginosa, α-hemolytic Streptococcus, coagulase-negative Staphylococcus, Enterococcus spp., Serratia spp.), were present in pancreatic duct or tissue, but not in the duodenum. Conclusion There is a connection between the presence of microorganisms and pathology of the pancreatic adenocarcinoma. Results show that Candida infection originates from the duodenum, while bacterial infections originate directly from blood or tissue injuries. © 2021, Serbia Medical Society. All rights reserved.

Background/Aim. In menopausal women lipid and lipoprotein values are important predictors of development of cardiovascular diseases (CVD). The use of estrogens reduces levels of low density lipoprotein cholesterol (LDL-C) and lipoprotein A [Lp(a)], and increases levels of triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) depending on the dose and route of administration. Simultaneous administration of progesterone, depending on the type, can have different effects on lipids. The aim of the study was to examine the effect of estroprogestagen therapy on the lipid metabolism of women in menopause, depending on the administration route. Methods. A study was conducted as prospective clinical interventional study with controlled parallel groups. It included 64 women in menopause, divided into three groups: the group 1 (n = 22) on oral therapy with estroprogestagens, the group 2 (n = 17) on transdermal patch therapy with estroprogestagens and the group 3 (n = 25) treated with estroprogestagens given intramuscularly. The following biochemical parameters in the serum were determined: total cholesterol (TC), HDL-C, LDL-C, TG, Lp(a), apoprotein A (Apo-A), apoprotein B (Apo-B), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-SO4), prolactin and thyroid-stimulating hormone (TSH), prior to administration of the menopausal hormonal therapy (MHT), as well as after sixth months and 2–5 years from the beginning of the therapy. The statistical significance of the difference in values obtained was examined independently and depending on the route of MHT application. Results. MHT, regardless of the administration route, led to a statistically significant continuous decrease of TC, LDL-C and Apo-B levels and the continuous increase of HDL-C and Apo-A levels. Serum levels of TC, LDL-C, HDL-C, Lp(a), Apo-A and Apo-B did not show a statistically significant differences among groups of women given MHT by different routes. It was found that the serum level of Apo-A increased significantly with the rise of estradiol, and the values of LDL and Apo-B decreased regardless of the route of the MHT application. Conclusion. MHT introduced in time, regardless of the route of administration, has beneficial effects on the lipid status of menopausal women and consequently might prevent numerous cardiovascular diseases that are the leading cause of mortality. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.