[The effect of estrogen deficiency, estrogen and estro-progestagene therapy on total plasma homocysteine and serum lipid peroxide levels in postmenopausal women]

OBJECTIVES

Elevated plasma homocysteine (Hcy) concentration is a risk factor for atherosclerosis and venous thrombosis.

DESIGN

an observational study.

MATERIALS AND METHODS

120 healthy women were recruited and divided in two subgroups--postmenopausal women (M-80 women) and premenopausal women (40 women) with normal menstruation as control group. 26 women with surgical menopause were treated with percutaneous estrogen therapy and remaining 54 women were treated with estro-progestagen replacement therapy. Measurements of FSH and estradiol was made using radioimmunoassay. HCY was assessed using enzymatic conversion method.

RESULTS

Concentrations of Hcy and lipid peroxides (LPO) in postmenopausal study group were higher than in the premenopausal. Treatment with estradiol (E2) alone or in combination with medroxyprogesterone acetate decreased LPO and Hcy concentrations to levels observed in premenopausal group.

CONCLUSIONS

Our results suggest that estrogens have a profound influence on Hcy and LPO levels. Reduction in Hcy levels after treatment lowers the production of free radicals and thus contributes to lipid peroxidation decrease and LPO levels reduction after therapy. A practical conclusion may be proposed: in postmenopausal women with elevated Hcy levels who require hormonal replacement therapy, Hcy level control is indicated in order to administer such a therapy, which decreases Hcy concentrations.

[The use for recombinant human TSH in patients with toxic and non-toxic nodular goiter]

Radioiodine ((131)I) treatment for multinodular toxic and non-toxic goiter is therapeutic procedure especially used in patients with contraindication for surgery. (131)I treatment diminishes the size of the goiter and treats hyperthyroidism. Sometimes, due to low radio-iodine uptake (RAIU), this procedure should not be used. In patients with goiter, the elimination of medication or substances rich in iodine is the first step to increase RAIU. Recombinant TSH (rhTSH) enhances RAIU in metastases distant from thyroid cancer. Studies were performed in recent years using rhTSH to increase the radio-iodine uptake in multinodular toxic and non-toxic goiter. These methods led to enhanced radio-iodine uptake, decreased the level of activity of the (131)I administered, changed the distribution of (131)I in the thyroid, lowered the absorption dose, and increased the number of patients with hypothyroidism. The uses of rhTSH can lead to exacerbation of the signs and symptoms of hyperthyroidism, so patients should be hospitalized. Until now there has been no evidence that the adverse effects outweigh the positive results of using rhTSH. The use of rhTSH in benign goiter disease is not yet approved, but its positive activity in multinodular goiter is very interesting and promising.

Prevalence of obesity in Poland

Obesity is an important health problem in Poland affecting adolescents and adults. A study of a Lower Silesian population aged 20-40 years (25 400 participants), between 1993 and 2003, showed an increase in obese women from 8.9% to 15.0%, but no change in men (6.3% vs. 6.5%, respectively). Obesity occurs more frequently in girls and women (6% and 15%) compared to boys and men (4.0% and 6.5%, respectively). Estimation of obesity prevalence in various parts of Poland seems to be regionally dependent; the highest prevalence of obesity was observed in eastern regions of Poland.

Influence of Vitamin D Receptor Gene Polymorphisms on Secondary Hyperparathyroidism and Bone Density After Kidney Transplantation

Secondary hyperparathyroidism and immunosuppressive treatments are the most important pathogenetic factors for bone disease after kidney transplantation. The aim of study was to compare the influence of vitamin D receptor (VDR) genotype on the PTH level and bone mineral density (BMD) in 67 patients, including 45 immunosuppressed with cyclosporine (CsA) and 22 with tacrolimus (Tac) versus 147 healthy volunteers. Two VDR polymorphisms: BsmI and FokI were assayed with RFLP-PCR. Scantibodies were utilized to evaluate 1-84 PTH. BMD was measured by DEXA. Hormone levels were measured on the third day and sixth month after transplantation. BMD was examined at the third and ninth month. The distribution of FokI genotype differed, but the BsmI genotypes did not differ between the transplant patients and the control group. All transplanted patients showed an elevated tPTH at the first examination. The highest PTH values, which were observed in bb genotype, significantly decreased after the transplant procedure. Patients with the FF genotype who were treated with CsA showed higher levels of tPTH than those with the Ff genotype. At 6 months, a decrease in tPTH occurred in both the CsA and the Tac patients. A low BMD at the third month was more frequent among patients of the BB genotype treated with CsA. The Z-score remained low at the third month and at the ninth month. In conclusion, kidney graft recipients show overrepresentation of the Ff genotype. Our preliminary data suggest that the bb genotype exhibits a protective effect on bone loss after renal transplantation.

Serum adiponectin concentration and cardiovascular risk factors in climacteric women

OBJECTIVE

Adiponectin plays a significant role in the modulation of glucose tolerance and insulin sensitivity. We attempted to evaluate the relationship between adiponectin level and parameters of the menopausal metabolic syndrome: body mass index, waist-to-hip ratio, lipid profile and insulin resistance indices.

SUBJECTS AND METHODS

Thirty-two women and ten men aged 40-63 years were included. The percentage of body fat and of abdominal fat deposits were measured with dual-energy X-ray absorptiometry. Serum adiponectin, tumour necrosis factor-a (TNFalpha) and leptin were measured with commercially available radioimmunoassay kits. To exclude the influence of nutritional factors on adiponectin secretion, diet content was analysed in the preceding three days.

RESULTS

Postmenopausal non-obese women had a non-significantly lower level of adiponectin compared with premenopausal women of corresponding body mass. Serum adiponectin level was significantly lower in postmenopausal obese women than in non-obese women (p = 0.0023). Men with similar age and body mass to the women had the lowest level of adiponectin (p = 0.06). Three months of estrogen replacement therapy in women with surgical menopause did not significantly change the serum level of adiponectin. We found a negative correlation of adiponectin with leptin, insulin resistance index and total cholesterol, and a positive correlation with high-density lipoprotein cholesterol. Adiponectin level was negatively correlated with free testosterone, but we did not find such a relationship with estradiol. There was no correlation of adiponectin level with TNFalpha; however, serum TNFalpha correlated positively with leptin. The dietary analysis showed no differences between the diets of obese and non-obese women over the preceding three days. Moreover, mean diastolic and systolic blood pressures were noted to be significantly lower in premenopausal women than in postmenopausal non-obese women (p = 0.05).

CONCLUSIONS

Our results suggest that adiponectin could be a marker of risk for developing menopausal metabolic syndrome. Moreover, it is possible that sex steroids have an influence on adiponectin secretion.

[Evaluation of the influence of sex hormones on homocysteine concentration in pre- and postmenopausal women]

The aim of study was to evaluate the influence of sex hormones: estradiol (E), follicle-stimulating hormone (FSH), progesterone (P), testosterone (T), dehydroepiandrosterone (DHEA-S) and cortisol (F) on the serum homocysteine concentration (HCY) in 40 premenopausal (group M) and 80 postmenopausal (group K) women. The influence of E2 therapy (ET) on the serum HCY level in the women with surgical menopause was also estimated. The plasma HCY concentration in the group M was significantly higher that in group K. After ET serum HCY level decreased significantly. No correlations were found between serum HCY and E2 concentrations in the all groups. No correlations were observed between HCY and FSH, P, T and F concentrations in pre-and postmenopausal groups. There was a significant negative correlation between serum HCY and DHEA-S concentration in group K. This result may indicate, that high level of DHEA decreases HCY concentration. There was no correlation in group M, where the mean concentration of DHEA was lower than in group K. The results of study indicate, that menopause increases and ET decreases plasma HCY concentration. DHEA-S may inhibit plasma HCY concentration in premenopausal women. More studies are needed to elucidate these hypotheses.

[Leptin level and the PPARgamma2 Pro12Ala and Pro115Gln polymorphisms in women with functional hyperandrogenism. Preliminary report]

Hyperandrogenism is a multifactoral chronic disease, characterised by an androgen excess, often connected with obesity, hirsutism, polycystic ovaries, hyperinsulinemia, insulin resistance and hyperleptynemia. Peroxisome proliferator activated receptors (PPARgamma) are one of the factors influencing insulin sensitivity. As a transcriptional factor it plays a crucial role in the regulation of genes involved in insulin action. The aim of this study was to evaluate the frequency of PPARgamma Pro12Ala and Pro115Gln polymorphisms in hyperandrogenic women. The additional aim was to investigate differences in leptin levels in healthy and FOH (functional ovarian hyperandrogenism) women (non-obese and obese).

MATERIAL AND METHODS

we investigated 90 women: 72 healthy women (37 nonobese and 35 obese)--control group, and 18 women with FOH (9 nonobese and 9 obese)--FOH group. We performed anthropological examination: BMI, WHR and total-body densytomery, biochemical and hormonal estimations in the whole group. PPARgamma polymorphism was studied using PCR and RFLP.

RESULTS

in the control group Pro12Pro ("wild" type) was observed in 45 women (26 obese and 19 nonobese) - 62.5% of the group. Heterozygosity Pro12Ala was observed in 15 women (20.8%): 4 obese and 11 with BMI < 30 kg/m2, homozygosity Ala12Ala was seen in 12 women (16.6%): 5 obese i 7 nonobese. In FOH group "wild" type was discovered in 9 women (4 obese and 5 nonobese) - 50% of FOH group, heterozygosity Pro12Ala was seen in 5 women (27.7%): 2 obese and 3 with BMI < 30 kg/m2, homozygosityAla12Ala was observed in 4 women (22.2%): 3 obese and in 1 non-obese. Ala allel frequency in control group was 28%. (37% in non-obese and 20% in obese). In FOH group Ala allel frequency was 36% (nonobese - 28%, obese - 44%). In the studied group we did not find Pro115Gln polymorphism. Leptin level in control group was 19.92 +/- 14.3 ng/ml, and in FOH group - 23.41 +/- 19.47 ng/ml. Depending on BMI leptin level in non-obese healthy group was 7.45 +/- 3.76 ng/ml, in non-obese FOH women - 18.33 +/- 16.54 ng/ml, p < 0.005. In obese controls leptin level was 43.6 +/- 17.28 ng/ml, and in obese FOH women - 45.72 +/- 14.89 ng/ml.

CONCLUSIONS

Leptin level in non-obese FOH women is significantly higher than in lean healthy controls. This difference was not observed in obese women. However the Pro12Ala polymorphism is quite common; it does not seem to be directly related to the obesity connected with hyperandrogenism. Higher frequency of Ala allele In FOH women compared to healthy controls (36% vs 28%) may at least partially explain the beneficial effect of tiazolidinediones in the treatment of hyperandrogenism.

Plasma adiponectin concentration in relation to severity of coronary atherosclerosis and cardiovascular risk factors in middle-aged men

Adiponectin, an adipocyte-derived protein, seems to be a link between obesity, insulin resistance, and atherosclerosis. The present study investigated the association between adiponectin and coronary artery disease in middle-aged men.

MATERIAL AND METHODS

We examined 48 men (aged 40-60) with angiographically confirmed coronary atherosclerosis and 19 healthy men, matched by age, as a control group. Concentrations of glucose and lipids were estimated with enzymatic methods. Plasma level of adiponectin, total and free testosterone, estradiol, estrone, DHEA-S, and insulin were estimated with RIA commercial kits.

RESULTS

Men with coronary atherosclerosis had lower plasma adiponectin level than controls (16.2+/-9.2 vs 20.5+/-6.7 microg/mL; p<0.05). However, after including BMI and waist as covariate data in ANCOVA, the difference in adiponectin levels between men with CAD and controls lost statistical significance (respectively for BMI and waist: p=0.4 and p=0.7). Moreover, although not significant, adiponectin levels decreased as a function of the number of significantly narrowed coronary arteries. In a priori comparison the lowest adiponectin plasma concentration was in men with three-vessel coronary artery disease (14.3+/-9.8 microg/mL) and the high-est in controls (20.5+/-6.8 microg/mL; p=0.09). Adiponectin plasma level correlated negatively (p<0.05) with BMI, waist, percentage of total fat, fasting-insulin-resistance index (FIRI), total cholesterol and triglycerides, and positively with quantitative insulin sensitivity check index (QUICKI), HDL cholesterol, total testosterone, and total testosterone/estradiol ratio.

CONCLUSIONS

Our data suggest that low plasma adiponectin level is connected with insulin resistance syndrome and atherogenic lipid profile. It seems that adiponectin plays a role in pathogenesis of coronary atherosclerosis, especially in obese and insulin-resistant subjects.

[Is obesity associated with a polymorphism Pro12Ala and Pro115Gln in the PPARgamma gene?]

PPARgamma is one of the pivotal factors that influence adipocyte differentiation. It is transcriptional factor that plays a crucial role in the regulation of genes involved in lipid utilisation and storage as well as insulin action. The objective of this study was to evaluate whether PPARgamma Pro12Ala and Pro115Gln polymorphisms are connected with obesity and its anthropological parameters.

MATERIAL AND METHODS

We investigated 93 subjects: 72 women (37 non-obese and 35 obese) and 21 men (8 non-obese and 13 obese). We performed anthropological examination: body mass index (BMI), waist to hip ratio (WHR) and total-body densitometry in the whole group. PPARgamma polymorphism was studied using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis.

RESULTS

Pro12Pro ("wild" type) variant was present in 57 subjects (32 obese and 25 non-obese): 45 women (26 obese and 19 non-obese) and 12 men (6 obese and 6 non-obese). Heterozygosity Pro12Ala was observed in 20 subjects (8 obese and 12 controls): 15 women (4 obese and 11 lean) and 5 men (4 obese). Homozygosity Ala12Ala was discovered in 16 subjects (8 obese and 8 controls): 12 women (5 obese and 7 non-obese) and 4 men (3 obese). Pro115Gln variant was not found in any of the studied subjects.

CONCLUSIONS

The frequency Ala allele (pro12Ala and Ala12Ala variant) was 28% in the whole group and 25% in the obese subjects. However the Pro12Ala polymorphism is quite common, it does not seem to be directly connected with onset of obesity. But it is interesting that the Ala allele is more frequent in non-obese women comparing to obese women (33 vs 20%). Reverse tendency was seen in men. Pro12Ala and/or Ala12Ala polymorphism is twice more frequent in obese subjects comparing to non-obese ones (38 vs 19%).

Evaluation of sex hormone levels and some metabolic factors in men with coronary atherosclerosis

BACKGROUND

Because of the great controversy over the role of androgens in the pathogenesis of atherosclerosis, we investigated the relationship between serum sex hormone levels and angiographically confirmed coronary artery disease in men.

MATERIAL AND METHODS

We investigated 86 men aged 40-60 years, 56 with coronary artery disease and 30 healthy men, matched by age, as a control group. Body mass index and waist to hip ratio were calculated and total body fat mass and percentage of abdominal deposit were investigated by dual-energy X-ray absorptiometry (Dpx (+) Lunar, USA). The serum levels of sex hormones and insulin were measured using commercial radioimmunoassay and IRMA (by SHBG) kits (DPC, USA). The serum levels of lipids and glucose were assessed by means of enzymatic methods.

RESULTS

Men with coronary artery disease had lower total testosterone levels (17.01+/-6.42 vs. 19.37+/-6.58 nmol/l; p < 0.05), testosterone/estradiol ratio (228.5+/-88.5 vs. 289.8+/-120.1; p < 0.05) and free androgen index (FAI) (59.49+/-14.79 vs. 83.03+/-25.81; p < 0.0001), and higher levels of estrone (49.5+/-27.7 vs. 36.6+/-12.7 pg/ml) than men in the control group. Moreover, men with coronary artery disease were more insulin-resistant than controls and had an atherogenic lipid profile. There was an inverse correlation (p < 0.05) between testosterone level and serum level of glucose (r = -0.29), triglycerides (r= -0.37), body mass index (r= -0.55), waist (r = - 0.43), total body fat mass (r = - 0.3) and fasting insulin resistance index. A significant positive association (p < 0.05) was found between testosterone and the quantitative insulin sensitivity check index and high density lipoprotein cholesterol level in serum (r = 0.26).

CONCLUSIONS

Low levels of total testosterone, testosterone/estradiol ratio and free androgen index and higher levels of estrone in men with coronary artery disease appear together with many features of metabolic syndrome and may be involved in the pathogenesis of coronary atherosclerosis.

Serum lipid peroxides and total antioxidant status in postmenopausal women on hormone replacement therapy

Estradiol (E2) has antioxidant properties. The role of progestins in antioxidant defense is still unknown. We have evaluated the influence of E2 and E2 plus medroxyprogesterone acetate (MPA) on serum lipid peroxide (LPO) levels, a marker of free radical reactions, and serum total antioxidant status (TAS) in postmenopausal women. Subjects consisted of 26 women with surgical menopause, before and after 4 months of estrogen replacement therapy (ERT; E2), and 54 women with natural menopause on hormone replacement therapy (HRT; E2 plus MPA). Forty premenopausal women served as a control group. Serum E2 was estimated by radioimmunoassay, follicle-stimulating hormone by IRMA methods, LPO and TAS by colorimetric methods. Before therapy, LPO levels in the postmenopausal women were significantly higher (p < 0.001) than in the control group. After both ERT and HRT, LPO decreased significantly and did not differ between both groups and the control group. TAS was significantly lower in postmenopausal women (p < 0.001) than in the control group before therapy. After both ERT and HRT, TAS increased significantly and did not differ between both groups and the control group. We conclude that oxidative stress is increased after menopause. ERT and HRT inhibit the generation of free radicals and raise antioxidant potential to the levels found in premenopausal women. MPA did not influence the antioxidant action of E2.

[Is obesity associated with a polymorphism Pro12Ala and Pro115Gln in PPARgamma gene?]

Gene PPARgamma is one of the pivotal factors that influence adipocyte differentiation. It is transcriptional factor that plays a crucial role in the regulation of genes involved in lipid utilisation and storage as well as insulin action. The aim of this study was to evaluate whether PPARgamma Pro12Ala and Pro115Gln polymorphisms are connected with obesity and its anthropological parameters.

MATERIAL AND METHODS

we investigated 93 subjects: 72 women (37 non-obese and 35 obese) and 21 men (8 non-obese and 13 obese). We performed anthropological examination: BMI, WHR and total-body densitometry in the whole group. PPARg polymorphism was studied using PCR and RFLP.

RESULTS

Pro12Pro ("wild" type) variant was present in 57 subjects (32 obese and 25 non-obese): 45 women (26 obese and 19 non-obese) and 12 men (6 obese and 6 non-obese). Heterozygosity Pro12Ala was observed in 20 subjects (8 obese and 12 controls): 15 women (4 obese and 11 lean) and 5 men (4 obese). Homozygosity Ala12Ala was discovered in 16 subjects (8 obese and 8 controls): 12 women (5 obese and 7 non-obese) and 4 men (3 obese). Pro115Gln variant was not found in any of the studied subjects.

CONCLUSIONS

The frequency Ala allele (pro12Ala and Ala12Ala variant) was 28% in the whole group and 25% in the obese subjects. However the Pro12Ala polymorphism is quite common, it does not seem to be directly connected with onset of obesity. But it is interesting that the Ala allele is more frequent in non-obese women comparing to obese women (33 vs 20%). Reverse tendency was seen in men. Pro12Ala and/or Ala12Ala polymorphism is twice more frequent in obese subjects comparing to non-obese ones (38 vs 19%).

Dehydroepiandrosterone replacement in healthy men with age-related decline of DHEA-S: effects on fat distribution, insulin sensitivity and lipid metabolism

Many animal and human studies show that supraphysiological doses of dehydroepiandrosterone (DHEA) can influence body composition and carbohydrate and lipid metabolism. Most studies have concentrated on women and have not been randomized, thus creating controversial results. With this in mind, we designed a cross-over double-blind placebo-controlled study of 12 men aged 59.0 +/- 4.8 years, who received either 50 mg/24 h DHEA or placebo for 3 months to assess the influence of DHEA on the content and distribution of fat tissue and serum insulin, glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels, as well as testosterone, estradiol, DHEA-sulfate (S), prostate-specific antigen (PSA) concentrations and indexes of insulin sensitivity and resistance. Patients were recruited from university employees attending for periodic health checks, with normal hepatic and renal function with endogenous DHEA-S level < 1500 ng/dl. Our results did not reveal any significant changes in study parameters, apart from a statistically significant increase in DHEA-S levels after therapy with active substance.

Influence of dietary and genetic factors on metabolic status in obese and lean postmenopausal women

This preliminary study addressed the possible associations between dietary, genetic and hormonal factors that are involved in the development of menopausal obesity and its metabolic consequences. We performed anthropometrical, hormonal and biochemical measurements and used a nutritional questionnaire on 43 postmenopausal women who were non-HRT-users (14 obese and 29 non-obese subjects, mean age +/- SD of 52.8 +/- 4.6 years, mean body mass 74.6 +/- 4.6 kg). All of the women also had fat mass assessed by DPX-Lunar. From the 24-h dietary recall, the nutrient intake in daily food rations was calculated using a computer program (Nutritionist IV, San Bruno, CA, USA) based on our own database. Restriction fragment length polymorphism of the estrogen-receptor-alpha gene was determined with the PvuII restriction enzyme. Obese women widely under-reported their daily food intake. The analysis of body fat distribution showed that the total body weight and the percentage of total fat mass were significantly increased in the obese group (p = 0.001). We observed significantly higher leptin (20.56 +/- 11.9 vs. 9.02 +/- 2.8 ng/ml) and total cholesterol (but lower cholesterol HDL), triglycerides levels in the obese subjects (261.89 +/- 48.8 vs. 248.23 +/- 55.9; 52.17 +/- 13.6 vs. 60.92 +/- 13.04; 142.82 +/- 61.02 vs. 106.61 +/- 27.7 mg/dl). Except for diastolic blood pressure, clinical variables were not significantly different between subjects with and without the PvuII ERalpha polymorphism. Allele frequencies of the ERalpha polymorphism did not differ from those previously reported (P-0.48, p-0.52) in our study. In this preliminary study we failed to find dietary and genetic factors involved in the pathogenesis of menopausal obesity. However, our results provide support for the notion that the perimenopausal increase in visceral fat is a significant factor involved in the increased cardiovascular risk in postmenopausal women.

Serum leptin levels in acromegaly--a significant role for adipose tissue and fasting insulin/glucose ratio

BACKGROUND

Leptin plays an important role in controlling satiety and maintaining energy balance. Acromegaly is characterized by decreased fat, which increases after the disease is cured. Our objective was to investigate serum leptin in acromegaly in terms of disease activity, body fat content, insulin and glucose levels, and selected anthropometric variables.

MATERIAL/METHODS

We examined 40 patients with acromegaly and 20 sex- and age-matched controls for the levels of serum GH, IGF-I, leptin, glucose, and insulin, and for body composition by DEXA, BMI and WHR. In 10 cases the acute effect on serum leptin of a somatostatin analogue, lanreotide, was studied.

RESULTS

We observed lower leptin in patients with active acromegaly than in cured patients and controls. Body fat was higher in cured than active patients. In the patients, we found significant correlations (p<0.05) between leptin and percent body fat (r=0.77), leptin and body fat mass (r=0.74), leptin and fasting insulin (r=0.62), leptin and fasting insulin/glucose ratio (r=0.97), leptin and BMI (r=0.44), leptin and height (r=-0.47). In the controls there was a significant correlation (p<0.05) only between leptin and WHR (r=-0.45). A paradoxical decrease of the leptin level after lanreotide was observed in 7 out of 10 patients with active acromegaly.

CONCLUSIONS

Changes in leptin release in acromegaly are related to differences in body fat content and mass, and in insulin resistance. Leptin in acromegaly is not influenced directly by GH or IGF-I secretion. The acute effect of medical treatment of acromegaly by a somatostatin analogue on leptin levels differs from the effect of a radical cure following pituitary adenoma surgery.

Polish consensus: procedure in case of estrogen deficiency in women after breast cancer therapy

Women surviving breast cancer in the postmenopausal period suffer from hormonal alternations with adverse effect on mental status and functioning of a number of organs and systems. Two thirds of these women had menopause before the diagnosis of breast cancer. In the remaining one-third ovarian failure is natural or induced by chemotherapy. Doctors cautiously approach the use of estrogen therapy in this group of patients. Their fears are not unsupported bearing in mind known epidemiological data exist linking breast cancer with the use of hormonal therapy. The purpose of this review is to evaluate current data on hormonal use and breast cancer risk.

Acromegaly due to GHRH-secreting large bronchial carcinoid. Complete recovery following tumor surgery

A case of acromegaly, secondary to GHRH secretion by a large bronchial carcinoid is reported. A 61-year-old woman presented with typical symptoms and signs of acromegaly for at least 10 years. She suffered from recurrent pneumonias, but repeated chest X-ray examinations failed to demonstrate the bronchial tumor. The diagnosis was confirmed by elevated GH, IGF-1 and GHRH secretion. We have shown an enlarged pituitary gland without focal lesions together with a cerebral meningioma on MRI and the presence of a bronchial carcinoid tumor. The latter was confirmed by histology carried out after bronchoscopy and tumor excision. We observed partial suppression of GH secretion following short-term oral bromocriptine administration in this patient. Surgical removal of the carcinoid tumor resulted in a complete clinical, hormonal and radiological cure of acromegaly. This case of acromegaly due to ectopic GHRH secretion by bronchial carcinoid differs from others described in the literature by an atypical large tumor size, the suppression of elevated GH secretion by oral bromocriptine and a concomitant meningioma.

Quantitative ultrasound of the heel and some parameters of bone turnover in patients with acromegaly

Acromegaly caused by growth hormone (GH) hypersecretion is characterized by enhanced skeletal growth and soft tissue enlargement. Insulin-like growth factor-1 (IGF-1) is the main peripheral mediator of GH action and it has a crucial role in the maintenance of a normal bone mass. However, in some patients with acromegaly, secondary osteoporosis is observed, despite the strong anabolic effect of GH and IGF-1 in bones. It is thought to be due to hypogonadism. The bone changes are accompanied by increased turnover. The aim of this study was to assess bone properties by ultrasound and turnover in patients with acromegaly. The study was carried out in 26 patients (13 men, 13 women): 14 with active acromegaly and 12 cured by surgery who had non-active disease. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and their combination Stiffness Index (SI) by quantitative ultrasound (QUS) of the heel, hormonal status, serum osteocalcin (OC) concentration and the urinary excretion of pyridinoline collagen crosslinks (PYR) were all studied. Controls were 20 age- and sex-matched healthy persons. We observed statistically significantly lower QUS values in patients with active disease than in those whose disease was cured. The differences were more pronounced in men. QUS values were lower in the entire group of patients compared with the controls; however, the differences were not statistically significant. Serum OC concentrations and urinary PYR excretion were higher in active disease. Statistically significant inverse correlations between serum GH levels and SOS (r = -0.58, p = 0.002); BUA (r = -0.66; p = 0.0001); T-score (r = -0,65, p = 0.0001) and Z-score (r = -0.66, p = 0.0001) were found only in male patients. No correlations between IGF-1, duration of the disease, OC, PYR and other data studied were observed. In conclusion, we have shown decreased QUS parameters suggesting impaired bone properties and quality in terms of density and elasticity in men, but not in women, with active acromegaly. This finding suggests osteoporosis with increased bone turnover. The above-mentioned changes might be caused by the action of GH on trabecular bone and its metabolism, since no hypogonadism in male patients was shown. Moreover, the influence of acromegaly on heel geometry and soft tissue swelling should also be considered.

Menopausal obesity--myth or fact?

Obesity, particularly with central fat distribution, and mortality from all causes are directly related in middle-aged women. Many studies have shown that women in their mid-life tend to gain weight, with a shift to visceral fat distribution. The etiology of perimenopausal obesity is not fully known, and it remains unclear whether excessive weight gain and changes in fat distribution at menopausal age result from climacteric changes or are related to the process of aging of the individual and/or to changing life-style factors. Obesity may have a genetic background. It is well established that an excessive amount of energy intake and too small an energy expenditure is crucial for the development of obesity. Diet composition also plays a role in the pathogenesis of obesity. Neuropeptides appear to be one of the factors that control food intake and nutrient balance. The aging process in women is associated with progressive declines in the levels of many hormones including estrogens, dehydroepiandrosterone (DHEA) and growth hormone-insulin-like growth factor I (GH-IGF-I). These endocrine perturbations may result in altered body composition and weight gain. Obesity in postmenopausal women is accompanied by many metabolic disturbances leading to increased mortality.

Serum lipid peroxide levels and erythrocyte glutathione peroxidase and superoxide dismutase activity in premenopausal and postmenopausal women

Free radical reactions are involved in processes connected with aging. Estradiol acts as antioxidant and free radical scavenger, but the mechanism of this action remains unknown. Estradiol has a hydroxyphenolic structure and may donate hydrogen atoms to lipid peroxyradicals to terminate chain reactions. There are a few reports concerning the influence of estradiol on natural antioxidant enzyme activity, such as superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT). The aim of this study was to estimate the relationship between the levels of estradiol and lipid peroxide (LPO), a marker of membrane lipid peroxidation, and the correlation between estradiol and erythrocyte SOD and GSH-Px activity. The study included 13 premenopausal and 13 postmenopausal healthy women. Serum levels of estradiol, follicle-stimulating hormone (FSH) and LPO, and erythrocyte SOD and GSH-Px activity were estimated in all subjects. Premenopausal women revealed significantly higher estradiol levels and lower LPO concentrations, as well as significantly higher GSH-Px activity than the postmenopausal group. SOD activity did not differ between the two groups. There was a negative correlation between serum estradiol and LPO levels as well as a positive correlation between estradiol and GSH-Px activity. These results support the hypothesis that estradiol exerts its antioxidant action not only through its chemical structure but probably also through its influence on natural cellular antioxidant enzyme activity.

Coexistence of parathyroid carcinoma and non-medullary carcinoma of the thyroid

A case of 35-year-old woman with parathyroid cancer is presented. Five years ago she underwent surgery for follicular thyroid cancer. Parathyroid cancer was evidenced by palpable, solid, irregularly shaped cervical tumor 5 cm in diameter. The patient had severe hyperparathyroidism confirmed by biochemical findings of hypercalcemia reaching 16 mg%, hypophosphatemia and hyperphosphatasemia. Serum parathormone level was 23-fold higher than the norm. These findings were accompanied by polyuria, polidypsia, symptoms of bone damage and renal calcification. After the surgery the patient's condition improved significantly despite persistent hyperparathyroidism. The level of parathormone decreased, but was still 11 times higher than the norm. Two months after the surgery she noticed a single node on her neck. The patient was re-operated for recurrence of parathyroid cancer. Serum parathormone level was then 6-8 times above the norm. Medical treatment with furosemide, calcitonin and biphosphonate resulted in normalization of calcemia and phosphatemia. Further management will aim at localization of foci of hyperactive parathyroid tissue in order to enable radical reoperation. The case is reported because of rare occurrence of parathyroid carcinoma as well as because the carcinoma occurred in a patient who previously had follicular thyroid cancer. There are no reports of coexistence of these two neoplasms in available literature.

[Characteristic features of primary hyperparathyroidism caused by parathyroid cancer--based on 2 cases]

Two cases of women with primary hyperparathyroidism caused by parathyroid cancer were presented. The authors noticed the following characteristic features of primary hyperparathyroidism in the course of the cancer: rich clinical symptomatology usually in form of considerable bone destruction, renal stones and nephrocalcinosis, biochemically very high level of calcium, above 14-16 mg%, threatening with hypercalcemic crisis and considerably higher parathormone serum concentration even up to twenty times above the norm. Parathyroid cancer, more often than adenoma, is a stiff and large neck tumour accessible for palpation. There are no specific biochemical and imagining examination techniques to recognise beyond any doubt the cancer character of primary hyperparathyroidism before operation. The histopathological diagnosis of this cancer is difficult and is not usually done intraoperatively. The recurrences of the malignancy are typical and they require reoperations after stating places of relapse or metastases.

Modified dexamethasone and gonadotropin-releasing hormone agonist (Dx-GnRHa) test in the evaluation of androgen source(s) in hirsute women

INTRODUCTION

Polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia (COH) are heterogeneous disorders, in which excess of androgens may be caused by improper function of ovaries and/or adrenals. In many cases an overlap between ovarian and adrenal type of functional hyperandrogenism has been observed. The relationship between adrenal and ovarian metabolism in hyperandrogenic women is not totally known and etiologic diagnosis of female hyperandrogenism is often difficult. The aim of the present study was to evaluate the usefulness of combined Dexamethasone-Triptoreline testing in distinguishing ovarian and adrenal type of functional hyperandrogenism, and checking if the test could be shortened in order to economise it.

MATERIALS AND METHODS

We have examined 57 women with androgen excess divided into two groups: ovarian (n = 42) and adrenal (n = 15) and 20 women with idiopathic hirsutism. There was also one patient suffering from Morris syndrome taken under examination just for curiosity. The blood for hormonal assay was taken in baseline conditions at 8.00 a.m. for LH, FSH, PRL, cortisol, T, DHEAS, 17OHP, E2. Dx was given for 4 days 0.5 mg p.o. every 6 hours. 8 hours after the last Dx administration, the blood was taken for 17OHP and T. Immediately after that Triptorelin 100 mg was given s.c. Then the blood was collected every 4 hours during 24 hours for 17OHP estimation.

RESULTS

Decrease in T levels (from 1.65 +/- 0.52 to 0.73 +/- 0.25 ng/ml) after Dexamethasone administration was observed in adrenal group, which indicates adrenal glands as a source of excessive androgen production. No significant differences were seen in ovarian group. But in women from ovarian group supranormal 17OHP response after Triptoreline administration was seen: (ng/ml): at 8.00 am-0.68 +/- 0.44, 12.00--1.21 +/- 0.7*, 16.00--1.71 +/- 1.19*, 20.00--2.39 +/- 1.81*, 24.00--3.41 +/- 2.64*, 4.00--3.91 +/- 2.82*, 8.00--6.06 +/- 2.43* (*p < 0.01, **p < 0.001). Such a response is typical for women with well defined PCOS and other forms of functional ovarian hyperandrogenism and indicates ovary as a source of androgens. Significant differences were also noticed in idiopathic group: 8.00--0.31 +/- 0.09, 12.00--0.38 +/- 0.17, 16.00--1.41 +/- 0.62*, 20.00--1.52 +/- 0.97*, 24.00--1.89 +/- 0.83*, 4.00--2.17 +/- 0.83*, 8.00--1.83 +/- 0.71** (*p < 0.01). 17OHP levels did not change significantly during the whole test in adrenal group: 8.00--1.83 +/- 1.24, 12.00--1.91 +/- 1.37, 16.00--1.95 +/- 0.86, 20.00--2.19 +/- 0.93, 24.00--2.63 +/- 1.58, 4.00--2.56 +/- 1.78, 8.00--237 +/- 0.94. But patients from this group had exaggerated 17OHP response to ACTH (from 4.32 +/- 1.31 to 15.34 +/- 4.1 ng/ml). In patient suffering from Morris syndrome, after Triptoreline, serum 17OHP levels reminded on the same level as they were before drug administration.

CONCLUSIONS

Combined Dx-Triptorelin test can be very useful to distinguish ovarian and adrenal type of functional hyperandrogenism. The number of times of blood collection for 17OHP can be reduced to 4 times a day (during 24 hours): at 8.00, 20.00, 24.00, 8.00.