Pseudohypoparathyroidism type 1A is a rare endocrine disorder caused by GNAS mutation and the resulting hormone resistance at the receptor level, i.e. the activation of the intracellular pathway of the Gs alpha subunit is not possible. This disorder is most often characterized by resistance to the parathyroid hormone. However, it can also be characterized by resistance to other hormones, such as thyroid-stimulating hormone, gonadotropins (luteinizing and follicle-stimulating hormones), growth hormone-releasing hormone, and calcitonin. In this article, we describe the case of a patient diagnosed with pseudohypoparathyroidism based on phenotypic features of hereditary Albright osteodystrophy. Due to the progressive decline in intellectual functions and changing behavior, neurological examination confirmed calcifications of the CNS as part of Fahr's syndrome. During hospitalization, higher levels of thyroid-stimulating hormone and calcitonin were observed, probably as a result of resistance at the level of the receptor and its intracellular pathway. Hypercalcitoninemia occurs sporadically in cases involving pseudohypoparathyroidism type 1-a and type 1-b. Elevated levels of calcitonin should be evaluated by means of anamnesis and clinical examination involving morphological and functional tests, considering that a highly specific tumor is a marker of medullary carcinoma of the thyroid gland, as well as some neuroendocrine tumors. Some authors recommend fine needle aspiration biopsy in order to minimize the risk of medullary thyroid cancer.
{"title":"Calcitonin values in pseudohypoparathyroidism","authors":"Bojan Marković, Sanja Klet, Mirjana Stojković, Tamara Janić, Biljana Nedeljković-Beleslin, Jasmina Ćirić, Miloš Žarković","doi":"10.5937/mgiszm2390065m","DOIUrl":"https://doi.org/10.5937/mgiszm2390065m","url":null,"abstract":"Pseudohypoparathyroidism type 1A is a rare endocrine disorder caused by GNAS mutation and the resulting hormone resistance at the receptor level, i.e. the activation of the intracellular pathway of the Gs alpha subunit is not possible. This disorder is most often characterized by resistance to the parathyroid hormone. However, it can also be characterized by resistance to other hormones, such as thyroid-stimulating hormone, gonadotropins (luteinizing and follicle-stimulating hormones), growth hormone-releasing hormone, and calcitonin. In this article, we describe the case of a patient diagnosed with pseudohypoparathyroidism based on phenotypic features of hereditary Albright osteodystrophy. Due to the progressive decline in intellectual functions and changing behavior, neurological examination confirmed calcifications of the CNS as part of Fahr's syndrome. During hospitalization, higher levels of thyroid-stimulating hormone and calcitonin were observed, probably as a result of resistance at the level of the receptor and its intracellular pathway. Hypercalcitoninemia occurs sporadically in cases involving pseudohypoparathyroidism type 1-a and type 1-b. Elevated levels of calcitonin should be evaluated by means of anamnesis and clinical examination involving morphological and functional tests, considering that a highly specific tumor is a marker of medullary carcinoma of the thyroid gland, as well as some neuroendocrine tumors. Some authors recommend fine needle aspiration biopsy in order to minimize the risk of medullary thyroid cancer.","PeriodicalId":31570,"journal":{"name":"Medicinski Glasnik Specijalne Bolnice za Bolesti Stitaste Zlezde i Bolesti Metabolizma Zlatibor","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135843064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Polyphenols represent one of the biggest and most widespread groups of secondary plant metabolites with more than 8000 polyphenolic compounds. Fruits, vegetables and beverages such as tea and red wine are the main sources of polyphenols. A significant number of studies indicate the ability of certain polyphenols to delay the development of atherosclerosis. According to the same polyphenols reduce lipid deposition, oxidative stress, inflammation of the blood vessel wall, proliferation of vascular smooth muscle cells and endothelial dysfunction. The widespread use of polyphenols requires further research on bioavailability, absorption and transformation. It is necessary to determine the effect of individual polyphenols as well as the interaction with other bioactive compounds, define the dietary reference intake and the safety of use in certain subpopulations.
{"title":"The influence of polyphenols on atherosclerosis development","authors":"Marijana Jandrić-Kočič","doi":"10.5937/mgiszm2390045j","DOIUrl":"https://doi.org/10.5937/mgiszm2390045j","url":null,"abstract":"Polyphenols represent one of the biggest and most widespread groups of secondary plant metabolites with more than 8000 polyphenolic compounds. Fruits, vegetables and beverages such as tea and red wine are the main sources of polyphenols. A significant number of studies indicate the ability of certain polyphenols to delay the development of atherosclerosis. According to the same polyphenols reduce lipid deposition, oxidative stress, inflammation of the blood vessel wall, proliferation of vascular smooth muscle cells and endothelial dysfunction. The widespread use of polyphenols requires further research on bioavailability, absorption and transformation. It is necessary to determine the effect of individual polyphenols as well as the interaction with other bioactive compounds, define the dietary reference intake and the safety of use in certain subpopulations.","PeriodicalId":31570,"journal":{"name":"Medicinski Glasnik Specijalne Bolnice za Bolesti Stitaste Zlezde i Bolesti Metabolizma Zlatibor","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135843067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Graves orbitopathy is the most common extrathyroidal manifestation of autoimmune hyperthyroidism, although it can rarely occur in euthyroid and hypothyroid patients. TSH-receptor antibodies and insulin-like growth factor-1 play a significant role in the pathogenesis of orbitopathy, and orbital fibroblasts are the central site of their action. In addition to the mentioned autoantibodies, T and B lymphocytes, as well as various cytokines, participate in this complex immune process. As the final product of this immune cascade, there is proliferation of fibroblasts, secretion of glycosaminoglycans, differentiation of fibroblasts into myofibroblasts and adipocytes, which is responsible for the appearance of the clinical presentation of orbitopathy. Before starting the therapy, it is necessary to perform a clinical assessment of orbitopathy, which is based on an assessment of the activity and severity of the disease, as well as an assessment of the patient's quality of life. The activity of orbitopathy is assessed based on the clinical activity score. For the severity of the disease the NOSPECS classification, and for the quality of life assessment the specific questionnaire of the European Group for Graves' Orbitopathy can be used. Based on the obtained data, orbitopathy is classified as active/inactive, mild/moderate-to-severe/severe. Treatment of Graves orbitopathy can be specific or supportive. The specific treatment will depend on the degree of clinical activity and severity of the disease, and the degree of impaired quality of life is taken as an additional factor when choosing individual therapy. Intravenous glucocorticoids are the most frequently used first-line therapy for active, moderate-to-severe Graves' orbitopathy, however, a certain number of patients respond poorly to the applied therapy. In such patients, the use of a second line of treatment is indicated. The most commonly used second line of therapy in our country for active, moderate-to-severe glucocorticoid-resistant GO is tocilizumab. We presented a patient with autoimmune thyroid disease who presented with primary hypothyroidism, in whom, despite the use of intravenous glucocorticoids on two occasions, maintained active, moderateto-severe orbitopathy, and therefore the treatment was continued with biological therapy (tocilizumab). A significant beneficial therapeutic effect was achieved with the applied therapy.
{"title":"Steroid-resistant Graves' orbitopathy: Therapeutic options","authors":"Sanja Klet, Bojan Marković, Tamara Janić, Mirjana Stojković, Jasmina Ćirić, Biljana Nedeljković-Beleslin, Miloš Žarković","doi":"10.5937/mgiszm2390078k","DOIUrl":"https://doi.org/10.5937/mgiszm2390078k","url":null,"abstract":"Graves orbitopathy is the most common extrathyroidal manifestation of autoimmune hyperthyroidism, although it can rarely occur in euthyroid and hypothyroid patients. TSH-receptor antibodies and insulin-like growth factor-1 play a significant role in the pathogenesis of orbitopathy, and orbital fibroblasts are the central site of their action. In addition to the mentioned autoantibodies, T and B lymphocytes, as well as various cytokines, participate in this complex immune process. As the final product of this immune cascade, there is proliferation of fibroblasts, secretion of glycosaminoglycans, differentiation of fibroblasts into myofibroblasts and adipocytes, which is responsible for the appearance of the clinical presentation of orbitopathy. Before starting the therapy, it is necessary to perform a clinical assessment of orbitopathy, which is based on an assessment of the activity and severity of the disease, as well as an assessment of the patient's quality of life. The activity of orbitopathy is assessed based on the clinical activity score. For the severity of the disease the NOSPECS classification, and for the quality of life assessment the specific questionnaire of the European Group for Graves' Orbitopathy can be used. Based on the obtained data, orbitopathy is classified as active/inactive, mild/moderate-to-severe/severe. Treatment of Graves orbitopathy can be specific or supportive. The specific treatment will depend on the degree of clinical activity and severity of the disease, and the degree of impaired quality of life is taken as an additional factor when choosing individual therapy. Intravenous glucocorticoids are the most frequently used first-line therapy for active, moderate-to-severe Graves' orbitopathy, however, a certain number of patients respond poorly to the applied therapy. In such patients, the use of a second line of treatment is indicated. The most commonly used second line of therapy in our country for active, moderate-to-severe glucocorticoid-resistant GO is tocilizumab. We presented a patient with autoimmune thyroid disease who presented with primary hypothyroidism, in whom, despite the use of intravenous glucocorticoids on two occasions, maintained active, moderateto-severe orbitopathy, and therefore the treatment was continued with biological therapy (tocilizumab). A significant beneficial therapeutic effect was achieved with the applied therapy.","PeriodicalId":31570,"journal":{"name":"Medicinski Glasnik Specijalne Bolnice za Bolesti Stitaste Zlezde i Bolesti Metabolizma Zlatibor","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135843059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adherence of patients to antihypertensive drugs refers to the extent to which their taking corresponds with agreed recommendations from a health care provider. The goal was to measure adherence and examine the association with socio-demographic and medication status variables. A cross-sectional pilot study was conducted with 120 respondents, aged ≥ 18 years, who are being treated for hypertension and who visited the ambulance of family physician at Primary Health Care Centre Cetinje in April and May 2022. A questionnaire with socio-demographic and medication status and the Hill-Bone scale was used. Adherence was categorized as good (≥ 80%) and worse (< 80%). The age of respondents was 64,6 ± 9,28. The majority were female, married, with a high school diploma, retired and treated for hypertension for ≥ 11 years. The total number of drugs in regular therapy was 6,1 ± 2,85 and antihypertensive 2,24 ± 0,85. 14,2% of respondents suspected the side effects of antihypertensive drugs and the majority participate in their costs. The number of points on the Hill-Bone scale was 10,04 ± 1,90 and 95% of respondents had good adherence. Of all the variables, a statistically significant association was found only for participation in the costs of antihypertensive drugs. The obtained results support the view that patients' personal beliefs about the necessity of taking therapy and the concerns of side effects are better predictors of adherence than other factors.
{"title":"Adherence of patients to antihypertensive drugs in the ambulance of family physician at Primary Health Care Centre Cetinje","authors":"Mitar Popović","doi":"10.5937/mgiszm2390007p","DOIUrl":"https://doi.org/10.5937/mgiszm2390007p","url":null,"abstract":"Adherence of patients to antihypertensive drugs refers to the extent to which their taking corresponds with agreed recommendations from a health care provider. The goal was to measure adherence and examine the association with socio-demographic and medication status variables. A cross-sectional pilot study was conducted with 120 respondents, aged ≥ 18 years, who are being treated for hypertension and who visited the ambulance of family physician at Primary Health Care Centre Cetinje in April and May 2022. A questionnaire with socio-demographic and medication status and the Hill-Bone scale was used. Adherence was categorized as good (≥ 80%) and worse (< 80%). The age of respondents was 64,6 ± 9,28. The majority were female, married, with a high school diploma, retired and treated for hypertension for ≥ 11 years. The total number of drugs in regular therapy was 6,1 ± 2,85 and antihypertensive 2,24 ± 0,85. 14,2% of respondents suspected the side effects of antihypertensive drugs and the majority participate in their costs. The number of points on the Hill-Bone scale was 10,04 ± 1,90 and 95% of respondents had good adherence. Of all the variables, a statistically significant association was found only for participation in the costs of antihypertensive drugs. The obtained results support the view that patients' personal beliefs about the necessity of taking therapy and the concerns of side effects are better predictors of adherence than other factors.","PeriodicalId":31570,"journal":{"name":"Medicinski Glasnik Specijalne Bolnice za Bolesti Stitaste Zlezde i Bolesti Metabolizma Zlatibor","volume":"285 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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