Background: In this paper the authors summarise the primary malignant thyroid tumors (p.m.t.t.) i... more Background: In this paper the authors summarise the primary malignant thyroid tumors (p.m.t.t.) incidence data from their centre over the period 1984-2005. The results are explained in the context of the p.m.t.t. incidence data from the National Cancer Register (1996 2002). Methods and results: Overall, 6434 thyroid operations were indicated and carried out during the sampling period at the authors' institution, of which 365 cases were histologically confirmed p.m.t.t. (5.7% of all histological findings). Specifically, p.m.t.t. were diagnosed in 295 women (80.8%) and 70 men (19.2%), with the most frequent occurrence in the 5th decade and a higher recent incidence in younger age groups. Whereas follicular thyroid carcinomas predominated in the 1984-1989 period (24 cases or 66.7%), the papillary thyroid carcinoma was the most frequent type in 1990-1997 and 1998-2005: 70 (61.4%) and 160 (74.4%) cases respectively. In the context of the national incidence, the authors' institution increasingly contributes to the diagnosis of p.m.t.t. in Slovakia (8.9% in 1996 vs. 13.9% in 2002). However, neither the progress in diagnostic methods nor the capacity expansion for patient examination can explain the increasing incidence of the p.m.t.t. (3.9/10(6) in 1996 vs. 5.6/10(6) in 2002 in women and 1.3/10(6) in 1996 vs. 1.7/10(6) in 2002 in men, respectively). Conclusions: It remains to be explained why there are significant differences in p.m.t.t. incidence among individual counties. For example, in county Trnava 0.6/10(6) in men in 1996 vs. 1.5/10(6) in 2002; in county Presov 1.2/10(6) in 1996 vs. 2.4/10(6) in 2002. Similarly, in women in county Trnava 3.6/10(6) in 1996 vs. 5.6/10(6) in 2002 and in county Presov 5.4/10(6) in 1996 vs. 8.4/10(6) in 2002. As far as the districts of Slovakia are concerned, data relative to the male population in 2002 indicate zero incidence in 42 out of 79 districts, with the highest incidence (15.9/10(6)) recorded in Svidnik. Likewise, data relative to the female population in 2002 indicate zero incidence in 15 out of 79 districts, with the highest incidence (26.5/10(6)) in Stropkov. These differences call for further (radio)epidemiological, geographical and genetic evaluation.
Background: External root resorption is an irreversible loss of dental hard tissue as a result of... more Background: External root resorption is an irreversible loss of dental hard tissue as a result of odontoclastic action. Multiple external cervical root resorptions in permanent teeth are rare. The exact cause of external cervical root resorption is unclear. It is currently well established that RANK/RANKL signaling is essential for osteoclastogenesis and osteoclast-mediated bone resorption. Denosumab is an anti-RANKL antibody used for the treatment of postmenopausal osteoporosis. RANK/RANKL pathway suppression by denosumab is expected to suppress the activity of clastic cells responsible for hard tissue resorption involving both osteoclasts and odontoclasts. Case presentation: This case report demonstrates aggressive and generalized idiopathic external cervical root resorption that started and advanced during ongoing antiresorptive therapy with the human monoclonal RANKLblocking antibody denosumab without discontinuation of therapy in a 74-year-old female patient treated for postmenopausal osteoporosis. The extent of resorptive defects was too large and progressively led to fractures of the teeth. The number of teeth involved and the extend of destruction excluded conservative treatment. The affected teeth had to be extracted for functional prosthetic reconstruction. This finding suggests that treatment with denosumab may be associated with severe and aggressive odontoclastic resorption of multiple dental roots despite an adequate inhibitory effect on osteoclasts in the treatment of osteoporosis. The RANKL-independent pathways of clastic cell formation are likely to be involved in this pathological process.
Recent studies suggest an important role for the skeletal endocannabinoid system in the regulatio... more Recent studies suggest an important role for the skeletal endocannabinoid system in the regulation of bone mass in both physiological and pathological conditions. Both major endocannabinoids (anandamid and 2-arachidonoylglycerol), endocannabinoid receptors - CB1-receptor (CB1R) a CB2-receptor (CB2R) and the endocannabinoid metabolizing enzymes are present or expressed in osteoblasts and osteoclasts. Previous studies identified multiple risk and protective variants of CNR2 gene dealing with the relationship to bone density and/or osteoporosis. Selective CB1R/ CB2R-inverse agonists/antagonists and CB2R-inverse agonists/antagonists are candidates for prevention of bone mass loss and combined antiresorptive and anabolic therapy for osteoporosis.Key words: cannabinoid receptors - endocannabinoids - marijuana - osteoporosis.
Parathyroid cancer is a rare endocrine malignancy, representing less than 1 % of all cases of pri... more Parathyroid cancer is a rare endocrine malignancy, representing less than 1 % of all cases of primary hyperparathyroidism. The exact etiology of the disease remains unknown. Known risk factors include neck irradiation, end stage renal failure, genetic factors, particularly the the HPRT2/CDCT73 gene mutation. The clinical picture is often indolent, yet progressive with a trend of local invasion and metastasis formation in advanced disease. The clinical picture includes symptoms of severe and resistant hypercalcemia, requiring intensive therapy often with the need of dialysis. Radical surgery is the mainstay of the parathyroid cancer treatment. Chemotherapy and radiotherapy are generally ineffective. An early and correct diagnosis of parathyroid carcinoma significantly influences both morbidity and mortality.Key words: diagnosis - hyperparathyroidism - parathyroid cancer - treatment.
The Journal of Clinical Endocrinology and Metabolism, Jul 1, 2010
A 25-yr-old man presented with headache, visual distur- bance, excessive perspiration, and progre... more A 25-yr-old man presented with headache, visual distur- bance, excessive perspiration, and progressive asymptomatic skin changes on the scalp for more than 8 yr. The physical examination showed multiple folds and furrows in the parietal region, with anterior to posterior direction, that could not been corrected by pressure or traction (Fig. , arrowheads). This finding was conclusive with the clinical diagnosis of cutis verticis gyrata (CVG), a condition of excessive growth of the scalp skin with cerebriform or gyrate formations. CVG is classified into a primary form, in which no other abnormalities are found, and a secondary form that accompanies mental deficiency,microcephaly,nevoidabnormalities,systemicdiseases, or a combination of these. Based on the other physical examination findings, acromegaly was suspected and was confirmed by laboratory tests. Magnetic resonance imaging study showed pituitary macroadenoma (Fig. , arrow). Acromegaly is only rarely an underlying cause of CVG, but it may be found in cases of extremely pronounced scalp changes or in a long-lasting course of the disease (1-3).
Objective Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parame... more Objective Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters. Purpose The aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters. Methods We prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry. Results Acromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly p...
Objective. Median neuropathy is a common manifestation of acromegaly, although its pathology is u... more Objective. Median neuropathy is a common manifestation of acromegaly, although its pathology is uncertain. Changes in levels of growth hormone (GH) and insulin-like growth factor I (IGF-I) and body composition are potential parameters in pathology of median neuropathy in acromegaly. We aimed to assess changes in the cross-sectional area (CSA) of the median nerve and body composition in newly diagnosed acromegalic patients 1 year after treatment and to determine their mutual relationships. Design. This prospective study included 30 patients with newly diagnosed acromegaly and 30 healthy controls matched for age, gender, and body mass index. Physical and laboratory examinations, dual-energy X-ray absorptiometry (DXA), and ultrasound evaluations were performed at baseline and 1 year after initial treatment. Results. The CSA of the median nerve was increased in acromegalic patients compared with controls (13.1 mm2 [12.2–14.9] vs 7.5 mm2 [6.4–8.4], P < 0.001 ). One year after treatmen...
Acromegaly is a rare disorder with an incidence rate of 3-4 patients per million per year . Kline... more Acromegaly is a rare disorder with an incidence rate of 3-4 patients per million per year . Klinefelter syndrome (KS) is the most common sex chromosome disorder, occurring in about 1/500 live male births . The coincidence of multiple endocrinopathies is rare but possible. We report the case of a 33-year-old man diagnosed with both of those rare conditions -acromegaly and 47, XXY Klinefelter syndrome. The patient was admitted to the Endocrinology Department of the National Institute of Endocrinology and Diabetology in Ľubochňa with clinical manifestation of acromegaly. He had a tall stature (body height 195 cm, weight 90 kg) and enlarged acral parts of the body (including enlargement of hands, feet, facial bones, nose, and tongue with wider spaces between his teeth). He suffered from headache, excessive sweating, and arthralgia. Presence of infertility with reduced facial and pubic hair and small, firm testes could not be explained by the diagnosis of acromegaly. Laboratory tests revealed high level of growth hormone (GH) not suppressed after glucose administration, high level of insulin like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP3), and low testosterone concentration with high concentration of luteinizing hormone (LH) and follicle stimulating hormone (FSH) (Tab. 1). Magnetic resonance imaging scan showed a 25 × 18 × 18 mm macroadenoma of the pituitary gland with dominant cystoid component, with dedifferentiation of adenohypophysis and neurohypophysis tissue and deviation of the infundibulum to the left. There was no compression of the optic chiasm (Fig. ). Diagnosis of acromegaly was established. Perimetry test, abdominal ultrasound, and echocardiography ruled out visual field defects, hepatomegaly, and cardiomyopathy, respectively. Subsequently, transsphenoidal resection of the pituitary
Akromegália je zriedkavé, chronické, progresívne ochorenie vznikajúce najčastejšie na podklade ad... more Akromegália je zriedkavé, chronické, progresívne ochorenie vznikajúce najčastejšie na podklade adenómu hypofýzy. V dôsledku dlhodobej elevácie rastového hormónu (RH) a inzulínu podobného rastového faktora 1 (IGF-1) pri tomto ochorení dochádza k rozvoju reumatologických, kardiovaskulárnych, pľúcnych a metabolických komplikácií. Kardiovaskulárne ochorenia sú hlavnou príčinou morbidity a mortality u pacientov s akromegáliou. Medzi kardiovaskulárne komplikácie akromegálie patrí artériová hypertenzia, kardiomyopatia, poruchy srdcového rytmu, chlopňové chyby ako aj endotelová dysfunkcia. Diagnóza akromegálie býva oneskorená aj niekoľko rokov v dôsledku pomalej progresie príznakov. Včasná diagnostika a liečba ochorenia je nevyhnutná na odvrátenie chronického kardiovaskulárneho poškodenia.
Background: In this paper the authors summarise the primary malignant thyroid tumors (p.m.t.t.) i... more Background: In this paper the authors summarise the primary malignant thyroid tumors (p.m.t.t.) incidence data from their centre over the period 1984-2005. The results are explained in the context of the p.m.t.t. incidence data from the National Cancer Register (1996 2002). Methods and results: Overall, 6434 thyroid operations were indicated and carried out during the sampling period at the authors' institution, of which 365 cases were histologically confirmed p.m.t.t. (5.7% of all histological findings). Specifically, p.m.t.t. were diagnosed in 295 women (80.8%) and 70 men (19.2%), with the most frequent occurrence in the 5th decade and a higher recent incidence in younger age groups. Whereas follicular thyroid carcinomas predominated in the 1984-1989 period (24 cases or 66.7%), the papillary thyroid carcinoma was the most frequent type in 1990-1997 and 1998-2005: 70 (61.4%) and 160 (74.4%) cases respectively. In the context of the national incidence, the authors' institution increasingly contributes to the diagnosis of p.m.t.t. in Slovakia (8.9% in 1996 vs. 13.9% in 2002). However, neither the progress in diagnostic methods nor the capacity expansion for patient examination can explain the increasing incidence of the p.m.t.t. (3.9/10(6) in 1996 vs. 5.6/10(6) in 2002 in women and 1.3/10(6) in 1996 vs. 1.7/10(6) in 2002 in men, respectively). Conclusions: It remains to be explained why there are significant differences in p.m.t.t. incidence among individual counties. For example, in county Trnava 0.6/10(6) in men in 1996 vs. 1.5/10(6) in 2002; in county Presov 1.2/10(6) in 1996 vs. 2.4/10(6) in 2002. Similarly, in women in county Trnava 3.6/10(6) in 1996 vs. 5.6/10(6) in 2002 and in county Presov 5.4/10(6) in 1996 vs. 8.4/10(6) in 2002. As far as the districts of Slovakia are concerned, data relative to the male population in 2002 indicate zero incidence in 42 out of 79 districts, with the highest incidence (15.9/10(6)) recorded in Svidnik. Likewise, data relative to the female population in 2002 indicate zero incidence in 15 out of 79 districts, with the highest incidence (26.5/10(6)) in Stropkov. These differences call for further (radio)epidemiological, geographical and genetic evaluation.
Background: External root resorption is an irreversible loss of dental hard tissue as a result of... more Background: External root resorption is an irreversible loss of dental hard tissue as a result of odontoclastic action. Multiple external cervical root resorptions in permanent teeth are rare. The exact cause of external cervical root resorption is unclear. It is currently well established that RANK/RANKL signaling is essential for osteoclastogenesis and osteoclast-mediated bone resorption. Denosumab is an anti-RANKL antibody used for the treatment of postmenopausal osteoporosis. RANK/RANKL pathway suppression by denosumab is expected to suppress the activity of clastic cells responsible for hard tissue resorption involving both osteoclasts and odontoclasts. Case presentation: This case report demonstrates aggressive and generalized idiopathic external cervical root resorption that started and advanced during ongoing antiresorptive therapy with the human monoclonal RANKLblocking antibody denosumab without discontinuation of therapy in a 74-year-old female patient treated for postmenopausal osteoporosis. The extent of resorptive defects was too large and progressively led to fractures of the teeth. The number of teeth involved and the extend of destruction excluded conservative treatment. The affected teeth had to be extracted for functional prosthetic reconstruction. This finding suggests that treatment with denosumab may be associated with severe and aggressive odontoclastic resorption of multiple dental roots despite an adequate inhibitory effect on osteoclasts in the treatment of osteoporosis. The RANKL-independent pathways of clastic cell formation are likely to be involved in this pathological process.
Recent studies suggest an important role for the skeletal endocannabinoid system in the regulatio... more Recent studies suggest an important role for the skeletal endocannabinoid system in the regulation of bone mass in both physiological and pathological conditions. Both major endocannabinoids (anandamid and 2-arachidonoylglycerol), endocannabinoid receptors - CB1-receptor (CB1R) a CB2-receptor (CB2R) and the endocannabinoid metabolizing enzymes are present or expressed in osteoblasts and osteoclasts. Previous studies identified multiple risk and protective variants of CNR2 gene dealing with the relationship to bone density and/or osteoporosis. Selective CB1R/ CB2R-inverse agonists/antagonists and CB2R-inverse agonists/antagonists are candidates for prevention of bone mass loss and combined antiresorptive and anabolic therapy for osteoporosis.Key words: cannabinoid receptors - endocannabinoids - marijuana - osteoporosis.
Parathyroid cancer is a rare endocrine malignancy, representing less than 1 % of all cases of pri... more Parathyroid cancer is a rare endocrine malignancy, representing less than 1 % of all cases of primary hyperparathyroidism. The exact etiology of the disease remains unknown. Known risk factors include neck irradiation, end stage renal failure, genetic factors, particularly the the HPRT2/CDCT73 gene mutation. The clinical picture is often indolent, yet progressive with a trend of local invasion and metastasis formation in advanced disease. The clinical picture includes symptoms of severe and resistant hypercalcemia, requiring intensive therapy often with the need of dialysis. Radical surgery is the mainstay of the parathyroid cancer treatment. Chemotherapy and radiotherapy are generally ineffective. An early and correct diagnosis of parathyroid carcinoma significantly influences both morbidity and mortality.Key words: diagnosis - hyperparathyroidism - parathyroid cancer - treatment.
The Journal of Clinical Endocrinology and Metabolism, Jul 1, 2010
A 25-yr-old man presented with headache, visual distur- bance, excessive perspiration, and progre... more A 25-yr-old man presented with headache, visual distur- bance, excessive perspiration, and progressive asymptomatic skin changes on the scalp for more than 8 yr. The physical examination showed multiple folds and furrows in the parietal region, with anterior to posterior direction, that could not been corrected by pressure or traction (Fig. , arrowheads). This finding was conclusive with the clinical diagnosis of cutis verticis gyrata (CVG), a condition of excessive growth of the scalp skin with cerebriform or gyrate formations. CVG is classified into a primary form, in which no other abnormalities are found, and a secondary form that accompanies mental deficiency,microcephaly,nevoidabnormalities,systemicdiseases, or a combination of these. Based on the other physical examination findings, acromegaly was suspected and was confirmed by laboratory tests. Magnetic resonance imaging study showed pituitary macroadenoma (Fig. , arrow). Acromegaly is only rarely an underlying cause of CVG, but it may be found in cases of extremely pronounced scalp changes or in a long-lasting course of the disease (1-3).
Objective Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parame... more Objective Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters. Purpose The aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters. Methods We prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry. Results Acromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly p...
Objective. Median neuropathy is a common manifestation of acromegaly, although its pathology is u... more Objective. Median neuropathy is a common manifestation of acromegaly, although its pathology is uncertain. Changes in levels of growth hormone (GH) and insulin-like growth factor I (IGF-I) and body composition are potential parameters in pathology of median neuropathy in acromegaly. We aimed to assess changes in the cross-sectional area (CSA) of the median nerve and body composition in newly diagnosed acromegalic patients 1 year after treatment and to determine their mutual relationships. Design. This prospective study included 30 patients with newly diagnosed acromegaly and 30 healthy controls matched for age, gender, and body mass index. Physical and laboratory examinations, dual-energy X-ray absorptiometry (DXA), and ultrasound evaluations were performed at baseline and 1 year after initial treatment. Results. The CSA of the median nerve was increased in acromegalic patients compared with controls (13.1 mm2 [12.2–14.9] vs 7.5 mm2 [6.4–8.4], P < 0.001 ). One year after treatmen...
Acromegaly is a rare disorder with an incidence rate of 3-4 patients per million per year . Kline... more Acromegaly is a rare disorder with an incidence rate of 3-4 patients per million per year . Klinefelter syndrome (KS) is the most common sex chromosome disorder, occurring in about 1/500 live male births . The coincidence of multiple endocrinopathies is rare but possible. We report the case of a 33-year-old man diagnosed with both of those rare conditions -acromegaly and 47, XXY Klinefelter syndrome. The patient was admitted to the Endocrinology Department of the National Institute of Endocrinology and Diabetology in Ľubochňa with clinical manifestation of acromegaly. He had a tall stature (body height 195 cm, weight 90 kg) and enlarged acral parts of the body (including enlargement of hands, feet, facial bones, nose, and tongue with wider spaces between his teeth). He suffered from headache, excessive sweating, and arthralgia. Presence of infertility with reduced facial and pubic hair and small, firm testes could not be explained by the diagnosis of acromegaly. Laboratory tests revealed high level of growth hormone (GH) not suppressed after glucose administration, high level of insulin like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP3), and low testosterone concentration with high concentration of luteinizing hormone (LH) and follicle stimulating hormone (FSH) (Tab. 1). Magnetic resonance imaging scan showed a 25 × 18 × 18 mm macroadenoma of the pituitary gland with dominant cystoid component, with dedifferentiation of adenohypophysis and neurohypophysis tissue and deviation of the infundibulum to the left. There was no compression of the optic chiasm (Fig. ). Diagnosis of acromegaly was established. Perimetry test, abdominal ultrasound, and echocardiography ruled out visual field defects, hepatomegaly, and cardiomyopathy, respectively. Subsequently, transsphenoidal resection of the pituitary
Akromegália je zriedkavé, chronické, progresívne ochorenie vznikajúce najčastejšie na podklade ad... more Akromegália je zriedkavé, chronické, progresívne ochorenie vznikajúce najčastejšie na podklade adenómu hypofýzy. V dôsledku dlhodobej elevácie rastového hormónu (RH) a inzulínu podobného rastového faktora 1 (IGF-1) pri tomto ochorení dochádza k rozvoju reumatologických, kardiovaskulárnych, pľúcnych a metabolických komplikácií. Kardiovaskulárne ochorenia sú hlavnou príčinou morbidity a mortality u pacientov s akromegáliou. Medzi kardiovaskulárne komplikácie akromegálie patrí artériová hypertenzia, kardiomyopatia, poruchy srdcového rytmu, chlopňové chyby ako aj endotelová dysfunkcia. Diagnóza akromegálie býva oneskorená aj niekoľko rokov v dôsledku pomalej progresie príznakov. Včasná diagnostika a liečba ochorenia je nevyhnutná na odvrátenie chronického kardiovaskulárneho poškodenia.
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