|
|
Molecular biology investigation of somatostatin receptors in diagnostics of pituitary tumors
Drastíková, Monika ; Beránek, Martin (advisor) ; Fryšák, Zdeněk (referee) ; Patočka, Jiří (referee)
Molecular biology investigation of somatostatin receptors in diagnostics of pituitary tumors The overwhelming majority of pituitary tumors are benign, with 25-30% of them representing clinically non-functioning pituitary adenomas (NFA). The treatment of choice for NFA is transsphenoidal neurosurgery. However, the procedure is often not completely successful and frequently tumor remnants remain, resulting in regrow over the long-term follow-up period. This fact has led to the development of new therapy strategies using pharmacological treatment: somatostatin analogs (SA) and estrogen receptor modulators. SA are effectively used in the treatment of acromegaly, neuroendocrine tumors and Cushing's disease. In contrast, pharmacological treatment of NFA has for the most part been unsuccessful. Low SA effectiveness could be associated with the variable expression of target receptors on the adenomas. The aim of the study was to determine the somatostatin (SSTR subtypes 1-5) and estrogen receptor 1 (ER1) expression profile. To obtain more complex receptor profile expression in the pituitary, we also investigated dopamin receptor 2 (D2R). Methods The group of patients was made up of 105 men and 101 women (20-87 years old; median 61). 144 samples were NFA, 44 growth hormone secreting (GHomas), 9 corticotrophin...
|
|
|
Aspiration biopsy of the thyroid - the significance of evaluation according to Bethesda classification, differentiated carcinoma incidence in autoimmune thyroiditis
Srbová, Libuše ; Čáp, Jan (advisor) ; Fryšák, Zdeněk (referee) ; Jiskra, Jan (referee)
Aspiration biopsy of the thyroid - the significance of evaluation according to Bethesda classification, differentiated carcinoma incidence in autoimmune thyroiditis. Introduction: Improved diagnostics led to an increased number of detected thyroid nodules. Sonography and fine needle thyroid biopsy has become the basic method for thyroid nodules evaluation. Since 2010 the Bethesda System for Reporting Thyroid Cytopathology is used in some centres. Another common thyroid disease is autoimmune thyroiditis. According to some older studies a nodule in a patient with thyroiditis has a higher risk of malignancy. Current opinions dispute these findings. The difference in data appears to depend primarily on whether cytological or surgical findings are analysed. Objective: The aim of our study was to reclassify thyroid biopsy results according to the Bethesda categories in patients who underwent thyroidectomy and to determine the malignant potential of the individual categories. We then determined in equivocal cytological findings whether the recommendations for surgery, the type of cytologic atypia and the results of repeated biopsies had an impact on the incidence of malignant findings. Another objective was to identify how autoimmune thyroiditis affects the risk of thyroid cancer, particularly by comparing...
|
|
|
Impairment of hypothalamo-pituitary function and its evaluation in various pathologic situations.
Kosák, Mikuláš ; Hána, Václav (advisor) ; Čáp, Jan (referee) ; Fryšák, Zdeněk (referee)
Traumatic brain injury represents serious medical problem. Besides various types of complications, endocrine dysfunction of hypothalmo-pituitary units can occur. Aim of our work was to determine whether chronic subdural haematoma, as specific type of traumatic brain injury, is associated with a risk of developing hypopituitarism as well. In a prospective study, pituitary functions in a cohort of 49 patients after surgery for chronic subdural haematoma, were evaluated. Patients were tested for hormonal deficits including dynamic tests, soon after surgery, in 3 and 12 months thereafter. 10 patients were tested retrospectively 12 months after surgery. Gonadotropic axis was impaired in 9 patients (25,7 %) in acute phase and reamained impaired in 3 (12 %) after 12 months. Growth hormone deficiency was present in 23 (46,9 %) patients during the acute phase and in 15 (46,9 %) patients in evaluation 12 months after the surgery. Serious hormonal deficiencies due to impairment of the most important axes (HPA a thyrotropic) were not proved in our patients. The second part of this work is devoted to the novel methods in diagnostic assesement of hypothalamo-pituitary-adrenocortical axis. Aim of our work was to evaluate and compare reliability of cortisol measurements in serum and saliva simultaneously during the...
|
|
|
Molecular biology investigation of somatostatin receptors in diagnostics of pituitary tumors
Drastíková, Monika ; Beránek, Martin (advisor) ; Fryšák, Zdeněk (referee) ; Patočka, Jiří (referee)
Molecular biology investigation of somatostatin receptors in diagnostics of pituitary tumors The overwhelming majority of pituitary tumors are benign, with 25-30% of them representing clinically non-functioning pituitary adenomas (NFA). The treatment of choice for NFA is transsphenoidal neurosurgery. However, the procedure is often not completely successful and frequently tumor remnants remain, resulting in regrow over the long-term follow-up period. This fact has led to the development of new therapy strategies using pharmacological treatment: somatostatin analogs (SA) and estrogen receptor modulators. SA are effectively used in the treatment of acromegaly, neuroendocrine tumors and Cushing's disease. In contrast, pharmacological treatment of NFA has for the most part been unsuccessful. Low SA effectiveness could be associated with the variable expression of target receptors on the adenomas. The aim of the study was to determine the somatostatin (SSTR subtypes 1-5) and estrogen receptor 1 (ER1) expression profile. To obtain more complex receptor profile expression in the pituitary, we also investigated dopamin receptor 2 (D2R). Methods The group of patients was made up of 105 men and 101 women (20-87 years old; median 61). 144 samples were NFA, 44 growth hormone secreting (GHomas), 9 corticotrophin...
|
|
|
Possibilities of genetic testing in patients with pheochromocytoma and paraganglioma.
Turková, Hana ; Zelinka, Tomáš (advisor) ; Malík, Jan (referee) ; Fryšák, Zdeněk (referee)
1. Abstract Pheochromocytoma/ paraganglioma (FEO/PGL) may be developed on the basis of an inherited genetic mutation of different genes. They are associated with a high risk of developing of secondary hypertension, organ damage and metastatic disease that can be fatal. The aim was to focus on the possibility of genetic testing in patients with FEO/PGL, especially in patients with malignant tumors. The issue FEO/PGL, however, concerns not only the examination and assessment of risks arising therefrom, as well as other therapies and monitoring, including appropriate recommendations for clinical practice. We demonstrated a 20% incidence of cardiovascular (CV) complications before determining the final diagnosis of FEO/PGL, mainly arrhythmic, followed by complications of myocardial ischemia and accentuate atherosclerosis. Elevated levels of vitamin C and decreased levels of malondialdehyde (MDA) following the successful removal of the tumor demonstrated reduction of oxidative stress postoperatively. We found that early postoperative testing of levels of plasma metanephrines to confirm the success of surgical removal of FEO/PGL is already possible, since there was no significant correlation between plasma levels of metanephrines and postoperative examination interval. Distribution of frequency of metastatic...
|
|
|
Selected Prognostic and Predictive Factors of Pituitary Tumours in Patients with Acromegaly
Soukup, Jiří ; Ryška, Aleš (advisor) ; Ehrmann, Jiří (referee) ; Fryšák, Zdeněk (referee)
Selected prognostic and predictive factors of pituitary tumours in patients with acromegaly (abstract) Pituitary tumours in patients with acromegaly (somatotroph adenomas, pituitary neuroendocrine tumours - PitNETs) are a rare disease with significant morbidity and high impact on economic resources of the health care system. The surgery is the first line of treatment, and while it cures a subset of the patients, another therapeutical approach combining radiotherapy and pharmacotherapy is needed in the rest. This usually includes treatment with costly somatostatin analogues (SSA). On the opposite, the therapeutic response to SSA is not a rule. This work aimed to perform precise clinicopathological characterisation of available tissue samples of PitNETs in acromegalic patients (n=110) from REgistr SEllárních Tumorů (RESET registry) and further explore potential factors related to clinically aggressive disease phenotype (tumour size, invasion, biochemical parameters) and factors that might predict therapeutic response to the first generation SSA. An extensive immunohistochemical evaluation was performed: tumours were histologically subclassified (expression of cytokeratins, prolactin, TSH) and proliferative activity was assessed (Ki67, p53, mitotic count) as well as expression of possible pharmacological...
|
|
|
Possibilities of genetic testing in patients with pheochromocytoma and paraganglioma.
Turková, Hana ; Zelinka, Tomáš (advisor) ; Malík, Jan (referee) ; Fryšák, Zdeněk (referee)
1. Abstract Pheochromocytoma/ paraganglioma (FEO/PGL) may be developed on the basis of an inherited genetic mutation of different genes. They are associated with a high risk of developing of secondary hypertension, organ damage and metastatic disease that can be fatal. The aim was to focus on the possibility of genetic testing in patients with FEO/PGL, especially in patients with malignant tumors. The issue FEO/PGL, however, concerns not only the examination and assessment of risks arising therefrom, as well as other therapies and monitoring, including appropriate recommendations for clinical practice. We demonstrated a 20% incidence of cardiovascular (CV) complications before determining the final diagnosis of FEO/PGL, mainly arrhythmic, followed by complications of myocardial ischemia and accentuate atherosclerosis. Elevated levels of vitamin C and decreased levels of malondialdehyde (MDA) following the successful removal of the tumor demonstrated reduction of oxidative stress postoperatively. We found that early postoperative testing of levels of plasma metanephrines to confirm the success of surgical removal of FEO/PGL is already possible, since there was no significant correlation between plasma levels of metanephrines and postoperative examination interval. Distribution of frequency of metastatic...
|
|
|
Aspiration biopsy of the thyroid - the significance of evaluation according to Bethesda classification, differentiated carcinoma incidence in autoimmune thyroiditis
Srbová, Libuše ; Čáp, Jan (advisor) ; Fryšák, Zdeněk (referee) ; Jiskra, Jan (referee)
Aspiration biopsy of the thyroid - the significance of evaluation according to Bethesda classification, differentiated carcinoma incidence in autoimmune thyroiditis. Introduction: Improved diagnostics led to an increased number of detected thyroid nodules. Sonography and fine needle thyroid biopsy has become the basic method for thyroid nodules evaluation. Since 2010 the Bethesda System for Reporting Thyroid Cytopathology is used in some centres. Another common thyroid disease is autoimmune thyroiditis. According to some older studies a nodule in a patient with thyroiditis has a higher risk of malignancy. Current opinions dispute these findings. The difference in data appears to depend primarily on whether cytological or surgical findings are analysed. Objective: The aim of our study was to reclassify thyroid biopsy results according to the Bethesda categories in patients who underwent thyroidectomy and to determine the malignant potential of the individual categories. We then determined in equivocal cytological findings whether the recommendations for surgery, the type of cytologic atypia and the results of repeated biopsies had an impact on the incidence of malignant findings. Another objective was to identify how autoimmune thyroiditis affects the risk of thyroid cancer, particularly by comparing...
|
|
|
Molecular biology investigation of somatostatin receptors in diagnostics of pituitary tumors
Drastíková, Monika ; Beránek, Martin (advisor) ; Fryšák, Zdeněk (referee) ; Patočka, Jiří (referee)
Molecular biology investigation of somatostatin receptors in diagnostics of pituitary tumors The overwhelming majority of pituitary tumors are benign, with 25-30% of them representing clinically non-functioning pituitary adenomas (NFA). The treatment of choice for NFA is transsphenoidal neurosurgery. However, the procedure is often not completely successful and frequently tumor remnants remain, resulting in regrow over the long-term follow-up period. This fact has led to the development of new therapy strategies using pharmacological treatment: somatostatin analogs (SA) and estrogen receptor modulators. SA are effectively used in the treatment of acromegaly, neuroendocrine tumors and Cushing's disease. In contrast, pharmacological treatment of NFA has for the most part been unsuccessful. Low SA effectiveness could be associated with the variable expression of target receptors on the adenomas. The aim of the study was to determine the somatostatin (SSTR subtypes 1-5) and estrogen receptor 1 (ER1) expression profile. To obtain more complex receptor profile expression in the pituitary, we also investigated dopamin receptor 2 (D2R). Methods The group of patients was made up of 105 men and 101 women (20-87 years old; median 61). 144 samples were NFA, 44 growth hormone secreting (GHomas), 9 corticotrophin...
|
|
|
Haemorheopheresis in treatment of severe thyroid associated orbitopathy, the role of changes in selected pathogenetic indicators
Ceeová, Věra ; Čáp, Jan (advisor) ; Zamrazil, Václav (referee) ; Fryšák, Zdeněk (referee)
Haemorheopheresis in treatment of severe thyroid associated orbitopathy, the role of changes in selected pathogenetic indicators Introduction: Thyroid associated orbitopathy (TAO) is an autoimmune disease characterized by inflammatory swelling and cellular infiltration of orbital tissues. In severe cases causes disablement and disfigurement of patients. The treatment of choice has been for many years corticosteroid treatment. Its benefit was clearly demonstrated in spite of many important adverse events. The effect of other immunosuppressive treatment has not been clearly demonstrated. Objective: The aim of our study was to determine the effect of haemorheopheresis on the course of TAO in patients with very severe form of disease in a randomized study (10 patients treated with high doses of glucocorticosteroids and 10 patients on combination of glucocorticosteroids and haemorheopheresis). Secondary aim is to follow selected pathogenetically important immunological and biochemical parameters during haemorheopheretic treatment and to evaluate safety and tolerability of our method modification. Patients and methods: 20 patients with very severe form of disease, without improvement on standard glucocorticoid treatment were enrolled into the study. They were randomized into two groups. Ten patients were treated...
|
guest ::
