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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...
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Metabolic syndrome and steroid spectrum
Pospíšilová, Hana ; Stárka, Luboslav (advisor) ; Hána, Václav (referee) ; Fingerová, Helena (referee)
Sex steroids influence the storing of fat, and differences in the distribution of fat are a typical secondary sexual characteristic. Androgens act on fatty tissues in males either directly through stimulation of the androgen receptor or indirectly through aromatization of the estrogen receptor. Androgens can be classified as aromatizable or non-aromatizable. Testosterone (T) is the main aromatizable androgen, while its metabolite dihydrotestosterone (DHT) is a non-aromatizable androgen that acts only through the androgen receptor. It is precisely this difference in having activity only through the androgen receptor that has given rise to the hypothesis concerning the differing effects of DHT and T on body composition, with DHT possibly being responsible for male-type fat distribution. As part of my post-graduate studies we analyzed the dependence serum levels of T and DHT on age, as well as changes in their ratio with age. Further, we sought relationships between aromatizable and non-aromatizable androgens and metabolic and anthropometric parameters. We also focused on following any changes in steroidogenesis in obese males. We showed that before puberty the dominant androgen is rather DHT than T, that the fDHT/fT ratio during the life of adult males is constant, and that there is no evidence of a reversal...
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How does the fluid intake affect the gastrointestinal absorbtion of levothyroxine.
Kročová, Radka ; Krátký, Jan (advisor) ; Hána, Václav (referee)
Thyroid diseases belong among the most common endocrinopathies, and, therefore, thyroid hormones are among the most commonly prescribed drugs in the Czech Republic, as well as in the world. Even though untreated thyropathies may cause several health complications for the patients, poorly administered treatment can also hurt the health of the individual. Several factors make the treatment difficult. A type of fluid used to ingest the drug belongs among such factors, and it represents the focus of this Master thesis. As is indicated by its title, the thesis focuses explicitly on the gastrointestinal absorption of levothyroxine after being ingested with water, black tea or cow's milk. The thesis was aimed at determining whether and to what extent, if any, the fluids may influence the gastrointestinal absorption of the drug. Based on this premise, research was conducted with six test subjects who underwent a relatively challenging absorption test with four blood samples taken over six hours. The data set (altogether 56 samples taken from all test subjects) had revealed that the gastrointestinal absorption of levothyroxine reached its maximum values when the drug was ingested with water. The other test fluids impair the bioavailability of L-thyroxine, and patients should wait to indulge in them at least...
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Steroid metabolome in human physiology and pathophysiology.
Hána, Václav ; Hill, Martin (advisor) ; Meloun, Milan (referee) ; Čáp, Jan (referee)
Many studies have shown steroid hormone changes in adrenal incidentalomas with subclinical hypercortisolism and various forms of Cushing's syndrome. The aim of our work was to measure, using novel steroid GC-MS/MS measurement procedure, complex picture of many steroids in these patients. With the knowledge of these changes we could better explain causal pathophysiologic changes. In the study on patients with adrenal incidentalomas we described complex steroid changes in patients with subclinical hypercortisolism. Previous studies showed decrease of DHEAS in subclinical hypercortisolism. We confirmed this finding and described a decrease in other androgens and their metabolites. We also evaluated their sensitivity and specificity when compared to routinely used parameters for diagnosis of subclinical hypercortisolism. Furthermore, we looked at the alterations in all measured steroids and their changes in the 1 mg dexamethasone suppression test. In another study, we analyzed steroid changes in various forms of Cushing's syndrome. We confirmed the decrease of adrenal androgens in the ACTH independent forms and mild increase in the ACTH dependent forms. We also described elevations of mineralocorticoid precursors in central and ectopic forms of ACTH secretion. In the distinction of ectopic and central...
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Relationship of body composition to endocrine orbitopathy
Nová, Veronika ; Hána, Václav (advisor) ; Krátký, Jan (referee)
In the theoretical part I briefly introduce the reader to the current state of given topic and describe the function of thyroid gland, how much important it is for our organism and also the possible influence of nutrition on this organ. The next chapters discuss endocrine orbitopathy. Endocrine orbitopathy is a chronic ocular disease, which is frequent in patients with Graves - Basedow disease. I focus not only on the epidemiology and causes of the disease, but also on assessing the severity and treatment of endocrine orbitopathy. The practical part focuses on eating habits and lifestyle of patients with endocrine orbitopathy and assesses the possible effect of body composition on endocrine orbitopathy. At the same time, 4 hypotheses were established. The first hypothesis assumed that higher % body fat and higher BMI may influence the course of endocrine orbitopathy. The second, that nicotine-dependent patients with endocrine orbitopathy predominate over individuals who do not use this addictive substance. In the third hypothesis, I assumed that patients with endocrine orbitopathy would have another associated civilization diseases. And the last, the fourth hypothesis compared the effect of fish consumption on the level of selenium in the blood. To collect data, I used questionnaires inquiring...
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Metabolic syndrome and steroid spectrum
Pospíšilová, Hana ; Stárka, Luboslav (advisor) ; Hána, Václav (referee) ; Fingerová, Helena (referee)
Sex steroids influence the storing of fat, and differences in the distribution of fat are a typical secondary sexual characteristic. Androgens act on fatty tissues in males either directly through stimulation of the androgen receptor or indirectly through aromatization of the estrogen receptor. Androgens can be classified as aromatizable or non-aromatizable. Testosterone (T) is the main aromatizable androgen, while its metabolite dihydrotestosterone (DHT) is a non-aromatizable androgen that acts only through the androgen receptor. It is precisely this difference in having activity only through the androgen receptor that has given rise to the hypothesis concerning the differing effects of DHT and T on body composition, with DHT possibly being responsible for male-type fat distribution. As part of my post-graduate studies we analyzed the dependence serum levels of T and DHT on age, as well as changes in their ratio with age. Further, we sought relationships between aromatizable and non-aromatizable androgens and metabolic and anthropometric parameters. We also focused on following any changes in steroidogenesis in obese males. We showed that before puberty the dominant androgen is rather DHT than T, that the fDHT/fT ratio during the life of adult males is constant, and that there is no evidence of a reversal...
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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...
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Quantitative analysis of D2 dopamine receptors in clinically non-functioning pituitary adenomas
Gabalec, Filip ; Čáp, Jan (advisor) ; Fryšák, Zdeněk (referee) ; Hána, Václav (referee)
Quantitative analysis of D2 dopamine receptors in clinically non-functioning pituitary adenomas Introduction Clinically non-functioning pituitary adenomas account for about one-third of pituitary tumors. The majority of them are pathologically classified as gonadotropinomas or null-cell adenomas without hormonal expression. The rest represent silent corticotroph adenomas and plurihormonal tumors. Conservative therapy with dopamine agonists is effective in some cases only depending on the expression of dopamine 2 receptors (D2R). Objective The aim of this study was to quantitatively estimate D2R expression in clinically nonfunctioning pituitary adenomas and correlate the results with adenoma type according to pathological classification. Methods and results Out of the 87 adenomas investigated, 63 expressed gonadotropins, 7 were silent corticotroph adenomas, 7 were plurihormonal tumors, and only 6 did not express any pituitary hormone on immunohistochemical investigation. With the use of the reverse transcriptase real-time PCR technique, D2R mRNA was expressed in all adenomas with very heterogeneous quantity. The expression was very low in corticotroph adenomas (relative median quantity after normalization to housekeeping gene 0.01) and lower in plurihormonal tumors (median 0.4) than in gonadotroph...
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Changes of bone mass density in selected endocrine diseases
Vašátko, Tomáš ; Čáp, Jan (advisor) ; Zamrazil, Václav (referee) ; Hána, Václav (referee)
Osteoporosis is a serious social and medical problem. About 6% people suffer from osteoporosis in European countries. As for aetiology it is a multi-factorial disease. Endocrinopaties play an important role in it's development. We focused on three specific endocrinopaties with relation to bone metabolism in our study. Goal of the study: 1/ To evaluate the influence of long term thyroid hormone therapy (substitution and suppressive dose) on bone mass and bone metabolism. 2/ To evaluate the possibility of prediction of bone mass increase after the operation in patients with mild primary hyperparathyroidism. 3/ To evaluate changes of bone mass, bone metabolism and body composition in patients with growth hormone deficiency treated with growth hormone substitution. Patients and methods: 1/ a) First - cross sectional part of the study - 76 patients on suppressive dose of L-thyroxine therapy, 34 patients on substitution therapy. We examined bone markers and bone mass in each group. We evaluated how each of the two doses of therapy influences the bone metabolism and we compared the groups with each other. b) In second - prospective part of the study - we observed the changes of bone mass in the course of the time (5 years) in each group. 2/ Retrospective cross-sectional study - 54 patients with primary...
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