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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...
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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...
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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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Selected monogenic endocrine conditions in childhood: patophysiological connections
Obermannová, Barbora ; Lebl, Jan (advisor) ; Marek, Josef (referee) ; Čáp, Jan (referee)
Monogenic conditions are based on a single gene mutation and therefore a "rare" allele formation. Such a mutation leads to a phenotypic abnormity with autosomal dominant, autosomal recessive, or gonosmal mode of inheritance. According to mutation severity, monogenic disorders manifest either in infancy or later in life. Phenotype of the disease is caused by a total or partial absence of the gene transcript (protein product). The protein product may represent either a structural molecule or an enzyme or receptor involved in regulation of physiological processes in organism and maintenance of homeostasis. In addition, the protein may act as a signal molecule or transcription factor regulating adequate organ development and function in embryogenesis or also later in life. Monogenic conditions represent a substantial number of paediatric endocrine diseases. Exact recognition of their etiopathogenesis allows understanding of the physiological processes in human body. The phenotype-genotype correlation supports to elucidate the complex physiology of endocrine regulations. The first part is devoted to the transcription factor PROP1 which regulates embryonic differentiation of anterior pituitary. We present a Czech study investigating the frequency of PROP1 gene mutations and its functional effect on hormonal...
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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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Acipimox during Short-Term Exercise Exerts A Negative Feedback of Growth Hormone on Ghrelin Secretion in Patients with Bulimia Nervosa and in Healthy Women: The Role of Lipolysis
Smitka, Kvido ; Nedvídková, Jara (advisor) ; Kršek, Michal (referee) ; Čáp, Jan (referee)
Title: Acipimox during Short-Term Exercise Exerts A Negative Feedback of Growth Hormone on Ghrelin Secretion in Patients with Bulimia Nervosa and in Healthy Women: The Role of Lipolysis Objective: Eating disorders, such as bulimia nervosa (BN) and anorexia nervosa (AN), are characterized by abnormal eating behavior. The main features of BN are binge-eating and inappropriate compensatory methods to prevent weight gain. The appetite-modulating peptide ghrelin is secreted by the stomach and shows a strong release of growth hormone (GH). A potential GH-ghrelin feedback loop between stomach and the pituitary has been recently reported. Acipimox (Aci), an analogue of nicotinic acid, inhibits lipolysis in adipose tissue (AT) and reduces plasma glycerol and free fatty acids (FFA) levels. Exercise and Aci are stimulators of GH secretion. We suppose that a negative feedback from increased GH levels during exercise may play a role in reducing plasma ghrelin levels. We surmised that altered baseline activity and exercise-induced activation of the sympathetic nervous system (SNS) results in excessive stimulation of lipolysis associated with negative energy balance and may lead to abnormal AT metabolism in patients with BN. Disruption of the gut-brain-AT axis might be involved in the pathogenesis of BN. The...
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