Obesity in rheumatological practice.

Obesity is a chronic disease that leads to the development of secondary metabolic disturbances and diseases and strongly contributes to increased morbidity and mortality. On the other hand, musculoskeletal disorders are currently the main cause of disability and the second most frequent reason for visits to the doctor. Many studies clearly show that excessive body weight adversely affects the course of almost all musculoskeletal system diseases, from osteoarthritis, through metabolic, systemic connective tissue, to rarely diagnosed diseases. The impact of increased fat mass on the musculoskeletal system is presumably complex in nature and involves the influence of biomechanical, dietary, genetic, inflammatory and metabolic factors. Due to the epidemic nature of obesity and its serious health consequences, this disease requires energetic treatment. It is always based on lifestyle modification enriched, if necessary, by pharmacological and, in justified cases, surgical treatment.

Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes.

Thyroid autoimmunity (TAI) is commonly defined as the presence of thyroperoxidase antibodies (TPOAbs) and/or thyroglobulin antibodies (TgAbs), which predisposes an individual to hypothyroidism. TAI affects nearly 10% of women of reproductive age and evokes great interest from clinicians because of its potentially negative impact on female fertility and pregnancy course. In this mini-review, we review the current literature concerning the influence of TPOAb or TPOAb/TgAb positivity without thyroid dysfunction on reproduction. TAI may negatively affect female fertility; several studies have found an increased prevalence of TAI in infertile women, especially in those with unexplained infertility and polycystic ovary syndrome. According to some observations, TAI might also be connected with premature ovarian insufficiency and endometriosis. The relationship between TAI and an increased risk of pregnancy loss is well documented. The pathophysiological background of these observations remains unclear, and researchers hypothesize on the direct infiltration of reproductive organs by thyroid antibodies, co-existence of TAI with other autoimmune diseases (either organ specific or systemic), immunological dysfunction leading to inhibition of immune tolerance, and relative thyroid hormone deficiency. Interestingly, in the current literature, better outcomes of assisted reproductive technology in women with TAI have been reported compared with those reported in earlier publications. One plausible explanation is the more widespread use of the intracytoplasmic sperm injection method. The results of randomized clinical trials have shown that levothyroxine supplementation is ineffective in preventing adverse pregnancy outcomes in women with TAI, and future research should probably be directed toward immunotherapy.

The effects of testosterone replacement therapy in men with age-dependent hypogonadism on body composition, and serum levels of leptin, adiponectin, and C-reactive protein.

INTRODUCTION: Age-related hypogonadism in men leads to abnormal body composition development and overproduction of inflammatory cytokines, and thus has atherogenic and potentially cancer promoting effects. The aim of the study was to assess the effect of agedependent testosterone deficiency replacement in men on body composition, serum leptin, adiponectin, and C-reactive protein levels. MATERIAL AND METHODS: Men aged 50-65 years (56.0 ± 5.7, average ± SD), with total testosterone levels < 4 ng/mL, and clinical symptoms of hypogonadism were divided into two groups of 20 men and treated with testosterone (200 mg/two weeks intramuscularly) or placebo during 12 months. RESULTS: Twelve months of treatment with testosterone led to body mass index (BMI) and fat mass (FM) decrease from 26.6 ± 2.1 to 26.1 ± 1.8 kg/m², p < 0.05, and from 17.0 ± 4.4 to 15.6 ± 4.0 kg, p < 0.05, respectively. Body mass index and FM did not change in placebo-receiving subjects. Serum leptin and highly selective C-reactive protein (hsCRP) levels in testosterone group decreased from 6.2 ± 1.4 to 4.0 ± 1.2 µg/L, p < 0.05, and from 1.4 ± 1.2 to 1.0 ± 1.0 mg/L, p < 0.05 after 12 months, respectively. Adiponectin increased from 7.6 ± 2.5 µg/mL to 9.4 ± 2.8 µg/mL, p < 0.05 in the same time. In the placebo group serum leptin, adiponectin, and hsCRP levels did not change significantly. CONCLUSIONS: Testosterone replacement in men with age-related hypogonadism causes a decrease in body mass index, fat mass, serum leptin, and C-reactive protein levels and increases serum adiponectin levels.

Gastric Contractility Modulation - a novel method for the treatment of type 2 diabetes mellitus and obesity.

Because the majority of antidiabetic medications are of limited efficacy and patient compliance with treatment is usually poor, new therapies are still being searched for. In the review a newly developed system for treatment of subjects with type 2 diabetes and concomitant overweight/obesity is described. The system consists of an implantable pulse generator that delivers electrical stimuli through leads implanted in the sero-muscular layer of the stomach. The device recognises and automatically modulates natural electrical activity of the stomach during meals, strengthening gastric contractility. This increase in the force of contractions enhances vagal afferent activity. Modulated signals are transmitted to the regulatory centres in the brain in order to provoke an early response of the gut typical of a full meal. Clinical trials performed to date show that the system improves glycaemic control with minimal patient compliance needed and with added benefits of body weight loss, a decrease in blood pressure, and favourable changes in the lipid profile. The system is safe, well-tolerated, with a low risk of hypoglycaemia, and will probably become an alternative to the use of incretins or to bariatric surgery in obese patients who are unwilling to undergo a major and anatomically irreversible operation.

Obesity in menopause - our negligence or an unfortunate inevitability?

Numerous concerns about menopause exist among women, and fear of an increase in body weight is one of the most important of them. This paper presents an overview of current knowledge concerning the etiology of obesity related to menopause and about the mechanisms of its development, with particular regard to the hormonal changes that occur during this period of life. The role of estrogens in the regulation of energy balance and the effect of sex hormones on metabolism of adipose tissue and other organs are presented. The consequence of the sharp decline in the secretion of estrogens with subsequent relative hyperandrogenemia is briefly discussed. The main intention of this review is to clarify what is inevitable and what perhaps results from negligence and unhealthy lifestyles. In the last part of the paper the possibilities of counteracting the progress of adverse changes in body composition, by promoting beneficial lifestyle modifications and the use of hormonal substitution treatment, in cases where it is reasonable and possible, are described.

Late-onset hypogonadism.

In Poland, the number of men over the age of 50 years exceeds 6 million. It is estimated that about 2-6% of this population develops symptoms of late-onset hypogonadism (LOH). In men, testosterone deficiency increases slightly with age. LOH is a clinically and biochemically defined disease of older men with serum testosterone level below the reference parameters of younger healthy men and with symptoms of testosterone deficiency, manifested by pronounced disturbances of quality of life and harmful effects on multiple organ systems. Testosterone replacement therapy may give several benefits regarding body composition, metabolic control, and psychological and sexual parameters.

Gastric electrical stimulation treatment of type 2 diabetes: effects of implantation versus meal-mediated stimulation. A randomized blinded cross-over trial.

Gastric electrical stimulation with the implanted DIAMOND device has been shown to improve glycemic control and decrease weight and systolic blood pressure in patients with type 2 diabetes inadequately controlled with oral antidiabetic agents. The objective of this study was to determine if device implantation alone (placebo effect) contributes to the long-term metabolic benefits of DIAMOND(®) meal-mediated gastric electrical stimulation in patients with type 2 diabetes. The study was a 48 week randomized, blinded, cross-over trial in university centers comparing glycemic improvement of DIAMOND(®) implanted patients with type 2 diabetic with no activation of the electrical stimulation (placebo) versus meal-mediated activation of the electrical signal. The endpoint was improvement in glycemic control (HbA1c) from baseline to 24 and 48 weeks. In period 1 (0-24 weeks), equal improvement in HbA1c occurred independent of whether the meal-mediated electrical stimulation was turned on or left off (HbA1c -0.80% and -0.85% [-8.8 and -9.0 mmol/mol]). The device placebo improvement proved to be transient as it was lost in period 2 (25-48 weeks). With electrical stimulation turned off, HbA1c returned toward baseline values (8.06 compared to 8.32%; 64.2 to 67.4 mmol/mol, P = 0.465). In contrast, turning the electrical stimulation on in period 2 sustained the decrease in HbA1c from baseline (-0.93%, -10.1mmol/mol, P = 0.001) observed in period 1. The results indicate that implantation of the DIAMOND device causes a transient improvement in HbA1c which is not sustained beyond 24 weeks. Meal-mediated electrical stimulation accounts for the significant improvement in HbA1c beyond 24 weeks.

Associations of vitamin D concentration with metabolic and hormonal indices in women with polycystic ovary syndrome presenting abdominal and gynoidal type of obesity.

GOAL: The aim of the study was to estimate potential associations of vitamin D concentration with metabolic and hormonal indices in women with polycystic ovary syndrome (PCOS) presenting abdominal and gynoidal type of obesity. MATERIAL AND METHODS: Twenty-six women with PCOS (19-49 years old, BMI: 26.8-53.8 kg/m2), presenting predominantly abdominal and gynoidal type of obesity were recruited. Anthropometric measures, body composition using dual-energy absorptiometry, fasting serum 25-hydroxyvitamin D, leptin, glucose, insulin, homeostatic model of assessment (HOMA), lipids, androgens and sex hormone-binding globulin (SHGB) were estimated. RESULTS: Vitamin D insufficiency was found in 2, and deficiency or deep deficiency in 12 patients. Levels of vitamin D were lower in obese than non-obese women, and in patients with abdominal as compared to gynoidal obesity (9.60±3.7 vs. 16.02±3.3 ng/mL, p<0.04). In obese women, vitamin D correlated negatively with all, except for gynoidal fat, measures of obesity fasting glucose levels, and HOMA. No correlations with androgens were found. In women with abdominal obesity vitamin D correlated with luteinizing hormone/follicle-stimulating hormone ratio (LH/FSH) and SHBG. CONCLUSIONS: We demonstrated that women with PCOS are often vitamin D deficient. Its concentration was lower in patients with predominantly abdominal obesity as compared to subjects with gynoidal fat excess. In overweight/obese subjects with PCOS, vitamin D correlated with fasting glucose and HOMA. The correlation with LH/FSH suggests that vitamin D status may contribute to hormonal dysregulation. Further studies are needed to elucidate a potentially different impact of abdominal and subcutaneous fat on vitamin D metabolism.

Fetuin-A levels in lean and obese women with polycystic ovary syndrome.

INTRODUCTION: The aim of this study was to estimate serum fetuin-A levels in lean and obese women with polycystic ovary syndrome (PCOS) and to find possible relationships between fetuin-A, metabolic factors and androgens in these patients. MATERIAL AND METHODS: In 25 lean (18-38 years, BMI 17.5-25.0 kg/m2) and 15 obese women (20-41 years, BMI 28.1-53.2 kg/m2) with PCOS, anthropometric indices and body composition were measured. Fasting serum fetuin-A, adiponectin, leptin, glucose, lipids, hsCRP, insulin, androgens and SHGB levels were estimated. RESULTS: There was no significant difference in serum fetuin-A levels between lean and obese patients: 0.54 ± 0.13 g/L and 0.60 ± 0.14 g/L, respectively. We noted a correlation between BMI and leptin levels (r = 0.88; p < 0.0001) and a nearly significant negative correlation between BMI and adiponectin levels (r = -0.53; p = 0.11) in all subjects. In lean patients, we found a correlation between fetuin-A levels and ALT activity (r = 0.44; p < 0.05). In all participants, fetuin-A correlated directly with DHEA-S levels (r = 0.44; p < 0.03). CONCLUSIONS: Serum fetuin-A levels were similar in lean and obese women with PCOS. We found an association between fetuin-A levels and ALT activity in lean patients and between fetuin-A levels and DHEA-S in all women. The role of fetuin-A in the mechanisms of insulin resistance, and its potential impact on androgenic hormones production in women with PCOS, need to be tested in further studies.

The DIAMOND system in the treatment of type 2 diabetes mellitus in an obese patient.

Obesity and type 2 diabetes mellitus have reached epidemic proportions worldwide. As the majority of antidiabetic medications are of limited efficacy and patient adherence to long-term therapy is one of the main limiting factors of effective blood glucose and body weight control, new therapies are still looked for. The DIAMOND system seems to be one of the most promising among them. This system recognizes natural electrical activity of the stomach and automatically applies electrical stimulation treatment during/after eating with subsequent modulation of signals transmitted to the regulatory centers in the brain in order to provoke an early response of the gut typical of a full meal. We present the case of a 47-year-old obese woman with type 2 diabetes. During treatment with this system, serum glucose and hemoglobin A1c levels significantly decreased. Body weight loss and waist circumference reduction were observed. Additionally, beneficial effect on lipid profile was found.

Body composition, glucose metabolism markers and serum androgens - association in women with polycystic ovary syndrome.

INTRODUCTION: To evaluate the association between abdominal and gynoid fat, glucose and lipid metabolism markers, and serum androgens in women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Anthropometric measurements were performed in 40 women with PCOS aged 19-49 years with body mass index (BMI) 18.7-53.8 kg/m2. Fasting serum glucose, lipids, insulin, leptin, LH, FSH, oestradiol, androgens, SHGB and TSH were estimated. Body composition was measured by DEXA scan. RESULTS: Four women (10%) were overweight, and 23 (57.5%) were obese. All subjects were hyperandrogenic (in 33 serum androgen levels were increased), and 16 of them were insulin resistant. All of the obese subjects had the abdominal type of obesity. Body weight, BMI, fat mass, fat mass of the trunk, abdominal and gynoidal fat mass correlated with serum triglyceride, glucose and insulin levels, and with HOMA index and blood pressure. Free androgen index (FAI) correlated with body weight (r = 0.43, p 〈 0.01), and BMI (r = 0.46, p 〈 0.05). CONCLUSIONS: Using the DEXA method, we demonstrated abdominal type of obesity in all our obese subjects. There were positive significant correlations between fatness, lipids and glucose metabolism indices and blood pressure. Direct positive correlations between free androgen index, body weight and BMI were found.

The high prevalence of testosterone deficiency in population of Polish men over 65 years with erectile dysfunctions.

OBJECTIVES: Erectile dysfunctions (EDs) are in part caused by hormonal causes; but in men over 65 years of age, testosterone deficiency seems to play an important role. However, in population of Polish men over 65 years of age with relative poor health status, the prevalence of testosterone deficiency in patients with ED is unknown. MATERIAL AND METHODS: 286 men over 65 years of age with EDs were invited to complete an erectile function questionnaire (IIEF-5), as a diagnostic tool for EDs. Serum total testosterone (TT) levels were measured. Linear regression model was used to analyze the factors that are associated with testosterone deficiency. RESULTS: The prevalence of testosterone deficiency was 17, 33, 42 and 57% for testosterone levels of less than 200, 250, 300 and 350 ng/dL, respectively. Only 47% patients had testosterone levels in the normal range (>350 ng/dL). The degree of ED was significantly higher in men with lowest testosterone levels (p < 0,002), and it was mild in 39.5% of cases, mild-to-moderate in 26.2%, moderate in 18.2% and severe in 16%. There was significant inverse relationship between age and TT (r = -0.3328, p < 0.05), IIEF-5 score and TT (r = -0.3149, p < 0.05) and IIEF-5 score and age (r = -0.3463, p < 0.05). The most common metabolic disorders were: obesity (68% in men with TT levels >350 ng/dL and 91% in men with TT levels <350 ng/dL) and dyslipidemia (54 and 95%, respectively). Obesity, age and hyperlipidemia all correlated with significantly decreased testosterone levels. Impaired fasting glucose did not affect the testosterone levels. CONCLUSIONS: Testosterone deficiency was very common in population of Polish men presenting with EDs and correlated negatively with age, obesity and dyslipidemia. These results can be associated with relative poor health status of Polish population.

Ghrelin - growth hormone releasing and orexigenic hormone in men declines with age, insulin and with decrease in testosterone concentration.

OBJECTIVES: Ghrelin, a natural ligand of the growth-hormone secretagouges receptor is the peptide known because of its growth hormone (GH)-releasing as well as orexigenic actions. THE AIM of the study was to examine the relationship between ghrelin levels and age, weight, glucose metabolism markers, GH, IGF-1 and androgens in men. PATIENTS AND METHODS: The study included 19 healthy men aged 16-73 yrs, mean 46,8 +/-18,5 (mean +/- SD). The height, weight, and body mass index (BMI) of the study subjects were assessed and serum concentration of fasting ghrelin, leptin, GH, IGF-1, glucose, insulin, estradiol, testosterone and DHA-S were measured. RESULTS: The negative correlation between age and serum ghrelin levels (r=-0,52; p<0,04) in men was found. In men under 30 years old serum ghrelin levels were significantly higher compared to men over 60 years old (p<0,02). Serum ghrelin levels in men were significantly lower compared to healthy women aged 43,5 +/- 12 years old (p<0,008). Serum insulin levels correlated negatively with ghrelin levels (r= -0,87; p<0,0006) and serum testosterone concentrations correlated with ghrelin levels (r= 0,69; p<0,00006). CONCLUSION: Our findings demonstrate that the serum ghrelin levels in men decline with age, is lower than in women and correlate negatively with fasting insulin levels. We demonstrated, for the first time, that serum testosterone levels in men correlate with total ghrelin levels.

[The relationship between androgens concentrations (testosterone and dehydroepiandrosterone sulfate) and metabolic syndrome in non-obese elderly men]. / Wspólzaleznosc pomiedzy stezeniami androgenów (testosteronu i siarczanu dehydroepiandrosteronu) a zespolem metabolicznym u starszych, nieotylych mezczyzn.

INTRODUCTION: The metabolic syndrome characterized by central obesity, insulin and lipid dysregulation, and hypertension, is a precursor state for atherosclerotic process and, in consequence, cardiovascular disease. Decline of both testicular and adrenal function with aging causes a decrease in androgen concentration in men. It has been postulated that low levels of total testosterone and dehydroepiandrosterone sulfate (DHEA-S) are associated with unfavorable levels of several strong cardiovascular disease risk factors, such as lipids and blood pleasure, which are components of the metabolic syndrome, and insulin levels. Both testosterone and DHEA-S deficiency are risk factors of obesity and insulin resistance, but it is not clear, whether this possible influence is independent. The aim of this study was to determined whether lower androgens (testosterone and DHEA-S) levels are associated with the development of metabolic syndrome in non-obese elderly men as well as analysis, whether these sex hormones influents on measured parameters separately. MATERIAL AND METHODS: Together 85 men age from 60 to 70 years (mean 66.3 +/- 1.5 years; mean +/- SEM) were analyzed. Testosterone levels < 4 ng/ml or DHEA levels < 2000 ng/ml and BMI < 30 kg/m(2) were including criteria. Patients were divided into three groups: 52 with testosterone deficiency (L-T), 32 with DHEA deficiency (L-DHEA-S) and 67 with deficiency of both sex hormones (L-T/DHEA-S). The influence of sex hormones deficiency in these groups on blood pressure, lipids, visceral obesity and fasting glucose were measured (according to metabolic syndrome definition NCEP III/IDF). RESULTS: Testosterone levels in L-T, L-DHEA and L-T/DHEA-S groups were respectively 3.19 +/- 0.23 ng/ml, 4.89 +/- 0.45 ng/ml and 3.25 +/- 0.34 g/ml (p < 0.002). While DHEA-S levels were respectively 2498 +/- 98 ng/ml, 1435 +/- 1010 ng/ml and 1501 +/- +/- 89 ng/ml). BMI values do not differ between groups. Waist circumference was significantly higher in L-T/DHEA-S group than in L-T i L-DHEA-S groups (respectively: 99.9 +/- 6,1 cm, 97.1 +/- 7.1 cm i 96.2 +/- 6.4 cm; mean +/- SD, p < 0.05 vs. L-T and L-DHEA-S groups). Mean triglycerides concentration in L-T/DHEA-S group was significantly higher than in L-T and L-DHEA-S groups (respectively: 188.2 +/- 13.3 mg/dl, 161.7 +/- 14.7 mg/dl and 152.2 +/- 12.8 mg/dl (mean +/- SD; p < 0.02 vs. L-T and L-DHEA-S groups). Analysis of prevalence of risk factors showed, that in L-T/DHEA-S group they were more frequent than in other groups. The most significant percentage difference was observed for triglycerides: concentration > or = 150 mg/dl was measured in 31% men in L-T group, 28% men in L-DHEA-S group and 42% men in L-T/DHEA-S group. According metabolic syndrome definition NCEP III/IDF prevalence of this syndrome was: 71% patients in L-T/DHEA-S group, 67% patients in L-T group and 64% patients in L-DHEA-S group. CONCLUSIONS: The DHEA-S and testosterone deficiency was a significant and independent risk factor of the metabolic syndrome in non-obese elderly men. It seems, that triglycerides concentration and waist circumference are more sensitive then others parameters to reflect the influence of sex hormones deficiency on risk of the metabolic syndrome in elderly men.

[Lowered ghrelin levels in acromegaly­normalization after treatment]. / Obnizone stezenie ghreliny w akromegalii--po wyleczeniu ulega noralizacji.

UNLABELLED: Ghrelin has been found as a natural ligand of growth hormone secretagouges receptors (GHSR-1a) that exerts a marked stimulatory effect on growth hormone (GH) secretion. It is also thought to be involved of eating behavior and control of energy homeostasis. However, still little is known about the physiology of ghrelin secretion in acromegaly. OBJECTIVE: The objective of the study was to examine effects of surgical and pharmacological treatment in patients with acromegaly on serum ghrelin levels. MATERIAL: 28 patients (17 women and 11 men) aged 47.7+/-11.4 years (mean+/-SD) with body mass index (BMI)=31.6+/-4.9 kg/m2. Diagnosis was based on: 1/peak GH in oral glucose tolerance test>or=1ng/mL, 2/serum IGF-1 levels above normal for gender and age, 3/ pituitary adenoma in magnetic resonance imagining. Patients were divided into two groups: Group I-surgically treated (transsphenoidal surgery): 10 women and 7 men aged 45+/-10.9 years with BMI=31.3+/-4.9 kg/m2. Criteria of cure in acromaegaly were: 1/peak GH<1 ng/ml in OGTT, 2/serum IGHF-1 levels according to gender and age. Group II-pharmacologically treated (Sandostatin LAR, Novartis Pharm. Ltd, 20 mg im, monthly): 7 women and 4 men aged 52+/-11 years, BMI=29.4 kg/m2. Criteria of good control of acromegaly were: 1/peak GH<1 ng/ml in OGTT, 2/serum IGHF-1 levels according to gender and age. Control group-healthy subjects: 10 women and 19 men aged 47.7+/-11.4 years, BMI=25.6 kg/m2. METHODS: In patients before and after treatment and in healthy subjects fasting serum levels of total ghrelin, leptin, growth hormone (GH), insulin-like growth factor I (IGF-1), glucose, insulin, total cholesterol and trigliceryde levels were measured. HOMA index of insulin resistance was calculated. The patients and control subjects underwent assessment of body height, weight and BMI. RESULTS: Body weight and BMI in patients before treatment were higher compared to healthy controls (87.3+/-18 to 74.4+/-16 kg, p<0.02 (body weight) and 31.6+/-4.9 to 25.5+/-4.1 kg/m2, p<0.0002 (BMI). Body weight and BMI after successful surgical treatment were still higher compared to healthy subjects (92.7+/-19 to 74.4+/-16 kg, p=0.02 (body weight) and 31.5+/-5 to 25.5+/-4.1 kg/m2, p<0.0003 (BMI). Body weight decreased during pharmacological treatment although BMI was still higher then in control subjects (30.1+/-6.3 to 25.2+/-4.1 kg/m2; p<0.003). Serum fasting GH and IGF-1 levels decreased after successful surgical treatment, from 26.3+/-29 to 1.6+/-2.5 microg/l (p<0.007) and from 926.1+/-325 to 337+/-213 microg/l (p<0.00003), respectively. Also during pharmacological treatment decrease in serum GH and IGF-1 levels were observed, from 29.4+/-40 to 5.8+/-7.6 microg/l and from 976.3+/-328 to 358.3+/-203 microg/l (p<0.002), respectively. Serum insulin levels decreased after successful surgical treatment, from 29.1+/-9.8 do 15.8+/-7.3 microU/ml (p<0.02). Also during pharmacological treatment serum insulin levels and HOMA index decreased, from 29.8+/-12.9 to 14.6+/-2.1 microU/ml (p<0.03) and from 9.1+/-3.6 to 3.5+/-0.4 (p<0.007), respectively. Serum fasting insulin and glucose levels and HOMA index were higher in patients before treatment compared to healthy subjects and didn't differ significantly after successful surgery and during pharmacotherapy. Serum ghrelin levels in patients with acromegaly were decreased compared to healthy subjects (1055.2+/-325 to 1266.8+/-374 pg/ml, p<0.04) and increased after successful surgical treatment, from 1164.2+/-321 to 1553.6+/-542 pg/ml (p=0.01). During pharmacotherapy decrease in serum ghrelin levels was observed, from 1038.7+/-344 to 568.5 +/-252 pg/ml (p<0.03). There were no significant differences in serum ghrelin level between healthy controls and patients after treatment. Significant negative correlation between serum ghrelin levels and body weight (r=-0.40, p=0.04) in healthy subjects was found. In patients with acromegaly significant negative correlation between serum ghrelin levels and insulin levels and HOMA index were found (r=-0.48; p<0.02 and r=-0.57; p<0.03, respectively. CONCLUSIONS: In patients with acromegaly: 1/serum ghrelin levels are decreased compared to healthy subjects. It can be speculated, that its at least partially caused by negative feedback control of ghrelin production and by GH-induced hyperinsulinaemia. 2/serum ghrelin levels increase after successful transsphenoidal surgery. 3/ treatment with somatostatin analoges causes decrease in serum ghrelin levels, despite of serum GH and IGF-1 normalization.

[The relationship between testosterone and dehydroepiandrosterone sulfate concentrations, insulin resistance and visceral obesity in elderly men]. / Wspólzaleznosc pomiedzy stezeniami testosteronu, siarczanu dehydroepiandrosteronu, insulinoopornoscia i otyloscia brzuszna u starszych mezczyzn.

INTRODUCTION: Sex hormones deficiency--hypotestosteronemia (20-30% of men) and dehydroepian-drosterone sulfate deficiency (60-70% of men) are often observed in elderly men. In these men also changes of body composition (visceral obesity, increasing of fat mass), and metabolic disturbances (hypercholesterolemia, hyperinsulinism and insulin resistance) are common disorders. Visceral obesity and insulin resistance may be either reasons or effects of testosterone deficiency. Probably also DHEA-S deficiency is the risk factor of visceral obesity and insulin resistance, but it is not clear, whether this possible influence is independent from testosterone deficiency. OBJECTIVES: The aim of this study was to analyze the association between testosterone and DHEA deficiency and waist/hip ratio (WHR), levels of glucose and insulin resistance (HOMA and FG/FI) in elderly men as well as analysis, whether these sex hormones influent on measured parameters separately. MATERIAL AND METHODS: Together 85 men with age from 60 to 70 years men (mean 66.3+/-1.5 years; mean+/-SEM) was analyzed. Testosterone levels<4 ng/ml or DHEA levels<2000 ng/ml and BMI<30 kg/m2 were including criteria. Patients were divided into three groups: 52 with testosterone deficiency (L-T), 32 with DHEA deficiency (L-DHEA-S) and 67 with deficiency of both sex hormones (L-T/DHEA-S). Statistical analysis was made using Student-t, Kruskal-Wallis, and Mann-Whitney tests. RESULTS: Testosterone levels in L-T, L-DHEA and L-T/DHEA groups were respectively 3.19+/-0.23 ng/ml, 4.89+/-0.45 ng/ml and 3.25+/-0.34 g/ml (p<0.002). While DHEA-S levels were respectively 2498+/-98 ng/ml, 1435+/-1010 ng/ml and 1501+/-89 ng/ml). BMI values do not differ between groups. WHR ratio values were the highest in L-T/DHEA-S group (p<0.05 vs. L-T) group, significant lower in L-T group (p<0.005 vs. L-DHEA-S) and the lowest in L-DHEA-S group. Insulin fasting levels were lowest in L-DHEA-S group, higher in L-T group (p<0.01) and the highest in L-T/DHEA-S group (p<0.001 vs, L-T group). FG/FI values were the highest in L-DHEA-S group, lower in L-T group (NS) and lowest in L-T/DHEA group (p<0.002 vs. L-T group). HOMA ratio values similarly did not change significantly between L-T (6.6+/-3.21) and L-DHEA-S group (5.5+/-2.92), although tendency to higher values in L-T group was noticed, while WHR ratio values were significantly higher in L-T/DHEA group (7.3+/-2.45; p<0.002 vs. L-T group). CONCLUSIONS: DHEA-S and testosterone deficiency were independently associated with higher insulin resistance and obesity. WHR ratio seems to be more sensitive then BMI ratio to reflect the androgen deficiency on obesity and body composition in elderly men.