Relationships between hormonal parameters, body fat distribution and bone mineral density in women with psychogenic functional hypothalamic amenorrhea.

OBJECTIVES: Available evidence implies that unfavorable changes in the distribution of adipose tissue resulting from hormonal imbalance associated with ovarian insufficiency might influence bone mineral density (BMD). The purpose of our study was to verify if volumes of visceral (VAT), female (FAT) and android (AAT) body fat as determined by densitometry determined influence BMD in women with functional menstrual disorders, and if these correlates some endocrine factors. MATERIAL AND METHODS: We examined 293 women (mean age 26.7 ± 4.4 years) who have had psychogenic type of functional hypothalamic secondary amenorrhea for at least three months (mean 5.82 ± 0.94). A variety of hormonal tests, determination of BMD and both distribution and volume of adipose tissue were performed. RESULTS: Volume of adipose tissue in all analyzed body regions indicated a positive correlation with BMD in lumbar spine (VAT: R = 0.277, FAT: R = 0.345, AAT: R = 0.336) and entire skeleton (VAT: R = 0.453, FAT: R = 0.527, AAT: R = 0.529). BMD in both the lumbar spine and entire skeleton had positive correlation with body mass index (R = 0.380 and R = 0.599, respectively) and free androgen index values (R = 0.150 and R = 0.279). It showed a negative correlation with sex hormone-binding globulin (R = -0.191 and R = -0.326). We did not find a parameter that could be an independent predictor of BMD. CONCLUSIONS: Distribution of body fat is only one of numerous determinants of BMD in women with functional menstrual disorders and should not be treated as the only predictor for bone mass deficiency. Determination of adipose tissue distribution in these patients has probably minor clinical impact.

Case report: rare case of infiltration of small lymphocytic B-cell lymphoma in the thyroid gland of female patient with B-cell chronic lymphocytic leukemia (CLL-B/SLL-B).

The article presents a case of 57-year-old woman with the infiltration of rare small lymphocytic B cell lymphoma in the thyroid gland. Initially, the patient was followed-up due to chronic lymphocytic B-cell leukemia diagnosed on the basis of histopathological examination of cervical lymph node. Eight months later, general symptoms occurred along with lymphocytosis and exacerbation of lesions in lymph nodes, and therefore, chemotherapy was started according to COP regimen. After four chemotherapy cycles, further progression of the disease was observed during chemotherapy. Computed tomography (CT) performed at that time showed generalized lymphadenopathy and the presence of an irregular area in left thyroid lobe. On palpation, the thyroid was asymmetrical, with enlarged left lobe and palpable lymph node packages on the left side of the neck. The levels of thyroid hormones and anti-thyroid antibodies were normal. Ultrasound examination of the thyroid gland showed non-homogeneous hypoechogenic structure of the left lobe and complete focal remodeling. Cytological examination of left-lobe lesion obtained during fine needle aspiration biopsy showed multiple small lymphoid cells, suggestive of small lymphocytic lymphoma. To confirm this diagnosis, flow cytometry of the biopsy material sampled from the left lobe was performed showing B cellimmunophenotype: CD19+/CD20+/CD22 dim/FMC-7, CD23+/CD5+, sCD79b-+, CD38-, CD10-, kappa and lambda-/weak reaction. The results of flow cytometry of the thyroid bioptate and blood were nearly identical, confirming leukemic nature of the infiltration in left thyroid lobe. Cytogenetic findings included the presence of 17p deletion (TP53 gene). The patient received immunochemotherapy with alemtuzumab. The progression of the disease occurred in the sixth week of therapy. The treatment was discontinued after 8 weeks due to worsening of patient's general status. The patient died 15 months after the diagnosis.

Polymorphism of the vitamin D3 receptor gene and bone mineral density in girls with functional hypothalamic amenorrhea subjected to oestroprogestagen treatment.

BACKGROUND: We investigated whether the vitamin D3 receptor gene (VDR) polymorphism can modulate therapeutic response of functional hypothalamic amenorrhea (FHA) patients to the oestroprogestagen (EP) treatment. MATERIAL AND METHODS: The study included 84 FHA girls and 50 controls. FHA patients underwent a four-year sequential EP therapy with 17-ß oestradiol (2 mg from the 2(nd) to 25(th) day of the menstrual cycle) and didrogesterone (10 mg from the 16(th) to the 25(th) day). Their hormonal parameters were monitored along with bone turnover marker levels and bone mineral density (BMD). Additionally, the VDR gene BsmI polymorphism was determined. RESULTS: Hormonal therapy was reflected by a substantial improvement of BMD. However, the values of BMD observed after four years of treatment in FHA patients were still significantly lower than baseline bone mineral density determined in the control group (1.007 ± 0.100 vs. 1.141 ± 0.093 g/cm(2), respectively; p < 0.001). No significant effects of the VDR genotype were observed on the dynamics of BMD during consecutive years of hormonal treatment and mean bone mineral density determined after completing the therapy (1.006 ± 0.101 vs. 1.013 ± 0.114 vs. 1.006 ± 0.094 g/cm(2) for BB, bb and Bb genotypes, respectively; p = 0.973). CONCLUSIONS: This study did not confirm that VDR polymorphism can modulate therapeutic outcome of FHA girls subjected to the hormonal treatment. Nonetheless, this study confirmed the effectiveness of EP therapy in the simultaneous treatment of menstrual disorders and the normalisation of bone mineral density in FHA patients.

Changes in inflammatory biomarkers after successful lifestyle intervention in obese children.

BACKGROUND: Obesity has been associated with low-grade systemic inflammation, potentially leading to insulin resistance, type 2 diabetes, dyslipidemia, and cardiovascular diseases. Even moderate weight loss through dietary changes and physical exercise is effective in preventing and managing obesity-associated disorders. The aim of this study was to determine the effect of weight loss in response to a lifestyle modification on the serum levels of inflammatory markers in obese children and adolescents. MATERIAL AND METHODS: Fifty obese subjects completed a six-month programme consisting of combined hypocaloric diet and moderate physical activity. High-sensitive C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen (FB), white blood count (WBC), glucose, insulin, insulin resistance index (HOMA IR), glycosylated haemoglobin (HbA(1c)), lipids as well as systolic (SBP) and diastolic blood pressure (DBP) were measured before and after intervention. RESULTS: Patients had a 5.3 ± 3.4 kg average weight loss, with significant decreases of SDS-BMI, percentage of body fat, SDS-waist, SBP and DBP, HOMA-IR, HbA(1c) and reductions in serum IL-6, CRP, WBC, FB. In the multivariable linear models, changes in percentage of body fat and HOMA-IR were positively associated with favourable changes in inflammatory parameters. CONCLUSION: This study demonstrates that weight reduction after successful lifestyle intervention results in improvements of blood inflammatory markers in obese children and adolescents.

Serum 25-hydroxyvitamin D (25-OH-D) in obese adolescents.

BACKGROUND: There is increasing evidence that vitamin D deficiency is common and has been associated with several non-bone related outcomes, including insulin resistance, type 2 diabetes and cardiovascular disease. The influences of gender, puberty, and adiposity on serum hydroxyvitamin D (25-OH-D) levels and the relationship between 25-OH-D and insulin resistance in obese children were studied. MATERIAL AND METHODS: Age, gender, pubertal stage, weight status (standard deviation score of body mass index: BMI-SDS, percentage body fat, waist circumference), 25-OH-D levels, and insulin resistance index calculated by homeostasis model assessment (HOMA-IR) were evaluated in 64 obese adolescents. Multivariable linear regression was used to determine factors associated with decreased serum 25-OH-D levels and to study the relationship between 25-OH-D and HOMA-IR. RESULTS: Median serum 25-OH-D level was 10.1 ng/mL (25.2 nmol/L). 14% of patients were vitamin D-sufficient (25-OH-D ≥ 20 ng/mL), 36% had intermediate values (11-19 ng/mL), and 50% were deficient (25-OH-D ≤ 10 ng/mL). In the multivariable model, older age, puberty, higher value of percentage of body fat, and the presence of acanthosis nigricans (AN) were all negatively associated with 25-OH-D. Lower 25-OH-D levels were also associated with higher blood glucose, insulin and HOMA-IR after adjustment for puberty and SDS-BMI. Summer positively correlated with 25-OH-D level. CONCLUSION: Our study confirms that obesity is a risk factor for vitamin D deficiency. Hypovitaminosis D, common in obese adolescents at risk for type 2 diabetes (older age, puberty, acanthosis nigricans) is associated with worse insulin resistance.

Late diagnosis of type 2B multiple endocrine neoplasia (MEN 2B) in a 23 year-old patient.

We present a case of MEN 2B diagnosed in a 23 year-old patient on the basis of bilateral pheochromocytoma and medullary thyroid carcinoma. This young male patient also had multiple paragangliomas located along the spine, marfanoid features of body habitus and numerous mucosal neuromas of the oral cavity and intestinal ganglioneuromatosis. The patient was hospitalised several times between the ages of 11 and 14 due to heart rhythm disorders (tachycardia, multiple supraventricular beats) and pain in the precardiac area. Elevated blood pressure was not observed at that time. In 2010, the patient was admitted to hospital due to abdominal pain, nausea, vomiting and hypertension; bilateral adrenal tumours were then detected. The patient was referred to the Department of Endocrinology in Szczecin, with suspected pheochromocytoma in order to continue the diagnostic process. This resulted in the diagnosis of bilateral pheochromocytoma and medullary thyroid carcinoma. On the basis of the whole clinical picture, the diagnosis of MEN 2B was established and subsequently confirmed with genetic test results. Following the removal of adrenal tumours and thyroidectomy, the patient was referred to the Cancer Centre and Institute of Oncology in Gliwice for further treatment (X-ray therapy and further surgery due to recurrence of medullary carcinoma). This article presents a case of late MEN 2B diagnosis despite the presence of clinical symptoms suggestive of Multiple Endocrine Neoplasia observed from early childhood.