Matulevičius, Valentinas

Aim: To evaluate the clinical, laboratory and radiological data of patients diagnosed with adrenal tumors. Methods: Analysis of medical histories of patients diagnosed with adrenal tumor in 2017-2018. 40 males and females with a mean age of 59.48 ± 12.45 and 63.83 ± 14.92, respectively. Results: 35% of the patients were overweight, and 41.3% - obese. Arterial blood pressure was elevated in 66 (82%) patients. The average heart rate in female patients was 77.48 ± 11.43 bpm, while in male – 78.53 ± 13 bpm. The most common: 1) complaint was high blood pressure (63,8%); 2) comorbidity - arterial hypertension (42,5%); 3) adrenal tumor - adenoma (42,5%); 4) tumor size - 3 cm (25%); and the least common adrenal tumor was aldosteronoma (3,8%). 37 tumors were enhanced according to the CT with a contrast enhancement. Males (30%) were more often diagnosed with bilateral tumors than females (5%). Finally, percental increase of metanephrine and noretanephrine was significantly higher in pheochromocytoma than in other tumors. Conclusions: 1) Differences between gender in BMI, blood pressure and heart rate were not significant. No significant differences were found between male and female complaint analysis. 2) The most common adrenal tumors were adenomas, and the changes in the hormone concentration of adenomas were not statistically significant. Pheochromocytomas were significantly larger than adenomas. Pheochromocytomas enhance statistically significantly more compared to other adrenal tumors. 3) In case of pheochromocytoma, the percentage of increase of metanephrine and normetanephrine is significantly higher than in other tumors.

Objective Parathyroid carcinoma (PC) is considered a rare malignancy which accounts for less than 1% of hyperparathyroidism cases in reported literature. In B. C. James study there were only 348 cases of PC reported in SEER database 2000-2012, which compose 0,36 (per 1 million) incidence rate. PC occurrence is equal in men and women, while benign parathyroid diseases incidence is higher in women with ratio 3-4:1. Diagnostic criteria were established in 1973 by A. Schantz and B. Castleman which include thick fibrous bands, mitotic activity, vascular and capsular invasion in pathomorphological tests. The variations and pathognomic features are debated as there have been reported large series of patients with metastatic tumours of which as many as 50% were initially misdiagnosed as benign tumours, therefore preoperative diagnosis and staging is often incorrect or not available. Imaging techniques such as sestamibi scintigraphy and neck ultrasound are only used in localizing the parathyroid tissue preoperatively and >3cm size mass may raise suspicion of PC as denoted in Cetani study, however these techniques are in no way diagnostic of PC. This lead to diagnostic markers application such as Ki-67, Cyclin D1, which are more specific to PC than parathyroid adenoma. The course of disease is indolent and most deaths occur due to untreated complications of hypercalcemia. Ten cases of PC were treated in our hospital during the period of 17 years. This review focuses on our experience with the diagnosis, treatment and survival of the patients. Our aim was to review the demographics, diagnostics, treatment and outcomes of the patients, who were surgically treated for parathyroid carcinoma in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. As large part of contemporary literature on the topic is referencing the older studies from the year 2000 and before, we think that a more recent standpoint can contribute to better understanding the PC. Methods The model of the study was retrospective. Data on demographics, initial symptoms, preoperative diagnostic blood tests and instrumental procedures, surgical operations, complications, postoperative blood tests, and histology of tumours was collected. The data concerning patients‘ survival was acquired from the Lithuanian National Cancer Institute’s Cancer Registry. Results There were 10 patients who were treated surgically for parathyroid carcinoma. During the study period patients with PC accounted for 2,2 percent of all the patients with parathyroid gland pathology treated surgically in our clinic. Among PC patients there were 7 females, age distribution was from 54 – 74, mean – 64 years. Eighty percent of admitted patients suffered from complications. The most prevalent symptoms were renal function impairment, nephrolithiasis and subsequent pyelonephritis. Three patients had suffered from spontaneous bone fractures. Other common complaints included joint pain and malaise, hoarseness of voice.. Five patients had palpable disease at time of admission. One patient was asymptomatic (Table 1). Preoperative blood tests showed increased serum calcium 2,62-3,4 mmol/l (normal range (NR) – 2,15-2,55 mmol/l), ionized calcium 1,15- 1,57 mmol/l (NR – 0,98-1,13 mmol/l), and PTH 23,91 – 210 pmol/l (NR – 1,2-5,3 pmol/l), which plunged to normal range after surgical treatment. All patients were tested with ultrasound and scintigraphy. Five fine needle aspirational (FNA) punctures of nodules were performed (Table 3). None of the tests were diagnostic of parathyroid carcinoma preoperatively, nevertheless 5 out of 5 cytology showed features of malignancy. En-bloc parathyroidectomies were performed on all patients with various extents of thyroid gland removal. The diagnoses of PC were confirmed with histologic tests. Most prevalent features included vascular invasion (70%), capsular invasion (60%) and presence of fibrous bands (60%). There were no cases with distant metastases at initial surgery and lymphonodectomies were not performed. Data from Cancer registry showed, that 8 out of 10 patients were alive (survivability ranging from 4 months to 16 years postoperatively). Two of the patients have deceased due to carcinoma of pancreas and thyroid gland 2 and 4 years respectively after the operation. Conclusions Parathyroid carcinoma has complex diagnostics and staging because of its rarity and lack of studies. Majority of PC patients present with hypercalcemia and its complications – renal insufficiency, nephrolithiasis. Palpable neck mass is prevalent in half of the patients. Lesser than 3,5 mmol/l values of serum calcium should not lessen the suspicion of PC. The outcome of non-metastasized PC is favourable when en-bloc resection of the tumour is performed. Brief description of the abstract Objective: Review the diagnostics, treatment and outcomes of the patients, who were surgically treated for parathyroid carcinoma in the Hospital of LUHS Kauno klinikos from 2003 to 2019. Conclusions: Majority of PC patients present with hypercalcemia and its complications – renal insufficiency, nephrolithiasis. Lesser than 3,5 mmol/l values of serum calcium should not lessen the suspicion of PC. The outcome of non-metastasized PC is favourable when en-bloc resection of the tumour is performed.

Background and objectives. A synthetic ACTH stimulation test is a gold standard to detect occult adrenal insufficiently. The advantages of the test are the ability to perform it at any time and well-known normal or pathological levels of cortisol during the test 30 or 60 minutes after the injection of synthetic ACTH. The aim. Of the work was to find out how often ACTH stimulation test was performed at the Kaunas Endocrinology Center in 2014-2017. Material and methods. Medical documentation of 1471 patients (764 - 52% - women, 707 - 48% - males) was performed for 3 main reasons: 1100 -for investigation of importance of DHEAS in males, 220 - for investigation of adrenal function in ENSAT study and 151 patients for the recent study of clinical expressions in the patients with adrenal tumors. Since cortisol is the most important vital hormone of the adrenal glands, we analyzed the conditions under which it was studied. Results. A suppression test of 1 mg of dexamethasone was usually performed. It was followed by small or high dose dexamethasone suppression tests. It was not possible to determine what time of day cortisol was tested. Of 1471 patients no patient could be found who underwent an ACTH stimulation test. [...].

Objective To analyse the radiological and clinical features of patients with adrenal tumours in one university center (Hospital of Lithuanian University of Health Sciences, Kauno klinikos) and to try to find any regularities, related to clinical data. Methods Medical documentation of 150 patients (53 women and 97 men), who had adrenal tumors diagnosed by CT or/and by MRI, were analysed. Essential clinical and laboratory (hormone assessment) data were documented. Age, height, weight, BMI, systolic and diastolic blood pressure, pulse were recorded together with results of investigation of DHEAS, testosterone, TTH, aldosterone, ACTH, fT4, cortisol, renin, metanefrine, normethanefrine, aldosterone/renin ratio. Results Age of women and men at the moment of AT diagnosis was the same (60,9 and 60,5 years respectively). No difference of systolic and diastolic blood pressure, pulse and BMI was detected between women and men. Concentration of aldosterone (around 70%), ACTH (around 40%), cortisol (around 70%), renin (around 60%), methanephrine and normethanephrine (around 65%) and aldosterone/renin ratio (around 25%) were investigated with the same frequency both in women and men. TTH, fT4 and DHEAS were assessed more frequently in female, than in male patients (48, 41 and 50% and 32, 28 and 40% respectively). Surprisingly, testosterone was assessed rarely both in women (7%) and men (8,25%). Without hormone investigations remained 5,5 % of women and 20,6% of men. Unilateral, as well as bilateral, adrenal tumours were detected with the same frequency (64,8% female vs 63,9% male, as well as 11,1% of female vs 16,5% of male patients). Minor visual changes of adrenals were detected with similar frequency in both genders (3,7% in females and 5,2% in males). Surgery was performed in 7,4% of female, and in 5,2% of male patients. In female patients all resections were unilateral, in male 3,1% of cases were unilateral. In case of bilateral AT, unilateral resection was performed more frequently in female, compared to male patients (5,6% vs 2,1%).ConclusionsTTH, fT4 and DHEAS were assessed more frequently in female, than in male patients. Surprisingly, testosterone was assessed rarely both sexes. Without hormone investigations remained 5,5 % of women and 20,6% of men. Unilateral, as well as bilateral, adrenal tumours were detected with the same frequency (female vs male patients). Minor visual changes of adrenals were detected with similar frequency in both genders, as well. In case of bilateral AT, unilateral resection was performed more frequently in female, compared to male patientsB rief description of the abstractAdrenal tumors are common a finding. Modern image techniques occupie a central place in the diagnosis of adrenal tumors. After diagnosis of an adrenal tumor, a multidisciplinary team clarifies the diagnosis and prescribes treatment for the patients. This is usually performed in tertiary hospital (university clinic in our case). We attempted to analyse retrospectively, how this system works in real life, and tried to find any regularities, related to clinical data and radiological findings.

Objective: To analyse the radiological and clinical features of patients with adrenal tumors in one university center, and to tr y to find any regularities, related to clinical data. Methods: Medical documentation of 53 women and 97 men, who had adrenal tumors diagnosed by CT or/and by MRI, were analysed. Essential clinical and laboratory data were documented. Age, height, weight, B MI, systolic and diastolic blood pressure, pulse were recorded together with results of investigation of DHEAS, testosterone, TTH, aldosterone, ACTH, fT4, cortisol, renin, metanefrine, normethanefrine, aldosterone/renin ratio. Results: Age of women and men at the time of AT diagnosis was the same. Concentration of aldosterone, ACTH, cortisol, renin, methanephrine and normethanephrine and aldosterone/renin ratio were investigated with the same frequency in both sexes. TTH, fT4 and DHEAS were assessed more fr equently in female, than in male patients (48, 41 and 50% and 32, 28 and 40% respectively). Surprisingly, testosterone was assessed rarely both in women and men. Without hormone investigations remained 5,5 % of women and 20,6% of men. Unilateral, as well a s bilateral, adrenal tumours were detected with the same frequency in both sexes. Surgery was performed in 7,4% of female, and in 5,2% of male patients. Conclusions: TTH, fT4 and DHEAS were assessed more frequently in female patients. Surprisingly, testos terone was assessed rarely in both sexes. Unilateral, as well as bilateral, adrenal tumours were detected with the same frequency (female vs male patients). In case of bilateral AT, unilateral resection was performed more frequently in female patients.

In men, prolactinomas are diagnosed in around their 40- 50- ties, and only incidentally – in younger persons. The main symptoms of prolactinoma in men are non-specific: headache, decrease of libido, erectile dysfunction and sign – gynaecomasty. Here we descibe an incidental aggressive oligosymptomatic macroprolactinoma in a 25-yearold man, with very good response to medical treatment as well as predictable consequences (2 ) of COVID-19 – related restrictions on the chronically ill patients. Case report. A 25 years old man was admitted to the hospital after falling off the harvester during fieldwork in 19 May 2018. An MRI scan revealed a large (30.3x23.4x22mm) previously unsuspected heterogeneous mass of a pituitary tumour with the invasion into the right cavernous system with the prolabation of the tumour into sphenoid synus. Prolactin was 100 fold upper limit of normal. LH, FSH, testosterone were low. DHEAS was 1.75 fold upper limit of normal. The treatment with bromocriptine had been initiated 2,5 mg/d, gradually increasing to 5 mg/d. Macroadenoma shrank by 45% with decrease of invasion to cavernous space. Serum prolactin decreased to normal levels. LH, FSH and T levels, despite the gradual increase, remained low. As the patient’s mother explained, following the limitations of movement and healthcare access during the Covid-19 pandemic, the patient experenced difficulties continuing his regular visits to the endocrinologist and stopped bromcriptine intake. He intrerupted bromocriptine for 3 months, and repeated MRI scan revealed the increase of the tumour by 50% comparing to the latest scan. Progression of invasion to the right cavernous sinus was also prominent.. After the patient restarted the treatment with bromocriptine (5 mg/d), prolactin quickly decreased to normal levels (70 mU/l). Among many other lessons, COVID-19 pandemic made medical professionals reanalyse and improve medical care in conditions of reduced direct contact to assure the optimal management for patients with chronic illnesses. This is especially important for majority of endocrine diseases, which are oligosymptomatic or asymptomatic.

Objective. To investigate the significance of DHEAS assessment in males of different ages. Methods. Retrospective cohort study of patients investigated in two large academic centres. Results. The data of DHEAS assessment of 3533 patients (3013 females and 520 males) was analysed. DHEAS was 1.6 - 13.5 times more frequently investigated in women than in men. A peak of DHEAS evaluation test for women was at 25 years old and distribution was uniform in males over decades, excepting being lower in 0-9 and 75+ages. In the age group 10-24 years, DHEAS levels were higher in females. After 45 years, DHEAS was higher in men than in women. Analysis of 510 case records showed low DHEAS levels in boys (0-9 years) and in men aged 65 84+. Higher DHEAS levels were detected as a peak at 30 years old, but never after 55 years. In individuals with low DHEAS levels prevailed congenital adrenal hyperplasia (32%), adrenal tumours (30%) and primary or secondary adrenal insufficiency (19%). High DHEAS levels prevailed in patients with arterial hypertension (26%), overweightobesity -(19%), non-toxic goiter (17%) and alopecia (9%). In the normal DHEAS miscellaneous diagnoses were met most frequently - 40%. Disorders exceeding 5% were non-toxic goiter (19%), adrenal tumours - 17%, overweight/obesity 16% and arterial hypertension- 8%. In 71 women and 124 men adrenal neoplasms were detected. Higher frequency of these was observed in women in their 30s. A peak of adrenal neoplasms in men was at their 70s. This gender difference was not conditioned by earlier attempts to seek medical care by women. A significant correlation of DHEAS, weight, body mass index and systolic blood pressure with diastolic blood pressure was found. Conclusion. Our study permits to determine which DHEAS secretion and clinical pattern might be associated in males of different ages.

Dehydroepiandrosterone sulfate (DHEAS) . Objective: To perform an investigation of significance of DHEAS assessment in males of different ages. Subjects. Methods. Results We analyzed clinical data of 3533 patient’s (3013 females and 520 males) from DHEAS assessment lists of Vilnius and Kaunas university hospitals. For comparison purposes, a cohort of women was also clinically investigated. DHEAS was assessed 1.6 – 13.5 times more frequently in women than in men. A peak of DHEAS test for women was around 25 years. In males, referrals for DHEAS were uniform during decades, excepting being lower in 0–9 and >75 ages. DHEAS levels in 10- to 24-year-old females were higher than in males. From birth to 9 years and after 45 years, DHEAS was statistically significantly higher in males. Analysis of 491 case records showed low DHEAS in boys, aged 0–9 years and in men, aged 65 – 84. High DHEAS was detected as a peak at around 30 years, but never after 55. Double peak distribution of normal values was evident, with one peak at 10–19 years and a second large peak at 45–64 years. In patients with low DHEAS prevailed congenital adrenal hyperplasia – 31.3%, adrenal tumors (AT) – 29.8% and adrenal insufficiency – 19.3%. High DHEAS prevailed in patients with arterial hypertension – 26.4% and overweight/obesity/hypothalamic dysfunction −18.8%. We found 71 women and 117 men with adrenal tumours (AT). Higher frequency of AT was observed in women around their 30-ties. A peak of AT frequency in men was around 70-ties. We analyzed a list of 3700 consecutive abdominal only and complex abdominal, chest and pelvic computer tomographies (CT) for the age and gender of this examination. Our hypothesis, that referral for CT was much later in men than woman was strongly rejected: peak performance of CT in men and women was the same- between 65 and 74 years of age. In summary, in males, low DHEAS was found in patients with [...].

Algoritmas (lot. algorismus

Sistemingą Dehidroepiandrosterono sulfato (DHEAS) tyrimą pradėjome po to, kai aprašėme savo pirmąjį atvejį – 36 metų moterį – su daugybe klinikinių simptomų, kurie išnyko, pašalinus dešinio antinksčio DHEAS sekretuojančią onkocitimą. Šiame tyrime analizavome 3533 pacientų duomenis pagal DHEAS sąrašus. 3013 buvo moterys, o 520 – vyrai. DHEAS buvo tiriamas 4-13,5 karto dažniau moterims, nei vyrams. Laikotarpyje tarp 20 ir 34 m. buvo stebimas moterų DHEAS tyrimų pikas. Daugmaž visose amžiaus grupėse vyrų DHEAS tyrimų kiekis buvo pasiskirstęs vienodai. Analizuojant 491 ligonio ambulatorines korteles pagal amžių ir įvairias DHEAS reikšmes, nustatėme, kad 0-9 m. amžiaus grupėje net 50% berniukų rastas žemas DHEAS.Tarp 10-19, 45-54 ir 55-64 m. amžiaus vyrų patologinių rezultatų easta labai mažai, o normalių – aukštas procentas (86,9-88,6 ir 91,3% atitinkamai). [...].