Banišauskaitė, Ilona

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 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.

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). [...].

Mes pradėjome sistemingą dehidroepiandrosterono sulfato (DHEA-S) tyrimą po to, kai aprašėme savo pirmą atvejį - 36 metų moterį - su daugybe klinikinių simptomų, kurie išnyko, pašalinus dešinio antinksčio onkocitomą. Šiame tyrime analizavome 3533 pacientų duomenis pagal DHEA-S tyrimų sąrašus. 3013 buvo moterys, o 520 – vyrai. DHEA-S tiriama 4-15 kartų dažniau moterims nei vyrams. Laikotarpyje tarp 20 ir 34 m. tiriamų moterų procentas buvo aukštesnis nei vyrų. Daugmaž visose amžiaus grupėse vyrų DHEA-S tyrimų kiekis buvo pasiskirstęs vienodai. Tiriant DHEA-S įvairaus amžiaus grupėse, 10-25 m. moterų DHEA-S buvo aukštesnis nei to paties amžiaus vyrų. Po 40 metų dešimtmečiais vyrų DHEA-S buvo statistiškai patikimai aukštesnis nei moterų. Pirmame mūsų ambulatorinių kortelių tyrime radome tik 3 nedidelius antinksčių auglius (AA) turinčias moteris su virilizacijos požymiais. Jau pirmo tyrimo metu tyrėjai pastebėjo, kad kai kuriems vyrams randamas žemas DHEA-S. Visai skirtingi rezultatai buvo gauti tiriant ligonius su AA. Radome 58 vyrus ir 71 moterį su AA. Čia didesnis procentas asmenų su AA buvo stebimas tarp jaunų moterų (0 – 40 m.), toks pat tarp abiejų lyčių 45-65 gyvenimo metais, o po 65 metų iki 90 m vyrų su AA buvo daugiau nei moterų. Vidutinis vyrų su AA amžius buvo 66 m, o moterų su AA – 44 m. Pirmoji hipotezė buvo, kad aukštas DHEA-S vyrams sulėtina AA vystymąsi. Vis tik įtikinamiau atrodė, kad moterims pilvo kompiuterinė tomograma (KT) atliekama jaunesniame amžiuje nei vyrams. Kad patikrinti šią hipotezę, LSMUL Kauno klinikų Radiologijos klinikoje išanalizavome, imdami eilės tvarka, 1704 pacientų pilvo KT tyrimus. Šio tyrimo rezultatai nustebino: pilvo KT buvo atliekamos tame pat amžiuje ir vyrams, ir moterims, ir nebuvo matoma jų dažnio padidėjimo tuo momentu, kai būdavo randamas moterų ar vyrų AA išaišk[...].

Įvadas. Poūmis tiroiditas – tai ūmi uždegiminė skydliaukės liga, dažniausiai pasireiškianti lokaliu skausmu kaklo priekiniame paviršiuje. Literatūroje minima apie skausmą skydliaukės projekcijoje, sergant lėtiniu autoimuniniu tiroiditu. Abiejų būklių metu, atliekant skydliaukės echoskopiją, galime stebėti hipoechogeniškas zonas. Klinikinis atvejis. 51 m. moteris kreipėsi į Lietuvos sveikatos mokslų universiteto Kauno Klinikas, Endokrinologijos kliniką dėl lokalaus skausmo kaklo priekiniame paviršiuje. Laboratoriniuose tyrimuose: eritrocitų nusėdimo greitis (ENG) 34 mm/h (norma 0-13), C reaktyvinis baltymas (CRB) 3.82 mg/l (0-10), TTH 0.11 mIU/l (0.27-4.2), FT4 17.95 pmol/l (12-22), FT3 4.2 (3.34-5.14), anti-TTH-R 3.9 U/l (n. <9), anti-TPO 7 kU/l (0-12), anti-Tg 316 kU/l (0-100). Atliekant skydliaukės echoskopiją stebėta žemesnio echogeniškumo, nehomogeniška skydliaukės parenchima ir hipoechogeniškos heterogeniškos zonos abejose skiltyse. Skirtas gydymas nesteroidiniais vaistais nuo uždegimo (NVNU), palaipsniui mažinant dozes. Nepaisant gydymo, išliko padidėjęs ENG ir žemesnis TTH. Kartojant skydliaukės echoskopiją, hipoechogeniškos zonos išliko panašaus dydžio. Atlikta aspiracinė punkcija plona adata (APPA), siekiant paneigti skydliaukės vėžį. Histologiškai patvirtinti poūmiam tiroiditui būdingi pakitimai. Nutarta tęsti NVNU, papildomai skirtas gydymas Prednizolonu, palaipsniui mažinant dozę. Stebėtas teigiamas efektas. Po 3 mėnesių skydliaukės funkcija buvo normali, echoskopijos metu hipoechogeniškos zonos ženkliai sumažėjo. Išvados. Poūmis tiroiditas lėtinio autoimuninio tiroidito fone yra reta būklė. Ligos eiga ir skydliaukės echoskopijos rezultatai gali būti panašūs abejų ligų atvejais, todėl diferencinė diagnostika gali būti sunki. Echoskopijos metu stebimi parenchimos pokyčiai gali išlikti iki 1-2 metų. [...].

Introduction Lymphoma usually occurs within lymph nodes, but in rare cases, it arises from lymphocytes that are presented within the thyroid gland. Thyroid lymphoma is rare, representing less than 5% of thyroid malignancies and less than 2% of all lymphomas occurring outside of the lymph nodes and it is more likely to occur in people with Hashimoto’s thyroiditis. In this case we present a patient with Hashimoto’s thyroiditis (HT) and thyroid lymphoma (TL). Case 63 years women presented to the outpatients clinic with complains of fatigue, weakness of voice and enlargement of the neck. She has autoimmune thyroiditis (anti-TPO 53 kU/l) for 10 years. She has been taking Levothyroxin 50 mg per day for 5 years. Few weeks ago, she had noticed painless fast swelling left side of the neck and after 2 weeks the enlargement of the right side of the neck. Physical examination showed a large palpable mass on the both sides of the neck and an enlarged thyroid. Laboratory studies showed elevated sedimetation rate 34 mm/h (normal !13 mm/h), elevated anti-TPO antibodies 689kU/l (0–12) and anti-Tg 682 kU/l (0–100). Other laboratory measurements, including haemoglobin and leukocytes, thyroid hormones (FT4 15.22 pmol/l (12–22), TSH 0.72 mU/l (0.27– 4.2), anti-TSH-R 3U/l (!9)), calcitonin !0.42 pmol/l (0–2.8), were normal. In the thyroid ultrasound examination thyroid enlarged, hypoechoic, heterogeneous, in the left side pathological lymph nodes – suspicion of lymphoma or anaplastic carcinoma. Other radiological tests, including abdomen ultrasound, chest X-ray and mammography, evaluating the spread of oncological process, were normal. Core needle biopsy of the thyroid was taken and showed a Diffuse large B-cell lymphoma (DLBCL). PET-CT scan showed metabolically active lymphoproliferative process in the thyroid, in the lymph nodes of mediastinum, in the small intestine and in the mesenteric lymph nodes. The patient was di

Introduction De Quervain’s Thyroiditis (DQT) is a self-restriction inflammatory disease of the thyroid gland that presents severe pain localized in the neck. But few cases of a painful variant of Hashimoto’s thyroiditis (HT) have been described as well. Thyroid ultrasound (US) may reveal in homogeneous hypoechoic pattern in both conditions. Case A 51-year old woman was admitted to the Hospital of Lithuanian University of Health Sciences, Kauno klinikos with the pain in anterior region of the neck and throat. Laboratory tests: erythrocyte sedimentation rate (ERS) 34 mm/h (normal 0–13), C-reactive protein 3.82 mg/l (0–10), TSH 0.11 mIU/l (0.27–4.2), FT4 17.95 pmol/l (12–22), FT3 4.2 (3.34–5.14), anti-TSH-R 3.9 U/l (n!9), anti-TPO 7 kU/l (0–12), anti-Tg 316 kU/l (0–100). US revealed decreased echogenicity, nonhomogeneous thyroid parenchyma and heterogeneous hypoechoic focal areas in both lobes. The treatment with nonsteroidal anti-inflammatory drug (NSAID) was started with gradually reduced dose. However, mildly elevated ERS and suppressed TSH remained. US showed the same size of focal area 2 months later. For the differential diagnosis (DD) of thyroid cancer (TC), painful HT and DQT coexisting with HT, fine needle aspiration biopsy (FNAB) was performed. FNAB showed changes compatible with DQT. It was decided to continue the treatment with NSAID and prednisolone was prescribed while gradually reducing the dose. The patient’s condition has improved significantly. During follow-up appointment, after 3 months, thyroid hormones were in normal range and US showed decreased size of heterogeneous hypoechoic focal areas in both lobes. Conclusions Coexistence of DQT and HT is very rare and the diagnosis can be challenging. Clinical manifestation

Relation of dehydroepiandrosterone sulphate (DHEAS) concentration and adrenal tumors (AT) has never been investigated systematically. After promising Terzolo group (1995, 1996, 2000) investigations, there was made a recommendation in the last clinical guidelines for adrenal incidentaloma (2016) to assess concentration of DHEAS in special clinical situations. Here we present the first systemic study of DHEAS in adrenal tumors. The aim was to analyse the clinical and laboratory characteristics (including DHEAS) of 109 males and 54 females with AT. Methods During 2014–2016 years concentration of DHEAS was determined in 5133 patients. Out of those case records of 590 females and 450 males were randomly selected for a detailed retrospective analysis. The relation between presence or absence of AT and DHEAS was established. Age and gender adjusted maximal values (R max) and minimal values (R min) of DHEAS concentration were used to express the results. Results AT were detected in 109 males and in 54 females. R max %0.4 was found in 64.81% of females starting from 45 years-old and in 67% of males starting from 60 years-old. R max valueO1 was found in 11 cases of females (20.4%) and only in one case of males (0.92%). R min !1 value was detected in 13 cases of males (11.92%) and in two cases (3.7%) of females. Conclusions Out of all 163 cases of adrenal tumors, high level of DHEAS was found more frequently in females (7.36%), otherwise, low level of DHEAS was found more frequently in males (7.97%).