Knispelis, Robertas

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Tikslas. Įvertinti pacientų, kuriems atlikta transfenoidalinė hipofizės adenomos šalinimo operacija, endokrinines išeitis bei komplikacijas. [...].

Spontaneous remission of Cushing disease might be a phase of cyclic disease, but could also be explained by an ACTH-microadenoma infarction or hemorrhage. True remission must be differentiated from cyclic Cushing’s disease with prolonged follow up. 63-years-old female patient was referred to endocrinologist’s and presented with uncontrolled hypertension, type 2 diabetes, central obesity, hirsutism, swelling of the face and legs and a ‘buffalo hump’. After additional investigation elevated ACTH (24.1pmol/l (n1.63-14.15)), basal cortisol (1187nmol/l (n147-726)) and high 24-hours urinary free cortisol 2236.4nmol/l (n138- 524) were determined. Cortisol was not suppressed after low-dose dexamethasone suppression test. Pituitary MRI revealed 0.5x0.2x0.3cm hypointense zone in posterior pituitary. Petrosal sinus sampling was planned, but the patient was admitted to the emergency department with panniculitis in her limbs. After chest and abdominal CT scan 3.1x2.4cm tumor in left ventricle and 0.6cm hypointense tumor in the liver was detected. Patient case was discussed at multidisciplinary team and it was concluded that at that moment biopsy benefit would not outweigh the risks. Patient was treated with iv a/b. When inflammation markers decreased petrosal sinus sampling was performed. It confirmed pituitary source of ACTH production and right side lateralization which coincided with MRI data. During two months period from the first suspicion of pituitary microadenoma till the petrosal sinus sampling was performed, clinical symptoms of Cushing syndrome significantly decreased as well as hormone levels: basal cortisol level 1187->403.16nmol/l, ACTH 24.1->7.1pmol/l. Diabetes control significantly improved as well. The situation was interpreted as spontaneous remission and it was decided to continue active observation of the patient. However, 10 months later worsening of patient’s status was observed. Basal cortis[...].

Background Patients with acromegaly may have high symptom burden. The phase 3 MPOWERED trial assessed control of acromegaly by oral octreotide capsules (OOC; MYCAPSSA®) in comparison to injectable somatostatin receptor ligands (iSRLs) in patients responding to both OOC and iSRLs. iSRLs have been first-line medical treatment for patients with acromegaly for decades. OOC are newly approved in the US for patients previously controlled on iSRLs. Methods Eligibility criteria for MPOWERED included acromegaly diagnosis, biochemical control of acromegaly (insulin-like growth factor I <1.3 × upper limit of normal; mean integrated growth hormone, <2.5 ng/ml) and ≥6 months’ iSRL (octreotide, lanreotide) treatment. Eligible patients entered a 26-week Run-in phase to determine the effective OOC dose; responders at week 24 then entered a 36-week randomized controlled treatment (RCT) phase receiving OOC or iSRLs. Acromegaly symptom number and severity (mild to severe, 1–3) were collected. Total score was calculated by summating all severity scores (Acromegaly Index of Severity [AIS]). Symptom results were assessed using total AIS score and proportion of patients experiencing individual symptoms. Results At beginning of Run-in, average AIS score of 92 randomized patients was 4.52, representative of symptoms experienced while previously receiving iSRLs. After 26 weeks’ OOC treatment at end of Run-in, average AIS score was significantly reduced to 3.46 (P <0.001). More than 80% of patients on OOC improved or maintained AIS score during Run-in compared to baseline. Over this 26-week period, there was a significant reduction in extremity swelling (P = 0.01) and fatigue (P = 0.03). During the RCT, of patients randomized to OOC (n = 55), 73% maintained or improved AIS score, and 75% maintained or reduced overall number of active symptoms. In comparison, 68% of those randomized to iSRLs (n = 37) maintained or improved AIS [...].

Algoritmas (lot. algorismus

Įvadas. Hipofizės adenoma (HA) gėrybinis navikas augantis iš priekinės hipofizės dalies. Dalis HA gali būti funkcionuojančios – pasireiškiančios įvairiais hormonų hipersekrecijos nulemtais klinikiniais simptomais. Prolaktiną produkuojančios hipofizės adenomos dažniausiai kliniškai pasireiškia amenorėja ar galaktorėja moterims, sumažėjusiu libido vyrams. Somatotropinomos, išskirdamos didelius augimo hormono kiekius sukelia dismorfinius veido bruožų pokyčius bei galūnių didėjimą. Centrinio tipo nutukimas, mėnulio formos veidas, pletora, būdingi Kušingo ligai. Šie kūno įvaizdžio pokyčiai gali sąlygoti emocinės būklės pokyčius. Tikslas. Nustatyti ryšį tarp kūno įvaizdžio ir emocinės būklės pokyčių bei HA hormoninio aktyvumo. [...].

Introduction Pituitary adenomas are benign intracranial tumors. However, some of them are resistant to multiple medical treatments and are clinically considered to be aggressive. Case report Twenty years old male patient presented with symptomatic hyperglycemia and general weakness. With suspected diagnosis of type 1 diabetes patient was hospitalized in Kauno Klinikos, Endocrinology Department. In further clinical observation acromegalic appearance noticed. After additional investigation elevated STH 126.05 ng/l (ULN!10) determined, pituitary MRI revealed 2.0!3.0 mm microadenoma. Patient was diagnosed with acromegaly and transsphenodal pituitary adenoma surgery was performed in 2000. However, 4 months after surgery STH 34 ng/ml (ULN!10) and IGF-1 951 nmol/l (ULN!2) remained elevated. Pituitary MRI revealed 0.9!0.9 cm adenoma’s regrowth and invasion into cavernous sinus. Despite of initiated treatment with dopamine agonist -Bromocriptine and dose escalation up to 35 mg/per day, no positive clinical effects were observed. One year after surgery hormones markedly increased STH 268 ng/ml (ULN!26), IGF 1613 nmol/l (ULN!3). Pituitary MRI revealed tumor extension 1.0!0.9!1.3 cm - second transsphenoidal pituitary adenoma surgery was performed, continuing treatment with Bromocriptine as well. 3 years after diagnosis of acromegaly, patient visited endocrinologist complaining of low libido, erectile dysfunction, headache and sweating. STH persisted elevated STH 30 ng/ml (ULN!20), MRI disclosed recurrence of pituitary adenoma, PRL (!10 mLU/l (LLN 50!) was suppressed due to continuation of treatment with dopamine agonists. As initial treatment with surgerys and dopamine agonist was insufficient radiotherapy was started. One year after RT MRI disclosed empty sella syndrome. Since modern medical treatment for acromegaly became available in 2007, treatment with subcutaneous injections of somatostatin receptor ligands was st[...].

Introduction Giant prolactinomas are rare tumours, they represent range from 0.5 to 4.0% of all pituitary tumours. We are presenting a patient with giant prolactinoma without visual field defects and any obvious clinical symptoms related to hyperprolactinemia and probably associated with alopecia universalis. Case 32 years old man has visited outpatient department of our hospital, complaining of severe headache for the last three years. He underwent brain CT scan and 4.8! 5.8 cm pituitary macroadenoma was revealed. The first prolactin measurement (RIA) was 4409.0 mU/L (NR: 38–379 mU/L). Further evaluation revealed episodically lower testosterone levels (from 8.85 up to 12.6 nmol/L (NR: 9.26– 35.1 nmol/L), and IGF-1 was near lower normal limit:K20.5 nmol/L (NR: 20.2– 25.4 nmol/L). Other hormones were at normal range and neuroophthalmological assessments were without any pathological signs for all time of observation. Physical examination revealed AU and family history was confirmed - patient’s mother also suffered from AU. Treatment was started with cabergoline 2 mg per week and after two weeks the dose was increased to 3 mg per week. After one month of treatment prolactin decreased to 948.0 mU/L, after 3 months the prolactin concentration reached the normal range- 321.0 mU/L. The dose of cabergoline was increased further to 4 mg per week. After 6, 12 and 24 months of treatment concentrations of prolactin were 171.0 mU/L, 77.0 mU/L and 48.0 mU/L respectively. The patient was treated with dose 4 mg per week for another 12 months and the prolactin concentration remained suppressed. One month after start of the treatment, the MRI scan was performed: the size of pituitary adenoma was decreased to 2.7!2.1!4.2 cm. The positive dynamics on the MRI scans steadily persisted after 3, 12 and 28 months, according to the last MRI the size of macroadenoma was reduced to 2.5!2.6!2.8 cm. Just after two weeks of[...].

Pituitary adenomas (PA) are benign brain tumors causing hormonal imbalance, which frequently is followed by physiological symptoms and cognitive dysfunction. PA patients usually suffer from deficits in different memory domains, including working memory, recall and recognition, which are essential for everyday tasks. Neurosurgery is one of main treatment options for PA. It is presumed that after PA is surgically removed, some of cognitive functions including memory might recover over time, however research studies in this area are scarce. The objective of this study was to assess whether longer period following PA surgery is related to better memory functioning. 36 patients (24 females and 12 males, mean age 50 (SD 13) years) participated in this study. Average follow-up duration after surgery was 82 ± 64 months. Memory domains (working memory, delayed recall and recognition) were measured by Lithuanian version of Hopkins Verbal Learning Test-Revised. Results showed that one-third of participants still demonstrated significant impairments in delayed recall and recognition domains, and nearly one-fifth had impaired working memory. Correlation analysis revealed significant relationship between longer period following PA surgery and better performance on recognition task (r = 0.361; p = 0.03), however no significant relationships were found between longer period following PA surgery and better functioning in working memory and delayed recall domains. In conclusion, memory impairment is prevalent many months after PA surgery. It seems, that working memory and delayed recall difficulties are relatively stable and do not improve over time, however recognition may recover after PA is surgically removed.