Úvodní slovo prof. MUDr. Michala Krška, CSc., editora tohoto vydání časopisu Vnitřní lékařství

Michal Kršek

Vnitr Lek 2015, 61(10):845  

Adrenal incidentaloma

Jan Čáp, Filip Gabalec

Vnitr Lek 2015, 61(10):852-857  

Incidentaloma is an adrenal mass discovered serendipitously. Because of increasing use of imaging techniques it is a common finding, being present in more than 1 % of adults. During work-up malignancy has to be ruled out. Classically imaging using CT or MRI is used. Recently PET-CT with FDG has been used more often as its sensitivity for diagnosis of malignancy is about 97 % and specificity 91 %. Hormonal evaluation should diagnose subclinical hypercortisolism. (Dexamethasone Suppression Test is the method of choice). Aldosterone and Renin should be measured only in patients with hypertension and catecholamines in tumours with higher native density...

Adrenal insufficiency

Filip Gabalec, Jan Čáp

Vnitr Lek 2015, 61(10):858-861  

Adrenal insufficiency is a potentially life threatening condition. The paper deals with differential diagnostics and limits of dynamic testing, possibilities of de-escalation of corticosteroid therapy and substitution therapy with glucocorticoids, mineralocorticoids and androgens. New replacement possibilities are mentioned including those in development.

Thyroid gland and pregnancy - summary of important findings

Zdeňka Límanová

Vnitr Lek 2015, 61(10):862-867  

Thyroid hormones play fundamental role in conception and pregnancy and are essential for normal adult health, fetus and childhood development. Many studies have shown an association between maternal thyroid diseases esp. hypothyroidism with obstetric problems and/or psychomotoric impairment in the offspring. The prevalence of undiagnosed lower thyroid function in pregnancy is present in about 4-8 % of pregnant women, and euthyroid women with thyroid autoimmunity (6-8 %) are further candidates for thyroid disorders in pregnancy. The thyroid gland needs to produce 50 % more thyroxine in pregnancy to maintain an euthyroid state to keep TSH ideally ≤...

Management of hypothyroidism and hyperthyroidism

Jan Jiskra

Vnitr Lek 2015, 61(10):868-872  

Functional thyropathies present significant health risks for patients. Advanced functional thyropathies are always treated while indications for therapy of subclinical thyropathies are individual and often controversial. It is widely agreed that these disorders should be diagnosed and individuals should be followed. The drug of choice in substitution therapy of hypothyroidism is levothyroxine, in the treatment of hyperthyroidism it is methimazole. Administration of propylthiouracil should be limited to the first trimester of pregnancy, because its serious hepatotoxicity has been described. Hyperthyroidism based on thyroid nodules and immunogenic hyperthyroidism...

Subclinical thyroid disease

Václav Zamrazil

Vnitr Lek 2015, 61(10):873-876  

Importance of subclinical thyroid disease (STh) is now a matter of discussion. Definition of this unit is laboratory: in presence of normal level of thyroxine (T₄) TSH value is changed: in lower TSH level the subclinical hyperthyroidism (STx) in increase TSH levels subclinical hypothyroidism (SH) is present. Risk of clinical manifestation is twoo three times highter in comparison with persons with normal TSH level. Clinical importance STh is still not evaluated definitively. SH caused disturbance of lipid metabolism, elasticity of vessels and endothelial function and therefore increases risk of atherosclerosis. STx causes electrical instability...

Autoimmune thyroiditis and thyroid cancer

Jan Krátký, Jan Jiskra

Vnitr Lek 2015, 61(10):878-881  

Association between autoimmune thyroiditis (CLT) and thyroid cancer remains not clear. Although both diseases often occur simultaneously in histological samples, it is not yet clear whether CLT can be regarded as a risk factor for thyroid malignancy. This review focus on the known epidemiological and molecular genetics links between both diseases. Most studies have shown a significant association between thyroid cancer and positive antibodies to thyroglobulin and histological evidence of CLT, as well. Both disorders share some risk factors (greater incidence in women, in areas with adequate supply of iodine and in patients after radiotherapy of the...

Functional hypothalamic amenorrhea

Luboslav Stárka, Michaela Dušková

Vnitr Lek 2015, 61(10):882-885  

Functional hypothalamic amenorrhea (FHA) besides pregnancy and syndrome of polycystic ovary is one of the most common causes of secondary amenorrhea. FHA results from the aberrations in pulsatile gonadotropin-releasing hormone (GnRH) secretion, which in turn causes impairment of the gonadotropins (follicle-stimulating hormone and luteinizing hormone). FHA is a form of the defence of organism in situations where life functions are more important than reproductive function. FHA is reversible; it can be normalized after ceasing the stress situation. There are three types of FHA: weight loss related, stress-related, and exercise-related amenorrhea. The...

Polycystic ovary syndrome

Jana Vrbíková

Vnitr Lek 2015, 61(10):886-895  

For diagnosing of polycystic ovary syndrome (PCOS) it is currently recommended to follow the ESHRE criteria. For diagnosis according to them two of the following three symptoms are sufficient: 1. morphology of polycystic ovaria, 2. clinical manifestations of hyperandrogenism or laboratory proof of hyperandrogenemia, and 3. oligo-anovulation. PCOS is a complex disorder in whose pathogenesis genetic and environmental effects interact. It is not a gynecological disorder alone, the syndrome is accompanied by insulin resistance which leads to increased incidence of type 2 diabetes mellitus and impaired glucose tolerance (4 times and twice, independently...

News in diagnostics and therapy of multiple endocrine neoplasia type 1

Karel Starý

Vnitr Lek 2015, 61(10):896-899  

MEN1 syndrome is an autosomal dominant disorder caused by mutation in the menin gene located on the 11th chromosome. It is a rare disorder with incidence of 1 : 30 000. It involves functional or cancerous diseases of parathyroid glands, hypophysis, endocrine pancreas, adrenal glands, or other tumors. The diagnosis of MEN1 is suspected if at least 2 components of this multiple tumor syndrome occur simultaneously. The increase in diagnostic precision enables detection of MEN1 in its early stages. Currently, the most frequently discussed topics include the use of biomarkers for diagnostics and new approaches in surgical treatment of MEN1.

Acromegaly: current view

Michal Kršek

Vnitr Lek 2015, 61(10):900-904  

Acromegaly is a rare disorder caused by autonomous oversecretion of growth hormone mostly by pituitary adenoma. Untreated acromegaly leads to significantly increased morbidity and mortality and impaired quality of life. Early diagnosis and treatment is therefore essential for improvement of patients' prognosis and management of acromegaly should be concentrated in specialized centres. Present article summarizes current view on diagnosis and treatment of acromegaly.

Systemic glucocorticoids treatment: practical view

Michal Kršek

Vnitr Lek 2015, 61(10):905-912  

Glucocorticoids are derivatives of natural human glucocorticoid cortisol. There are used for treatment of a number of diseases and disorders for more than 65 years mainly because of their immunosuppressive properties. However, their use is accompanied by various side effects that have to be considered when treating patients. The article summarizes biological effects of glucocorticoids, main indications for their use, their side effects and precautions necessary to bear in mind during treatment.

Významné životní jubileum prof. MUDr. Josefa Marka, DrSc.

Štěpán Svačina, Petr Sucharda, Michal Kršek

Vnitr Lek 2015, 61(10):843  

Náš pan profesor Marek

Michal Kršek

Vnitr Lek 2015, 61(10):844