Úvodní slovo prof. MUDr. Michala Krška, CSc., spolueditora tohoto čísla časopisu Vnitřní lékařství

Michal Kršek

Vnitr Lek 2017, 63(9):545  

Thyroid disease in the Czech Republic: the EUthyroid project and the evaluation of the General Health Insurance Company epidemiological data for the period of 2012-2015

Radovan Bílek, Lenka Horáková, Robert Goš, Václav Zamrazil

Vnitr Lek 2017, 63(9):548-554 | DOI: 10.36290/vnl.2017.111  

Institute of Endocrinology participates in the grant of European Commission EUthyroid (Towards the elimination of iodine deficiency and preventable thyroid-related diseases in Europe), together with other 28 European countries. The role of Institute of Endocrinology in EUthyroid is among other things to ensure access to national registers relating to thyroid diseases. The results presented here correspond to the years 2012-2015 and are based on data from the General Health Insurance Company Czech Republic (VZP CR), which has 6 million insured persons (ratio male : female = 1 : 1). The set is sufficiently representative to be related to the whole of...

Thyroid screening in pregnancy - guideline in practice

Patrícia Páleníková, Iveta Kalafutová, Zdenka Horníková, Juraj Payer

Vnitr Lek 2017, 63(9):555-560 | DOI: 10.36290/vnl.2017.112  

Thyroid diseases may adversely affect the conception, maintain pregnancy. They increase the risk of complications in pregnancy and may have a negative effect on the fetus. Therefore it is necessary to capture thyroid diseases in the population of pregnant women, in the early stage of pregnancy. In Slovakia, since 2009, the Expert Guideline of the Ministry of Health of the Slovak Republic for the diagnosis and treatment of autoimmune thyroid diseases in women during pregnancy has been in force. In our patient cohort, we monitored 666 pregnant patients, the timeliness of screening, thyroid parameters, the number of pregnancies and their complications,...

Valvular heart disease in relation to the treatment of hyperprolactinemia with dopamine agonists

Filip Gabalec, Jan Čáp, Jakub Radocha

Vnitr Lek 2017, 63(9):561-565 | DOI: 10.36290/vnl.2017.113  

Adverse effect of dopamine agonists on the heart valves aroused much attention some time ago. Gradually, as data accumulated, the approach to the problem was rationalised and further examinations were only recommended in indicated cases. The paper reviews the current knowledge about the treatment of hyperprolactinemia with dopamine agonists and the risk of valvular disease.

Hypothyroidism in patients with heart disease

Jan Jiskra

Vnitr Lek 2017, 63(9):566-571 | DOI: 10.36290/vnl.2017.114  

Hypothyroidism is frequently found in patients with heart disease. It is a risk factor for atherosclerosis and ischemic heart disease and has a direct negative effect on both the left and right ventricular functions (hypothyroidism-induced cardiomyopathy). The confirmed manifest hypothyroidism is always a reason for replacement therapy with levothyroxine; regarding patients with heart disease, we always begin treatment with a small dose and increase it gradually. The treatment of subclinical hypothyroidism in patients with heart disease is disputable and its benefits probably depend on age. At a higher age, the therapy-related risks often outweigh...

Thyroid carcinomas: the present view on diagnostics and therapy

Petr Vlček, Dana Nováková, Rami Katra

Vnitr Lek 2017, 63(9):572-579 | DOI: 10.36290/vnl.2017.115  

Thyroid carcinoma (TC) represents 1-2 % of all human tumors, and is the seventh most common tumor. Women are in large majority among new patients. For women, this is the fifth most common tumor. In the Czech Republic, 1 143 new cases of TC were diagnosed in 2015. It is the tumor with the highest increase in incidence. Among newly diagnosed tumors, most of those are differentiated thyroid gland carcinomas (DTCs) originating from follicular thyroid cells. These tumors are follicular and papillary carcinomas and Hurthle carcinoma, accounting for 95 % of new cases. Due to the great progress in treatment, the prognosis is most commonly good for these tumors....

Diagnosis and management of metastatic pheochromocytoma and paraganglioma

Ivana Jochmanová, Ivica Lazúrová

Vnitr Lek 2017, 63(9):580-588 | DOI: 10.36290/vnl.2017.116  

Pheochromocytoma (PHEO) and paraganglioma (PGL) are rare catecholamine-producing neuroendocrine tumors arising from adrenal medulla or extra-adrenal sympathetic and parasympathetic ganglia. Most of the PHEOs/PGLs are benign tumors, but metastatic disease is common, especially in patients with particular genetic background. Although PHEOs/PGLs were described more than a century ago, diagnosis and therapy of metastatic disease are still challenging. Advances in understanding molecular and metabolic changes associated with tumorigenesis lead us to identification of the background of these tumors. Novel information allowed for development of more precise...

Bone quality in patients with acromegaly

Martin Kužma, Ivana Ságová, Dušan Pávai, Peter Jackuliak, Zdenko Killinger, Peter Vaňuga, Juraj Payer

Vnitr Lek 2017, 63(9):589-592 | DOI: 10.36290/vnl.2017.117  

The impact of acromegaly on bone and the risk of fractures has not been sufficiently investigated. GH hypersecretion stimulates bone turnover, leading to an increase in bone turnover markers. Normal or even increased bone mineral density (BMD) in comparison to healthy controls have been reported, but there are some works where decreased BMD was observed among acromegaly patients with hypogonadism, particularly at lumbar spine. Less pronounced effect of GH overproduction was observed at the femoral neck, as explained by the positive effect of hypersecretion on the cortical bone (due to periosseal ossification). Several studies have documented morphometric...

Syndrome of inappropriate antidiuresis and the current management of hyponatremia

Ivica Lazúrová

Vnitr Lek 2017, 63(9):593-597 | DOI: 10.36290/vnl.2017.118  

Hyponatremia defined as serum sodium lower than 135 mmol/L is the most common electrolyte abnormality in outpatients and also in hospitalized patients. It has been documented that hyponatremia is associated with significantly higher morbidity, mortality and longer hospitalization stay. Hyponatremia is manifested by variety of symptoms, from mild up to life threatening conditions. Syndrome of inappropriate antidiuresis (SIAD) is the most common type of hyponatremia. This article presents new aspects in the etiology, diagnosis, differential diagnosis ant treatment of the SIAD according to European guidelines.

Anabolic steroid induced hypogonadism in men: overview and case report

Luboslav Stárka, Michaela Dušková, Lucie Kolátorová, Oldřich Lapčík

Vnitr Lek 2017, 63(9):598-603 | DOI: 10.36290/vnl.2017.119  

An important potential consequence of the anabolic steroid misuse is hypogonadotropic hypogonadism due to the inhibition of pituitary secretion of gonadotropins. By the symptoms as testicular atrophy, spermatogenic and fertility disturbances or dysfunction in sexual life, the anabolic steroids induced hypogonadism (ASIH) could be differentiated from organic hypogonadotropic hypogonadism only with difficulty unless the misuse is reported by the user. When diagnosed, the crucial step in the therapy is the stop of anabolic use. Convalescence lasts usually several months or even more than one year. First could be seen the retreat of testicular atrophy...

Primary hyperparathyroidism - new clinical forms of the disease

Kateřina Zajíčková

Vnitr Lek 2017, 63(9):604-608 | DOI: 10.36290/vnl.2017.120  

Primary hyperparathyroidism (PHPT) has been increasingly diagnosed incidentally in its asymptomatic form owing to calcium screening tests. This form of PHPT represents 80% in developed countries. Although PHPT patients are asymptomatic, target organ (bone and kidney) involvement is frequently observed. Mild PHPT is associated with a reduction of bone mineral densityand, moreover, with increased risk of vertebral fractures. The extent of a patient evaluation and indications for parathyroidectomy are based on expert guidelines from 2014. Normocalcemic variant of PHPT has been recently recognized, possibly with higher prevalence in general population...

Antidiabetic drugs and their effect on bone

Peter Jackuliak, Martin Kužma, Juraj Payer

Vnitr Lek 2017, 63(9):609-616 | DOI: 10.36290/vnl.2017.121  

It is well established that osteoporosis and diabetes are prevalent diseases with significant associated morbidity and mortality. Patients with diabetes mellitus are at an increased risk of bone fractures. Today we have several groups of effective and save antidiabetic drugs, which are very given often in combination. Although diabetes-related complications are important in the etiology, the effects of medications on bone metabolism and fracture risk should not be neglected, because the diabetes medication may affect also bone health and fracture risk. Increased risk of fracture has been identified with use of thiazolidinediones, most definitively...

Adenosine - a mediator with multisystemic effects (or a hormone?)

Zora Lazúrová, Peter Mitro

Vnitr Lek 2017, 63(9):617-623 | DOI: 10.36290/vnl.2017.122  

Adenosine is a nucleoside regulating many physiological and pathological processes in human organism. It is produced by almost all cells and is metabolised by adenosinedeaminase enzyme. Effect of adenosine is mediated by three types of adenosine receptors. Adenosinergic system significantly influences function of cardiovascular system, furthemore it plays a key role in sleep homeostasis, in regulation of bone metabolism and activation of immune system. Adenosine mediates effect of various hormones, but also adenosine itself has its own autocrine, paracrine and systemic effects. Changes in endogenous adenosine levels, or changes of adenosine receptor...