Hlavná téma – Endokrinológia

prof. MUDr. Juraj Payer, CSc.

Vnitr Lek 2024, 70(1):3  

Pituitary adenomas from the internist's perspective

Jana Ježková, Tomáš Brutvan

Vnitr Lek 2024, 70(1):7-12 | DOI: 10.36290/vnl.2024.001  

Pituitary adenomas are the most common tumours of the sellar region. Prolactinomas are the most common type, followed by clinically non-functioning pituitary adenomas, acromegaly (Growth-Hormone secreting pituitary adenoma) and Cushing's disease (ACTH-secreting pituitary adenoma). Thyrotropinomas (TSH-secreting pituitary adenoma) and functional gonadotropinomas are rare. The correct diagnosis is based on the manifestation of clinical symptoms, evaluation of laboratory test results including dynamic tests, and imaging findings - most commonly Magnetic Resonance Imaging. Treatment of pituitary adenomas is often complex and involves a combination of treatment...

Personalized treatment of acromegaly - prediction of therapeutic response

Filip Gabalec, Jan Drugda, Jan Čáp

Vnitr Lek 2024, 70(1):13-16 | DOI: 10.36290/vnl.2024.002  

The article deals with the issue of personalized treatment of acromegaly with emphasis on prediction of therapeutic response. In the context of the rapidly developing field of personalized medicine, it emphasizes the variability of the clinical, biochemical and radiological features of acromegaly and the need for more accurate classification and personalized therapeutic approaches. Surgery remains the main therapeutic approach, and this article analyzes preoperative predictors of successful surgery, such as higher growth hormone concentrations before surgery and the negative impact of cavernous sinus invasion. Factors including signal intensity on...

Catecholamine induced cardiomyopathies in patients with pheochromocytoma

Zora Lazúrová

Vnitr Lek 2024, 70(1):17-21 | DOI: 10.36290/vnl.2024.003  

Pheochromocytoma/paraganglioma (PPGL) is a rare neuroendocrine tumour arising from chromaffine cells of sympathetic ganglia. 90% of PPGLs are located in adrenal medulla (pheochromocytoma), the rest are extraadrenal paragangliomas. PPGLs produce catecholamines - adrenaline and/or noradrenaline, in case of extraadrenal forms, dopamine may be rarely secreted. An overproduction of these hormones usually manifests by the cardiovascular diseases, mostly with arterial hypertension. In 8-11% of patients, catecholamine excess leads to heart injury. Katecholamine-induced cardiomyopathies (CICMP) are severe, potentially fatal complications of PPGLs. Clinical...

Clinical manifestations of chronic hypoparathyroidism

Roman Králik, Martin Kužma, Juraj Payer

Vnitr Lek 2024, 70(1):22-27 | DOI: 10.36290/vnl.2024.004  

Hypoparathyroidism is a rare disease, which is unique among endocrine diseases because of the fact, that it is the only disease with a hormonal deficit not treated with hormonal supplementation as the standard mode of therapy. Conventional therapy is based on oral calcium and vitamin D substitution. This treatment is often complicated, especially in adjusting the dosage of calcium and vitamin D supplementation and also because of the numerous complications affecting virtualy every system in the human body. Generally, these complications are divided into skeletal and nonskeletal. Changes in bone mineral density and microarchitecture are the main skeletal...

Dual GIP and GLP-1 agonists and changes in the lipid spectrum

David Karásek

Vnitr Lek 2024, 70(1):35-39 | DOI: 10.36290/vnl.2024.006  

Tirzepatide - a dual agonist of receptors for glucagon-like peptide-1 (GIP) and glucose-dependent insulinotropic polypeptide (GIP) is an effective antidiabetic drug associated with significant weight loss, which is expected to have the potential to influence the cardiovascular risk of patients. This review focuses on its effects on the lipid spectrum, compares it to the effects of selective GLP-1 receptor agonists, and provides insight into the development of other incretin agonists and their metabolic actions.

Sildenafil in a new innovative dosage form (orodispersible film)

Jiří Slíva

Vnitr Lek 2024, 70(1):40-43 | DOI: 10.36290/vnl.2024.007  

Erectile dysfunction is characterised by a high prevalence. As part of pharmacotherapy, substances that induce reversible inhibition of phosphodiesterase 5 (PDE-5) have been used for a quarter century. Such an inhibition results in a significantly better filling of the cavernous bodies. A typical representative of this group of drugs is sildenafil. In addition to the classic tablet form, it can be used in the form of an orally dispersible film.

Expert opinion of representatives of professional societies on the position of finerenone in the treatment of type 2 diabetics with chronic kidney disease

Ondřej Viklický, Vladimír Tesař, Ivan Rychlík, Martin Prázný, Romana Ryšavá, Richard Češka, Martin Haluzík, Petr Ošťádal, Jan Krejčí, Miloš Táborský

Vnitr Lek 2024, 70(1):44-48 | DOI: 10.36290/vnl.2024.008  

Both heart failure and chronic kidney disease (CKD) are detected more often in the type 2 diabetic population than in the general population. CKD screening should focus on its early detection to reverse, or at least significantly slow down its course and delay stage 5 CKD with the need for chronic dialysis or transplant treatment. Finerenone is a nonsteroidal, selective mineralocorticoid receptor antagonist. The effects of finerenone in patients with type 2 diabetes were investigated in the large registration phase III clinical trials FIDELIO-DKD, FIGARO-DKD and subsequently in their pooled analysis FIDELITY. Based on the results of published prospective...

News in insulin treatment

Dominika Mačáková, Ondřej Krystyník, Ľubica Cibičková, David Karásek

Vnitr Lek 2024, 70(1):49-54 | DOI: 10.36290/vnl.2024.009  

Although more than 100 years have passed since the discovery of insulin, this body's own hormone and drug is still widely used in the treatment od diabetes. With the help of modern procedures we try to adapt its administration to the physiological state as much as possible. The changed pharmacokinetics of rapid-acting insulin analogs, which closely copies the physiological curve of insulin release after food intake, helps us. And we also add prolonged effect of basal insulin analogs and theirs flatter pharmacokinetic profile. Thanks to these modifications, we are able to individualize the treatment of diabetes, archieve better compensation and lower...

The liver manifestation of metabolic syndrome is now called MASLD - an up-to-date view of the most common liver disease today

Václav Šmíd, Karel Dvořák

Vnitr Lek 2024, 70(1):E8-E14 | DOI: 10.36290/vnl.2024.013  

Non-alcoholic fatty liver disease together with alcohol-related liver disease represent the most common chronic liver diseases in the Czech population. Both could - according to their severity - manifest as a whole spectrum of clinical pictures from simple steatosis to cirrhosis with its serious complications, especially portal hypertension and hepatocellular carcinoma. Due to increasing prevalence of diabetes mellitus type 2 and obesity, the first disease mentioned above gains importance and this article is discussig its diagnosis and treatment options. At the same time, the authors take the liberty of drawing the reader's attention to a significant...

Postgraduate training in internal medicine - where do we stand? We can take inspiration from the European Board of Internal Medicine's qualification requirements for internal medicine training

Zdeněk Monhart

Vnitr Lek 2024, 70(1):E15-E19 | DOI: 10.36290/vnl.2024.014  

The education of high-quality specialists in the field of internal medicine is a demanding process that requires a lot of effort, especially on the part of the trainee, but also the active involvement of the supervisor and the training institution. The current system of postgraduate education in the Czech Republic is still based on the completion of the prescribed practice and the acquisition of a prescribed amount of knowledge, the knowledge of which is verified at the end of the educational process. However, the competencies of an internist have more dimensions than just acquiring enough knowledge in the field of internal medicine. The education...

The results of a survey: "Diagnosis and treatment of heart failure in the clinical practice"

Filip Málek, Aleš Linhart, Radek Pudil, Jiří Veselý

Vnitr Lek 2024, 70(1):28-34 | DOI: 10.36290/vnl.2024.005  

The survey from outpatients secondary care clinics was focused on questions related to diagnostics and treatment of heart failure. A special attention was paid to the presence of symptoms of patients not yet diagnosed with heart failure. The survey showed reserves in the heart failure treatment. It has been further shown, that the important proportion of patients have symptoms but are not properly diagnosed with heart failure, despite having elevated NT-proBNP levels.

Advanced technologies in medicine: experts' views on prescribing a "closed-loop insulin pump/sensor" to a patient with advanced diabetic complications and a history of non-adherence to treatment - a qualitative study

Ema Povolná, Pavlína Krollová, Lucia Bučková, Jana Urbanová, Svatava Krejčová, Juraj Michalec, Ludmila Brunerová, Adina Večeřová, Vratislav Blažek, Jan Brož

Vnitr Lek 2024, 70(1):E3-E7 | DOI: 10.36290/vnl.2024.012  

A case study of a complicated patient with type 1 diabetes (reduced adherence to treatment, dialysis programme, unilateral amaurosis, poor social background) served as a basis for eight respondents of a qualitative study to consider whether modern hybrid closed-loop therapy can help similar patients and how to work with them further. Emphasis on patient motivation, involvement of the close family in care, selection of an appropriate device, good quality step-by-step education, increased frequency of check-ups at the beginning of therapy, and regular assessment of treatment progress were mentioned as essential elements for effective treatment.

Practical clinical recommendations for perioperative care in bariatric surgery 2023: adaption of ERAS (Enhanced Recovery After Surgery) recommendations with consensual voting of working group of Joint Section of Bariatric and Metabolic Surgery of Czech Surgery Society and Czech Obesitology Society

Igor Satinský, Martin Hrubý, Petra Šrámková, Jiří Patka, Michal Čierný, Pavol Babiak, Igor Šimoník, Peter Schwarz, Martin Haluzík

Vnitr Lek 2024, 70(1):E20-E32  

Introduction: Bariatric surgery is the most effectice treatment for the morbid obesity. It results in sustained weight loss as well as pronounced effects on obesity-related comorbidities. In the last twenty years the number of procedures performed worldwide increased. Therefore, the effort to establish a consensus in perioperative care based on best evidence in this issue is evident. Methods: Working Group of Joint Section of Bariatric and Metabolic Surgery of Czech Surgery Society and Czech Obesitology Society reached practical recommendations for ERAS (Enhanced Recovery After Surgery) in perioperative care in bariatric surgery. It issued from ERAS...

Coincidence of liver cirrhosis and Cushing's disease

Lucie Krausová, Mikuláš Kosák, Petr Hříbek, David Netuka, Václav Masopust, Tomáš Tůma, Soňa Fraňková, Petr Urbánek

Vnitr Lek 2024, 70(1):55-59 | DOI: 10.36290/vnl.2024.010  

Liver cirrhosis as well as Cushing's syndrome have quite characteristic clinical picture that usually leads to an early diagnosis. Here we present a rather complex case of a 46-year-old patient with an unusual coincidence of Cushing's disease and cirrhosis causing complications during diagnostic evaluation and particularly during the treatment of both diseases.

Bleeding disorders - overview for clinical practice

Monika Bradáčová, Antonín Hluší

Vnitr Lek 2024, 70(1):E33-E39 | DOI: 10.36290/vnl.2024.015  

bleeding disorders are situations manifested clinically by bleeding or an increased risk of bleeding caused by various reasons. In addition to anatomical causes, the main reasons for haemorrhage include impaired haemostasis. From the clinical point of view these are clinical situations in which bleeding is inadequate to inducing stimulus or begins spontaneously and may manifested itself as difficult-to-stop bleeding or prolonged bleeding after operation or after injury. The basis is disturbance of balance due to a quantitative or qualitative disturbance of one of the hemostatic mechanisms, the causes can be combined. The aim of this article is to provide...

Recommended dosing of anticoagulants in times of obesity pandemic

Alena Pilková

Vnitr Lek 2024, 70(1):60-65 | DOI: 10.36290/vnl.2024.011  

Anticoagulants are an important therapeutic group of drugs used in the prevention and treatment of thromboembolic disease. Despite their widespread use, many questions remain unanswered regarding their dosage in the growing group of obese patients. Published studies indicate that an increase in prophylactic dose of parenteral anticoagulants may be appropriate, although for the most studied drug, enoxaparin, various recommendations lead to significant dosing differences for patients with higher degree of obesity. Therapeutic dosing of enoxaparin should be kept at the standard 1 mg/kg twice daily up to the weight of approx. 150 kg. The growing experience...