Fibrilácia predsiení (FP) je najčastejšia arytmia v klinickej praxi prispievajúca k zvýšenej morbidite a mortalite. Humorálne biomarkery, ako natriuretické peptidy, troponín, aldosterón, kortizol, kopeptín a apelín, zohrávajú čoraz dôležitejšiu úlo- hu v diagnostike, predikcii prognózy a manažmente FP. Zvýšené hladiny týchto biomarkerov naznačujú nielen poruchu funkcie myokardu a remodeláciu predsiení, ale aj zápalové a prokoagulačné stavy, ktoré ovplyvňujú vývoj a komplikácie FP. Sledovanie hladín biomarkerov poskytuje hlbší náhľad na patofyziologické mechanizmy FP a môže pomôcť pri identi- fikácii pacientov so zvýšeným rizikom komplikácií, ako sú tromboembolické príhody alebo progresia ochorenia. Integrácia biomarkerov do klinickej praxe môže výrazne zlepšiť stratifikáciu rizika, umožniť personalizovanejší prístup k liečbe FP a prispieť k efektívnejšiemu monitorovaniu priebehu ochorenia. Dôkazy o spojitosti medzi biomarkermi a FP sú povzbud- zujúce, avšak sú potrebné ďalšie štúdie na potvrdenie ich klinického využitia v štandardnej starostlivosti o pacientov s týmto závažným ochorením.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, contributing to increased morbidity and mortality. Humoral biomarkers, such as natriuretic peptides, troponin, aldosterone, cortisol, copeptin, and apelin, are gaining importance in the diagnosis, prognosis, and management of AF. Elevated levels of these biomarkers indicate not only myocardial dysfunction and atrial remodeling but also inflammatory and procoagulant states that influence the progression and complications of AF. Monitoring biomarker levels provides deeper insight into the pathophysiological mechanisms of AF and can aid in identifying patients at higher risk of complications, such as thromboembolic events or disease progression. Integrating biomarkers into clinical practice can significantly improve risk stratification, facilitate a more personalized approach to AF treatment, and contribute to more effective disease monitoring. Evidence linking biomarkers with AF is promising; however, further studies are needed to confirm their clinical utility in standard care for patients with this serious condition.

• MeSH
• aldosteron MeSH
• apelin MeSH
• arginin vasopresin MeSH
• biologické markery MeSH
• fibrilace síní * diagnóza   MeSH
• hydrokortison MeSH
• lidé MeSH
• natriuretické peptidy MeSH
• troponin krev   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Adult and paediatric patients with pathogenic variants in the gene encoding succinate dehydrogenase (SDH) subunit B (SDHB) often have locally aggressive, recurrent or metastatic phaeochromocytomas and paragangliomas (PPGLs). Furthermore, SDHB PPGLs have the highest rates of disease-specific morbidity and mortality compared with other hereditary PPGLs. PPGLs with SDHB pathogenic variants are often less differentiated and do not produce substantial amounts of catecholamines (in some patients, they produce only dopamine) compared with other hereditary subtypes, which enables these tumours to grow subclinically for a long time. In addition, SDHB pathogenic variants support tumour growth through high levels of the oncometabolite succinate and other mechanisms related to cancer initiation and progression. As a result, pseudohypoxia and upregulation of genes related to the hypoxia signalling pathway occur, promoting the growth, migration, invasiveness and metastasis of cancer cells. These factors, along with a high rate of metastasis, support early surgical intervention and total resection of PPGLs, regardless of the tumour size. The treatment of metastases is challenging and relies on either local or systemic therapies, or sometimes both. This Consensus statement should help guide clinicians in the diagnosis and management of patients with SDHB PPGLs.

• MeSH
• dítě MeSH
• dospělí MeSH
• feochromocytom * genetika   terapie   diagnóza   MeSH
• lidé MeSH
• nádory nadledvin * genetika   terapie   diagnóza   MeSH
• paragangliom * genetika   terapie   MeSH
• sukcinátdehydrogenasa genetika   MeSH
• zárodečné mutace genetika   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Background: Hypothyroidism is common, however, aspects of its treatment remain controversial. Our survey aimed at documenting treatment choices of European thyroid specialists and exploring how patients' persistent symptoms, clinician demographics, and geo-economic factors relate to treatment choices. Methods: Seventeen thousand two hundred forty-seven thyroid specialists from 28 countries were invited to participate in an online questionnaire survey. The survey included respondent demographic data and treatment choices for hypothyroid patients with persistent symptoms. Geo-economic data for each country were included in the analyses. Results: The response rate was 32.9% (6058 respondents out of 17,247 invitees). Levothyroxine (LT4) was the initial treatment preferred by the majority (98.3%). Persistent symptoms despite normal serum thyrotropin (TSH) while receiving LT4 treatment were reported to affect up to 10.0% of patients by 75.4% of respondents, while 28.4% reported an increasing such trend in the past 5 years. The principal explanations offered for patients' persistent symptoms were psychosocial factors (77.1%), comorbidities (69.2%), and unrealistic patient expectations (61.0%). Combination treatment with LT4+liothyronine (LT3) was chosen by 40.0% of respondents for patients who complained of persistent symptoms despite a normal TSH. This option was selected more frequently by female thyroid specialists, with high-volume practice, working in countries with high gross national income per capita. Conclusions: The perception of patients' dissatisfaction reported by physicians seems lower than that described by hypothyroid patients in previous surveys. LT4+LT3 treatment is used frequently by thyroid specialists in Europe for persistent hypothyroid-like symptoms even if they generally attribute such symptoms to nonendocrine causes and despite the evidence of nonsuperiority of the combined over the LT4 therapy. Pressure by dissatisfied patients on their physicians for LT3-containing treatments is a likely explanation. The association of the therapeutic choices with the clinician demographic characteristics and geo-economic factors in Europe is a novel information and requires further investigation.

• MeSH
• demografie MeSH
• hypotyreóza * farmakoterapie   epidemiologie   MeSH
• lidé MeSH
• thyreotropin * MeSH
• thyroxin MeSH
• trijodthyronin MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Thyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors. METHODS: Thyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS). Geographic regions were defined according to the United Nations Statistics Division. The national economic status was estimated using World Bank data on the gross national income per capita (GNI per capita). RESULTS: 5,695 valid responses were received (response rate 33·0%). The mean age was 49 years, and 65·0% were female. The proportion of female respondents was lowest in Northern (45·6%) and highest in Eastern Europe (77·2%) (p <0·001). Respondent work volume, university affiliation and private practice differed significantly between countries (p<0·001). Age and GNI per capita were correlated inversely with the proportion of female respondents (p<0·01). GNI per capita was inversely related to the proportion of respondents working exclusively in private practice (p<0·011) and the proportion of respondents who treated >100 patients annually (p<0·01). DISCUSSION: THESIS has demonstrated differences in characteristics of thyroid specialists at national and regional levels, strongly associated with GNI per capita. Hypothyroid patients in middle-income countries are more likely to encounter female thyroid specialists working in private practice, with a high workload, compared to high-income countries. Whether these differences influence the quality of care and patient satisfaction is unknown, but merits further study.

• MeSH
• hypotyreóza * epidemiologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• příjem * MeSH
• průzkumy a dotazníky MeSH
• socioekonomické faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Ortostatická intolerancia (OI) sa definuje ako skupina ochorení, pre ktoré je typická manifestácia príznakov v stojacej polohe. Tieto príznaky vyplývajú z cerebrálnej hypoperfúzie a vymiznú v polohe ležiacej. Do tejto skupiny chorôb zaraďujeme syndróm posturálnej ortostatickej intolerancie (POTS), ortostatickú hypotenziu (OH) a vazovagálnu ortostatickú synkopu. Jednotlivé ochorenia majú podobný klinický obraz (poruchy vízu, slabosť, závraty, nevoľnosť, bolesti hlavy, únava). Vzájomne sa však odlišujú biochemickými, autonómnymi a hemodynamickými charakteristikami. Cieľom uvedenej práce je podať prehľad poznatkov o humorálnych a neuronálnych markeroch, ktoré sa zapájajú do etiopatogenézy ortostatickej intolerancie.

Orthostatic intolerance (OI) is defined as a group of diseases which symptoms are typically manifested in a standing position. These symptoms result from cerebral hypoperfusion and disappear in the supine position. We include postural orthostatic intolerance syndrome (POTS), orthostatic hypotension (OH) and vasovagal orthostatic syncope in this group of diseases. Each of them have similar clinical presentation (blurred vision, weakness, dizziness, nausea, headaches, fatigue). However, they vary from each other in biochemical, autonomic and hemodynamic characteristics. The aim of the work is to provide an overview of humoral and non-human markers that are involved in the etiopathogenesis of orthostatic intolerance.

• MeSH
• biologické markery krev   MeSH
• lidé MeSH
• ortostatická intolerance * diagnóza   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Tumor-induced osteomalacia (TIO) is an uncommon type of osteomalacia associated with phosphaturic mesenchymal tumors (PMTs). Due to nonspecific symptoms, the diagnosis and appropriate management of the disease is often delayed for many years. Involvement of spine with TIO associated tumors is exceedingly rare. We present a 53-year-old woman with a 10-year history of bone pain, muscle weakness and multiple bone fractures that markedly impaired her quality of life. Biochemical evaluation revealed hypophosphatemia due to renal phosphate wasting and elevated plasma fibroblast growth factor 23 (FGF-23) concentration indicating PMT. It was found using 68Ga DOTA TOC PET/CT scan in the vertebral body L2. The patient underwent surgical resection of the tumor. Postoperatively, there was a significant decrease in phosphaturia, normalization of serum phosphate, 1.25 dihydroxyvitamin D and plasma FGF23 concentration. Thereafter the patient's condition markedly improved concerning her motility and basic daily activities. This case report demonstrates the first known case of TIO in the Slovakia and points to a long way from onset of symptoms toward correct diagnosis and successful surgical management.

• Publikační typ
• kazuistiky MeSH

Tumorom indukovaná osteomalácia (TIO) je vzácny paraneoplastický syndróm spôsobený typicky malými endokrinnými nádormi, ktoré vylučujú fibroblastový rastový faktor 23 (FGF23). TIO je klinicky charakterizovaná progresívnou muskuloskeletálnou bolesťou, únavou, slabosťou proximálnych svalov a viacnásobnými zlomeninami, ktoré vedú k dlhodobej invalidite. Kvôli nešpecifickým symptómom ochorenia môže trvať aj niekoľko rokov, kým sú pacienti správne diagnostikovaní a liečení a preto je dôležité zvýšiť povedomie o tomto vzácnom paraneoplastickom syndróme.

Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome typically caused by small endocrine tumors that secrete fibroblast growth factor 23(FGF23). TIO is clinically characterized by progressive muskuloskeletal pain, fatigue, proximal muscle weakness, and multiple fractures that lead to long-term disability. Due to the non-specific symptoms of the disease, it may take several years for them to be properly diagnosed and treated, so it is important to better inform about this rare paraneoplastic syndrome. Key word: FGF23, hypophosphataemia, tumor induced osteomalacia.

• MeSH
• diferenciální diagnóza MeSH
• fibroblastové růstové faktory škodlivé účinky   MeSH
• hypofosfatemie MeSH
• lidé MeSH
• mezenchymom MeSH
• opomíjené nemoci diagnóza   terapie   MeSH
• osteomalacie * diagnóza   terapie   MeSH
• paraneoplastické endokrinní syndromy * diagnóza   terapie   MeSH
• vzácné nemoci diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• lidé MeSH
• nadledviny patologie   MeSH
• poruchy metabolismu glukózy * patologie   MeSH
• Check Tag
• lidé MeSH

Autoimmune thyroiditis (AIT) and type 2 diabetes mellitus (DM2) are the most common endocrinological diseases worldwide. Relation between these diseases explains several hypotheses. One of them is influence of some adipocytokines. This study evaluated association between three adipocytokines (adiponectin, resistin and visfatin) and thyroid and glycid status in patients with DM2 and AIT compared to the control group (CG). The group consisted of four subgroups: patients with DM2 without thyreopathies, patients with AIT on substitution therapy without diabetes and prediabetes, patients with DM2 and AIT on substitution therapy and healthy subjects as the CG. We investigated parameters of thyroid and glucose metabolism and serum levels of three adipocytokines. The mean level of resistin in the group of patients with diabetes and thyroiditis was significantly higher than in patients with thyroiditis without diabetes and than in the CG. We found a weak negative correlation between visfatin and fasting glucose levels in patients with thyroiditis without diabetes. We detected a weak negative correlation between resistin and glycated haemoglobin and a weak negative correlation between visfatin and thyroid gland volume in patients with diabetes without thyroiditis. In the CG we determined a weak positive correlation between visfatin and free thyroxin. Our results are consistent with several studies, which confirmed association between AIT and adipocytokines.

• MeSH
• adipokiny krev   MeSH
• autoimunitní tyreoiditida krev   komplikace   diagnostické zobrazování   MeSH
• cytokiny krev   MeSH
• diabetes mellitus 2. typu krev   komplikace   MeSH
• dospělí MeSH
• glykovaný hemoglobin metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nikotinamidfosforibosyltransferasa krev   MeSH
• senioři MeSH
• štítná žláza diagnostické zobrazování   MeSH
• studie případů a kontrol MeSH
• ultrasonografie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• diabetes mellitus diagnóza   terapie   MeSH
• komorbidita MeSH
• komplikace diabetu diagnóza   terapie   MeSH
• Publikační typ
• sborníky MeSH
• směrnice pro lékařskou praxi MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• diabetologie