Roma living in marginalised communities are among the most disadvantaged groups in Slovakia. Socioeconomic disadvantage is associated with higher hair cortisol concentrations (HCC), including in parents. The aim of this study is therefore to assess differences in HCC, reflecting the levels of stress, between mothers living in MRCs and from the majority population, to assess the association of socioeconomic disadvantage with HCC, and whether disadvantage mediates the MRC/majority differences in HCC. Participants were mothers of children aged 15-18 months old living in MRCs (N=61) and from the Slovak majority population (N=90). During preventive paediatric visits, visits at community centres and home visits, hair samples and data by questionnaire were collected. HCC differed significantly between mothers living in MRCs and mothers from the majority population, with the mean HCC value being twice as high in mothers living in MRCs (22.98 (95% confidence interval, CI, 15.70-30.30) vs. 11.76 (8.34-15.20), p<0.05). HCC was significantly associated with education, household equipment and household overcrowding, but not with billing, socioeconomic stress and social support. The difference in HCC between mothers living in MRCs and mothers from the majority population was partially mediated by poor house equipment, such as no access to running water, no flushing toilet or no bathroom (the indirect effect of B=7.63 (95% CI: 2.12-13.92)). Practitioners and policymakers should be aware of high stress levels among mothers living in MRCs and aim at enhancing their living and housing conditions.
- MeSH
- dospělí MeSH
- hydrokortison * analýza metabolismus MeSH
- kojenec MeSH
- lidé MeSH
- matky * psychologie MeSH
- psychický stres * metabolismus MeSH
- Romové * MeSH
- sociální marginalizace psychologie MeSH
- sociální opora MeSH
- socioekonomické faktory * MeSH
- socioekonomické nerovnosti ve zdraví MeSH
- vlasy, chlupy * chemie MeSH
- zranitelné populace psychologie MeSH
- Check Tag
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Slovenská republika MeSH
OBJECTIVE: Currently available methods for endogenous cortisol monitoring in patients with hormonal insufficiency rely on measurements of plasma levels only at a single time point; thus, any kind of chronic exposure to cortisol is challenging to evaluate because it requires collecting samples at different time points. Hair cortisol levels acquired longitudinally better reflected chronic exposure (both cortisol synthesis and deposition) and may significantly contribute to better outcomes in glucocorticoid replacement therapies. DESIGN: Twenty-two patients on cortisol substitution therapy were monitored for plasma, urinary, and hair cortisol levels for 18 months to determine whether hair cortisol may serve as a monitoring option for therapy setting and adjustment. METHODS: Plasma and urinary cortisol levels were measured using standardized immunoassay methods, and segmented (∼1 cm) hair cortisol levels were monitored by liquid chromatography coupled to mass spectrometry. A log-normal model of the changes over time was proposed, and Bayesian statistics were used to compare plasma, urinary, and hair cortisol levels over 18 months. RESULTS AND CONCLUSIONS: Hair cortisol levels decreased over time in patients undergoing substitutional therapy. The residual variance of hair cortisol in comparison to plasma or urinary cortisol levels was much lower. Thus, longitudinal monitoring of hair cortisol levels could prove beneficial as a noninvasive tool to reduce the risk of overdosing and improve the overall patient health.
- MeSH
- Bayesova věta MeSH
- chromatografie kapalinová MeSH
- Cushingův syndrom * farmakoterapie MeSH
- glukokortikoidy terapeutické užití MeSH
- hydrokortison * analýza MeSH
- lidé MeSH
- tandemová hmotnostní spektrometrie MeSH
- vlasy, chlupy chemie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Diferenciální diagnostika zvětšení hypofýzy zahrnuje fyziologické a patologické procesy. Používání termínu hyperplazie hypofýzy, hypofyzitida nebo selární expanze není v české ani zahraniční literatuře konzistentní a popisuje nález zvětšení hypofýzy při zobrazovacím vyšetření bez ohledu na příčinu. Nejčastější příčinou nefyziologického zvětšení hypofýzy je adenom. Další příčiny zahrnují fyziologické zvětšení v třetím trimestru gravidity, jiné primární a sekundární nádory, autoimunitní hypofyzitidu, infiltrativní procesy při sarkoidóze, histiocytóze a další. Narůstá incidence hypofyzitidy vzniklé v důsledku onkologické imunoterapie checkpoint inhibitory.
Enlargement of the pituitary gland is heterogenous in the etiology. Common causes of pituitary enlargement are physiological hypertrophy during pregnancy, primary and secondary tumors, autoimmune hypophysitis including side effects of anticancer therapy with check-point inhibitors. Terms like hypertrophy, hyperplasia, sellar expansion and hypophysitis are commonly used to describe enlargement of the pituitary gland on MR scan regardless its etiology. The most common pathology causing pituitary gland enlargement is pituitary adenoma. Magnetic resonance imaging can differentiate pituitary tumors from diffuse enlargement due to hypophysitis in most but not all cases. Changes on imaging during time or response to pharmacotherapy might help determine the final diagnosis in uncertain cases. We present a case report of a young woman with sellar expansion due to prolonged untreated peripheral hypothyroidism mimicking pituitary adenoma. Interdisciplinary cooperation of endocrinologist, radiologist and neurosurgeon is crucial in determining the diagnosis.
- MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- hydrokortison analýza terapeutické užití MeSH
- hypofýza diagnostické zobrazování patologie MeSH
- hypofyzitida diagnóza klasifikace patologie terapie MeSH
- hypotyreóza diagnóza farmakoterapie MeSH
- inhibitory kontrolních bodů terapeutické užití MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mozek diagnostické zobrazování patologie MeSH
- nádory hypofýzy diagnóza farmakoterapie MeSH
- nemoci hypofýzy * diagnostické zobrazování diagnóza epidemiologie etiologie farmakoterapie klasifikace patologie MeSH
- opožděná diagnóza MeSH
- thyroxin terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
INTRODUCTION: Psychological testing to examine potentially aggressive behaviour is a gold standard, but it is not sufficient. Testosterone might increase an aggressive behaviour. AIM: The aim of this study was to evaluate whether testosterone along with psychological assessment of fitness to drive could help to identify aggressive drivers. METHODS: Male participants (n=150) aged from 20 to 25, who possessed a driving license and drive at least 100 km per week, were evaluated in this study using an Inventory of traffic-relevant personality characteristics, the Sensation Seeking Scale and the Buss-Durkee Aggression Inventory. Saliva was collected for testosterone and cortisol measurements. The five binomial logistic models with dependent variables Caused an accident, Driving license taken away, Court trial, Intoxicated driving and Sporty self-report were tested in this study. RESULTS: The ‘Intoxicated driving’ model, was found to be statistically highly significant, explaining 48.8 % of the dependent variable’s variance (χ2(16)=36.145, p<0.01). In this model with sensation seeking, actual testosterone and their interaction was highly significant and explained 20.4 % of intoxicated driving variability (χ2(3)=14.283, p<0.01). This was higher than sensation seeking scores only. CONCLUSION: To conclude, salivary testosterone might prove a biological marker that improves the identification of those with a high probability of aggressive driving or its subtypes (Tab. 3, Ref. 53).
- MeSH
- agresivní jízda * psychologie MeSH
- bezpečnost MeSH
- dospělí MeSH
- hydrokortison analýza klasifikace MeSH
- lidé MeSH
- mladý dospělý MeSH
- řízení motorových vozidel psychologie MeSH
- testosteron * analýza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
Cushingův syndrom (CS) je nepříliš časté onemocnění s přibližnou populační prevalencí 40 pacientů/1 milion obyvatel. Prevalence CS je však pravděpodobně vyšší mezi pacienty s diabetes mellitus (DM). U pacientů s DM randomizovanými do studií z ambulantních provozů, u nichž lze předpokládat lepší kontrolu diabetu a nižší výskyt komplikací, byl subklinický CS potvrzen u 0–2,9 %. U pacientů, kteří byli v době randomizace hospitalizováni, se CS vyskytoval v 2–9,4 %. Na základě dostupných dat není v tuto chvíli plošný skrínink CS u pacientů s DM 2. typu doporučován. Přesto je třeba na CS i v jeho subklinické podobě myslet jako na možnou příčinu diabetu, a to u pacientů s hypertenzí, obezitou, mikrovaskulárními komplikacemi, dlouhodobě špatnou kompenzací onemocnění či při nutnosti neobvykle vysokých dávek inzulinu, zejména pak při kombinaci těchto faktorů. Samozřejmostí je hormonální vyšetření pacientů se zachyceným incidentalomem nadledviny.
Cushing´s syndrome is a rare disease with the population prevalence about 40 patients per 1 million inhabitants, the number among patients with diabetes mellitus (DM) is probably higher. The screening of CS among the DM patients showed the prevalence between 0–2.9% in the groups of outpatients and 2–2.9% among the patients admitted to the hospital at the time of randomization. The routine screening of CS among patients with type 2 DM is not recommended at the moment. Nevertheless, the possibility of CS should be taken into the account mainly in patients with hypertension, obesity, microvascular complications, bad level of metabolic control or high insulin doses, especially, if more of these features are present. A hormonal profile of patients with adrenal incidentaloma should be evaluated.
The purpose of this study was to determine the changes in the resting level of serum cortisol, testosterone and T/C ratio in response to different training modalities and their variations. A secondary purpose was to identify if the various six weeks training programs are an effective way to improve physical fitness. 86 regularly active young males were assigned to one of six groups: Endurance constant running (ECR), Endurance interval running (EIR), Resistance training (RT), Explosive training (ET), Speed-endurance 50 m running (SER50) and Speed-endurance 150 m running (SER150) training. The resting levels of testosterone, cortisol and T/C ratio, as well as physical fitness, were measured. The ECR, EIR, and RT training program decreased COR level (P < 0.05). An increase of the T/C ratio was observed in the ECR and EIR group (P < 0.05). Except for SER50, each training program improved physical fitness. Our results suggest that endurance and resistance training modalities performed with a moderate to vigorous intensity may be a usable way to manage the resting cortisol level and enhance physical fitness in active young males.
- MeSH
- hydrokortison * analýza MeSH
- kondiční příprava MeSH
- lidé MeSH
- vytrvalostní trénink MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Methods for determination of biocompounds in biological samples, mainly molecules of steroid nature, have always been a well-discussed issue. This review is focused on the recent trend in clinical biochemistry, namely the use of methods that provide extreme accuracy for both research and clinical practice, such as liquid chromatography – mass spectroscopy/mass spectroscopy. These highly sophisticated methods may seem to have some advantages over the traditionally employed immunochemical methods (usually various types of enzyme immunoassay, mostly different modes of enzyme-linked immunosorbent assay). However, the former is significantly more costly, more time-consuming (as taken from the pre-analytic phase to verified results), and more demanding with respect to the qualification of the personnel. Thus, this review shows that, in many cases, these drawbacks cannot be compensated for by the benefits.
Cushingov syndróm (CS) je pomerne vzácne ochorenie charakterizované autonómnou hypersekréciou kortizolu. Ročná incidencia CS je 2–3/milión obyvateľov. Incidencia akromegálie je 3–4 pacienti na 1 000 000 za rok. Ochorenie je spôsobené hypersekréciou rastového hormónu (RH) v 99 % na podklade adenómu hypofýzy. V našej kazuistike prezentujeme 41-ročnú ženu s kombináciou Cushingovho syndrómu a akromegálie. Pacientka bola vyšetrená v NEDU Ľubochňa pre centripetálny typ obezity a hirzutizmus. Laboratórne bola prítomná hyperkortizolémia bez cirkadiánnej variácie, hyperkortizolúria s ele-vovanou hladinou adrenokortikotropného hormónu (ACTH). Realizovaná 2 mg dexametazónová blokáda bez adekvátnej supresie kortizolu v sére a moči až v 8 mg blokáde došlo k supresii kortizolúrie. Magnetická rezonancia (MR) s nálezom v. s. pikoadenómu hypofýzy veľkosti 2 mm. Následne bola realizovaná transsfenoidálna resekcia pikoadenómu hypofýzy. Histopatologické a imunohistochemické nálezy neodhalili ACTH produkujúci adenóm hypofýzy. Pozákrokovo pretrvával hyperkortizolizmus s novozachyteným hypersomatotropizmom. Do liečby bol pridaný Ketokonazol 200 mg tbl 1/2-0-1 a Lanreotid v dávke 120 mg každých 42 dní. Kontrolná MR hypofýzy preukázala drobnú ložiskovú štruktúru s rozmermi 3 × 4 mm. Po súhlase pacientky s odstupom 3 rokov bola vykonaná endoskopická revízia rezidua. Histologické a imunohistochemické vyšetrenia bez potvrdenia adenómu s ACTH a RH sekréciou. Pozákrokovo opäť nedošlo k znormalizovaniu plazmatických hladín IGF-1 s pretrvávaním hyperkortizolizmu. Bola opätovne začatá liečba Lanreotidom v pôvodnej dávke ako aj Ketokonazolom s na-výšením dávky 200 mg na 3-krát 1 tbl.
Cushing's syndrome (CS) is a relatively rare disease characterized by autonomous hypersecretion of cortisol. The incidence of CS is estimated to be equal to 2–3 cases per million inhabitants per year. The incidence of acromegaly is 3–4 patients per 1 000 000 per year. The disease is caused by hypersecretion of growth hormone which is mainly caused by benign tumour of the pituitary gland. In our case report we present a 41- year old woman suffering from both Cushing's syndrome and acromegaly. The patient was examined in National Institute of Endocrinology and Diabetology Ľubochňa for a centripetal type of obesity and hirsutism. Laboratory tests revealed high plasma cortisol levels without circulating variation, hypercortisoluria and elevated plasmatic levels of ACTH. A 2 mg dexamethasone blockade was performedwithout adequate cortisol suppression in serum and urine up to 8 mg blockade resulted in suppression of 24 hour urine free cortisol. A magnetic resonance imaging (MR) scan revealed suspectpikoadenoma of the pituitary gland (size 2 mm). Subsequentlytrans-sphenoidal resection was performed. Histopathological and immunohistochemical examinations did not reveal the ACTH-producing pituitary adenoma. After surgery hypercortisolism persisted with newly revealed hypersomatotropism. Treatment with Ketoconazole at dose 200 mg 1/ 2-0-1 and somatostatin analogues (Lanreotide) at dose 120 mg every 42 days were initiated. Control magnetic resonance imaging of the sella demonstrated small tumour of pituary gland of size 3 × 5 mm. Later 3 years after firstsurgery another transsphenoidal resection of residue was performed. Histological and immunohistochemical examinations did not confirmadenoma with ACTH and RH secretion. After second surgery, IGF-1 plasma levels were not normalized with persistence of hypercortisolism. The treatment with Lanreotide at the initial dose as well as Ketoconazole was reinitiated (with increased dose of Ketoconazole to 1-1-1 tbl per 200 mg).
- MeSH
- akromegalie etiologie MeSH
- Cushingův syndrom * chirurgie diagnóza farmakoterapie MeSH
- dospělí MeSH
- hydrokortison analýza krev moč MeSH
- hypersekrece ACTH v hypofýze MeSH
- hypofýza chirurgie diagnostické zobrazování MeSH
- ketokonazol terapeutické užití MeSH
- lidé MeSH
- růstový hormon MeSH
- somatostatin analogy a deriváty terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
V předkládané kazuistice popisujeme vzácný případ pacientky s feochromocytomem produkujícím adrenokortikotropní hormon (ACTH). Tento ektopicky produkovaný ACTH stimuloval kontralaterální nadledvinu ke zvýšené produkci kortikoidů a vyvolal Cushingův syndrom. Podezření na tuto diagnózu bylo vysloveno na základě laboratorního vyšetření (opakovaná hypokalemie a metabolická alkalóza) a definitivně bylo potvrzeno po histopatologickém, histochemickém a imunohistochemickém vyšetření nádoru.
We present a case of a patient with pheochromocytoma producing adrenocorticotropic hormone (ACTH). This ectopically produced ACTH stimulated the contralateral adrenal to produce higher amounts of corticoids and it led to Cushing's syndrome. Suspicion of this diagnosis was based on laboratory results (hypokalemia and metabolic acidosis) and definitely confirmed after histopathological, histochemical and immunohistochemical examination of tumour.
- MeSH
- adrenalektomie MeSH
- adrenokortikotropní hormon analýza MeSH
- alfa blokátory terapeutické užití MeSH
- chlorid draselný aplikace a dávkování MeSH
- dospělí MeSH
- feochromocytom * chirurgie diagnostické zobrazování komplikace patofyziologie MeSH
- hydrokortison analýza MeSH
- hypersekrece ACTH v hypofýze * chirurgie diagnóza etiologie komplikace MeSH
- hypokalemie etiologie MeSH
- klinické chemické testy statistika a číselné údaje MeSH
- lidé MeSH
- metanefrin analýza MeSH
- nádory nadledvin chirurgie diagnostické zobrazování komplikace patofyziologie MeSH
- spironolakton aplikace a dávkování MeSH
- výsledek terapie MeSH
- vzácné nemoci chirurgie diagnostické zobrazování komplikace patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
As nursing is one of the most stressful occupations worldwide, its management warrants more attention to identify possible ways to cope with its pressures. This study aims to evaluate whether animal-assisted therapy (AAT) with the presence of a dog affects the stress level of nurses. As a stress biomarker, we used salivary cortisol level testing. Twenty female nurses (mean age: 30) in physical medicine (PMR) (n = 11) and the department of internal medicine and long-term care (IM < C) (n = 9). On each of the three observed days, saliva was collected at 10 a.m. and then again after 50 min. The first sampling was performed during a normal working process without a break (Condition A), the second was carried out during a normal working process with a break of choice (Condition B), and the third sampling was performed during a normal working process with a break with AAT (Condition C). All participants were enrolled in all three interventional conditions in a randomized order. The results demonstrated the effect of a reduction of cortisol levels in Condition C, where AAT was included (p = 0.02) only in nurses recruited from the IM < C department. By way of explanation, nurses from the PMR department already showed low cortisol levels at baseline. We propose including AAT with a dog in healthcare facilities where nurses are at a high risk of stress.
- MeSH
- dospělí MeSH
- hydrokortison analýza MeSH
- lidé MeSH
- pracovní stres metabolismus prevence a kontrola MeSH
- psi * MeSH
- sliny chemie MeSH
- vojenské nemocnice MeSH
- zdravotní sestry psychologie MeSH
- zooterapie * MeSH
- zvířata MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- psi * MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Česká republika MeSH