Biomedical subjects

K Vondra

Publications and source records attributed to K Vondra.

At least 19 recordsLinked to original sources

PubMed2005

Metabolic syndrome in young Czech women with polycystic ovary syndrome.

METHODS: Sixty-nine young women with polycystic ovary syndrome (PCOS) [age 25.2+/- 4.7 years, with body mass index (BMI) 24.3 +/- 4.8 kg/m2; mean 6 SD] and 73 age-matched healthy females (BMI 22.3 +/- 3.3 kg/m2; mean +/- SD) were evaluated for the occurrence of features of metabolic syndrome according to the Adult Treatment Panel III. RESULTS: Overt metabolic syndrome (the presence of three and more risk factors) was not more common in PCOS women (1/64, 1.6%) than in healthy controls (0/73, 0%). On the other hand, in nearly 50% of PCOS women isolated features of metabolic syndrome, most often a decrease in high-density lipoprotein (HDL) cholesterol, were found. Women with at least one feature of metabolic syndrome were, in comparison with women without any of these features, significantly more obese (P = 0.0001), with lower insulin sensitivity (P = 0.05). When comparing PCOS women according to the degree of insulin sensitivity, as determined by euglycaemic clamp, isolated features of metabolic syndrome were found in 8/17 women above the upper quartile, compared with 11/16 women below the lower quartile of insulin sensitivity (P = 0.20). CONCLUSIONS: Overt metabolic syndrome is only rarely encountered in young Czech females affected by PCOS but its isolated features are relatively frequent, both in young PCOS patients and in age-matched control women.

Adult↗

PubMed2005

Differences in type I diabetes mellitus of young adults with and without thyroid autoimmunity.

This work was intended to study if the coexistence of thyroid and Langerhans islets autoimmunity is associated with a different nature and course of diabetes in young adult diabetic patients. We followed the laboratory and clinical course of diabetes and the thyroid gland status of 47 young adults with Type I diabetes over a 9-year period starting from the onset of diabetes (ranging from 18 to 35 years of age). The patients were divided into subgroup I (with thyroid peroxidase and thyroglobulin antibodies, n = 13), subgroup II (thyroid peroxidase antibody only, n = 10), and subgroup III (without thyroid autoimmunity, n = 24). Out of the 22 females followed, 10 (46 %) and 5 (23 %) were in subgroups with thyroid autoimmunity (TA), I and II, respectively. On the contrary, out of the 25 men followed, 17 (68 %) were in group III. Within the 9 years, insulin secretion nearly ceased (C-peptide < 0.03 nmol/L) in all of the patients of subgroup I and 70 % of subgroup II, but only in 46 % of patients in subgroup III (I : II p < 0.01, I : III, p < 0.01, II : III, p < 0.05). The cumulative incidence of antiGAD > 1 U/mL (CIS, RIA) in subgroup I was higher (92 %) than in subgroups II (80 %) and III (53 %); I : III, p < 0.05. The cumulative incidence of tyrosine phosphatase antibodies (anti-IA2, BRAHMS, RIA) was insignificantly higher in subgroups I and II when compared with subgroup III (62 %, 60 %, and 42 %). The study of organ-specific and systemic autoantibodies showed their highest cumulative incidence in subgroup I, i.e., in patients with the most expressed manifestations of TA and the lowest one in subgroup III, i.e., diabetic patients without TA. Our results suggest that overall thyroid autoimmunity in young adult patients with Type I diabetes was associated not only with female gender, but also with more pronounced Langerhans islets autoimmunity and significantly faster cessation of endogenous insulin secretion; it was associated with therapeutical doses of insulin as well.

Adolescent↗

PubMed2005

Decrease in serum dehydroepiandrosterone level after fenofibrate treatment in males with hyperlipidemia.

The influence of steroid hormones on plasma lipids and lipoproteins was confirmed by many studies. On the other hand, the effect of plasma lipids on metabolism of steroid hormones has so far not been examined. The objective of this research project was to determine (1) the levels of cortisol, testosterone, estradiol, dehydroepiandrosterone (DHEA), its sulfate (DHEAS), 7-hydroxylated DHEA, and SHBG in men suffering from mixed hyperlipidemia (HPL) (n=23, age 46.1+/-7.9 years) in comparison with healthy male volunteers (n=17, age 45.1+/-15.6 years); (2) whether therapy with fenofibrate influences the levels of the above mentioned steroids and SHBG; (3) what are the correlations between lipids and steroids in healthy males and HPL patients before and after therapy. Compared to controls, untreated patients had significantly higher estradiol and free testosterone index (IFT) levels (p<0.0003 and p<0.02, respectively) and significantly lower SHBG (p<0.02). Due to fenofibrate therapy, a significant decrease of TC, TG, and DHEA levels occurred (mean decrease: 14 %, 52 % and 21 %, respectively). Triglycerides correlated negatively with testosterone and SHBG in healthy subjects. HDL-C correlated positively and consequently, atherogenic index correlated negatively with 7-hydroxylated epimers of DHEA in treated patients. This is the first study dealing with the influence of fenofibrate administration on the steroid levels. Taking together, the most important is the finding of decrease DHEA levels after fenofibrate therapy. It could be explained, at least in part, by the effect of the fenofibrateon on the biosynthesis of DHEA and its regulation.

Adult↗

PubMed2005

Thyroid gland diseases in adult patients with diabetes mellitus.

This review concerns the relation between most frequent thyroid gland diseases and diabetes mellitus in adult patients. Special attention is paid to autoimmune thyroiditis, Graves' disease, thyroid autoimmunity in pregnant diabetic women, and iodine metabolism. We focused on mechanisms leading to coexistence of both endocrine disorders, and on distinctions in the prevalence, diagnosis, clinical course and treatment of thyroid diseases in diabetic patients. The prevalence of thyroid diseases in diabetic patients is 2-3 times higher than in nondiabetic subjects; it raises with age, and is strongly influenced by female gender and autoimmune diabetes. Clinical relevance of thyroid diseases, especially in diabetic patients, significantly increases if it is associated with deteriorated function, which always cause a number problems with metabolic compensation of diabetes. Most serious consequences are increased frequency of hypoglycaemia in hypothyroidism and development of potentially life-threatening ketoacidosis in thyrotoxicosis. In spite of that, little attention is paid to the diagnosis of thyroid diseases in diabetics, as they are diagnosed in only about half of the patients. At the end, we provide recommendations for the thyroid disease screening and diagnosis in patients with diabetes mellitus based on our experience.

Adult↗

PubMed2004

Flutamide suppresses adrenal steroidogenesis but has no effect on insulin resistance and secretion and lipid levels in overweight women with polycystic ovary syndrome.

The authors evaluate the effects of 2 months of treatment with 250 mg flutamide daily on adrenal steroidogenesis (ACTH test) and metabolic parameters (lipids, insulin resistance) in 12 PCOS women aged 33.8 +/- 7.5 years and with a BMI of 33.6 +/- 4.2 kg/m2. Significant decreases in basal DHEA-S (p < 0.0001), DHEA (p < 0.01) and androstenedione (p < 0.05), in the ACTH-stimulated levels of DHEA-S (p < 0.0001), testosterone (p < 0.05) and in ACTH-stimulated 17beta-hydroxysteroid dehydrogenase activity (p < 0.01) were observed. No significant change in basal blood glucose, insulin, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides or in insulin resistance, as estimated by the insulin tolerance test, was found. Flutamide is effective in reducing adrenal androgen production in overweight women, but has no effect on lipid spectrum or on insulin resistance.

17-Hydroxysteroid Dehydrogenases↗

PubMed2004

Thyroid autoantibodies and their clinical relevance in young adults with type 1 diabetes during the first 12 yr after diabetes onset.

In order to obtain prospective data on occurrence of thyroid autoantibodies [against thyroid peroxidase (antiTPO) and against thyroglobulin (antiTgl)] and their clinical relevance, we followed up on 109 young adults with Type 1 diabetes for 12 yr after diabetes onset. The patients were divided into subgroup I [positivity of both thyroid autoantibodies (T-Ab); 25%, women predominantly], subgroup II (isolated antiTPO positivity only, 26%, men and women equally) and subgroup III (thyroid autoimmunity not present, 49%, men mainly). Cumulative incidence of T-Ab during the 12 yr of follow-up was 51% with predominance of women over men (65% vs 38%, p<0.01). At the time of the first T-Ab detection, an ultrasonography pattern of a hypoechogenic thyroid gland was noted in 59% of subgroup I patients and in 25% of subgroup II patients (p<0.05). At the same time, TSH>4.5 mlU/I was shown in 30 and 7% of patients of subgroups I and II, respectively (p<0.05). In the patients with the repeated positivity of both T-Ab (subgroup I) subclinical hypothyroidism developed in all patients within 4 yr after the first detection of T-Ab. On the contrary, the clinical course in patients with isolated antiTPO positivity (subgroup II) was milder with 11% developing subclinical hypothyroidism within 4 yr after the first antiTPO detection (p<0.001). The data shed new light on the relative diagnostic value of thyroid antibodies, ultrasonography and functional examination for an early detection of thyroid autoimmunity of adult diabetic patients.

Adolescent↗

PubMed2004

Metabolic and endocrine effects of treatment with peroral or transdermal oestrogens in conjunction with peroral cyproterone acetate in women with polycystic ovary syndrome.

OBJECTIVE: To compare the influence of transdermal and peroral oestrogen treatments in conjunction with cyproterone acetate (CPA) on metabolic and hormonal parameters in women with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: Twenty-four women with PCOS, aged 25.4+/-4.3 (mean+/-s.d.) years, body mass index 24.5+/-3.9 kg/m2 were randomly assigned to receive either transdermal oestradiol plus CPA (n=12) or a peroral oestradiol-CPA combination (n=12). Before and after 3 months of treatment, basal blood samples, euglycaemic hyperinsulinaemic clamp combined with indirect calorimetry and arginine tests were performed. ANOVA and Student's t-test or Wilcoxon's test were used for statistical analyses. RESULTS: After peroral oestradiol-CPA, insulin sensitivity (P<0.004) and the disposition index as the function of insulin sensitivity and secretion (P<0.0001) decreased significantly. Fasting insulin (P<0.05), cholesterol (P<0.05), high-density lipoprotein cholesterol (P<0.05) and sex-hormone binding globulin (P<0.0001) increased significantly. Dehydroepiandrosterone (P<0.05) and 17-OH progesterone (P<0.01) decreased significantly. After transdermal oestradiol+CPA, no significant changes were observed in sex-hormone binding globulin and androgen concentrations, insulin sensitivity or disposition index. CONCLUSIONS: In women with PCOS, peroral oestrogens (at doses common in combined oral contraceptives) led to a significant impairment in insulin secretion and action. In contrast, the transdermal application of oestrogens did not significantly influence insulin sensitivity.

Administration, Cutaneous↗

PubMed2004

Somatostatin: beneficial effects on remission in young adult patients with newly diagnosed diabetes mellitus type 1.

To assess a possible influence of short-term administration of somatostatin on remission development in adult patients with newly diagnosed diabetes mellitus type 1, the somatostatin analog octreotide was given for two weeks after the establishment of the diagnosis at the daily dose of 150 microg subcutaneously in addition to the regular insulin and metabolic therapy. When compared to the control group, the remission was achieved earlier in the octreotide group (6+/-4 weeks vs. 11+/-12 weeks in the control group, p 0.05) and its duration was longer (99+/-49 weeks vs. 49+/-31 weeks in the control group, p 0.05). Moreover, remission also appeared in patients from the octreotide group with lower endogenous residual secretion of insulin (basal C peptide at the time of diagnosis in patients who later entered remission was 0.23+/-0.16 nmol/l vs. 0.34+/-.18 nmol/l in the control group, p<0.05). The increase of 24-h urine excretion of C-peptide after the therapy with octreotide was predictive for remission development. It can thus be concluded that octreotide administration in adults with newly diagnosed diabetes mellitus type 1 positively influences both the onset and duration of remission.

Adult↗

PubMed2004

Anti-GAD-positive patients with type 1 diabetes mellitus have higher prevalence of autoimmune thyroiditis than anti-GAD-negative patients with type 1 and type 2 diabetes mellitus.

The aim of our study was to evaluate antibodies against thyroglobulin (anti-TG) and thyroid peroxidase (anti-TPO) - markers of autoimmune thyroiditis - in several groups of adult patients with type 1 and type 2 diabetes mellitus (DM). We were particularly interested whether the presence of thyroid antibodies is related to the positivity of glutamic acid decarboxylase antibodies (anti-GAD). We found elevated anti-GAD in 46 % (97/210) patients with type 1 DM. All patients with type 2 diabetes were anti-GAD-negative. At least one thyroid antibody (anti-TG and/or anti-TPO) was found in 30 % (62/210) patients with type 1 DM and 27 % (22/83) type 2 diabetes patients. The patients with type 1 DM were further grouped according to their anti-GAD status. The anti-GAD-positive patients had a higher prevalence of anti-TG antibodies than the anti-GAD-negative patients (25 % vs. 12 %, p=0.03) as well as anti-TPO antibodies (32 % vs. 12 %, p<0.001). At least one thyroid antibody was detected in 39 % (38/97) of anti-GAD-positive but only in 21 % (24/113) of anti-GAD-negative patients with type 1 DM (p=0.006). No significant difference in the frequency of thyroid antibodies was found between anti-GAD-negative patients with type 1 and type 2 DM (21 % vs. 27 %, p=0.4). The groups with or without thyroid antibodies in both type 1 and type 2 diabetic patients did not differ in actual age, the age at diabetes onset, duration of diabetes, body mass index or HbA1c level. Patients with elevated thyroid antibodies had significantly higher levels of TSH than those without thyroid antibodies (1.86 vs. 3.22 mIU/l, p=0.04 in type 1 DM; 2.06 vs. 4.89 mIU/l, p=0.003 in type 2 DM). We conclude that there is a higher frequency of thyroid-specific antibodies in anti-GAD-positive adult patients with type 1 DM than in anti-GAD-negative patients or in patients with type 2 DM. Patients with or without thyroid antibodies do not differ in age, DM onset and duration, BMI or HbA1c. Thyroid antibodies-positive patients have higher levels of thyroid stimulating hormone (TSH).

Adolescent↗

PubMed2002

[Metformin has a positive effect on disorders of carbohydrate metabolism in long-term care with low doses of prednisone].

BACKGROUND: The influence of long-term, low doses of prednison administration (< 0.3 mg/kg/day) on glucoregulation and glucose tolerance was studied in 20 female patients (15-20 yrs), including verification of possibility to correct the impairment of glucose tolerance (IGT) by metformin (M). METHODS AND RESULTS: During prednison treatment, we found typical signs of insulin resistance manifestation: HOMAIR 3.55 (5.13), blood insulin/glucose ratio 3.8 (5.84), QUICKI 0.61 (0.124). These were associated with higher Langerhans (L.) islets hormone secretion detected under basal conditions as well as after bolus of 5 g arginine chloride. However, detailed analysis of hormone secretion ratios revealed distinct signs of L. islets function impairment and subcompensation. Specifically, low ratio C peptide/proinsulin and C peptide/glucagon were characteristicaly observed. Six months of M. administration (1000 mg/day) had a beneficial effect on glucose metabolisms deviations as indicated by the following: insulin resistance decreased (HOMAIR 1.96 (1.60), insulin/glucose ratio 2.34 (1.52), QUICKI increased at 0.699 (0.238)). At the same time we found a decrease in the basal levels of insulin, proinsulin, glucagon, C peptide and amyline, and AUC proinsulin and glucagon as well. HOMAsecretion decreased from an initial value of 389 (376) to 207 (119). CONCLUSIONS: Judging by the new hormonal secretion ratios, the L. islets' function following M. treatment substantially improved. From the clinical point of view, it is important to note that M. was tolerated very well. No patient interrupted the follow up because of M. intolerance. IGT in the whole group normalised, in spite of the fact that no accent was put on the regime, diet including. The 90% of lactate values did not exceed 1.7 mmol/l. Based on the results, we may conclude that M. has a beneficial effect on long-term, low doses of glucocorticoid-related (induced) glucose metabolism impairment, and therefore, M. administration could be recommended, particularly in the situations with higher levels of glycosylated hemoglobin.

Adolescent↗

PubMed2002

[Role of the steroids, SHBG, IGF-1, IGF BP-3 and growth hormone in glucose metabolism disorders during long-term treatment with low doses of glucocorticoids].

BACKGROUND: The relationships between selected steroids, SHBG, growth hormone, IGF-1, IGF BP-3 and indicators of glucose metabolism were studied in the group of 20 female patients (15-20 yrs) on long-term treatment with low prednisone doses (< 0.3 mg/kg/day) (baseline phase) and after adding 1000 mg of metformin per day for following 6 months to improve impaired glucose metabolism (control phase). METHODS AND RESULTS: Lower basal DHEAS and DHEA (DHEA/S) levels were found as compared with reference values. Only DHEAS level returned into the reference range after the treatment with metformin. Decrease of DHEA/S depended on the doses (DHEAS -0.7621, DHEA -0.7685). Positive correlations between DHEA/S and of the results insulin tolerance were found as at the baseline (+0.4452, resp. +0.4455) as well as in the control period after the metformin administration (+0.7549, resp. +0.6073). Testosterone (T) and dihydrotestosterone(DHT) values were within the reference range during the whole study. Due to very low SHBG levels higher free androgen index (FAI) was recorded in more than half of the patients. Significant relationships were revealed between former gonadal androgens and indicators of glucose metabolism deterioration at the control phase: T correlated: with fasting insulin (+0.6005), with HOMAIR (+0.5380), with insulin/glucose (+0.5261), with fasting glucose (+0.9268), with AUC glucose (+0.6792), FAI: with fasting insulin (+0.5560), with HOMAIR (+0.5269), with fasting glucose (+0.9025), with AUC glucose (+0.7143), DHT: with fasting C peptide (+0.7921), with AUC C peptide (+0.7143). SHBG correlated: with fasting glucose (-0.6519), and with AUC glucose (-0.5868). The tendency of GH to lower, and IGF-1, IGF BP-3 to higher values at the baseline changed at the control phase: fasting and AUC value of GH increased (signif.), while were IGF-1 (nonsignif.) and IGF BP-3 (signif.) levels decreased. Surprisingly, no correlation was observed between GH and parameters of glucose metabolism. Contrary to GH, baseline IGFBP-3 values correlated: with HOMAIR (+0.5002), with insulin/glucose (+0.4860). The same relationships were found between AUC IGF BP-3 (+0.5676, +0.5559), IGF-1 (HOMAIR only +0.5412), IGF-1/IGF BP-3 (+0.5059, +0.5716) and parameters of insulin sensitivity (HOMAIR, insulin/glucose) in the control period. For the first time negative correlations between IGF-1, IGF-1 AUC, IGF BP-3, IGF-1/IGF BP-3 and somatostatin blood levels were discovered at the control phase. CONCLUSIONS: The study brought a number of new information about the importance of the "non-classical" glucoregulatory hormones in impairment of glucose metabolism, during long-term administration of low prednisone doses. The results suggest, that without normalisation of low DHEA/S, SHBG and high FAI levels it would not be possible to correct glucose metabolism properly in patients with long-term glucocorticoid therapy.

Adolescent↗

PubMed2002

Autoimmune thyroiditis in non-obese subjects with initial diagnosis of Type 2 diabetes mellitus.

Autoimmune thyroiditis is often associated with Type 1 diabetes mellitus (T1DM). In non-obese adult-onset diabetes diagnosed initially as Type 2 diabetes mellitus (T2DM), there is a proportion of cases with so far undiagnosed T1DM. The objective of this study was to estimate the frequency of autoimmune thyroiditis (AT) among non-obese (BMI <30.0 kg/m2) patients with T2DM and to compare the frequency of AT in subgroups of patients according to the presence of glutamic acid decarboxylase antibodies (GADA), insulin requirement, and post-breakfast C-peptide levels. The study included 118 adult patients (55 men and 63 women) with the initial diagnosis of T2DM and age at the onset of diabetes > 35 yr. Median of age was 66 yr (range 39-82), and median duration of diabetes was 9 (range 1-27) yr. AT was diagnosed using thyroid peroxidase antibodies, TG-antibodies, US and TSH levels. Nineteen per cent of the subjects were found to have AT, and the frequency of AT did not significantly differ between the groups of GADA+ and GADA- subjects. There was no difference in the frequency of AT between the group treated with hypoglycemic agents and/or diet and the group requiring insulin. The frequency of AT was higher in the group with post-breakfast C-peptide levels < or = 0.8 nmol/l compared to the group with post-breakfast C-peptide levels > 0.8 nmol/l (37% vs 16%), however the group with post-breakfast C-peptide levels < or = 0.8 nmol/l had longer duration of diabetes.

Adult↗

PubMed2002

Prediction of the effect of metformin treatment in patients with polycystic ovary syndrome.

The objective of the study was to find predictors of a successful therapy with metformin in polycystic ovary syndrome. 24 women with polycystic ovary syndrome were examined (oral glucose tolerance test and gonadotropin-releasing hormone analogue test) before and after a 6-month course of metformin (1 g/day). In 58% of the women, a significant improvement in the menstrual cycle pattern was observed. After a treatment course, a significant reduction in gonadotropin-releasing hormone analogue stimulated levels of testosterone (p < 0.05), free testosterone index (p < 0.01), luteinizing hormone (p < 0.05), and estradiol (p < 0.01) was found. The best prediction of the improvement in menstrual cyclicity after metformin was achieved with a combination of basal values of 17-hydroxyprogesterone, testosterone, sex hormone binding globulin, and androstenedione. These variables correctly classified 86.7% of the responders. The best predictor of changes in the index of free testosterone after metformin treatment was the combination of estradiol and androstenedione in the gonadotropin-releasing hormone analogue test, with basal testosterone correctly classifying 91.7% of the subjects.

Female↗

PubMed2001

[Effect of long-term treatment with metformin on steroid levels and parameters of insulin resistance in women with polycystic ovary syndrome].

BACKGROUND: Insulin resistance is probably the key factor in the pathogenesis of polycystic ovary syndrome, and thus insulin sensitization can be a beneficial treatment. We tried to investigate effects of long-term therapy with metformin in polycystic ovary syndrome on steroid levels, ovarian steroidogenesis and on insulin resistance and secretion. We also tried to find predictors of the successful therapy (in terms of improvement of menstrual cyclicity). METHODS AND RESULTS: 24 oligo/amenorhoeic women with polycystic ovary syndrome were included into the study. Basal blood samples were taken for the determination of testosterone, estradiol, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone-sulphate, 17OH progesterone, 17OH pregnenonole, sex-hormone binding globulin and cortisol. Gonadoliberin (GnRH) analogue test was performed with estimation of the same steroids and LH. Oral glucose tolerance test was done with dextrose, and with estimation of glucose, insulin, and C peptide. HOMA model assessment was used for calculation of insulin resistance and insulin secretion. All examinations were done before and after 27 +/- 4 weeks (average +/- standard deviation) of therapy with metformin 1000 mg/day. Significant improvement in menstrual cyclicity was observed in 58% of women. No significant change in basal steroid levels was found. A trend towards decline in insulin resistance and secretion was detected. Significant decrease in the mean stimulated testosterone level (from 1.74 to 1.54 nmol/l, 95% CI 1.42-2.08 and 1.21-1.87; p < 0.05), 17OH progesterone level (from 3.32 to 2.37, 95% CI 1.42-2.08 and 1.21-1.87; p < 0.05), LH (from 9.1 to 4.8 IU/l, 95% CI 6.4-12.8 and 3.4-6.8; p < 0.05), and estradiol level (from 0.91 to 0.43 nmol/l, 95% CI 0.69-1.19 and 0.38-0.65; p < 0.01) were detected. The best prediction of the improvement in menstrual cyclicity after metformin was achieved with the combination of basal 17OH progesterone, androstendione, testosterone and SHBG. This model correctly classified 86.7% of subjects. CONCLUSIONS: Long-term therapy with metformin led to the improvement in menstrual cyclicity, without significant change in basal steroid levels or parameters of insulin resistance.

17-alpha-Hydroxypregnenolone↗

PubMed2001

[Osteopenia and osteoporosis in diabetic women over 40 years of age].

BACKGROUND: The aim of this study was to find the prevalence of osteopenia and osteoporosis in postmenopausal diabetic females and its association with the diabetic compensation and angiopathic complications. METHODS AND RESULTS: Bone mineral density was measured in 156 diabetic females, 44 of them had type 1 diabetes mellitus (mean age 53 +/- 8.9 years) and 112 type 2 (mean age 60 +/- 9.2 years). In the lumbar spine and proximal femur the prevalence of osteoporosis varied between 9-11% and 18-20% respectively. The respective prevalence of osteopenia amounted 30-36% and 34-48%. No statistically significant differences were found between type 1 and type 2 diabetes. Any association with diabetic compensation and the diabetic microangiopathic complications was not found. Only in females with osteoporosis the prevalence of cardiovascular heart disease was higher than in those with normal bone mineral density. CONCLUSION: The prevalence of osteoporosis and osteopenia in postmenopausal diabetic women is similar to those in the common population of the respective age.

Adult↗

PubMed2001

The effects of long-term metformin treatment on adrenal and ovarian steroidogenesis in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate adrenal and ovarian steroidogenesis before and after long-term treatment with metformin in women with polycystic ovary syndrome (PCOS). DESIGN AND METHODS: Twenty-four women with PCOS were evaluated before and after treatment (27+/-4 weeks) with metformin (1000 mg/day) using adrenocorticotrophin (ACTH), GnRH analogue and oral glucose tolerance (oGTT) tests. For statistical evaluation, ANOVA and Wilcoxon's test were used. RESULTS: In 58% of the women a significant improvement in menstrual cyclicity was observed. No significant change in basal steroid levels was found. After ACTH stimulation, a significant decrease in the activity of 3 beta-hydroxysteroid dehydrogenase in C(21) steroids (P<0.05) and in 17 beta-hydroxysteroid dehydrogenase (P<0.01) was observed, as was an increase in the activity of C17,20-lyase in the Delta(4) pathway (P<0.01). A significant growth in the dehydroepiandrosterone (DHEA)/DHEA-sulfate ratio (P<0.05) was detected. With regard to ovarian steroidogenesis, a significant decrease in the stimulated levels of testosterone (P<0.05), index of free testosterone (P<0.01), LH (P<0.05) and oestradiol (P<0.01), and an increase in the levels of 17-hydroxypregnenolone (P<0.05) were detected. In the indices of ovarian enzyme activities, we observed a significant decrease in 3 beta-hydroxysteroid dehydrogenase in C21 steroids (P<0.01), in C17,20-lyase in the Delta 5 pathway (P<0.01), in 17 beta-hydroxysteroid dehydrogenase (P<0.05) and in aromatase. In glucose metabolism, a tendency towards reduction in the homeostasis model assessment (HOMA)-R (for insulin resistance) and HOMA-F (for beta cell function) was detected. In addition, an increase in the levels of C peptide during oGTT was observed (P<0.01). CONCLUSIONS: Long-term metformin treatment reduced various steroid enzymatic activities both in the ovary and the adrenal glands, without apparent changes in basal steroid levels and in insulin sensitivity.

Adrenal Glands↗

PubMed2000

An analysis of the relationship between insulin resistance and the activity of steroid C17,20-lyase and 3beta-hydroxysteroid dehydrogenase in ovaries and adrenals in women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is connected with insulin resistance (IR), and often with the hypersecretion of adrenal androgens. Mutual relationships between IR and adrenal and ovarian steroidogenesis were investigated in the group of 19 oligo/amenorhoeic women with PCOS. The age and body mass index (BMI) of the patients were 21+/-4.7 years and 26.4+/-5 kg/m2 (average+/-SD), respectively. All underwent a 60-minute adrenocorticotrophic hormone (ACTH) stimulation test, a gonadoliberin analogue (GnRHa) test with buserelin and an oral glucose tolerance test (oGTT) in the early follicular phase of the menstrual cycle. When absolute stimulated steroid levels after GnRHa were studied, a significant positive correlation between DHEA and area under curve during oGTT for C peptide (AUC-CP) (r=0.477, p= 0.039) and a borderline negative correlation (r=-0.404, p= 0.087) between AUC-CP and 17-OH progesterone, were found. Considering steroid values after ACTH, a significant positive correlation of IR index was found only with 17-OH-progesterone (r=0.499, p= 0.03). When stimulated enzymatic activities (expressed as product/ precursor ratios) were analyzed using factor analysis, a positive relationship between IR and ovarian C17,20-lyase in both delta4 and delta5 pathway was revealed. On the other hand, no relationship was confirmed between IR and enzymatic activities in the adrenals. The authors conclude that insulin resistance and/or hyperinsulinemia is probably not the primary factor responsible for the exaggerated adrenal androgen secretion found in a great number of patients with PCOS.

17-alpha-Hydroxyprogesterone↗

PubMed1998

[Importance of short-term administration of low doses of somatostatin analog in the development and remission of type 1 diabetes mellitus in adult patients].

The objective of the presented work was to evaluate the short-term administration of octreotide on the development, onset and persistence of remission in recent insulin-dependent diabetics. The importance of remission means for the patient a clinically favourable condition with satisfactory metabolic compensation and a greater metabolic stability during the subsequent course of the disease. The period of remission is important from the aspect of prevention of late organ complications. Two-week treatment with octreotide, 150 micrograms/day, administered during the first month after establishment of the diagnosis was not associated with serious undesirable effects. Treatment with octreotide led to more frequent development of remission, partial and complete, as compared with a control group. In the majority of diabetics in the intervened group remission started immediately after administration of octreotide. The serum value of peptide-C as part of the glucagon test made at the time of diagnosis had a predictive value for the development of induced and spontaneous remission. Octreotide administration increased the probable development of remission even in patients with a substantially lower peptide C value at the time of diagnosis as compared with controls. The preliminary results indicate also a protraction of the remission period.

Adult↗