Objective Cardiovascul diseases are the most common comorbidities in acromegaly. Potential parameters in pathology of cardiovascular comorbidities are changes in levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) as well as body composition parameters. Purpose The aim of this study was to examine morphological and functional parameters of the cardiovascular system by echocardiography and to assess its relationship with disease activity and body composition parameters. Methods We prospectively enroled 129 acromegalic patients (82 females, 47 males) and 80 healthy controls (53 females, 27 males) matched for age, gender, and BMI. All patients underwent two-dimensional echocardiography. Body composition parameters were assessed by dual-energy X-ray absorptiometry. Results Acromegaly patients presented with higher left ventricle mass (LVM) compared to controls (LVMI: 123 ± 45 g/m2 vs 83 ± 16 g/m2, P < 0.001). Prevalence of left ventricle hypertrophy in acromegaly patients was 67% (78% concentric, 22% eccentric). IGF -1 levels, BMI, and lean mass positively correlated with LVM in all acromegaly patients (P < 0.001). Fat mass positively correlated with LVM in females (R = 0.306, P = 0.005), but this correlation was not found in males. We did not find any difference in size of the left and right ventricle between acromegaly patients and controls. Acromegaly patients presented with left atrium enlargement, diastolic dysfunction and low incidence of systolic dysfunction. Valvopathy was found in 43% of patients with predominant (31%) prevalence of mitral regurgitation. Conclusion Our study demonstrates higher prevalence of cardiovascular comorbidities in acromegaly patients and the impact of IGF-1 levels and body composition parameters in pathology in some of these comorbidities.

SúhrnAkromegália je zriedkavé ochorenie, ktorého najčastejšou príčinou je adenóm hypofýzy. V dôsledku dlhodobej elevácie rastového hormónu (RH) a inzulínu podobného rastového faktora 1 (IGF1) pri tomto ochorení dochádza k rozvoju komplikácií ako kardiomyopatia, diabetes mellitus, syndróm spánkového apnoe a artropatia. Incidencia akromegálie je 3-4 pacienti na 1 000 000 za rok. Klinefelterov syndróm (KS) je najčastejšou príčinou mužského hypogonadizmu, vyskytujúcou sa u približne 1 z 500 živo narodených chlapcov. Medzi klinické charakteristiky KS patria najmä malé semenníky, spomedzi ďalších príznakov je to vysoká postava, znížený svalový tonus, oneskorená puberta s nedostatočným vývojom sekundárnych pohlavných znakov a gynekomastia. V našej kazuistike prezentujeme 32-ročného muža s kombináciou akromegálie a 47,XXY Klinefelterovho syndrómu. Pacient klinicky s typickými akromegalickými znakmi. Laboratórne bola potvrdená vysoká hladina rastového hormónu bez supresie v orálnom glukózovom tolerančnom teste, vysoká hladina IGF1, nízka hladina testosterónu s vysokými hladinami luteinizačného hormónu (LH) a folikuly stimulačného hormónu (FSH). Doplnená magnetická rezonancia s nálezom makroadenómu hypofýzy veľkosti 25 × 18 × 18 mm. Na základe uvedeného bola potvrdená diagnóza akromegálie. Následne realizovaná transsfenoidálna resekcia makroadenómu hypofýzy. Histopatologické a imunohistochemické nálezy odhalili rastový hormón produkujúci adenóm hypofýzy. Prítomnosť klinických znakov -malých, tuhých semenníkov, nedostatku sekundárnych pohlavných mužských znakov, ako aj laboratórne vyšetrenia suponovali hypergonadotropný hypogonadizmus, ktorý nemohol byť vysvetlený diagnózou akromegálie. Chromozomálny karyotyp 47,XXY potvrdil diagnózu KS. Substitučná liečba testosterónom nebola zahájená z dôvodu nesúhlasu pacienta. Pooperačne pretrvávala zvýšená plazmatická koncentrácia RH a IGF1. Bola zahájená liečba somatostatínovými analógmi (lanreotid) v dávke 120 mg každých 28 dní. Kontrolná magnetická rezonancia hypo fýzy preukázala reziduum veľkosti 14 × 14 × 7 mm. Aktuálne je pacient po endoskopickej revízii rezidua. Kľúčové slová: akromegália -IGF1 -Klinefelterov syndróm -rastový hormón -testosterón The combination of acromegaly and Klinefelter syndrome in one patient SummaryAcromegaly is a rare disorder usually caused by a benign tumour of the pituitary gland. Long-term presence of elevated growth hormone (GH) and insulin like growth factor 1 (IGF1) levels accompanying this disease is associated with complications such as cardiomyopathy, diabetes mellitus, sleep apnoea and arthropathy. Incidence of acromegaly is 3-4 patients per million per year. Klinefelter syndrome (KS) is the most common sex chromosome disorder occuring in about 1/500 live male births. Common physical features include particularly small testes, among other symptoms are tall stature, reduced muscle tone, delayed pubertal development, lack of secondary male sex characteristics and gynecomastia. We present a 32-year-old man suffering from both acromegaly and 47, XX...

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Comparison of intraparenchymal circulation in various areas of the kidneys of newborns by means of Doppler ultrasoundSir, I am delighted to have an opportunity to present the results of our study.In our previous Doppler study [1] we set normal values of renal circulation for a population of healthy newborns. Comparisons of Doppler parameters of intraparenchymal (IP) renal arteries in various areas of the kidney in this age group have, however, not yet been published. Available sources of information are not sufficient [2, 3], and are not targeted to the neonatal period.Thirty physiologically normal term neonates (17 girls and 13 boys) with negative perinatal history were enrolled in this study. The examination was performed on day 4. No sedation was required. Colour Doppler ultrasound scanners were used with linear 5-12-MHz multifrequency transducers. Babies were examined in the prone position and kidneys were scanned from the dorsolateral view. Colour-flow mapping was performed to display renal blood flow. The longest possible segment of the artery was examined under the optimal insonating angle (less than 30°), keeping the sample volume as small as possible (1 mm).IP arteries (arcuate and interlobular arteries) from the upper pole, the middle part and the lower pole of the kidney were assessed. One measurement of each artery was obtained. V max , V ed and V mean were measured; the resistive index (RI) and the pulsatility index were subsequently calculated. The data were compared reciprocally using analysis of variance for statistical assessment, with a value of P<0.05 being recognised as statistically significant.We found no statistically significant differences in any of the parameters assessed between IP arteries of the upper pole, the middle part and the lower pole of the kidney, nor were the differences considered to be clinically significant (Table 1). There were no side differences either.The absence of intrarenal changes within IP circulation has already been proved in adults, but no reports of such studies on neonates are available. Terry et al. [2] recognised no differences between the RI values measured in the upper pole, the middle part and the lower pole of the kidney in their study considering changes of the RI with age from childhood to old age. Keogan et al. [3], comparing these areas too, concluded that the renal region does not have a significant influence on the value of the RI in the adult population.It is quite difficult to perform measurements on small IP arteries in newborns, including finding a suitable IP artery in three particular areas of the kidney. Breathing movements force us to find a suitable artery, place a sample volume, correct an angle and take a measurement in short amount of time, while the baby is breathing slowly and shallowly or during short apnoeic pauses. Owing to these facts the rate of unsuccessful measurements in the