The high prevalence of vitamin D deficiency in patients with T2DM and particularly in patients with T2DM and CVD suggests that supplementation with vitamin D may be beneficial although there is still not sufficient evidence for recommending prescribing vitamin D.

Summary Background: Laboratory thyroid function tests play a central role in the diagnosis of thyroid disorders. The aim of our cross-sectional study was to determine reference values for thyroid tests in a rigorously selected group of Montenegrin females, investigate the impact of possible age-related changes and the influence of the interassay bias between three frequently used immunoassays. Methods: Female subjects were randomly selected, aged between 20 and 69 and 946 of them met the selection criteria. TSH, fT3, fT4, thyroid peroxidase and thyroglobulin antibodies were measured. Eighty samples were further analyzed on two other immunochemistry platforms. Results: Median TSH progressively increased with age, there was no difference in fT3, while fT4 was significantly higher in the two oldest groups compared to the others. When using the age-related 97.5 percentile of TSH the percentage of reclassification was highest in the 20–29 years of age group (5.2%, p<0.05). In the oldest band, 7.7% had TSH values above cohort-specific and below the age-related upper reference limit. Bland-Altman bias plots revealed the highest interassay absolute mean difference between compared TSH assays of 24.5% and for fT4 assays of 13.8%. Conclusions: The correlation coefficients between fT3 assays from different manufacturers were low. Serum TSH and fT4 concentrations increased with age and the implementation of age-specific TSH reference intervals would be of interest. The bias between the three commercial immunoassays indicated that the standardization of thyroid function tests is a task of great importance.

People are at higher risk of cancer as they get older or have a strong family history of cancer. The potential influence of environmental and behavioral factors remains poorly understood. Earlier population and case control studies reported that upper quartile of circulating IGF-I is associated with a higher risk of developing cancer suggesting possible involvement of the growth hormone (GH)/IGF system in initiation or progression of cancer. Since GH therapy increases IGF-1 levels, there have been concerns that GH therapy in hypopituitarism might increase the risk of cancer. We report a 42-year-old female patient who presented with subacute onset of symptoms of meningitis and with the absence of fever which resulted in death 70 days after the onset of symptoms. The patient together with her younger brother was diagnosed at the age of 5 years with familial congenital hypopituitarism, due to homozygous mutation c.150delA in PROP1 gene. Due to evolving hypopituitarism, she was replaced with thyroxine (from age 5), hydrocortisone (from age 13), GH (from age 13 until 17), and sex steroids in adolescence and adulthood. Her consanguineous family has a prominent history of malignant diseases. Six close relatives had malignant disease including her late maternal aunt with breast cancer. BRCA 1 and BRCA 2 mutational analysis in the patient's mother was negative. Histology after autopsy disclosed advanced ovarian cancer with multiple metastases to the brain, leptomeninges, lungs, heart, and adrenals. Low circulating IGF-1 did not seem to protect this patient from cancer initiation and progression in the context of strong family history of malignancies.

No abstract

Calcinosis cutis reffers to a group of disorders in which calcium deposits are being formed in the skin. Depending on the pathophysiologic mechanisms, calcinosis cutis has been classified as metastatic, dystrophic, idiopathic, or iatrogenic (1). In connective tissue diseases, calcinosis is mostly of the dystrophic type and it seems to be a localized process rather than an imbalance of calcium homeostasis (2). Juvenile dermatomyositis (JDM) is a systemic, autoimmune inflammatory muscle disorder and a small vessel vasculopathy that affects children younger than 18 years, primarily the skin and the skeletal muscles (3). Calcinosis cutis occurs in 20-40% of patients with JDM (4). Some severe cases may be associated with advanced calcinosis but the exact mechanism that leads to their development and spreading remains unclear. Picture 1: Calcinosis over a right hip and proximal part of the right arm Althought a number of drugs are often given for the treatment of calcinosis, the approach to menagement is still not established due to inconsistent responses. Revealing a patogenesis of calcium deposits would certanly bring a new insight to this and similares cases. A female patient firstly admitted to the hospital at the age of 17 for skin rash, malaise and pain in peripheral joints and muscles. After evaluation a syndroma overlap with dominant atypic dermatomyositis (without muscle enzymes elevated) and systemic lupus erythematosus was suspected and treatment with prednisolone and choroquine initiated. After six months subcutaneous calcium deposits in form of multiple firm nodules appeared, firstly in gluteal region, than polytopically. The nodules were gradually enlarging, causing pain and exudation of chalky white material without a previous traumatic event. No metabolic disorders were observed; levels of PTH, phosphorus and calcium have always been in reference range; ANA and anti-dsDNA occasionally elevated. During the last 12 years, systemic corticosteroids and other different immunosuppressive and immunomodulatory agents (methotrexate, cyclophosphamide, azathioprin, mycophenolat, colchicine), intravenous bisfosfonates, imunoglobulins and calcium antagonists were given in attempt to establish a better disease control, stop spreading and reduce a calcinosis along with tissue damage but without any significant improvement.