Papers by Mirjana Stojkovic
Arhiv za farmaciju
Thyroid function disorders are the most common endocrine disorders in humans. They are frequently... more Thyroid function disorders are the most common endocrine disorders in humans. They are frequently diagnosed, with prevalence varying between 2 and 6%, and a female to male ratio of up to 10:1. Disorders of thyroid function in the narrower sense are presented by its hyperactivity or underactivity, although there are conditions that lead to an increased concentration of thyroid hormones, without its increased activity. In iodine-sufficient regions, the most common cause of hyperthyroidism, as well as hypothyroidism, is an autoimmune disease of the thyroid. For hyperthyroidism, it is Graves' disease, with typical symptoms and signs of hypermetabolism. The diagnosis of hyperthyroidism is based on suppressed TSH and elevated fT4 (free, and in the differential diagnosis, elevated TSH-receptor-antibodies are crucial for Graves' disease. Management of Graves' disease relies on three equally potent approaches: medical therapy, ablative treatments with 131I-radiotherapy-RAI, and t...
Journal of Medical Biochemistry, 2021
Background: Although thyroid hormones have significant effect on cardiovascular system, the impac... more Background: Although thyroid hormones have significant effect on cardiovascular system, the impact of subtle thyroid dysfunction such as subclinical hypothyroidism (SCH) remains to be determined. We investigated coronary flow reserve (CFR) in patients with subclinical hypothyroidism. Methods: Thirty two subjects with SCH and eighteen control subjects with normal serum thyroid hormones and thyroid-stimulating hormone (TSH) levels were included in the study. TSH, free thyroxine, free triiodothyronine, glucose, insulin, HbA1c, cholesterol, triglyceride and plasma levels of C-reactive protein were measured. Coronary diastolic peak flow velocities in left anterior descending coronary artery were measured at baseline and after adenosine infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity. Results: CFR values were not significantly different between the two groups (SCH 2.76±0.35 vs controls 2.76±0.42). There was a significant correlation of CFR with w...
There are three basic modalities for the treatment of thyrotoxicosis: thyrosuppresive drug therap... more There are three basic modalities for the treatment of thyrotoxicosis: thyrosuppresive drug therapy, ablation with radioactive iodine and surgical treatment. Patients who do not achieve adequate thyrotoxicosis control, as was the case of described patient, have a high mortality rate due to the possibility of developing a thyroid storm. The use of drug therapy for hyperthyroidism, as the first line of treatment, is associated with the appearance of various side effects, as was the case in our patient. Side effects of Methimazole are dose-dependent, while in the case of Propylthiouracil, the occurrence of side effects is not clearly dose-dependent. In the case of the described patient, all alternative, lesser known modalities for the treatment of hyperthyroidism were applied, after the occurrence of adverse reactions to thyrosuppressive therapy. Sodium perchlorate, ie. Sodium with perchloric acid is rarely used in the treatment of hyperthyroidism, as in cases of severe idiosyncratic re...
European review for medical and pharmacological sciences, 2015
OBJECTIVE Malignancies and autoimmune thyroid disease are still controversial, but recent studies... more OBJECTIVE Malignancies and autoimmune thyroid disease are still controversial, but recent studies prove that a long lasting thyroid disease may be linked with malignancy, e.g. papillary thyroid carcinoma in patients with Hashimoto thyroiditis. Having in mind that thyrotropin is a thyroid growth factor, the relationship between its serum values, as well as the levels of anti-peroxidase and anti-thyroglobulin antibodies and thyroid malignancy in patients with nodular thyroid goiter was examined. PATIENTS AND METHODS Six-hundred-thirty-seven medical records, which included the thyroid fine-needle aspiration cytology were retrospectively evaluated. Patients were grouped regarding the levels of thyrotropin, anti-peroxidase and anti-thyroglobulin antibodies (in or out of the reference ranges) and compared with cytology findings for establishing their prognostic potential for malignancy. RESULTS Elevated serum thyrotropin (≥ 4.5 mIU/L) was found in 27.3% of patients with thyroid malignancy...
Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma, 2019
Uloga i preporuke za monitoring krvnog pritiska (ABPM). Koje uređaje i softver koristiti. Kako se... more Uloga i preporuke za monitoring krvnog pritiska (ABPM). Koje uređaje i softver koristiti. Kako se programiraju uređaji. Normalne vrednosti krvnog pritiska za dan i noć i kako analizirati i koristiti dobijene podatke u kliničkoj praksi. ABPM je potpuno automatizovana tehnika u kojoj se meri krvni pritisak (KP) u pravilnim intervalima (obično svakih 15 do 30 minuta) tokom 24 sata, pružajući vrednosti KP tokom normalnih dnevnih aktivnosti pacijenta. Pojedini specijalisti predlažu upotrebu ABPM-a za postavljanje prve dijagnoze hipertenzije i za donošenje odluka o lečenju. National Institute for Health and Clinical Excellence u Velikoj Britaniji preporučio je da se ABPM uradi svim ljudima za koje se sumnja da imaju hipertenziju. Analizom diunarnih promena krvnog pritiska pomoću ABPM-a možemo proceniti kardiovaskularni morbiditet i mortalitet, predviđajući ozbiljnost i prognozu bolesti kod pacijenta sa značajnim kardiovaskularnim rizikom. Za upotrebu ABPM-a preporučuju se samo provereni uređaji. Najčešće se ABPM koristi da se vidi da li osoba ima hipertenziju belih mantila, a u preporukama se preporučuje za otkrivanje maskirane hipertenzije, procene variranja krvnog pritiska tokom 24h i dijagnozu hipotenzije. Neophodna je obuka kako se koristi ABPM koja može biti deo programa redovne nastave Medicinskog fakulteta, kongresa ili radionice. U poslednjih nekoliko decenija dosta studija nalazi da srednja vrednost KP koja se dobija pomoću ABPM-a ima veću prediktivnu vrednost za kardiovaskularni rizik u odnosu na standardno merenje krvnog pritiska.
Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma, 2016
Mister XX Sažetak: Ženski pseudohermafroditizam predstavlja nesklad između kariotipskog i gonadno... more Mister XX Sažetak: Ženski pseudohermafroditizam predstavlja nesklad između kariotipskog i gonadnog pola s jedne strane, i fenotipskog i psihogenog, sa druge. Kongenitalna adrenalna hiperplazija je deo spektra ženskog pseudohermafroditizma i nastaje zbog deficita enzim puta steroidogeneze. Više od 95% obolelih ima nedostatak 21 hidroksilaze što posledično dovodi do nedostatka kortizola i hipersekrecije ACTH iz hipofize, hiperprodukcije 17 hidroksi progesterona (17OHP) i androgena i hiperplazije kore nadbubrežnih žlezda (1). Klinički fenotip KAH-a je klasifikovan kao klasični i neklasični (tzv. 'late onset' forma). Klasični oblik se deli na formu sa gubitkom soli i bez gubitka soli (virilišuća forma), u zavisnosti od stepena nedostatka aldosterona. Patofiziologija KAH-a zbog nedostatka 21α hidroksilaze tesno je povezana sa stepenom nedostatka enzima. Hiperprodukcija androgena vodi ubrzanoj virilizaciji. Klasična forma se manifestuje u detinjstvu i karakteriše se hiperprodukcijom prekursora kortizola i adrenalnih androgena. U najtežoj formi, istovremena deficijencija aldosterona vodi do gubitka soli sa svim komplikacijama. Devojčice sa klasičnim oblikom KAH tipično imaju dvopolne genitalije na rođenju zbog izloženosti visokim koncentracijama androgena in utero. KAH zbog deficijencije 21OH je najčešći razlog dvopolnih genitalija u 46XX novorođenčadi. Karakteristično se nalazi uvećan klitoris, parcijalno spojene labia maiora i zajednički urogenitalni sinus na mestu uretre i vagine. Materica, jajovodi i jajnici su prisutni i normalni, a strukture Wolfovog kanala su odsutne. Kada se dijagnostikuje KAH u detinjstvu u 46XX osoba do sada je bilo indikovano opredeljivanje za ženski pol na osnovu 46, XX kariotipa čak i u izraženo virilizovane novorođenčadi. Ovakav dogmatski prostup zasnivan je na očuvanju fertiliteta,te ukoliko postoji barem uterus, opredeljivanje za ženski pol smatralo se opravdanim. Samo oko 5% 46 XX pacijenata sa KAH ima muški psihogeni pol 1
European Journal of Endocrinology, 2008
ObjectiveInterleukin 6 (IL6) has the ability to influence each level of the hypothalamo-pituitary... more ObjectiveInterleukin 6 (IL6) has the ability to influence each level of the hypothalamo-pituitary–adrenocortical (HPA) axis. The aim of the study was to test whether IL6 concentration correlates with the adrenal cortex response to ACTH in healthy humans. We postulated that higher basal IL6 concentration would be associated with the higher cortisol response to the stimulation.Design and methodsBasal IL6 concentration was measured and a low dose (1 μg) ACTH test was performed to assess cortisol response. Twenty-seven apparently healthy subjects (11 male, 16 female, mean age 31.1 years, age range 22–47 years) were included in the study.ResultsData are presented as mean±s.e.m. Basal IL6 level was 0.84±0.10 pg/ml. Basal cortisol was 351.9±18.3 nmol/l. Maximal cortisol during synacthen test was 653.0±20.6 nmol/l. Maximal cortisol increment was 301.1±20.0 nmol/l. IL6 concentration was not correlated with basal or maximal cortisol concentration, but correlated significantly with cortisol in...
Journal of Medical Biochemistry, 2019
Summary Background Primary aldosteronism (PA) is associated with increased prevalence of metaboli... more Summary Background Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications. Methods Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS). Results Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p<0.001). The metabolic syndrome was significantl...
Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma, 2021
Purpose: The aim of this study was to assess the relationship between adrenal incidentaloma size,... more Purpose: The aim of this study was to assess the relationship between adrenal incidentaloma size, cortisol secretion suppressibility by Dexamethasone and relevant clinical and laboratory parameters. Methods: This retrospective study included all patients diagnosed with adrenal incidentaloma and admitted to the single department of the Clinic of endocrinology, Diabetes and Diseases of Metabolism during the period from 2012 till the end of 2019. The inclusion criterion was the presence of an asymptomatic adrenal mass on imaging not performed for suspected adrenal disease. The study group included 197 subjects. Adrenal masses were detected using CT or NMR scan. We analysed the correlation between tumour size and relevant hormonal and clinical parameters. Results: We found a significant positive correlation between incidentaloma size and morning cortisol, cortisol after overnight Dexamethasone, and a significant negative correlation between incidentaloma size and morning ACTH, and hip T...
Hypothyroid Graves' ophthalmopathy is a rare condition, present in about 3% of all cases. Since t... more Hypothyroid Graves' ophthalmopathy is a rare condition, present in about 3% of all cases. Since thyroid-stimulating antibodies could be detected in a majority of euthyroid and hypothyroid Graves' patients, the most probable explanation for unincreased thyroid function is a reduction of tissue capability to response to stimulation. We present a 57-yr-old man visited the hospital with signs and symptoms typical of hypothyroidism. Since TSH was 77 IU/ml, FT4 6.8 pmol/l and TPO Ab 4828 IU/ml, the treatment with 100 mcg/day T4 was started. Three months later, when euthyroid, he developed Graves' ophthalmopathy with slight proptosis, moderate palpebral edema, conjuctival injection and chemosis, reduction of visual acuity to 0.7, diplopia and secondary glaucoma. He had no palpable goiter and ultrasound revealed small (V 5 cm 3), diffuse hypoechoic thyroid. Orbital computed tomography (CT) showed a pronounced enlargement of all extraocular muscles (9-15 mm). TSH receptor antibodies were 65 U/l. Patient was treated with two doses of 0.5 g intravenous methylprednisolone during three days, followed by oral prednisone 40 mg/day tapered to 10 mg/day in four weeks. Six courses of therapy were performed. There were no significant side effects during the treatment. A prompt improvement of visual acuity, intraocular pressure and inflammatory signs was noticed, but diplopia became permanent. Orbital CT revealed a significant reduction of all rectus muscles (2-10mm). TSH receptor antibodies were 10 U/l, TPO Ab 8603 IU/ml. He developed cataract on his left eye and refused extraocular muscle surgery since he lost diplopia. Conclusion: Hypothyroid Graves' disease reflects a subtle relations between destructive changes in the thyroid gland and autoimmune mechanisms involved in thyroid pathology.
Medicinski glasnik Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor, 2016
PONAVLJANA NEFROLITIJAZA-CISTINURIJA APSTRAKT UVOD: Nefrolitijaza se sve više smatra sistemskom b... more PONAVLJANA NEFROLITIJAZA-CISTINURIJA APSTRAKT UVOD: Nefrolitijaza se sve više smatra sistemskom bolešću koja je udružena sa hroničnom bubrežnom insuficijencijom i koštanim poremećajima. Ako se ne leči to je hronična bolest sa stopom ponavljanja više od 50% za 10 godina. Pacijenti sa cistinurijom imaju visoku stopu rekurentne kalkuloze. PRIKAZ SLUČAJA: Tridesetsedmogodišnja pacijentkinja žalila se na bolove u levoj slabini sa širenjem prema napred pri naglom ustajanju prilikom ispitivanja zbog rekurentne kalkuloze. U 24. godini ustanovljena je kalkuloza desnog bubrega i zbog hidronefroze i anurije urađena je nefrektomija. Poslednje tri godine, bar jednom godišnje, imala je anuriju a litoklast kalkulusa u pelvičnom delu levog bubrega rađen je 2009. i 2011.g. U maju 2009. prvi put je pregledana od strane nadležnog endokrinologa kada je PTH bio blago povišen 70,8 (15-65ng/l), uz uredan jonizovani kalcijum u serumu. Kvantitativne analize 24h urina pokazale su uredne vrednosti kreatinin klirensa, proteinurije, natriureze, kaliureze, normalne vrednosti kalciurije, fosfaturije, oksalurije, urikozurije i citraturije. U hormonskim analizama graničan PTH 66 (10-65ng/L) i deficit vitamina D (15,3ng/L). Analiza hemijskog sastava kalkulusa ukazala je da se radi o cistinskim kalkulusima. Testiranjem sina i same pacijentkinje u Institutu za zdravstvenu zaštitu majke i deteta "dr Vukan Čupič", na osnovu povećanog izlučivanja cistina, lizina, ornitina i arginina u 24h urinu, kod pacijentkinje je potvrđena cistinurija. Savetovana je prevencija formiranja kalkulusa (povećan unos tečnosti na 4-4,5l/d, alkalizacija urina tabletama kalijum-citrata, uz monitoring pH urina test trakama i kontrolu kalemije) uz terapiju Vigantol kapima zbog hipovitaminoze D. ZAKLJUČAK: Prevencija kalkuloze je moguća nakon pravilno postavljene dijagnoze. Zato je važno da se utvrdi uzrok nefrolitijaze. 1 Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Klinički centar Srbije, tijana_lalic@ yahoo.com.
Endocrine Abstracts, 2016
Medicinski glasnik Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor, 2013
Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma, 2018
u Beogradu. protokolu za bubrežnu bolest. Po završenom lečenju registruje se redukcija proteinurije.
Journal of Hypertension, 2021
Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma, 2019
Solitarni fibrozni tumor pleure je najčešći mezenhimalni tumor koji putem ektopične sekrecije IGF... more Solitarni fibrozni tumor pleure je najčešći mezenhimalni tumor koji putem ektopične sekrecije IGF2 uzrokuje non-islet cell hipoglikemiju, nazvanu Doege Potterov sindrom.
Hormones, 2014
OBjECTIVE: Glucocorticoids (GC) are the treatment of choice for moderate-to-severe and active Gra... more OBjECTIVE: Glucocorticoids (GC) are the treatment of choice for moderate-to-severe and active Graves' orbitopathy (GO), but optimal treatment is still undefined. The aim of the present study was to analyze the efficacy and tolerability of combined parenteral GC pulse therapy followed by oral GC in the interpulse period. DESIGN: The study included 50 patients (48±10 years; 37 female) with untreated, active and moderate-to-severe GO. Patients received 500mg of methylprednisolone in 500ml of physiologic saline. Infusion was repeated after 48h and then followed by tapering doses of oral prednisone and the cycle repeated each month for the next 5 months. The cumulative dose was 10.2g. Ophthalmic assessment was performed before and 6 months after start of treatment. Side effects of GC therapy were evaluated and recorded each month. REsuLts: GC showed the greatest effectiveness on soft tissue changes (incorporated in the CAS). Median CAS values decreased from 4.5 to 2 (p>0.001). Improvement was demonstrated in 37 patients (74%), there was no change in 13 patients (26%) and none of the patients presented with deterioration of inflammatory status. Diplopia improved in 21 patients (42%), was unchanged in 28 patients (56%) and deteriorated in 1 patient (2%). Improvement in visual acuity occurred in 36% of patients. At 6 months, 33/50 patients (66%) demonstrated overall treatment response. Response to GC therapy was influenced by CAS, TSHRAb and smoking behavior. The only independent parameter associated with positive treatment response was CAS ≥4 (p<0.001). Side effects occurred in 35/50 patients (70%) and the vast majority of them were mild to moderate. During the 6-months follow-up period, 2/33 patients (6%) had relapsing GO. COnCLusIOn: With appropriate selection of patients and careful monitoring during and after treatment, combined parenteral and oral GC therapy is effective and safe.
Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma, 2016
Cilj rada je da se proceni da li iznenadna promena koncentracije glukoze kod zdravih osoba dovodi... more Cilj rada je da se proceni da li iznenadna promena koncentracije glukoze kod zdravih osoba dovodi do promene pulsatilne sekrecije glukoze slična onoj koja se nalazi kod obolelifh od diabetzes mellitusa tip 2 (T2D). DESIGN: Koncenpt studije je bio da se pankreas "resetuje" I i da se isprazne postojeće rezerve insulina, tako da se diskretne promene insulinske sekrecije mogu detektovati. METODE METHODS: Studija ej je uključila 6 kontrola I I 7 obolelih od T2D subjects. Krv za određivanje pulsatilne sekrecije insulina je uzorkovana na 2 minuta tokom 60 minuta. Bolus glukoze (0.3 g/kg) je dat da bi se ispraznile rezerve insulina. REZULTATI RESULTS: Srednja koncentracija glukoze u T2D bila je značajno veća nekgo kod kontrola, ali se koncentracije insulina nisu razilkovale. Poluživot insulina, amplitida pulsa, broj i interval između pulsea se nisu razlikovali između grupa. ZAKLJUČAK CONCLUSIONS: Pulsatilna sekrecija insulina posle povećanja glikemje se ne razlikuje između zdravih i obolelih T2Ds. Međutim, defekt u insulinskoj sekreciji kod obolelih je prisutan, s obzirom na to da se ne luči dovoljno insulina kao odgovor na povećanu glikemiju.
Medicinski glasnik Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor, 2016
Apstrakt: Adrenaloleukodistrofija (ALD) predstavlja bolesti akumulacije masnih kiselina veoma dug... more Apstrakt: Adrenaloleukodistrofija (ALD) predstavlja bolesti akumulacije masnih kiselina veoma dugih lanaca u tkivima po celom telu. Najteže pogođena tkiva su mijelin u centralnom nervnom sistemu, kora nadbubrežne žlezde i Leidig ćelije u testisima. Klinički, ALD je heteroehogeni poremećaj, predstavljajući se sa nekoliko različitih fenotipova, i ne postoji jasan obrazac genotip-fenotip korelacije. Prikaz slučaja: Pacijent A. A, star 50 godina, u trećoj godini života dijagnostikovan primarni hipokorticizam, od 45. godini života ima tegobe: malaksalost, glavobolje, vrtoglavice, zanošenje udesno, noćno umokravanje, povremena inkotinencija urina. Razgovara sam sa sobom, godinu dana svakodnevno boravi na groblju, povremeno viče nekontrolisano a da se kasnije toga ne seća. adrenal insufficiency.
Srpski arhiv za celokupno lekarstvo, 2016
Introduction. In interpreting thyroid hormones results it is preferable to think of interference ... more Introduction. In interpreting thyroid hormones results it is preferable to think of interference and changes in concentration of their carrier proteins. Outline of Cases. We present two patients with discrepancy between the results of thyroid function tests and clinical status. The first case presents a 62-year-old patient with a nodular goiter and Hashimoto thyroiditis. Thyroid function test showed low thyroid-stimulating hormone (TSH) and normal to low fT4. By determining thyroid status (?SH, T4, fT4, T3, fT3) in two laboratories, basal and after dilution, as well as thyroxine-binding globulin (TBG), it was concluded that the thyroid hormone levels were normal. The results were influenced by heterophile antibodies leading to a false lower TSH level and suspected secondary hypothyroidism. The second case, a 40-year-old patient, was examined and followed because of the variable size thyroid nodule and initially borderline elevated TSH, after which thyroid status showed low level of ...
Uploads
Papers by Mirjana Stojkovic