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Vljudno Vas prosim za Vašo razlago spodaj navedenega in mnenje.

Zanima me predvsem, če se Medrol in hormon DHEA izključujeta v zdravljenju neplodnosti zaradi avtoimunih boleznih.


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tekst:

5. ENDOCRINOLOGICAL CHANGES IN AUTOIMMUNE DISEASES

KL5
HYPOTHALAMIC-PITUITARY-ADRENAL AND ADRENOMEDULLARY FUNCTION IN PREMENOPAUSAL FEMALES WITH SYSTEMIC SCLEROSIS
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Jozef Rovensky1, Jozef Lukac1, Richard Imrich2, Zofia Radikova2, Adela Penesova2, Richard Kvetnansky2, Miroslava Huckova2, Milan Vigas2, Ladislav Macho2, Marco Matucci Cerinic3
1 - National Institute of Rheumatic Diseases, Piestany, Slovakia; 2 - Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia; 3 - Servizio di Reumatologia, Dipartimento di Medicina Interna, Ospedale Careggi, Firenze, Italy
OBJECTIVES: To evaluate function of the hypothalamic-pituitary-adrenal axis and adrenomedullary hormonal system (AMHS) in premenopausal females with systemic sclerosis (SSc).
METHODS: Insulin-induced hypoglycaemia (0.1 IU/kg) was performed in 17 long-term, glucocorticoid-naive SSc patients with low disease activity and in 18 healthy females matched for age and body mass index (BMI). Concentrations of glucose, adrenocorticotrophic hormone (ACTH), cortisol, D4-androstenedione (ASD), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), 17a-hydroxyprogesterone (17OHP), epinephrine (EPI), norepinephrine (NE), interleukin 1a (IL-1a), IL-6, and tumor necrosis factor a (TNFa) were analyzed in plasma.
RESULTS:Basal plasma levels of cortisol, ASD, 17OHP, DHEAS, IL-1f, IL-6, and TNFa? were not significantly different in SSc compared to controls. Patients had higher basal ACTH (6.76 (1.0) in SSc v 4.14 (0.45) in controls; p < 0.05), lower basal DHEA (9.02 (1.64) nmol/l in SSc v 17.0 (2.8) nmol/l in controls; p < 0.05) and lower basal NE (1.61 (0.26) nmol/l in SSc v2.57 (0.38) nmol/l in controls; p < 0.05). Patients had comparable responses of glucose and ACTH to hypoglycaemia. General linear model for repeated measurements with BMI and age as covariates revealed that the responses of 17OHP (p < 0.05), ASD (p < 0.05), DHEA (p < 0.01), EPI (p < 0.001), NE (p < 0.001) to hypoglycaemia were lower in SSc compared to controls. Cortisol response to hypoglycemia tended to be lower in SSc patients (p = 0.06) compared to controls.
CONCLUSIONS: The present data indicate decreased adrenocortical and AMHS functions in premenopausal females with SSc. Whether or not the observed changes in the neuroendocrine system are secondary due to chronic disease will deserve further investigation.

OR51
PROLACTIN LEVELS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS
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Zelmira Macejova, Dusan Trejbal, Ivica Lazurova
Internal Clinic, University Hospital, Kosice, Slovakia
INTRODUCTION: Prolactin (PRL) has been found to affect immunological system which leads to hypothesis about its role in ethiopathogenesis of autoimmune diseases. The increased levels of PRL were found also in patient with rheumatoid arthritis (RA).
AIM: to investigate diurnal secretion of prolactin in patient with early RA.
PATIENTS AND METHODS: 15 patients were evaluated, 11 women with average age of 42.3 yaers and 4 men with average age of 39.4 years.Duration of the disease: 2.32 months. As controls we evaluated 6 volunteers, average age 41.3 years. Blood was collected at 4 hours intervals. PRL was analysed by chemiluniniscence-immunochemical reaction with monoclonal antibody using Imunolite.
RESULTS: Compared to the control group, higher levels of PRL were found in patients with RA. Mean levels of PRL in the group of RA patients: at 8.00 a.m.:9.64 ng/ml, at 12.00 p.m.: 9.47 ng/ml, at 4.00 p.m.: 12.34 ng/ml, at 8.00 p.m.: 14.77 ng/ml, at 12.00 a.m.: 18.89 ng/ml, at 4.00 a.m.: 18.94 ng/ml. Statistically significant differences between control group and RA patients were found at 4.00 p.m.(*p < 0.05) and at 8.00 p.m., 12.00 a.m., 4.00 a.m. (*p < 0.01). If we took the lowest cortisol levels measured at these times into account reciprocal ratio of prolactin/cortisol might then be involved in alteration of daily activity of the disease with maximum of difficulties in the morning.
CONCLUSION: Better understanding to interactions between neuroendocrine and immune system will help to reveal the ethiology of autoimmune disease and will contribute to search for new therapeutic strategies in the future.

OR52
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Hvala, ker si boste vzeli čas za to vprašanje in Vaš odgovor!

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Navedena članka samo potrjujeta, da je povezava med nevroendokrinim in imunskim sistemom kompleksna. Vašega vprašanja žal nisem povsem razumel. Za zdravljenje avtoimunskih, posebej sistemskih bolezni, se uporablja Medrol. DHAES je hormon, ki lahko vpliva na neplodnost. Višje vrednosti DHAES niso zadržek za zdravljenje z Medrolom, če je to potrebno.

LP

Spoštovani!

Če prav razumem prebrane članke o DHEA hormonu in hormonu 7-Kheto DHEA, z njimi zdravimo lupus in ostale avtoimune bolezni.

Torej, ti hormoni zdravijo vzrok za pojav avtoimunih bolezni, Medrol pa posledico le-tega.

Če imam prav, potem je pametno za tovrstno zdravljenje uporabiti hormone in ne imunske supresive, kot je Medrol. Prebrala sem, da 7-kheto DHEA nima stranskih učinkov na naše zdravlje, kot DHEA, ki povzroča poraščenost, pojav moških hormonov in razvoj tumorjev.

ALi lahko kombiniramo 7- Kheto DHEA in Medrol, ko želimo uspešno nosečnost in preprečitev morebintega splava, zaradi avtoimunih boleznih?

Hvala za odgovor!

Spoštovani!

Kolikor mi je znano za zdravljenje sistemskega lupusa, oziroma drugih sisitemskih bolezni ne uporabljamo DHEA. Natančnejši odgovor morda lahko dobite pri revmatologu oziroma imunologu.

Lp

Pozdravljeni,

Imam eno vprašanje pri vas glede hormonov. Mene zanima če lahko ima moški več ženskih hormonov, kot je normalno, tako zvani super moški (mislim da je pravi medicinski izraz).

Star sem 32let in me muči poraščenost. Poraščen sem kot neki najstnik, saj imam samo brado in brke, zalisca pa mi ne poganjajo, pa še ta poraščenost je tako majhna da se lahko brijem samo 1x na teden. Po eni strani me to nekaj extra ne moti, ker se ne rabim dosti briti, ampak me moti moj izgled, saj izgledam kot neki 20-23letni fant.
Pa zanima me tudi če to kaj vpliva na spolno življenje, saj imam semenski izliv zelo hitro okoli 5min, ali še prej.

Hvala za odgovor
LP, Boštjan

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Poraščenost pri moških je deloma pogojena z genetskimi dejavniki, deloma posledica ravni testosterona, oziroma odgovora tkiv na testosteron. Tudi libido je povezan s testosteronom, ne pa sama ejakulacija. Pri vas verjetno niso problem zvišane ravni ženskih hormonov, ampak morda nekoliko nižje ravni testosterona.

Lp

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Asis.dr. Edvard Pirnat, dr. med., spec. internist - tirolog