Faculty of Medicine
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Item type:Publication, IMPACT OF HORMONE REPLACEMENT THERAPY ON HYPERANDROGENICITY AND GLUCOSE HOMEOSTASIS IN POSTMENOPAUSAL DIABETIC WOMEN(Bioscientifica on behalf of the Society for Endocrinology, 2016); ; ; ; Hyperandrogenicity in women is closely associated with insulin resistance and a risk factor for cardiovascular disease and noninsulin-dependent diabetes mellitus. It is known that hormone replacement therapy (HRT) decreases hyperandrogenicity and improves glucose homeostasis in postmenopausal diabetic women. To investigate the role of HRT on hyperandrogenicity and glucose homeostasis in postmenopausal diabetic women. A total of 40 type 2 diabetic postmenopausal women were prospectively enrolled and followed for 12 months. The examined group consisted of 20 women who were assigned to take HRT, while the rest were left without hormone therapy. HRT consisted of 17β- estradiol (E2) 1 mg and DRSP (drospirenone) 2 mg. Fasting blood glucose ( FPG), glycosylated hemoglobin (HbA1C), insulin, sex hormone binding globuline (SHBG) and total testosterone were measured, free androgen index (FAI) was calculated by formula and insulin sensitivity was determined by the homeostatic model assessment of insulin resistance ( HOMA-IR). All metabolic measurements were taken at baseline and after 12 months.HRT treatment, compared with control group, was followed by a marked increase of SHBG (from 29.0 ± 12.3 to 56.0 ± 8.54 nmol/l) and significant decrease of free testosterone (5.17 ± 1.2 to 1.92 ± 1.3), FPG (7.8 ± 0.86 to 6.9 ± 0.6 mmol/l), HbA1C(7.6 ± 0.54 to 7.2 ± 0.43 % and HOMA-IR (4.23 ± 1.7 to 3.18 ± 1.4 µU/ml-mmol/l).HRT in postmenopausal diabetic women ameliorated hyperandrogenicity, accompanied by marked improvements in glucose homeostasis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Incidence of Cushing’s Disease in the Republic of North Macedonia for the period from 2013 to 2020, according to data derived from the national health system.(University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Medical Faculty, University “Ss. Cyril and Methodius” - Skopje, 2022-10-13); ; ; Stevchevska, AleksandraCushing’s disease is a rare endocrine disorder characterized by increased secretion of adrenocorticotrophic hormone (ACTH) by a corticotropic pituitary adenoma. In our country there are no data on the incidence of Cushing’s disease and only sporadic case report have been published. Aim: To find the annual incidence rates of Cushing’s disease in the Republic of North Macedonia for the period from 2013 to 2020, based on data derived from the National eHealth System. Methods: The National eHealth System was searched for all patients with ICD-10 diagnosis E24.0 in their electronic healthcare records. The annual incidence rate of Cushing’s disease was estimated per 106 persons, according to the initial occurrence of the diagnosis. The National Data records from State Statistical Office (MAKSTAT) for the population per year were used. Results: The number of newly diagnosed registered cases with Cushing’s disease was 3 in year 2013, 4 in 2014, 5 in 2015, 2 in 2016, 4 in 2017, 4 in 2018 and there were no new cases diagnosed in 2019 and 2020. Compared to the registered number of citizens by years, the annual incidence rate of Cushing’s disease was 1.45 per one million for 2013; 1.93 /106 for 2014; 2.4/106 for 2015; 0.96 /106 for 2016; 1.93 /106 for 2017 and 1.92 /106 for 2018. The average annual incidence rate for Cushing’s disease was 1.77 cases per 100000 inhabitants. Conclusion: The worldwide incidence rate of Cushing’s disease is 1.2-2.4 cases in a million. The average annual incidence rate in our country corresponds to the reported global incidence. - Some of the metrics are blocked by yourconsent settings
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Item type:Publication, Тромбофилични мутации како рзик фактори за спонтани абортуси(2018); ; ; Todorova, Biljana - Some of the metrics are blocked by yourconsent settings
Item type:Publication, P-12 Postpartum vertebral compressive fractures in a young female with osteoporosis - A case report(The Endocrine Society, 2024-01); ; ; ; Stevchevska, Aleksandra<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Osteoporosis is а metabolic disorder characterized by low bone mass and deep changes in bone architecture that lead to an increased vertebral or hip fracture in elderly.</jats:p> <jats:p>Osteoporosis in young population is a very rare condition especially when is associated with compressive fractures.</jats:p> <jats:p>Pregnancy and postpartum-related osteoporosis is condition that occurs in the last trimester of pregnancy оr in the first months of lactation. It is self-limited condition that return to normal after 12-18 months. In rare cases leаds to spinal compressive fractures.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Case</jats:title> <jats:p>We present a 33-year-old female with back pain that occurs after birth during the early lactation period. In consultation with an orthopedic surgeon, an X-ray was made on the thoracolumbar spinal column with a finding of vertebral compressive fractures.</jats:p> <jats:p>A DEXA scan (double energy-X rays of absorptiometry) is also made with the finding of vertebral osteoporosis and hip osteopenia.</jats:p> <jats:p>We calculate BMI and perform blood tests for vitamin D3, calcium, hormones and markers for bone metabolism. This was our patient's first birth, she was thin with height 157 cm, weight 42 kg and calculated BMI-17.</jats:p> <jats:p>Blood test showed very low concentration of vitamin D3- 16 ng/ml (20-44) with normal level of calcium- 1,20 mmol/l (1,10-1,40) and PTH-31,01 pg./ml (15-65). Thyroid, gonadal and adrenal axis was with normal function.</jats:p> <jats:p>We told the patient to stop the lactation and to take a supplementation of vitamin D3 2000 IE, Calcium 1000 mg and bisphosphonates (alendronate).</jats:p> <jats:p>After two years of treatment, we made a control DEXA scan. Our patient now has vertebral osteopenia, normal serum concentration of vitamin D (44 ng/ml) and her weight is 48 kg. She feels good, has no pain and no new fractures.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Pregnancy and lactation increase need for calcium and this condition is complemented by increased intestinal absorption of calcium and increased bone resorption of the mother's skeleton.</jats:p> <jats:p>Risk factors for low bone density are deficit of 1-25 OH vitamin D3, malnutrition, low body mass index, treatment with low dose of enoxaparin (LMWH), physical inactivity.</jats:p> <jats:p>Our patient has an increased risk of low bone density (she has a low body mass index, low serum concentration of 1–25 OH vitamin D3 and this was her first pregnancy).</jats:p> <jats:p>Normal serum level 1–25 OH vitamin D concentration is required to establish calcium metabolism and prevent low bone density, osteopenia or osteoporosis.</jats:p> <jats:p>Antiresorptive therapy with bisphosphonates lead to rapid improvement in bone density, prevent new fractures and relieves pain. Treatment of postpartum osteoporosis is debatable because this condition is reversible, so when we decide to treat or not to treat, we must consider present of fractures, pain and plan for future pregnancy.</jats:p> </jats:sec> - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association Between Hormone Replacement Therapy and Glycemic Control in Postmenopausal Women with Type 2 Diabetes(Македонско лекарско друштво = Macedonian medical association, 2015-01); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Diabetes in pregnancy and risk for mother and newborn(2018); ; ; Introduction: DM in pregnancy carries a risk for the course of pregnancy, mother and fetus. It may be progestational (DM1 and DM2) and gestational DM (GDM). Aim: Bad glycemic control before and after conception increases risk for neonatal mortality and congenital malformations. Material and methods: At the clinic for endocrinology for a period of one year were analyzed the risk factors for GDM, glycemic control, maternal and fetal risks in 43 DM pregnant patients. Results: The patients were aged 25-47 years, one of them (2.4%) with DM1, 5 (11.6%) with DM 2 and 37 (86%) with GDM. Of the risk factors for GDM: 31 (72%) had> 30 years, 2 (4.6%) had GDM in the previous pregnancy (PP), 6 (13.9%) had a dead fetus in PP, 26 (60%) have DM in a family. Average HbA1C was 6,4 %, from which 55,6% had HbA1C>6% and 44,4% had HbA1C<6 %. Hypertension had 10 (23.3%) patients, of whom 7 (16.3%) had hypertension in PP and 3 (7%) in this pregnancy. Pregnancy complications: 3(6.9%) had pre-eclampsia, 12 (27.9%) gave birth before 37 weeks of gestation, of which 4 (9.3%) were over 30 years old and 1 (2.3%) became pregnant with invitro fertilization. From obstetric complications: 11 (25.6%) had polyhydramnios, 4(9.3%) macrosomia. The average body weight of a newborn was 3160 grams. A newborn born with a ventricular septal defect and one with a multiorgan disease. Average APGAR score 7/8. Conclusion: Optimal pre-conception glycemic control with HbA1C<6.5% and in pregnancy HbA1C<6% is required to reduce the risk of spontaneous abortions and congenital anomalies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Evaluation of the osteoporosis risk factors in postmenopausal women on Ibandronic acid treatment(2018); ; ; Introduction: The aim of this study was to evaluate the risk factors for osteoporosis in postmenopausal women with osteoporosis treated with ibandronic acid. Matherials and methods: Examinees were 22 postmenopausal women with Ibandronic acid ampular treatment for osteoporosis. Risk factors for osteoporosis were evaluated as well as ionized Ca (iCa), PTH, vitamin D (D), HBA1C, and spine and hip BMD and BMC (g/cm2). Resuts: All examinees had contraindications for oral bisphosphonate treatment. They had mean BMI values 25.57±4.8kg/m2, no one <19kg/m2. Mean age was 64.89±7.06 yr., all >45 years. Mean menopause on age of 45.13±5.89yr, 53.75% before the age of 45yr. and 21.43% had ovariectomy. Fracture had 31.03% of the examinees with mean age of 67.44±5.2yr. A greater reduction in body height than 3cm had 57.89% of patients, and 14.29% received corticotherapy. No one consumed alcohol, 34.48% smoked moderalety up to 1 box per day. Physical activity for less than 30 minutes was in 39.29% of subjects, 22.22% had sunbathing less than 10 min/day, HTA had 73% and DM type 2 50%, only two were on insulin with good glycoregulation. Average mean HBA1C was 6.33±1.29%. Osteoporosis was generally detected before 7.09±4.33 years. All of them received Sol Vigantol 3 gutts a day and calcium preparation. Mean D levels were 32.85±11.57 ng/ml, mean iCa levels were 1.2±0.29mmol/l, mean PTH levels were 58.64±21.98 pg/ml, L1-L4 was 84.55±7.51%. L1-L4 mean BMC 0.86±0.08 gr/cm2, L1-L4 T score -2.64±0.71 and left hip total -1.72±1.02, and in patients with fracture -2.17±1.07. Right hip total -2.18±0.96 in patients with fracture, mean value for the whole group -1.72 ± 0.93. Conclusion: Postmenopausal women treated with i.v.ibandronate had several risk factor, older age, early menopause, DM type 2, arterial hypertension, fracture, lower height, corticotreatment, reduced physical activity, no sunbathing, lower BMC and BMD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Subclinical and overt hypothyroidism in pregnancy - adverse neonatal oucomes(2018); ; ; ; Background: Hypothyroidism is associated with an increased risk of adverse maternal and neonatal outcomes, including miscarriage, pre-eclampsia, premature delivery, low birth weight and impaired neuropsychological development of off-spring. Aim: To evaluate the adverse fetal outcomes in women with overt (OH) and subclinical hypothyroidism (SCH) during pregnancy. Material and methods: This retrospective study included 36 women with singleton pregnancies and primary hypothyroidism on levothyroxine replacement, treated at the University Clinic of Endocrinology, diabetes and metabolic disorders. Results: Hypothyroidism was diagnosed prior to the pregnancy in 64% of women, while in 36% hypothyroidism was diagnosed during the pregnancy. SCH was diagnosed in 57%, while 43% had overt hypothyroidism. Optimization of TSH values was observed in the second trimester of pregnancy and mainatined throughout the pregnancy (6.86±1.07 mU/l; 2.49±1.78 mU/l and 1.02±0.53 mU/l, consecutively), with normal fT4 values (11.55±0.63 pmol/l; 13.71±2.75 pmol/l and 13.69±2.87 pmol/l consecutively). Adverse neonatal outcomes in SCH and OH included preterm birth (14%) and low birth weight 14%), with Apgar score of the neonates of 8.83±0.4. Conclusion: The presence of hypothyroidism during pregnancy in our study was associated with adverse neonatal outcomes. Early adequate replacement therapy is especially important in pregnant women presenting with overt hypothyroidism.