Krstevska, Brankica
Preferred name
Krstevska, Brankica
Official Name
Krstevska, Brankica
Translated Name
Крстевска, Бранкица
Alternative Name
Krstevska, Branka
Krstevska, B
Brankica Krstevska
Main Affiliation
65 results
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Item type:Publication, DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH ADRENAL INCIDENTALOMAS: OUR EXPERIENCE(Macedonian Academy of Sciences and Arts, 2022); Popov, ZhivkoIntroduction: Adrenal incidentalomas (AIs) are adrenal masses which are incidentally discovered with imaging technology. They are non-functional and functional, benign, and malignant lesions. Aim: We present a 5-year study of diagnostic and follow up of adrenal incidentalomas with special emphasis on their hormonal activity and differentiation from benign to malignant masses. Material and methods: A group of 26 patients with AIs were investigated at the Internal Medical Centre “Srce”. In all patients, clinical examination, CT, and hormonal tests were performed. Results: Of the 26 patients (10 male and 16 female), aged between 25 and 80, the median tumour size was 33 mm, unilateral AIs in 96.1%, located on the right side in 52%, 96% were benign masses, of which 81% were nonfunctional adrenal masses. Non-functional asymptomatic autonomous cortisol secretion tumours were 22.2%, 7.7% were pheochromocytoma, 3.8% was Cushing's syndrome, adrenocortical carcinoma in 3.8%, and Schwannoma in 3.8%. Statistically significant positive correlation was found between HTA and secreting adrenal tumours (r=0.426, p<0.05), and between the post- suppressive level of cortisol and the size of adrenal tumour (r= 0.560, p<0.05). Age, symptoms and DMT2 have statistically significant impact on the prediction of tumour masses larger then 4 cm (p<0.05). 53.8% of patients underwent surgery and the others are followed. In this small study of 26 cases with AIs, 11.5% were benign hypersecreting tumours, and only one patient (3.8%) had a malignant tumour. Appearance of symptoms, age, or tumour masses larger than 4 cm are more likely to be secreting or malignant tumours. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Cystic pheochromocytoma, a diagnostic challenge: A case report(Bioscientifica, 2020-08); ; We describe a case of cystic pheochromocytoma (PCC) with negative biochemical evaluation, diagnosed on the basis of hypertensive crises during operative management and histopathologic findings. A 57-year-old woman complained of several episodes of stabbing right upper abdominal pain accompanied by tachycardia, headache, lack of breath, elevated blood pressure and vomiting in the preceding three years. At presentation, blood investigations were significant only for mildly elevated transaminases and serum amylase. An abdominal ultrasound was performed and revealed large right adrenal incapsulated and heterogenous mass, 7 × 7 cm in size, with mass effect. Computed tomography imaging confirmed incapsulated adrenal mass with internal septations and unenhanced attenuation of >30 Hounsfield units. Based on imaging appearance and patient’s history, a suspicion of PCC was established, and the patient was referred to endocrinologist. Laboratory exams for Cushing’s syndrome were unremarkable and urinary vanilmandelic acid, metanephrines and serum chromorgranin A were within normal range on several occasions. Further evaluation with iodine-123 (123I)-labeled metaiodobenzylguanidine (MIBG) scintigraphy would have been useful to differentiate the mass, but it was not available at the moment of investigations. Despite negative biochemical diagnosis,strong clinical suspicion for PCC was established and the patient was preoperatively prepared with α-adrenoreceptor and beta blockers. Initial attempt for laparoscopic adrenelectomy was unsuccessful due to early intraoperative occurrence ofhypertensive crises with blood pressure 300/150 mmHg. Three months later a successful open adrenelectomy was performed with nonsignificant intraoperative hemodynamic instability. Histopathologic evaluationconfirmed cystic benign PCC with dominance of multnuclear giant, foamy macrophages, presence of hemosiderin deposition and hemolyzed erythrocytes. Although cystic adrenal lesions comprise several types of non-functionating benign lesions, the differential diagnosis should include cystic form of PCC, an entity that is rarely reported. In cystic PCC the number of cateholamin-producing cells are low, especially when an extensive necrotic cystic regions are present. Furthermore, catecholamines stored in the capsular mass may not be released into the blood circulation until surgical attempt for isolation of PCC is made. Therefore, high clinical suspicion for PCC is necessary since negative biochemical diagnosis is possible. As demonstrated by our case, clinical presentation was crucial in the diagnosis and preoperative management. Preoperative optimization with antihypertensive drugs and blood volume expansion fluids is obligatory in PCC surgery in order to prevent detrimental intraoperative hemodynamic instability. Albeit laparoscopic adrenelectomy is becoming a first line surgical option for PCC, still it’s not always feasible as shown in our case. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The effect of thyroid substitution therapy on serum lipids in patients with a mild form of subclinical hypothyroidism(Publicidad Permanyer, SLU, 2023-02-23); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A case of ACTH producing oat cell carcinoma cause of ectopic Cushing's syndrome and life threatening hypokalaemia(Bioscientifica, 2013-04-01); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of hormone replacement therapy on hyperandrogenicity and glucose homeostasis in postmenopausal women with diabetes(Medical Faculty, Ss Cyril and Methodius University in Skopje, 2016); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Hypercalcaemia in patient with primary hyperparathyroidism and acromegaly(Bioscientifica, 2015-05); ; Introduction: Hypercalcaemia in acromegaly can be a result of several pathophysiological mechanisms. Multiple endocrine neoplasia type 1 (MEN1) syndrome, mitogenic effect of hyperactivated GH–parathyroid gland axis, i.e. primary hyperparathyroidism and hypercalcaemia mediated by elevated 1,25-dihydroxyvitamin D should be considered. Case report: We describe a case of acromegaly associated with primary hyperparathyroidism. A 52-year-old female was diagnosed with acromegaly due to GH secreting pituitary microadenoma. Evaluation at diagnosis showed normal levels of hormones other than GH and IGF1, and presence of hypertension and multinodular goiter (volume 80 mm3). Because the patient denied surgery, treatment with cabergoline was administrated and a biochemical control was accomplished. Within 1 year of the diagnosis laboratory data showed hypercalcaemia (serum calcium 1.51 mmol/l (1.10–1.40)) in the setting of elevated parathormone (PTH) levels (158 pg/ml (15–65)) and low levels of vitamin D (5.6 nmol/l (>25)). Bone densitometry detected osteoporosis limited to the right radius (T score value −4.0 S.D.). Analysis of 24-h urine showed normal calcium and phosphate excretion. This findings were consistent with diagnosis of primary hyperparathyroidism. Imaging and radioisotope studies identified enlarged thyroid gland, predominantly the left lobe with consequent tracheal compression, and higher radioisotope uptake in the lower pole of the left thyroid lobe. Surgical excision of left lower parathyroid gland and subtotal thyroidectomy was done. Histopathological examination confirmed hyperplasia of parathyroid and thyroid gland. After surgery, serum calcium normalised, PTH levels significantly reduced to 73.2 pg/ml. Vitamin D remained low (17.8 nmol/l) and TSH levels elevated to 27 mU/l (0.4–4) for which vitamin D and levothyroxine substitution was started. Conclusion: The approach to hypercalcaemia in the course of acromegaly implies evaluation for several potential pathophysiological mechanisms, which in turn dictates the treatment strategy – parathyroidectomy vs biochemical control of acromegaly. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Maternal 75 g OGTT glucose levels as predictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus(Bioscientifica, 2013-04-01); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, National register in prevention and control of diabetes mellitus(Македонско лекарско друштво = Macedonian medical association, 2002); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Менопауза, липиден профил и кардиоваскуларни болести(MACEDONIAN ASSOCIATION OF ANATOMISTS AND MORPHOLOGISTS, 2008); ; ; Mishevska, Petranka - Some of the metrics are blocked by yourconsent settings
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