In case of prolactin-secreting pituitary adenomas, the attention of patients and physicians is drawn to the clinical manifestations of pituitary adenoma, including associated metabolic disorders. The success of conservative methods of treating prolactinomas, the development and implementation of new approaches to the treatment of aggressive and resistant pituitary adenomas allow us to focus on non-obvious pathological conditions accompanying prolactin-secreting adenomas. These include secondary bone metabolism disorders with decreased bone mineral density (BMD), leading to osteoporosis and low-traumatic fractures. The key to effective prevention and treatment of osteoporosis is timely and accurate diagnostics, but not all methods for determining BMD developed to date can be characterized in this way. This paper highlights the use of new methods for diagnosing osteoporosis in the context of its high risk in hormonally active pituitary adenomas, in particular in prolactinomas, using a real clinical case as an example

Laboratory diagnostic methods are the main tools in the practice of a doctor of any specialty, including an endocrinologist. Factors were identified that could change the concentration of the biologically active fraction of the test substance, subsequently complicating the interpretation of laboratory results and making the right clinical decision. The literature describes a variety of circulating autoantibodies involved in binding to pituitary hormones (prolactin (PRL), thyroid-stimulating hormone (TSH), growth hormone, luteinizing, follicle-stimulating, and adrenocorticotropic hormones), hypothalamus (vasopressin and oxytocin), pancreas (insulin and glucagon) , parathyroid glands (parathyroid hormone), as well as with thyroid hormones. As a rule, the resulting macromolecules lead to an increase in laboratory parameters, in which the prevailing fraction of the hormone does not have biological activity, which determines the main problem of this phenomenon. The most common variants include immune complexes with PRL and TSH, causing the phenomena of macroprolactinemia and macrothyrotropinemia (macro-TSH-emia/macro-TSH), respectively. Most laboratory test systems used in clinical practice are capable of determining only the total amount of PRL and TSH. The presented clinical observation describes a combination of the phenomena of macro-TSH and macroprolactinemia in a patient with autoimmune thyroiditis (AIT) and vitiligo.

Autoimmune/lymphocytic hypophysitis is one of the rare causes of central diabetes insipidus in adults and is most common among women in the second or third trimester of pregnancy. Numerous studies have shown that lymphocytic hypophysitis is characterized by a very variable clinical signs with the development of neurological symptoms, visual disturbances and hypopituitarism with partial or complete loss of pituitary function, as well as a number of features in magnetic resonance imaging (MRI). Isolated lymphocytic indibuloneurohypophysitis occurs in fewer cases and involves the posterior lobe and stalk of the pituitary gland with a clinical presentation of diabetes insipidus. The above clinical case describes the development of hypophysitis in a pregnant woman with a predominant lesion of the posterior pituitary gland and an outcome in diabetes insipidus, which persists 6 years after pregnancy and childbirth. In the article some aspects of the differential diagnosis of diabetes insipidus in pregnant women, as well as instrumental diagnosis and treatment approaches of hypophysitis are discussed.

In recent years, there has been a significant increase in the prevalence of autoimmune endocrinopathies, which are known to affect various levels of the endocrine system, including the pituitary gland. Hypophysitis is a general term used to describe any form of sellar and suprasellar inflammation that leads to structural changes in the hypothalamic-pituitary region and manifests itself in varying degrees of hormonal deficiency of the anterior and posterior pituitary glands. To date, there is a primary form of hypophysitis, which occurs as a result of an autoimmune lesion directly to the pituitary gland, and a secondary form of hypophysitis, which occurs as a result of the presence of a systemic autoimmune disease. Regardless of the etiology, patients with hypophysitis show various signs and symptoms caused by an inflammatory process in the pituitary gland, which can lead to the development of hypopituitarism, compression of the sellar and parasellar structures. MRI is currently the best non-invasive diagnostic tool for diagnosing hypopituitarism, however, the diagnosis can be made with certainty only by histological examination of the pituitary tissue, which requires an invasive approach, which greatly reduces the feasibility of this procedure. In this article, we present a patient with MRI showing signs of hypophysitis in the absence of clear clinical symptoms.

Vitamin D deficiency and insufficiency are widespread globally with multiple factors playing a role in their development. Such as limited exposure to sunlight, poor nutrition, gastrointestinal diseases, and obesity, which affects approximately 39% of the world’s adult population. In addition to its canonical role in skeletal function, vitamin D modulates adipogenesis, insulin secretion, and action in diabetes. Vitamin D deficiency due to obesity is likely due to decreased bioavailability of vitamin D through synthesis in the skin and from dietary sources, which is associated with its deposition in body fat depots. While a direct effect on adipogenesis appears to be realized during critical periods of life (pre- and postnatal periods). Vitamin D directly regulates genes involved pathways of insulin secretion and action. The high worldwide prevalence of vitamin D deficiency may be associated with the high incidence of type 2 diabetes, and normalizing vitamin D levels in patients may be an effective strategy to slow the progression of type 2 diabetes and its complications.

Acromegaly is a severe neuroendocrine disease characterized by excessive production of the growth hormone (GH). The slow development of symptoms increases the diagnostic search up to 15 years. Permanent effect of the growth hormone on the human body can cause structural and functional disorders of organs. The main complications of acromegaly include cardiovascular, respiratory, and musculoskeletal system dysfunction, as well as impaired carbohydrate metabolism and an increased risk of developing neoplasms.Often, nonspecific symptoms of acromegaly can be masked by other pathologies or their complications, such as obesity. An increase in subcutaneous fat, increased blood pressure, joint pain, edema, and impaired carbohydrate and lipid metabolism are observed both in acromegaly and in obesity. An additional factor in the development of obesity as a complication of acromegaly is the development of sleep apnea, which triggers a series of pathological processes that ultimately lead to Pickwickian syndrome.We present a clinical case of a patient with acromegaly and obesity, discussing the effects of excess body weight on the course of the underlying disease, the presence of complications, and an individual approach to treatment.

Diabetic nephropathy (DN) is a specific kidney involvement in diabetes mellitus (DM), caused by hemodynamic and metabolic factors. In the kidneys takes place an important step in the metabolism of vitamin D — 1α-hydroxylation, which results in the formation of its biologically active form. Reduced number of functioning nephrons in DN leads to impaired vitamin D metabolism, contributing to the development of a number of complications. In this review, we have focused in detail on both normal vitamin D metabolism and the features of vitamin D metabolism in chronic kidney disease (CKD). DN is the most common cause of CKD and, as a consequence, of kidney transplantation and one of the leading causes of cardiovascular morbidity and mortality in patients with DM. Bone mineral disorders resulting from abnormal vitamin D metabolism are also independent factors of high mortality among patients with DM. The final part of our review briefly highlights current approaches to vitamin D therapy in CKD and, in particular, in DN. It is worth noting that, despite the increasing number of patients with DN, there is currently no unified view on the use of vitamin D as a therapeutic agent in this pathology.

The main treatment option of prolactin-secreting pituitary adenomas is dopamine agonist therapy, which demonstrates prolactin level normalizing and reducing the size of an adenoma in the majority of cases. However, significant amount of patients - about 20% - poorly responds even to high doses of dopamine agonists that is explained by the resistance to therapy. The occurrence of pharmacodynamic characteristics is one of the causes responsible for the development of resistance to typical therapy. Clinical manifestations of persistent hyperprolactinemia are due to following pathological factors: hormonal hypersecretion and the mass-effect of pituitary adenoma. Prevention of irreversible changes is possible only with timely detection of resistance and determination of the optimal personalized treatment algorithm.We report a clinical case of dopamine-agonist resistant microprolactinoma. Patient's health stabilisation, normal level of prolactin and reduction in size of adenoma were achieved due to administration of combined treatment with tamoxifen and dopamine agonists. Hyperprolactinaemia occurring because of prolactin-secreting pituitary adenoma and associated adverse effects are significant problem, decreasing quality of life and demographics in general. This underlines the importance of figuring out causes and identifying predictors of the therapy resistance.The results of the study, illustrated by a clinical example, are presented in the present paper.

The prevalence of pituitary adenomas in the population among tumors of the central nervous system is about 17%. Pituitary adenomas are divided into non-functional (about 36–54%), characterized by the absence of secretory activity, and functional (about 46–64%), secreting hormones or their subunits. The most common are prolactinomas (32–51%), somatotropinomas (9– 11%), corticotropinomas (3–6%), the frequency of gonadotropins and thyrotropins is low and amounts to less than 1% of cases. This article presents a clinical observation of a patient with gonadotropinoma, which has been occurring for a long time under the guise of hyperprolactinemia.

Nephrogenic diabetes insipidus is a heterogeneous disease in the etiopathogenesis of which are involved acquired and congenital factors. In this case, the kidneys do not respond to vasopressin and continue to produce large concentrated volumes of urine. Distinctive features in the pathology of central genesis are the fact of trauma, brain tumor with involvement of pituitary gland, response to intranasal vasopressin in the form of decreased diuresis.For diagnosis it is important to perform a series of differential diagnostic tests.In this article we present a unique clinical case of a patient with a long-term course of diabetes insipidus with the development a spectrum of comorbid conditions, metabolic disorders, required kidney transplantation.