Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Introduction: Crohn's disease (CB) is idiopathic, chronic inflammatory disease that can affect any part of the gastrointestinal tract. Extraintestinal manifestations (EIM) of CD affect about 20-40% of patients. Endocrine aspect of CD can be observed through glycemic disregulation, dyslipidemia, metabolic bone disease, hypogonadism, low growth, delayed puberty and other. All endocrine manifestations are closely related to severe inflammatory response and corticosteroid therapy (CSt). The most common complications are diabetes (generally poorly regulated) and osteoporosis in the elderly and low growth (with late puberty) in the younger ones. Case Report: A 57-year-old patient, S. Z., was hospitalized at our Clinic due to unstable glycoregulation within long-term diabetes with microvascular complications (on bolus-basal insuli treatment) The CD in patient was poorly regulated with changing multiple therapeutic modalities. During hospitalization, the CD therapy was corrected and aminosalicylate therapy was replaced with CSt, the glycoregulation was further worsened and only a partial improvement in glycemia was achieved. Malabsorption was diagnosed and supstitutional therapy was introduced. Secondary osteoporosis in patient has been initially treated with intravenous bisphosphonate while monitoring the effect. Due to long-term use of CSt and poor life quality anxiety disorder has been evaluated and treated properly. Conclusion: Long-term poorly-regulated CD is predictor of extraintestinal complications. All EIMs result in poor quality of life and bad prognosis. CD therapy and chronic inflammation constitute vicious circle in which all the consequences and manifestations are inadequately regulated and require a multimodal-multidisciplinary approach.

Individuals with type 1 diabetes have an increased risk of premature atherosclerosis. The aim of this study was to evaluate the possible predictive significance of elevated plasma total homocysteine (tHcy), lower serum 25-hydroxy vitamin D (25(OH)D) concentrations and increased carotid intima-media thickness (CIMT) for the development of coronary atherosclerosis in patients with type 1 diabetes mellitus (T1D) and no previous history of ischemic heart disease. The study included 73 patients previously diagnosed with T1D. The patients were divided into groups with and without non-obstructive moderate coronary artery stenosis. Coronary artery stenosis was examined using coronary multidetector computed tomographic angiography (MDCTA); CIMT was measured by B-mode ultrasound. The patients with moderate stenosis had significantly higher HbA1c (p<0.001), elevated tHcy (p<0.001), increased CIMTmax. (p<0.001) but lower 25(OH)D (p<0.001) in comparison to patients without detectable coronary atherosclerosis. Homocysteine (AUCHcy=0.955; p<0.001), vitamin D (AUCvit D=0.792; p<0.001) and CIMT max (AUCCIMT=0.743; p<0.001) (AUC or area under the curve) appear to be adequate markers for detecting stenosis of coronary arteries using receiver operating characteristic (ROC) curve analysis. Multivariate logistic regression analysis showed that serum homocysteine was the only significant predictor of moderate coronary artery stenosis. Our study implies that tHcy can be used as a reliable predictor of coronary artery atherosclerosis in patients with T1D. 25(OH)D and CIMT can also be used, but with lower diagnostic accuracy.

BACKGROUND/AIM:[corrected] During the first 10 years over 50% of diabetes patients develop erectile dysfunction (ED). It is more severe and resistant to therapy than in male patients with normal glucoregulation. The purpose of this pilot study was to estimate the tadalafil (Cialis) efficacy and safety in male patients with diabetes mellitus (DM), together with moderate to severe ED.METHODS:The study included 30 male patients with diagnozed type 1 or type 2 DM together with ED. ED was estimated through the International Index of Erectile Function (IIEF-6), Sexual Encounter Profile (SEP) questionnaire and prostaglandin test, at the beginning of the research and three months after the 20 mg tadalafil therapy initiation, once a week (on Fridays). Glycosylated haemoglobin in blood (HbAlc) values were also monitored. According to the ED severity (IIEF values at the beginning of the therapy) the patients were divided into 2 groups. The previous experience with sildenafil citrate (Viagra) and prostaglandin E1 intracavernous therapy was recorded.RESULTS:Tadalafil significantly improved ED (p < 0.001) for 7.40 points of the IIEF score, i.e. for 58% and 60% towards SEP2 and SEP3 questionnaire, respectively. Compared to the previous ED therapy subjectively better tadalafil experience was recorded. Each group experienced a significant improvement in IIEF score (p < 0.001), more significantly in the group 2 (8.26+/-1.49 points) compared with the medium improvement in the group 1 (6.27+/-1.35 points). After three months HbA1c values decreased for 2.26+/-1.62 (p < 0.001).CONCLUSION:Tadalafil is an effective tool for treating ED in diabetes patients. In some situations tadalafil application could replace prostaglandin test. The sexual sphere motivation leads to the improvement of glucoregulation in DM patients.