Background: Thyroid dysfunction includes hyper- and hypofunction of the thyroid gland (hyperthyroidism and hypothyroidism). The spectrum encompasses both subclinical and clinical disease presentation. The etiology is vast and varied, as are the risk factors and simptoms. Objective: The main aim of the research is to indicate the leading symptom for initial thyroid hormone status evaluation, as well as to identify the distribution of positive and negative test results, and specific disorders according to sex and age groups. Methods: The research is designed as a retrospective, clinical, descriptive study. There were 500 participants included, 355 female and 145 male. Patients were referred to the Department of endocrinology by their primary care physicians. The data was collected through patient documentation. Results: The study included 500 participants, 71% of diagnostic requests made were for women. 80% of subjects had normal thyroid hormone status, p<0.001. Most requests were made for the 41-60 age group, p<0.001. Women had similar number of positive and negative test outcomes, as well as men. When it comes to the age groups, outcomes were similar in all of them, 15-23% positive and 77-85% negative. There were significant differences in the type of symptom expressed in both men and women, as well as all the age groups. Men reported high blood pressure as the most common symptom (30.3%), while women reported weight gain (22.3%). In the 18-25 and 26-40 age groups most common symptom belongs to the category of other. Age group of 41-60 reported weight gain as the most common symptom, while in participants older than 60, high blood pressure is proven to be the most common. Hypothyroidism is the most common disorder in both men and women, as well as in all age groups. Conclusion: It is statistically proven that there were more requests made for women, and older age groups. Leading symptom for initial thyroid hormone status evaluation is high blood pressure. There is no statistically significant difference in distribution of thyroid disorders according to sex or age groups.

Introduction Diabetes mellitus(DM) is considered an independent cardiovascular risk factor. Having in mind concomitant occurence of diabetes and other cardiovascular risk factors, it is expected that patients with poor glucoregulation will have more cardiovascular risk factors and higher cardiovascular risk than patients with good glucoregulation. Aim To compare cardiovascular risk and cardiovascular risk factors between patients with poorly controlled and patients with well-controlled Diabetes mellitus. Material and Methods Hundered ten patients aged 40-70 years suffering from Diabetes mellitus type 2 were included. Research is designed as a retrospective, descriptive study. Patients with glycosylated hemoglobin (HbA1c) > 7% were considered to have poorly controlled diabetes. The following data and parameters were monitored: age,sex, family history, data on smoking and alcohol consumption, BMI (body mass index), blood pressure, blood glucose, total cholesterol, triglycerides, LDL, HDL, fibrinogen, uric acid. For the assessment of cardiovascular risk, the WHO / ISH (World Health Organization/International Society of hypertension) tables of the 10-year risk were used, and due to the assessment of the risk factors prevalence, the optimal values of individual numerical variables were defined. Results Differences in the mean values of systolic, diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol are statistically significant higher in patients with poorly controlled diabetes. Hypertension more frequently occurre in patients with poorly controlled DM. The majority of patients with well-controlled DM belong to the group of low and medium cardiovascular risk, while the majority of patients with poorly controlled DM belong to the group of high and very high cardiovascular risk. In our research, there was a significant difference in cardiovascular risk in relation to the degree of DM regulation, and HbA1c proved to be an important indicator for the emergence of the CVD. Conclusion There are significant differences in certain risk factors between patients with poorly controlled and well controlled DM. Patients with poorly controlled diabetes mellitus have a higher cardiovascular risk than patients with well controlled diabetes. The value of HbA1c should be considered when assessing cardiovascular risk.

Our aim was to determine the incidence of prediabetes and risk of developing cardiovascular disease (CVD) in women with polycystic ovary syndrome (PCOS). This prospective, observational study included 148 women with PCOS, without Type 2 diabetes mellitus (T2DM) and CVD present at baseline. In the fasting blood samples, we measured lipids, glucose, and insulin levels during oral glucose tolerance test, levels of C-reactive protein (CRP), steroids, 25-hydroxyvitamin D (25-OHD), prolactin, thyroid-stimulating hormone, and parathyroid hormone. The follow-up period was 3 years. At baseline, prevalent prediabetes was present in 18 (12%) of PCOS cases and it progressed to T2DM in 5 (3%) of the cases. Incident prediabetes during the follow-up was noted in 47 (32%) women or 4.7 per 1000 persons/year. Prediabetes was associated with elevated body mass index (BMI) (odds ratio [OR] = 1.089, confidence interval [CI]: 1.010; 1.174, p = 0.026), high baseline levels of CRP (OR = 3.286, CI: 1.299; 8.312, p = 0.012), homeostatic model assessment - insulin resistance (IR) (OR = 2.628, CI: 1.535; 4.498, p < 0.001), and high lipid accumulation product (LAP) (OR = 1.009, CI: 1.003; 1.016, p = 0.005). Furthermore, prediabetes was associated with low 25-OHD (OR = 0.795, CI: 0.724; 0.880, p ≤ 0.05). In addition, cardiovascular risk in PCOS women with prediabetes was high (hazard ratio = 1.092, CI: 1.036; 1.128, p < 0.001). We showed association of prediabetes with high BMI, IR, markers of inflammation, LAP, and low serum 25-OHD concentration. IR appears to be more relevant than the other predictors of prediabetes risk in this study. PCOS women are considered as a high-risk population for prediabetes.

Introduction: Diabetes mellitus, the most frequent endocrinology disease is a predisposing factor for infections. Diabetic patients have 4,4 times greater risk of systemic infection than non diabetics. Aim: a) To determine the prevalence and characteristics of acute infectious diseases in hospitalized diabetics; b) To correlate values of blood glucose levels and HbA1c with acute infections in hospitalized diabetics; c) To identify the etiology of infectious diseases. Material and methods: The study included 450 diabetic patients hospitalized in the 24-month period in the Intensive care unit of the Clinic for Endocrinology, Diabetes and Metabolic Disorders CCUS. In 204 patients (45,3%) there was an acute infectious condition and the following data was registered: a) gender and age; b) basic illness; c) laboratory parameters of inflammation (Le, CRP); d) blood glucose upon admission, parameters of glucoregulation (HbA1c, fructosamine); e) type of infection; f) verification of etiological agent; g) late complications of diabetes; and h) outcome. Results: Out of 204 diabetic patients with infection, there was 35,3% men and 64,7% women. More than half of patients (61%) were in the age group 61-80 years. The most common primary disease was Diabetes mellitus type 2. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection compared to diabetics without acute infection. There is a positive correlation between HbA1c levels and CRP, and blood glucose and CRP in diabetic patients with acute infection. Most frequent infections: urinary tract infection (70,0%), followed by respiratory infections (11,8%), soft tissue infections (10,3%), generalized–bacteremia / sepsis (6,9%). The most common cause of urinary infection and generalized infection was Escherichia colli. The most common bacteria causing soft tissue infections was Staphylococcus aureus. Conclusion: Almost half (45,3%) of hospitalized diabetic patients had acute infectious condition. They present most frequently in women, aged 61-80 years, with Type 2 Diabetes mellitus. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection. There is a positive correlation between the parameters of inflammation and glucoregulation in diabetics with acute infection. Most frequent was a urinary tract infection and the most common causative agent was Escherichia coli. The most common cause of soft tissue infections was Staphylococcus aureus. Out of 21 patients with verified soft tissue infections, 18 of them (85,7%) had confirmed diagnosis of diabetic microangiopathy diabetica. A total of 96,1% of patients fully recovered.

INTRODUCTION Diabetes mellitus, the most frequent endocrinology disease is a predisposing factor for infections. Diabetic patients have 4,4 times greater risk of systemic infection than non diabetics. AIM a) To determine the prevalence and characteristics of acute infectious diseases in hospitalized diabetics; b) To correlate values of blood glucose levels and HbA1c with acute infections in hospitalized diabetics; c) To identify the etiology of infectious diseases. MATERIAL AND METHODS The study included 450 diabetic patients hospitalized in the 24-month period in the Intensive care unit of the Clinic for Endocrinology, Diabetes and Metabolic Disorders CCUS. In 204 patients (45,3%) there was an acute infectious condition and the following data was registered: a) gender and age; b) basic illness; c) laboratory parameters of inflammation (Le, CRP); d) blood glucose upon admission, parameters ofglucoregulation (HbA1c, fructosamine); e) type of infection; f) verification of etiological agent; g) late complications of diabetes; and h) outcome. RESULTS Out of 204 diabetic patients with infection, there was 35,3% men and 64,7% women. More than half of patients (61%) were in the age group 61-80 years. The most common primary disease was Diabetes mellitus type 2. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection compared to diabetics without acute infection. There is a positive correlation between HbA1c levels and CRP, and blood glucose and CRP in diabetic patients with acute infection. Most frequent infections: urinary tract infection (70,0%), followed by respiratory infections (11,8%), soft tissue infections (10,3%), generalized-bacteremia / sepsis (6,9%). The most common cause of urinary infection and generalized infection was Escherichia colli. The most common bacteria causing soft tissue infections was Staphylococcus aureus. CONCLUSION Almost half (45,3%) of hospitalized diabetic patients had acute infectious condition. They present most frequently in women, aged 61-80 years, with Type 2 Diabetes mellitus. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection. There is a positive correlation between the parameters of inflammation and glucoregulation in diabetics with acute infection. Most frequent was a urinary tract infection and the most common causative agent was Escherichia coli. The most common cause of soft tissue infections was Staphylococcus aureus. Out of 21 patients with verified soft tissue infections, 18 of them (85,7%) had confirmed diagnosis of diabetic microangiopathy diabetica. A total of 96,1% of patients fully recovered.

INTRODUCTION Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of antihyperglycemic drugs that block degradation ofincretin hormones. GOAL To assess the effects oftreatment with DPP-4 inhibitors on glucoregulation and body weight in obese patients with type 2 diabetes mellitus. PATIENTS AND METHODS The study included 9 females and 9 males with type 2 diabetes (n=18), BMI=31.24 +/- 2,26 kg/m2, mean age 58 +/- 6,8 years. The patients have been thoroughly evaluated before treatment, and 6 months after treatment with DPP-4 inhibitor (sitagliptin) in combination with metformin. RESULTS After 6 months of treatment with DPP-4 inhibitors in combination with metformin HbAlc (-1,49%)., FBG (-3.75 mmol/L) and PBG (-5.79 mmol/L) significantly reduced (p=0.000). Mean body weight also significantly reduced (-12.5%; p=0.000). Reduction of mean fasting insulin was 5.46 mIU/L or 27% (p=0.000). Mean HOMA-IR change was -1.64 (p=0.000). Also there was significant decreasing of systolic blood pressure (p=0.001), cholesterol (p=0.004), triglycerides (p=0.001), LDL (p=0.002) and increasing of HDL (p=0.002). Hypoglycaemia was not registered in any of the patients. CONCLUSION These results show that in obese patients with type 2 diabetes, DPP-4 inhibitors treatment in combination with metformin was associated with improvements in glycaemic control, and a reduction in body weight.

INTRODUCTION Women with Polycystic Ovary Syndrome (PCOS) are at increased risk for cardiovascular morbidity and metabolic disorders including: dyslipidaemia, hypertension, insulin resistance, gestational diabetes, type 2 diabetes, systemic inflammation and endothelial dysfunction. The prevalence of obesity and insulin resistance in women with PCOS is significantly higher compared to the general population. Lipid accumulation product is a new, cheap and easily available predictor for metabolic syndrome both in general population and in women with PCOS. MATERIALS AND METHODS The study included 50 patients at the Clinic of Endocrinology, Diabetes and Metabolic Disorders, Clinical Center University of Sarajevo. All patients were diagnosed with PCOS according to the Rotterdam ESHRE criteria and were divided into two groups according to their body mass index (BMI). A prospective study established the following parameters: anthropometric measurements (waist circumference, height, weight), BMI, and serum triglycerides and insulin resistance. LAP was calculated using the formula: LAP (women) = [waist circumference (cm)-58] x [triglycerides (mmol/L)]. RESULTS Waist circumference in women with BMI < or = 24.9 kg/m2 was 31 cm lower than waist circumference in women with a BMI > 25 kg/m2. Mean triglyceride value of the patients in group BMI < or = 24.9 kg/m2 was 1.15 mmol/l lower than the mean value of triglycerides in women with a BMI > 25 kg/m2. Insulin resistance was present in 66.7% in group with BMI < or = 24.9 kg/m2, and in 75.0% in the group with BMI > 25.0 kg/m2. LAP was shown to be a marker for the differentiation of insulin-resistant and nonresistant patients with a cut-off value of 17.91. CONCLUSION Patients with PCOS and BMI < or = 24.9 kg/m2 were significantly different from those with BMI > 25 kg/m2 in the values of body weight, waist circumference and triglycerides. There was no statistically significant difference in insulin resistance. LAP values were higher in patients in the group with BMI > 25 kg/m2. LAP was a marker for differentiation of insulin--resistant and non-resistant women with PCOS.

Diabetes mellitus is a chronic, incurable disorder, but can be successfully managed to improve patient's quality of life and extend lifetime. Late diabetic complications that affect various organs can be postponed with appropriate treatment. HbA(1C) value tells us about glucoregulation in last 3-4 month and it helps us in estimating the treatment efficiency. In last several years number of type 2 diabetics increased in the world and also in our country. Treatment approach must be aggressive to prevent late diabetic complications in type 2 diabetes. Type 2 diabetics can be treated with oral medications as monotherapy, or in various combinations as long as the following values can be maintained: HbA(1C) value under 7%, fasting blood glucose under 6.0 mmol/l and postprandial blood glucose under 8.9 mmol/l. Insulin treatment should be introduced when HbA(1C) value gets above 7%.

The aim of the work is to present the way how the latest insult might cause hyperosmolar coma. Case report: About 10 o'clock a.m. the dispatcher received a call by the police who having broken into the apartment found N.M. 73, in the unconscious state. On coming to the case spot the emergency aid team found the patient on the floor unconscious with vomited content on the dress and carpet, urinated. From the heteroanaemnesis (taken from a nearby merchant): the woman was on her own, and the last time seen in the grocery two days before. From the status: The patient was in a deep comatose state, did not react to tough stimulations, febrilous, with her tongue extremely dry, coated with brownish layers, the skin also dry. Cor: heart beating rhythmical, tachycardiac, tones lower, slight systolic murmur above ictus, frequency 150/min, TA unmesaurable. Pulmo: airways murmor normal. Other findings insignificant. Glucose highly unmeasurable on the glucometer. The tablets of glibenklamid, metformin and lizinopril were found on the dresser. The venuous ways were hardly open, and cardiotonic, physiological solution was given immediately on the spot and after that the patient was transported to to the clinic. In the course of the transportation, another venuous way was open, included physiological solution with 10 I.J. of efficient insuline. On arriving to the clinic, the next laboratory fin-dinggs were carried out within the intensive care unit: On 157:K 5,4: GUK 104 mmol/l: urea 28,0: creatinine 206: ABS: normal. The therapy at the clinic: fractioned 4 x s.c. effective insuline, hypotonic solution of natrium chloride with effective insuline, cardiotonic, wide spectrum antibiotic. After 48 hours, glycaemia stable, from 9,8 to 14,5:Na 147:K 4,2: urea 9,8: creatinine 123, the patient conscious, somnolent, does not speak with a right hemiplegia. An urgent head CT is done with the evidence of fresh lesion on the left parietally. .

This work is to show hypertireosis as provoking factor of katoacidosis incentive in diabetes, type 2, verified at an early chilhood and treated by insuline. A 33-year-old female patient who has been suffering from diabetes since being only six months old, has been treated by fixed mixture therapy of intermediate-acting and rapid-acting insulin (70/30). The patient complains about weakness, loss of appetite, vomitting urge and vomitting itself. In the course of general medical examination the patient is somnolent, extremely dehidrated, slight exoftalmus, anisocoric, sight impaired, with dry tongue coated by whitish layers. Thyroid gland is palpatory slightly increased. Heart beat is tachycardiac, tones clear, heart murmur inaudible. Frequency 150/min, TA 90/40 mm Hg. Weakened respiratory murmur is basal followed by audible inspiratory tone, inclined to the left side. Below chest, abdomen is soft, palpatory sensitive to pain in the area of epigastrium, liver and spleen do not palpate. Extremities: Without oedema, weakened pulse of dorsalis pedis artery at both sides. According to the admission results it is as follows: SE 50/80, Fe 3,8: TIBC 38,7: UIBC 34,9: index saturation 0,10: Na 128: K 56: Cl 89: Ca 2,56: urea 10,6: creatinin 127: GUK 40,8: ABS: pH 7,059: pCO2 1,78: HCO3 3,6: total CO2 4: excess base - 27: pO2 10,66: saturation O2 91,7%: HbA ic 10,0 %: thyroid gland hormone: FT4 98,2: FT3 14,0: TSH 0,01. Medical examination control on discharge: Na 137: K 4,2: Cl 99: urea 3,0: creatinine 52: GUK 4,1: ABS: all parameters within referent value limits. Thyroid gland hormones: FT4 56,9: FT3 10,3: TSH 0,007. On admission, the patient was administered with a four dose crystal insuline s.c. crystal solutions of a wide range usage from the group of cephalosporine, parenterally. Due to repeated disturbances of ABS, and the oscillation of glycaemia, gastroscopy was carried out. Even after regular rehydration and suitable therapy, the occurrence of slight disturbances of ABS followed by tachycardia, about 100/min, was registered. After hormonal status analysis of thyroid gland, a high dosage of ureostatics was administered which resulted in stabilizing of glyacemia and ABS. Gland thyroid control results showed a significant improvement in the patient after 7 days of therapy. Siderosis anaemia is to be corrected by paranteal application of Fe elements. The final regulation of glycaemia is achieved by intensive regime of insuline therapy. After improving the general health condition, the standard analyses were carried out with a view to evaluating diabetes complications. On the ground of clinical survey and other relevant researches, we made the conclusion that diabetes mellitus, type 1, in concerned in this case. All complications detected on target organs of a registered hypertireosis which, together with lungs infiltration, resulted in decompensation of basic disease and hence lead the patient to ketoacidosis. Moreover, the very hypertireosis lead to hyperglyacemia, glyacemia oscillation and repeated ketoacidosis after which, the adequate therapy was applied.

Panhypopitutarism is a decreased hormone activity of hypophysis. The aim of the study is to present the case of the patient with a previous diagnosed disease and regular therapy together with occurrence of a new symptomology resulting in pondering over another diseases. A female fifty-seven-year-old patient was admitted to the Clinic of Intensive Care Unit for Endocrinology, Diabetes and Metabolism Disorders. The patient was in a comatose state. According to heteroanaemnestic analysis, the patient had been feeling weakness, lack of appetite, sickness, stomach pain accompanied with vomiting and every-day headaches. The same patients has also been treated for psychiatric disorders for 15 years. She suffers from hypothyreosis and is inclined to anaemia. In 1994 she was admitted to hospital due to medicament poisoning. In the course of the last month she has been at general practitioner's due to her general bad health condition who eliminated the possibility of anaemia and acute disorders of thyroid gland and liver, according to the previous laboratory results. Gastritis was recorded through gstroscopic survey. Psychiatrist was asked to contribute with his advice. Due to low blood pressure attributed to high temperatures, the patient was provided with infusion. While being checked up, the patient was asthenic, in a certain comatose state, with reactions to any kind of external irritation, extremely pale with watery and yellowish mucous membrane without distinctive lateralization. Cor: the rhythmical heart action, clear tones, murmurs almost inaudible. Frequency 60/30 mm Hg. Other results insignificant, no signs of fresh bleeding. By ECG, it is registered chronic ischaemia in precordial arteries. Due to hyponatraemia, hypochloremia, hypoglycaemia, bradycardia, hypotension, weakness and prevailing paleness of the skin, the White Addison was presumed. On the ground of clinical picture, it was concluded that it was the case of panhypopitutarism of unknown cause. The patient was at the state of well-being because of substitutional therapy and indirect implications of cortisoic activity (GUK, Na, Cl, K, tension, frequency) were good. The conclusion was that even in patients with previous verified diagnoses, it is essential that we should think and act differentially and diagnostically.