Publications by authors named "Michal Krsek"

Background: Thymic neuroendocrine tumor as a cause of Cushing syndrome is extremely rare in children.

Case Presentation: We report a case of a 10-year-old girl who presented with typical symptoms and signs of hypercortisolemia, including bone fractures, growth retardation, and kidney stones. The patient was managed with oral ketoconazole, during which she experienced adrenal insufficiency, possibly due to either cyclic adrenocorticotropic hormone (ACTH) secretion or concurrent COVID-19 infection.

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Article Synopsis
  • Adrenal insufficiency (AI) is a syndrome that can be classified as primary, due to damage to the adrenal glands, or secondary, caused by a lack of stimulation from the pituitary gland.
  • Diagnosis involves clinical evaluation and various biochemical tests that measure hormone levels and assess adrenal function.
  • Proper diagnosis and timely hormone replacement therapy are essential to manage AI and prevent serious complications like adrenal crises.
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  • An online survey of European thyroid specialists revealed that 28% believe thyroid hormone (TH) treatment may be appropriate for euthyroid patients with growing simple goiters, despite guidelines against this practice.
  • There were significant regional differences in support for TH treatment, with only 7% in The Netherlands compared to 78% in the Czech Republic.
  • Factors influencing the likelihood of recommending TH included the specialist's age and the historical iodine insufficiency of their region, while gender, country, and economic factors showed weak associations.
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  • - The study aimed to assess how European thyroid specialists view levothyroxine (LT4) treatment for euthyroid women with positive thyroid peroxidase antibodies (TPOAb) to improve fertility, as current evidence does not support this practice.
  • - An international survey (THESIS) revealed that 42.8% of over 2,316 respondents believe LT4 might be indicated for these patients, with significant variation across countries, highlighting a range from 22.9% to 83.7% of positive responses.
  • - Factors such as gender, age, and clinical experience influenced opinions; younger specialists and those who treat more thyroid patients were more likely to consider LT4, raising concerns about potential overtreatment risks in
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Article Synopsis
  • Context
  • : Maternal diabetes negatively impacts the development of the fetal cardiovascular system, with an emphasis on the link between maternal glucose control and fetal heart structure/function.
  • Study Design
  • : A case-control study with 62 pregnant women with type 1 diabetes and 30 healthy controls assessed fetal heart measures in the second and third trimesters using various ultrasound techniques, while analyzing maternal glucose management over three gestational periods.
  • Findings
  • : Fetuses of diabetic mothers showed significant changes (e.g., increased heart dimensions and output) compared to controls, and certain fetal heart metrics were inversely related to poor glucose control and higher hemoglobin levels
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Hypothyroidism is common, however, aspects of its treatment remain controversial. Our survey aimed at documenting treatment choices of European thyroid specialists and exploring how patients' persistent symptoms, clinician demographics, and geo-economic factors relate to treatment choices. Seventeen thousand two hundred forty-seven thyroid specialists from 28 countries were invited to participate in an online questionnaire survey.

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Objective: The aim of this study was to evaluate the prevalence of venous thromboembolism (VTE) in patients included in the European Registry on Cushing's syndrome (ERCUSYN), compare their clinical characteristics with those who did not develop VTE and identify risk factors for VTE.

Design: A retrospective observational cohort study.

Methods: Data extraction from the registry was taken on February, 7, 2022.

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Introduction: Thyroid specialists influence how hypothyroid patients are treated, including patients managed in primary care. Given that physician characteristics influence patient care, this study aimed to explore thyroid specialist profiles and associations with geo-economic factors.

Methods: Thyroid specialists from 28 countries were invited to respond to a questionnaire, Treatment of Hypothyroidism in Europe by Specialists: an International Survey (THESIS).

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Summary: Severe Cushing's syndrome from an ectopic adrenocorticotropic hormone-producing tumour is rare but often demands rapid diagnostics and treatment of hypercortisolism with its comorbidities. Pharmacotherapy of hypercortisolism by ketoconazole, metyrapone and osilodrostat is currently available. If unsuccessful or insufficient a bilateral adrenalectomy is an option.

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Healthcare data held by state-run organisations is a valuable intangible asset for society. Its use should be a priority for its administrators and the state. A completely paternalistic approach by administrators and the state is undesirable, however much it aims to protect the privacy rights of persons registered in databases.

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Background: We report four pediatric subjects with Cushing's disease (CD) diagnosed in the Czech Republic. We focus on initial symptoms of Cushing's syndrome (CS) which can lead to early diagnosis, on typical symptoms of CS in children, their age and sex distribution, the mean length of symptoms prior to diagnosis, indication for examination, post-cure growth, sexual development and pituitary function in our four CD patients after transsphenoidal pituitary surgery (TSS). We describe the diagnostic process leading to confirmation of CD and we emphasize the biochemical and radiological diagnostic difficulties.

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To determine the optimal week for labor induction in women with diet-controlled gestational diabetes mellitus by comparing differences in perinatal and neonatal outcomes of labor induction to expectant management at different gestational weeks. Methods: This was a retrospective analysis of a prospectively recruited cohort of 797 singleton pregnancies complicated by diet-controlled gestational diabetes mellitus that were diagnosed, treated, and delivered after 37 weeks in a tertiary, university-affiliated perinatal center between January 2016 and December 2021. Results: The incidence of neonatal complications was highest when delivery occurred at 37 weeks, whereas fetal macrosomia occurred mostly at 41 weeks (20.

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Objective: Insulin-like growth factors (IGFs) are involved in regulating growth and metabolism and increase insulin sensitivity, improve glucose metabolism, and are potentially related to gestational diabetes mellitus (GDM) and its complications for mothers and fetuses.

Design: This study aimed to assess serum levels and cord blood levels of IGF system components in pregnant women with (39 participants) and without GDM (22 participants). Blood samples were obtained at 28-32 and 36-38 weeks of gestation and 6-12 months after delivery.

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Pituitary incidentaloma are being accidentally found during imaging procedures in approximately 10% of normal population. Facing pituitary incidentalomas endocrinologists have to decide about further management based on the assessment of hormonal activity, aetiology, size, and possible compressive symptoms. Treatment of choice for prolactinomas is medical therapy.

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Background: Inconsistencies in the management of hypothyroidism have been reported among endocrinologists in different European countries. Aim of this study was to explore Czech endocrinologists' use of thyroid hormones in hypothyroid and euthyroid patients.

Methods: We used a web-based survey containing 32 questions regarding the use of thyroid hormones.

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Tumor-induced osteomalacia (TIO) is an uncommon type of osteomalacia associated with phosphaturic mesenchymal tumors (PMTs). Due to nonspecific symptoms, the diagnosis and appropriate management of the disease is often delayed for many years. Involvement of spine with TIO associated tumors is exceedingly rare.

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Article Synopsis
  • - Despite advancements in medical care, pregnancies in women with type 1 diabetes mellitus (T1DM) face higher risks for both mothers and babies, highlighting the importance of optimal diabetes management before and during pregnancy to reduce complications.
  • - A study analyzing 221 pregnancies from 2008 to 2018 found that most women had inadequate diabetes compensation at conception; however, those with proper management before pregnancy had fewer perinatal issues.
  • - The findings suggest that women with T1DM should plan their pregnancies and seek proper medical guidance to improve outcomes, as planned pregnancies with good diabetes control result in fewer complications for both mother and child.
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In somatotroph pituitary tumours, somatostatin analogue (SSA) therapy outcomes vary throughout the studies. We performed an analysis of cohort of patients with acromegaly from the Czech registry to identify new prognostic and predictive factors. Clinical data of patients were collected, and complex immunohistochemical assessment of tumour samples was performed (SSTR1-5, dopamine D2 receptor, E-cadherin, AIP).

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Gestational diabetes mellitus (GDM) is diabetes that is first diagnosed in the second or third trimester of pregnancy in patients who did not have a history of diabetes before pregnancy. Consequences of GDM include increased risk of macrosomia and birth complications in the infant and an increased risk of maternal type 2 diabetes mellitus (T2DM) after pregnancy. There is also a longer-term risk of obesity, T2DM, and cardiovascular diseases in the child.

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Context: Gestational diabetes mellitus (GDM) is accompanied by subclinical inflammation; however, little is known about local inflammation in adipose tissue and placenta.

Objective: To analyze systemic and local subclinical inflammation and adipose tissue lymphocyte content and phenotype in pregnant women with and without GDM.

Design: Observational study.

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Objective: The optimal time to perform stereotactic radiosurgery after incomplete resection of adrenocorticotropic hormone (ACTH)-producing pituitary adenoma in patients with Cushing's disease (CD) remains unclear. In patients with persistent CD after resection of ACTH-producing pituitary adenoma, the authors evaluated the association of the interval between resection and Gamma Knife radiosurgery (GKRS) with outcomes.

Methods: Pooled data from 10 institutions participating in the International Radiosurgery Research Foundation were used in this study.

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Contemporary health care is facing deep personal crisis appearing mainly in nurses. It particularly involves departments characterized by mentally and physically demanding workload especially departments of internal medicine, that are immediately endangered by the lack of the nursing staff. The importance and capability of motivation come to fore among other factors.

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Purpose: Cushing's syndrome is characterized by metabolic disturbances including insulin resistance. Mitochondrial dysfunction is one pathogenic factor in the development of insulin resistance in patients with obesity. We explored whether mitochondrial dysfunction correlates with insulin resistance and other metabolic complications.

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Objective: The aim of the Acromegaly Consensus Group was to revise and update the consensus on diagnosis and treatment of acromegaly comorbidities last published in 2013.

Participants: The Consensus Group, convened by 11 Steering Committee members, consisted of 45 experts in the medical and surgical management of acromegaly. The authors received no corporate funding or remuneration.

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Objectives: The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model.

Methods: This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign").

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