The aim of this review article is to highlight the consequences of COGHD after the end of linear growth on bone mass and body composition and the opposing beneficial effects of continuing GH replacement in the transition period and young adults. The role of growth hormone in the period of late adolescence and young adulthood is well established, mainly in achieving peak bone mass and a favorable body composition, characterized by muscle mass increase and fat mass reduction. Patients with childhood onset growth hormone deficiency (COGHD), after reaching the adult height, have a reduced bone mineral density and muscle mass with increased fat mass compared to healthy controls. Inadequate body composition is a predictor for cardiovascular risk, while low bone mass in early youth hallmarks the risk of osteoporosis and bone fractures in later life. Cessation of growth hormone replacement (GHr) after completion of growth will lead to delayed peak bone mass and unbalanced body composition with increased abdominal fat deposits. According to numerous clinical studies monitoring the effects of GH treatment on the physical and psychological status of patients with persistent GHD after completion of growth, we suggest continuing this treatment between 16 and 25 years of age. It is advised that GHr in the transition period be administered in intermediate doses between those for the pediatric population and those for the adult population. Usual daily GHr doses are between 0.3 and 0.5 mg but need to be individually optimized, with the aim of maintaining IGF-I in the age-specific normal range.

Background/Aim: Chronic kidney disease (CKD) has seen a rapid increase worldwide in recent decades, now recognised as a global health issue of the 21st century. Optimal, continuous control of hypertension represents a crucial part of treatment capable of slowing the progression of CKD. The aim of this study was to demonstrate that optimal regulation blood pressure control in patients with essential and secondary hypertension, along with CKD, slows the progression of CKD. Methods: The research was conducted at the University Clinical Centre of the Republic of Srpska, Banja Luka, Internal Clinic Nephrology Department. A retrospective-prospective study was blind for patients and lasted for 24 months. It included 97 patients, aged 18 and above, of both genders, hypertensive, in the 3rd or 4th stage of CKD (creatinine clearance of 15-59 mL/min). Assess the outcome of CKD, a "complex (undesirable) clinical outcome" was taken - one of three fundamental clinically undesirable events: double increase in serum creatinine values at the end of 24 months, onset of terminal renal insufficiency, or patient death. Patients were classified into three groups: I group - 30 patients with essential hypertension and CKD with optimally regulated blood pressure; II group - 32 patients with secondary hypertension and CKD with optimally regulated blood pressure; III control group - 35 patients with hypertension of various causes and CKD who did not achieve target blood pressure values. Blood pressure control was measured from month 0 to month 24 - once a month. Laboratory tests were taken every 3 months (red blood cells, haemoglobin, glycaemia, cholesterol, urea, creatinine, uric acid, sodium, potassium in serum and urine). Results: There was a highly statistically significant difference in glomerular filtration rate in the first group compared to the third group and in the second group compared to the third group. No statistically significant difference in glomerular filtration rate between the first and second groups was observed, where good blood pressure regulation was achieved. Conclusion: Optimal blood pressure control in the examined groups, regardless of the cause of CKD, was responsible for slowing the progression of CKD compared to the group with unregulated blood pressure.

Background/Aim: Secondary failure of oral therapy occurs after a long period of successful use of oral antidiabetic drugs. The exact mechanism of its occurrence is not known. Recent data suggest heterogeneity of this phenomenon, analogous that of type 2 diabetes pathogenesis. Research objective was to assess glucoregulation and insulin secretory function before, three months after the use of insulin therapy and three months after the exclusion and re-introduction of oral antidiabetic therapy. Methods: Forty-nine patients with unsatisfactory glycaemic control were selected and insulin therapy in four daily doses (basal-bolus regimen) was subsequently initiated. Glycaemic regulation and beta cell function (C-peptide and insulinemia) were monitored at three time points: before starting insulin therapy, three months after initiating insulin and three months after discontinuing insulin and resuming the previously used oral antidiabetics. Results: After the introduction of insulin therapy, there was a significant improvement in glycaemic regulation parameters (p < 0.001). Improvements in beta-cell function and reductions in insulin resistance were confirmed during the period after insulin therapy (p < 0.001). However, a certain deterioration in these parameters was observed following the discontinuation of insulin therapy. Additionally, there was a slight decrease in C-peptide and an increase in insulinemia, though these changes were not statistically significant. Conclusion: Application of intensified insulin therapy for three months leads to improvement of glucoregulation and partial recovery of the secretory function of the endocrine pancreas. The reintroduction of oral antidiabetic therapy led to a slight worsening of the observed parameters, although this change was not statistically significant.

Introduction. Benign pituitary tumors are a heterogeneous group of neoplasms with varying clinical presentations depending on their hormonal activity, size, and mass effects. These tumors can cause significant morbidity due to endocrine dysfunction and compression of adjacent structures. Understanding their clinical characteristics is essential for improving diagnostic accuracy, optimizing treatment strategies, and predicting complications. This study aimed to evaluate the clinical profiles of patients with benign pituitary tumors, focusing on demographic characteristics, hormonal activity, and tumor size.Methods. This retrospective five-year study (2019–2023) conductedat the University Clinical Center of Republic of Srpska, Banja Luka included patients diagnosed with benign pituitary tumors who underwent clinical, biochemical, and radiological evaluations. Demographic data, hormonal profiles, and tumor dimensions assessed via MRI were analyzed. Tumors were classified as functioning or non-functioning based on hormonal secretion. Statistical analysis explored associations between clinical parameters and tumor characteristics.Results. This study analyzed data from patients diagnosed with benign pituitary gland neoplasms. The mean patient age was 48.61 years (SD = 17.60), ranging from 20 to 85 years. Among 53 patients with available tumor functionality data, 79.2% had functional adenomas, with prolactinomas being the most common (64.1%). Macroadenomas were present in 58.0% of cases, and 22.4% of tumors were invasive. Surgery was performed in 21 patients, with 76.2% undergoing transsphenoidal surgery. Remission was achieved in 5.9%, and complete resection in 17.7%.Conclusions. A comprehensive assessment of clinical features in benign pituitary tumors is essential for tailoring individualized treatment and improving patient outcomes.