ABSTRACT
Autoimmune polyendocrine syndromes (APS, PGA ) originally defined by Blizzard, Maclaren and Neufelt as a constellation of various autoimmune diseases became more frequent in the clinical practice. The specific autoantibodies are the main serologic markers for diagnosing APS. 
The aim of this study was to establish the frequency and clinical relevance of organ-specific antibodies against islets, adrenal and parietal- cell antigens in patients with autoimmune thyroid disease ( ATD ) as components of APS. We studied 51 pts with Graves' disease and Hashimoto's thyroiditis (42f and 9m, mean age 45±13 y) divided into 3 groups according to the APS type (ATD and diabetes mellitus type I ­ n=22; ATD and Addison's disease ­ n=7; ATD and vitiligo/alopecia ­ n=22), as well as 100 healthy controls. Thyroid antibodies (TgAb, TMAb ), b-cell specific antibodies (GAD65-Ab, Insulin Ab), perietal-cell (PcAb) were measured by ELISA, and adrenal antibodies (AAb), by indirect IF. The data obtained showed that 12 (54,5%) pts with ATD and diabetes (APS type IIIA) were b-cell Ab positive but 6 of them started as LADA (Latent Onset Autoimmune Diabetes of Adults). The frequency of Ab-positivity against b-cell and adrenal antigens ( 27% and 50% resp.) was significantly higher in 22 pts with APS type IIIC all of them without manifested diabetes or Addison's disease. Pc-Abs were positive in all groups (58­78% vs.1,8% in controls) but only 30% of pts had chronic gastritis. Our data show that a significant percentage of ATD-patients reveal the multiple associated subclinical abnormalities of endocrine autoimmunity which required the follow up in respect to the risk of their clinical manifestation in a later stage of disease. This holds true also for patients with vitiligo and/or alopecia areata (APS type IIIC ).  
KEY WORDS: autoimmune thyroid disease, GAD65 autoantibodies, insulin autoantibodies, adrenal autoantibodies , polyendocrine autoimmunity.
 

Indapamide ­ the Better Alternative 
to Thiazides for the Prevention and Treatment of Recurring Bilateral Renal Calculosis and Osteoporosis Resulting 
from Renal Hypercalciuria
S. Simeonov, D. Iliev, N. Botusharov, E. Koumchev*, E.Enchev, 
D. Troev, L. Mincheva, M. Pavlova, B. Nonchev
Clinic of Endocrinology and Metabolism, Higher Medical Institute - Plovdiv
*Clinic of Nephrology and Haemodialysis, Higher Medical Institute - Plovdiv

ABSTRACT
Thiazide diuretics and indapamide (IND) have similar effects upon urine excretion of electrolytes. Little is known about the hypocalciuric effect of indapamide. The aim of the study is to evaluate and compare the effects of hydrochlorthiazide (HHT) and IND on urine excretion of calcium in patients with recurring renal calculosis due to renal hypercalciuria and osteoporosis. During the first stage of the study for periods of 10 days, 20 patients are treated consecutively with HHT 12,5 mg, 25 mg, 50 mg,  and IND 2,5 mg daily. Dose dependent effects of HHT are observed. The effect of IND 2,5 mg is equal to that achieved with 50 mg HHT and greater than the doses of 25 mg and 12,5 mg HHT daily. During the second stage of the study are compared the effects of IND 2,5 mg (a group of 20 patients), HHT 25 mg (28 patients) and HHT (12 patients) over a 6 months period. The lowest and sustained calciuric effect is achieved with 2,5 mg IND ­ x± SD=0,052±0,012 mmol/kg/24 h. Almost the same are the results with 25 mg HHT ­ x±SD=0,076 ±0,01 mmol/kg/ 24 h, but undesired adverse  effects are observed ­ hypokalemia, hyperglicemia, hyperuricemia and hyperlipoproteinemia, which are absent during treatment with IND. Lower doses of HHT (12,5 mg/24 h) prove metabolically safe, but their hypocalciuric effect is unsatisfactory. There are no available data in the literature about the use of IND in the treatment of osteoporosis. Changes in bone mineral density (BMD) are measured in 20 patients treated with HHT 25 mg/24 h and 11 treated with IND 2,5 mg/24 h for 6 months by dual-energy X-ray absorbtiometry (LUNAR ­ X-ray bone densitometer). In both groups the changes of BMD are similar and statistically significant (p<0,05). We can recommend IND as a better and safer alternative of the thiazides in treating renal  hupercalciuria associated with recurrent renal stones. The results of the study show that we can use IND also in the treatment of osteoporosis.
KEY WORDS: hypercalciuria, nephrolithiasis, indapamide, thiazide, osteoporosis.
 

Blood Lactate Response to Maximal Exercise in Women: Influence of Sex Steroid Hormones Levels
Z. Obminiski, R. Stupnicki*, J. Dobridge**, A. C. Hackney**
Institute of Sport, Warsaw ­ Poland
*Biometry Department, University-Academy of Physical Education, 
Warsaw ­ Poland
**Endocrine Section ­ Applied Physiology Laboratory, 
University of North Carolina ­ USA

Running Heading: Steroid Hormones and Exercise Metabolism

Abstract
It is the purpose of the study to findout whether or not differences exist in blood lactate response of women with a high female sex steroid hormone status (circulating estrogens and progestins) versus low female sex steroid hormone status. Twenty healthy female athletes performed maximal cycle ergometry exercise testing to provoke a change in blood lactate concentration. The athletes were divided into a HIGH and LOW hormonal concentration grouping and lactate responses compared to ANCOVA analysis. Results revealed that the post exercise lactate response in the HIGH group (11,34±0,48 mM/l; Mean±SD) was significantly less than in the LOW group (12,81±0,34 mM/l, p=0,036). Correlation analysis indicated the hormonal state (HIGH vs. LOW) and the overall lactate concentrations of the subjects in response to exercise were well correlated (Spearman rho = ­0,464; p=0,039). This suggests that as subject’s hormonal concentrations were elevated their lactate concentrations were lower. From practical viewpoint, the present findings imply that blood lactate monitoring may be a reliable technique to assess exercise intensity in eumenorrheic female athletes. For endocrinologists, the findings further demonstrate that sex steroid hormones have influences beyond that of just regulating reproduction in healthy women.
KEY WORDS: Estrogen, progesterone, human performance.