[Pancreatic endocrine tumors - management guidelines (recommended by the Polish Network of Neuroendocrine Tumors)]

Pancreatic endocrine tumors (PETs) are rare neoplasms of this organ. The majority of PETs are tumors without hormonal activity. In this publication, we present the diagnostic and therapeutic guidelines for the management of these tumors proposed by the Polish Network of Neuroendocrine Tumors. These guidelines refer to biochemical and location diagnostics, including scintygraphy of somatostatin receptors, endoscopic ultrasonography and other anatomical and functional imaging methods. High importance is attached to correct histopathological diagnosis which determines further management of patients with PETs. Antitumor therapy requires multidirectional procedure, and therefore the rules of surgical treatment, biotherapy, chemotherapy and peptide receptor radionuclide therapy are discussed.

The blood concentration of intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) in patients with active thyroid-associated orbitopathy before and after methylprednisolone treatment

BACKGROUND

The soluble forms of vascular cell adhesion molecule-1 (sVCAM-1) and intercellular adhesion molecule-1 (sICAM-1) have been found to be increased in the blood of patients with Graves disease. The aim of this study is evaluation of the serum concentrations of soluble forms of adhesion molecules ICAM-1 and VCAM-1 in patients with thyroid-associated orbitopathy (TAO) before and after methylprednisolone treatment.

MATERIAL AND METHODS

The study was performed in 40 Graves disease, hyperthyroid and euthyroid patients with a clinically active form of TAO. Serum concentrations of sVCAM-1 and sICAM-1 in TAO patients were determined by enzymelinked immunoabsorbent assay (ELISA) before and after intensive pulse methylprednisolone treatment.

RESULTS

We did not find any significant changes in the studied parameters between TAO patients with hyperthyroidism and those with euthyroidism. The serum concentrations of sICAM-1 and sVCAM-1 were significantly increased in patients with TAO before methylprednisolone therapy when compared with the control group. After treatment serum concentrations of sICAM-1 and sVCAM-1 decreased significantly but were still significantly higher than for the control group.

CONCLUSION

From the results obtained we can conclude that Graves orbitopathy itself but not thyroid function is probably responsible for the elevated level of the adhesion molecules studied.

Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas

AIM OF THE STUDY

The paper presents endoscopic surgical technique used in the treatment of hormonally active pituitary adenomas and assessment of the method in terms of its effectiveness and safety.

MATERIAL AND METHODS

In 217 cases the surgery was performed due to pituitary adenomas applying the technique developed by Jho and Carrau, with our own modifications. 70 patients were treated for hormonally active adenomas. The group consisted of 36 somatotrophic adenomas, 21 prolactinomas and 13 corticotrophic adenomas. There were 51 females and 19 males with mean age of 42.6 years (range 11-77 years). The follow-up period was between 7 and 56 months (mean - 34 months). The effectiveness and occurrence of complications were confirmed on the basis of neurosurgical, laryngological, endocrinological, ophthalmological examinations and neuroimaging.

RESULTS

Biochemical and neurosurgical criteria for complete resection were obtained in 21 (58.3%) of 36 patients with all somatotrophic adenomas. In the group of prolactinomas complete resection was achieved in 17 (80.9%) of 21 patients. Of the 13 patients with Cushing's disease 11 (84.6%) were cured. In the studied group there were no deaths. In the postoperative course only 2 (2.8%) patients suffered liquorrhoeas and new anterior lobe pituitary insufficiency was noted in 8 (11.4%) cases. Meningitis was noted in 1 (1.4%) case and another 1 (1.4%) patient had epistaxis which required repeated endoscopic surgery.

CONCLUSIONS

Endoscopic technique is an effective method of treatment of hormonally active pituitary adenomas. It is characterised as being minimal invasive and has a low severe complication rate.

[Natriuretic peptides: their role in diagnosis and therapy]

Cardiac natriuretic peptide hormones, atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), are synthesized and secreted by the heart, producing several biological effects, such as natriuresis, vasorelaxation and hypotension. During the last decade these peptides, especially BNP, have received increasing attention as potential markers of cardiovascular disease. Their measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money. BNP levels can enable the differentiation between dyspnoic patients secondary to ventricular dysfunction and subjects with primary respiratory disorders. Moreover, there is good evidence that natriuretic peptides may have a diagnostic role in arterial hypertension, acute coronary syndromes, pulmonary hypertension, some valvular heart disease and some disorders affecting other systems (diabetes or thyroid disorders). In this paper we discuss the clinical utility of assessment of natriuretic peptide hormones in the diagnosis of various clinical conditions and their use as pharmacological agents.

[Consensus of the Polish Society of Endocrinology. Presurgical somatostatin analogs therapy in acromegaly]

Consensus statement of the Polish Society of Endocrinology, regarding presurgical somatostatin analogs in acromegaly has been presented. It is suggested to administer depot somatostatin analog (Octreotide LAR at the dose 20 mg and then 30 mg or equivalent doses of Lanreotide Autogel 90/120 mg every 4 weeks) in order to normalize or suppress to a maximal extent GH and IGF-1 concentrations. The period of therapy in case of microadenoma would be at least 3 months (targets: biochemical improvement, reduced risk of disease's complications, perioperative risk reduction, inhibition of tumor growth). The period of therapy in case of macroadenoma would be at least 6 months, until maximal possible reduction of GH and IGF-1 concentrations (targets: tumor shrinkage, biochemical improvement, reduced risk of disease's complications, perioperative risk reduction). Using an uniform approach in a group, as numerous as possible, of treated patients would allow objective evaluation of long-term efficacy of the treatment.

Octreotide suppression test in diagnosing and predicting the outcome of therapy in patients with neuroendocrine tumors. Preliminary report

INTRODUCTION

Chromogranin A (CgA) is a non-specific marker of neuroendocrine tumors (NET) and is important in monitoring the disease course and NET treatment.

AIM OF THE STUDY

Usefulness of suppression test of CgA secretion with octreotide in diagnosis and predicting the therapy outcome in NET patients.

MATERIAL AND METHODS

The study included 32 patients with NET of gastrointestinal tract, lung and of unknown origin. CgA level in blood plasma on fasting, before and 30, 60, 90 and 120 minutes after subcutaneous administration of 100 mug octreotide, was determined in all patients. The subjects were divided into two subgroups with relation to CgA level and to the results of somatostatin receptor scintigraphy (SRS).

RESULTS

Statistically significant CgA decrease after octreotide administration in all study time points and positive results of SRS were found in the patients with the elevated CgA level. No statistically significant decrease of CgA level after octreotide was found in the group with normal CgA levels. In this group, 13 patients had a negative result of SRS, and somatostatin receptors expression was found in one patient. Tolerance of somatostatin analogs (SSA) therapy was very good.

CONCLUSIONS

Octreotide suppression test with CgA level assessment in NET patients is a simple, straightforward examination, providing information on the predicted response to the applied SSA and the data on initial clinical tolerance of those agents. This examination can also be a screening test useful in planning the treatment with SSA in patients with NET.

[Glucocorticoid-induced osteoporosis]

Prolonged glucocorticoids administration is the most common cause of secondary osteoporosis. It is estimated that 30% to 50% of chronic glucocorticoids users experience vertebral or hip fractures. The highest bone loss (up to 30% in some studies) is observed in the first six months of treatment. Only a minority of patients who take chronic glucocorticoids receive optimal osteoporosis diagnosis, prevention, and/or treatment. The aim of this paper is to present the pathophysiology of glucocorticoid-induced osteoporosis, as well as some guidelines on diagnostic, preventive and therapeutic strategies for this disorder in an effort to promote the greater awareness of it.

[Insulinoma--diagnosis and treatment]

Insulinomas are the most common functioning endocrine tumors of pancreas. Approximately 10% are multiple, less than 10% can be malignant and 5-10% associated with the MEN-1 syndrome. Insulinomas are the most common cause of hypoglycemia resulting from endogenous hyperinsulinism. The aim of this lecture is to present the up-to-date information concerning the prevalence, diagnosis and treatment of insulinoma.

Polypeptide growth factors in gastroenteropancreatic neuroendocrine tumours

Polypeptide growth factors form a potent class of extracellular signal molecules in the regulation of cellular differentiation and proliferation. Disturbances in the expression of growth factors influence the normal pathway of differentiation and lead to cellular transformation and tumour progression. Contemporary medical studies report that various growth factors such as those for platelet-derived growth factor, vascular endothelial growth factor, epidermal growth factor, hepatocyte growth factor and insulin-like growth factor are expressed in gastroenteropancreatic neuroendocrine tumours (GEP/NET). Polypeptide growth factors have great significance in the growth, progression and development of metastases by various tumours. We describe the role of growth factors in GEP/NET on the basis of the available reports of medical research.

[Hormonal factors in aetiopathogenesis of psoriasis]

Psoriasis is one of the most common chronic and recurrent dermatosis. Aetiopathogenesis of this disease is complex and not yet well known. Lately, besides many different factors regarded to play an important role in psoriasis pathology, hormones have been taken into account, too. The paper discusses, based on the available literature, the impact of various hormonal factors on development and modulation of psoriasis course. Authors emphasize the possible role of sex hormones, stress hormones, prolactin and somatotrophin axis hormones in aetiology of this dermatosis. They also try to establish, what interrelationships between endocrinologic system and skin in psoriasis are. Further research connected with this issue could lead to new clinical implications as well as therapeutical methods in dermatology.

Plasma ghrelin concentrations in patients with polycystic ovary syndrome before and after 6months therapy: correlation with androgen levels

OBJECTIVE

Ghrelin is a natural ligand of the growth hormone secretagogue receptor and has been shown to be a potent stimulant of GH secretion. It has also orexigenic effects and regulates energy homeostasis. Recent studies claim that ghrelin influences the androgen level and probably takes part in PCOS pathomechanism. The aim of the study was an assessment of ghrelin level in plasma in women with PCOS before and after the treatment and ghrelin's influence on androgen level change.

MATERIAL AND METHODS

The study included 25 women with the diagnosed PCOS (mean age 25.3+/-4.05 yr). The tests were done twice: before the treatment and after 6-month therapy with Diane 35 (cyproterone acetate 2 mg with ethinylestradiol 35 mug). Following hormones were measured: ghrelin, free testosterone, androstendione, dehydroepiandrosterone sulfate, 17-OH-progesterone and estradiol.

RESULTS

The received results in both groups were compared with the control group (11 healthy women, mean age 26.0+/-2.6 yr). No statistically significant differences in ghrelin levels before (187.8+/-8.1 fmol/ml) and after the therapy (185.6+/-9.5 fmol/ml) were found. Similar results were received when two groups of women compared with the control (186.5+/-8.7 fmol/ml). No correlations between ghrelin and androgen levels were confirmed.

CONCLUSIONS

Final conclusion is that there is no direct impact of ghrelin level on PCOS pathogenesis, however, its role in development of obesity, hyperinsulinemia and insulin resistance co-occurring with metabolic disorders syndrome cannot be excluded.

[Melatonin and bone status]

This paper reviews the findings accumulated on the role of melatonin (MEL) on bone status and the role of RANKL/RANK/OPG system (receptor activator of nuclear factor-kappa B ligand/ receptor activator of nuclear factor-kappa B/osteoprotegerin) in this mechanism. Recent studies indicate that MEL may influence on the bone directly by acting osteoclasts and perhaps osteoblasts, and/or indirectly by down-regulating RANK-mediated osteoclast formation and activation. Induced by MEL, changes in the level of factors which play a role in the regulation of bone remodelling, may secondarily (directly and/or indirectly through RANKURANK/OPG system) influence on bone status.

The effect of various methods of psoriasis treatment on somatotrophin axis hormones in serum

OBJECTIVE

To investigate the effect of pharmacotherapy and phototherapy on the concentration of hormones of the somatotrophin axis [growth hormone (GH), insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3)] in the serum of patients with psoriasis in exacerbation and remission.

METHODS

GH and IGFBP-3 in serum were determined by immunoradiometric assay (IRMA), and IGF-I concentrations - by radioimmunological assay (RIA). The dermatological state was assessed by the psoriasis area and severity index (PASI).

RESULTS

There was no significant difference in the GH concentrations in patients both in exacerbation and remission, irrespective of therapy applied. However, in the group treated by phototherapy a significant increase in IGFBP-3 secretion was observed, whereas in the group treated with cyclosporin A - a significant increase in IGF-I secretion was observed in remission.

CONCLUSION

Different methods of treatment have different effects on the secretion of somatotrophin axis hormones, but generally the hormone concentrations do not return to the values observed in healthy people. The therapeutic actions of the drugs concerned are not fully known and require further investigations.

[Sex hormones and adipocytokines in postmenopausal women]

Visceral fat accumulation occuring in postmenopausal women is connected with hypoestrogenism, decreased production of sex-hormone binding globuline (SHBG) and with rise in free testosterone. They have been identified as risk factors for cardiovascular diseases. The exact mechanisms mediating relationships between the excess of visceral adiposity, hormonal variations after menopause and metabolic disturbances, remain unknown. We speculate that adipocytokines produced by adipose tissue: adiponectin, leptin and resistin, might play a role. Adiponectin is a hormone which plays a role in insulin sensitivity and lipid oxidation, and possesses anti-inflammatory properties. Increased levels of androgens post menopause and low SHBG are connected with decreased production of adiponectin. Leptin is another of the adipocytokines which has been shown to be linked to insulin resistance, increased pressure and hypertriglyceridaemia. Sex steroids have effect on leptin secretion but the associations between leptin and menopause are controversial. Recently it was found that resistin, another bioactive substance produced by adipose tissue may related to insulin resistance. Studies on animals indicate that ovariectomy and testosterone significantly increased resistin expression. It seems that adipocytokines may be a link connecting postmenopasual hormonal changes, the excess of visceral fat and increased risk of cardiovascular diseases.

[Contemporary methods of diagnosis and treatment of neuroendocrine gastrointestinal tumors]

Neuroendocrine tumors of digestive tract (GEP NET) occur rather rarely, causing many problems with both diagnosis and treatment. Thanks to the extreme devotion of specialists, a great leap has been made in the field development. Clinicians and scientists gathered in The European Neuroendocrine Tumour Society publish current proposals for diagnosis solutions, together with the most up-to-date methods of treatment, which we have attempted to present in this general overview. It describes general methods of treating patients with GEP NET, as well as discusses ways of dealing with cases of tumours type foregut, midgut and hindgut.

[Unique case of caecum plasmablastic lymphoma CD138(+) in patient with late diagnosed colon neuroendocrine carcinoma]

Neuroendocrine tumors are frequently associated with other primary malignancies. Plasmablastic lymphoma is a rare, aggressive neoplasm, derived from large B-cell, associated with human immunodeficiency virus infection. Plasmablastic lymphoma cells share many cytomorphologic and immunophenotypic features with plasmablastic cells, causing some diagnostic problems. We present a unique case of coexisting two very uncommon neoplasms: plasmablastic lymphoma and neuroendocrine carcinoma in 54-years-old men. This is the first report of caecum localization of plasmablastic lymphoma. Presented case images diagnostic problems in rare neoplasms.

[Thyroid hormones and the cardiomyocytes]

The authors present the current knowledge on the intracellular mechanisms of thyroid hormone action in the cardiomyocytes. Many of the clinical manifestations of thyroid diseases are due to the ability of thyroid hormone to alter cardiovascular hemodynamics. Triiodothyronine affects the hemodynamic state mainly by its influence on the expression of cardiomyocyte genes. These genes encode both structural and regulatory proteins in the heart (myosin heavy chains, sarcoplasmic reticulum calcium-activated ATP-ase, phospholamban). The impaired myocardium contractile activity in hypothyreosis reminds findings in heart failure and may warrant further exploration of therapeutic approaches using thyroid hormone to improve cardiac function in heart failure.

[Five year remission of GHRH secreting bronchial neuroendocrine tumor with symptoms of acromegaly. Utility of chromogranin A in the monitoring of the disease]

Acromegaly is usually caused by excess GH (growth hormone) secretion by pituitary adenoma. Extremely rare (< 1% of cases) acromegaly can be a result of ectopic GHRH (growth hormone releasing hormone) secretion by bronchial tubes, lung, pancreatic or intestinal tumor. The aim of this description is to present the case of successfully treated acromegaly caused by ectopic GHRH secretion by bronchial neuroendocrine tumor and the usefulness of chromogranin A assay in the disease monitoring. The diagnosis of acromegaly in 61-year old woman was based on typical clinical picture and elevated GH and IGF-1(insulin-like growth factor-1) levels. MRI (magnetic resonance imaging) images revealed no tumor in the pituitary but only the pituitary enlargement. Moreover, the right lung tumor (10 cm size) and elevated GHRH level were documented. The secretion of GH, IGF-1 and GHRH were normalized and progression of acromegaly was stopped after the carcinoid tumor surgery. Currently, 5 year after surgery, acromegaly is still in the remission, as the normal levels of GH, IGF-1, chromogranin A and normal chest and pituitary images confirm. The authors emphasize usefulness of measurement of chromogranin A concentration for the evaluation of the tumor remission in case the routine GHRH assay is not accessible.

The relation of serum adiponectin and leptin levels to metabolic syndrome in women before and after the menopause

INTRODUCTION

It is well known that there is a higher prevalence of cardiovascular risk factors and metabolic syndrome (MS) in postmenopausal women. Recently it has become evident that adiponectin and leptin secreted by adipose tissue may be involved in the pathophysiology of MS.

THE AIM OF THE STUDY

was to assess the effects of the menopause on the relationships between adiponectin and leptin and different cardiovascular and metabolic risk factors.

MATERIALS AND METHODS

A total of 56 postmenopausal women and 75 premenopausal subjects were enrolled in this study. We measured blood pressure, BMI, waist circumference and WHR, triglycerides (TG), high density lipoprotein cholesterol (cHDL) levels and fasting glucose and applied the oral glucose tolerance test (OGTT). Women were categorised as having 0, 1, 2, 3 or more risk factors. The presence of at least 3 abnormalities was defined as MS. Serum was assayed for adiponectin and leptin by the radioimmunoassay (RIA) method.

RESULTS

A decline in adiponectin was related to an increased number of MS variables in postmenopausal and premenopausal women. Postmenopausal women with MS had significantly lower adiponectin concentrations than premenopausal women with MS. Serum adiponectin concentrations were inversely correlated to leptin in postmenopausal women. In premenopausal women no clear relationships were found between serum leptin and the number of metabolic disturbances. In contrast to young women, postmenopausal women showed an increase in leptin secretion with a growing number of MS elements. Compared to premenopausal women with MS, postmenopausal women with MS had higher levels of leptin. We found associations between leptin and different risk factors, mainly in the postmenopausal group. When the presence of MS was used as a dependent variable (yes/no) and adiponectin, leptin and menopause status as independent factors, adiponectin and leptin remained significant variables related to MS.

CONCLUSION

The significant role of adiponectin in the pathophysiology of MS in premenopausal and postmenopausal women is confirmed in this study. Leptin is correlated with several MS components but this adipocytokine appears to play a role only in postmenopausal women.

[Influence of pinealectomy and long-term melatonin administration on bone metabolism in orchidectomized rats]

INTRODUCTION

The aim of the study was to demonstrate whether pinealectomy and long-term MEL administration can affect bone metabolism (as evaluated on the basis of serum concentrations of PICP and ICTP) in orchidectomized rats.

MATERIAL AND METHODS

The study included 248 adult male Wistar rats; 6 remained intact, 120 were orchidectomized (Orch), and the remaining ones underwent a sham operation (SOrch). Two weeks after surgery, the rats were divided into 8 groups: 1) SOrch + SPx; 2) SOrch + SPx + MEL; 3) Orch + SPx; 4) Orch + SPx + MEL; 5) SOrch + Px; 6) SOrch + Px + MEL; 7) Orch + Px; 8) Orch + Px + MEL. Animals from 5(th), 6(th), 7(th) and 8(th) groups were pinealectomized (Px) while the remaining ones underwent a sham operation (SPx). Two weeks after surgery rats in the 2(nd), 4(th), 6(th) and 8(th) groups were administered MEL (50 microg/100 g of bm) intraperitoneally while the remaining animals were administered solvent only (daily between 5 and 6 pm during a month). The animals were decapitated before the experiment (intact rats), after 2 weeks from Orch and SOrch, Px and SPx, after 4 weeks from MEL or solvent administration and after 4 and 8 weeks from discontinuing administration of MEL, and blood was collected for PICP and ICTP concentrations assays with the use of RIA method.

DISCUSSION

In Orch rats, a distinct tendency to increase the studied bone markers, especially ICTP was shown. Pinealectomy had inducing, while MEL suppressing effect upon the level of PICP and ICTP; these changes were more pronounced in Orch + Px and SOrch + Px + MEL groups, respectively. After discontinuing administration of MEL distinct tendency to increase of PICP and ICTP level was shown.

CONCLUSIONS

Our findings indicate that MEL is an important modulator of bone tissue metabolism in male rats and that deficiency of MEL concentration may be a co-factor in osteoporosis development.

Somatotrophin axis hormones in patients affected with psoriasis

OBJECTIVES

The serum concentrations of somatotrophin axis hormones (growth hormone--GH, insulin-like growth factor-I--IGF-I and insulin-like growth factor binding protein-3--IGFBP-3) in the patients with psoriasis in its active stage have been evaluated in relation to the control group consisting of healthy people in order to see whether these hormones may play a role in the psoriasis aetiopathogenesis.

MATERIAL AND METHODS

The subjects included 85 psoriatic patients (mean age 36.9 +/- 11.2 years) in the active state of disease and 20 healthy persons (mean age 35.6 +/- 6.6 years) as a control group. GH and IGFBP-3 concentrations in serum were determined by immunoradiometric assay (IRMA), IGF-I concentrations--by radioimmunological assay (RIA). Evaluation of the dermatological state also included a determination of psoriasis area and severity index (PASI).

RESULTS

In the patients with psoriasis the concentration of the growth hormone was found to be significantly higher than in the healthy people at the simultaneously much lower concentrations of the insulin-like growth factor-I and its binding protein-3. IGF-I concentrations correlated negatively to PASI value.

CONCLUSION

In the psoriatic patients the somatotrophin axis activity is disturbed and these disturbances may effect the psoriasis process modulation. However, it is impossible to determine if the disturbances are of the primary, i.e. aetiological, importance for the disease pathogenesis, or only of the secondary--psoroid character.

Homocysteine, vitamin B12, and folic acid in age-related macular degeneration

PURPOSE

Hyperhomocysteinemia is considered an independent risk factor for atherosclerosis and thrombosis. The purpose of this study was to evaluate plasma homocysteine, red blood cell folate, plasma folate, and plasma vitamin B12 concentration in patients with exudative age-related macular degeneration (ARMD).

METHODS

The participants of this study included 30 patients aged 60 to 71 years (mean age 66.2+/-3.6) with exudative ARMD. Plasma homocysteine levels were determined by high performance liquid chromatography (HPLC). Red blood cell folate, plasma folate, and plasma vitamin B12 concentration were determined using a standard kit (Dualcount Solid Phase No Boill radioassay kit for B12/folic acid, DPC Diagnostic, USA) by radioassay method.

RESULTS

The plasma concentration of Hcy (14.88+/-6.23 micromol/L) in ARMD patients was significantly increased (p<0.0001) compared with the control group (8.72+/-3.34 micromol/L). We found not a significant decrease of the plasma vitamin B12 concentration in the ARMD group (476.88+/-220.91 pg/mL) compared with the control group (527.08+/-208.97 pg/mL). Red blood cell folate (158.44+/-56.30 ng/mL) and plasma folate (6.5+/-3.4 ng/mL) in ARMD patients were also not significantly decreased when compared with the control group (183.86+/-59.33 ng/mL and 7.93+/-5.05 ng/mL).

CONCLUSIONS

Hyperhomocysteinemia might be one of the risk factors for the exudative form of ARMD.

[Serum adiponectin levels in patients with acromegaly]

Acromegaly is frequently associated with impaired glucose tolerance or diabetes. Insulin resistance has been reported to be related to low levels of adiponectin, which is exclusively produced by adipose tissue, as well as to decreased concentration of sex hormone binding globuline (SHBG). Growth hormone (GH) excess is associated with increased muscle mass and decreased fat mass. Influence of GH on production and secretion of adiponectin is not completely understood. The aims of this study were to assess serum adiponectin levels in patients with active acromegaly and to compare them with concentrations in the control group and to investigate relationships between adiponectin and indexes: body mass index (BMI) and waist-to-hip ratio (WHR) as well as SHBG levels.

MATERIALS AND METHODS

Serum adiponectin and SHBG levels were measured by radioimmunoassay in 30 patients with active acromegaly and in 22 sex-, age-, BMI- and WHR-matched controls. The groups were comparable in prevalence of hypertension and disturbances of glucose metabolism.

RESULTS

Serum adiponectin concentrations were higher in acromegalic patients compared with control group (24.03 +/- 9.85 mg/ml vs. 14.46 +/- 3.96 mg/ml, p<0.001). When the subjects were fallen into two groups according to sex, significant differences were also observed. Serum SHBG levels were lower in cases compared with controls (25.36 +/- 22.89 nmol/l vs. 33.54 +/- 15.07 nmol/l, p=0.03). In the control group we found adiponectin positively correlated with SHBG concentrations (r=0.53, p=0.01) and negatively correlated with BMI (r=-0.52, p=0.02) and WHR (r=-0.51, p=0.03). However, these relationships were not observed in patients with acromegaly. No significant associations were found between adiponectin and GH or IGF-I.

CONCLUSIONS

Serum concentration of adiponectin is significantly higher in patients with acromegaly when compared with the control group and is independent of BMI, WHR and SHBG. The results suggest that adiponectinemia does not directly affect development of insulin resistance in acromegaly.

[Quantitative assessment of mRNA TGF-beta1 in liver tissue in connection with serum mean daily level of TGF-1 in chronic hepatitis B patient]

Monitoring of fibrosis process with the use of histopathologic studies on liver's bioptates is limited, so it is attempted to find reliable, obtained with less invasive methods, sensitive and reflecting fibrosis dynamics markers of this process. The aim of the study was simultaneously to assess liver's expression as well as circadian and mean daily TGF-betal concentration in serum of patients with chronic hepatitis type B in comparison to control group. Studies were performed on 50 patients (9 women, 41 men) aged 45.9 +/- 2.3 years with chronic hepatitis type B. Control group consisted of 20 patients (mean age 38.6 +/- 3.7 years), in which so called minimal changes without fibrosis were observed in histophatologic bioptate of liver. Blood for studies was collected every 4 houres during the day. Serum concentration of TGF-betal was assessed with the use of ELISA method, and expression of mRNA TGF-betal in liver with QRT-PCR method. No significant difference between circadian as well as mean daily serum TGF-betal concentration beetwen control group and the group with chronic hepatitis type B was shown. Increased expression of mRNA, TGF-betal in bioptate of liver of patients with chronic hepatitis type B in comparison to control group was noted. In "minimal changes" control group presence of significant positive correlation between expression of mRNA TGF-beta1 in liver and concentration of this cytokine in serum was shown, in the group of patients with chronic hepatitis B this connection was not noted.

[The role of the oxidative mechanisms in the pathogenesis of age related macular degeneration]

Oxidative stress, are believed to be an important factor in the pathogenesis of age related diseases e.g. age related macular degeneration (AMD) and age related cataract. The is strong evidence suggesting that antioxidants can protect against development of this diseases, how ether experimental and clinical data have often been inconsistent. In this paper authors presents the review of the literature concerning on the connections between oxidative mechanisms and AMD and protective role of the antioxidative vitamin and other antioxidative factors supplementation in this disorder. This publication tries to estimate the anti-pericyte autoantibodies role in progression of diabetic retinopathy.

[Tear film profile in patients with active thyroid orbithopathy]

Dry eye symptoms and tear film profile were examined in 21 patients with Graves' disease complicated by active thyroid orbitopathy (OT). Dry eye symptoms and clinical tests: break-up time (BUT), Schirmer I, fluorescein and lissamine green staining in OT patients, were comparable with control group. Dry eye symptoms were present in 85% of OT patients compared with 30% in control group. BUT (5.84 +/- 3,31sec.) and Schirmer test (11.11 +/- 9,14mm) were significantly lower when compared with control group (11.4 +/- 3,75sec and 20.5 +/- 9,65mm). Lissamin green staining intensity score (3.61 +/- 1,74) as well as positive fluorescein staining in OT patients, were significantly higher when compared with control.

[Diagnostic and therapeutic opportunities in neuroendocrine tumors of the gastroenteropancreatic system]

Neuroendocrine tumors of the gastroenteropancreatic (GEP) system are rare neoplasms, characterized by their capacity to synthesize, store, and release hormonal products and biogenic amines. Because of their low incidence, limited data about clinical outcomes and prognostic variables are available. They can present clinical symptoms caused by the products secreted, tumor mass or metastases. Assessment of specific or nonspecific tumor markers offers high sensitivity in establishing diagnosis and can also have prognostic significance. Imaging modalities include endoscopic ultrasonography, computerized tomography, magnetic resonance imaging, and in particular, scintigraphy with somatostatin analogs. The radical treatment of GEP tumors is tumor surgery, but this is rarely possible. Somatostatin analogs have been the treatment of choice in symptomatic patients with GEP tumors. In poorly differentiated tumors or in selected cases of advanced or rapidly growing disease, interferon alpha, chemotherapy, and/or radio-metabolic treatment with radiolabeled somatostatin analogs can be performed. Symptomatic therapy is also helpful.

[Serum leptin levels in children with chronic renal failure on continuous ambulatory peritoneal dialysis and on hemodialysis treatment]

Malnutrition and loss of appetite remain a frequent problem in children with chronic renal failure (CRF). Recent studies in human gave much attention for leptin, polypeptide produced by adipocytes, and its influence on appetite and energetic balance regulation. The study aimed at evaluation of serum leptin levels (SLL) in children with CRF with regard to applied method of treatment. Study included 29 children, mean age 13.9 +/- 4.2 years. Among them 10 on peritoneal dialysis (PD, mean age 11.9 +/- 4.3 years), 10 - on maintenance hemodialysis (HD, mean age 16.3 +/- 2.4 years), 9 - on conservative treatment of CRF (CT, 13.0 +/- 4.3 years). SLL was evaluated by RIA. In all groups of children with CRF SLL was high: group I (PD): 34.3 +/- 44.0, group II (HD): 31.5 +/- 57.4, group III (CT): 16.5 +/- 21.1 ng/ml. There was no difference of SLL in children with CRF regarding to method of treatment. Evaluated SLL/BMI index (body mass index) showed no difference in comparison of examined groups of children with CRF (values respectively: PD: 1.5 +/- 1.8; HD: 1.3 +/- 2.1; CT: 0.8 +/- 1.9 ng/ml +/- kg/m2). Also SLL/creatinine index did not differ between examined groups (values respectively: PD: 5.2 +/- 8.2; HD: 4.4+/-8.4; CT: 4.0 +/- 4.6 ng/mg). In both subgroups on dialysis treatment SLL correlated with BMI, additionally in HD SLL correlated with body weight, in PD - with serum ionised calcium. No correlation with age, dialysis treatment duration, creatinine and urea levels was found.

CONCLUSIONS

In children on maintenance dialysis high SLL were observed. The highest SLL in PD patients, when considering CRF group could be related to high dialysate glucose concentration and probably decreased clearance through the peritoneal membrane. The correlation between SLL and BMI was preserved in all groups of children with CRF, irrespective of applied method of treatment.

[Homocysteine and diabetes]

The authors present the current knowledge on the role of hyperhomocysteinemia in developing of vascular changes, especially in diabetes. A high serum homocysteine concentration is a new independent risk factor in the development of arteriosclerosis and cardiovascular diseases. The role of the hyperhomocysteinemia in diabetes has not been explained yet. Probably hyperhomocysteinemia affects the clinical course, metabolic control and possible complications of diabetes mainly by its influence on the development of macro- and microangiopathy.

Plasma concentration of soluble intercellular adhesion molecule-1 in women with polycystic ovary syndrome

Soluble intercellular adhesion molecule-1 (sICAM-1) is ranked as one of the endothelial dysfunction markers and factors predicting diseases of the cardiovascular system. The main objective of this study was to assess the serum concentration of sICAM-1 in women with polycystic ovary syndrome (PCOS) and to verify correlations between serum sICAM-1 levels and selected anthropometric, metabolic and hormonal indices. The study assessed 57 women with PCOS (mean age 28.2 +/- 6.4 years). That group was further divided into two subgroups: the first with body mass index (BMI) < or =25 kg/m2 (21 women of mean age 27.4 +/- 7.0 years) and the second with BMI >25 kg/m2 (36 women of mean age 28.6 +/- 6.0 years). In the control group there were 22 healthy women (mean age of 31.6 +/- 8.5 years). That group again was divided accordingly to BMI into two subgroups: the first with BMI <25 kg/m2 (ten women, mean age 30.2 +/- 8.4 years) and the second with BMI > 25 kg/m2 (12 women, mean age 31.7 +/- 8.7 years). The results demonstrated statistically significantly higher mean concentrations of sICAM-1 in women with PCOS as compared to healthy individuals from the whole control group and also from the control subgroup of women with BMI >25 kg/m2. There was no statistically significant difference in sICAM-1 concentration between the PCOS group and the control subgroup with BMI < or =25 kg/m2 In conclusion, higher concentrations of sICAM-1 in women with PCOS may confirm the presence of a higher risk for cardiovascular diseases in this group. Further studies are therefore necessary to identify both the factors that are responsible for the increase in sICAM-1 concentration and the clinical usefulness of routine sICAM-1 measurement in females with PCOS.

[Circadian rhythm of melatonin in patients with hypertension]

Few reports, especially experimental ones indicate cause-effect connection between melatonin (Mel) and blood pressure. The aim of the study was to assess connection between a daily profile of Mel concentration in saliva and 24-hour cycle of blood pressure in 22 patients with moderate hypertension (12 men, 10 women), 20 patients with severe hypertension (9 men, 11 women) and 25 healthy subjects with normal blood pressure (13 men, 12 women). The age of studied subjects oscillated between 37 and 46 years. Concentrations of Mel were assessed in saliva collected during the day with intervals of 3 hours with the use of RIA method. Blood pressure assessment was done at the same time. A significant decrease of mesor's value and amplitude of Mel rhythm without essential changes in acrophase's value were observed in men and women with severe hypertension. Mean concentrations of Mel in saliva were significantly decreased from 8 pm to 5 am. Significant, negative correlation between nighttime Mel concentrations in saliva and both systolic and diastolic blood pressure was shown in patients with moderate and severe hypertension. Correlation coefficients values were in general higher in patients with severe hypertension. Results of our studies seem to confirm the conception that decreased Mel secretion can be one of the causes of hypertension.

[The apolipoprotein E polymorphism in age related macular degeneration]

PURPOSE

The aim of the study was to evaluate association of apo E polymorphism with AMD.

MATERIAL AND METHODS

The included participants of this study were: 45 patients aged 60 to 71 (mean age 66.2 +/- 3.6), treated because of AMD. Genomic DNA was extracted from peripheral blood leukocytes, and the subsequent analysis of apo E genotypes was performed by polymerase chain reaction (PCR).

RESULTS

In our study the allele frequencies in control group of patients weresimilar to the apo E allele distribution presented by other authors in Caucasian populations. We have not found significant differences between AMD and control group patients for apo (E) genotype or allele frequency. Compared with control group (epsilon4 -13.6%, epsilon2 -2.27%), the frequency of epsilon4 allele was not significantly decreased (11.11%) and epsilon2 allele frequency (7.77%) increased in AMD patients.

CONCLUSIONS

The results of our present study have not indicate a significant association between AMD development and apo E allele frequency, in our studied population of AMD patients.

[Blood concentration of homocysteine, vitamin B (12), and folic acid in patients with exudative age related macular degeneration]

PURPOSE

Recent studies have shown a relationship between elevated levels of Hcy and vascular disease including cerebrovascular accidents and myocardial infarctions. Elevated Hcy plasma is considered as an independent risk factor for atherosclerosis and trombosis.

MATERIAL AND METHODS

This study included 30 patients with diagnosed exudative form of AMD. We evaluated plasma homocysteine levels, by high performance liquid chromatography and red blood cell folic acid, plasma folic acid and plasma vitamin B12 concentration by radioassay method.

RESULTS

The plasma concentration of Hcy in AMD patients had significantly increased when compared with control group. We found not significant decrease of the plasma vitamin B12, red blood cell folic acid and plasma folic acid concentration in AMD group, when compared with the control group.

[Serum aminoterminal peptide of type III procollagen (PIIINP) and transforming growth factor-beta1 (TGF-beta1) levels in patients with chronic hepatitis B and C]

Fibrosis is the process accompanying majority of chronic diseases of liver, independent of etiological factor and leading to cirrhosis and hepatic failure. Monitoring fibrosis process by liver's biopsy is limited, so many attempts are undertaken to assess concentrations of definite proteins in blood, which could be easily accessible marker of intrahepatic process. It seems, that among others, determinations of blood concentration of aminoterminal propeptide of procollagen III--index of collagen's III synthesis and TGF-beta 1--cytokine of antiproliferative action and inhibiting hepatocytes' growth, yet inducing fibroblasts' growth and stimulating fibrosis process brings out such a possibility. The aim of the study was simultaneous determination of TGF-beta 1 and PIIINP concentration in blood of patients with chronic hepatitis B and C before interferone's therapy in comparison to healthy controls, assessment of the parameters in dependence on stage of liver fibrosis and determination of correlation between TGF-beta 1 and PIIINP. Studies were performed in 40 patients with chronic hepatitis B (CAH B) and 35 patients with chronic hepatitis C (CAH C). Significantly increased serum concentrations of TGF-beta 1 as PIIINP in both groups of patients (CAH B and CAH C; grading 2-3, staging 1-2) in comparison with control group was noted. Significant positive correlation of TGF-beta 1 and PIIINP serum concentrations in both groups of patients was observed. There was not significant changes in PIIINP serum levels in patients with hepatitis B and C in dependence on stage of liver fibrosis (staging 1 vs staging 2) but TGF-beta 1 serum levels was significantly increased in CAH B and C patients with higher stage of liver fibrosis process. On the base of obtained results, it seems that changes in TGF-beta 1 concentrations in blood reflect "grading" and "staging" and can be a marker of intensification of intrahepatic fibrosis process whereas PIIINP levels in blood have rather the relation with "grading".

Serum free testosterone in men with coronary artery atherosclerosis

BACKGROUND

The role of testosterone in the pathogenesis of atherosclerotic changes has not been fully explained. The aim of our work was to determine whether levels of serum free testosterone differ between men with and without coronary artery disease.

MATERIAL/METHODS

We examined the serum concentration of free testosterone by the radioimmunoassay method in two groups of subjects, carefully matched for body mass index and age: 105 men with angiographically diagnosed coronary artery disease, and 23 control subjects without any changes in coronary arteries. We also evaluated the concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides by enzymatic methods.

RESULTS

Men with coronary artery disease had significantly lower levels of free testosterone than did controls. The concentration of free testosterone diminished with age, and a negative correlation was found between free testosterone and body mass index. We did not discover any connection between the concentration of free testosterone and lipids.

CONCLUSIONS

A low level of free testosterone may be related to the development of coronary artery disease.

Changes in blood antioxidants and several lipid peroxidation products in women with age-related macular degeneration

PURPOSE

The aim of this study was to evaluate the ferric reducing ability of plasma (FRAP), selected enzymatic and non-enzymatic components of the antioxidative system, and the intensity of peroxidative processes in the blood of patients with age-related macular degeneration (AMD).

METHODS

In the peripheral blood, we evaluated FRAP; concentrations of vitamins C, A, and E; and of thiols. We assayed the activity of enzymatic components of the antioxidative system-superoxide dismutase, catalase, ceruloplasmin and the concentration of reduced glutathione as an indicator of glutathione peroxidase activity. In order to determine the intensity of lipid peroxidation, we measured the concentrations of malondialdehyde and hydroxyalkenales (MDA-HNA) and conjugated diens (CD).

RESULTS

We found a significant increase in FRAP in patients with AMD compared with the control group. The average concentrations of vitamins A and C were low and vitamins E and GSH were significantly higher in AMD than in the control group. The activity of almost all the antioxidative enzymes was high. We found a significant increase in MDA-HNA but no difference in CD.

CONCLUSIONS

The significantly higher concentration of lipid peroxidation products in patients with AMD indicates an important pathogenic role of oxido-reduction disturbance. The high FRAP concentration may be one of the protective mechanisms in oxidation stress. The adaptive increase of the antioxidant barrier mostly involves the enzymatic components.

Adrenal cortex function in asthmatic patients following the discontinuation of chronic therapy with systemic glucocorticosteroids

OBJECTIVE

To estimate the time it takes for adrenal cortex function in asthmatic patients to return to normal after discontinuation of chronic therapy with systemic glucocorticosteroids (GCs) and to assess the relationship between the duration of the disease, chronic therapy, and the return of the normal adrenal cortex functioning.

MATERIALS AND METHODS

The study involved 58 asthmatic patients and 31 healthy volunteers (aged 20-69 years). Adrenal cortex function was evaluated with the Synacthen short test, and determining serum and urinary free cortisol levels after 1, 3, 6, 12, 18, and 21 months following the discontinuation of systemic therapy with GCs.

RESULTS

A decreased adrenal reserve was observed 1 month after withdrawal of GCs in 50% of the chronically treated patients. Adrenal cortex function returned to normal in 55% of patients within 6 months, in 24% within 12 months, and in 14% within 15 months of discontinuation of systemic GCs administration. A significant positive correlation between the time taken for return to normal adrenal cortex function and duration of the disease and of GCs therapy was found.

CONCLUSIONS

Symptoms of adrenal failure may develop in about 50% of asthmatic patients. In the majority of patients treated long term with systemic GCs, adrenal cortex function returns to normal within 6 months following discontinuation of GCs. The time of such return depends on the duration of the disease and of therapy with systemic GCs.

[The role of hormone replacement therapy in the treatment of women with complicated chronic renal failure]

Patients with chronic renal failure (CRF) show an increased mortality and morbidity from cardiovascular disease. Women with CRF are also at high risk of accelerated bone loss and fracture because of complications such as renal osteodystrophy and many endocrine disturbances leading to premature menopause and estrogen deficiency. Hormone replacement therapy (HRT) has been known to have beneficial effects on various atherosclerotic parameters in population of postmenopausal women and its role in primary prevention of coronary artery disease has been proved in many studies. In general population estrogen replacement therapy has also been used as an effective form of treatment in women suffering from bone loss as well as a form of prevention of osteoporosis. Until now, the role of estrogen replacement therapy in the treatment of complications of end-stage renal disease in female patients has not been fully elucidated and the use of hormone replacement therapy needs to be carefully analysed in each individual case taking into account all risks and benefits.

[Surgical complications of trabeculectomy and methods of their treatment]

The author presents the review of new literature concerning advances in conservative and surgical treatment of the most common postoperative complications after trabeculectomy--the most popular antiglaucoma operation.

[Cardiovascular effects of growth hormone deficiency in adults]

The role of growth hormone (GH) in maintaining normal cardiovascular function and the influence of GH deficiency and GH replacement therapy on cardiovascular risk are presented.

Does the negative correlation found in breast cancer patients between plasma melatonin and insulin-like growth factor-I concentrations imply the existence of an additional mechanism of oncostatic melatonin influence involved in defense?

BACKGROUND

Insulin-like growth factor-I (IGF-I) is probably involved in promoting both normal and neoplastic cell growth, neoplastic transformation processes, angiogenesis, and neoplasma progression. On the other hand, one possible mechanism of the oncostatic action of melatonin is its influence on the action and/or release of the growth factors that stimulate neoplastic cell growth. Quantitative changes in melatonin and IGF-I, as well as an imbalance between melatonin and IGF-I, may affect the growth of breast cancer cells and exacerbate the disease. The aim of our research was to study the interactions between plasma melatonin and IGF-I concentrations in pre-menopausal breast cancer patients.

MATERIAL/METHODS

Our research involved 24 breast cancer patients (mean age 43 +/-6) with stage II breast cancer (Bloom and Richardson classification), confirmed by histological studies, and were 4 weeks after radical mastectomy. The control group consisted of 16 healthy women volunteers (mean age 44 +/- 5).

RESULTS

No statistically significant relations were found between mean plasma melatonin and IGF-I concentrations in the two study groups. In the breast cancer group the correlation coefficient between IGF-I concentration in plasma and melatonin was r = -0.392 (p = 0.058).

CONCLUSIONS

The negative correlation between the plasma melatonin and IGF-I concentrations in the breast cancer patients we studied could reach statistical significance in a larger population. The presence of such a negative correlation between plasma melatonin and IGF-I concentrations in patients with neoplastic disease may imply the existence of an additional defense mechanism based on the oncostatic influence of melatonin.

[Hormones--underestimated problem in dermatology. Part I. Diseases connected with excessive androgenisation]

This article is devoted to hormonal pathogenesis of chosen dermatoses--acne vulgaris and androgenetic alopecia--basis of the latest literature. Authors take note of possible role of many different hormonal factors, not only androgens, in etiology these diseases. The further study of mentioned problems can lead to new clinical and therapeutic implications in dermatology.

[Hormones--underestimated problem in dermatology. Part 2. Autoimmune disease]

This article is devoted to hormonal pathogenesis of chosen autoimmune diseases--systemic lupus erythematosus and systemic sclerosis--basis of the latest literature. Authors take note of possible role of many different hormonal factors, especially estrogens, androgens and prolactin, in etiology of these diseases. The further study of mentioned problems can lead to new clinical and therapeutic implications in dermatology and rheumatology.

Effects of hormone replacement therapy on endocrine and spirometric parameters in asthmatic postmenopausal women

The aim of the study was to see if there are any correlations between changes in the endocrine system and clinical condition of asthmatic patients, in particular their lung function, caused by hormone replacement therapy (HRT). Fifty-five asthmatic and 20 healthy postmenopausal women (aged 48-60) were studied before HRT and after 6 months of cyclical transdermal 17 beta-estradiol and medroxyprogesterone acetate treatment. Serum estradiol, cortisol and dehydroepiandrosterone sulfate (DHEAS) concentrations were assessed with the use of RIA, and spirometry parameters were measured. Statistically significant diminution of asthma exacerbations, reduced consumption of inhaled glucocorticosteroids and improvement in all investigated spirometry parameters was shown in patients treated with glucocorticosteroids during HRT. A reduction in mean 24-hour serum estradiol levels in asthmatic women was noted, whereas cortisol and DHEAS serum concentrations were decreased in asthmatic patients treated with glucocorticosteroids compared with the control group, before HRT. HRT produced increases in the concentrations of estradiol, cortisol and DHEAS in serum. Significant positive correlations were noted between estradiol concentrations and small and medium bronchi tests. In conclusion, HRT in postmenopausal asthmatic women has a favorable influence on the course of asthma, reduces daily use of glucocorticosteroids and frequency of asthma exacerbations and normalizes serum concentrations of estradiol, cortisol and DHEAS, which were decreased before HRT.

[Grave's and Basedow's thyroid associated ophthalmopathy--pathogenesis, symptoms and selected aspects of treatment]

The author presents the review of new literature concerning advances in therapy, especially immunosuppressive, orbital radiotherapy, as well as pathogenesis, epidemiology, symptoms and natural history of thyroid associated Graves' ophthalmopathy.

[Function of the growth hormone axis--insulin-like growth factors--insulin-like growth factor binding proteins in patients with chronic liver diseases]

Up to date have demonstrated that more and more young people are affected by chronic liver diseased. There is a close relationship between the liver and endocrine system as far as hormone inactivation, synthesis of growth factors, proteins binding hormones and proteins binding growth factors in the liver are related. Impairment of the hepatocyte function may lead to disturbed homeostasis of the endocrine system. Current opinions on growth hormone (GH)--insulin-like growth factors (IGFs)--insulin-like growth factors binding proteins (IGFBPs) axis activity in men with chronic liver diseases are presented.

[Growth hormone and its interactions with chosen parameters of hormonal state in pre-menopausal women after mastectomy for breast cancer on adjuvant chemotherapy]

It seems, that quantitative changes of growth hormone (GH) in blood and imbalance between GH and hormones can influence the breast cancer cells proliferation, and can be a favourable element in breast cancer progression. The procedure to normalize hormonal system can have a therapeutic action. The aim of the presented work is to asses the plasma GH levels in 24 pre-menopausal women after mastectomy for breast cancer on adjuvant chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil (CMF). In this study interactions between GH and insulin like growth factor-I, prolactin, estradiol, progesterone (P), melatonin, cortisol and met-enkephalin were assessed. The control group was consisted of 16 healthy women. Plasma GH concentration and interactions between GH and studied parameters in women with breast cancer did not differ from healthy women. Highly significant positive correlation between GH and P after administration CMF was shown. CMF did not influence the interactions between GH and other studied parameters.