1
|
Dziedzic M, Bonczar M, Ostrowski P, Stachera B, Plutecki D, Buziak-Bereza M, Hubalewska-Dydejczyk A, Walocha J, Koziej M. Association between serum TSH concentration and bone mineral density: an umbrella review. Hormones (Athens) 2024:10.1007/s42000-024-00555-w. [PMID: 38581565 DOI: 10.1007/s42000-024-00555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The aim of this study was to summarize the results of previous studies, standardize the data, and present new statistical results in order to provide physicians with clinically significant outcomes regarding the association between serum TSH concentration and bone mineral density (BMD). METHODS To perform this umbrella review, a systematic search was conducted in which major online medical databases, such as PubMed, Web of Science, Embase, Scopus, Cochrane Library, and Google Scholar, were searched for meta-analyses and systematic reviews regarding the effect of TSH on BMD. Furthermore, all primary studies were screened for statistical analysis. RESULTS The statistical outcomes of the present study were based on the data of 75,898 patients. The pooled risk ratio of any kind of fracture in patients with subclinical hyperthyroidism was estimated to be 1.36 (95% CI: 1.18-1.56; p < 0.001). The SMD for BMD in the distal radius in male patients receiving L-thyroxine suppression therapy was estimated to be -0.61 (95% CI: -1.10-(-0.11); p = 0.02). Furthermore, the pooled risk ratio of any fracture in patients receiving L-thyroxine suppression therapy was estimated to be 1.98 (95% CI: 0.98 - 3.98; p = 0.06). In these patients, the BMD may significantly differ from that in non-treated patients. However, the difference depends on the type of bone. CONCLUSIONS Our data confirmed that subclinical hyperthyroidism has a detrimental effect on bones, causing decreased BMD. Based on the obtained results, the authors suggest that a reduced TSH serum level itself may be an individual factor associated with decreased BMD and, thus, with a greater risk of bone fracture. Nevertheless, it should be noted that the effects of TSH suppression therapy differ between areas of interest for assessing BMD. Furthermore, the results have shown that this issue may, in specific areas, concern not only postmenopausal women but also male patients. These conclusions should contribute to a careful consideration of the application of TSH suppressive therapy in all patients. Particular attention should be given to patients after DTC, while all the advantages and disadvantages of implementing L-thyroxine therapy should be individually considered.
Collapse
Affiliation(s)
- Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.
- Youthoria. Youth Research Organization, Kraków, Poland.
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Bartłomiej Stachera
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Dawid Plutecki
- Youthoria. Youth Research Organization, Kraków, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Monika Buziak-Bereza
- Department of Endocrynology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| |
Collapse
|
2
|
Kokoszka J, Opalinska M, Sitarz K, Kolasa M, Szewczyk M, Bugajska J, Berska J, Sztefko K, Hubalewska-Dydejczyk A. 24-hour urine metanephrine excretion in patients diagnosed with adrenal incidentaloma: impact of commonly used drugs on a clinical decision. Pol Arch Intern Med 2024; 134:16646. [PMID: 38164744 DOI: 10.20452/pamw.16646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Incidentaloma is an adrenal tumor detected during diagnostic imaging performed for extra‑adrenal causes. Evaluation of metanephrine concentrations in a 24‑hour urine collection can be a significant challenge in patients with multiple medications and comorbidities. OBJECTIVES The aim of this study was to evaluate the effect of commonly used groups of drugs on metanephrine levels in the 24‑hour urine collection. PATIENTS AND METHODS A total of 1051 patients with adrenal mass below 10 Hounsfield units on unenhanced computed tomography were included in the study. Patients diagnosed with Cushing or Conn syndrome, adrenal carcinoma, pheochromocytoma, active extra‑adrenal malignant neoplasms, and exacerbation of severe illnesses were excluded. Metanephrine, normetanephrine, and 3‑methoxytyramine in the 24‑hour urine collection were measured by high‑performance liquid chromatography with electrochemical detection. Information on concomitant medication (β‑blockers, calcium channel blockers [CCBs], loop diuretics, thiazide diuretics, potassium‑sparing diuretics, α‑blockers, angiotensin‑converting enzyme inhibitors / angiotensin II receptor blockers, metformin, nonmetformin antidiabetic drugs [NMADs], lipid‑lowering drugs, proton pump inhibitors, levothyroxine, thyreostatics, antidepressants, neuroleptics, benzodiazepines, glucocorticosteroids, inhaled B‑receptor agonists, and ipratropium) was collected from each patient. RESULTS The urinary excretion of normetanephrine was significantly higher in the patients on β‑blockers, CCBs, loop diuretics, α‑blockers, NMADs, and neuroleptics. α‑Blockers increased urine metanephrine concentration, and NMADs, antidepressants, and glucocorticosteroids lowered it. There was no association between the analyzed drugs and urinary 3‑methoxytyramine level. CONCLUSIONS Many drug groups interfere with the measurement of urinary fractionated metanephrines. These interactions should be taken into account during interpretation of a hormonal evaluation, as they can be crucial for further management, especially for making a decision on surgical treatment.
Collapse
|
3
|
Bryk-Wiązania AH, Minasyan M, Świątkowska-Stodulska R, Undas A, Hubalewska-Dydejczyk A, Webb SM, Valassi E, Gilis-Januszewska A. The thrombotic risk in Cushing's syndrome-questions, answers, and the algorithm to consider in its assessment: part I-thrombotic risk not related to surgery. Front Endocrinol (Lausanne) 2024; 15:1350010. [PMID: 38529392 PMCID: PMC10961355 DOI: 10.3389/fendo.2024.1350010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Recently, it has been reported that there is a great diversity in strategies used for thromboprophylaxis in patients with Cushing's syndrome (CS). An aim of this review was to discuss these practices in light of the existing data on the thrombotic risk in patients with CS and guidelines for medically ill patients. Methods The four relevant topics and questions on thrombotic risk in CS were identified. The current guidelines on prevention and diagnosis of venous thromboembolism (VTE) were reviewed for the answers. An algorithm to consider in the assessment of the thrombotic risk in patients with CS was proposed. Results To address both generic and CS-specific risk factors for VTE, the algorithm includes the stepwise approach consisting of Padua Score, urine free cortisol, and CS-VTE score, with no indication for routine thrombophilia testing in the prediction of an index VTE episode. Having confirmed VTE, selected patients require thrombophilia testing to aid the duration of anticoagulant treatment. The separate part of the algorithm is devoted to patients with ectopic adrenocorticotropic hormone syndrome in whom exclusion of VTE precedes introducing routine thromboprophylaxis to prevent VTE. The cancer-related VTE also prompts thromboprophylaxis, with the possible vessel invasion. The algorithm presents a unifactorial and multifactorial approach to exclude high-bleeding risks and safely introduce thromboprophylaxis with low-molecular-weight heparin. Summary Our article is the first to present an algorithm to consider in the thrombotic risk assessment among patients with Cushing's syndrome as a starting point for a broader discussion in the environment. A plethora of factors affect the VTE risk in patients with CS, but no studies have conclusively evaluated the best thromboprophylaxis strategy so far. Future studies are needed to set standards of care.
Collapse
Affiliation(s)
- Agata Hanna Bryk-Wiązania
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Mari Minasyan
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Renata Świątkowska-Stodulska
- Department of Endocrinology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anetta Undas
- The John Paul II Hospital, Kraków, Poland
- Department of Thromboembolic Disorders, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Susan M. Webb
- Department of Endocrinology, Hospital S Pau, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Research Center for Pituitary Diseases, Barcelona, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER) Unit 747, Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Valassi
- Centre for Biomedical Network Research on Rare Diseases (CIBERER) Unit 747, Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Endocrinología, Hospital e Institut de Recerca Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| |
Collapse
|
4
|
Bogusławska A, Godlewska M, Hubalewska-Dydejczyk A, Korbonits M, Starzyk J, Gilis-Januszewska A. Tall stature and gigantism in adult patients with acromegaly. Eur J Endocrinol 2024; 190:193-200. [PMID: 38391173 DOI: 10.1093/ejendo/lvae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Increased height in patients with acromegaly could be a manifestation of growth hormone (GH) excess before epiphysis closure. The aim of this study was to evaluate the relationship between the height of adult patients with GH excess related to mid-parental height (MPH) and population mean and to find whether taller patients with acromegaly come from tall families. METHODS This is a single-centre, observational study involving 135 consecutive patients with acromegaly diagnosed as adults and no family history of GH excess. We established three categories for height for patients with acromegaly: normal stature, tall stature (TS, height above the 97th percentile (1.88 standard deviations (SD)) to <3 SD for gender- and country-specific data or as a height which was greater than 1.5 SD but less than 2 SD above the MPH) and gigantism (height which was greater than 3 SD) above the gender- and country-specific mean or greater than 2 SD above MPH). RESULTS Thirteen percent (17/135) of patients (53% females) met the criteria for gigantism, 10% (14/135) fulfilled the criteria for TS (57% females). Parents and adult siblings were not taller than the population mean. CONCLUSION In a group of 135 consecutive adult patients with acromegaly, 23% had increased height based on country-specific and MPH data: 13% presented with gigantism while 10% had TS. The frequency of gigantism and TS in patients diagnosed with GH excess as adults is not higher in males than in females. Patients with acromegaly come from normal-stature families.
Collapse
Affiliation(s)
- Anna Bogusławska
- Department of Endocrinology, Jagiellonian University, Medical College, 31-008 Krakow, Poland
| | - Magdalena Godlewska
- Department of Endocrinology, Jagiellonian University, Medical College, 31-008 Krakow, Poland
| | | | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ London, UK
| | - Jerzy Starzyk
- Department of Paediatric and Adolescence Endocrinology, Paediatric Institute, Jagiellonian University Medical College, 31-000 Krakow, Poland
| | | |
Collapse
|
5
|
Skalniak A, Trofimiuk-Müldner M, Surmiak M, Totoń-Żurańska J, Jabrocka-Hybel A, Hubalewska-Dydejczyk A. Whole-Exome Screening and Analysis of Signaling Pathways in Multiple Endocrine Neoplasia Type 1 Patients with Different Outcomes: Insights into Cellular Mechanisms and Possible Functional Implications. Int J Mol Sci 2024; 25:1065. [PMID: 38256138 PMCID: PMC10816043 DOI: 10.3390/ijms25021065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a syndrome characterized by tumors in multiple organs. Although being a dominantly inherited monogenic disease, disease phenotypes are unpredictable and differ even among members of the same family. There is growing evidence for the role of modifier genes in the alteration of the course of this disease. However, genome-wide screening data are still lacking. In our study, we addressed the different outcomes of the disease, focusing on pituitary and adrenocortical tumors. By means of exome sequencing we identified the affected signaling pathways that segregated with those symptoms. Most significantly, we identified damaging alterations in numerous structural genes responsible for cell adhesion and migration. Additionally, in the case of pituitary tumors, genes related to neuronal function, survival, and morphogenesis were repeatedly identified, while in patients with adrenocortical tumors, TLR10, which is involved in the regulation of the innate immunity, was commonly modified. Our data show that using exome screening, it is possible to find signatures which correlate with the given clinical MEN1 outcomes, providing evidence that studies addressing modifier effects in MEN1 are reasonable.
Collapse
Affiliation(s)
- Anna Skalniak
- Department of Internal Medicine, Jagiellonian University Medical College, 31-066 Krakow, Poland;
| | - Małgorzata Trofimiuk-Müldner
- Department of Endocrinology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (M.T.-M.); (A.J.-H.); (A.H.-D.)
| | - Marcin Surmiak
- Department of Internal Medicine, Jagiellonian University Medical College, 31-066 Krakow, Poland;
| | - Justyna Totoń-Żurańska
- Center for Medical Genomics—OMICRON, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Agata Jabrocka-Hybel
- Department of Endocrinology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (M.T.-M.); (A.J.-H.); (A.H.-D.)
| | - Alicja Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (M.T.-M.); (A.J.-H.); (A.H.-D.)
| |
Collapse
|
6
|
Komisarz-Calik M, Sarba P, Trofimiuk-Müldner M, Sokołowski G, Szpor J, Hubalewska-Dydejczyk A. A challenging case of ectopic ACTH-dependent Cushing's syndrome due to medullary thyroid carcinoma. Endokrynol Pol 2024; 75:115-116. [PMID: 38497400 DOI: 10.5603/ep.96863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 03/19/2024]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
- Maria Komisarz-Calik
- Students' Scientific Group of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Paulina Sarba
- Students' Scientific Group of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | | | - Grzegorz Sokołowski
- Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Szpor
- Department of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland
| | | |
Collapse
|
7
|
Olearska H, Sowa-Staszczak A, Morawiec-Sławek K, Kurzyńska A, Kolasa M, Tkacz E, Szumińska M, Hubalewska-Dydejczyk A, Opalinska M. Prediction of disease recurrence in patients after complete pancreatic NET (PanNET) G2 resection. Endokrynol Pol 2024; 75:102-108. [PMID: 38497396 DOI: 10.5603/ep.98635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The number of detected pancreatic neuroendocrine tumours (PanNETs) has been increasing over the last decades. Surgical resection remains the only potentially curative treatment, but the management is still controversial. This study aimed to compare patients after radical PanNET G2 resection to determine the most important predictive factors for relapse. MATERIAL AND METHODS All patients with histologically confirmed PanNET G2 who underwent successful surgery between 2006 and 2020 with the intention of radical treatment were enrolled. RESULTS In total, 44 patients were eligible for the analysis. The average follow-up was 8.39 ± 4.5 years. Disease recurrence was observed in 16 (36.36%) patients. The dominant location of the primary tumour was the tail of the pancreas (43.18%), especially in the subgroup with disease recurrence (56.25%). The smallest tumour diameter associated with the PanNET G2 recurrence was 22 mm. The relationship between the largest dimension of the tumour with a division of < 4 cm vs. > 4 cm and the relapse was close to statistical significance. Recurrence was associated with a larger tumour size (p = 0.018). There was a statistically significant relationship and a weak correlation between Ki-67 (p = 0.036, V Cramer = 0.371) and disease relapse. CONCLUSION For the group of PanNET G2 patients after radical surgery, the overall risk of recurrence was 36.36%, with the highest rate in the first 5 years after surgery, but in individual cases it occurred significantly later, even 10 years after surgery. The most important predictive factors of the PanNET G2 recurrence was Ki-67 over 5.75% and size of tumour > 4 cm.
Collapse
Affiliation(s)
- Helena Olearska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Anna Kurzyńska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Kolasa
- Department of Endocrinology, Oncological Endocrinology, Nuclear Medicine and Internal Medicine, University Hospital, Krakow, Poland
| | - Edyta Tkacz
- Department of Endocrinology, Oncological Endocrinology, Nuclear Medicine and Internal Medicine, University Hospital, Krakow, Poland
| | - Małgorzata Szumińska
- Department of Endocrinology, Oncological Endocrinology, Nuclear Medicine and Internal Medicine, University Hospital, Krakow, Poland
| | | | - Marta Opalinska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland.
| |
Collapse
|
8
|
Rzepka E, Opalińska M, Przybylik-Mazurek E, Szczepanik A, Gilis-Januszewska A, Hubalewska-Dydejczyk A. A rare case of mesenteric paraganglioma with late-onset metastases possibly accelerated by surgery. Pol Arch Intern Med 2023; 133:16583. [PMID: 37819005 DOI: 10.20452/pamw.16583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Ewelina Rzepka
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland.
| | - Marta Opalińska
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Antoni Szczepanik
- Third Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | | | | |
Collapse
|
9
|
Opalinska M, Lezaic L, Decristoforo C, Kolenc P, Mikolajczak R, Studen A, Simoncic U, Virgolini I, Trofimiuk-Muldner M, Garnuszek P, Rangger C, Fani M, Glowa B, Skorkiewicz K, Hubalewska-Dydejczyk A. Comparison of 99mTc radiolabeled somatostatin antagonist with [ 68 Ga]Ga-DOTA-TATE in a patient with advanced neuroendocrine tumor. Eur J Nucl Med Mol Imaging 2023; 50:4110-4111. [PMID: 37452871 PMCID: PMC10611881 DOI: 10.1007/s00259-023-06335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Marta Opalinska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Luka Lezaic
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Petra Kolenc
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Renata Mikolajczak
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, Otwock, Poland
| | - Andrej Studen
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Urban Simoncic
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Piotr Garnuszek
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, Otwock, Poland
| | - Christine Rangger
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | |
Collapse
|
10
|
Gilis-Januszewska A, Gamrat A, Minasyan M, Bogusławska A, Rzepka E, Hubalewska-Dydejczyk A. Ectopic, CRH-responsive Cushing syndrome with negative 68Ga-DOTATATE and 18F-FDG PET/CT imaging findings and pituitary microadenoma: a challenging case with a successful outcome. Pol Arch Intern Med 2023; 133:16548. [PMID: 37622169 DOI: 10.20452/pamw.16548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
| | - Aleksandra Gamrat
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Mari Minasyan
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Anna Bogusławska
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Ewelina Rzepka
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | |
Collapse
|
11
|
Dziedzic M, Sokołowski G, Hubalewska-Dydejczyk A, Trofimiuk-Müldner M. Eagle's syndrome mimicking thyroid-associated orbitopathy. Endokrynol Pol 2023; 74:536-564. [PMID: 37779377 DOI: 10.5603/ep.96351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 10/03/2023]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
- Martyna Dziedzic
- Students' Scientific Interest Group, Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Sokołowski
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | | | |
Collapse
|
12
|
Minasyan M, Gamrat A, Bryk-Wiązania AH, Hubalewska-Dydejczyk A, Gilis-Januszewska A. Pulmonary embolism after delivery as the first manifestation of Cushing disease in pregnancy. Pol Arch Intern Med 2023; 133:16528. [PMID: 37416938 DOI: 10.20452/pamw.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Mari Minasyan
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Aleksandra Gamrat
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Agata H Bryk-Wiązania
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | | | |
Collapse
|
13
|
Opalińska M, Gilis-Januszewska A, Morawiec-Sławek K, Kurzyńska A, Sowa-Staszczak A, Bogusławska A, Rzepka E, Hubalewska-Dydejczyk A. Differences in clinical characteristics, treatment, and outcomes of sporadic and MEN-1-related insulinomas. Endokrynol Pol 2023:VM/OJS/J/95007. [PMID: 37431872 DOI: 10.5603/ep.a2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/07/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Although in most cases insulinomas are small, benign, sporadic tumours, they can also be associated with hereditary syndromes, most commonly multiple endocrine neoplasia type 1 (MEN-1). Such a diagnosis significantly affects patient management. The objective was to elucidate the clinical differences between sporadic and MEN-1-linked insulinoma. MATERIAL AND METHODS Comparison of clinical and histopathological characteristics, types of surgery, and outcomes of patients with sporadic and MEN-1-related insulinoma diagnosed between 2015 and 2022. RESULTS There were 17 cases of insulinomas that underwent MEN-1 genetic testing (10 women and 7 men). In 7 cases, the mutation in the menin gene was confirmed. The median age at the time of diagnosis of sporadic insulinoma related to MEN-1 was 69 years (range 29-87) and 31.5 years (16-47), respectively. Primary hyperparathyroidism (PHP) was found in 6 of 7 patients with MEN-1-related insulinoma, while in none of the patients without MEN-1 mutations. Multifocal pancreatic NETs were found in 3 patients with MEN-1 syndrome, while in all sporadic cases there was a single pancreatic tumour. Two patients with insulinoma related to MEN-1 had a positive familial history of MEN-1-related diseases, while none with sporadic form. Dissemination at diagnosis was found in 4 cases, including 3 patients with insulinoma related to MEN-1-related insulinoma. Patients with sporadic and MEN-1-related insulinoma did not differ in tumour size, Ki-67 proliferation index, and outcome. CONCLUSIONS Of all the features evaluated, only the multifocal nature of pancreatic neuroendocrine tumour (PanNET) lesions and a positive family history differentiated between patients with sporadic and MEN-1-related insulinomas. An age of insulinoma diagnosis of less than 30 years may be a strong indicator of an increased risk of MEN-1 syndrome.
Collapse
Affiliation(s)
- Marta Opalińska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Anna Kurzyńska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Bogusławska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Ewelina Rzepka
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | |
Collapse
|
14
|
Bogusławska A, Minasyan M, Hubalewska-Dydejczyk A, Gilis-Januszewska A. COVID-19 infection in a patient with Cushing's disease on osilodrostat treatment. Endokrynol Pol 2023; 74:342-343. [PMID: 37335068 DOI: 10.5603/ep.a2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 06/21/2023]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
- Anna Bogusławska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Mari Minasyan
- Endocrinology, Oncological Endocrinology, and Nuclear Medicine Department, University Hospital, Krakow, Poland
| | | | | |
Collapse
|
15
|
Kokoszka J, Rzepka E, Ulatowska-Białas M, Richter P, Richter P, Hubalewska-Dydejczyk A. Difficulties in the diagnosis and treatment of ruptured pheochromocytoma. Endokrynol Pol 2023; 74:211-212. [PMID: 37039495 DOI: 10.5603/ep.a2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 04/12/2023]
Abstract
Not required fo Clinical Vignette.
Collapse
Affiliation(s)
- Joanna Kokoszka
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Cracow, Poland.
| | - Ewelina Rzepka
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | | | | | | | | |
Collapse
|
16
|
Sokołowski G, Motyka M, Gilis-Januszewska A, Stefańska A, Hubalewska-Dydejczyk A. Liquid levothyroxine in the treatment of myxoedema coma. Endokrynol Pol 2023; 74:215-216. [PMID: 37039496 DOI: 10.5603/ep.a2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 04/12/2023]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
- Grzegorz Sokołowski
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Motyka
- Department of Endocrinology, Endocrine Oncology and Nuclear Medicine, University Hospital, Krakow, Poland
| | | | - Agnieszka Stefańska
- Department of Endocrinology, Endocrine Oncology and Nuclear Medicine, University Hospital, Krakow, Poland
| | | |
Collapse
|
17
|
Novak D, Janota B, Hörmann AA, Sawicka A, Kroselj M, Hubalewska-Dydejczyk A, Fani M, Mikolajczak R, Kolenc P, Decristoforo C, Garnuszek P. Development of the 99mTc-Labelled SST2 Antagonist TECANT-1 for a First-in-Man Multicentre Clinical Study. Pharmaceutics 2023; 15:pharmaceutics15030885. [PMID: 36986746 PMCID: PMC10053408 DOI: 10.3390/pharmaceutics15030885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/24/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023] Open
Abstract
Broad availability and cost-effectiveness of 99Mo/99mTc generators worldwide support the use, and thus the development, of novel 99mTc-labelled radiopharmaceuticals. In recent years, preclinical and clinical developments for neuroendocrine neoplasms patient management focused on somatostatin receptor subtype 2 (SST2) antagonists, mainly due to their superiority in SST2-tumour targeting and improved diagnostic sensitivity over agonists. The goal of this work was to provide a reliable method for facile preparation of a 99mTc-labelled SST2 antagonist, [99mTc]Tc-TECANT-1, in a hospital radiopharmacy setting, suitable for a multi-centre clinical trial. To ensure successful and reproducible on-site preparation of the radiopharmaceutical for human use shortly before administration, a freeze-dried three-vial kit was developed. The final composition of the kit was established based on the radiolabelling results obtained during the optimisation process, in which variables such as precursor content, pH and buffer, as well as kit formulations, were tested. Finally, the prepared GMP-grade batches met all predefined specification parameters together with long-term kit stability and stability of the product [99mTc]Tc-TECANT-1. Furthermore, the selected precursor content complies with micro-dosing, based on an extended single-dose toxicity study, where histopathology NOEL was established at 0.5 mg/kg BW, being more than 1000 times higher than the planned human dose of 20 µg. In conclusion, [99mTc]Tc-TECANT-1 is suitable to be advanced into a first-in-human clinical trial.
Collapse
Affiliation(s)
- Doroteja Novak
- The Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Barbara Janota
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| | - Anton Amadeus Hörmann
- Department of Nuclear Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Agnieszka Sawicka
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| | - Marko Kroselj
- Department of Nuclear Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- The Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Melpomeni Fani
- Division of Radiopharmaceutical Chemistry, University Hospital Basel, 4031 Basel, Switzerland
| | - Renata Mikolajczak
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| | - Petra Kolenc
- The Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-80951
| | - Piotr Garnuszek
- Radioisotope Centre POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| |
Collapse
|
18
|
Skalniak A, Trofimiuk-Müldner M, Jabrocka-Hybel A, Totoń-Żurańska J, Wołkow P, Hubalewska-Dydejczyk A. Whole-exome sequencing as a tool for searching for genetic background modifiers in MEN1 patients with neuroendocrine pancreatic tumours, including insulinomas. Endokrynol Pol 2023; 74:31-46. [PMID: 36847722 DOI: 10.5603/ep.a2023.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Multiple endocrine neoplasia type 1 (MEN1) is a monogenic disease caused by inactivating variants in the MEN1 gene. Although the reason for its development is well-known, disease phenotypes are unpredictable and differ even among carriers of the same pathogenic driver mutation. Genetic, epigenetic, and environmental factors may play a role in driving the individual phenotype. Those factors, however, still mostly remain unidentified. In our work, we focused on the inherited genetic background in pancreatic neuroendocrine neoplasms (pNENs) in MEN1 patients, and the pancreatic tumour subgroup with insulinoma. MATERIAL AND METHODS Whole exome sequencing was performed in MEN1 patients. The symptoms of interest were pancreatic neuroendocrine tumours in one analysis and insulinoma in the second. The study included families as well as unrelated cases. Genes with variants that are not neutral to the encoded gene product were defined in symptom-positive patients as compared to symptom-negative controls. The interpretation of the results was based on functional annotations and pathways shared between all patients with the given symptom in the course of MEN1. RESULTS Whole-exome screening of family members and unrelated patients with and without pNENs revealed a number of pathways that are common for all the analysed cases with pNENs. Those included pathways crucial for morphogenesis and development, proper insulin signalling, and structural cellular organization. An additional analysis of insulinoma pNEN patients revealed additional pathways engaged in glucose and lipid homeostasis, and several non-canonical insulin-regulating mechanisms. CONCLUSIONS Our results show the existence of pathways that are identified in a non-literature-predefined manner, which might have a modifying function in MEN1, differentiating the specific clinical outcomes. Those results, although preliminary, provide evidence of the reasonableness of performing large-scale studies addressing the genetic background of MEN1 patients in determining their individual outcomes.
Collapse
Affiliation(s)
- Anna Skalniak
- Chair and Department of Endocrinology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
| | - Małgorzata Trofimiuk-Müldner
- Chair and Department of Endocrinology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agata Jabrocka-Hybel
- Chair and Department of Endocrinology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Justyna Totoń-Żurańska
- Center for Medical Genomics - OMICRON, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Wołkow
- Center for Medical Genomics - OMICRON, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
19
|
Minasyan M, Bryk-Wiązania AH, Rzepka E, Sowa-Staszczak A, Hubalewska-Dydejczyk A, Gilis-Januszewska A. Saddle pulmonary embolism as a fatal complication of Cushing syndrome: a call for standardized anticoagulation regimen in hypercortisolism. Pol Arch Intern Med 2023; 133. [PMID: 36468760 DOI: 10.20452/pamw.16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mari Minasyan
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Agata H Bryk-Wiązania
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Ewelina Rzepka
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Sowa-Staszczak
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | | | |
Collapse
|
20
|
Kamińska M, Sokołowski G, Mitka K, Walczak-Bogatek A, Buziak-Bereza M, Pach D, Pityński K, Michałowska-Kaczmarczyk A, Hubalewska-Dydejczyk A. A patient with advanced breast cancer and hyperthyroidism associated with struma ovarii. Endokrynol Pol 2023; 74:115-116. [PMID: 36704978 DOI: 10.5603/ep.a2023.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 01/28/2023]
Abstract
Not required for Clical Vignettes.
Collapse
Affiliation(s)
| | - Grzegorz Sokołowski
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland.
| | - Kamila Mitka
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Agata Walczak-Bogatek
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Buziak-Bereza
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Pach
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Kazimierz Pityński
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Kraków, Poland
| | | | | |
Collapse
|
21
|
Trofimiuk-Müldner M, Domagała B, Sokołowski G, Skalniak A, Hubalewska-Dydejczyk A. AIP gene germline variants in adult Polish patients with apparently sporadic pituitary macroadenomas. Front Endocrinol (Lausanne) 2023; 14:1098367. [PMID: 36843582 PMCID: PMC9950257 DOI: 10.3389/fendo.2023.1098367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Up to 5% of all pituitary tumors are hereditary e.g. due to MEN1 or aryl hydrocarbon receptor-interacting protein (AIP) genes mutations. OBJECTIVES The study was aimed at the assessment of the frequency and characteristics of AIP-mutation related tumors in patients with apparently sporadic pituitary macroadenomas in the Polish population. MATERIALS AND METHODS The study included 131 patients (57 males, 74 females; median age 42 years) diagnosed with pituitary macroadenomas, and with a negative family history of familial isolated pituitary adenoma (FIPA) or multiple endocrine neoplasia type 1 (MEN1) syndromes. Sanger sequencing was used for the assessment of AIP gene variants. The study was approved by the Ethics Board of JUMC. RESULTS AIP variants were identified in five of the 131 included subjects (3.8%): one diagnosed with Cushing's disease, two with acromegaly, and two with non-secreting adenomas. Patients harboring hereditary AIP gene alterations did not differ from the rest of the study group in median age at diagnosis (41.0 vs. 42.5 years, P=0.8), median largest tumor diameter (25 vs. 24 mm, P=0.6), gender distribution (60.0% vs. 56.3% females, P=0.8), secreting tumor frequency (60.0% vs. 67.5%, P=0.7), or acromegaly diagnosis frequency (40.0% vs.37.3%, P=0.9). CONCLUSIONS In our series of apparently sporadic pituitary macroadenomas, AIP gene variant carriers did not differ substantially from patients with negative genetic testing. A risk factor-centred approach to AIP genetic screening may result in missing germline variants. Considering the clinical impact of such genetic variants and their relatively low penetrance, it is, however, doubtful if general genetic screening benefits the whole cohort of pituitary macroadenoma patients and their families.
Collapse
Affiliation(s)
- Małgorzata Trofimiuk-Müldner
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
- *Correspondence: Małgorzata Trofimiuk-Müldner,
| | - Bartosz Domagała
- Department of Endocrinology, Endocrine Oncology and Nuclear Medicine, University Hospital in Kraków, Kraków, Poland
| | - Grzegorz Sokołowski
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Skalniak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | |
Collapse
|
22
|
Bednarczuk T, Kajdaniuk D, Marek B, Bolanowski M, Dedecjus M, Gilis-Januszewska A, Hubalewska-Dydejczyk A, Jarząb B, Junik R, Kamiński G, Kos-Kudła B, Kowalska A, Lewiński A, Matyjaszek-Matuszek B, Ruchała M, Siemińska L, Sworczak K, Syrenicz A, Zgliczyński W. Basics of prevention and management of iodine-based contrast media-induced thyroid dysfunction - position paper by the Polish Society of Endocrinology. Endokrynol Pol 2023; 74:1-4. [PMID: 36847719 DOI: 10.5603/ep.a2023.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
Medical practice involves a high number of radiological examinations using iodinated contrast media (ICM). Therefore, it is crucial for doctors of different specialties to be aware of possible adverse effects associated with ICM use. The most common and well characterized adverse effect is contrast-induced nephropathy, whereas thyroidal adverse reactions remain a diagnostic and therapeutic dilemma. ICM-induced thyroid dysfunction represents a highly heterogenous group of thyroid disorders. Due to supraphysiological iodine concentration, ICM can induce both hyper- and hypothyroidism. In most cases, the ICM-induced thyroid dysfunction is oligo- or asymptomatic, mild, and transient. In rare cases, however, the ICM-induced thyroid dysfunction may be severe and life threatening. Recently, the European Thyroid Association (ETA) Guidelines for the Management of Iodine-Based Contrast Media-Induced Thyroid Dysfunction were published. The authors advise an individualized approach to prevention and treatment of ICM-induced thyroid dysfunction, based on patient's age, clinical symptoms, pre-existing thyroid diseases, coexisting morbidities, and iodine intake. There is a geographic variation of ICM-induced thyroid dysfunction prevalence, which is linked to iodine intake. The prevalence of ICM-induced hyperthyroidism, which may pose a serious therapeutic challenge, is greater in countries with iodine deficiency. Poland is a region with a history of iodine deficiency, contributing to an increased prevalence of nodular thyroid disease, especially in the elderly. Therefore, the Polish Society of Endocrinology has proposed national, simplified principles of ICM-induced thyroid dysfunction prevention and treatment.
Collapse
Affiliation(s)
- Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Kajdaniuk
- Chair of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.
| | - Bogdan Marek
- Chair of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marek Bolanowski
- Chair and Department of Endocrinology, Diabetes, and Isotope Therapy, Medical University of Wroclaw, Wroclaw, Poland
| | - Marek Dedecjus
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | - Barbara Jarząb
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Beata Kos-Kudła
- Chair of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Aldona Kowalska
- Department of Endocrinology, Holycross Cancer Centre, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Beata Matyjaszek-Matuszek
- Chair and Department of Endocrinology, Diabetology and Metabolic Diseases, Medical University of Lublin, Lublin, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Medical University in Poznan, Poznan, Poland
| | - Lucyna Siemińska
- Chair of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Sworczak
- Chair and Department of Endocrinology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
23
|
Kluczyński Ł, Morawiec-Sławek K, Pantofliński J, Opalińska M, Sowa-Staszczak A, Grochowska A, Gilis-Januszewska A, Hubalewska-Dydejczyk A. Pituitary stalk metastasis of a neuroendocrine tumour of unknown origin. Endokrynol Pol 2022; 73:992-993. [PMID: 36519655 DOI: 10.5603/ep.a2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 12/16/2022]
Abstract
Not required for Clinical Vignettes.
Collapse
Affiliation(s)
- Łukasz Kluczyński
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Jacek Pantofliński
- Endocrinology, Oncological Endocrinology and Nuclear Medicine Department, University Hospital, Krakow, Poland
| | - Marta Opalińska
- Endocrinology, Oncological Endocrinology and Nuclear Medicine Department, University Hospital, Krakow, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Grochowska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | | |
Collapse
|
24
|
Trofimiuk-Muldner M, Domagala B, Koziara M, Skalniak A, Hubalewska-Dydejczyk A. PSAT384 Familial Non-Medullary Thyroid Cancer — Does The Number Of Alanine Residues In The FOXE1 Gene Play A Role? J Endocr Soc 2022. [PMCID: PMC9629159 DOI: 10.1210/jendso/bvac150.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Familial non-medullary thyroid cancer (FNMTC) constitutes about 3–9% of all thyroid cancers. One of the genes believed to predispose to non-syndromic FNMTC is FOXE1. It contains a polyalanine tract (polyAla) with a variable number (11–22) of alanine residues. This length polymorphism could lead to changes in the FOXE1-encoded protein (FOXE1 transcription factor) structure and predispose to papillary thyroid cancer (PTC). The aim of the study was to investigate the relationship between the length of the polyAla tract and the stage of PTC at diagnosis (according to AJCC 8th edition) in patients with FNMTC. The study included 27 patients (from twenty families) with familial PTC (at least two family members were diagnosed with the disease). The length of the polyAla tract of the FOXE1 gene was analyzed. The following numbers of polyAla variants were detected: 11-Ala – 2, 12-Ala – 1, 14-Ala – 23, 16-Ala – 28 alleles. The staging at diagnosis was compared in two groups: less than 16-Ala and at least 16-Ala. The stages of pT1a and pT1a (m) were found in 20 alleles in the less than 16-Ala group, whereas in 16 alleles of the at least 16-Ala group, pT1b-pT2(m) was the most common (p = 0.039). Lymph node metastases were found more frequently in the less than 16-Ala group than in the at least 16-Ala group but this difference was not statistically significant (10 vs. 3 respectively; p = 0.680). Conclusions The analysis of the length of the polyAla tract may be a useful diagnostic tool in predicting the course of PTC in patients with a positive family history. The research was funded by the Jagiellonian University Medical College grant No N41/DBS/000087. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
Collapse
|
25
|
Ruchała M, Bossowski A, Brzozka MM, Gietka-Czernel M, Hubalewska-Dydejczyk A, Kos-Kudła B, Lewiński A, Syrenicz A, Zgliczyński W. Liquid levothyroxine improves thyroid control in patients with different hypothyroidism aetiology and variable adherence - case series and review. Endokrynol Pol 2022; 73:893-902. [PMID: 36621916 DOI: 10.5603/ep.a2022.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/07/2022]
Abstract
It is estimated that hypothyroidism treatment may be either suboptimal or excessive in about 32-45% patients treated with L-thyroxine (LT4). There are multiple possible causes of poor control of hypothyroidism, including narrow LT4 therapeutic index, food and drug interactions, comorbidities, and patient non-adherence. Some of these obstacles could possibly be overcome with the novel liquid LT4 formulation. Liquid LT4 reaches maximum blood concentration about 30 minutes faster than the tablet form. Faster pharmacokinetics might lead to more efficient LT4 absorption, as suggested by a recent real-world study in patients with primary and central hypothyroidism. Liquid LT4 treatment led to increased free thyroxine (FT4) and sex hormone binding globulin (SHBG) with decreased low-density lipoprotein (LDL) cholesterol concentration and substantially improved quality of life for the patients. Herein we present a series of 31 patients with hypothyroidism of different aetiologies treated with the novel liquid LT4 formulation in standard clinical care in light of the latest scientific publications on liquid LT4 formula. We observed normalization of thyroid function tests shortly after introduction of liquid LT4, irrespective of concurrent diseases or concomitant medications that could diminish LT4 absorption. In more detail, the treatment with liquid LT4 managed to normalize thyroid-stimulating hormone (TSH) concentrations in patients without any known causes of LT4 absorption disturbances, as well as in those with malabsorption: with gastric bypass, partial small and large intestine resection, scleroderma, gluten intolerance, celiac disease, atrophic gastritis, and polytherapy. In conclusion, considering many factors disturbing LT4 absorption, hypothyroidism therapy with liquid LT4 seems to be a particularly effective option.
Collapse
Affiliation(s)
- Marek Ruchała
- Department of Endocrinology, Metabolism, and Internal Medicine, University of Medical Sciences, Poznań, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | | | | | | | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Disorders, Medical University of Łódź, Polish Mother's Memorial Hospital - Research Institute, Łódź, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Pomeranian Medical University, Szczecin, Poland
| | - Wojcech Zgliczyński
- Department of Endocrinology, Medical Centre of Postgraduate Education, Warsaw, Poland
| |
Collapse
|
26
|
Krajewska J, Chmielik E, Dedecjus M, Jarząb B, Hubalewska-Dydejczyk A, Karbownik-Lewińska M, Kos-Kudła B, Lewiński A, Ruchała M. Diagnosis and treatment of thyroid cancer in adult patients — Recommendations of Polish Scientific Societies and the National Oncological Strategy. Update of the 2022 Update [Diagnostyka i leczenie raka tarczycy u chorych dorosłych — Rekomendacje Polskich Towarzystw Naukowych oraz Narodowej Strategii Onkologicznej. Aktualizacja na rok 2022 — uzupełnienie]. Endokrynol Pol 2022; 73:799-802. [PMID: 37067538 DOI: 10.5603/ep.a2022.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022]
|
27
|
Bogusławska A, Rzepka E, Opalińska M, Sowa-Staszczak A, Gilis-Januszewska A, Hubalewska-Dydejczyk A. A rare case of metastatic pheochromocytoma in the course of neurofibromatosis type 1. Pol Arch Intern Med 2022; 132. [PMID: 35785935 DOI: 10.20452/pamw.16291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Anna Bogusławska
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Ewelina Rzepka
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Marta Opalińska
- Endocrinology, Oncologic Endocrinology and Nuclear Medicine Department, University Hospital, Kraków, Poland
| | - Anna Sowa-Staszczak
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | | | |
Collapse
|
28
|
Rydzewska G, Strzelczyk J, Bednarczuk T, Bolanowski M, Borowska M, Chmielik E, Ćwikła JB, Foltyn W, Gisterek I, Handkiewicz-Junak D, Hubalewska-Dydejczyk A, Janas K, Jarząb M, Junik R, Kajdaniuk D, Kamiński G, Kolasińska-Ćwikła A, Kołos M, Kowalska A, Królicki L, Kunikowska J, Kuśnierz K, Lewiński A, Liszka Ł, Londzin-Olesik M, Marek B, Malczewska A, Nasierowska-Guttmejer A, Nowakowska-Duława E, Pavel ME, Pilch-Kowalczyk J, Reguła J, Rosiek V, Ruchała M, Siemińska L, Sowa-Staszczak A, Starzyńska T, Stojčev Z, Studniarek M, Syrenicz A, Szczepkowski M, Wachuła E, Zajęcki W, Zemczak A, Zgliczyński W, Zieniewicz K, Kos-Kudła B. Gastroduodenal neuroendocrine neoplasms including gastrinoma - update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne żołądka i dwunastnicy z uwzględnieniem gastrinoma - uaktualnione zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)]. Endokrynol Pol 2022; 73:455-490. [PMID: 36059172 DOI: 10.5603/ep.a2022.0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022]
Abstract
After another meeting of experts of the Polish Network of Neuroendocrine Tumours, updated recommendations for the management of patients with gastric and duodenal neuroendocrine neoplasms, including gastrinoma, have been issued. As before, the epidemiology, pathogenesis and clinical symptoms of these neoplasms have been discussed, as well as the principles of diagnostic procedures, including biochemical and histopathological diagnostics and tumour localisation, highlighting the changes introduced in the recommendations. Updated principles of therapeutic management have also been presented, including endoscopic and surgical treatment, and the options of pharmacological and radioisotope treatment. The importance of monitoring patients with gastric and duodenal NENs, including gastrinoma, has also been emphasised.
Collapse
Affiliation(s)
- Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Janusz Strzelczyk
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Bolanowski
- Chair and Department of Endocrinology, Diabetes, and Isotope Therapy, Medical University of Wroclaw, Wroclaw, Poland
| | - Małgorzata Borowska
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jarosław B Ćwikła
- Department of Cardiology and Internal Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Wanda Foltyn
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.
| | - Iwona Gisterek
- Chair of Oncology and Radiotherapy, Medical University of Silesia, Katowice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Brench, Gliwice, Poland
| | | | - Ksenia Janas
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Michał Jarząb
- Breast Unit, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Dariusz Kajdaniuk
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Kolasińska-Ćwikła
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | | | - Aldona Kowalska
- Department of Endocrinology, Holycross Cancer Centre, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kuśnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Łukasz Liszka
- Department of Pathomorphology and Molecular Diagnostics, Medical University of Silesia, Katowice, Poland
| | - Magdalena Londzin-Olesik
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Bogdan Marek
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Malczewska
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | | | - Ewa Nowakowska-Duława
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Marianne E Pavel
- Department of Medicine 1, Endocrinology and Diabetology, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Joanna Pilch-Kowalczyk
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Jarosław Reguła
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | - Violetta Rosiek
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Medical University in Poznan, Poznan, Poland
| | - Lucyna Siemińska
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Medical Pomeranian University in Szczecin, Szczecin, Poland
| | - Zoran Stojčev
- Department of Oncology and Breast Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Studniarek
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Marek Szczepkowski
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Wachuła
- Department of Clinical Oncology, Gdynia Oncology Centre of the Polish Red Cross Maritime Hospital, Gdynia, Poland
| | - Wojciech Zajęcki
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Anna Zemczak
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Chair and Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
29
|
Bednarczuk T, Zemczak A, Bolanowski M, Borowska M, Chmielik E, Ćwikła JB, Foltyn W, Gisterek I, Handkiewicz-Junak D, Hubalewska-Dydejczyk A, Jarząb M, Junik R, Kajdaniuk D, Kamiński G, Kolasińska-Ćwikła A, Kopacz-Wróbel K, Kowalska A, Królicki L, Kunikowska J, Kuśnierz K, Lewiński A, Liszka Ł, Londzin-Olesik M, Marek B, Malczewska A, Nasierowska-Guttmejer A, Nowakowska-Duława E, Pavel ME, Pilch-Kowalczyk J, Reguła J, Rosiek V, Ruchała M, Rydzewska G, Siemińska L, Sowa-Staszczak A, Starzyńska T, Stojčev Z, Strzelczyk J, Studniarek M, Syrenicz A, Szczepkowski M, Wachuła E, Zajęcki W, Zgliczyński W, Zieniewicz K, Kos-Kudła B. Neuroendocrine neoplasms of the small intestine and the appendix - update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego - uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)]. Endokrynol Pol 2022; 73:549-583. [PMID: 36059174 DOI: 10.5603/ep.a2022.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
Updated Polish recommendations for the management of patients with neuroendocrine neoplasms (NENs) of the small intestine (SINENs) and of the appendix (ANENs) are presented here. The small intestine, and especially the ileum, is one of the most common locations for these neoplasms. Most of them are well-differentiated and slow-growing tumours; uncommonly - neuroendocrine carcinomas. Their symptoms may be untypical and their diagnosis may be delayed or accidental. Najczęściej pierwszą manifestacją ANEN jest jego ostre zapalenie. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of SINENs patients with distant metastases. In laboratory diagnostics the assessment of 5-hydroxyindoleacetic acid concentration is helpful in the diagnosis of carcinoid syndrome. The most commonly used imaging methods are ultrasound examination, computed tomography, magnetic resonance imaging, colonoscopy and somatostatin receptor imaging. Histopathological examination is crucial for the proper diagnosis and treatment of patients with SINENs and ANENs. The treatment of choice is a surgical procedure, either radical or palliative. Long-acting somatostatin analogues (SSAs) are essential in the medical treatment of functional and non-functional SINENs. In patients with SINENs, at the stage dissemination with progression during SSAs treatment, with high expression of somatostatin receptors, radioisotope therapy should be considered first followed by targeted therapies - everolimus. After the exhaustion of the above available therapies, chemotherapy may be considered in selected cases. Recommendations for patient monitoring are also presented.
Collapse
Affiliation(s)
- Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Zemczak
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marek Bolanowski
- Chair and Department of Endocrinology, Diabetes, and Isotope Therapy, Medical University of Wroclaw, Wroclaw, Poland
| | - Małgorzata Borowska
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jarosław B Ćwikła
- Department of Cardiology and Internal Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Wanda Foltyn
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.
| | - Iwona Gisterek
- Chair of Oncology and Radiotherapy, Medical University of Silesia, Katowice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Brench, Gliwice, Poland
| | | | - Michał Jarząb
- Breast Unit, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Dariusz Kajdaniuk
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Kolasińska-Ćwikła
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | - Karolina Kopacz-Wróbel
- Department od Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Aldona Kowalska
- Department of Endocrinology, Holycross Cancer Centre, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kuśnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Łukasz Liszka
- Department of Pathomorphology and Molecular Diagnostics, Medical University of Silesia, Katowice, Poland
| | - Magdalena Londzin-Olesik
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Bogdan Marek
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Malczewska
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | | | - Ewa Nowakowska-Duława
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Marianne E Pavel
- Department of Medicine 1, Endocrinology and Diabetology, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Joanna Pilch-Kowalczyk
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Jarosław Reguła
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | - Violetta Rosiek
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Medical University in Poznan, Poznan, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Lucyna Siemińska
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Medical Pomeranian University in Szczecin, Szczecin, Poland
| | - Zoran Stojčev
- Department of Oncology and Breast Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Janusz Strzelczyk
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Michał Studniarek
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Marek Szczepkowski
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Wachuła
- Department of Clinical Oncology, Gdynia Oncology Centre of the Polish Red Cross Maritime Hospital, Gdynia, Poland
| | - Wojciech Zajęcki
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Chair and Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
30
|
Kos-Kudła B, Rosiek V, Borowska M, Bednarczuk T, Bolanowski M, Chmielik E, Ćwikła JB, Foltyn W, Gisterek I, Handkiewicz-Junak D, Hubalewska-Dydejczyk A, Jarząb M, Junik R, Kajdaniuk D, Kamiński G, Kolasińska-Ćwikła A, Kowalska A, Królicki L, Kunikowska J, Kuśnierz K, Lewiński A, Liszka Ł, Londzin-Olesik M, Marek B, Malczewska A, Nasierowska-Guttmejer A, Nowakowska-Duława E, Pavel ME, Pilch-Kowalczyk J, Reguła J, Ruchała M, Rydzewska G, Siemińska L, Sowa-Staszczak A, Starzyńska T, Stojčev Z, Strzelczyk J, Studniarek M, Syrenicz A, Szczepkowski M, Wachuła E, Zajęcki W, Zemczak A, Zgliczyński W, Zieniewicz K. Pancreatic neuroendocrine neoplasms - update of the diagnostic and therapeutic guidelines (recommended by the Polish Network of Neuroendocrine Tumours) [Nowotwory neuroendokrynne trzustki - uaktualnione zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)]. Endokrynol Pol 2022; 73:491-548. [PMID: 36059173 DOI: 10.5603/ep.a2022.0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
In this paper, we present the current guidelines for the diagnostics and management of pancreatic neuroendocrine neoplasms (PanNENs) developed by Polish experts providing care for these patients in everyday clinical practice. In oncological diagnostics, in addition to biochemical tests, molecular identification with the use of NETest liquid biopsy and circulating microRNAs is gaining importance. Both anatomical and functional examinations (including new radiopharmaceuticals) are used in imaging diagnostics. Histopathological diagnosis along with immunohistochemical examination still constitute the basis for therapeutic decisions. Whenever possible, surgical procedure is the treatment of choice. Pharmacological management including biotherapy, radioisotope therapy, targeted molecular therapy and chemotherapy are important methods of systemic therapy. Treatment of PanNENs requires a multidisciplinary team of specialists in the field of neuroendocrine neoplasms.
Collapse
Affiliation(s)
- Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Violetta Rosiek
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Borowska
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Bolanowski
- Chair and Department of Endocrinology, Diabetes, and Isotope Therapy, Medical University of Wroclaw, Wroclaw, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jarosław B Ćwikła
- Department of Cardiology and Internal Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Wanda Foltyn
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.
| | - Iwona Gisterek
- Chair of Oncology and Radiotherapy, Medical University of Silesia, Katowice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Brench, Gliwice, Poland
| | | | - Michał Jarząb
- Breast Unit, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Dariusz Kajdaniuk
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Kolasińska-Ćwikła
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | - Aldona Kowalska
- Department of Endocrinology, Holycross Cancer Centre, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kuśnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Łukasz Liszka
- Department of Pathomorphology and Molecular Diagnostics, Medical University of Silesia, Katowice, Poland
| | - Magdalena Londzin-Olesik
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Bogdan Marek
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Malczewska
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | | | - Ewa Nowakowska-Duława
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Marianne E Pavel
- Department of Medicine 1, Endocrinology and Diabetology, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Joanna Pilch-Kowalczyk
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Jarosław Reguła
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Medical University in Poznan, Poznan, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Lucyna Siemińska
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Medical Pomeranian University in Szczecin, Szczecin, Poland
| | - Zoran Stojčev
- Department of Oncology and Breast Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Janusz Strzelczyk
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Michał Studniarek
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Marek Szczepkowski
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Wachuła
- Department of Clinical Oncology, Gdynia Oncology Centre of the Polish Red Cross Maritime Hospital, Gdynia, Poland
| | - Wojciech Zajęcki
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Anna Zemczak
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Chair and Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
31
|
Kos-Kudła B, Foltyn W, Malczewska A, Bednarczuk T, Bolanowski M, Borowska M, Chmielik E, Ćwikła JB, Gisterek I, Handkiewicz-Junak D, Hubalewska-Dydejczyk A, Jarząb B, Jarząb M, Junik R, Kajdaniuk D, Kamiński G, Kolasińska-Ćwikła A, Kowalska A, Królicki L, Krzakowski M, Kunikowska J, Kuśnierz K, Lewiński A, Liszka Ł, Londzin-Olesik M, Marek B, Nasierowska-Guttmejer A, Nowakowska-Duława E, Pavel ME, Pilch-Kowalczyk J, Reguła J, Rosiek V, Ruchała M, Rydzewska G, Siemińska L, Sowa-Staszczak A, Starzyńska T, Stojčev Z, Strzelczyk J, Studniarek M, Syrenicz A, Szczepkowski M, Wachuła E, Zajęcki W, Zemczak A, Zgliczyński W, Zieniewicz K. Update of the diagnostic and therapeutic guidelines for gastro-entero-pancreatic neuroendocrine neoplasms (recommended by the Polish Network of Neuroendocrine Tumours) [Aktualizacja zaleceń ogólnych dotyczących postępowania diagnostyczno-terapeutycznego w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)]. Endokrynol Pol 2022; 73:387-454. [PMID: 36059171 DOI: 10.5603/ep.a2022.0049] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
Continuous progress in the diagnostics and treatment of neuroendocrine neoplasms (NENs), the emerging results of new clinical trials, and the new guidelines issued by medical societies have prompted experts from the Polish Network of Neuroendocrine Tumours to update the 2017 recommendations regarding the management of neuroendocrine neoplasms. This article presents the general recommendations for the management of NENs, resulting from the findings of the experts participating in the Fourth Round Table Conference, entitled "Polish Guidelines for the Diagnostics and Treatment of Neuroendocrine Neoplasms of the gastrointestinal tract, Żelechów, June 2021". Drawing from the extensive experience of centres treating these cancers, we hope that we have managed to formulate the optimal method of treating patients with NENs, applying the latest reports and achievements in the field of medicine, which can be effectively implemented in our country. The respective parts of this work present the approach to the management of: NENs of the stomach and duodenum (including gastrinoma), pancreas, small intestine, and appendix, as well as large intestine.
Collapse
Affiliation(s)
- Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Wanda Foltyn
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland.
| | - Anna Malczewska
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Bolanowski
- Chair and Department of Endocrinology, Diabetes, and Isotope Therapy, Medical University of Wroclaw, Wroclaw, Poland
| | - Małgorzata Borowska
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jarosław B Ćwikła
- Department of Cardiology and Internal Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Iwona Gisterek
- Chair of Oncology and Radiotherapy, Medical University of Silesia, Katowice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Brench, Gliwice, Poland
| | | | - Barbara Jarząb
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Brench, Gliwice, Poland
| | - Michał Jarząb
- Breast Unit, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Roman Junik
- Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Dariusz Kajdaniuk
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Agnieszka Kolasińska-Ćwikła
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | - Aldona Kowalska
- Department of Endocrinology, Holycross Cancer Centre, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumours, Maria Sklodowska-Curie Memorial, National Research Institute of Oncology, Warsaw, Poland
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kuśnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Łukasz Liszka
- Department of Pathomorphology and Molecular Diagnostics, Medical University of Silesia, Katowice, Poland
| | - Magdalena Londzin-Olesik
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Bogdan Marek
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | | | - Ewa Nowakowska-Duława
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Marianne E Pavel
- Department of Medicine 1, Endocrinology and Diabetology, Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Joanna Pilch-Kowalczyk
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Jarosław Reguła
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Warsaw, Poland
| | - Violetta Rosiek
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Medical University in Poznan, Poznan, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Lucyna Siemińska
- Division of Pathophysiology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Teresa Starzyńska
- Department of Gastroenterology, Medical Pomeranian University in Szczecin, Szczecin, Poland
| | - Zoran Stojčev
- Department of Oncology and Breast Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Janusz Strzelczyk
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Michał Studniarek
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Marek Szczepkowski
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Ewa Wachuła
- Department of Clinical Oncology, Gdynia Oncology Centre of the Polish Red Cross Maritime Hospital, Gdynia, Poland
| | - Wojciech Zajęcki
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - Anna Zemczak
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Chair and Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
32
|
Zawadzka K, Wilczyńska M, Sokołowski G, Hubalewska-Dydejczyk A, Trofimiuk-Müldner M. Adrenal crisis prompted by SARS-CoV-2 infection in a patient with autoimmune polyglandular syndrome type 1 (APS type 1). Endokrynol Pol 2022; 73:786-787. [PMID: 35971934 DOI: 10.5603/ep.a2022.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 06/15/2023]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
- Karolina Zawadzka
- Students' Scientific Group of Endocrinology at the Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Maja Wilczyńska
- Students' Scientific Group of Endocrinology at the Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Sokołowski
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | | |
Collapse
|
33
|
Jagiełło-Korzeniowska A, Bałdys-Waligórska A, Hubalewska-Dydejczyk A, Romanowska-Dixon B. Functional and Morphological Changes in the Visual Pathway in Patients with Graves’ Orbitopathy. J Clin Med 2022; 11:jcm11144095. [PMID: 35887859 PMCID: PMC9318671 DOI: 10.3390/jcm11144095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The aim of the study was to perform a functional and structural evaluation of the anterior visual pathway in patients with Graves’ Orbitopathy (GO) using electrophysiological tests and OCT, as well as to identify potential parameters that could be useful in detecting early optic nerve damage. Methods: 47 GO patients were enrolled in the study and divided into three groups, depending on their disease severity: Group 1 with mild GO, Group 2 with moderate-to-severe GO, and Group 3 with dysthyroid optic neuropathy (DON). Pattern visual evoked potential (PVEP), flash visual evoked potential (fVEP), pattern electroretinogram (pERG), and optical coherence tomography (OCT) findings were compared between the groups. Results: In the DON Group (Group 3), N75, P100, and P2 latencies were significantly extended, whereas P100, P50, and N95 amplitudes were significantly reduced as compared to the non-DON group (Groups 1 and 2). Group 3 also had significantly thinner peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC). In Group 2, as compared to Group 1, P100 amplitudes were significantly reduced for all check sizes, while P100 latency was elongated for the check size of 0.9°. Group 2 also had a significantly thinner average GCC and GCC in the superior quadrant. Conclusions: Electrophysiological examinations may be of use in diagnosis of DON. OCT findings and electrophysiological responses vary in patients with different GO severity. Including regular electrophysiological evaluation and OCT in the examination of patients with GO could be of benefit. However, more research is needed to establish the true significance of pVEP, fVEP, pERG, and OCT in monitoring patients with GO.
Collapse
Affiliation(s)
- Agnieszka Jagiełło-Korzeniowska
- Department of Ophthalmology and Ocular Oncology, Jagiellonian University Medical College, 31-501 Kraków, Poland;
- Correspondence:
| | - Agata Bałdys-Waligórska
- Department of Endocrinology and Internal Medicine, Faculty of Health Science and Medicine, Andrzej Frycz Modrzewski Krakow University, 30-705 Kraków, Poland;
- Department of Endocrinology, Jagiellonian University Medical College, 30-688 Kraków, Poland;
| | | | - Bożena Romanowska-Dixon
- Department of Ophthalmology and Ocular Oncology, Jagiellonian University Medical College, 31-501 Kraków, Poland;
| |
Collapse
|
34
|
Kurzyńska A, Skalniak A, Franson K, Bistika V, Hubalewska-Dydejczyk A, Przybylik-Mazurek E. Molecular analysis and genotype-phenotype correlations in patients with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency from southern Poland - experience of a clinical center. Hormones (Athens) 2022; 21:241-249. [PMID: 35079965 PMCID: PMC9130175 DOI: 10.1007/s42000-022-00348-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The prevalence of CYP21A2 gene variants and genotype-phenotype correlations are variable among populations. The aim of this study was to characterize CYP21A2 gene variants in adult patients with classical congenital adrenal hyperplasia (CCAH) from southern Poland and to analyze genotype-phenotype correlations. MATERIALS/METHODS A total of 48 patients (30 women and 18 men) with CCAH were included in the study. Patients were divided into two clinical subgroups, namely, salt-wasting (SW) - 38 patients and simple virilizing (SV) - 10 patients. A genetic analysis MLPA (multiplex ligation-dependent probe amplification) was performed in all of them. In dubious cases, the analysis was complemented by Sanger sequencing. Genotypes were classified into five groups (depending on the residual in vitro enzymatic activity), namely, null, A, B, C, and D, and correlated with the clinical picture. RESULTS Molecular defects were investigated and identified in 48 patients. The most common variant in the studied group was I2G, followed by whole or partial gene copy deletion, and I172N. One novel variant c.[878G>T] (p.Gly293Val) was found. In nine patients, a non-concordance between genotype and phenotype was observed. Genotype-phenotype correlations measured by positive predictive value (PPV) were as follows: 100% in group null, 90.5% in group A, and 66.7% in group B. CONCLUSIONS CYP21A2 variants in the studied cohort were similar to values previously reported in other countries of the region. There was a good correlation between genotype and phenotype in the null and A groups, the correlation being considerably lower in group B.
Collapse
Affiliation(s)
- Anna Kurzyńska
- Clinical Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skalniak
- Clinical Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Viola Bistika
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | |
Collapse
|
35
|
Jarząb B, Dedecjus M, Lewiński A, Adamczewski Z, Bakuła-Zalewska E, Bałdys-Waligórska A, Barczyński M, Biskup-Frużyńska M, Bobek-Billewicz B, Bossowski A, Buziak-Bereza M, Chmielik E, Czarniecka A, Czepczyński R, Ćwikła J, Dobruch-Sobczak K, Dzięcioł J, Gawlik A, Gawrychowski J, Handkiewicz-Junak D, Harasymczuk J, Hubalewska-Dydejczyk A, Januszkiewicz-Caulier J, Jarząb M, Kaczka K, Kalemba M, Kamiński G, Karbownik-Lewińska M, Kawecki A, Kluczewska-Gałka A, Kolasińska-Ćwikła A, Kołton M, Konturek A, Kos-Kudła B, Kotecka-Blicharz A, Kowalska A, Krajewska J, Kram A, Królicki L, Kukulska A, Kusiński M, Kuzdak K, Lange D, Ledwon A, Małecka-Tendera E, Mańkowski P, Migda B, Niedziela M, Oczko-Wojciechowska M, Polnik D, Pomorski L, Ruchała M, Samborski K, Skowrońska-Szcześniak A, Stanek-Widera A, Stobiecka E, Stojčev Z, Suchorzepka-Simek M, Syrenicz A, Szczepanek-Parulska E, Trofimiuk-Müldner M, Tysarowski A, Wygoda A, Zajkowska K, Zembala-Nożyńska E, Żyłka A. Diagnosis and treatment of thyroid cancer in adult patients - Recommendations of Polish Scientific Societies and the National Oncological Strategy. 2022 Update [Diagnostyka i leczenie raka tarczycy u chorych dorosłych - Rekomendacje Polskich Towarzystw Naukowych oraz Narodowej Strategii Onkologicznej. Aktualizacja na rok 2022]. Endokrynol Pol 2022; 73:173-300. [PMID: 35593680 DOI: 10.5603/ep.a2022.0028] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
Abstract
The guidelines Thyroid Cancer 2022 are prepared based on previous Polish recommendations updated in 2018. They consider international guidelines - American Thyroid Association (ATA) 2015 and National Comprehensive Cancer Network (NCCN); however, they are adapted according to the ADAPTE process. The strength of the recommendations and the quality of the scientific evidence are assessed according to the GRADE system and the ATA 2015 and NCCN recommendations. The core of the changes made in the Polish recommendations is the inclusion of international guidelines and the results of those scientific studies that have already proven themselves prospectively. These extensions allow de-escalation of the therapeutic management in low-risk thyroid carcinoma, i.e., enabling active surveillance in papillary microcarcinoma to be chosen alternatively to minimally invasive techniques after agreeing on such management with the patient. Further extensions allow the use of thyroid lobectomy with the isthmus (hemithyroidectomy) in low-risk cancer up to 2 cm in diameter, modification of the indications for postoperative radioiodine treatment toward personalized approach, and clarification of the criteria used during postoperative L-thyroxine treatment. At the same time, the criteria for the preoperative differential diagnosis of nodular goiter in terms of ultrasonography and fine-needle aspiration biopsy have been clarified, and the rules for the histopathological examination of postoperative thyroid material have been updated. New, updated rules for monitoring patients after treatment are also presented. The updated recommendations focus on ensuring the best possible quality of life after thyroid cancer treatment while maintaining the good efficacy of this treatment.
Collapse
Affiliation(s)
- Barbara Jarząb
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Marek Dedecjus
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland.,Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | | | - Elwira Bakuła-Zalewska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland, Poland
| | - Agata Bałdys-Waligórska
- Andrzej Frycz Modrzewski Krakow University, Faculty of Medicine and Health Sciences, Department of Endocrinology and Internal Medicine, Poland
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Biskup-Frużyńska
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | - Barbara Bobek-Billewicz
- Radiology and Diagnostic Imaging Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Artur Bossowski
- Department of Paediatrics, Endocrinology, and Diabetology with a Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - Monika Buziak-Bereza
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Cracow, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Rafał Czepczyński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Jarosław Ćwikła
- Department of Cardiology and Internal Medicine; School of Medicine, University of Warmia and Mazury Olsztyn, Poland
| | - Katarzyna Dobruch-Sobczak
- Department of Radiology II, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland, Warsaw, Poland
| | - Janusz Dzięcioł
- Department of Human Anatomy, Medical University of Bialystok, Poland
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jacek Gawrychowski
- Department of General and Endocrine Surgery, Medical University of Silesia, Katowice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jerzy Harasymczuk
- Department of Pediatric Surgery, Traumatology & Urology, Karol Marcinkowski University of Medical Sciences in Poznan, Karol Jonscher Teaching Hospital, Poland
| | | | - Joanna Januszkiewicz-Caulier
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michał Jarząb
- Breast Cancer Unit, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | - Krzysztof Kaczka
- Department of General and Oncological Surgery, Chair of Surgical Clinical Sciences, Medical University, Lodz, Lodz, Poland
| | - Michał Kalemba
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Karbownik-Lewińska
- Chair and Department of Oncological Endocrinology, Medical University of Lodz, Lodz, Poland.,Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Andrzej Kawecki
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aneta Kluczewska-Gałka
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Kolasińska-Ćwikła
- Department of Oncology and Radiotherapy, Maria Skłodowska‑Curie National Research Institute of Oncology, Warsaw, Poland
| | - Magdalena Kołton
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Aleksander Konturek
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Kotecka-Blicharz
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Aldona Kowalska
- Collegium Medicum Jan Kochanowski University Kielce, Poland, Poland.,Endocrinology Clinic, Holycross Cancer Center, Kielce, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Andrzej Kram
- Pathology Department, West Pomeranian Oncology Center, Szczecin, Poland
| | - Leszek Królicki
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Kukulska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Michał Kusiński
- Department of Endocrine, General and Vascular Surgery, Medical University of Lodz, Poland
| | - Krzysztof Kuzdak
- Department of Endocrine, General and Vascular Surgery, Medical University of Lodz, Poland
| | - Dariusz Lange
- University of Technology, Faculty of Medicine, Katowice, Poland
| | - Aleksandra Ledwon
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Ewa Małecka-Tendera
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Przemysław Mańkowski
- Department of Pediatric Surgery, Traumatology & Urology, Karol Marcinkowski University of Medical Sciences in Poznan, Karol Jonscher Teaching Hospital, Poland
| | - Bartosz Migda
- Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical Faculty, Medical University of Warsaw, Poland
| | - Marek Niedziela
- Department of Oncology and Breast Diseases, CMKP, Warsaw, Poland
| | - Małgorzata Oczko-Wojciechowska
- Department of Genetic and Molecular Diagnostics of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | - Dariusz Polnik
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Lech Pomorski
- Department of General and Oncological Surgery, Chair of Surgical Clinical Sciences, Medical University, Lodz, Lodz, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Konrad Samborski
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | | | | | - Ewa Stobiecka
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | - Zoran Stojčev
- Department of Oncology and Breast Diseases, CMKP, Warsaw, Poland
| | - Magdalena Suchorzepka-Simek
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Andrzej Tysarowski
- Cancer Molecular and Genetic Diagnostics Department, Maria Sklodowska‑Curie - National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Wygoda
- Radiation and Clinical Oncology Department, Maria Sklodowska‑Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Klaudia Zajkowska
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ewa Zembala-Nożyńska
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | - Agnieszka Żyłka
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| |
Collapse
|
36
|
Längericht J, Mitka KI, Hubalewska-Dydejczyk A, Krämer I, Kahaly GJ. Drug safety in thyroid eye disease - a systematic review. Expert Opin Drug Saf 2022; 21:881-912. [PMID: 35447047 DOI: 10.1080/14740338.2022.2069239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The autoimmune-induced thyroid eye disease (TED) is a frequent extrathyroidal manifestation of Graves' disease and less frequently of Hashimoto's thyroiditis. Pathognomonic clinical signs, i.e. exophthalmos, double vision, and inflammation of the orbital tissue cause physical, ophthalmic, and socio-psychological limitations. AREAS COVERED PubMed and MeSH database were searched for specific guidelines, randomized controlled trials, prospective clinical studies, systematic reviews and meta-analyses pertaining to the safety profile of currently administered immunosuppressive agents for the treatment of TED. Occurred adverse events (AE), severe AE (SAE), side effects (SE), and severe SE (SSE) were classified according to the standardized medical dictionary for regulatory activities (MedDRA). EXPERT OPINION This novel systematic analysis offers an overview of potential AE, SAE and SE for currently recommended immunosuppressive drugs for the treatment of TED. Non-specific, anti-inflammatory drugs and more specific, targeted biologicals are treatment options for active and severe TED. Critical evaluation of the pertinent literature confirms an evidence-based, beneficial efficacy/risk ratio of the current first-line and second-line treatment recommendations endorsed by the European Society of Endocrinology. However, further large, well-conceived trials are mandatory to enhance our knowledge and experience with novel specific small molecules and/or monoclonal antibodies targeting the key autoantigens in TED.
Collapse
Affiliation(s)
- Jan Längericht
- Department of Medicine I., Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Kamila I Mitka
- Department of Medicine I., Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany.,Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | | | - Irene Krämer
- Department of Pharmacy, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - George J Kahaly
- Department of Medicine I., Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| |
Collapse
|
37
|
Bogusławska A, Gilis-Januszewska A, Godlewska M, Nowak A, Starzyk J, Hubalewska-Dydejczyk A. Gender and age differences among patients with acromegaly. Pol Arch Intern Med 2022; 132. [DOI: 10.20452/pamw.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
38
|
Møllehave LT, Eliasen MH, Strēle I, Linneberg A, Moreno-Reyes R, Ivanova LB, Kusić Z, Erlund I, Ittermann T, Nagy EV, Gunnarsdottir I, Arbelle JE, Troen AM, Pīrāgs V, Dahl L, Hubalewska-Dydejczyk A, Trofimiuk-Müldner M, de Castro JJ, Marcelino M, Gaberšček S, Zaltel K, Puig-Domingo M, Vila L, Manousou S, Nyström HF, Zimmermann MB, Mullan KR, Woodside JV, Völzke H, Thuesen BH. Register-based information on thyroid diseases in Europe: lessons and results from the EUthyroid collaboration. Endocr Connect 2022; 11:e210525. [PMID: 35044931 PMCID: PMC8942317 DOI: 10.1530/ec-21-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Registers of diagnoses and treatments exist in different forms in the European countries and are potential sources to answer important research questions. Prevalence and incidence of thyroid diseases are highly dependent on iodine intake and, thus, iodine deficiency disease prevention programs. We aimed to collect European register data on thyroid outcomes to compare the rates between countries/regions with different iodine status and prevention programs. DESIGN Register-based cross-sectional study. METHODS National register data on thyroid diagnoses and treatments were requested from 23 European countries/regions. The provided data were critically assessed for suitability for comparison between countries/regions. Sex- and age-standardized rates were calculated. RESULTS Register data on ≥1 thyroid diagnoses or treatments were available from 22 countries/regions. After critical assessment, data on medication, surgery, and cancer were found suitable for comparison between 9, 10, and 13 countries/regions, respectively. Higher rates of antithyroid medication and thyroid surgery for benign disease and lower rates of thyroid hormone therapy were found for countries with iodine insufficiency before approx. 2001, and no relationship was observed with recent iodine intake or prevention programs. CONCLUSIONS The collation of register data on thyroid outcomes from European countries is impeded by a high degree of heterogeneity in the availability and quality of data between countries. Nevertheless, a relationship between historic iodine intake and rates of treatments for hyper- and hypothyroid disorders is indicated. This study illustrates both the challenges and the potential for the application of register data of thyroid outcomes across Europe.
Collapse
Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Correspondence should be addressed to L T Møllehave:
| | - Marie Holm Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Ieva Strēle
- The Institute of Occupational Safety and Environmental Health, Riga Stradiņš University, Riga, Latvia
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo Moreno-Reyes
- Nuclear Medicine Department, Erasme Hospital, Brussels, Belgium
- Université Libre de Bruxelles, Bruxelles, Belgium
| | - Ludmila B Ivanova
- Faculty of Medicine, Sofia University St. Kl. Ohridski, Sofia, Bulgaria
| | - Zvonko Kusić
- Croatian Academy of Sciences and Arts, Zagreb, Croatia
- School of Medicine, Zagreb, Croatia
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ingibjorg Gunnarsdottir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
- Department of Clinical Nutrition, Landspitali-National University Hospital, Reykjavik, Iceland
| | - Jonathan Eli Arbelle
- Division of Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
- Goldman School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Aaron Milton Troen
- The Institute of Biochemistry Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Valdis Pīrāgs
- Internal Medicine, University of Latvia, Riga, Latvia
| | - Lisbeth Dahl
- Seafood, Nutrition and Environmental State, Institute of Marine Research (IMR), Bergen, Norway
| | | | | | | | | | - Simona Gaberšček
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Zaltel
- Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manuel Puig-Domingo
- Department of Endocrinology and Nutrition, Germans Trias Research Institute and Hospital, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluis Vila
- Endocrinology and Nutrition Service, Hospital Moisés Broggi, Sant Juan Despi, Barcelona, Spain
| | - Sofia Manousou
- Sahlgrenska Academy, Institute of Medicine, Gothenburg, Sweden
- Frölunda Specialist Hospital, Västra Frölunda, Sweden
| | - Helena Filipsson Nyström
- Department of Endocrinology, Specialist Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre of Molecular and Translational Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Karen R Mullan
- Regional Centre for Endocrinology and Diabetes, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Betina Heinsbæk Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| |
Collapse
|
39
|
Wilczyńska M, Suchmiel M, Sokołowski G, Hubalewska-Dydejczyk A, Trofimiuk-Müldner M. Disseminated medullary thyroid cancer - an alternative therapeutic approach. Endokrynol Pol 2022; 73:909-910. [PMID: 35971935 DOI: 10.5603/ep.a2022.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 04/18/2023]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
- Maja Wilczyńska
- Students' Scientific Group of Endocrinology at the Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Suchmiel
- Students' Scientific Group of Endocrinology at the Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Sokołowski
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | | |
Collapse
|
40
|
Hubalewska-Dydejczyk A, Gietka-Czernel M, Trofimiuk-Müldner M, Zgliczyński W, Ruchała M, Lewiński A, Bednarczuk T, Syrenicz A, Kos-Kudła B, Jarząb B, Szczepanek-Parulska E, Krajewska J, Andrysiak-Mamos E, Zygmunt A, Karbownik-Lewińska M. Thyroid diseases and fertility disorders - Guidelines of the Polish Society of Endocrinology [Choroby tarczycy a zaburzenia płodności - rekomendacje Polskiego Towarzystwa Endokrynologicznego]. Endokrynol Pol 2022; 73:645-679. [PMID: 36059162 DOI: 10.5603/ep.a2022.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Thyroid hormones influence female fertility, directly stimulating oocyte maturation and regulating prolactin and sex hormone binding globulin (SHBG) concentrations. Hyperthyroidism affects 1-2%, overt hypothyroidism 0.3%, and subclinical hypothyroidism up to 15% of women of childbearing age. Approximately 10% of euthyroid women have elevated concentrations of anti-thyroid peroxidase antibodies (aTPO) and/or anti-thyroglobulin (aTg) antibodies. Hypothyroidism can cause menstrual and ovulation disorders, and impact fertility. Studies carried out to date have not conclusively demonstrated that subclinical hypothyroidism or elevated aTPO/aTg concentrations make it harder to conceive, but they do increase the risk of pregnancy loss. Subclinical hypothyroidism and elevated aTPO/aTg concentrations without thyroid disorders are more common in polycystic ovary syndrome, premature ovarian insufficiency, and idiopathic infertility. Fertility problems are therefore an indication for screening for thyroid diseases (in females as well as in some males). A thyroid disorder diagnosed in subfertile couples should be treated appropriately, especially before attempting assisted reproductive techniques. These recommendations are intended as a guide for the management of thyroid diseases associated with infertility.
Collapse
Affiliation(s)
| | | | | | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marek Ruchała
- Chair and Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Beata Kos-Kudła
- Division of Endocrinology and Neuroendocrine Tumours, Chair of Pathophysiology and Endocrinology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Barbara Jarząb
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Ewelina Szczepanek-Parulska
- Chair and Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Elżbieta Andrysiak-Mamos
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Arkadiusz Zygmunt
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Karbownik-Lewińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
- Department of Oncological Endocrinology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
41
|
Minasyan M, Bryk-Wiązania A, Hubalewska-Dydejczyk A, Gilis-Januszewska A. [Pulmonary embolism as the first manifestation of Cushing syndrome in a young woman]. Endokrynol Pol 2022; 73:990-991. [PMID: 36621924 DOI: 10.5603/ep.a2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 12/31/2022]
Abstract
Not required for Clinical Vignettes.
Collapse
Affiliation(s)
- Mari Minasyan
- Clinical Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Agata Bryk-Wiązania
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | | |
Collapse
|
42
|
Gilis-Januszewska A, Bogusławska A, Rzepka E, Ziaja W, Hubalewska-Dydejczyk A. Individualized medical treatment options in Cushing disease. Front Endocrinol (Lausanne) 2022; 13:1060884. [PMID: 36531477 PMCID: PMC9755355 DOI: 10.3389/fendo.2022.1060884] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Cushing disease (CD) is caused by a pituitary tumor which oversecretes adrenocorticotropic hormone (ACTH). It is a serious endocrine disease associated with increased mortality and impaired quality of life. The management of CD remains challenging. Although transsphenoidal surgery is the treatment of choice in most cases, in approximately half of CD patients, second or third-line treatment options are needed. Currently, new medical therapies are available which target adrenal steroidogenesis, pituitary somatostatin and dopamine receptors, and glucocorticoid receptors. Selection of which medication to use should be individualized and is determined by many factors including severity of the disease, possible side effects, patients preferences and local availability. The aim of this article is to describe currently available medical therapy to help clinicians individualize the treatment options in the context of recently updated Pituitary Society recommendations.
Collapse
|
43
|
Rzepka E, Kokoszka J, Grochowska A, Ulatowska-Białas M, Lech M, Opalińska M, Przybylik-Mazurek E, Gilis-Januszewska A, Hubalewska-Dydejczyk A. Adrenal bleeding due to pheochromocytoma - A call for algorithm. Front Endocrinol (Lausanne) 2022; 13:908967. [PMID: 35992110 PMCID: PMC9389316 DOI: 10.3389/fendo.2022.908967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adrenal hemorrhage is a rare, usually life-threating complication. The most common neoplasm resulting in spontaneous adrenal bleeding is pheochromocytoma and it accounts for nearly 50% of cases. Currently, the recommendations for the diagnosis and management of patients with adrenal bleeding due to pheochromocytoma are unavailable. MATERIALS AND METHODS We performed a database search for all pheochromocytoma patients, diagnosed and treated from 2005 to 2021 in tertiary endocrinology center. 206 patients were identified, 183 with complete data were included in the analysis. We investigated clinicopathological characteristics, treatment and outcomes of hemorrhagic pheochromocytoma cases and characterize our approach to perioperative diagnosis and medical management. Finally our experiences and data from previously published articles concerning adrenal hemorrhage were analyzed to propose a diagnostic and therapeutic algorithm for hemorrhagic pheochromocytomas. RESULTS In the whole group, seven patients (4 men and 3 women) with adrenal bleeding were found, (3.8%). Median patient's age was 49 years (range: 36-78 years). The most common manifestation of adrenal bleeding was acute abdominal pain (5/7). Two patients developed shock. Hormonal assessment was performed in five patients, based on 24-hour urinary fractionated metanephrines with urinary 3-methoxytyramine. Normetanephrine was elevated in all patients, metanephrine and 3-methoxytyramine - in four cases (4/5). Most patients (6/7) had symptoms suggesting pheochromocytoma before hemorrhage - most commonly paroxysmal hypertension (4/7). One patient died, before the diagnosis of adrenal bleeding was made. Diagnostic imaging performed in six out of seven patients revealed adrenal tumor, with median largest diameter equal to 7.4 cm (range: 5-11 cm). Five patients had elective surgery, in one case an urgent surgery was performed. In all cases the diagnosis of pheochromocytoma was confirmed in postoperative histopathology or in autopsy. The perioperative survival rate was 85.7%. CONCLUSIONS Diagnosis of pheochromocytoma should be always considered in patients with adrenal bleeding, especially with accompanying abdominal pain, hemodynamic shock and previous history of pheochromocytoma-associated symptoms. Lack of proper diagnosis of pheochromocytoma before surgery is associated with an additional perioperative risk. To improve the decision making in this life-threatening clinical situation, based on our results and literature data, we proposed a diagnostic and treatment algorithm.
Collapse
Affiliation(s)
- Ewelina Rzepka
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Kokoszka
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Cracow, Poland
| | - Anna Grochowska
- Department of Radiology, University Hospital, Cracow, Poland
| | | | - Martyna Lech
- Department of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland
| | - Marta Opalińska
- Nuclear Medicine Unit, Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Cracow, Poland
| | | | - Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
- *Correspondence: Aleksandra Gilis-Januszewska,
| | | |
Collapse
|
44
|
Opalińska M, Morawiec-Sławek K, Kania-Kuc A, Al Maraih I, Sowa-Staszczak A, Hubalewska-Dydejczyk A. Potential value of pre- and post-therapy [68Ga]Ga-DOTA-TATE PET/CT in the prognosis of response to PRRT in disseminated neuroendocrine tumors. Front Endocrinol (Lausanne) 2022; 13:929391. [PMID: 36046793 PMCID: PMC9420847 DOI: 10.3389/fendo.2022.929391] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peptide receptor radionuclide therapy (PRRT) is one of the most effective therapeutic options for the treatment of metastatic, well-differentiated neuroendocrine tumors (NETs). It improves progressive disease-free survival and enables the control of hormone secretion in functioning tumors.Currently, there are no clearly established predictors of response to PRRT. The main factors hindering such a prediction are the heterogeneity of somatostatin receptor expression within and between lesions, lack of standardized parameters for functional imaging, and the use of different PRRT protocols.The main goal of our study was to quantify SUVmax changes in [68Ga]Ga-DOTA-TATE PET/CT scans as a potential predictor of long-term response to PRRT. MATERIAL AND METHODS Out of 20 patients treated with PRRT using [177Lu]Lu and/or [177Lu]Lu/[90Y]Y-DOTA-TATE in 2017-2019 due to dissemination of neuroendocrine neoplasm, 12 patients underwent [68Ga]Ga-DOTA-TATE PET/CT on average 3.1 months before and 4.5 months after PRRT and were eligible for the analysis.In total, 76 NET lesions were evaluated. We measured SUVmax for every lesion in both PET/CT scans (before and after PRRT). Those values were corrected by liver SUVmax and liver SUVmean measured in volumetric analysis and specified as SUVlmax and SUVlmean. As a next step, changes in SUVlmax and SUVlmean were assessed based on both PET/CT scans. Finally, results were correlated with the clinical outcome assessed as progressive disease, disease stabilization, or partial response. RESULTS The mean follow-up period was 19.9 months. Progressive disease, partial response, and disease stabilization were found in five, two, and five patients, respectively. Among patients with a partial response, the decrease in mean SUVlmax was 66.3% when compared to baseline. In patients with stable disease, the decrease in SUVlmax was 30.3% when compared to baseline. In patients with progressive disease, the mean increase in SUVlmax was 9.1% when compared to baseline. The changes in SUVlmean were -69,8%, -30.8%, and -3.7%, respectively. CONCLUSIONS A decrease in the SUVmax value in NET lesions, corrected by normal liver tissue uptake assessed in [68Ga]Ga-DOTA-TATE PET/CT scans, indicates a lower risk for NET progressive disease within 20 months after PRRT and may constitute an additional and independent parameter for the estimation of overall risk for disease progression.
Collapse
Affiliation(s)
- Marta Opalińska
- Nuclear Medicine Unit, Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | | | - Adrian Kania-Kuc
- Nuclear Medicine Unit, Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | - Ibraheem Al Maraih
- Nuclear Medicine Unit, Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- *Correspondence: Anna Sowa-Staszczak,
| | | |
Collapse
|
45
|
Hubalewska-Dydejczyk A, Trofimiuk-Müldner M, Ruchala M, Lewiński A, Bednarczuk T, Zgliczyński W, Syrenicz A, Kos-Kudla B, Jarząb B, Gietka-Czernel M, Szczepanek-Parulska E, Krajewska J, Andrysiak-Mamos E, Zygmunt A, Karbownik-Lewińska M. Thyroid diseases in pregnancy: guidelines of the Polish Society of Endocrinology [Choroby tarczycy w ciąży: zalecenia postępowania Polskiego Towarzystwa Endokrynologicznego]. Endokrynol Pol 2021; 72:425-488. [PMID: 34855189 DOI: 10.5603/ep.a2021.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022]
Abstract
Appropriate care of pregnant women with coexisting thyroid dysfunction is still a subject of much controversy. In recent years, there has been a dynamic increase in the number of scientific reports on the diagnosis and treatment of thyroid diseases in women planning pregnancy, pregnant women, and women in the postpartum period. These mainly concern the management of hypothyroidism, autoimmune thyroid diseases, and fertility disorders. Therefore, the Polish Society of Endocrinology deemed it necessary to update the guidelines on principles of diagnostic and therapeutic management in this group of patients, previously published in 2011. The recommendations were prepared by Polish experts according to evidence based medicine principles, if such data were available.
Collapse
Affiliation(s)
| | | | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Lewiński
- Chair and Department of Oncological Endocrinology, Medical University of Lodz, Lodz, Poland, Lodz, Poland
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic Diseases and Internal Diseases, Pomeranian Medical University, Poland
| | - Beata Kos-Kudla
- Department of Endocrinology and Neuroendocrine Tumours, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Barbara Jarząb
- Nuclear Medicine and Endocrine Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | | | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Jolanta Krajewska
- Nuclear Medicine and Endocrine Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Elzbieta Andrysiak-Mamos
- Department of Endocrinology, Metabolic Diseases and Internal Diseases, Pomeranian Medical University, Poland
| | - Arkadiusz Zygmunt
- Department of Oncological Endocrinology, Medical University of Lodz, Lodz, Poland
| | | |
Collapse
|
46
|
Sowa-Staszczak A, Opalińska M, Kurzyńska A, Morawiec-Sławek K, Gilis-Januszewska A, Palen-Tytko J, Olearska H, Hubalewska-Dydejczyk A. Self-Administration of Long-Acting Somatostatin Analogues in NET Patients—Does It Affect the Clinical Outcome? Medicina (B Aires) 2021; 57:medicina57121287. [PMID: 34946232 PMCID: PMC8708475 DOI: 10.3390/medicina57121287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives: Long-acting somatostatin analogues (SSA) (octreotide LAR and lanreotide Autogel) are recommended as first line treatment of locally advanced or metastatic well-differentiated neuroendocrine tumors (NETs) with a good expression of somatostatin receptor (SSTR). Both of these SSAs are usually administered via injections repeated every 4 weeks. The purpose of the study was to compare the route of SSA administration (injection performed by professional medical staff and self-administration of the drug) with progression-free survival. Materials and methods: 88 patients in 2019 and 96 patients in 2020 with locally advanced or metastatic well-differentiated NETs were included in the study. All patients had a good expression of SSTR type 2 and had been treated for at least 3 months with a stable dose of long-acting somatostatin analogue every 4 weeks. All of them had received training on drug self-injections from professional NET nurses at the beginning of the COVID-19 epidemic. Results: The rate of NET progression in the study group in 2020 was higher than in 2019 29.1% vs. 18.1% (28 vs. 16 cases), p = 0.081. Conclusions: The method of administration of long-acting SSA injection performed by professional medical staff vs. self-injection of the drug may significantly affect the risk of NET progression. The unequivocal confirmation of such a relationship requires further observation.
Collapse
Affiliation(s)
- Anna Sowa-Staszczak
- Department of Endocrinology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (A.S.-S.); (A.K.); (K.M.-S.); (A.G.-J.); (H.O.); (A.H.-D.)
| | - Marta Opalińska
- Nuclear Medicine Unit, Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, ul. Jakubowskiego 2, 30-688 Kraków, Poland
- Correspondence: ; Tel.: +48-12-400-14-66
| | - Anna Kurzyńska
- Department of Endocrinology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (A.S.-S.); (A.K.); (K.M.-S.); (A.G.-J.); (H.O.); (A.H.-D.)
| | - Karolina Morawiec-Sławek
- Department of Endocrinology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (A.S.-S.); (A.K.); (K.M.-S.); (A.G.-J.); (H.O.); (A.H.-D.)
| | - Aleksandra Gilis-Januszewska
- Department of Endocrinology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (A.S.-S.); (A.K.); (K.M.-S.); (A.G.-J.); (H.O.); (A.H.-D.)
| | - Joanna Palen-Tytko
- Department of Endocrinology, Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, 30-688 Kraków, Poland;
| | - Helena Olearska
- Department of Endocrinology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (A.S.-S.); (A.K.); (K.M.-S.); (A.G.-J.); (H.O.); (A.H.-D.)
| | - Alicja Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University Medical College, 31-008 Kraków, Poland; (A.S.-S.); (A.K.); (K.M.-S.); (A.G.-J.); (H.O.); (A.H.-D.)
| |
Collapse
|
47
|
Opalińska M, Sowa-Staszczak A, Grochowska A, Olearska H, Hubalewska-Dydejczyk A. Value of Peptide Receptor Radionuclide Therapy as Neoadjuvant Treatment in the Management of Primary Inoperable Neuroendocrine Tumors. Front Oncol 2021; 11:687925. [PMID: 34868906 PMCID: PMC8633407 DOI: 10.3389/fonc.2021.687925] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/21/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Neuroendocrine neoplasms including neuroendocrine tumors (NETs) are often diagnosed as primary disseminated or inoperable. In those cases, systemic extensive therapy is necessary, but radical treatment is unlikely. As described in the literature, in some selected cases, peptide receptor radionuclide therapy (PRRT) may be used as a first-line/neoadjuvant therapy that allows further successful surgery. Such treatment may enable a reduction of total tumor burden or allow a radical treatment which improves the final outcomes. AIM This study aims to assess whether neoadjuvant PRRT could be a treatment option for patients with initially unresectable NETs. METHODS Among the group of 114 patients treated with PRRT between the years 2005 and 2020, in 32 cases, it was the first-line therapy, mainly due to massive disease burden at the time of diagnosis. Among them, nine patients received PRRT as the first-line treatment due to the primary inoperable tumors with the intention of preoperative reduction of the tumor size in order to allow for a surgical treatment. RESULTS Neoadjuvant PRRT enabled surgery in four out of nine (45%) patients. Finally, in two out of four cases, the goal (radical surgery) has been achieved. CONCLUSION PRRT may be considered not only as a palliative but also as a neoadjuvant therapy in advanced, somatostatin-positive NETs that were initially inoperable.
Collapse
Affiliation(s)
- Marta Opalińska
- Nuclear Medicine Unit, Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Grochowska
- Department of Radiology, University Hospital, Kraków, Poland
| | - Helena Olearska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | | |
Collapse
|
48
|
Bolanowski M, Hubalewska-Dydejczyk A, Kos-Kudła B, Ruchała M, Witek P, Zgliczyński W, Houchard A, Bartmańska M. Quality of life in patients with acromegaly receiving lanreotide autogel: a real-world observational study. Endokrynol Pol 2021; 72:512-519. [PMID: 34647602 DOI: 10.5603/ep.a2021.0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with acromegaly have substantially reduced quality of life (QoL). This study evaluated QoL in patients with acromegaly treated with lanreotide autogel. MATERIAL AND METHODS This was a prospective, non-interventional, observational, multi-centre study conducted in Poland (NCT02396966). We included patients with acromegaly, who received treatment with lanreotide autogel 120mg for ≥ 3 months and < 3 years. Patients were assessed approximately every 4-5months for twoyears (six visits). QoL was measured with the Acromegaly Quality of Life Questionnaire (AcroQoL). RESULTS Of 152 patients enrolled from November 2014 to May 2018 in 37 centres, 24 were excluded due to major protocol deviations. The results are reported for the study population (n = 128). At baseline, the median [95% confidence interval (CI)] time from diagnosis was 3.3 (2.8, 4.2)years, and the median time since lanreotide initiation was 13.4 (9.9, 17.3) months. Symptoms of acromegaly were present at baseline in 86% of patients (headache, 57%; sweating, 58%; joint symptoms, 64%); symptoms remained unchanged at two years in 82% of patients. At baseline, 27% of patients had hormonal control (growth hormone < 2.5 μg/L and insulin-like growth factor-1 within the normal range); hormonal control status did not change during the study period in over 81% of patients. At baseline, 88% of patients were either very satisfied or satisfied with treatment; treatment satisfaction was unchanged in 62% of patients over the study period. Mean (95% CI) AcroQoL scores at baseline were as follows: total, 50.3 (47.3, 53.3); physical dimension, 48.8 (45.2, 52.4); psychological dimension, 51.3 (48.2, 54.4); appearance subdimension, 40.7 (37.5, 43.8); and personal relations subdimension, 62.5 (58.8, 66.2). The psychological appearance subscore improved by 3.8 points (1.2, 6.5) over the two years; scores in the remaining dimensions and subdimensions did not change substantially. The total AcroQoL score remained unchanged over the twoyears, regardless of prior acromegaly treatment, surgery or radiotherapy, hormonal control, or lanreotide dosing interval. No new safety findings were identified. CONCLUSIONS AcroQoL total scores and physical and psychological subscores remained stable but impaired among patients with long-lasting acromegaly treated with lanreotide autogel for two years. The psychological appearance subdimension improved numerically.
Collapse
Affiliation(s)
- Marek Bolanowski
- Department of Endocrinology, Diabetes, and Isotope Therapy, Medical University, Wroclaw, Poland
| | | | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumours, ENETS Centre of Excellence, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism, and Internal Diseases, University of Medical Sciences, Poznan, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology, and Diabetes, Medical University of Warsaw, Poland
| | - Wojciech Zgliczyński
- Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | | |
Collapse
|
49
|
Kurzyńska A, Przybylik-Mazurek E, Skalniak A, Buziak-Bereza M, Brzozowska-Czarnek A, Tomaszewska R, Hubalewska-Dydejczyk A. A rare case of aggressive, hereditary paraganglioma associated with a pathogenic variant in SDHD. Endokrynol Pol 2021; 72:403. [PMID: 34010450 DOI: 10.5603/ep.a2021.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
- Anna Kurzyńska
- Clinical Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Anna Skalniak
- Clinical Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Buziak-Bereza
- Clinical Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Romana Tomaszewska
- Department of Clinical and Experimental Pathology, Jagiellonian University Medical College, Krakow, Poland
| | | |
Collapse
|
50
|
Morawiec-Sławek K, Opalińska M, Stefańska A, Sowa-Staszczak A, Hubalewska-Dydejczyk A. Clinical challenges and dilemmas in the management of advanced pancreatic neuroendocrine tumour - the first manifestation of von Hippel-Lindau disease in a young patient. Endokrynol Pol 2021; 72:412-413. [PMID: 34010452 DOI: 10.5603/ep.a2021.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
Collapse
Affiliation(s)
| | - Marta Opalińska
- Chair and Department of Endocrinology, University Hospital, Krakow, Poland
| | | | - Anna Sowa-Staszczak
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | |
Collapse
|