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Zygmunt-Górska A, Wójcik M, Gilis-Januszewska A, Starmach A, Bik-Multanowski M, Starzyk JB. Correction: Comparison of clinical characteristics of a pediatric cohort with combined pituitary hormone deficiency caused by mutation of the PROP1 gene or of other origins. Hormones (Athens) 2024:10.1007/s42000-024-00543-0. [PMID: 38498234 DOI: 10.1007/s42000-024-00543-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Agata Zygmunt-Górska
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland.
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Ul. Wielicka 265, Cracow, 30-663, Poland.
| | | | - Anna Starmach
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Ul. Wielicka 265, Cracow, 30-663, Poland
| | | | - Jerzy B Starzyk
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Ul. Wielicka 265, Cracow, 30-663, Poland
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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.
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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
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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.
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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
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Zygmunt-Górska A, Wójcik M, Gilis-Januszewska A, Starmach A, Bik-Multanowski M, Starzyk JB. Comparison of clinical characteristics of a pediatric cohort with combined pituitary hormone deficiency caused by mutation of the PROP1 gene or of other origins. Hormones (Athens) 2024; 23:69-79. [PMID: 38147295 PMCID: PMC10847174 DOI: 10.1007/s42000-023-00510-1] [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: 07/13/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023]
Abstract
The most commonly identified genetic cause of combined pituitary hormone deficiency (CPHD) is PROP1 gene mutations. The aim of the study was to compare selected clinical features of patients with CPHD caused by variants of the PROP1 gene (CPHD-PROP1) and patients with inborn CPHD of other etiology (CPHD-nonPROP1). MATERIAL AND METHODS The retrospective analysis included childhood medical records of 74 patients (32 female) with CPHD, including 43 patients (23 female) with the mutation in the PROP1 gene. RESULTS Patients with CPHD-PROP1 compared to the CPHD-nonPROP1 presented with the following: significantly higher median birth weight (0.21 vs. - 0.29 SDS, p = 0.019), lower growth velocity within 3 years preceding growth hormone administration (- 2.7 vs. - 0.8 SDS, p < 0.001), higher mean maximal blood concentration of growth hormone within the stimulation process (1.2 vs. 1.08 ng/mL, p = 0.003), lower TSH (1.8 vs. 2.4 µIU/mL, p < 0.001), significantly lower prolactin concentrations (128 vs. 416.3 µIU/mL, p < 0.001), and less frequent typical signs of hypogonadism at birth in boys (n = 6; 30% vs. n = 12, 54%, p < 0.001). Secondary adrenal insufficiency was less frequent in CPHD-PROP1 (20 vs. 25 cases, p = 0.006) and occurred at a later age (13.4 vs. 10.4 years). MRI of the pituitary gland in CPHD-PROP1 revealed a small pituitary gland (21 cases), pituitary gland enlargement (eight cases), and one pituitary stalk interruption and posterior lobe ectopy, while it was normal in nine cases. CONCLUSION Patients with the PROP1 mutations present a clinical picture significantly different from that of other forms of congenital hypopituitarism. Certain specific clinical results may lead to the successful identification of children requiring diagnostics for the PROP1 gene mutation.
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Affiliation(s)
- Agata Zygmunt-Górska
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland.
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Ul. Wielicka 265, 30-663, Cracow, Poland.
| | | | - Anna Starmach
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Ul. Wielicka 265, 30-663, Cracow, Poland
| | | | - Jerzy B Starzyk
- Department of Pediatric and Adolescent Endocrinology, University Children's Hospital in Cracow, Cracow, Poland
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Ul. Wielicka 265, 30-663, Cracow, Poland
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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
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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
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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
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Maciejczyk M, Gilis-Januszewska A. Editorial: Insights in adrenal endocrinology: 2023. Front Endocrinol (Lausanne) 2023; 14:1263894. [PMID: 37635969 PMCID: PMC10455912 DOI: 10.3389/fendo.2023.1263894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Mateusz Maciejczyk
- Department of Hygiene, Epidemiology, and Ergonomics, Medical University of Bialystok, Bialystok, Poland
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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.
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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
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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.
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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
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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.
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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
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Gabriel R, Boukichou-Abdelkader N, Gilis-Januszewska A, Makrilakis K, Gómez-Huelgas R, Kamenov Z, Paulweber B, Satman I, Djordjevic P, Alkandari A, Mitrakou A, Lalic N, Egido J, Más-Fontao S, Calvet JH, Pastor JC, Lindström J, Lind M, Acosta T, Silva L, Tuomilehto J. Reduction in the Risk of Peripheral Neuropathy and Lower Decrease in Kidney Function with Metformin, Linagliptin or Their Fixed-Dose Combination Compared to Placebo in Prediabetes: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12052035. [PMID: 36902821 PMCID: PMC10004435 DOI: 10.3390/jcm12052035] [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] [Received: 01/24/2023] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To compare the effect of glucose-lowering drugs on peripheral nerve and kidney function in prediabetes. METHODS Multicenter, randomized, placebo-controlled trial in 658 adults with prediabetes treated for 1 year with metformin, linagliptin, their combination or placebo. Endpoints are small fiber peripheral neuropathy (SFPN) risk estimated by foot electrochemical skin conductance (FESC < 70 μSiemens) and estimated glomerular filtration rate (eGFR). RESULTS Compared to the placebo, the proportion of SFPN was reduced by 25.1% (95% CI:16.3-33.9) with metformin alone, by 17.3% (95% CI 7.4-27.2) with linagliptin alone, and by 19.5% (95% CI 10.1-29.0) with the combination linagliptin/metformin (p < 0.0001 for all comparisons). eGFR remained +3.3 mL/min (95% CI: 0.38-6.22) higher with the combination linagliptin/metformin than with the placebo (p = 0.03). Fasting plasma glucose (FPG) decreased more with metformin monotherapy -0.3 mmol/L (95%CI: -0.48; 0.12, p = 0.0009) and with the combination metformin/linagliptin -0.2 mmol/L (95% CI: -0.37; -0.03) than with the placebo (p = 0.0219). Body weight (BW) decreased by -2.0 kg (95% CI: -5.65; -1.65, p = 0.0006) with metformin monotherapy, and by -1.9 kg (95% CI: -3.02; -0.97) with the combination metformin/linagliptin as compared to the placebo (p = 0.0002). CONCLUSIONS in people with prediabetes, a 1 year treatment with metformin and linagliptin, combined or in monotherapy, was associated with a lower risk of SFPN, and with a lower decrease in eGFR, than treatment with placebo.
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Affiliation(s)
- Rafael Gabriel
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), 28001 Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- Correspondence:
| | - Nisa Boukichou-Abdelkader
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- EVIDEM CONSULTORES, 28030 Madrid, Spain
| | | | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29018 Málaga, Spain
| | - Zdravko Kamenov
- Clinic of Endocrinology, University Multi-Profile Hospital for Active Treatment Alexandrovska EAD, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Bernhard Paulweber
- Gemeinnuetzige Salzburger Landeskliniken Betriebsgesellschaft (SALK), 5020 Salzburg, Austria
| | - Ilhan Satman
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Istanbul University, 34093 Istanbul, Turkey
| | | | | | | | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain
| | - Sebastián Más-Fontao
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain
| | | | - José Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Hospital Clínico Universitario, Universidad de Valladolid, 47011 Valladolid, Spain
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Department of Medicine, NU-Hospital Group, 451 53 Uddevalla, Sweden
- Department of Internal Medicine, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Tania Acosta
- Department of Public Health, Universidad del Norte, Barranquilla 080001, Colombia
| | | | - Jaakko Tuomilehto
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), 28001 Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), 28001 Madrid, Spain
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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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
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14
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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.
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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
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15
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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.
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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
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16
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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
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17
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Gadelha M, Bex M, Feelders RA, Heaney AP, Auchus RJ, Gilis-Januszewska A, Witek P, Belaya Z, Yu Y, Liao Z, Ku CHC, Carvalho D, Roughton M, Wojna J, Pedroncelli AM, Snyder PJ. Randomized Trial of Osilodrostat for the Treatment of Cushing Disease. J Clin Endocrinol Metab 2022; 107:e2882-e2895. [PMID: 35325149 PMCID: PMC9202723 DOI: 10.1210/clinem/dgac178] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 12/20/2021] [Indexed: 02/08/2023]
Abstract
CONTEXT Cushing disease, a chronic hypercortisolism disorder, is associated with considerable morbidity and mortality. Normalizing cortisol production is the primary treatment goal. OBJECTIVE We aimed to evaluate the safety and efficacy of osilodrostat, a potent, orally available 11βhydroxylase inhibitor, compared with placebo in patients with Cushing disease. METHODS LINC 4 was a phase III, multicenter trial comprising an initial 12-week, randomized, double-blind, placebo-controlled (osilodrostat:placebo, 2:1) period followed by a 36-week, open-label treatment period (NCT02697734). Adult patients (aged 18-75 years) with confirmed Cushing disease and mean urinary free cortisol (mUFC) excretion ≥ 1.3 times the upper limit of normal (ULN) were eligible. The primary endpoint was the proportion of randomized patients with mUFC ≤ ULN at week 12. The key secondary endpoint was the proportion achieving mUFC ≤ ULN at week 36 (after 24 weeks' open-label osilodrostat). RESULTS Seventy-three patients (median age, 39 years [range, 19-67]; mean/median mUFC, 3.1 × ULN/2.5 × ULN) received randomized treatment with osilodrostat (n = 48) or placebo (n = 25). At week 12, significantly more osilodrostat (77%) than placebo (8%) patients achieved mUFC ≤ ULN (odds ratio 43.4; 95% CI 7.1, 343.2; P < 0.0001). Response was maintained at week 36, when 81% (95% CI 69.9, 89.1) of all patients achieved mUFC ≤ ULN. The most common adverse events during the placebo-controlled period (osilodrostat vs placebo) were decreased appetite (37.5% vs 16.0%), arthralgia (35.4% vs 8.0%), and nausea (31.3% vs 12.0%). CONCLUSION Osilodrostat rapidly normalized mUFC excretion in most patients with Cushing disease and maintained this effect throughout the study. The safety profile was favorable.
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Affiliation(s)
- Mônica Gadelha
- Correspondence: Mônica Gadelha, Endocrine Unit, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Professor Rodolpho Paulo Rocco, 255, 9° floor - 9F - Sala de Pesquisa em Neuroendocrinologia, Rio de Janeiro – RJ – Brazil, CEP: 21941-913
| | - Marie Bex
- University Hospitals Leuven, Leuven, Belgium
| | - Richard A Feelders
- Department of Internal Medicine, Endocrine Section, Erasmus Medical Center, Rotterdam CA, The Netherlands
| | - Anthony P Heaney
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Richard J Auchus
- Division of Metabolism, Endocrinology and Diabetes, Departments of Internal Medicine and Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | | | - Przemyslaw Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Zhanna Belaya
- Department of Neuroendocrinology and Bone Disease, Endocrinology Research Centre, Moscow, Russia
| | - Yerong Yu
- West China Hospital of Sichuan University, Chengdu, China
| | - Zhihong Liao
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Universidade do Porto, Porto, Portugal
| | | | - Judi Wojna
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Peter J Snyder
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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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]
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19
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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.
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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
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20
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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.
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21
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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.
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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,
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22
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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.
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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.)
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23
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Bogusławska A, Gilis-Januszewska A, Magdid K, Godlewska M, Olszewska M, Nowak AJ, Starzyk J, Korbonits M, Hubalewska-Dydejczyk A. One Fourth of Adult Patients With Acromegaly Have Tall Stature With Similar Frequency in Males And Females. J Endocr Soc 2021. [PMCID: PMC8090662 DOI: 10.1210/jendso/bvab048.1319] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Tall stature (TS) is a manifestation of growth hormone (GH) excess, with higher prevalence reported for males. The aim of this study was (i) to evaluate the relationship between height of patients with GH excess related to midparental height (MPH) and population mean height; (ii) to test whether TS patients with acromegaly come from tall families. Methods: Single-centre, observational study on 101 consecutive adult patients with acromegaly and no family history of pituitary adenoma. Patients were analysed in two subgroups depending on height using country-specific data: 1) normal stature and 2) TS group, defined as either height above gender-specific 97 percentile or as >1.5 country-specific standard deviation (SD) from MPH. Results: Twenty-four percent of acromegaly patients (13 females/11 males) met one or both of the TS criteria. TS patients were significantly younger at the diagnosis (mean±SD, 33.6±13.4 vs 50.6±12.3 years) and at first symptoms (median 27.5, range 23-42 vs 41 (33-54) years) with greater tumour size and higher basal GH concentration than normal stature patients (p<0.01). The TS criteria based on the 1.5 SD above MPH identified more TS patients than the above 97 percentile height (92% vs 38%) and especially increased the diagnosis of TS in women (92% vs 31%). There was no difference in height of family members of acromegaly patients with or without TS. Height of family members were not taller than the population mean. Conclusion: One fourth of adult patients with acromegaly have TS with similar frequency in males and females. Based on our data TS patients with acromegaly do not come from tall families.
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Affiliation(s)
- Anna Bogusławska
- Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland, Krakow, Poland
| | | | - Kesson Magdid
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Magdalena Godlewska
- Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland, Krakow, Poland
| | - Marta Olszewska
- Department of Paediatrics, Jagiellonian University, Collegium Medicum, Cracow, Poland, Krakow, Poland
| | - Andrzej Jerzy Nowak
- Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland, Krakow, Poland
| | - Jerzy Starzyk
- Department of Paediatric and Adolescent Endocrinology, Paediatric Institute, Jagiellonian University Medical College, Cracow, Poland, Krakow, Poland
| | - Marta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Gadelha M, Bex M, Feelders RA, Heaney AP, Auchus RJ, Gilis-Januszewska A, Witek P, Belaya Z, Liao Z, Ku CHC, Carvalho D, Roughton M, Wojna J, Hofstetter G, Pedroncelli AM, Snyder PJ. Osilodrostat Is an Effective and Well-Tolerated Treatment for Cushing’s Disease (CD): Results From a Phase III Study With an Upfront, Randomized, Double-Blind, Placebo-Controlled Phase (LINC 4). J Endocr Soc 2021. [PMCID: PMC8090763 DOI: 10.1210/jendso/bvab048.1055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: In a prior Phase III, randomized-withdrawal study, osilodrostat, a potent oral 11β-hydroxylase inhibitor, provided rapid and sustained normalization of mean urinary free cortisol (mUFC) in most patients (pts) with CD. Now, we report efficacy and safety results from another Phase III study of osilodrostat in pts with CD that included an upfront, double-blind, randomized, placebo-controlled phase (LINC 4: NCT02697734). Methods: Adults with CD with mUFC >1.3 x ULN were randomized 2:1 to osilodrostat 2 mg bid or matching placebo for a 12-week (W) double-blind period, with dose adjustments at W2, 5 and 8 (range 1-20 mg bid) based on efficacy and tolerability; dose matching and adjustments were managed by independent endocrinologists. From W12 to W48, all pts received open-label osilodrostat, with dose adjustments permitted (range 1-30 mg bid). At W48, pts could enter an optional extension. Primary endpoint: proportion of randomized pts in each arm who received ≥1 treatment dose with mUFC ≤ULN at W12. Results: 73 pts were randomized and received osilodrostat (n=48) or matching placebo (n=25; baseline median [range] mUFC 2.5 x ULN [0.7-12.5] vs 2.2 x ULN [0.2-18.9]). 77% of osilodrostat recipients achieved mUFC ≤ULN at W12 vs 8% of placebo recipients (OR 43.4; 95% CI 7.1-343.2; P<0.0001). At W36, 81% (95% CI 69.9-89.1) of osilodrostat recipients had mUFC ≤ULN (key secondary endpoint). Median time to first controlled mUFC response was 35 days (95% CI 34‒52) for pts randomized to osilodrostat. Median duration of osilodrostat exposure at data cut-off (Feb 25, 2020) was 71.7 vs 62.3 weeks for pts randomized to osilodrostat and placebo (median [IQR] dose 4.7 [3.8-9.0] vs 6.0 mg/day [3.7-9.7]). Up to W12, 3 osilodrostat pts discontinued, 1 because of an AE (arthralgia), vs 0 with placebo. The most common (≥30%) AEs occurring by W12 were decreased appetite (38% osilodrostat vs 16% placebo), arthralgia (35% vs 8%) and nausea (31% vs 12%). AEs related to hypocortisolism and adrenal-hormone-precursor accumulation occurred in 15% vs 0% and 44% vs 36% of osilodrostat and placebo pts; most were grade 1/2 and resolved with dose reduction/interruption and/or concomitant medication. During the overall study period, the most common (≥30%) AEs occurring on osilodrostat treatment were arthralgia (45%), decreased appetite (45%), fatigue (38%), nausea (37%) and headache (33%). Improvements in cardiovascular- and metabolic-related parameters, including systolic and diastolic blood pressure and HbA1c, were observed with osilodrostat treatment at W12 and W48. Conclusion: Osilodrostat was superior to placebo at normalizing mUFC levels at W12 (77% vs 8%). Improvements in mUFC levels were sustained at W36. Few pts discontinued because of AEs; hypocortisolism-related AEs were infrequent and manageable. We conclude that osilodrostat is a highly effective and well-tolerated treatment for pts with CD.
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Affiliation(s)
- Mônica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marie Bex
- University Hospitals Leuven, Leuven, Belgium
| | | | - Anthony P Heaney
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Zhanna Belaya
- Endocrinology Research Centre, Moscow, Russian Federation
| | - Zhihong Liao
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Davide Carvalho
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Judi Wojna
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Peter J Snyder
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Godlewska M, Nowak AJ, Boguslawska A, Kluczynski L, Grochowska A, Hubalewska-Dydejczyk A, Gilis-Januszewska A. Diverse Manifestation of Acromegaly With Suspicion of Ectopic GHRH Secretion. Report of Two Cases. J Endocr Soc 2021. [PMCID: PMC8090624 DOI: 10.1210/jendso/bvab048.1188] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Acromegaly can rarely be caused by an ectopic production of GH or GHRH by various neoplasms, most commonly neuroendocrine tumors of pancreatic or pulmonary origin. Squamous cell carcinoma of the lung has not been associated with ectopic GHRH secretion yet. The authors present two cases of acromegaly with suspicion of GHRH ectopy. Presentation of the Cases: Case 1. A male born in 1945 presenting with typical morphologic features of acromegaly. Pituitary MRI revealed a cuneatic-shaped, hypointense focal lesion (8x7x6 mm) in the right posterior part of the anterior pituitary lobe, radiologically interpreted as either hyperplasia of the intermediate lobe or atypical adenoma in a normal-sized pituitary. IGF-1 and no suppression of GH secretion after oral glucose load were observed. Furthermore, a polycyclic tumor in the 2nd segment of the right lung with pathological metabolic activity in 18FDG- PET/CT was discovered. Ga68- DOTA TATE PET/CT revealed no pathological accumulation of the tracer. After upper right lobectomy, squamous cell carcinoma, non-keratinizing, G3, with a negative immunohistochemical reaction for GH was confirmed. IHC for GHRH and serum GHRH have been scheduled. After surgery and chemotherapy, no biochemical remission of acromegaly was observed and the pituitary MRI showed stable radiological image of the pituitary tumor, suggesting rather a possible metastasis to the pituitary. Due to unfavorable prognosis, the patient was disqualified from neurosurgical resection of the pituitary tumor. Case 2. a male born in 1948 with typical symptoms of acromegaly, elevation of IGF-1 and no suppression of GH in OGTT. Due to MRI contraindications, only CT of the head was performed- it revealed partially empty sella, compressed pituitary with maximal diameter 3 mm and no focal lesions. Treatment with somatostatin analogue was introduced, however, only partial biochemical control was achieved. Ga68- DOTA TATE PET/CT performed after 8 years showed pathological expression of somatostatin receptors in the pancreatic tail. Abdominal CT confirmed a focal lesion in this location, 14x9 mm, with a strong enhancement after contrast administration, suggesting a neuroendocrine tumor. The patient refused to undergo any invasive procedures and remains treated with SRL. Serum GHRH has been scheduled. Conclusion: The authors report two cases of ectopic acromegaly suspicion, with an ambiguous clinical and radiological presentation. In unclear cases of acromegaly, ectopic production of GHRH should be taken into consideration.
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Affiliation(s)
- Magdalena Godlewska
- Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Anna Boguslawska
- Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Kluczynski
- Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Grochowska
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
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Kluczynski L, Godlewska M, Rogozinski D, Nowak AJ, Zygmunt-Gorska A, Wojcik M, Starzyk J, Hubalewska-Dydejczyk A, Gilis-Januszewska A. Pituitary Stalk Lesions - Single Center Long Term Observation. J Endocr Soc 2021. [PMCID: PMC8090673 DOI: 10.1210/jendso/bvab048.1287] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background & Methods: Pituitary stalk lesions (PSL) are various changes located in the pituitary infundibulum. The underlying pathology and exact diagnosis are difficult to establish due to their unique anatomical locus. A retrospective observational analysis of 60 adult patients (34W/26M) with pituitary lesions was performed. The mean age of diagnosis was 33.8 years (SD 23.7). The etiologies were divided into 3 groups (congenital, inflammatory, neoplastic), classified as exact, probable or unknown and characterized hormonally. Aim: To present the etiological spectrum of pituitary stalk lesions and their clinical and hormonal characteristics on the basis of long term observation in the pediatric/adult endocrinology departments of our university. Results: The most common causes of PSL were neoplasms (20/60, 33.3%, 14W/6M); congenital malformations were detected in 17/60 (28.3%, 6W/11M), while inflammatory etiology was found in 15/60 (25.0%, 9W/6M) of patients. The exact diagnosis was established in 26/60 (43.3%) cases (16 congenital malformations, 6 adenomas, 1 pituitary cancer, 1 craniopharyngioma, 1 germinoma and 1 lymphocytic hypophysitis [LH]). The probable cause was suggested in 26/60 patients (43.3%) - 10 with the suspicion of LH, 4 with histiocytosis, 3 with a metastatic tumor from a disseminated cancer, 3 craniopharyngiomas, 1 posterior pituitary lobe ectopy, 1 prolactinoma, 1 granular cell tumor, 2 adenomas and 1 pituicytoma. The origin of 8/60 PSL (13.3%) remains unknown. During hormonal assessment the most common insufficiency concerned the gonadal axis found in 29/60 (48.3%) of patients, followed by thyroid (26/60, 43.4%), somatotropic (21/60, 35.0%) and adrenal axis (20/60, 33.3%) insufficiencies. Hyperprolactinemia was detected in 20/60 (33.3%) of patients, while diabetes insipidus was confirmed in 15/60 (25%) of cases. 45 patients presented at least 1 hormonal deficit, some of them were transient. In clinical aspect, symptoms associated with hormonal deficits led to the initiation of diagnostic work-up in 29 patients (48.3%; including 15 patients (25.0%) with growth retardation). Neurological symptoms such as headaches, visual disturbances and seizures were seen in 13 patients (21.7%). Polydipsia and polyuria were the primary presentation in 11 cases (18.3%), while 5 cases (8.3%) had a clinical manifestation of hormone overproduction. Incidental diagnosis was seen in 2 female patients (3.3%). Conclusions: The diagnosis, management and treatment of the pituitary stalk lesions remains challenging. Difficulties in establishing the exact diagnosis might also be related to the non-specific, transient characteristics of the symptoms and hormonal insufficiencies. Long term observations might help better the understanding of the disease and result in improvement of management.
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Affiliation(s)
| | | | | | | | | | | | - Jerzy Starzyk
- Jagiellonian University Medical College, Krakow, Poland
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27
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Nowak AJ, Grochowska A, Adamek D, Godlewska M, Motyka M, Gilis-Januszewska A, Hubalewska-Dydejczyk A. Intrasellar Cavernous Hemangioma, a Rare Condition Causing Both Radiological And Clinical Difficulties- a Case Report. J Endocr Soc 2021. [PMCID: PMC8265847 DOI: 10.1210/jendso/bvab048.1202] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: Intrasellar cavernous hemangiomas constitute an extremely rare group of findings in endocrinological practice. Diagnosis remains challenging due to non-characteristic symptoms and neuroradiological features which may resemble those of pituitary adenomas. Presentation of the Case: We present a case of female born in 1941, diagnosed with a hemangioma cavernosum located in the Sella turcica. In 2004 our patient presented with uncharacteristic symptoms: syncopes and chronic headaches. Computed tomography (CT) of the head revealed an intrasellar hyperdense tumor mass with radiological features suggesting a pituitary adenoma. In 2005 the patient underwent transcranial resection of the sellar mass, with subsequent oculomotor nerve palsy. In histopathological examination, diagnosis of cavernous hemangioma was determined. Between 2005 and 2020 patient was asymptomatic, with multiple follow-up head MRIs scans, showing gradual progression in size of the intrasellar tumor. The patient was consulted by a neurosurgeon, with no direct indications for surgical approach found. Furthermore, due to suprasellar expansion into the direct proximity of the right optic nerve, the patient was disqualified for Gamma-Knife radiotherapy. The last MRI of the hypothalamic-pituitary area in 2020 revealed a polycyclic, homogeneous, 33x31x29 mm mass, filling in the space of the Sella turcica, with strong enhancement after contrast administration. Invasion of the surrounding structures, including the clivus, right cavernous sinus and right trigeminal cave were described. Bilaterally, internal carotid arteries and right optic nerve adhered directly to the lesion. Pituitary gland was compressed by the tumor mass. In July 2020, in order to verify the ambiguous radiological and clinical characteristics of the lesion including tumor regrowth and its invasiveness, a transsphenoidal partial resection was performed. Tissue samples were collected for the histopathological examination, which confirmed the initial diagnosis of cavernous hemangioma originating from the cavernous sinus. During a multidisciplinary tumor board, having taken into consideration relatively stable clinical condition and high risk possible surgical complications, the patient was currently disqualified from neurosurgical re-operation nor radiotherapy. Surprisingly, during whole follow up, patients pituitary function remained unimpaired. A watchful waiting approach, with radiological and endocrinological follow up were scheduled. Conclusion: To date, only few cases of intrasellar cavernous hemangiomas have been reported. Intrasellar hemangiomas may originate from the vascular tissue of the cavernous sinus. Surgical removal remains the recommended treatment modality, but radiosurgery could be a therapeutic option as well. Stable patients with no clinical symptoms may remain in observation.
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Affiliation(s)
- Andrzej Jerzy Nowak
- Department of Endocrinology, University Hospital in Cracow, Poland, Cracow, Poland
| | - Anna Grochowska
- Departament of Radiology Jagiellonian University Medical College, Cracow, Poland, Cracow, Poland
| | - Dariusz Adamek
- Department of Neuropathology Jagiellonian University Medical College in Cracow, Poland, Cracow, Poland
| | - Magdalena Godlewska
- Department of Endocrinology, Jagiellonian University Medical College in Cracow, Poland, Krakow, Poland
| | - Marcin Motyka
- Department of Endocrinology, Jagiellonian University Medical College in Cracow, Poland, Krakow, Poland
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Gilis-Januszewska A, Rogoziński D, Nowak AJ, Piwońska-Solska B, Zygmunt-Górska A, Wójcik M, Starzyk J, Hubalewska-Dydejczyk A. Testing of Adrenal Axis Function in Patients With Combined Pituitary Hormone Deficiency Caused by PROP1 Mutation. J Endocr Soc 2021. [PMCID: PMC8090037 DOI: 10.1210/jendso/bvab048.1293] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: The mechanism of adrenal axis deterioration in PROP1 mutation remains uncertain and challenging. Aim: The aim of the project was to investigate the adrenal axis function in patients with combined pituitary function deficiency and PROP1 mutation. Methods: We performed the corticotrophin (CRH) stimulation test in 15 patients ((8W/7M) with confirmed CPHD due to the PROP1 mutation. 9/15 were familial cases from four families. Time of observation (ToO) was calculated since the first pituitary axis/ACTH insufficiency has occurred. The results were reported in the group with confirmed Adrenal Insufficiency (AI) and without AI defined as cortisol >18 ug/dl at any point during CRH test. ACTH is reported in pg/ml and cortisol in ug/dl, time of test is given in minutes (0‘, 15’,30’,45’,60’,120’). Results: The mean age of the group was 40,6 ± 12,1 years with mean 34,7 ± 10,3 years of CPHD observation (range 18 – 54 years). The In 5/15 the cortisol response met the criteria excluding AI. Among siblings there were patients both with/without AI. Both subgroups had similar ToO (without AI 35,6 ± 10,0 years vs 34,2 ± 10,3 years with AI). Mean time of AI duration was 15,0 ± 9,3 years. In the group of 5 patients without AI the mean morning cortisol was 12,48 ± 4,31 and ACTH was 31,26 ± 5,43. The mean maximal concentration of cortisol and ACTH were 24,94 ± 3,6 and 123,6 ± 39,9 respectively; Mean increase of cortisol was 12,46 ±4,04 and 92,34±34,48 for ACTH. In 10 patients with AI the mean morning cortisol was 3,33±1,39 and ACTH 22,71±6,75. The mean maximal concentration of cortisol and ACTH were 10,15±4,47 and 97,05 ± 59,15 respectively; Mean increase of cortisol was 6,83 ± 3,41 and 74,35 ± 53,72 for ACTH. For two patients high ACTH increase from 36,7 to 260 and from 28,65 to 112,0 was observed. Analysis of cortisol and ACTH response in both groups revealed that in group without AI the time of peak of ACTH was observed in 15’ (2/5) and 30’ (3/5) vs. in 15’(3/10), 30’(6/10) and 45’ in group with AI. The peak cortisol was observed in 30’, 45’ and 60’ (3/5) in group without AI vs 60’(6/10) or 120’ (4/10) in AI group. The mean maximal increase of ACTH was by 4,09±1,46 and 4,12±1,58 in AI group vs no AI group respectively. Conclusions: In patients with PROP1 mutation the adrenal axis can deteriorate long after other axis insufficiencies, however there are patients with no adrenal insufficiency even during lifelong observation. There is no specific order of deterioration even among affected siblings. In the vast majority of patients independently of cortisol increase there is ACTH response after CRH. Further studies on the pituitary function deterioration in patients with PROP1 mutation should be carried out to understand better the underlying mechanism and to set up the diagnostic timing and procedures.
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Affiliation(s)
| | - Damian Rogoziński
- Department of Endocrinology, University Hospital in Cracow, Poland, Krakow, Poland
| | - Andrzej Jerzy Nowak
- Department of Endocrinology, University Hospital in Cracow, Poland, Krakow, Poland
| | | | - Agata Zygmunt-Górska
- Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University, Medical College, Kraków, Poland, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University, Medical College, Kraków, Poland, Krakow, Poland
| | - Jerzy Starzyk
- Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University, Medical College, Kraków, Poland, Krakow, Poland
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Opalińska M, Sowa-Staszczak A, Olearska H, Ulatowska-Bialas M, Gilis-Januszewska A, Hubalewska-Dydejczyk A. Clinical Approach to Neuroendocrine Neoplasm Associated With Ovarian Teratoma. Front Endocrinol (Lausanne) 2021; 12:770266. [PMID: 34917031 PMCID: PMC8670552 DOI: 10.3389/fendo.2021.770266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/03/2021] [Accepted: 11/03/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Neuroendocrine neoplasms are a heterogeneous group of cancers that develop from enterochromaffin cells of the diffuse endocrine system, with an increase in incidents over the last years. Ovarian neuroendocrine tumors (NET) are rare neoplasms, comprising 0.1% of all ovarian neoplasms and less than 5% of all neuroendocrine tumors. They may arise alone (as monodermal, specialized teratoma - ovarian carcinoid) or as a part of other ovarian lesion: cystic mature or immature teratomas. Due to the rarity and limited amount of such cases reported in the literature, there is no consensus on diagnostic and therapeutic procedures in this group of patients. MATERIALS AND METHODS The group of 10 patients at the age of 19 to 77 years (mean 42.8 ± 17.9), diagnosed with unilateral NET within ovarian teratoma were analyzed. The histopathological type of tumor, progression free survival after surgical treatment and presence of hormonally active syndrome were assessed. RESULTS 70% (n=7) of patients was diagnosed with mature cystic teratomas containing NET component and 30% (n=3) with monodermal teratoma (strumal carcinoid). All cases of monodermal teratomas were found in women at premenopausal age. Determined Ki67 ranged from 2% to 9%. Ninety percent of lesions (n=9) stained positive for synaptophysin and chromogranin, while markers: CK20, CK7, TTF-1 and CDX2 were negative in all cases, which ruled out their metastatic nature. None of the patients presented with carcinoid syndrome. All followed-up patients remain progression-free, which confirms surgical intervention being a crucial and sufficient method of treatment. CONCLUSIONS The prognosis and clinical behavior of NETs associated with ovarian teratomas are good with long progression-free survival.
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Affiliation(s)
- Marta Opalińska
- Nuclear Medicine Unit, Department of Endocrinology 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
- *Correspondence: Anna Sowa-Staszczak,
| | - Helena Olearska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
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30
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Paleń-Tytko JE, Przybylik-Mazurek EM, Rzepka EJ, Pach DM, Sowa-Staszczak AS, Gilis-Januszewska A, Hubalewska-Dydejczyk AB. Ectopic ACTH syndrome of different origin-Diagnostic approach and clinical outcome. Experience of one Clinical Centre. PLoS One 2020; 15:e0242679. [PMID: 33237923 PMCID: PMC7688153 DOI: 10.1371/journal.pone.0242679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/05/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Ectopic Cushing Syndrome (EAS) is a rare condition responsible for about 5–20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production–especially neuroendocrine tumors with other neoplasms. Methods Twenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed. Results Half of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia. Conclusion EAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients.
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31
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Godlewska M, Bogusławska A, Nowak A, Skalniak A, Sowa-Staszczak A, Gilis-Januszewska A, Hubalewska-Dydejczyk A. Acromegaly and late-onset primary hyperparathyroidism in a female with a rare MEN1 gene variant of yet undetermined clinical significance (p.Val167Ala). Endokrynol Pol 2020; 71:579-580. [PMID: 33125695 DOI: 10.5603/ep.a2020.0063] [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: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Magdalena Godlewska
- Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Anna Bogusławska
- Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Andrzej Nowak
- Department of Endocrinology, University Hospital in Cracow, Poland
| | - Anna Skalniak
- Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Anna Sowa-Staszczak
- Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
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32
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Rogoziński D, Gilis-Januszewska A, Skalniak A, Kluczyński Ł, Pantofliński J, Hubalewska-Dydejczyk A. Pituitary tumours in MEN1 syndrome - the new insight into the diagnosis and treatment. Endokrynol Pol 2020; 70:445-452. [PMID: 31681967 DOI: 10.5603/ep.a2019.0026] [Citation(s) in RCA: 2] [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: 04/16/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 11/25/2022]
Abstract
Pituitary tumours are a common pathology affecting 15-20% of the population. Only about 1‰ of adenomas are clinically manifested; among them, about two/thirds are hormonally active, most often secreting prolactin or growth hormone. Pituitary tumours are mainly an isolated pathology, without any genetic background. However, the latest studies pay special attention to the possibility of developing an adenoma as a result of genetic mutation. Among pituitary adenomas, the leading group of genetically determined lesions is related to a mutation in AIP or MEN1, followed by PRKAR1A, GRP101, DICER, and SDHx. The genetic basis of these pituitary tumours is related to positive family history, young age of the patient, aggressive clinical process, and resistance to treatment. Pituitary tumours occur in over 40% of patients with MEN1 syndrome - often in women, they are more than 1 cm in diameter, and secrete prolactin. They are usually diagnosed in the fourth decade of life and show a worse response to pharmacotherapy than sporadic ones. Confirmation of the genetic background of the pituitary tumour implies measurable implications; it might help to direct the diagnosis in patients' family members, partially predict the development of the disease, and, above all, extend patients' life expectancy.
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Affiliation(s)
- Damian Rogoziński
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland.
| | - Aleksandra Gilis-Januszewska
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland.,Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skalniak
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland.,Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Łukasz Kluczyński
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland.,Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Alicja Hubalewska-Dydejczyk
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland.,Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
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Gilis-Januszewska A, Kluczyński Ł, Hubalewska-Dydejczyk A. Traumatic brain injuries induced pituitary dysfunction: a call for algorithms. Endocr Connect 2020; 9:R112-R123. [PMID: 32412425 PMCID: PMC7274553 DOI: 10.1530/ec-20-0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury affects many people each year, resulting in a serious burden of devastating health consequences. Motor-vehicle and work-related accidents, falls, assaults, as well as sport activities are the most common causes of traumatic brain injuries. Consequently, they may lead to permanent or transient pituitary insufficiency that causes adverse changes in body composition, worrisome metabolic function, reduced bone density, and a significant decrease in one's quality of life. The prevalence of post-traumatic hypopituitarism is difficult to determine, and the exact mechanisms lying behind it remain unclear. Several probable hypotheses have been suggested. The diagnosis of pituitary dysfunction is very challenging both due to the common occurrence of brain injuries, the subtle character of clinical manifestations, the variable course of the disease, as well as the lack of proper diagnostic algorithms. Insufficiency of somatotropic axis is the most common abnormality, followed by presence of hypogonadism, hypothyroidism, hypocortisolism, and diabetes insipidus. The purpose of this review is to summarize the current state of knowledge about post-traumatic hypopituitarism. Moreover, based on available data and on our own clinical experience, we suggest an algorithm for the evaluation of post-traumatic hypopituitarism. In addition, well-designed studies are needed to further investigate the pathophysiology, epidemiology, and timing of pituitary dysfunction after a traumatic brain injury with the purpose of establishing appropriate standards of care.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | - Łukasz Kluczyński
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
- Correspondence should be addressed to Ł Kluczyński:
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
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Rzepka E, Gilis-Januszewska A, Opalińska M, Sowa-Staszczak A, Hubalewska-Dydejczyk A. Difficulties in the diagnosis and treatment of malignant paraganglioma of the urinary bladder. Endokrynol Pol 2020; 71:196-197. [PMID: 32293698 DOI: 10.5603/ep.a2019.0068] [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: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 02/05/2023]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Ewelina Rzepka
- Clinical Department of Endocrinology, University Hospital, Jagiellonian University, Medical College, Krakow, Poland
| | - Aleksandra Gilis-Januszewska
- Clinical Department of Endocrinology, University Hospital, Jagiellonian University, Medical College, Krakow, Poland.
| | - Marta Opalińska
- Clinical Department of Endocrinology, University Hospital, Jagiellonian University, Medical College, Krakow, Poland.,Nuclear Medicine Department, University Hospital, Jagiellonian University, Medical College, Krakow, Poland, Krakow, Poland
| | - Anna Sowa-Staszczak
- Clinical Department of Endocrinology, University Hospital, Jagiellonian University, Medical College, Krakow, Poland.,Nuclear Medicine Department, University Hospital, Jagiellonian University, Medical College, Krakow, Poland, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Clinical Department of Endocrinology, University Hospital, Jagiellonian University, Medical College, Krakow, Poland.,Nuclear Medicine Department, University Hospital, Jagiellonian University, Medical College, Krakow, Poland, Krakow, Poland
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Gabriel R, Boukichou Abdelkader N, Acosta T, Gilis-Januszewska A, Gómez-Huelgas R, Makrilakis K, Kamenov Z, Paulweber B, Satman I, Djordjevic P, Alkandari A, Mitrakou A, Lalic N, Colagiuri S, Lindström J, Egido J, Natali A, Pastor JC, Teuschl Y, Lind M, Silva L, López-Ridaura R, Tuomilehto J. Early prevention of diabetes microvascular complications in people with hyperglycaemia in Europe. ePREDICE randomized trial. Study protocol, recruitment and selected baseline data. PLoS One 2020; 15:e0231196. [PMID: 32282852 PMCID: PMC7153858 DOI: 10.1371/journal.pone.0231196] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/09/2019] [Accepted: 03/14/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives To assess the effects of early management of hyperglycaemia with antidiabetic drugs plus lifestyle intervention compared with lifestyle alone, on microvascular function in adults with pre-diabetes. Methods Trial design: International, multicenter, randomised, partially double-blind, placebo-controlled, clinical trial. Participants Males and females aged 45–74 years with IFG, IGT or IFG+IGT, recruited from primary care centres in Australia, Austria, Bulgaria, Greece, Kuwait, Poland, Serbia, Spain and Turkey. Intervention Participants were randomized to placebo; metformin 1.700 mg/day; linagliptin 5 mg/day or fixed-dose combination of linagliptin/metformin. All patients were enrolled in a lifestyle intervention program (diet and physical activity). Drug intervention will last 2 years. Primary Outcome: composite end-point of diabetic retinopathy estimated by the Early Treatment Diabetic Retinopathy Study Score, urinary albumin to creatinine ratio, and skin conductance in feet estimated by the sudomotor index. Secondary outcomes in a subsample include insulin sensitivity, beta-cell function, biomarkers of inflammation and fatty liver disease, quality of life, cognitive function, depressive symptoms and endothelial function. Results One thousand three hundred ninety one individuals with hyperglycaemia were assessed for eligibility, 424 excluded after screening, 967 allocated to placebo, metformin, linagliptin or to fixed-dose combination of metformin + linagliptin. A total of 809 people (91.1%) accepted and initiated the assigned treatment. Study sample after randomization was well balanced among the four groups. No statistical differences for the main risk factors analysed were observed between those accepting or rejecting treatment initiation. At baseline prevalence of diabetic retinopathy was 4.2%, severe neuropathy 5.3% and nephropathy 5.7%. Conclusions ePREDICE is the first -randomized clinical trial with the aim to assess effects of different interventions (lifestyle and pharmacological) on microvascular function in people with pre-diabetes. The trial will provide novel data on lifestyle modification combined with glucose lowering drugs for the prevention of early microvascular complications and diabetes. Registration - ClinicalTrials.Gov Identifier: NCT03222765 - EUDRACT Registry Number: 2013-000418-39
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Affiliation(s)
- Rafael Gabriel
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), Madrid, Spain
| | - Nisa Boukichou Abdelkader
- EVIDEM CONSULTORES, Madrid, Spain
- Asociación para la Investigación y Prevención de la Diabetes y Enfermedades Cardiovasculares (PREDICOR), Madrid, Spain
| | - Tania Acosta
- EVIDEM CONSULTORES, Madrid, Spain
- Department of Public Health. Universidad del Norte, Barranquilla, Colombia
| | | | | | | | - Zdravko Kamenov
- University Multi-Profile Hospital for Active Treatment Alexandrovska EAD, Sofia, Bulgaria
| | - Bernhard Paulweber
- Gemeinnuetzige Salzburger Landeskliniken Betriebsgesellschaft, (SALK) Salzburg, Austria
| | | | - Predrag Djordjevic
- General Hospital Medical System Beograd-MSB Belgrade Serbia, Beograd, Serbia
| | | | | | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stephen Colagiuri
- The University of Sydney, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney, Australia
| | - Jaana Lindström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Andrea Natali
- Department of Internal Medicine, Universita di Pisa, Pisa, Italy
| | - J Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Hospital Clínico Universitario, Valladolid, Spain
| | - Yvonne Teuschl
- Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Marcus Lind
- Västra Götalands Läns Landsting, Gothenburg, Sweden
| | | | | | - Jaakko Tuomilehto
- Departamento de Salud Internacional, Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
- World Community for Prevention of Diabetes Foundation (WCPD), Madrid, Spain
- National Institute for Health and Welfare, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
- King Abdulaziz University, Jeddah, Saudi Arabia
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Abstract
The management of pregnant women is a major concern of health care around the world. There is growing evidence regarding the influence of selenium (Se) on pregnancy and fetus outcomes. However, due to as yet insufficient evidence, lack of measurable markers to assess the effect of Se supplementation on the human metabolism, and Se's narrow therapeutic index, the majority of experts and the current guidelines published by several scientific societies do not recommend the use of Se in pregnancy and in women of childbearing age. Further research based on well-designed studies, including assessment of the complex interactions between different micronutrients and individual response to different doses of Se, is needed.
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Affiliation(s)
- Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17 Str, 31-501, Cracow, Poland.
| | - Leonidas Duntas
- Unit of Endocrinology, Diabetes and Metabolism, Evgenideion Hospital, Athens, Greece
| | - Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17 Str, 31-501, Cracow, Poland
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Gilis-Januszewska A, Kluczyński Ł, Rogoziński D, Hubalewska-Dydejczyk A. Radiological and hormonal improvements in a 22-year-old patient with lymphocytic hypophysitis - the watchful waiting approach. Endokrynol Pol 2019; 71:104-105. [PMID: 31681974 DOI: 10.5603/ep.a2019.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
| | - Łukasz Kluczyński
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Damian Rogoziński
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
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Karamanakos G, Costa-Pinel B, Gilis-Januszewska A, Velickiene D, Barrio-Torrell F, Cos-Claramunt X, Mestre-Miravet S, Piwońska-Solska B, Hubalewska-Dydejczyk A, Tuomilehto J, Liatis S, Makrilakis K. The effectiveness of a community-based, type 2 diabetes prevention programme on health-related quality of life. The DE-PLAN study. PLoS One 2019; 14:e0221467. [PMID: 31603914 PMCID: PMC6788719 DOI: 10.1371/journal.pone.0221467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/05/2018] [Accepted: 08/05/2019] [Indexed: 01/10/2023] Open
Abstract
Background and aims The DE-PLAN was a European multicenter study, with the primary objective of testing whether a community-based lifestyle modification programme could serve as a means of primary prevention for type 2 diabetes (T2D) in high-risk individuals (based on the FINDRISC questionnaire). The aim of this study was to examine the impact of a 1-year community-based lifestyle intervention on health-related quality of life (HRQOL) in individuals from four participating European centers (Athens, Barcelona, Krakow, Kaunas), through a post-hoc analysis. Materials and methods Each center was allowed to implement different intervention strategies specifically tailored to the needs of their corresponding population sample. Before and after the intervention, participants underwent clinical evaluation, anthropometric measurements, an oral glucose tolerance test and lipid profile measurements. Health-related quality of life was assessed using the validated HRQOL-15D questionnaire. A difference of ±0.015 in the 15D questionnaire score was set as the threshold of clinically meaningful change. Results Data from 786 participants (67% females, mean age 59.7±9.4 years, BMI 31.5±4.5 kg/m2) with complete data regarding the HRQOL were analyzed (Athens: 104, Barcelona: 434, Krakow: 175, Kaunas: 70). After 1 year, a significant overall improvement in HRQOL was shown, as depicted by a change of 15D score from baseline value (0.88±0.9) to post-intervention (0.90±0.87, P<0.001), achieving the threshold of clinically meaningful change. A significant weight reduction was also observed (-0.8±4.0 kg, P<0.001). In multivariate analysis, improvement in HRQOL was independently associated with lower 15D score at baseline (P<0.001) and self-reported increase in overall exercise time (P<0.001) as assessed through specifically designed trial questionnaires. Conclusion A community-based lifestyle intervention programme aiming at T2D prevention, applied on a heterogeneous population and with varied methods, was shown to improve overall health-related quality of life to a clinically meaningful degree.
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Affiliation(s)
- Georgios Karamanakos
- First Department of Propaedeutic Medicine, Diabetes Center, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- * E-mail:
| | - Bernardo Costa-Pinel
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | | | - Dzilda Velickiene
- Lithuanian University of Health Sciences, Institute of Endocrinology, Kaunas, Lithuania, LT
| | - Francisco Barrio-Torrell
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | - Xavier Cos-Claramunt
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | - Santiago Mestre-Miravet
- Catalan Diabetes Prevention Research Group, Jordi Gol Primary Care Research Institute, Catalan Health Institute, Primary Health Care Division, Reus-Barcelona, Spain
| | - Beata Piwońska-Solska
- Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | | | - Jaakko Tuomilehto
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Diabetes Center, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Diabetes Center, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Kluczyński Ł, Gilis-Januszewska A, Rogoziński D, Pantofliński J, Hubalewska-Dydejczyk A. Hypophysitis — new insights into diagnosis and treatment. Endokrynologia Polska 2019; 70:260-269. [DOI: 10.5603/ep.a2019.0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/28/2019] [Indexed: 11/25/2022]
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Ożga K, Krzyczkowska-Sendrakowska M, Hubalewska-Dydejczyk A, Gilis-Januszewska A, Ratajczak M, Ratajczak M, Chaykivska Z, Jach R. The value of the free androgen index depends on the phenotype of polycystic ovary syndrome - a single-centre experience. Endokrynol Pol 2019; 70:330-335. [PMID: 30938834 DOI: 10.5603/ep.a2019.0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The free androgen index (FAI) values differ among patients with polycystic ovarian syndrome; however, the differences are not fully understood or known. The aim of the study was to evaluate FAI in women with polycystic ovary syndrome (PCOS) in regard to the phenotype of the PCOS and insulin resistance status. MATERIAL AND METHODS Anthropometric, hormonal, and biochemical parameters were assessed in 312 recruited women with PCOS. The FAI values were calculated in the reproductive and metabolic phenotypes of PCOS in groups of insulin resistance status based on the homeostasis model assessment-insulin resistance (HOMA-IR) > 2.0 or fasting insulin (FI) > 10 mmol/L. To test the relationship between individual variables, Spearman's correlation analysis, the Kolmogorov-Smirnov test, and Student's t-test were used. RESULTS The correlation between FAI values and HOMA-IR and FI was 0.42 and 0.47, respectively, in PCOS patients. A two fold higher FAI value was observed in metabolic PCOS phenotype when compared to the reproductive one (8.51 ± 5.56 vs. 4.40 ± 2.45 for HOMA-IR and 8.73 ± 6.09 vs. 4.31 ± 3.39 for FI, respectively; p < 0.05). CONCLUSIONS PCOS patients are not a homogenous group in terms of FAI value. Patients with metabolic PCOS phenotype are characterised by two-fold higher FAI values compared with reproductive PCOS phenotype. Further studies on the metabolic and androgenic status of different types of PCOS phenotypes should be carried out.
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Affiliation(s)
- Katarzyna Ożga
- Department of Gynaecological Endocrinology and Gynaecology, Jagiellonian University Medical College, Cracow, Poland.
| | | | | | | | - Maciej Ratajczak
- Department of Endocrinology, Medical Centre of Postgraduate Education, Bielański Hospital in Warsaw, Poland
| | | | - Zlata Chaykivska
- Clinical Department of Metabolic Diseases, Jagiellonian University Medical College, Cracow, Poland
| | - Robert Jach
- Department of Gynaecological Endocrinology and Gynaecology, Jagiellonian University Medical College, Cracow, Poland
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Gilis-Januszewska A, Barengo NC, Lindström J, Wójtowicz E, Acosta T, Tuomilehto J, Schwarz PEH, Piwońska-Solska B, Szybiński Z, Windak A, Hubalewska-Dydejczyk A. Predictors of long term weight loss maintenance in patients at high risk of type 2 diabetes participating in a lifestyle intervention program in primary health care: The DE-PLAN study. PLoS One 2018; 13:e0194589. [PMID: 29570724 PMCID: PMC5865727 DOI: 10.1371/journal.pone.0194589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/06/2018] [Indexed: 02/02/2023] Open
Abstract
Lifestyle interventions in type 2 diabetes (DM2) prevention implementation studies can be effective and lasting. Long-term weight loss maintenance enhances the intervention effect through a significant decrease in diabetes incidence over time. Our objective was to identify factors predicting long-term successful weight reduction maintenance achieved during a DM2 prevention program in patients with high DM2 risk in primary health care. Study participants (n = 263), middle-aged, slightly obese with baseline increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC)>14), but no diabetes were invited to receive 11 lifestyle counselling sessions, guided physical activity sessions and motivational support during 10-months. The study participants had three clinical examinations during the study (baseline, one and three years). Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of weight reduction maintenance two years after the discontinuation of the intervention. Out of 105 patients who completed all three examinations (baseline age 56.6 (standard deviation (SD) = 10.7), body mass index 31.1 kg/m2 (SD = 4.9), FINDRISC 18.6 (SD = 3.1)), 73 patients (70%) showed weight loss during the intervention (mean weight loss 4.2 kg, SD = 5.1). The total weight loss achieved in the maintainers (27 of 73 study participants) two years after the intervention had finished was 6.54 kg (4.47 kg+2.0 kg). The non-maintainers, on the other hand, returned to their initial weight at the start of the intervention (+0.21 kg). In multivariable analysis baseline history of increased glucose (odds ratio (OR) = 3.7; 95% confidence interval (CI) 1.0-13.6) and reduction of total fat in diet during follow-up (OR = 4.3; 95% CI 1.5-12.2) were independent predictors of successful weight loss. Further studies exploring predictors of weight loss maintenance in diabetes prevention are needed to help health care providers to redesign interventions and improve long-term outcomes of real life interventions.
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Affiliation(s)
| | - Noël C. Barengo
- Department of Medical and Population Health Science Research, Herbert Wertheim College of Medicine, Florida International University, Miami, United States of America
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ewa Wójtowicz
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Tania Acosta
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Dasman Diabetes Institute, Dasman, Kuwait
| | - Peter E. H. Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technical University Dresden, Dresden, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Beata Piwońska-Solska
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Zbigniew Szybiński
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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Gilis-Januszewska A, Lindström J, Barengo NC, Tuomilehto J, Schwarz PEH, Wójtowicz E, Piwońska-Solska B, Szybiński Z, Windak A, Hubalewska-Dydejczyk A. Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project. Medicine (Baltimore) 2018; 97:e9790. [PMID: 29384876 PMCID: PMC5805448 DOI: 10.1097/md.0000000000009790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/04/2017] [Revised: 12/23/2017] [Accepted: 01/14/2018] [Indexed: 11/25/2022] Open
Abstract
It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.
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Affiliation(s)
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Noël C Barengo
- Department of Medical and Population Health Science, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Jaakko Tuomilehto
- Dasman Diabetes Institute, Dasman, Kuwait
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Department of Chronic Disease Prevention, National Institute for Health and Welfare
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Peter EH Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic, Carl Gustav Carus at Technical University Dresden
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technical University Dresden, Dresden
- German Center for Diabetes Research, Neuherberg, Germany
| | | | | | | | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
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Gilis-Januszewska A, Wilusz M, Pantofliński J, Turek-Jabrocka R, Sokołowski G, Sowa-Staszczak A, Kluczyński Ł, Pach D, Zieliński G, Hubalewska-Dydejczyk A. Temozolomide therapy for aggressive pituitary Crooke's cell corticotropinoma causing Cushing's Disease - a case report with literature review. Endokrynol Pol 2018; 69:306-312. [PMID: 29319131 DOI: 10.5603/ep.a2018.0011] [Citation(s) in RCA: 2] [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: 09/22/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022]
Abstract
CONTEXT Aggressive pituitary tumours causing Cushing's Disease are very rare, difficult to treat, and usually resistant to conventional therapy. There is growing evidence for the use of temozolomide (TZM), an alkylating chemotherapeutic agent, as first line chemotherapy in tumours resistant to repeated neurosurgery, radiotherapy and adrenalectomy. OBJECTIVE To present the response to TMZ in a rare case of an aggressive pituitary tumour in the course of Cushing's Disease and to review the literature referring to similar cases. PATIENT In this report, we present the case of a 61 year old male patient who was diagnosed with Cushing's Disease in the course of a pituitary invasive macroadenoma in 2011. The patient underwent 4 transphenoidal non-radical neurosurgeries (2012,2013) with rapid tumour progression, repeated non-radical bilateral adrenalectomy (2012, 2013) and stereotactic radiotherapy, and gamma knife surgery (2013, 2015). Histopathological examination revealed macroadenoma with high cell polymorphism and the presence of Crooke's cells, Ki- < 2%. Since 2015 the patient has been treated with 6 cycles of TMZ (320 mg per day for 5 consecutive days, 28-day cycle) with clinical and biochemical improvement and stabilized tumour size and no side effects. TMZ was continued for up to 9 cycles with a stable serum level of cortisol and ACTH being observed. However, clinical symptoms like headaches, visual field impairment, and finally hearing loss started to progress from the eighth cycle. After the ninth cycle of TMZ, there was a sudden increase in the size of the tumour, impairment of the cortisol and ACTH level, marked deterioration of the clinical status with the recurrence of severe headaches, narrowing of the visual field and hearing loss. At the beginning of 2016, a sudden clinical status and sight deterioration, strong headaches, drop of the right eyelid with widening of the pupil were observed. The patient died in February 2016. LESSONS The case of our patient suggests that the response to the TMZ treatment monotherapy in aggressive pituitary tumour causing Cushing's Disease could be partial and restricted to 7-8 cycles followed by rapid progression of the tumor mass. Therefore, further research should be carried out with regard to new methods to extend the responsiveness and duration of TMZ treatment and to investigate predictors of responsiveness. < p > < /p >.
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Gilis-Januszewska A, Piwońska-Solska B, Lindström J, Wójtowicz E, Tuomilehto J, Schwarz PEH, Kissimova-Skarbek K, Szybiński Z, Windak A, Hubalewska-Dydejczyk A. Determinants of weight outcomes in type 2 diabetes prevention intervention in primary health care setting (the DE-PLAN project). BMC Public Health 2018; 18:97. [PMID: 29291708 PMCID: PMC5749019 DOI: 10.1186/s12889-017-4977-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/27/2016] [Accepted: 12/05/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Real life implementation studies performed in different settings have proved that lifestyle interventions in the prevention of type 2 diabetes (DM2) can be effective, although the weight reduction results are typically modest compared to randomized control trials. Our objective was to identify the factors that predict successful weight loss in a less intensive, lower budget, real life setting lifestyle diabetes prevention intervention. METHODS Study participants (n = 175) with increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC) > 14) but no diabetes at baseline received ten group lifestyle counselling sessions, physical activity and motivation sessions during a ten-month intervention. Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of successful weight reduction defined as a reduction of ≥5% of the initial body weight. RESULTS At 12 months following the initiation of the intervention, 23.4% of study participants lost ≥5% weight (mean loss of 7.9 kg, SD = 5.8). Increased physical activity (44% vs 25%, p = 0.03), decreased total fat consumption (88% vs 65%, p = 0.006) and adherence to four-five lifestyle goals (71% vs 46%, p = 0.007) were more often reported among those who managed to lose ≥5% weight versus those who did not. In a multivariate analysis, meeting the ≥5% weight loss goal was most effective in individuals with a higher baseline BMI (OR 1.1, 95%CI 1.0-1.2), baseline and medium versus higher education (OR 5.4, 95% CI 1.2-24.7) and a history of increased glucose (OR 2.6, 95%CI 1.1-1.3). A reduction of total fat in the diet was an independent lifestyle predictor, increasing the probability of successful weight loss by 3.8 times (OR 3.8, 95% CI 1.2-11.4). CONCLUSION Baseline higher BMI, lower education and a history of increased glucose predicted the successful weight loss among individuals with a high risk for the DM2 following lifestyle intervention in a real life primary health care setting. People who manage to lose weight more often adhere to lifestyle changes, while the reduction of total fat in diet independently predicts successful weight loss. Further studies exploring the predictors of success in implementation studies in DM2 prevention should help health care providers redesign interventions to improve their effectiveness and outcomes. TRIAL REGISTRATION ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland.
| | - Beata Piwońska-Solska
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare(THL), Helsinki, Finland
| | - Ewa Wójtowicz
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria.,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Dasman Diabetes Institute, Dasman, Kuwait
| | - Peter E H Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University Dresden, Dresden, Germany
| | - Katarzyna Kissimova-Skarbek
- Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Medical College, Krakow, Poland
| | - Zbigniew Szybiński
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University, Medical College, ul. Kopernika 17, 31-501, Krakow, Poland
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Gilis-Januszewska A, Kluczyński Ł, Wilusz M, Pantofliński J, Turek-Jabrocka R, Pach D, Hubalewska-Dydejczyk A. Pituitary insufficiency following traumatic thoracic injury in an adolescent male patient: A case report and literature review. Medicine (Baltimore) 2017; 96:e8406. [PMID: 29095270 PMCID: PMC5682789 DOI: 10.1097/md.0000000000008406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Traumatic thoracic injuries in adolescents are rare but could be connected with traumatic brain injuries (TBI) and development of chronic hypopituitarism. Early recognition of these endocrine problems is a significant challenge to clinicians. We present difficulties in diagnosis of hypothalamic-pituitary insufficiency following traumatic thoracic injury in adolescence. We also review the literature of similar cases. PATIENT CONCERNS We present a case of a 24-years-old male. In 2007, at the age of 15 he underwent a severe traffic accident followed by thoracic injury with concussion, hemothorax and dissection of the aorta requiring aortic stent-graft implantation. DIAGNOSES During the post-traumatic period, transient polydipsia and polyuria symptoms were observed. The patient had no medical history of any serious disease before the accident, his growth and pubertal development was normal. After the accident the patient did not undergo any routine medical check-ups. In 2013 gonadal axis deficiency was diagnosed during investigation of libido problems. Following the diagnosis testosterone replacement therapy was initiated. INTERVENTIONS Further endocrinological investigation was carried out in 2016. The patient's main complaints were decreased mood and poor physical fitness. BMI was 27.34 kg/m, with a tendency to abdominal fat distribution. The patient's height is 160 cm, while Mid Parental Height (MPH) is 173.5 cm. Decreased bone density was found in DEXA examination. Serum growth hormone level (GH) was normal while insulin-like growth factor-1 (IGF-1) level was below normal. Insulin tolerance test (ITT) and low levels of IGF-1 confirmed somatotropic axis deficiency. Nuclear magnetic resonance (NMR) of the hypothalamo-pituitary region showed no abnormalities. PROP 1 and other common genetic mutations associated with GH deficits were excluded. Testosterone treatment was continued. The patient increased physical activity and implemented diet. OUTCOMES The patient has lost weight, improved physical activity performance and is feeling better. The procedure to start GH supplementation is now in process. LESSONS Based on our case and available literature we suggest that adolescent patients after traumatic brain injuries may require precise investigation and strict monitoring due to the possibility of unrecognized hypopituitarism.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | - Łukasz Kluczyński
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | | | | | - Renata Turek-Jabrocka
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | - Dorota Pach
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | - Alicja Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
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Gilis-Januszewska A, Piątkowski J, Skalniak A, Piwońska-Solska B, Nazim J, Pach D, Przybylik-Mazurek E, Sowa-Staszczak A, Starzyk J, Hubalewska-Dydejczyk A. Noninsulinoma pancreatogenous hypoglycaemia in adults--a spotlight on its genetics. Endokrynol Pol 2017; 66:344-54. [PMID: 26323472 DOI: 10.5603/ep.2015.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/16/2014] [Indexed: 11/25/2022]
Abstract
Hyperinsulinaemic hypoglycaemia (HH) is also classically referred to as "nesidioblastosis". Heterogeneous clinical manifestation of the disease causes risk of late diagnosis or even misdiagnosis. In infants and children, it can lead to serious and permanent damage to the central nervous system, which leads to the manifesting mental retardation. HH is characterised by unregulated insulin secretion from pancreatic β-cells. This effect has been correlated with nine genes: ABCC8, KCNJ11, GCK, GLUD-1, HADH1, SLC16A1, HNF4A, HNF1A, and UCP2. Mutations in these genes were found in approximately 48% of cases. The genetic background of the remaining cases is unknown. Understanding the genetic basis of familial hyperinsulinism has changed the early look at the disease. It has allowed for the differentiation of specific types of the disease. Depending on which of the nine disease-associated loci bears a pathogenic mutation, they differ in phenotype and pattern of inheritance. This review provides a brief overview of the genetic mechanisms of HH and its possible clinical presentations.
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Gilis-Januszewska A, Lindström J, Tuomilehto J, Piwońska-Solska B, Topór-Mądry R, Szybiński Z, Peltonen M, Schwarz PEH, Windak A, Hubalewska-Dydejczyk A. Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. BMC Public Health 2017; 17:198. [PMID: 28202029 PMCID: PMC5312576 DOI: 10.1186/s12889-017-4104-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/03/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Real life implementation studies performed in different settings and populations proved that lifestyle interventions in prevention of type 2 diabetes can be effective. However, little is known about long term results of these translational studies. Therefore, the purpose of this study was to examine the maintenance of diabetes type 2 risk factor reduction achieved 1 year after intervention and during 3 year follow-up in primary health care setting in Poland. METHODS Study participants (n = 262), middle aged, slightly obese, with increased type 2 diabetes risk ((age 55.5 (SD = 11.3), BMI 32 (SD = 4.8), Finnish Diabetes Risk Score FINDRISC 18.4 (SD = 2.9)) but no diabetes at baseline, were invited for 1 individual and 10 group lifestyle counselling sessions as well as received 6 motivational phone calls and 2 letters followed by organized physical activity sessions combined with counselling to increase physical activity. Measurements were performed at baseline and then repeated 1 and 3 years after the initiation of the intervention. RESULTS One hundred five participants completed all 3 examinations (baseline age 56.6 (SD = 10.7)), BMI 31.1 (SD = 4.9)), FINDRISC 18.57 (SD = 3.09)). Males comprised 13% of the group, 10% of the patients presented impaired fasting glucose (IFG) and 14% impaired glucose tolerance (IGT). Mean weight of participants decreased by 2.27 kg (SD = 5.25) after 1 year (p = <0.001). After 3 years a weight gain by 1.13 kg (SD = 4.6) (p = 0.04) was observed. In comparison with baseline however, the mean total weight loss at the end of the study was maintained by 1.14 kg (SD = 5.8) (ns). Diabetes risk (FINDRISC) declined after one year by 2.8 (SD = 3.6) (p = 0.001) and the decrease by 2.26 (SD = 4.27) was maintained after 3 years (p = 0.001). Body mass reduction by >5% was achieved after 1 and 3 years by 27 and 19% of the participants, respectively. Repeated measures analysis revealed significant changes observed from baseline to year 1 and year 3 in: weight (p = 0.048), BMI (p = 0.001), total cholesterol (p = 0.013), TG (p = 0.061), fasting glucose level (p = 0.037) and FINDRISC (p = 0.001) parameters. The conversion rate to diabetes was 2% after 1 year and 7% after 3 years. CONCLUSIONS Type 2 diabetes prevention in real life primary health care setting through lifestyle intervention delivered by trained nurses leads to modest weight reduction, favorable cardiovascular risk factors changes and decrease of diabetes risk. These beneficial outcomes can be maintained at a 3-year follow-up. TRIAL REGISTRATION ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland.
| | - Jaana Lindström
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria.,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.,Dasman Diabetes Institute, Dasman, Kuwait
| | - Beata Piwońska-Solska
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland
| | - Roman Topór-Mądry
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Szybiński
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland
| | - Markku Peltonen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Peter E H Schwarz
- Department for Prevention & Care of Diabetes, Medical Clinic Unit III, University Clinic Carl Gustav Carus at Technical University DreSDen, DreSDen, Germany
| | - Adam Windak
- Department of Family Medicine, Chair of Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland
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Turek-Jabrocka R, Szafraniec K, Pach D, Piwońska-Solska B, Gilis-Januszewska A, Kieć-Klimczak M, Hubalewska-Dydejczyk A. Metabolic syndrome as a useful tool in the identification of persons with an increased risk of nonfatal cardiovascular events in the Polish urban population — a prospective study. Folia Cardiologica 2016. [DOI: 10.5603/fc.2016.0067] [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: 11/25/2022] Open
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Skalniak A, Sokołowski G, Jabrocka-Hybel A, Piątkowski J, Białas M, Gilis-Januszewska A, Pach D, Hubalewska-Dydejczyk A. A novel in-frame deletion in MEN1 (p.Ala416del) causes familial multiple endocrine neoplasia type 1 with an aggressive phenotype and unexpected inheritance pattern. Mol Med Rep 2016; 14:2061-6. [PMID: 27430871 DOI: 10.3892/mmr.2016.5462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/15/2016] [Indexed: 11/05/2022] Open
Abstract
The present study describes a family with multiple endocrine neoplasia type 1 (MEN1) caused by a previously undescribed in-frame deletion c.1246_1248delGCC (Ala416del) in the MEN1 gene. Evidence for the pathogenic character of this mutation, which triggers an aggressive clinical outcome, is demonstrated. Aggregation analysis in the tested family was strongly suggestive of causality of the detected mutation. This was supported by the analysis of LOH (loss of heterozygosity) in tumor-derived DNA and by computational analysis of the functional and structural implications of the mutation. Different phenotypic characteristics were identified among family members, which is typical for MEN1. Additionally, an unexpected disease inheritance pattern was observed in this kindred, in which either all or none of the siblings of one branch inherited the disease.
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Affiliation(s)
- Anna Skalniak
- Department of Endocrinology, Jagiellonian University Medical College, 31‑501 Krakow, Poland
| | | | - Agata Jabrocka-Hybel
- Department of Endocrinology, Jagiellonian University Medical College, 31‑501 Krakow, Poland
| | - Jakub Piątkowski
- Department of Endocrinology, Jagiellonian University Medical College, 31‑501 Krakow, Poland
| | - Magdalena Białas
- Department of Pathomorphology, Jagiellonian University Medical College, 31‑501 Krakow, Poland
| | | | - Dorota Pach
- Department of Endocrinology, Jagiellonian University Medical College, 31‑501 Krakow, Poland
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Kiec-Klimczak M, Malczewska-Malec M, Razny U, Zdzienicka A, Gruca A, Goralska J, Pach D, Gilis-Januszewska A, Dembinska-Kiec A, Hubalewska-Dydejczyk A. Assessment of incretins in oral glucose and lipid tolerance tests may be indicative in the diagnosis of metabolic syndrome aggravation. J Physiol Pharmacol 2016; 67:217-226. [PMID: 27226181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/12/2016] [Indexed: 06/05/2023]
Abstract
Incretins stimulated by oral meals are claimed to be protective for the pancreatic beta cells, to increase insulin secretion, to inhibit glucagon release, slow gastric emptying (glucagon-like peptide-1) and suppress appetite. Recently it has however been suggested that glucagon-like peptide-1 (GLP-1) is putative early biomarker of metabolic consequences of the obesity associated proinflammatory state. The study was aimed to compare the release of incretins and some of early markers of inflammation at the fasting and postprandial period induced by functional oral glucose as well as lipid load in healthy controls and patients with metabolic syndrome (MS) to see if functional tests may be helpful in searching for the inflammatory status of patients. Fifty patients with MS and 20 healthy volunteers (C) participated in this study. The 3-hour oral glucose (OGTT) and the 8-hour oral lipid (OLTT) tolerance tests were performed. At fasting leptin and adiponectin, as well as every 30 minutes of OGTT and every 2 hours of OLTT blood concentration of GLP-1, glucose-dependent insulinotropic polypeptide (GIP), glucose, insulin, triglycerides, free fatty acids, glutathione peroxidase, interleukin-6, sE-selectin, monocyte chemoattractant protein-1 (MCP1) and visfatin were measured. At fasting and during both OGTT and OLTT the level of incretins did not differ between the MS and the C group. Both glucose and lipids reach food activated incretins secretion. Glucose was the main GLP-1 release activator, while the lipid load activated evidently GIP secretion. A significantly larger AUC-GIP after the lipid-rich meal over the carbohydrate meal was observed, while statistically bigger value of AUC-GLP-1 was noticed in OGTT than in OLTT (P < 0.001) within each of the investigated groups. In patients with the highest fasting plasma GIP concentration (3(rd) tertile), IL-6, MCP-1, sE-selectin and visfatin blood levels were increased and correlated with glutathione peroxydase, leptin/adiponectin ratio, higher visfatin and interleukin-6 levels. The fat containing meals stimulate the long-lasting release of incretins, mainly GIP, parallel to the increase of the markers of low grade inflammation associating obesity in metabolic syndrome. The possibility of use of the postprandial (OLTT) GIP release measurement for the low grade inflammation progress in MS patients is suggested.
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Affiliation(s)
- M Kiec-Klimczak
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Cracow, Poland.
| | - M Malczewska-Malec
- Chair and Department of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - U Razny
- Chair and Department of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - A Zdzienicka
- Chair and Department of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - A Gruca
- Chair and Department of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - J Goralska
- Chair and Department of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - D Pach
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - A Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - A Dembinska-Kiec
- Chair and Department of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Cracow, Poland
| | - A Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University, Collegium Medicum, Cracow, Poland
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