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Background Fat mass and obesity-associated gene (FTO) polymorphism remains the strongest known genetic determinant of common obesity. However, its influence depends on ethnicity, and the FTO-mediated predisposition to other metabolic disturbances is questionable. Objectives The aim of our study was to evaluate the association between FTO rs9939609 polymorphism and metabolic syndrome in a population of Prospective Urban Rural Epidemiology (PURE) study in Poland. Material and methods We enrolled 1,097 participants of the PURE study (683 women and 414 men) from the Lower Silesian voivodeship. Anthropometrical parameters and blood pressure were measured. Blood samples were taken for an examination of lipid profile and fasting glucose level. Genomic DNA was isolated and FTO polymorphism rs9939609 was genotyped. Results Male A-allele carriers had significantly higher mean body mass, body mass index (BMI), waist-to-hip ratio (WHR), and waist and hip circumferences than men without risk allele. They were also more often diagnosed with obesity on the basis of BMI and central obesity parameters. No such influence was observed in women. There were no significant associations between FTO polymorphism and metabolic syndrome or its components. Conclusions Our results suggest a sex-specific association between FTO polymorphism and obesity traits. The occurrence of metabolic syndrome or its components was not related with FTO gene variation in our cohort.

Introduction: The aim of this study was to assess the therapeutic effect and the safety of pre surgical treatment with long-acting octreotide in patients with acromegaly. Material and methods: This project was conducted in 25 centres across Poland as a non interventional, multicentre, observational study in patients with acromegaly, in which long-acting octreotide (Sandostatin® LAR®) was administered before surgery. They were 148 patients included into the study: 88 females and 60 males aged 18–86 years (51.3 ± 13.4). Results: Eighty patients completed the study (underwent tumour surgery). The CRF included: baseline visit, four follow-up visits every three months before surgery, and two follow-up visits every three months after surgery. Sandostatin® LAR® was administered every four weeks. The efficacy measures were as follows: change of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels, number of patients fulfilling criteria of cure, and change of adenoma (micro- and macroadenomas) size during the treatment. Normalisation of GH and IGF-1 concentrations were obtained in 42.4 and 49.1% of patients at the end of medical therapy, respectively. Normalisation of GH and IGF-1 concentrations were obtained in 77.9 and 83.8% of patients after surgery, respectively. Reduction of microadenoma size was documented in 58.8% of patients, and in 70% of patients with macroadenomas at the end of medical therapy. In 74.0% of patients no pituitary tumour was shown on MRI after surgery. Conclusion: In conclusion, we have shown good surgical outcome in patients with acromegaly after pre-treatment with somatostatin analogue, and good tolerance and safety of the therapy, supporting the national recommendation for pre-surgical treatment with longacting somatostatin analogues in acromegaly patients.

BACKGROUND Plasma cholesteryl ester transfer protein (CETP) activity is often decreased in patients with hypothyroidism, whereas less is known about the phospholipid transfer protein (PLTP). We aimed to evaluate simultaneously serum CETP and PLTP activity in patients diagnosed with hypothyroidism. MATERIAL AND METHODS The selection criteria for control group members (without thyroid dysfunction) in this case to case study were levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides similar to those in study group patients (101 patients diagnosed with hypothyroidism). Serum CETP and PLTP activities were measured by homogenous fluorometric assays using synthetic donor particle substrates. RESULTS Serum CETP and PLTP activities in hypothyreotic patients were lower (p

Paget’s disease is a rare finding in Poland. It is a disorder of the osteoarticular system, which, in adults, mostly affects people over 55 years of age. The clinical picture varies, depending on the location of the lesions, making the diagnosis difficult, sometimes taking many years for a correct diagnosis to be made. In etiopathogenesis, genetic predispositions as well as viral infections play an important role. From the genetic point of view, Paget’s disease is heterogeneous, as numerous mutations are known, and the genotype to phenotype relationship is unclear. The first phase of the disease is characterized by an increased osteocytes activity, due to morphologically changed and RANKL overstimulated osteocytes. This leads to an intensification of ossification processes that occur in a chaotic manner. Therefore, the resulting bone is weak, extensively vascularized and there is an increased risk of fracture or deformity. Clinical manifestations of Paget’s disease might include pain, excessive warmth, bone deformations, degenerative lesions in the adjacent joints, compression of the neural structures, hearing loss, and dilated cardiomiopathy. Other possible complications include the development of benign and malignant bone tumors and hypercalcaemia in the case of immobilization. An elevated level of serum alkaline phosphatase, bone x-ray and bone scintigraphy are crucial in making the diagnosis. The disease should be distinguished from osteomalacia, osteoporosis, hyperparathyroidism and multiple myeloma. Bisphosphonates at doses higher than those applied for osteoporosis are an effective treatment. The occurrence of orthopedic, neurological and laryngological complications is often a reason for surgical intervention.

Background. The minor allele frequencies (MAFs) of the FTO gene vary substantially among different ethnic groups, and this variation may explain, to some degree, the differences between estimates of the effects of these alleles on body fat distribution indicators. Objectives. The aim of this study was to investigate the prevalence of fat mass and obesity associated (FTO) gene variants characterizing the structure of FTO haplotypes in a large Polish population, and to examine the influence of FTO gene variants on body fat distribution among metabolically obese normal weight (MONW) individuals, i.e. those with a normal BMI and visceral obesity. Material and Methods. A total of 854 non-obese individuals aged from 20 to 40 years, residing in three different regions in Poland, were studied. All the patients from this group were genotyped for four FTO gene variants (rs9939609, rs9930506, rs1421085 and rs1121980). Simultaneous identification of all single nucleotide polymorphisms (SNPs) was conducted using the minisequencing method with a pair of designed specific primers. Results. Over 90% of the diplotypes contain only the two most common haplotypes, in three combinations of haplotype pairs: CTAT/CTAT comprised 26.9% in women and 30.9% in men; CTAT/TCGA comprised 45.0% in women and 44.4% in men; and TCGA/TCGA comprised 19.3% in woman and 14.8% in men. The analysis of the variance in body fat distribution parameters shows no statistically significant differences between the three common haplotype pairs in either men or women. Conclusions. The young Polish population is characterized by two disparate haplotypes of common FTO gene variants: TCGA (a risk SNP haplotype), and CTAT (a protective haplotype). No significant differences were found between fat distribution indicators in relation to haplotypes in either women and men (Adv Clin Exp Med 2016, 25, 1, 33–42).

BACKGROUND Psoriasis has been shown to increase cardiovascular risk, and a contributor to this might be enhanced myocardial fibrosis promoted by the disease-associated pro-inflammatory milieu. OBJECTIVE We sought to investigate the relationship of galectin-3 (Gal-3) - a recognized mediator of fibrosis with inflammatory activation and left ventricular (LV) systolic and diastolic function in patients with psoriasis. METHODS We enrolled 102 psoriatic patients (mean age: 52.5 ± 12.6 years). Sixty-five age- and sex-matched healthy subjects served as controls. Echocardiographic assessment of myocardial function included estimation of LV longitudinal systolic deformation (GLS) and diastolic indices: tissue e' velocity and E/e' ratio. Laboratory measurements encompassed blood Gal-3, creatinine, glucose, insulin, CRP and erythrocyte sedimentation rate (ESR). RESULTS Patients with psoriasis were characterized by elevated Gal-3 (12.3 [9.3-13.4] vs. 6.3 [5.5-9.4] ng/mL in healthy controls, P < 0.001), ESR (17.0 [11.0-29.0] vs. 8.5 [6.0-13.0] mm, respectively, P < 0.001) and CRP (3.1 [1.7-10.6] vs. 1.9 [1.5-4.0] mg/L, respectively, P < 0.001), and reduced GLS (19.9 ± 3.7 vs. 22.0 ± 3.0%, respectively, P < 0.001). Progressive deterioration of GLS was demonstrated across Gal-3 tertiles. Significant associations between GLS and age (beta = -0.21, P < 0.04), Gal-3 (beta = -0.27, P < 0.01), CRP (beta = -0.22, P < 0.03), ESR (beta = -0.25, P < 0.01), waist circumference (beta = -0.22, P < 0.03) and waist-to-hip ratio (beta = -0.20, P < 0.05) were found. Stepwise multiple regression analysis revealed that the independent determinants of GLS in psoriatic patients were Gal-3 (beta = -0.24, P < 0.01) and ESR (beta = -0.21, P < 0.03). Regression-based mediation analysis demonstrated that the relationship between ESR and GLS was partially mediated by Gal-3. CONCLUSIONS Subclinical left ventricular systolic dysfunction in psoriasis, as evidenced by reduced GLS, is linked with the inflammatory upregulation, and enhanced profibrotic activity (as reflected by elevated serum Gal-3) may be involved in this process. These putative mechanisms may be responsible for the observed higher incidence of heart failure in this disease condition and should be considered as a potential target for preventive and therapeutic measures.

Introduction: The knowledge about obesity pathogenesis is insufficient. The aim of our study was to investigate environmental and individual determinants of obesity in population of PURE study from Lower Silesia. Material and methods: This was a cross sectional observation of 1064 inhabitants of Wroclaw and neighbouring rural area (671 women, 393 men), who took part in PURE study in years 2007–2010. Each participant answered PURE questionnaire and International Physical Activity Questionnaire providing information about obesity risk factors. Anthropometric measurements were collected, blood samples were taken for assessment of FTO gene polymorphism. A stepwise logistic regression analysis was performed to identify the most significant predictors of obesity. Results: 31% of the study group had obesity (BMI over 30 kg/m 2 , no difference between men and women), overweight (BMI 25–29.9 kg/m 2 ) affected 48.1% of men and 36.7% of women. Determinants of obesity in female group were: rural inhabitancy, chronic medication, unemployment, age, sedentary leisure time activity, non-smoking, hypertension in family, family related stress (p = 0.66 in the Hosmer-Lemeshow test). Determinants of obesity in male group were rural inhabitancy, chronic medication, family related stress, diabetes in family (p = 0.27 in the Hosmer-Lemeshow test). Risk factors for central obesity were similar, however in women oral contraception and physical activity were associated with lower obesity risk. Conclusions: Environmental factors, especially rural inhabitancy and family related stress were associated with higher obesity risk in our study. Employment, smoking, physical activity and use of oral contraception seemed to have protective role in women.

Wstep: Osoby z zespolem metabolicznej otylości z prawidlową masa ciala (MONW), mimo prawidlowego wskaźnika masy ciala (BMI), są narazone na powiklania typowe dla otylości. Moze to wynikac z subklinicznego stanu zapalnego, wynikającego z nadmiernego gromadzenia tkanki tluszczowej brzusznej. Celem pracy byla ocena związku pomiedzy nagromadzeniem tkanki tluszczowej, szczegolnie okolicy brzusznej, a stezeniem wybranych cytokin prozapalnych — interleukiny 6, 18 i bialka C-reaktywnego (CRP), biorących udzial w aterogenezie. Material i metody: Badaniem objeto 342 osoby (218 kobiet, 124 mezczyzn w wieku 20–40 lat, z BMI > 27 kg/m2), mieszkancow Wroclawia. Grupe podzielono ze wzgledu na wartośc wskaźnika insulinooporności (HOMA): 90 osob — grupa MONW ( HOMA < 1.69), 252 osoby — grupa kontrolna. Oceniono parametry antropometryczne, stezenia IL-6, IL-18, CRP, glukozy, insuliny oraz wskaźniki insulinowrazliwości i insulinooporności. Wyniki: Stezenie CRP bylo istotnie wyzsze w grupie kobiet MONW niz kontrolnej (3,26 vs. 1,97, p = 0,03). Stezenia IL-6 i IL-18 nie roznily sie pomiedzy grupami, zarowno u kobiet, jak i u mezczyzn. Dodatnią korelacje zanotowano miedzy stezeniem IL-6 a wskaźnikiem centralizacji tluszczu u kobiet. Stwierdzono dodatnią korelacje miedzy stezeniem CRP a BMI, wskaźnikiem talia– biodra, obwodem talii u obu plci. U kobiet istniala takze dodatnia korelacja miedzy CRP a wskaźnikami HOMA i FIRI i ujemna ze wskaźnikiem QUICKI. Wnioski: Zwiekszone gromadzenie tluszczu okolicy brzusznej u zdrowych, mlodych osob, wiąze sie z podwyzszonym stezeniem CRP. (Endokrynol Pol 2014; 65 (6): 449–455)

Obesity is an epidemic of the 21st century. The magnitude of this problem stems from its increasing prevalence and numerous metabolic complications caused by excessive fat accumulation. The pathogenesis involves both environmental and genetic factors, and FTO (fat massand obesity-associated gene) is one of the most significant among genes predisposing to obesity. The role of FTO polymorphism in the development of obesity has been confirmed in many studies, but the effect varies significantly in different ethnic groups. Moreover, the exact mechanisms of FTO influence are yet to be explained. The association between FTO and lifestyle factors such as diet and physical activity has been extensively studied in recent years. This paper presents current knowledge about the role of FTO gene in the development of obesity and type 2 diabetes in different ethnic groups and the association between FTO polymorphism and lifestyle modifications predisposing to adiposity.

We are reporting a case of 68-year-old woman with insulinoma, after a non-successful tumor surgery and a long-term diazoxide treatment. She had a lot of hypoglycemia cases, and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in the diameter, in the head of the pancreas. The patient did not agree for the repeated insulinoma surgery. Furthermore, we found a lesion in the left adrenal gland (14 mm in the diameter) and in the right lung (8 mm in the diameter). Pheochromocytoma was diagnosed on the basis of hypertension, elevated levels of normetanephrine in the 24-h urine collection, and an elevated level of norepinephrine in a plasma sample. After the left adrenal gland removal we observed lower blood pressure. Since we had revealed the presence of somatostatin receptors by the somatostatin receptors scintigraphy, we decided to control hypoglycemia by a monthly subcutaneous administration of the long-acting lanreotide. Because of higher glucose levels (300–400 mg/dl) we started an intense insulin therapy. Nowadays, the patient feels better, she has lost 20 kg of her body weight, and we have observed normal blood glucose levels during the long-term lanreotide treatment. We have noticed neither side effects nor hypoglycemic episodes and we have reduced the dose of insulin. The presented case can be an evidence of the effective treatment of the pancreatic neuroendocrine tumor of insulinoma type, with somatostatin analogue.

BACKGROUND The proper diagnosis and management of patients after surgery for pituitary tumors are of great importance in clinical practice. The purpose of this study was to investigate the magnetic resonance features of the postoperative sella with fast spin echo T2-weighted imaging and to evaluate the benefits of this sequence compared to the classically performed contrast-enhanced T1-weighted imaging at 1.5T unit. MATERIAL/METHODS The study group consisted of 101 patients who underwent resection of pituitary tumors. There were 58 women (57.4%), aged 22 to 75 (mean age, 52.67 years) and 43 men (42.6%), aged 21 to 79 (mean age, 49 years). In all patients preoperative and multiple postoperative MR studies were performed. Post-contrast T1 and pre-contrast T2 images were interpreted by 2 independent readers (neuroradiologists). RESULTS Contrast-enhanced T1-weighted imaging was significantly superior to T2-weighted imaging in assessment of infundibulum (p

Five to ten percent of women of reproductive age suffer from polycystic ovary syndrome (PCOS). Leptin, NPY, galanin, cholecystokinin (CCK) are involved in the regulation of eating behavior. PPARγ are receptors that are probably involved in hyperandrogenism. This study was designed to assess associations between the Pro12Ala PPARγ2 gene polymorphism and satiety factors in PCOS. Fifty-four PCOS women and 51 healthy women were studied. Leptin, NPY, galanin, CCK levels, and genetic studies to detect Pro12Ala PPARγ2 gene polymorphism were assessed. The leptin levels in the PCOS women carrying Pro12Ala genotype were higher than in those with Pro12Pro and Ala12Ala. The PCOS women had higher leptin and NPY levels and lower galanin levels. Obese PCOS patients had lower CCK levels. Conclusions: In the PCOS women, a single Ala allele may have a protective role as far as hyperleptinemia is concerned. The PCOS women may reveal a disrupted central leptin/NPY feedback loop with some shifts in food intake.

Myocardial fibrosis is one of the mechanisms underlying left ventricular (LV) dysfunction in obese patients and may result from dysregulation of extracellular matrix (ECM) turnover. Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) represent a regulatory system playing a crucial role in ECM metabolism.We sought to assess plasma levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 in obese young women and to evaluate the association between MMP/TIMP system components and LV function in this population.Prospective, cross-sectional study.University hospital.Seventy-one women aged35 years with body mass index30 kg m(-2) and 30 healthy slim female controls.Plasma MMP-2, MMP-9, TIMP-1 and TIMP-2 measurements and echocardiographic studies, including LV strain/strain rate evaluation.We demonstrated increased levels of MMP-9 and TIMP-1 and decreased MMP-2 in the obese population. LV dysfunction shown in patients with obesity was characterized by significantly lower values of strain/strain rate parameters. Plasma MMP-2 correlated positively and TIMP-1 negatively with systolic strain (r = 0.39, P0.001 and r = -0.40, P0.001, respectively), peak systolic strain rate (r = 0.38, P0.001 and r = -0.27, P0.03, respectively) and peak early diastolic strain rate (r = 0.40, P0.001 and r = -0.24, P0.05, respectively). Plasma MMP-2, fasting insulin and body mass index proved the only independent determinants of strain/strain rate parameters of LV systolic and diastolic performance in obese subjects.In premenopausal obese women (1) plasma MMP/TIMP profile is altered, (2) abnormalities of LV function are related to the changes in the MMP/TIMP system that might promote attenuated ECM degradation, mainly to the downregulation of MMP-2.

Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis. Patients may present with hormone excess or a local mass effect. The most common imaging techniques (CT and MRI) use both size and appearance to distinguish between benign and malignant tumors. Open surgery by an expert surgeon with R0 target is the treatment of choice. Mitotane (alone or in combination with cytotoxic drugs) may be administered after surgery or in patients not amenable to surgery. The role of radiotherapy as an adjuvant treatment is uncertain whereas targeted radionuclide therapy seems to be a promising option. New adjuvant treatment options, even after complete tumor removal, are desired because postoperative disease-free survival at 5 yrs is only around 30%. The establishment of detailed guidelines with the purpose of optimizing therapy with only mitotane but also in combination with other antineoplasmatic drugs is still a task to be done. Future advances in the management of ACC will probably be connected with better understanding of the molecular pathogenesis.

The aim The aim of this study was to determine whether polymorphisms of the VDR gene may increase the risk of Alzheimer disease (AD) development in Lower Silesian patients in comparison with other populations. Material and methods 108 AD patients (aged 73.7 ± 8.6) vs 77 healthy volunteers (aged 64.5 ± 7.8) in the Lower Silesian population were studied. We investigated the frequency of the VDR polymorphisms rs731236 (TaqI), rs7975232 (ApaI), rs10735810 (FokI) and rs1544410 (BsmI) in the AD group vs the healthy group. Afterwards, MEDLINE and ResearchGate were studied to compare our investigation with other populations, due to the relatively small group size in our study. Results We did not observe any significant differences in frequency of genotypes of rs731236 (TaqI), rs10735810 (FokI) or rs1544410 (BsmI) VDR polymorphisms between the two Lower Silesian groups. Frequency of allele A of ApaI in the control group was significantly higher vs AD patients (p

Background Subclinical hypothyroidism (SCH) is a common endocrine disorder, probably increasing cardiovascular (CV) risk. However, the relation between SCH and atherosclerosis risk factors remains unclear. Objectives The aim of the study was to evaluate selected atherosclerosis risk factors in women with SCH in comparison to a group of healthy women and women with overt hypothyroidism, as well as to investigate the influence of L-thyroxine replacement on those risk factors. Material and methods The study group consisted of 187 obese women aged between 50 and 70 years: 100 women with SCH, 45 women with overt hypothyroidism and 42 women with TSH level in reference ranges. Anthropometric parameters were evaluated. Laboratory tests included thyroid hormones concentrations, lipid profile with apolipoproteins, CRP, homocysteine. Atherosclerotic indexes were calculated: LDL C/HDL C ratio, apoA1/apoB ratio and Castelli risk index. Women with hypothyroidism were given L-thyroxine treatment and after 6 months in euthyroidism the evaluation was repeated. Results Total cholesterol, LDL-cholesterol and triglycerides concentrations as well as LDL-C/HDL-C ratio and Castelli index were higher in SCH than in controls and decreased after L-thyroxin substitution. All of the calculated atherosclerosis indexes showed significant positive correlations with TSH concentration in SCH group. Also in this group the systolic and diastolic blood pressure decreased significantly after treatment. Conclusions Dyslipidemia in obese SCH women is not severe, but if untreated for many years, it may lead to atherosclerosis. Substitution therapy improves the lipid profile, changing the relations between protective and proatherogenic fractions of serum lipids, and optimises blood pressure.

Estradiol (E2) has antioxidant properties. The role of progestins in antioxidant defense is still unknown. We have evaluated the influence of E2 and E2 plus medroxyprogesterone acetate (MPA) on serum lipid peroxide (LPO) levels, a marker of free radical reactions, and serum total antioxidant status (TAS) in postmenopausal women. Subjects consisted of 26 women with surgical menopause, before and after 4 months of estrogen replacement therapy (ERT; E2), and 54 women with natural menopause on hormone replacement therapy (HRT; E2 plus MPA). Forty premenopausal women served as a control group. Serum E2 was estimated by radioimmunoassay, follicle-stimulating hormone by IRMA methods, LPO and TAS by colorimetric methods. Before therapy, LPO levels in the postmenopausal women were significantly higher (p0.001) than in the control group. After both ERT and HRT, LPO decreased significantly and did not differ between both groups and the control group. TAS was significantly lower in postmenopausal women (p0.001) than in the control group before therapy. After both ERT and HRT, TAS increased significantly and did not differ between both groups and the control group. We conclude that oxidative stress is increased after menopause. ERT and HRT inhibit the generation of free radicals and raise antioxidant potential to the levels found in premenopausal women. MPA did not influence the antioxidant action of E2.

Wstep: Osoby z zespolem metabolicznej otylości z prawidlową masa ciala (MONW), mimo prawidlowego wskaźnika masy ciala (BMI), są narazone na powiklania typowe dla otylości. Moze to wynikac z subklinicznego stanu zapalnego, wynikającego z nadmiernego gromadzenia tkanki tluszczowej brzusznej. Celem pracy byla ocena związku pomiedzy nagromadzeniem tkanki tluszczowej, szczegolnie okolicy brzusznej, a stezeniem wybranych cytokin prozapalnych — interleukiny 6, 18 i bialka C-reaktywnego (CRP), biorących udzial w aterogenezie. Material i metody: Badaniem objeto 342 osoby (218 kobiet, 124 mezczyzn w wieku 20–40 lat, z BMI > 27 kg/m2), mieszkancow Wroclawia. Grupe podzielono ze wzgledu na wartośc wskaźnika insulinooporności (HOMA): 90 osob — grupa MONW ( HOMA < 1.69), 252 osoby — grupa kontrolna. Oceniono parametry antropometryczne, stezenia IL-6, IL-18, CRP, glukozy, insuliny oraz wskaźniki insulinowrazliwości i insulinooporności. Wyniki: Stezenie CRP bylo istotnie wyzsze w grupie kobiet MONW niz kontrolnej (3,26 vs. 1,97, p = 0,03). Stezenia IL-6 i IL-18 nie roznily sie pomiedzy grupami, zarowno u kobiet, jak i u mezczyzn. Dodatnią korelacje zanotowano miedzy stezeniem IL-6 a wskaźnikiem centralizacji tluszczu u kobiet. Stwierdzono dodatnią korelacje miedzy stezeniem CRP a BMI, wskaźnikiem talia– biodra, obwodem talii u obu plci. U kobiet istniala takze dodatnia korelacja miedzy CRP a wskaźnikami HOMA i FIRI i ujemna ze wskaźnikiem QUICKI. Wnioski: Zwiekszone gromadzenie tluszczu okolicy brzusznej u zdrowych, mlodych osob, wiąze sie z podwyzszonym stezeniem CRP. (Endokrynol Pol 2014; 65 (6): 449–455)

Free radical reactions are involved in processes connected with aging. Estradiol acts as antioxidant and free radical scavenger, but the mechanism of this action remains unknown. Estradiol has a hydroxyphenolic structure and may donate hydrogen atoms to lipid peroxyradicals to terminate chain reactions. There are a few reports concerning the influence of estradiol on natural antioxidant enzyme activity, such as superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT). The aim of this study was to estimate the relationship between the levels of estradiol and lipid peroxide (LPO), a marker of membrane lipid peroxidation, and the correlation between estradiol and erythrocyte SOD and GSH-Px activity. The study included 13 premenopausal and 13 postmenopausal healthy women. Serum levels of estradiol, follicle-stimulating hormone (FSH) and LPO, and erythrocyte SOD and GSH-Px activity were estimated in all subjects. Premenopausal women revealed significantly higher estradiol levels and lower LPO concentrations, as well as significantly higher GSH-Px activity than the postmenopausal group. SOD activity did not differ between the two groups. There was a negative correlation between serum estradiol and LPO levels as well as a positive correlation between estradiol and GSH-Px activity. These results support the hypothesis that estradiol exerts its antioxidant action not only through its chemical structure but probably also through its influence on natural cellular antioxidant enzyme activity.

The authors estimated the influence of dehydroepiandrosterone (DHEA) administration, a potential antiatherogenic agent, on serum lipids, sex hormones and insulin levels in male rabbits fed on an atherogenic diet. They concluded that (1) DHEA administration has an unfavorable impact on the serum lipid profile; (2) an atherogenic diet causes insulin resistance; (3) the glucose and insulin levels are not related to DHEA in normally fed rabbits and in rabbits with hyperlipoproteinemia; (4) an atherogenic diet causes a slight increase of estradiol concentration; (5) DHEA treatment has no significant effect on testosterone and estradiol concentrations in both normally fed rabbits and those on an atherogenic diet; (6) DHEA administration has an anti-obesity effect.

Background— Obesity predisposes to left ventricular (LV) dysfunction and heart failure; however, the risk of these complications has not been assessed in patients with a normal body mass index (BMI) but increased body fat content (normal-weight obesity, NWO). We hypothesized that LV performance in NWO may be impaired and sought to investigate potential contributors to cardiac functional abnormalities. Methods and Results— One hundred sixty-eight subjects (age, 38±7 years) with BMI 2 and no history of any disease affecting the myocardium were classified on the basis of body fat content into 2 groups: with NWO and without NWO. Echocardiographic indices of LV systolic and diastolic function, including myocardial velocities and deformation, serological fibrosis markers, indicators of proinflammatory activation, and metabolic control, were evaluated. Subjects with NWO demonstrated impaired LV systolic and diastolic function, increased fibrosis intensity (assessed by procollagen type I carboxy-terminal propeptide [PICP]), impaired insulin sensitivity, and increased proinflammatory activation as compared with individuals with normal body fat. The independent correlates of LV systolic and diastolic function variables were as follows: for strain, IL-18 (β=−0.17, P P P P P P P P P P Conclusions— In patients with NWO, subclinical disturbances of LV function are independently associated with the extent of abdominal fat deposit, profibrotic state (as reflected by circulating PICP), reduced insulin sensitivity, and proinflammatory activation.

Subclinical hyperthyroidism is a clinical condition with a laboratory diagnosis defined as a suppressed below the normal range TSH level and normal free thyroxine and triiodothyronine levels. The condition is frequently recognized but its long-term clinical consequences are constantly debated. There is little good evidence available to guide the management of patients with subclinical hyperthyroidism. This review summarizes current state of knowledge on the prevalence, aetiology, clinical consequences and treatment of subclinical hypertyroidism.

The pathogenesis of PCOS has not been definitively determined and includes a number of genes linked with steroidogenesis, regulation of gonadotropin secretion, actions of insulin, obesity as well as chronic inflammatory processes. Some authors indicate that PPARgamma play a role in insulin sensitivity and are probably involved in hyperandrogenism in PCOS. The aim of the study was to assess the frequency of the Pro12Ala and Pro115Gln PPARgamma2 gene polymorphisms in women with PCOS.54 PCOS women and 51 healthy women were recruited. Genetic studies to detect Pro12Ala and Pro115Gln PPARgamma2 gene polymorphism were performed.In the whole studied group the Pro115Gln polymorphism of the PPARgamma2 gene was not found. The frequency of the Pro12Ala polymorphism was estimated at 26.47% in the controls and at 23.15% in the PCOS patients. Women from the control and PCOS groups with BMIor = 30 had statistically higher occurrence of the Ala allele than women with BMI30 (38.80% versus 12.50% and 38.23% versus 18.75%).The frequency of the Pro12Ala polymorphism observed in the sample of women from the Lower Silesian population was significantly higher than in the majority of European populations.

Pituitary abscess is a rare pituitary pathology which may be potentially life-threatening if not treated. Therefore, early accurate diagnosis and therapy are extremely important. However, the clinical diagnosis is difficult because there are no clinical symptoms characteristic of pituitary abscess. It is frequently indistinguishable clinically or with neuroimaging studies from other pituitary lesions. The MR diagnosis of pituitary abscess must be suspected in cases of sellar cystic mass with a peripheral rim enhancement after contrast administration. It must be highlighted that pituitary abscess may show various signal intensity on T1-weighted images, as in our case, making the diagnosis even more difficult. We report an unusual case of a 66-year-old woman who presented with a recurrent pituitary abscess, initially misdiagnosed as a pituitary adenoma because of its high signal intensity on T1-weighted images. The woman was operated on three times, using transsphenoidal access with a good final outcome.

Homozygosity for interleukin-6 (IL-6) 174G_C promoter polymorphism has recently been associated with indices of metabolic syndrome; however, this problem has not been investigated in non-obese subjects. The aim of this study was to explore the relation between abdominal fat distribution and some inflammatory risk factors of atheromatosis and IL-6 174G_C gene polymorphism in non-obese healthy subjects.Relationships were investigated between anthropometric variables, i.e. weight, height, BMI, waist circumference (WC), waist-to-hip ratio (WHR), body fat distribution (DXA), serum CRP and IL-6, insulin sensitivity/resistance indices, and IL-6 174G_C gene polymorphism, in healthy non-obese Polish subjects: 232 women (age 31.4 +/- 5.5 years) and 199 men (age 30.3 +/- 6.0 years).The genetic study revealed that the CC genotype was observed in 15.56% of subjects, the CG genotype in 52.74%, and the GG genotype in 31.7%. IL-6 and CRP concentration did not differ among the genotypes. There were also no differences regarding BMI and WHR. The only differences among genotypes, observed only in men, were those concerning total fat (CC had higher fat content than CG and GG); the difference being statistically significant between CC and GG (p0.05), and gynoidal fat deposit (CC had higher gynoidal fat deposit than CG and GG); the difference being statistically significant between CC and GG (p0.025) and between CC and CG (p0.05). Biochemical parameters and insulin sensitivity did not differ among the genotypes.These data show that IL-6 174G_C polymorphism is not associated with features describing metabolic syndrome in nonobese healthy subjects.

Pheochromocytoma is rare tumor with a highly variable clinical presentation. This report provides clinical picture, efficiency of diagnostics and treatment of pheochromocytoma in 8-years in the endocrinological center in Wroclaw.The records of 37 patients with pheochromocytoma were identified, who were treated in 2000-2007 in the Department of Endocrinology, Diabetology and Isotope Treatment in Wroclaw. There were 23 women (age 23-75 year) and 14 men (age 17-74). We studied frequency of clinical signs, usefulness of diagnostic methods and efficacy of treatment.The duration of the clinical history ranged from 2 months to 16 years. The most frequent symptoms were: hypertension paroxysmal and constant, palpitations, headache, sweating and anxiety. The most sensitive diagnostic method was increased concentration of urinary metanephrine in 24-hour urine. Computed tomography was the most widely used method for tumor localization. Adrenal pheochromocytoma was detecting by CT in all patients, predominated in right adrenal, in 1 case in urinary bladder. Surgery caused remission of hypertension in 59%, improvement in 26.8%, and no changes in 13.9% of patients. Malignancy was reported in 2 cases, 1 woman died after surgery. MEN 2A occur in 21.6%.The diagnosis of pheochromocytma is usually made after long duration of the disease. The study confirms that clinical presentation of pheochromocytoma is variable and nonspecific, this finding makes the diagnosis very difficult. The most typical symptom is paroxysmal hypertension, which is present only in 40%, other symptoms are nonspecific. The measurement of 24-hour urinary metanephrines was the best indicator. CT was almost always successful in localizing the tumor. Patients with pheochromocytoma should be consider for other endocrine diseases especially medullary carcinoma, primary hyperparathyroidism and other component of MEN 2A.

Receptor CD36 is involved in foam cells formation and in atherogenesis. Visceral obesity is important risk factor of accelerated atherosclerosis. There are no data about the role of CD36 in pathogenesis of atherosclerosis in women with visceral obesity. The aim of the study was to assess the impact of visceral obesity on CD36 expression on peripheral blood monocytes.CD36 expression was evaluated (by flow cytometry) in study population consisted of 30 women aged 25-45 years (mean 34.03 +/- 11.14) with visceral obesity. Control group consisted of 15 nonobese women aged 25-45 years (mean 31.93 +/- 2.43). Physical examination was performed with body mass, BMI, waist and hip circumferences, waist to hip ratio evaluation. Oral glucose tolerance test was performed with estimation of glucose and insulin concentrations.Body mass, BMI, WHR, waist and hip circumferences were significantly higher in obese than in nonobese women. Glucose and insulin concentrations in 0', 30' 60' of OGTT as well as HOMA and FIRI values were significantly higher in obese than in nonobese women. Expression of CD36 on monocytes was significantly lower in obese women (mean 62.99 +/- 18.07) than in controls (mean 82.5 +/- 22.93). There were not significant correlations between CD36 expression and BMI, WHR and IR indexes.Expression of scavenger receptor CD36 on monocytes in obese women is significantly lower than in lean individuals. This observation needs further investigations.

Estrogens have some anti-atherosclerotic prop- erties and they influence nitric oxide (NO) production. The aim of this study was to determine NOx levels in post-meno- pausal women and the effect of estrogen/estrogen-proges- teron therapy (ET/EPT) on plasma NO levels. Eighty post- menopausal women (M1) comprising 26 with surgically in- duced menopause (ET1), mean age 50.9±2.9 yr, and 54 with physiological menopause (EPT1), mean age 50.5±3.0 yr, were studied. Forty healthy pre-menopausal women, mean age 48.3±2.3 yr were the controls (C). The post-menopausal wom- en were treated for 4 months: group ET1 with ET and group EPT1 with EPT. Serum estradiol (E2), FSH, NOx and lipid pro- file before and after therapy were measured. NOx levels were lower in group M1 than in group C (8.75±1.57 vs 10.27±2.62, p

We presented a case of a 58 year old women suffering from three diseases: primary hyperparathyroidism, Marfan's syndrome and von Willebrand's disease. The coexistence of these diseases is not mentioned in medical literature. Because of the coexistence of Marfan's syndrome with primary hyperparathyroidism, the examinations of other endocrinopathy including multiple endocrine neoplasia (MEN). Their coexistence was not confirmed at the present time. In this paper the new views on both patogenesis and treatment of the mentioned diseases were included.

Most research confirms that metformin therapy has a positive influence on cardiovascular risk factors (CVRF) such as dyslipidemia, insulin resistance and hyperandrogenism in polycystic ovary syndrome (PCOS). The aims of the present study were to establish other CVRF, such as plasma adiponectin, tumor necrosis factor-alpha (TNFalpha), interleukin-6 (IL-6) and C-reactive protein (CRP) levels, in obese premenopausal women with PCOS and to investigate the effect of metformin treatment on these factors.The study group consisted of 29 PCOS woman with body mass index (BMI)25 kg/m(2). They were treated over 6 months with 500 mg metformin twice daily. Twenty-nine healthy individuals matched for age and BMI were controls. Adiponectin, TNFalpha, IL-6 and CRP levels were examined in all PCOS (before and after treatment) and control women.In the PCOS group significantly lower plasma adiponectin and TNFalpha levels were observed, whereas there were no differences in plasma IL-6 and CRP levels between PCOS and control groups. Plasma adiponectin increased significantly after metformin treatment, but levels of inflammatory factors did not change.

Somatostatin analogs, dopamine agonists and GH-receptor antagonist--pegvisomant are used in medical therapy of acromegaly. Since pegvisomant has not antitumor effect, the combination of pegvisomant and somatostatin analog could be an attractive option. Aim of study was to assess the effects of pegvisomant and octreotide LAR treatment on GH and IGF-1 levels, and glucose tolerance in acromegaly, and to assess efficacy and tolerability of rapid (after 7 days) pegvisomant dose titration.Six patients (4 men, 2 women) aged 47.5 years (median) with active acromegaly, after neurosurgery failed, resistant to maximal doses of octreotide, received daily 10-20 mg pegvisomant throughout 2 weeks. They were given octreotide LAR 30 mg monthly for at least 6 months before pegvisomant therapy. Clinical symptoms, GH, IGF-1, fasting glucose and insulin levels were measured on the 0, 8th and 15th day of pegvisomant therapy. On the 8th day pegvisomant dose was titrated based on serum IGF-1 level.IGF-1 levels reduced from 739 at the beginning to 418 ng/ml (medians) on the 15th day of treatment and normalized in one patient. These changes were associated with improvement of glucose metabolism. One diabetic patient could even stop insulin therapy.Pegvisomant is an attractive adjuvant therapy for controlling acromegaly. Pegvisomant improves insulin sensitivity as well as glucose tolerance. The GH receptor antagonist is good option for patients with active acromegaly coexistent with disturbances of glucose metabolism, especially with diabetes mellitus. Rapid pegvisomant dose increasing to efficient or maximal is well tolerated and effective.

The aim of study was to evaluate the influence of sex hormones: estradiol (E), follicle-stimulating hormone (FSH), progesterone (P), testosterone (T), dehydroepiandrosterone (DHEA-S) and cortisol (F) on the serum homocysteine concentration (HCY) in 40 premenopausal (group M) and 80 postmenopausal (group K) women. The influence of E2 therapy (ET) on the serum HCY level in the women with surgical menopause was also estimated. The plasma HCY concentration in the group M was significantly higher that in group K. After ET serum HCY level decreased significantly. No correlations were found between serum HCY and E2 concentrations in the all groups. No correlations were observed between HCY and FSH, P, T and F concentrations in pre-and postmenopausal groups. There was a significant negative correlation between serum HCY and DHEA-S concentration in group K. This result may indicate, that high level of DHEA decreases HCY concentration. There was no correlation in group M, where the mean concentration of DHEA was lower than in group K. The results of study indicate, that menopause increases and ET decreases plasma HCY concentration. DHEA-S may inhibit plasma HCY concentration in premenopausal women. More studies are needed to elucidate these hypotheses.

Acromegaly is a rare disease with increased mortality rate. The aim was to present our centre experience in the diagnosis and treatment of a series of patients suffering from acromegaly.130 patients (55 men, 75 women) aged 19-84 years presenting with clinical and hormonal features of acromegaly, attending Department of Endocrinology and Out-patient Clinic between 1990 and 2004 were studied. They were analyzed their GH and IGF-1 levels, CT and MRI scans, and they were administered medical therapy, neurosurgery and radiotherapy.We have observed 106 macro-, 16 microadenomas and 1 case of ectopic GHRH. 115 patients were operated, as cured were recognized 74 of them. Pituitary irradiation was applied to 11 patients, in 4 of them it did not cure the disease. Medical therapy was efficacious in 12% patients treated with bromocriptine, 73% with long-acting lanreotide and 58% with long-acting octreotide. In 7 patients other malignant neoplasm were detected. 11 patients died during the follow-up.There is possible underdiagnosis of acromegaly in our region, especially in males. We have observed better diagnostic opportunities in recent years when MRI was available. It was accompanied by better outcome of surgical and pharmacological treatment and better control of the complications of the disease.

Hipercortisolemia in pregnancy occurs rarely because of menstrual disturbances and infertility in subjects with Cushing syndrome. The diagnosis of pathological hipercorisolemia in pregnant women is often difficult because some symptoms of the disease may be associated with complicated pregnancy. Hipercortisolemia causes weight gain, especially trunk obesity with thin extremities, arterial hypertension, glucose intolerance, purple-blue skin striae and hirsutism. Hormonal and radiological diagnostic in pregnancy is limited. Results of hormonal estimations and of dynamic tests are difficult to interpret because of physiological changes in the hypothalamo-pituitary-adrenal axis connected with pregnancy. Interpretation of magnetic resonance imaging of pituitary gland should include hypertrophy of pituitary gland connected with pregnancy. The choice of optimal time and method of treatment should be cautious and individualized because of the possibility of maternal and fetal complications.

Summary Objective Data concerning the relationship between sex steroid hormones and the cellular antioxidative enzyme system are controversial. We investigated the effects of oestradiol deficiency after menopause and the influence of transdermal oestradiol therapy (ET) and hormonal (oestradiol plus medroxyprogesterone) replacement therapy (HT) on erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT). GSH and selenium (Se) concentrations were also estimated. Serum lipid peroxide (LPO) levels were measured as an indicator of free-radical production and lipid peroxidation. Patients The study group consisted of 80 postmenopausal women, divided into two subgroups: 26 women with surgically induced menopause (ET1) and 54 women with physiological menopause (HT1). Forty premenopausal healthy volunteers were controls (C group). Results LPO was higher in postmenopausal women and decreased after both ET and HT. GSH-Px and GSH were lower in the postmenopausal groups but increased significantly after both types of therapy. Se concentrations did not differ significantly among the groups. CAT activities were similar in all groups and decreased after ET and HT. SOD activities in postmenopausal women were similar to those in the C group and did not change significantly after treatment. Conclusions The administration of natural oestrogens to postmenopausal women diminishes oxidative stress and increases antioxidative cell potency.

Hyperandrogenism is a multifactoral chronic disease, characterised by an androgen excess, often connected with obesity, hirsutism, polycystic ovaries, hyperinsulinemia, insulin resistance and hyperleptynemia. Peroxisome proliferator activated receptors (PPARgamma) are one of the factors influencing insulin sensitivity. As a transcriptional factor it plays a crucial role in the regulation of genes involved in insulin action. The aim of this study was to evaluate the frequency of PPARgamma Pro12Ala and Pro115Gln polymorphisms in hyperandrogenic women. The additional aim was to investigate differences in leptin levels in healthy and FOH (functional ovarian hyperandrogenism) women (non-obese and obese).we investigated 90 women: 72 healthy women (37 nonobese and 35 obese)--control group, and 18 women with FOH (9 nonobese and 9 obese)--FOH group. We performed anthropological examination: BMI, WHR and total-body densytomery, biochemical and hormonal estimations in the whole group. PPARgamma polymorphism was studied using PCR and RFLP.in the control group Pro12Pro ("wild" type) was observed in 45 women (26 obese and 19 nonobese) - 62.5% of the group. Heterozygosity Pro12Ala was observed in 15 women (20.8%): 4 obese and 11 with BMI30 kg/m2, homozygosity Ala12Ala was seen in 12 women (16.6%): 5 obese i 7 nonobese. In FOH group "wild" type was discovered in 9 women (4 obese and 5 nonobese) - 50% of FOH group, heterozygosity Pro12Ala was seen in 5 women (27.7%): 2 obese and 3 with BMI30 kg/m2, homozygosityAla12Ala was observed in 4 women (22.2%): 3 obese and in 1 non-obese. Ala allel frequency in control group was 28%. (37% in non-obese and 20% in obese). In FOH group Ala allel frequency was 36% (nonobese - 28%, obese - 44%). In the studied group we did not find Pro115Gln polymorphism. Leptin level in control group was 19.92 +/- 14.3 ng/ml, and in FOH group - 23.41 +/- 19.47 ng/ml. Depending on BMI leptin level in non-obese healthy group was 7.45 +/- 3.76 ng/ml, in non-obese FOH women - 18.33 +/- 16.54 ng/ml, p0.005. In obese controls leptin level was 43.6 +/- 17.28 ng/ml, and in obese FOH women - 45.72 +/- 14.89 ng/ml.Leptin level in non-obese FOH women is significantly higher than in lean healthy controls. This difference was not observed in obese women. However the Pro12Ala polymorphism is quite common; it does not seem to be directly related to the obesity connected with hyperandrogenism. Higher frequency of Ala allele In FOH women compared to healthy controls (36% vs 28%) may at least partially explain the beneficial effect of tiazolidinediones in the treatment of hyperandrogenism.

The authors presented a case of 52-years old woman with advanced adrenocortical carcinoma completely recovered after surgical resection followed by chemotherapy and mitotane treatment. Two years later metastatic tumor of hepar was excised. From the first diagnosis - patient lives 12 years, without any symptoms of recurrence until now. The authors accentuate a big value of postoperative control, especially imaging studies for early diagnosis of recurrent of cancer and beginning therapy.

Elevated plasma homocysteine (Hcy) concentration is a risk factor for atherosclerosis and venous thrombosis.an observational study.120 healthy women were recruited and divided in two subgroups--postmenopausal women (M-80 women) and premenopausal women (40 women) with normal menstruation as control group. 26 women with surgical menopause were treated with percutaneous estrogen therapy and remaining 54 women were treated with estro-progestagen replacement therapy. Measurements of FSH and estradiol was made using radioimmunoassay. HCY was assessed using enzymatic conversion method.Concentrations of Hcy and lipid peroxides (LPO) in postmenopausal study group were higher than in the premenopausal. Treatment with estradiol (E2) alone or in combination with medroxyprogesterone acetate decreased LPO and Hcy concentrations to levels observed in premenopausal group.Our results suggest that estrogens have a profound influence on Hcy and LPO levels. Reduction in Hcy levels after treatment lowers the production of free radicals and thus contributes to lipid peroxidation decrease and LPO levels reduction after therapy. A practical conclusion may be proposed: in postmenopausal women with elevated Hcy levels who require hormonal replacement therapy, Hcy level control is indicated in order to administer such a therapy, which decreases Hcy concentrations.

A case of 24-year old woman with chronic renal failure and primary hypoparathyroidism is presented. Primary hypothyroidism and bilateral hypoacousis were also found. Typically concomitant with chronic renal failure is development of secondary hyperparathyroidism and its co-morbidities, i.e. renal osteodystrophy that consists of osteomalacia, osteoporosis and pathological fractures. In case of some patients with very high concentration of parathormone (PTH) and with signs of renal osteodystrophy, which is the case of tertiary hyperparathyroidism, subtotal parathyroidectomy is the optimal treatment. Reduction of PTH concentration protects bones from further destruction and from accumulation of calcium phosphate in tissues. The accompanying primary parathyroid failure would probably protect from the further consequences of PTH over-production--renal osteodystrophy. The case is reported in view of a rare occurrence of such co-existence, lack of its description in Polish literature as well as diagnostic difficulties.

Atherosclerosis is a progressive pathological process based on endothelial dysfunction and chronic inflammation. Monocytes, macrophages, and modified lipoproteins, especially oxidized LDLs (oxLDLs), play a fundamental role in the pathogenesis of atherosclerosis. Monocytes evolve into macrophages in the vascular wall and then accumulate oxLDLs, forming foam cells. OxLDLs are toxic and activate foam cells, stimulate the replication of macrophages and their migration into atherosclerotic plaque, and increase the expression of metaloproteinases. Macrophages bind oxLDLs through many types of receptors, among them scavenger receptors. One of these is CD36, a membrane glycoprotein expressed by endothelial cells, adipocytes, smooth and skeletal muscle cells, cardiomiocytes, platelets, monocytes, and macrophages. CD36 recognizes and binds many ligands, such as oxLDLs, long-chain fatty acids, collagen, thrombospondin 1, apoptotic cells, anionic phospholipids, and Plasmodium falciparum-infected erythrocytes. CD36 is involved in many processes, e.g. inner immune system responses, removal of apoptotic cells and Plasmodium falciparum-infected erythrocytes, and the transport of long-chain fatty acids, and it also mediates collagen and thrombospondin action. Recent reports indicate that CD36 may play a role in the development of atherosclerosis. An animal model revealed that lack of CD36 expression restrains atheroslerosis. Increased expression of CD36 was shown in atheroslerotic plaque and damaged vascular tissue. Contradictory data about the effects of antiatherosclerotic drugs on CD36 expression indicate the necessity for further investigation of the role of CD36 in the development of atherosclerosis.

Chronic lymphocytic leukemia (CLL) is characterized by the clonal proliferation of small mature lymphocytes with their accumulation in blood, bone marrow, lymph nodes, spleen and lien. In advanced stages of CLL, the leukemic metastases can occur in skin, pleura and lungs. They are often strictly connected with disease progression and are present with advanced lymphadenopathy and hepatosplenomegaly, high leukocytosis 100G/1 with 80-90% lymphocytes in blood smear, anemia Hb10 g% and thrombocytopenia PLT100 G/L. In this article we present two CLL patients with non typical leukemic metastases localization in bulbus oculi, vertebral column (case 1) and in thyroid gland and trachea (case 2), that occurred in hematological stabilization phase of disease during normal lymphocytes number or a little lymphocytosis in peripheral blood and a lack of progression in lymphoid organs.

Glucose metabolism disorders are significant risk factors for accelerated atherosclerosis, but the exact pathogenesis of this impact and possible co-factors are not precisely known. On the other hand, only two thirds of all atherosclerosis cases are linked to so-called "classic" risk factors, and numerous studies are conducted to recognize those non-classic risk factors, among which homocysteine and adhesive molecules are the most often mentioned. Recently, the class B scavenger receptor CD36 has become an object of interest. Receptor CD36 is a membrane glycoprotein found on the surface of many cells, such as endothelial cells, cardiomyocytes, dendritic cells, platelets, monocytes, and macrophages. Ligands for receptor CD36 are oxidized LDL particles, long-chain fatty acids, collagens, thrombospondin I, apoptotic cells, and phospholipids. Receptor CD36 plays an important role in various processes, e.g. inner immune system response, apoptotic and necrotic cells removal, transport of fatty acids, and inhibition of neoplastic angiogenesis. Scavenging oxidized LDL particles is one of its most important functions. The most recent studies put forward the participation of receptor CD36 in atherogenesis. Additionally, increased CD36 expression has been described in diabetes mellitus and insulin resistance and in the pathogenesis of diabetic macro- and microangiopathy. Confounding data regarding human hereditary receptor CD36 deficiency as well as still unknown interactions between antidiabetic drugs and CD36 expression suggest the necessity for further studies on the participation of receptor CD36 in the atherogenesis linked with glucometabolic disorders and in the development of diabetes mellitus complications.

This paper is a review of the literature about adrenal myelolipoma. It is a rare, benign, hormonally inactive tumor of the adrenal gland composed of mature fat tissue and hematopoietic tissue in varying amounts. Adrenal myelolipoma is usually small (4 cm), unilateral and causes no clinical disorders. The age range of the affected patients is 20-90 years; most are men in their fourth to sixth decade. This tumour is discovered during autopsy or USG, CT MRI of the abdomen usually by chance and because of that is included in the group of tumors called incidentaloma. Etiology of myelolipoma is unclear. It is usually hormonally inactive but there were several cases in which adrenal myelolipoma coexisted with various endocrine disorders such as Cushing's syndrome, Conn's syndrome, Addison's disease, hirsutism, hermaphroditism, inborn deficiencies of 17- and 21-hydroxylase. It is also more frequent in patients with obesity, hypertension and leading stressful life. Surgical treatment is called for when the diameter of tumor reaches more than 4 cm, tumour shows tendency to fast growth or causes clinical disorders. In cases of small lesions, that show no progression, it is advised to observe the tumor using imaging techniques.

Addison-Biermer's anaemia is an autoimmune disease. It may coexist with other auto-aggressive diseases, precede them or join the other existing autoimmune diseases. It most often accompanies the Hashimoto disease but also may coexist polyglandular autoimmune syndrome (PGA). Three types of PGA are distinguished: PGA1--Blizzard's Syndrome, PGA2--Schmidt's Syndrome, and PGA3. The latter, unlike the remaining ones, is characterized by normal function of adrenal glands. Addison-Biermer's anaemia occurrence may be often difficult to diagnose as coexisting illnesses might ouflage its clinical symptoms. The aim of this paper was to analyse patients with different types of PGA with coexisting Addison-Biermer's anaemia. Group of 24 individuals was analysed: 2 women with PGA1, 10 patients with PGA2, 10 patients with PGA3. In 2 remaining ones PGA was not confirmed. Addison-Biermer's anaemia occurred in 7 patients (2 with PGA2 and 5 with PGA3 syndrome). Decreased concentration of vitamin B12 was diagnosed in 3 individuals among 24 examined patients (1 with type 3 and 2 with type 2), as well in 2 patients with unconfirmed PGA. Addison-Biermer's anaemia was not observed in patients with PGA1. We observed that megaloblastic anaemia occurred characteristic schedule depending on appearance of autoimmune diseases: in PGA2--many years after other immunopathies were found, in PGA3--as first auto-aggressive disease. Our analysis suggests the necessity of detailed check-ups on patients with Addison-Biermer's anaemia, as with time they may develop other diseases, especially hypothyroidism and/or PGA failure. On the contrary, in individuals with thyroid gland diseases and PGA syndromes further checkups should be megaloblastic anaemia-sensitive. In both cases it is important to consider substitutive treatment. The possibility of family coexisting both pernicious anaemia and autoimmune endocrinopathies needs diagnostics of members of the patient's family.

Amiodarone is an iodine-rich drug. Its chronic administration may lead to disturbances in thyroid hormone metabolism and/or overt gland dysfunction. It causes an increased in serum fT4, rT3, and TSH concentrations and a decreased serum level of fT3 without thyroid dysfunction. Amiodarone may induce thyrotoxicosis (AIT--Amiodarone-induced thyrotoxicosis) or hypothyroidism (AIH--Amiodarone-induced hypothyroidism) in some persons. AIT occurs more frequently in areas with low iodine intake. The excess iodine contributes to excessive thyroid hormone synthesis-type I AIT or may lead to thyroiditis and a destructive process of thyroid follicular cells, resulting in excess thyroid hormone release-type II AIT. The mixed form of AIT also occurs. Type I AIT should be treated with antithyroid drugs alone or in association with potassium perchlorate, type II AIT benefits from treatment with glucocorticoids, whereas the mixed form of AIT is most effectively treated with a combination of thionamides, potassium perchlorate, and glucocorticoids. AIT often requires thyroidectomy after restoration of euthyroidism or radioiodine therapy, provided that 24-h thyroid radioactive iodine uptake values permit. AIH prevails in areas with high dietary iodine intake. It requires a discontinuation of amiodarone therapy and thyroid hormone (levothyroxine) replacement. It can remit spontaneously. Amiodarone and L-thyroxine therapy is also possible. Baseline thyroid function tests, thyroid antibodies, and imaging examinations such as thyroid ultrasound on initial evaluation and follow-ups every 6 months must be carefully monitored before starting amiodarone therapy.