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Purpose Graves' orbitopathy (GO) is an important problem in endocrinology. Currently used methods of assessing the degree of activity of the autoimmune process are not satisfactory. Therefore, there is a need to establish indicators of greater utility. Patients and methods The study included 35 patients: 15 with GO, 10 with Graves' disease (GD) without GO and 10 controls. Patients with GO received methylprednisolone (MP) for 12 weeks. Concentrations of thyrotropin receptor antibodies (TSHRab), interleukin 17 (IL-17) and 23 (IL-23) were obtained before administering the first dose of MP, after 6 and 12 weeks of therapy, and 3 months after treatment cessation. Patients were classified as responders (n ​= ​11) if a reduction of ≥2 points in the Clinical Activity Score (CAS) was observed. Results A significant decrease in exophthalmos, muscles' thickness and CAS value was demonstrated after MP treatment in responders group. Significantly higher concentrations were found in baseline IL-23 between the GD and GO groups compared to controls. No statistically significant differences in serum concentrations of IL-17 and IL-23 were observed during treatment with MP and 3 months after treatment cessation. A statistically significant reduction in TSHRab concentration was demonstrated 3 months after treatment cessation compared to baseline values in responders group. Conclusions Low baseline IL-17 concentration, in addition to high TSHRab titre, serves as marker of disease activity. Although, we expect that low IL-23 concentration, in addition to high TSHRab titre, could be used as predictors of disease activity and a prognostic factor of response to immunosuppressive therapy in GO.

Purpose Dysfunction of the right ventricle (RV) is an important determinant of survival in patients with pulmonary arterial hypertension (PAH). The presence of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) at RV insertion points (RVIPs) has been found in majority of PAH patients and was associated with parameters of RV dysfunction. We hypothesize, that more detailed quantification of LGE may provide additional prognostic information. Material and methods Twenty-eight stable PAH patients (mean age 49.9 ​± ​15.9 years) and 12 healthy subjects (control group, 44.8 ​± ​13.5 years) were enrolled into the study. Septal LGE mass was quantified at the RVIPs and subsequently indexed by subject’s body surface area. Mean follow-up time of this study was 16.6 ​± ​7.5 months and the clinical end-point (CEP) was defined as death or clinical deterioration. Results Median LGE mass index (LGEMI) at the RVIPs was 2.75 ​g/m2 [1.41–4.85]. We observed statistically significant correlations between LGEMI and hemodynamic parameters obtained from right heart catheterization – mPAP (r ​= ​0.61, p ​= ​0.001); PVR (r ​= ​0.52, p ​= ​0.007) and from CMR – RVEF (r ​= ​−0.54, p ​= ​0.005); RV global longitudinal strain (r ​= ​0.42, p ​= ​0.03). Patients who had CEP (n ​= ​16) had a significantly higher LGEMI (4.49 [2.75–6.17] vs 1.67 [0.74–2.7], p ​= ​0.01); univariate Cox analysis confirmed prognostic value of LGEMI. Furthermore, PAH patients with LGEMI higher than median had worse prognosis in Kaplan-Meier analysis (log-rank test, p ​= ​0.0006). Conclusions The body surface indexed mass of LGE at RV septal insertion points are suggestive of RV hemodynamic dysfunction and could be a useful non-invasive marker of PAH prognosis.

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Treatment with radioactive iodine (RAI) in women with differentiated thyroid cancer is associated with decreased serum concentrations of anti-Müllerian hormone (AMH); however, other markers have not been investigated. Therefore, this study aimed to evaluate the effect of RAI treatment on antral follicle count (AFC) and the serum concentration of inhibin B, follicle-stimulating hormone (FSH), and AMH in women with papillary thyroid cancer (PTC) treated with RAI. We examined 25 women at a median age of 33 years treated with a single dose of RAI. We divided the participants into women over (n = 11) and under 35 years of age (n = 14). Serum concentrations of inhibin B, FSH, AMH, and AFC were assessed at baseline and 1 year after RAI treatment. We found decreased AFC (P = 0.03), serum levels of AMH (P < 0.01), inhibin B (P = 0.03), but not FSH (P = 0.23), 1 year after RAI treatment in comparison to baseline in the whole group. When we compared serum levels of AMH in younger vs older women separately, we observed a significant reduction of this hormone’s serum level after RAI treatment in both groups (P < 0.01; P = 0.04, respectively). We concluded that RAI treatment significantly impacts the functional ovarian reserve in premenopausal women with PTC.

Introduction: Laparoscopic adrenalectomy is the gold standard management of benign adrenal masses and isolated metastases to adrenal glands. Two techniques of endoscopic adrenalectomy: lateral transperitoneal approach (LTA) and posterior retroperitoneal approach (PRA) seem to be equally safe and effective. Recent studies suggest advantages of PRA over LTA in terms of lower intensity of postoperative pain, shorter hospital stay, faster recovery, and lower early morbidity. However, PRA involves high insufflation pressure of CO 2 within a limited retroperitoneal space. The aim of our study was to prospectively assess the effect of LTA versus PRA laparoscopic adrenalectomies on renal function. Material and methods: We randomly assigned patients referred for unilateral adrenalectomy to either LTA (n = 33) or PRA (n = 44). The inclusion criteria were: hormonal activity and/or tumour diameter > 4 cm and/or suspicion of metastasis to adrenal gland. The exclusion criteria comprised: tumours > 8 cm, results of imaging studies suggesting primary invasive malignancy, and refusal to undergo randomisation. The patients were prospectively followed for a minimum of six months. Serum creatinine, cystatin C, and urinary neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively and at postoperative days: 1, 7, and 30. Results: We found increased concentrations of urinary NGAL at day 1 following laparoscopic adrenalectomy using PRA, as compared to LTA. Patients undergoing right-sided PRA had increased creatinine concentrations, as compared to left-sided PRA. Patients with aldosterone-producing adenoma had decreased preoperative eGFR as compared to subjects with non-functioning incidentaloma. NGAL increased significantly in this group postoperatively. All the disturbances normalised within one month postoperatively. Conclusions: Renal function impairment after PRA may result from compression of inferior vena cava by high retroperitoneal pressure during right-sided adrenalectomy. Despite the transient character of the observed abnormalities, we suggest that patients with high risk of acute kidney injury may benefit from an alternative technique of adrenalectomy using LTA.

Purpose It is possible to raise the rate of the uptake of 131I in the thyroid gland (RAIU) by increasing the endogenous TSH level through appropriate use of methimazole (MMI) prior to 131I therapy. The purpose of this paper is to assess the impact of pre treatment with MMI on the efficacy of 131I therapy in non-toxic multinodular goitre (NMG). Methods Thirty-one patients with NMG received 131I treatment in order to reduce the volume of the thyroid (TVR). Those in group 1 (n = 16) were administered 10 mg of methimazole for 6 weeks. Four days after its discontinuation, they received 131I. Patients in group 2 (n = 15) were given a placebo instead of MMI. The therapeutic activity of 131I was constant (800 MBq) and was repeated every 6 months. Treatment was discontinued when TVR reached Results In group 1, RAIU increased approximately twofold. Ten patients from group 2 and four patients from group 1 received further doses of 131I. The median of time until TVR decreased below 40 ml was 9 months [6–12 months] and 18 months [14–22 months] in group 2. At 2 years after the 131I therapy, the occurrence of hypothyroidism did not differ significantly (36% in group 1 and 33% in group2, p = 0.074). Conclusions Radioiodine treatment of NMG preceded with appropriate application of MMI is efficient thanks to increased RAIU, shorter period of treatment, and lower frequency of 131I administration, without an increase in the incidence of post-treatment hypothyroidism.

Background: The paper presents a pre-processing method which, based on positron-emission tomography (PET) images of 18F-fluorodeoxyglucose ([18F] FDG) hypermetabolic pulmonary nodules, makes it possible to obtain additional visual characteristics and use them to enhance the specificity of imaging. Material and Methods: A retrospective analysis of 69 FDG-PET/CT scans of solitary hypermetabolic pulmonary nodules (40 cases of lung cancer and 29 benign tumours), where in each case, the standardised uptake value of the hottest voxel within the defined volume of interest was greater than 2.5 (SUVmax &gt, 2.5). No diagnosis could be made based on these SUVmax values. All of the PET DICOM images were transformed by means of the pre-processing method for contouring the uptake levels of [18F] FDG (PCUL-FDG). Next, a multidimensional comparative analysis was conducted using a synthetic variable obtained by calculating the similarities based on the generalised distance measure for non-metric scaling (GDM2) from the pattern object. The calculations were performed with the use of the R language. Results: The PCUL-FDG method revealed 73.9% hypermetabolic nodules definitively diagnosed as either benign or malignant lesions. As for the other 26.1% of the nodules, there was uncertainty regarding their classification (some had features suggesting malignancy, while the characteristics of others made it impossible to confirm malignancy with a high degree of certainty). Conclusions: Application of the PCUL-FDG method enhances the specificity of PET in imaging solitary hypermetabolic pulmonary nodules. Images obtained using the PCUL-FDG method can serve as point of departure for automatic analysis of PET data based on convolutional neural networks.

The activity of radioiodine (131I) used in adjuvant therapy for thyroid cancer ranges between 30 mCi (1.1 GBq) and 150 mCi (5.5 GBq). Dosimetry based on Marinelli's formula, taking into consideration the absorbed dose in the postoperative tumour bed (D) should systematise the determination of 131I activity. Retrospective analysis of 57 patients with differentiated thyroid cancer (DTC) after thyreidectomy and adjuvant 131I therapy with the fixed activity of 3.7 GBq. In order to calculate D from Marinelli's formula, the authors took into account, among other things, repeated dosimetry measurements (after 6, 24, and 72 h) made during scintigraphy and after administration of the therapeutic activity or radioiodine. In 75% of the patients, the values of D were > 300 Gy (i.e. above the value recommended by current guidelines). In just 16% of the patients, the obtained values fell between 250 and 300 Gy, whereas in 9% of the patients, the value of D was

Background: nowadays, primary aldosteronism (PA) is suggested to be the most frequent cause of secondary hypertension and it reaches 10% of whole hypertensive population. The CYP11B2 promoter polymorphism might cause aldosterone overproduction. The aim of this study was to establish whether the polymorphism CYP11B2 promoter has a significant impact on diagnostic of PA. Material and Methods: study group consisted of 239 hypertensive patients previously diagnosed with adrenal incidentaloma. For diagnose of PA were performed: screening test&ndash, aldosterone-renin ratio (ARR) and saline suppression test (SIT) as a confirmatory test. Genotyping was carried out by the real time PCR method. The significance of differences between the groups was evaluated through Student&rsquo, s t-test. Results: our study revealed that genotype TT had plasma aldosterone concentration (PAC), ARR and SIT significantly higher in comparison with CC patients. The mean PAC in CC was 12.71 ng/dL vs. 20.55 ng/dL in TT patients (p = 0.037), which consequently gave a higher ARR in TT patients (119 vs. 44, p = 0.034). Mean aldosterone concentration in SIT was 2.40 ng/dL in CC patients and 9.99 ng/dL in TT patients (p = 0.046). Patients with CC genotype required less hypotensive drugs in comparison with TT genotype (p = 0.044). PA was recognized in 16 patients. Nine patients had TC genotype, six TT, and one with CC genotype. Conclusion: our study revealed predisposing TT genotype to PA. Additionally, patients with TT genotype, regardless of the PA presence, had more severe hypertension. The determination of the CYP11B2 promoter polymorphism seems to be useful in the diagnosis of PA, especially in cases where it is difficult to properly prepare patients for hormonal tests or even results of the hormonal test are incoherent.

Summary Papillary thyroid gland carcinoma is the most common type of malignancy of the endocrine system. Metastases to the pituitary gland have been described as a complication of papillary thyroid cancer in few reported cases since 1965. We report the case of a 68-year-old female patient with a well-differentiated form of thyroid gland cancer. Despite it being the most common malignant cancer of the endocrine system, with its papillary form being one of the two most frequently diagnosed thyroid cancers, the case we present is extremely rare. Sudden cardiac arrest during ventricular fibrillation occurred during hospitalization. Autopsy of the patient revealed papillary carcinoma of the thyroid, follicular variant, with metastasis to the sella turcica, and concomitant sarcoidosis of heart, lung, and mediastinal and hilar lymph nodes. Not only does atypical metastasis make our patient’s case most remarkable, but also the postmortem diagnosis of sarcoidosis makes her case particularly unusual. Learning points: The goal of presenting this case is to raise awareness of the clinical heterogeneity of papillary cancer and promote early diagnosis of unexpected metastasis and coexisting diseases to improve clinical outcomes. Clinicians must be skeptical. They should not fall into the trap of diagnostic momentum or accept diagnostic labels at face value. Regardless of the potential mechanisms, clinicians should be aware of the possibility of the coexistence of thyroid cancer and sarcoidosis as a differential diagnosis of lymphadenopathy. This case highlights the importance of the diagnostic and therapeutic planning process and raises awareness of the fact that one uncommon disease could be masked by another extremely rare disorder.

BACKGROUND: Radioiodine therapy (RIT) in patients with large nontoxic multinodular goiter (MNG) recently becomes more common method in comparison to surgery (especially in elderly patients and with contraindications because of severe chronic diseases other systems). Repeatedly low thyroid radioactive iodine uptake (RAIU) decreases effectiveness of RIT or makes it impossible. The recombinant human thyrotropin can increase RAIU and improve the results of RIT. The aim of the study was to assess the influence of a single very low dose (0.03 mg) of rhTSH on RAIU and thyroid function in euthyroid (MNG-EU) and subclinical hyperthyroid (MNG-SC) patients with a large multinodular goiter. MATERIAL AND METHODS: 40 patients (14 male, 26 female, age 57–80 yr) with large non-toxic MNG over 80 grams and with baseline RAIU < 40% were included into the double-blind randomized study and divided into two groups: rhTSH-group and control group. First group received the single intramuscular injection of 0.03 mg rhTSH and the second received placebo. The RAIU were measured 24 and 48 hours after the rhTSH and then all the patients were administered therapeutic doses of I-131. TSH and free thyroxine levels were measured at 1st and 2nd day after the injection of rhTSH and later, at 4 and 8 weeks after the RIT. RESULTS: The mean RAIU increased significantly from 30.44 ± 7.4% to 77.22 ± 8.7% (p < 0.001). There were no statistically significant differences in RAIU between euthyroid (MNG-EU) and subclinically hyperthyroid (MNG-SC) patients. The peak of serum TSH was noticed 24 hours after rhTSH injection and in MNG-EU patients it has remained within normal range, similarly as fT4. In the MNG-SC group the administration of rhTSH resulted in a significant increase in the TSH values after 24 hours, whose mean level slightly exceeded the upper limit of the normal range with normalization at 48 hours. 8 weeks after the RIT, the TSH and fT4 levels did not exceed the normal range and did not differ in a statistically significant way. Conclusions: Even the single very low dose of rhTSH increases the values of RAIU in significant way, in euthyroid and subclinically hyperthyroid patients. The administration of rhTSH is well-tolerated. Neoadjuvant administration of a low dose (0.03 mg) of rhTSH before I-131 seems to be an optimal method of management which may increase the effectiveness of RIT and decrease the exposure of the patients to absorbed doses of ionizing radiation.

Introduction: Radioiodine (131I) isotope therapy is the method of choice in the treatment of Graves’ disease relapse. The efficiency of this method is dependent on many factors; therefore, the present paper aims to identify the parameters that have a crucial impact on the efficacy of radioiodine therapy for Graves’ disease. Material and methods: The authors performed a retrospective analysis of the medical documentation of 700 Graves’ disease sufferers treated with131I. The patients were divided into three groups depending on the thyroid-absorbed dose of 131I: group I — 100 Gy, II — 150 Gy, and III — 200 Gy. The authors assessed the influence of gender, age, presence of orbitopathy, TRab titres, thyroid mass, iodine uptake after 24 and 48 hours, and the absorbed dose on the treatment efficacy at one year post-131I administration. Results: The volume of thyroid gland (P 50 mL, the percentage of hyperthyroidism was lowest in group III (10%). Conclusions: The absorbed dose of 131I and the volume of the thyroid gland are two parameters that have a significant influence on the efficacy of radioiodine therapy for Graves’ disease. 150 Gy is the optimal dose for glands 50 mL requires an absorbed dose of 200 Gy in order to minimise the risk of recurrent hyperthyroidism. (Endokrynol Pol 2015; 66 (2): 126–131)

A 36-year-old female patient underwent a laparoscopic surgery to remove a uterine fibroid. The procedure failed to relieve the pelvic pain, although its nature changed. After a period of observation, the patient was re-admitted to hospital on suspicion of a vesico-uterine fistula to be differentiated with endometriosis. Diagnostic investigations — cystography, cystoscopy, computed tomography and magnetic resonance — did not reveal a fistula. Laparoscopy was performed, with a possible biopsy in order to eliminate endometriosis. The result was negative, but chronic progressive reactive/inflammatory lesions were noticed, possibly indicating the presence of a vesico-peritoneal fistula. Therefore, a direct radionuclide cystography was performed. The scintigraphic images single-photon emission computed tomography (SPECT/CT) showed a radioactive spot, indicative of a vesico-peritoneal fistula. The fistula was treated for three months by catheterisation of the urinary bladder. The follow-up SPECT-CT did not reveal any urine leakage from the bladder. The clinical symptoms disappeared as well.

Purpose Autoimmune diseases are a group of complex diseases localized in multiple organ systems, with a wide spectrum of symptoms and still unclear causes. The aim of the present study was to analyse a possible association of three autoimmune disabilities - Multiple sclerosis (MS), LADA diabetes and Graves’ disease (GD) with single nucleotide polymorphism (SNP; rs1990760) in the IF IH1 gene (also known as a melanoma differentiation-associated protein 5 - MDA5) within the Polish population. An additional goal was also to look for a correlation between this polymorphism and different clinical patient-related factors. Materials and methods The study population consisted of four groups of 944 unrelated Polish origin Caucasian patients – 324 with GD, 171 with MS, 49 with LADA diabetes and 400 healthy subjects as a control group. The SNP analysis was performed using the allelic discrimination technique. Results & Conclusions There were significant associations of risk T allel of the analyzed polymorphism with all studied autoimmune diseases (GD OR = 1.34, p = 7.02e-03; MS OR = 1.36, p = 2.17e-02; LADA – OR = 3.36, p = 8.73e-07). We also found that the frequency of CT and TT genotypes of the rs1990760 IFIH1 gene only in females (with LADA, GD, MS) was significantly higher than those in the female control group (47%, 41% vs 44%, 34%; p = 1.32e-03, p = 4.39e-04; OR = 2.08, 95%CI: (1.33–3.28), OR = 2.29, 95% CI: (1.44–3.65) respectively). Our research has shown significant differences regarding some clinical features (BMI, TRAb, TSH, HbA1C, anti-GAD antibodies) and age at the beginning of the studied autoimmune disabilities. This study showed an association of rs1990760 polymorphism in the IFIH1 gene in the development of GD, LADA diabetes and MS within the Polish population. To our knowledge, this is the first study to investigate the relationship between IFIH1 polymorphisms and the risk of the development of MS and LADA in Poland.

The therapeutic activity of 131I administered to patients with Graves’ disease can be calculated by means of Marinelli’s formula. The thyroidal iodine uptake (131IUmax) needed for the calculation is usually determined with the use of 131I. The purpose of the paper was to estimate 131IUmax on the basis of technetium uptake in the thyroid at 20 min (99mTcU20min). Eighty patients suffering from Graves’ disease were qualified for radioiodine therapy with measurement of fT4, fT3, thyroid-stimulating hormone and its receptor (TRAb). Prior to the treatment, all the patients were euthyroid. 131IUmax for each patient was determined according to the levels of 131I after 24 h (131IU24h), while effective half-life (T eff) according to the measurements of 131IU24h and 131I uptake after 48 h (131IU48h). Additionally, on the day before measuring 131IU24h, 99mTcU20min was calculated for each patient. It was demonstrated that there existed a correlation, with statistical significance at p 10 IU/ml. It is possible to predict thyroid iodine uptake 131IU24h in Graves’ disease on the basis of measuring the uptake of 99mTcU20min. This shortens the time necessary for diagnosis and enables the calculation of 131I activity using Marinelli’s formula.

There are only few studies evaluating lymphocytes activation in the diabetic vascular complications. ICAM-1/LFA-1 adhesion molecules not only participate in the lymphocyte T proliferation but also mediate leukocyte migration to the site of inflammation. We assess a relationship between the percentage of ICAM-1 and LFA-1 expressing PBMCs and the evolution of vascular complications in T1D in children and adolescents. The study was carried out on 60 children and adolescents with T1D (aged 9-20): (a) T1D lasting 5 years (n=20), without complications c) T1D lasting >5 years complicated with microalbuminuria, arterial hypertension, diabetic retinopathy (20 n). 20 healthy volunteers, age and sex matched constituted the control group. The expression of adhesion molecules was evaluated by using three-color flow cytometry. In children and adolescents with T1D 5 years without vascular complications and in T1D with vascular disease the percentage of LFA-1+ T lymphocytes was significantly reduced in the peripheral blood (p

TNFalpha was shown to play an important role in the autoimmune inflammatory process of Graves' ophthalmopathy (GO). In our previous study we found no significant changes in serum TNFalpha levels in GO patients. The aim of the present study was to estimate an influence of corticosteroids on serum levels of TNFalpha receptors (sTNFR1 and sTNFR2) in GO patients and to assess their potential as a guideline of immunosuppressive therapy. We detected serum sTNFRI and sTNFR2 in three groups of subjects: 18 patients with clinical symptoms of ophthalmopathy [Clinical Activity Score (CAS)or = 4, anamnesis of GOor = 1 yr], 16 patients with Graves' disease without ophthalmopathy (Gd) and 14 healthy volunteers. Corticosteroid therapy consisted of intravenous infusions of methylprednisolone (MP) and subsequent treatment with oral prednisone (P). The serum samples were collected 24 hours before MP, 24 hours after MP, 14 days of treatment with prednisone and after the end of the corticosteroid therapy. The levels of serum sTNFR1 and sTNFR2 were determined by ELISA. Serum levels of sTNFR1 were significantly higher in GO individuals as compared to the control group (p0.01). We have found a significant decrease in sTNFR1 concentration in corticosteroid-respondent patients (satisfactory clinical effect, decrease of CASor = 1) as compared to the pretreatment values after MP treatment (p0.05) and after 14 days of prednisone (p0.01). There were significant differences in sTNFR2 level after MP treatment (p0.02) and after corticosteroid administration (p0.05) between responders and non-responders. Baseline values of sTNFRI in GO individuals were positively correlated with CAS (r = 0.6, p0.02).TNFalpha acting through its receptors plays an important role in the pathogenesis of Graves' ophthalmopathy. Moreover, the beneficial influence of corticosteroids on the course of GO may be explained, at least in part, by an inhibition of sTNFR1 and sTNFR2. Measurement of soluble TNFalpha receptors might potentially serve as an indicator in prognostic estimation of corticosteroids' efficacy.

Radioiodine ((131)I) isotope therapy is the method of choice in the treatment of Graves' disease relapse. The efficiency of this method is dependent on many factors; therefore, the present paper aims to identify the parameters that have a crucial impact on the efficacy of radioiodine therapy for Graves' disease.The authors performed a retrospective analysis of the medical documentation of 700 Graves' disease sufferers treated with (131)I. The patients were divided into three groups depending on the thyroid-absorbed dose of (131)I: group I - 100 Gy, II - 150 Gy, and III - 200 Gy. The authors assessed the influence of gender, age, presence of orbitopathy, TRab titres, thyroid mass, iodine uptake after 24 and 48 hours, and the absorbed dose on the treatment efficacy at one year post-(131)I administration.The volume of thyroid gland (P0.002) and the thyroid-absorbed dose (P0.001) were the only factors that had a significant impact on the outcome of the treatment. The likelihood of hyperthyroidism persisting (odds ratio: 3.71, 95% confidence interval: 2.4-5.87) was greatest in patients from group I. In group II, with thyroid volume amounting both to 25 mL and to 25-50 mL, the percentage of hyperthyroidism was lowest (1 and 0%). However, with thyroid volume50 mL, the percentage of hyperthyroidism was lowest in group III (10%).The absorbed dose of (131)I and the volume of the thyroid gland are two parameters that have a significant influence on the efficacy of radioiodine therapy for Graves' disease. 150 Gy is the optimal dose for glands50 mL. A goitre50 mL requires an absorbed dose of 200 Gy in order to minimise the risk of recurrent hyperthyroidism.

Circulating forms of l -selectin were found to be elevated in several autoimmune diseases. ICAM-1 has been suggested a predictor of the onset of GO. The aim of the study was an estimation of serum l -selectin and ICAM-1 in patients with Graves’ disease with ophthalmopathy during treatment with corticosteroids to assess their potential as a guideline of immunosuppressive therapy. We detected serum l -selectin and ICAM-1 in three groups of subjects: 20 patients with Graves’ disease without ophtamopathy (Gd), 17 patients with clinical symptoms of ophthalmopathy (CAS≥3, anamnesis of GO≥1 year) and 24 healthy volunteers. Corticosteroid therapy consisted of intravenous infusions of metyloprednisolone (MP) and subsequent treatment with oral prednisone (P). The serum samples were collected 24 h before MP, 24 h after MP, 12±2 days of treatment with prednisone and after the end of the corticosteroid therapy. The levels of soluble l -selectin and ICAM-1 in the serum were determined by the ELISA method. The statistical significance was estimated by the Mann-Whitney U-test. Serum l -selectin and ICAM-1 were significantly increased in patients with GO (respectively 1182±222 and 438±68 ng/ml) and in patients with Graves’ disease without ophthalmopathy (respectively: 1168±130 and 343±109) in relation to the controls. After MP treatment in corticosteroid-responsive patients (improvement in CAS ≤1) serum concentration of l -selectin and ICAM-1 decreased significantly and gradually increased during subsequent treatment with prednisone. In corticosteroid-responsive patients serum l -selectin was significantly higher before MP administration and after P treatment in relation to corticosteroid-resistant subjects. Conclusions: 1. Serum l -selectin and ICAM-1 were elevated in patients with active GO 2. Metyloprednizolone decreased levels of the studied adhesion molecules in corticosteroid-responsive patients with GO 3. Lack of clinical results in corticosteroid therapy in patients with a low starting l -selectin level would suggest the possibility of serum l -selectin estimation as a prognostic for immunotherapy efficacy.

Macrophages and T lymphocytes are the first cells to appear in pancreatic islets in the development of autoimmune diabetes. It has been suggested that cytokines released by monocytes/macrophages, including interleukin-1beta (IL-1beta), interleukin-12 (IL-12) and tumour necrosis factor-alpha (TNF-alpha) could have an initial role in islet B-cell damage. The aim of the present study was to estimate the effect of human insulin and nicotinamide on the levels of monocyte/ macrophage derived cytokines in the peripheral blood of humans at risk of Type 1 diabetes, and in patients with newly diagnosed Type 1 diabetes compared to healthy control subjects. The study was carried out on three groups of subjects: 20 first degree relatives of people with Type 1 diabetes (with two or more antibodies against pancreatic B-cell antigens); 22 patients with recent onset of Type 1 diabetes (duration of the disease 3-6 months); and 25 age- and sex-matched healthy subjects. Cytokine levels (IL-1beta, IL-12, and TNF-alpha) in the supernatants of whole blood cultures incubated with PHA alone (10 microg/ml), or PHA + human insulin (50 microg/ml), or PHA + nicotinamide (100 micromol/l) were quantified by ELISA. In the cultures with nicotinamide the concentration of IL-12 and TNF-alpha was significantly lower in the prediabetic group, diabetic patients, and the healthy controls than in the cultures with PHA only or with PHA + insulin. There were no significant differences in IL-1beta production in the cultures after incubation with the different stimuli in the studied groups and healthy controls. No significant influence of human insulin on macrophage/monocyte cytokines secretion in in vitro cultures of the peripheral blood was found. This suggests that nicotinamide could influence monocyte/macrophage function in peripheral blood by inhibiting production of IL-12 and TNF-alpha.

The therapeutic effect of radioactive iodine ((131)I) on benign goitre consists of the emission of tissue-destructive beta-radiation. Since the range of beta (131)I radiation in tissue can reach 2.4 mm, it can affect the adjacent parathyroid glands. The purpose of this paper is to assess parathyroid function in patients with toxic and non-toxic goitres, up to five years following (131)I therapy.The study sample consisted of 325 patients with benign goitres (220 with toxic nodular goitre (TNG), 25 with non-toxic nodular goitre (NTNG), and 80 with Graves' disease (GD) treated with (131)I. The therapeutic activity of (131)I for each patient was calculated using Marinelli's formula. The serum levels of fT3, fT4, TSH, iPTH and Ca(2+), Ca and phosphates were determined one week before (131)I administration, as well as every two months up to a year following the therapy, and then after three and five years post-treatment.After two months following the administration of (131)I, all the treated patients showed a statistically significant above normal increase in iPTH concentrations (amounting to a value almost twice the norm in patients with TNG), which remained stable up to ten months after treatment, to return to normal level in the following months. In all the patients, Ca(2+), Ca, phosphates concentration remained within normal range throughout the course of the study. The concentrations of fT3 and fT4 quickly returned to normal after (131)I administration, and remained within normal range until the completion of the study.Radioiodine treatment of benign thyroid disorders results in transient (up to ten months after (131)I administration) hyperparathyroidism. The condition does not influence the level of calcium and phosphates concentration in any significant way.

Wstep: Celem pracy bylo porownanie oznaczen kortyzolu w surowicy o 23 godz. (SCM), poźnowieczornego stezenia kortyzolu w ślinie(LSC), wolnego kortyzolu z dobowej zbiorki moczu (UFC) u pacjentow z podejrzeniem endogennej hiperkortyzolemii oraz ocenaprzydatności tych oznaczen w diagnostyce jawnego zespolu Cushinga (OCS), rzekomego zespolu Cushinga (PCS) oraz subklinicznegozespolu Cushinga (SCS). Material i metody: Badania przeprowadzono u 82 pacjentow, wśrod ktorych u 4 zdiagnozowano SCS, u 3 OCS oraz u 8 PCS. Do oznaczeniaLSC uzyto metody immunoenzymatycznej, UFC oraz SCM oznaczono metodą immunochemiluminescencji. Wyniki: Najwyzszywspolczynnik korelacji charakteryzowal LSC oraz SCM (r = 0,72). Pole pod krzywą (AUC) dla SCM i LSC w analizie charakterystykioperacyjnej odbiornika (ROC) dla OSC wynosilo odpowiednio 0,86 v. 0,74 dla PCS: 0,83 v. 0,70 dla SCS: 0,74 v. 0,79. Wnioski: Uzyskane wyniki wskazują, ze LSC jest bardziej przydatny w porownaniu do SCM w diagnostyce subklinicznego zespolu Cushinga. LSC rowniez wydaje sie byc wartościowym kryterium diagnostycznym w roznicowaniu rzekomego zespolu Cushinga.Jednakze do określenia wiarygodnych punktow odciecia dla LSC potrzebne są badania przeprowadzone w wiekszej grupie chorychz hyperkortyzolizmem.

Pheochromocytoma is a rare tumour, but one of great clinical importance as a risk factor of malignancy, cardiovascular diseases and sudden death.15 consecutive patients (eight women and seven men) were hospitalised and submitted for adrenalectomy with pheochromocytoma confirmed by histopathologic examination. Adrenalectomies were performed laparoscopically in 14 cases (93.3%): in nine by the retroperitoneal posterior mode and in five by the transperitoneal lateral approach.Molecular-genetic examination of VHL, RET, SDHB, SDHC and SDHD genes revealed inherited predisposition for PHEO in three of 15 patients (20%): RET mutations typical for MEN 2a in two patients and VHL mutation in one patient. Disturbances of the carbohydrate metabolism occurred in nine patients (60%). Ten patients (66%) reported paroxysmal symptoms. In all cases, with the exception of a von Hippel-Lindau patient, density of tumours exceeded 20 HU. In all studied patients, urine concentration of normetanephrines exceeded their normal range and greatly prevailed over metanephrines values, which were increased in six of them (40%).Urine metoxycatecholamines and increased tissue density are sufficient in pheochromocytoma detection. However, taking into account clinical and supplemental biochemical data may be helpful in the diagnostic process. Laparoscopic adrenalectomy is a fully sufficient and safe method of pheochromocytoma excision.

In view of the fact that primary aldosteronism (PA) is a problem that is more prevalent than previously thought and its diagnosis is of greater clinical significance than previously believed, the Endocrine Society has recently published recommendations on the diagnosis and management of PA. Due to the fact that the currently available tests cannot be considered the gold standard in the diagnosis of PA and the discrepancies in the results of determination of aldosterone levels and plasma renin activity (PRA) are considerable the authors of this document do not provide strict cutoff values, leaving the interpretation of results to clinicians. This paper, which focuses on screening and confirmatory tests and on the aetiological diagnosis and treatment of PA, is based on the experience of the Department of Endocrinology, Diabetes and Internal Diseases, Medical University in Bialystok, Poland, but it also takes into account other points of view presented in papers published in the past few years.

During the last few years, increasing evidence suggests that primary aldosteronism is the cause of over 10% of arterial hypertension (AH). There are no "gold standard" methods for PA screening. The aim of study was plasma renin activity (PRA), plasma aldosterone concentration (PAC), and ARR assessment as criteria for diagnosis of PA and their usefulness in clinical practice.Eighty-one consecutive patients were admitted for diagnosis of primary aldosteronism: 51 women and 30 men, aged 31-69 years. In each patient, PAC and PRA were evaluated by radioimmunoassay. In 65 patients, urine concentration of catecholamine metabolites was assayed, and in 51 patients, diagnostics for hypercortisolaemia was carried out. In patients with adrenal incidentaloma, 16-row computer tomography was performed.The proportion of patients with PAC over 150 pg/ml was 35% (n = 28). The number of patients with PRA under 0.07 ng/ml/h was 19 (n = 15). The ratio of patients whose values of ARR exceeded over 20, 30, 40, 50, and 180 were 55, 47, 37, 28, and 15%, respectively.The most common indication for primary screening was the presence of incidentally found adrenal mass. The quotient of plasma aldosterone concentration/plasma renin activity at whichever cut-off point is not effective enough for the selection of patients for further diagnostics or its cessation. (Pol J Endocrinol 2010; 61 (1): 2-5).

Apoptosis plays a pivotal role in the regulation of immune mechanisms in the pathogenesis of autoimmune thyroid diseases (AITD). The prevalence of AITD increases with age. Purpose to compare soluble Fas, FasL and Bcl-2 in Graves disease (GD) and Hashimoto thyroiditis (HT) in relation to the age of the studied patients.3 groups of subjects: 1/25 patients with GD in euthyreosis on methimazol 2/27 patients with ChH in euthyreosis on levothyroxine. 3/12 healthy volunteers age and sex-matched to group 1-2. The serum levels of Fas, FasL and Bcl-2 were determined by the ELISA kit.We found positive correlations between sFas and age in GD patients (r = 0.35; p0.05). In GD patients we found a negative correlation between sFasL and age in all studied patients with AITD (r = -0.34; p0.01). We also found a negative correlation between sBcl-2 and age in HT patients (r = -0.42; p0.05).Fas/FasL and Bcl-2 signaling pathways seem to be age-related and may explain, at least in part, milder course of Graves disease in elderly patients and increased prevalence of Hashimoto disease in this group of subjects.

The aim of this study was to estimate the influence of corticosteroids on soluble MMP-2, MMP-9 and VCAM-1 in patients with Graves ophthalmopathy (GO) in order to assess their usefulness as a guideline in a therapeutic approach.Serum gelatinases and VCAM-1 were detected in three groups of subjects: 20 patients with GO (CASor = 3, anamnesis of GOor = 1 yr), 12 patients with no clinical symptoms of ophthalmopathy (Gd) and 10 healthy volunteers. Corticosteroid therapy consisted of intravenous infusions (2 series, 3 grams each time) of methylprednisolone (MP) and subsequent treatment with oral prednisone (60 mg per day) in a tapering schedule. The serum samples were collected 24 hours before MP, 24 hours after MP, after 14 days of treatment with prednisone and at the end of corticosteroid therapy. The levels of soluble MMP-2, MMP-9 and VCAM-1 were determined by the ELISA method.We have found no differences in serum MMP-2 between the groups studied and a significant reduction after MP only in corticosteroid-resistant GO patients. Soluble MMP-9 was highest in the GO group compared with both the Gd and control individuals. Moreover serum MMP-9 decreased in corticosteroid-responsive GO patients after MP and remained at the lower level at the end of the study. Positive correlations between MMP-2 and MMP-9 before and after MP administration were observed. Serum VCAM-1 was significantly elevated both in GO and Gd subjects and pre-treatment VCAM-1 levels were elevated in corticosteroid-responders compared with non-responders.Our results suggest that serum VCAM-1 may serve as a marker predicting the efficacy of corticosteroids and that soluble MMP-9 may be helpful in monitoring corticosteroid administration and in decision-making with regard to further GO treatment.

To investigate by means of pattern visual evoked potentials (PVEPs) early neuropathic changes in Graves' ophthalmopathy (GO) patients without any clinical symptoms of optic neuropathy in order to evaluate the prevalence of subclinical optic neuropathy in GO patients and to elucidate whether there is a relationship between PVEP (P100 and N75 latency), intraocular pressure (IOP) and exophthalmometry.Two groups of patients were examined: 15 patients with GO without clinical signs of dysthyroid optic neuropathy (DON) and 12 healthy controls. The correlations between the N75 and P100 latencies, IOP and Hertel exophthalmometry were investigated.The mean PVEP N75 and P100 latencies were significantly delayed in the GO uncomplicated with DON in comparison with controls (LP100- 106.2 +/- 4.4 ms vs. 102.4 +/- 2.7 ms, p0.01 and LN75- 79.0 +/- 3.7 ms vs. 73.9 +/- 2.8 ms, p0.001). In GO patients we documented a positive correlation between the LN75 latency and exophthalmometric readings (R = 0.51; p0.01). The value of LP100 and LN75 was above the normal limit in 5/30 eyes (17%) and in 3/30 eyes (10%) respectively.The assessment of PVEPs (especially the P100 latency) in GO patients without clinical signs of DON is a useful tool for the early diagnosis of optic nerve involvement.

The discovery of the aquaporin family of water channels has explained to a high degree the mechanism of water transport across cell membranes. The molecular structure of the first purified aquaporin shows its tetrameric organization with each subunit containing an individual aqueous pore selectively permeable for water but not for protons. At least 11 human aquaporins have been identified. Definition of sites of their expression enabled explanation of their physiological role as well as pathological importance in congenital cataract or nephrogenic diabetes insipidus.

Neuroendocrine tumors are rare gastrointestinal tract disorders, in which diagnosis and treatment are often difficult. The aim of the paper is to present two cases of patients with neuroendocrine tumor of gastrointestinal tract, who underwent surgical procedure in II Department of General and Gastroenterological Surgery of Medical University of Białystok in 2005. A 63-year-old female patient with primary diagnosis of neuroendicrine tumor metastases in liver was not successfully investigated for primary tumor in the preoperative period. The laparotomy procedure indicated the malignant neuroendocrine tumor in the terminal ileum and metastases to the liver and to the greater omentum. The right hemicolectomy and liver metastatic segment VII and VIII resection were performed. The neurological disturbances of obscure origin were observed in the postoperative period and the patient suddenly died on the 15(th) day after surgery. A 57-years-old male patient was operated on for lymph node recurrence of gastric tumor. Pathologic examination of tissue sample revealed the diagnosis of carcinoid. The patient underwent subtotal gastric resection for a pyloric ulcer, diagnosed as Adenocarcinoma G2 pT2N0M0 6 years before. Liver and abdominal node metastases, confirmed by octreoscan, were observed after lymphadenectomy, The treatment of somatostatin analogues (LAR octreotide) was used. In spite of therapy the patient died. The authors present their own experiences and show the preoperative diagnostic difficulties in patients with neuroendocrine gastrointestinal tumors. Unexpected neurological complications in the treatment course were described.

Autoimmune thyroid diseases (AITD) constitute a group of the most common disorders caused by autoaggression of the immune system, comprising up to 1.5% of the human population. That is why optimalisation of diagnostics of Hashimoto thyroiditis (ChH) and Graves' disease (ChG) is an important issue. Aim of the study was to assess usefulness of humoral markers estimation: antithyroperoxidase antibodies (anty-TPO), antithyreoglobulin antibodies (anty-TG) and antithyroropin receptor antibodies (anty-TSHR).The study was carried out in 5 groups of subjects: 1/14 patients with GD in euthyreosis on methimazol (Geu) 2/20 patients with hyperthyroid GD (Ghiper) 3/15 patients with ChH in euthyreosis on levothyroxine (Heu) 4/16 patients with hypothyroid ChH (Hhipo) 5/12 healthy volunteers age and sex-matched to group 1-4. The serum levels of anty-TPO and anty-TG were determined by the ELISA kit. Anty-TSHR were measured by the RIA method.The highest level of anty-TPO were observed in Hhipo group: 2.81 IU/I (1.79-3.22) (p0.001 vs controls, p0.05 vs ChH in euthyreosis). Among ChG patients higher values of anty-TPO were found in Ghiper group: 1.87 IU/I (0.68-2.88) (p0.01 vs controls, p0.05 vs ChG in euthyreosis). In ChH patients a positive correlation was observed between serum TSH and anty-TPO (R=0.47, p0.01). In studied groups it was found a positive correlation between anty-TPO and anty-TG. Levels of anty-TG were increased in all studied patients as compared to controls, however there were no significant differences in anty-TG values between the groups. The highest concentration of anty-TSHR were found in Ghiper group: 6.71 (3.92-11.32) (p0.001 vs controls, p0.001 vs ChG in euthyreosis). There was a significant difference in anty-TSHR concentration between ChH groups: Hhipo i Heu (p0.05). There was a negative correlation between serum TSH and anty-TSHR level in ChG patients (R=-0.05, p0.001).In diagnostics of humoral markers in patients with AITD the most valuable in clinical practice is estimation of antithyroperoxidase antibodies serum level in Hashimoto thyroiditis and antithyroropin receptor antibodies serum concentration in Graves' disease.

Aim of the study was to estimate the efficacy of 6-alpha-methylprednisolone injection into involved extraocular muscles in eyes with motility disturbances caused by endocrine ophthalmopathy.For further evaluation we qualified 4 patients, 1 female and 3 males, aged: 60, 43, 42 and 64 years, with clinical activity score equal 4, with duration of Graves' ophthalmopathy of mean 2.1 years (0.16 - 5.5). Included were patients with movement restrictions in vertical plane and echographic findings of isolated extraocular muscle involvement (inferior rectus). Each of the patients received 20 mg 6-alpha-methylprednisolone into the muscle belly of inferior rectus, in one case injection was done in both eyes.In all cases we were able to archive lessening of the intraocular pressure in secondary position, with slight improvement in ocular motility and bigger range of duction free of diplopia.Visual function improvement found by the patients is the best evidence for application of 6-alpha-methylprednisolone into the extraocular muscles of patients with motility disturbances secondary to endocrine ophthalmopathy.

Thyrotropin secreting tumors constitute 0,9 to 2,8% of all pituitary tumors. Thus, it is very rare tumor of this endocrine gland. Standards of the diagnosis of TSH-omas are based on me lack of inhibition of TSH levels in the presence of increased free thyroid hormones and abnormal, neoplastic intrasellar or parasellar mass. The additional criterion is lack of response of TSH after TRH stimulation. The proper treatment is surgical excision (selective adenomectomy) by the transsphenoidal route. In this paper we report the case presenting TSH-oma and consecutive subacute thyroiditis.

Apoptosis plays an important role in the pathogenesis of autoimmune thyroid diseases. Soluble form of Fas (sFas) appeared as reliable markers of inflammation activity in rheumatic autoimmune diseases. The aim of the study was an estimation of sFas in patients with Graves' disease with ophthalmopathy during treatment with corticosteroids to assess their potential as a guideline of immunosuppressive therapy.We detected serum Fas in three groups of subjects: 25 patients with clinical symptoms of ophthalmopathy (OG)(CASor = 4, anamnesis of OGor = 1 yr), 18 patients with Graves' disease without ophthalmopathy (ChG) and 14 healthy volunteers. Corticosteroid therapy consisted of intravenous infusions of methylprednisolone (MP) and subsequent treatment with oral prednisone. The serum samples were collected 24 hours before MP, 24 hours after MP, 14 days of treatment with prednisone and after the end of the corticosteroid therapy. The levels of soluble Fas in the serum were determined by the ELISA and TSH receptor antibodies by RIA method.sFas concentration was significantly increased in patients with OG. We found a positive correlation between sFas and CAS and a negative correlation with duration of OG. During corticosteroid treatment there was no difference in sFas between responders and non-responders.sFas is a potent surrogate marker of inflammatory process activity in Graves' ophthalmopathy, however it has no prognostic value in the prediction of the immunotherapy efficacy.