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Introduction: Subclinical hyperthyroidism (SCH), also known as mildly symptomatic hyperthyroidism, has recently been diagnosed more frequently. One of the main endogenous causes of this disorder is autonomously functioning thyroid nodule (AFTN). Despite the fact that it is usually asymptomatic, SCH entails repercussions on the cardiovascular system and bone, and it carries a risk of progression to overt hyperthyroidism with a typical clinical picture. Treatment is still controversial, and its benefits are widely debated in literature. Material and methods: From 459 patients authors selected a group of 49 patients (10.6% of all subjects with hyperthyroidism), 41 women (83.7%) with AFTN at the stage SCH treated in the Outpatient Endocrinological Clinic and the Department of Endocrinology of the Medical University of Lublin over a three-year period. The method applied in the study was a retrospective analysis of medical records with a particular account of medical history, physical examination, and additional tests obtained during the process of diagnostic and therapeutic procedures. Results: Forty-one patients (83.7%) suffered from typical symptoms of hyperthyroidism; only eight patients (16.3%) were asymptomatic. The most frequently reported symptoms were tachycardia in women (51.2%) and anxiety in men (50%). The type of thyrostatic drugs and the length of therapy did not affect the outcome of iodine-131 therapy. In the vast majority of the patients (87.8%) radioidodine therapy was effective; 30 patients (61.2%) reached euthyreosis and 13 patients (22.5%) developed hypothyroidism. Conclusions: Most patients with SCH in the course of AFTN suffered from typical symptoms of overt hyperthyroidism; only every sixth patient was asymptomatic. The volume of autonomous adenomas did not affect the result of 131I therapy; however, the impact of AFTN volume as well as the thyroid volume on RIT efficacy requires futher investigation. In the vast majority of patients 131I therapy was an effective method of treatment, and an earlier therapeutic effect was observed more often in the patients with focal lesions located in the right lobe.

The side effects of oncological treatment, which appear during or after therapy, are sometimes very annoying for patients and are not adequately treated by physicians. Among the symptoms experienced by breast cancer patients are hot flushes, which result from a natural or cancer therapy-induced menopause. The intensity of hot flushes in breast cancer patients may be more severe than those experienced by women undergoing a natural menopause. Taking into account the incidence of breast cancer and long-lasting hormone-suppression therapies, the problem of hot flushes will affect many women. Hormonal replacement therapy, the most effective therapeutic means for alleviating hot flushes, is usually contraindicated for breast cancer patients. For intense and severe hot flushes, pharmacological treatment using agents from a group of selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors such as venlafaxine or citalopram may be introduced. Other agents from different pharmacological groups, such as clonidine, gabapentin, or pregabalin, have also proved to be effective in treating hot flushes. The efficacy of phytoestrogens has not been proven in randomized clinical trials. The importance of the placebo effect in decreasing vasomotor symptoms has also been reported in many research papers. Educating breast cancer patients in lifestyle changes which decrease the frequency and intensity of vasomotor symptoms can offer significant help too. This paper reviews the current state of research in order to assess the options for the treatment of hot flushes in breast cancer survivors.

Gestational Diabetes Mellitus (GDM) is a growing epidemiological problem, and it is currently the most common metabolic disorder in pregnancy, as it affects approximately 2-6% of all pregnant women. In 2014, the Polish Diabetic Association introduced significant changes in the diagnosis of hyperglycemia as first diagnosed in pregnancy, based on the recommendations of the IADPSG of 2010 and WHO of 2013. There are now two categories: diabetes in pregnancy, and GDM. These involve different degrees of severity of metabolic complications for the mother and the growing fetus. Establishing a new diagnostic criterion is significant because of the negative impact of hyperglycemia on the fetus (especially in the first trimester), the increased prevalence of malformations or the possibility of spontaneous abortions in early pregnancy.

[b]introduction and objective[/b]. Current literature provides contradictory information on the role of adiponectin (AdipoQ) in the course of gestational diabetes mellitus (GDM) and the changes after delivery. The aim of the study was to measure AdipoQ concentration in blood of women with GDM, and to conduct a comparative analysis of AdipoQ concentrations in gestation at 3 and 12 months after delivery. [b]material and methods[/b]. The study group consisted of 50 women diagnosed with GDM between 24 and 28 weeks of gestation. Three months after delivery, 41 women underwent further tests, while 12 months after delivery 30 patients. All patients underwent clinical and laboratory evaluation at GDM diagnosis at 3 and 12 months after delivery. Laboratory evaluation included fasting glucose, fasting insulin, OGTT and lipid parameters in serum. Serum AdipoQ concentration was measured at GDM diagnosis as well as at 3 and 12 months after delivery. [b]results[/b]. AdipoQ concentrations did not differ significantly between the groups during gestation (p=0.7054) and 3 months after delivery (p=0.9732), while a significant rise was observed 12 months after delivery, compared to the values during pregnancy (p=0.0006). AdipoQ in the GDM group 12 months after delivery inversely correlated with fasting glucose and 2-hour post-load plasma glucose after a 75-g oral glucose tolerance test (r=-0.37 * ; p

Wstep: Ocena bezpieczenstwa i efektow leczenia analogiem GLP-1 (eksenatyd) i dlugodzialajacym analogiem insuliny (glargina) pacjentow z cukrzycą typu 2, nieskutecznie leczonych doustną terapia skojarzoną, biorących udzial w polskiej grupie 26-tygodniowego, wieloośrodkowego, otwartego, randomizowanego badania klinicznego GWAA. Material i metody: 80 pacjentow z cukrzycą typu 2 skojarzoną z otylością (BMI 25–45 kg/m2), nieskutecznie (7% < HbA1c < 10%) leczonych doustną terapią skojarzoną (metformina + pochodna sulfonylomocznika) zostalo zrandomizowanych do dwoch grup leczenia interwencyjnego. Pierwsza otrzymywala eksenatyd 20 μg/dobe, a druga glargine w jednej dawce na dobe. Analizie porownawczej poddano mase ciala, BMI, HbA1c, dobowy profil glikemii i dzialania niepoządane. Wyniki: Średnie stezenie HbA1c bylo 7,9% (0,86) i 7,8% (1,02) w odpowiednich grupach, W 26 tygodniu leczenia uzyskano redukcje HbA1c w obu grupach (eksenatyd –0,72% [0,12]; glargina –0,64% [0,12]). Poposilkowa glikemia, po śniadaniu i kolacji, byla nizsza u pacjentow leczonych eksenatydem. Masa ciala w tej grupie ulegla redukcji 1,9 (0,48) kg, natomiast wzrosla 1,6 (0,48) kg u pacjentow leczonych insuliną (roznica: –3,5 kg [95%CI –4,9; –2,2]). Nocne hipoglikemie zostaly zgloszone przez 3 pacjentow w porownaniu do 7 (3 v. 24 epizody) odpowiednio w grupie leczonej eksenatydem i glarginą. Objawy uboczne wystepowaly cześciej w grupie leczonej eksenatydem (nudności n = 22 v. n = 1, wymioty n = 5 v. 0, bole glowy n = 8 v. n = 2) w porownaniu z grupą leczoną glarginą. Wnioski: Eksenatyd byl rownie efektywny jak glargina w zakresie wyrownania gospodarki weglowodanowej w badanych grupach pacjentow z cukrzycą typu 2. Terapia eksenatydem skuteczniej obnizala glikemie poposilkowe, zaś insulinoterapia zapewniala nizsze glikemie na czczo. Przewagą leczenia eksenatydem byla redukcja masy ciala oraz mniej epizodow hipoglikemii, jednak przy wiekszej czestości objawow ubocznych ze strony przewodu pokarmowego. (Endokrynol Pol 2013; 64 (5): 375–382)

Current literature provides contradictory information on the role of adiponectin (AdipoQ) in the course of gestational diabetes (GDM). The aim of the study was to measure AdipoQ concentration in blood of women with GDM and to find relationships between this adipokine and clinical and biochemical parameters. The study group included 50 women diagnosed with GDM between 24 and 28 weeks of gestation who underwent routine prenatal tests for GDM in compliance with the guidelines of the Polish Diabetes Association. All patients underwent clinical and laboratory evaluation at GDM diagnosis. Laboratory tests included serum AdipoQ concentration, fasting glucose, fasting insulin, OGTT and lipid parameters in serum. AdipoQ concentrations did not differ significantly between the groups during gestation (p=0.7054). In the subgroup (2h glucose level in the OGTT 200 mg/dl) the concentration of AdipoQ tended to be decreased as compared to the remaining patients from the study and control groups, though the decline was insignificant (p=0.0541). The concentration of AdipoQ in the subgroup was about 20% lower than in the other patients from the study group. No correlations, except with the neonatal weight (r= - 0.29, p

Aims We hypothesised that serum fibroblast growth factor 21 (FGF-21), a novel adipokine with postulated insulin-sensitizing effects, may be predictive of cardiovascular (CV) events in patients with type 2 diabetes (DM2) at a relatively short-term follow-up. Methods Serum FGF-21 levels were assessed in 87 DM2 patients, aged 57–66 years, with the median duration of diabetes of 10 years, who were referred to the Department of Endocrinology for routine annual metabolic assessment. During a follow-up of 24 months, overall mortality, CV mortality and CV nonfatal events were registered. Cox proportional hazards regression assessed adjusted differences in CV morbidity and mortality risk. Results Patients stratified according to serum FGF-21 levels ≤ and > the median value of 240.7pg/mL showed no significant differences at baseline in gender distribution, diabetes duration, insulin therapy, BMI, biochemical profiles and previous CV events. At 24-month follow-up, 21 (24.1%) patients experienced a nonfatal CV event. A significantly ( P =0.0013) higher incidence of the combined end point of CV morbidity and mortality was observed in the FGF-21>240.7pg/mL group. In the multivariate Cox proportional hazards regression model, the presence of FGF-21>the median value was associated with a significant increase in the risk of the combined end point of CV morbidity and mortality (HR: 4.7, 95% CI 1.67–13.24). Conclusions The obtained results support the prognostic value of FGF-21 in DM2 and may provide a useful tool for stratification of CV prognosis in DM2 patients.

Fibroblast growth factor 21 (FGF21) is a newly discovered adipokine, synthesized by several organs, mostly by the liver, which was introduced as a potent metabolic regulator and insulin-sensitizing factor. Numerous animal studies have demonstrated that FGF21 improves glucose and lipids metabolism and exerts anti-inflammatory effects. However, data obtained from human studies have shown contradictory results, in which circulating FGF21 levels were often elevated in obesity, dyslipidemia, type 2 diabetes (DM2) and other conditions connected with insulin resistance. This increase in basal FGF21 concentrations observed in patients with obesity and other conditions related to insulin resistance was being explained as a compensatory response to the underlying metabolic disturbances or tissue resistance to FGF21 action. Furthermore, the results of clinical trials have shown that increased FGF21 concentrations were associated with increased cardiovascular (CV) risk and had a prognostic value in CV outcomes. In recent years, it has been reported that FGF21 may exert cardioprotective effects. This mini-review aims to summarize the current state of knowledge about the role of FGF21 in CV disorders, and discuss the molecular mechanism underlying the anti-atherogenic properties of this compound.

Insulin-like growth factor-1 (IGF-1), which has effects similar to insulin, reduces blood glucose level, improves insulin sensitivity and may play an important role in the pathogenesis of gestational diabetes (GDM).The aim of the study was to estimate the concentration of IGF-1 in pregnant women with GDM and 3 months after delivery and find relationships between IGF-1 and clinical and biochemical parameters.67 women between 24th - 28th week of pregnancy were enrolled in the study (46 with GDM and 21 as a control group). All women underwent clinical and biochemical examinations. Concentrations of IGF-1, adiponectin, fasting glucose, insulin, lipids, CRP, fibrinogen were measured during pregnancy, additionally IGF-1 concentration was determined 3 months after delivery.IGF-1, glucose, insulin, CRP, fibrinogen, lipids concentrations and HOMA-IR were significantly higher in women with GDM than in the control group (p0.05). A significant decrease in IGF-1 concentration was observed in both groups after delivery. In the GDM group significant correlations between IGF-1 and BMI (r=0.370, p0.05), insulin (r=0.469, p0.01) and HOMA-IR (r=0.439, p0.01) were observed. Regression analysis with IGF-1 as a dependent parameter showed that only BMI and insulin remained as predictors, explaining 32% of plasma IGF-1 variation. Re-evaluation after delivery revealed impaired glucose tolerance in 9% of the population studied.Increased IGF-1 concentrations in pregnancy complicated with GDM may partly reflect metabolic disturbances, especially insulin resistance and hyperinsulinemia, and may be one of possible compensatory reactions of the organism in response to these disturbances.

Fibroblast growth factor 21 FGF-21 is a newly discovered adipocytokine which may play a vital role in improvement of insulin sensitivity and pathogenesis of type 2 diabetes. The aim of the study was to assess FGF-21 concentrations in the serum of patients with type 2 diabetes, in comparison to a control group, and evaluate the possible relationships between the studied cytokine and selected clinical and biochemical parametersThe study was conducted in 64 patients with type 2 diabetes, 28 women and 36 men aged 47-70 (median age 61.5), with a median duration of diabetes of 8.5 years. In fasting serum samples, concentrations of glucose, insulin, lipids profile parameters, creatinine, C-reactive protein (CRP), fibrinogen, HbA(1c), adiponectin, and FGF-21 were determined. The control group comprised 20 healthy persons matched for age to the study group, with no disturbances in carbohydrate metabolism: 14 women and 8 men.We found significant differences concerning the medians of body mass index (BMI) 32.4 kg/m(2) v. 24.1 kg/m(2), p0.001; waist circumference 114 cm v. 81 cm, p0.001; HDL cholesterol 42.5 mg/dl v. 62.5 mg/dl, p0.001; triglyceride (TG) 152 mg/dl v. 99 mg/dl, p0.01 in the studied group, in comparison with the control group, respectively. In patients with diabetes, median FGF-21 concentration was 239.9 pg/ml and was significantly greater in comparison to the control group: 112.6 pg/ml p0.01. Median adiponectin concentration in patients with type 2 diabetes was significantly lower in comparison to the control group, 7.5 ng/ml v. 9.95 ng/ml, p0.05. Significant correlations between FGF-21 concentrations and adiponectin (r = -0.24, p0.05), weight (r = 0.27, p0.05), glucose (r = 0.27, p0.05), HDL cholesterol (r = -0.26, p0.05), TG (r = 0.27, p005), and estimated glomerular filtration rate (eGFR) (r = -0.28, p0.05) were observed. No significant correlations between FGF-21 and parameters of metabolic control, markers of inflammatory status, and insulin resistance, or the presence of vascular complications of diabetes, were noticed.On the basis of the conducted studies it can be concluded that the greater FGF-21 concentration observed in the examined group of patients with type 2 diabetes may result from a compensatory reaction to metabolic disturbances or tissue resistance to this cytokine. The negative correlation between FGF-21 and eGFR suggests renal elimination of the examined compound. (Pol J Endocrinol 2010; 61 (1): 50-54).

In the pathogenesis of diabetes type 2, increasing insulin resistance is accompanied by dysfunction of pancreatic islet b cells. It is hypothesized that at the basis of this pathology lies an incretin defect of insulinotropic gut-derived hormones, relying on decreased secretion of GLP-1 (glucagon-like peptide 1), with preserved insulinotropic effect, whereas GIP (glucose-dependent insulinotropic polypeptide) secretion remains within physiological limits, but its action is mostly impaired due to total loss of possibility for stimulation of the second phase insulin secretion. Possibilities for pharmacological correction of incretin defect create an opportunity of causative treatment of diabetes and provide basis for development of research on a new group of drugs which promote hypoglycemia. In the presence of these findings there are many ongoing clinical studies with the use of GLP-1 analogues or GLP-1 receptors activators (GLP-1 agonists), as well as the inhibitors of dipeptidyl peptidase IV (DPP-IV), the enzyme responsible for incretin proteolysis, in the treatment of type 2 diabetes. Multidirectional, glucoregulative mechanism of action of these drugs, aiming at the pathogenesis of the disease, restores the proper function of the intestinal-pancreatic axis in subjects with type 2 diabetes and ensures good metabolic control and improvement in quality of life in this group of patients.