Endokrynologia Polska最新文献

Introduction: Radioiodine-refractory differentiated thyroid cancer (RAIR DTC), although rare, constitutes a real clinical challenge due to its prognosis despite a growing number of available treatment modalities. This study aimed to analyze the real-world efficacy and toxicity of lenvatinib therapy in a group of Polish patients with advanced RAIR DTC.

Material and methods: A group of 27 patients was eligible for lenvatinib therapy due to measurable, progressive, RAIR DTC, of whom 21 ultimately received the treatment. Treatment outcomes were assessed in terms of Response Evaluation Criteria in Solid Tumors (RECIST) as well as Kaplan-Meier estimates of overall survival and progression-free survival (PFS) for the whole cohort and for subgroups receiving lenvatinib as the first or subsequent line of targeted therapy. PFS was reported using both intention-to-treat (ITT) and per-protocol (PP) definitions, depending on whether treatment discontinuation was treated as censoring. Treatment toxicity was evaluated according to Common Terminology Criteria for Adverse Events (CTCAE).

Results: Median overall survival (OS) in the whole group was 38.9 months [95% confidence interval (CI): 23.8- not reached (NR)], while one-year and two-year survival rates were 0.85 (95% CI: 0.72-1.00) and 0.63 (95% CI 0.45-0.89), respectively. ITT-PFS was 21.3 months (95% CI: 12.2-NR). One-year ITT-PFS was 0.75 (95% CI: 0.57- .00), while 2-year ITT-PFS was 0.44 (95% CI: 0.22-0.76). Similar estimates were obtained using the PP-PFS definition. All patients reported treatment-related side effects, the most common being proteinuria, weight loss, hypertension, and mucositis.

Conclusion: This retrospective analysis of a Polish RAIR thyroid cancer cohort demonstrated very good efficacy of lenvatinib in the first-line setting, while its activity in the second-line setting, although still present, was reduced. Based on these results, we suggest that lenvatinib should again be available for the treatment of RAIR thyroid cancer in Poland.

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Diabetes is a major metabolic disease that is undergoing a global increase and negatively impacts the body's ability to regulate blood glucose levels. Although currently there are common therapeutic strategies, there is growing interest in alternative treatments, driven by concerns over potential side effects and limited efficacy. This review evaluates the influence of phytochemicals on diabetes treatment, as supported by evidence from recent clinical trials. A wide array of phytochemicals, including polyphenols, flavonoids, and alkaloids, have shown considerable potential in the management of diabetes. Their reported effects include regulation of blood glucose levels, improvement of insulin sensitivity, and modulation of carbohydrate metabolism. In addition, phytochemicals have demonstrated antioxidant activity by reducing oxidative stress and strengthening endogenous defense mechanisms, along with anti-inflammatory effects mediated through cytokine regulation and signaling pathways. Collectively, these actions contribute to improved glycemic control and overall metabolic stability. It has also been hypothesized that phytochemicals may help ameliorate diabetes-related complications such as cardiovascular dysfunction, nephropathy, and neuropathy. Although promising results have been observed in clinical trials, limitations exist due to variability in study design, intervention dose, and treatment duration. Furthermore, most available findings are short-term, leaving the long-term efficacy and safety of phytochemicals less clearly defined. In conclusion, phytochemicals represent a promising adjunctive approach in diabetes management, offering multi-targeted effects on glycemic regulation, oxidative stress, and inflammation. However, further large-scale, well-designed studies are required to clarify their mechanisms of action and establish their long-term clinical implications.

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Introduction: Proven risk factors for thyroid orbitopathy (TO) are thyroid dysfunction, smoking, and high levels of thyrotropin receptor antibodies (TRAb), and the role of insulin-like growth factor 1 (IGF-1), the receptor for IGF-1 (IGF-1R), and antibodies to the receptor for IGF-1 (IGF-1RAb) are also debated. IGF-1R is overexpressed in fibroblasts and orbital lymphocytes in TO patients. It forms a functional complex and mediates signal transduction through thyroid stimulating hormone receptor (TSHR). The study aimed to evaluate the levels of IGF-1RAb, IGF-1, and IGFBP-3 in a group of Graves' and Basedow's disease (GBD) patients with or without TO.

Material and methods: Sixty-seven patients were included in the study, including 47 GBD and 20 control patients. In the GBD group, 31 patients were diagnosed with active TO and were treated with immunosuppressive therapy according to the standard of European Group on Graves' Orbitopathy (EUGOGO) guidelines. In this group, 10 patients were in the sight-threatening stage of TO severity according to EUGOGO classification. IGF-1 and IGFBP-3 levels were determined with the use of chemiluminescence immunoassay (CLIA) methods. IGF-1RAb was measured by the "in-house" constructed enzyme-linked immunosorbent assay (ELISA) method.

Results: Including our cut-off value (Q75 - 232.48 ng/mL), positive serum IGF-1RAb was found in 25% of patients in the control group (5 out of 20 patients), in 38.3 % (18 out of 47 patients) of patients with GBD, and in 22.5% of GBD patients with active TO (7 out of 31 patients). In GBD patients with active TO, there were no differences in IGF-1RAb when compared to the control group but with a significantly lower level when compared to the GBD patients without active TO. The group of patients with active TO in the sight-threatening stage had significantly lower values of IGF-1RAb compared to the group of patients with GBD without the presence of TO (p = 0.004). There was also a difference in IGF-1RAb concentration between the groups in moderate-to-severe and sight-threatening stages of TO before starting immunosuppressive treatment (p = 0.014). There was no difference in IGF-1 levels between the control group and GBD patients with active TO before starting immunosuppressive treatment and GBD patients without active TO. The was a significant difference in IGF-1 concentration between the group with moderate-to-severe and sight-threatening stages of TO before starting immunosuppressive treatment (p = 0.009). We found significantly lower IGFBP-3 concentrations in GBD patients regardless of the presence of TO compared to the control group (p = 0.016). There was no difference in IGFBP-3 concentrations between patients with moderate-to-severe and sight-threatening stages of TO (p = 0.203).

Conclusion: It seems that high IGF-1RAb levels may have a protective effect against the onset or severe course of TO,

This article presents framework guidelines for the care of adolescent transgender (T) and non-binary (NB) individuals experiencing gender dysphoria (GD) and/or gender incongruence (GI). Developed by a multidisciplinary expert panel, these guidelines aim to address the complex medical, psychological, and social needs of this diverse population. The document emphasises the importance of individualised, affirmative care that respects the autonomy, identity, and rights of adolescents. It outlines best practices for psychiatric, psychological, and sexological assessment; criteria and protocols for gender-affirming hormonal interventions (GAHI) and puberty suppression; and ethical considerations for medical decision-making. The guidelines advocate for comprehensive support systems, including family involvement and multidisciplinary team collaboration, while addressing co-occurring mental health conditions and neurodiversity. The article also highlights global perspectives on gender-affirming care, comparing practices and policies across countries to provide a contextualised approach that aligns with international standards while addressing local legal and healthcare frameworks. The proposed care model is designed to enhance the mental and physical well-being of adolescents, reduce stigma, and improve their overall quality of life. This work serves as a vital resource for healthcare professionals, policymakers, and advocates seeking to advance equitable, effective, and compassionate care for gender-diverse youths.

Introduction: The aim was to explore the correlation between adipose tissue insulin resistance and metabolic dysfunction-associated steatotic liver disease (MASLD), and to assess how the serum lipoprotein(a) [Lp(a)] level modifies the association between adipose insulin resistance and MASLD.

Material and methods: We analyzed hospitalized type 2 diabetes mellitus (T2DM) patients and calculated the adipose insulin resistance (Adipo-IR) index as the product of the fasting insulin and free fatty acid concentration. There were 2247 participants in the study, 64.6% (n = 1452) with MASLD.

Results: Compared to subjects in the first quartile of the Adipo-IR index, there were 1.29 [odds ratio (OR): 2.29, 95% confidence interval (CI): 1.56-3.36], 2.55 (OR: 3.55, 95% CI: 2.34-5.37), and 2.00 (OR: 3.00, 95% CI: 1.94-4.63) fold higher odds of having MASLD among subjects in the second, the third, and the fourth Adipo-IR index quartile, respectively. As the Adipo-IR index was in the range lower than 7.5, Adipo-IR was a risk factor for MASLD (OR: 1.349, 95%CI: 1.226-1.484). Conversely, if the Adipo-IR index was higher than 7.5, it became a protective factor for MASLD (OR: 0.980, 95% CI: 0.964-0.997). Subjects with high Lp(a) and low Adipo-IR showed the lowest risk of MASLD. Compared to this group, the ORs of MASLD was 2.411 (95% CI: 1.590-3.656) for the high Adipo-IR and low Lp(a) group, 2.770 (95% CI: 1.808-4.246) for the high Adipo-IR and high Lp(a) group, and 1.473 (95% CI: 1.003-2.164) for the low Adipo-IR and low Lp(a) group.

Conclusions: In patients with T2DM, with the increase of Adipo-IR, the incidence of MASLD showed a trend of first an increase and then a decrease. Among patients with T2DM, those with low Adipo-IR combined with high Lp(a) had the lowest risk of developing MASLD.

Introduction: Thyroid diseases are often associated with the amounts and functioning of thyroid hormones, which may have an impact on the makeup of gut microbiomes. Multiple studies have shown a correlation between gut microbiota and both Graves' disease and Hashimoto's thyroiditis. However, there is no proven link between the gut microbiota and thyroid nodules. Researchers will examine the correlation between Lactobacillus acidophilus and thyroid nodules and hormones.

Materials and methods: This work is a prospective case-control investigation undertaken from 2021 to 2022 at endocrine clinics situated at Ain Shams University in Cairo. A total of 90 participants, 30 as a control group (group C), 30 patients with benign thyroid nodules (group A), and 30 patients with malignant thyroid nodules (group B) participated in the study. Measurements of hormonal profile, serum selenium, zinc, thyroglobulin, thyroid peroxidase antibody (anti-TPO), and stool polymerase chain reaction (PCR) for Lactobacillus acidophilus levels were made in all groups.

Results: The cycle threshold (CT) at which lactobacilli PCR was expressed in group A was 32.340 ± 5.025 while in group B it was 34.957 ± 5.834 and in group C it was 27.530 ± 5.834, p < 0.001. There was highly significant variation between the studied groups.

Conclusion: The stool count of Lactobacillus acidophilus PCR showed a significant difference across the groups under study.

Introduction: Resection of pancreatic neuroendocrine tumors is associated with a high risk of clinically relevant postoperative complications. This study aimed to evaluate and analyze the relationship between selected preoperative risk factors and the occurrence of clinically relevant early postoperative complications, including pancreatic fistulas, after distal pancreatic resections for neuroendocrine tumors.

Material and methods: The analysis included 78 patients who underwent surgery for neuroendocrine tumors of the body or tail of the pancreas. A retrospective analysis was carried out regarding age, sex, comorbidities, preoperative C-reactive protein (CRP) levels, American Society of Anesthesiologists (ASA) score, tumor size, and Wirsung's duct diameter as measured on preoperative computed tomography (CT) scans of the abdomen. The severity of postoperative complications was assessed using the Clavien-Dindo classification, while the International Study Group on Pancreatic Fistula (ISGPF) classification was utilized to evaluate pancreatic fistulas.

Results: Pancreatic fistula was the most common complication and occurred in 42 cases (55.3%). A significant relationship was found between the ASA score and complication severity according to the Clavien-Dindo classification (p = 0.01). Multivariate analyses indicated associations between the occurrence of pancreatic fistula and male sex (OR = 0.17, p = 0.06), age (OR = 0.86, p < 0.01), preoperative CRP level (OR = 1.05, p = 0.01), and ASA score (OR = 125.97, p < 0.01). No significant correlation was identified between tumor size or Wirsung's duct diameter and the occurrence of clinically relevant postoperative complications or pancreatic fistulas (p > 0.05).

Conclusion: The ASA score correlates with the severity of postoperative complications as assessed by the Clavien-Dindo classification. The risk factors for developing B and/or C pancreatic fistulas include age, male sex, elevated preoperative CRP levels, and higher ASA scores.

Introduction: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive and lethal malignancies. The MiR-22 host gene (MIR22HG) has been identified as a novel long non-coding RNA (lncRNA) in a few types of cancer. Nevertheless, little is known about the potential role of MIR22HG in ATC. In this study, we aimed to investigate the biological functions and underlying molecular mechanisms of MIR22HG in ATC.

Material and methods: The expression of MIR22HG in tissues and cells of ATC were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The cell viabilities and invasive abilities were evaluated by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay, wound healing assay, and Matrigel invasion assay. The mechanism of MIR22HG interacting with microRNA-141-3p (miR-141-3p) was measured by RNA immunoprecipitation (RIP) assay, RNA pull-down assay, and dual-luciferase reporter assay.

Results: MIR22HG was downregulated in ATC tissues and cells. More importantly, decreased expression of MIR22HG was found to be correlated with poor prognosis of ATC patients. Functional analysis showed that overexpression of MIR22HG attenuated the proliferation and metastasis of ATC both in vitro and in vivo. Mechanistically, MIR22HG positively modulated phosphatase and tensin homolog deleted on chromosome ten (PTEN) expression via sponging miR-141-3p, thus inhibiting downstream protein kinase B (AKT) signaling cascade.

Conclusions: MIR22HG serves as a tumor suppressor in ATC and impedes the progression of ATC through regulation of miR-141-3p/PTEN/AKT axis. Our findings illustrate the critical role of the MIR22HG/miR-141-3p/PTEN/AKT axis in the progression of ATC, which offers new insights for the therapeutic strategies of ATC.