Endokrynologia Polska最新文献

Introduction: Primary thyroid lymphoma (PTL) is a rare thyroid malignancy, usually presenting as a rapidly enlarging neck mass. We aimed to describe its clinical, biochemical, imaging, and pathological features.

Material and methods: Retrospective single-center study, including 20 patients diagnosed with PTL between 2000 and 2023 (median age 76 years, range 47-84; 85% female). Clinical presentation, thyroid function, imaging, histopathology, treatment, and outcomes were reviewed.

Results: Nineteen patients (95%) presented with a rapidly growing neck mass with a median duration of one month. Compressive symptoms occurred in 70%, and B symptoms in 20%. Hypothyroidism was present in 45%, and thyroid autoimmunity in 67% of patients with available data. Ultrasound (performed in 16 patients) showed hypoechoic nodules in most cases, with a mean size of 49.7 mm; cervical lymphadenopathy was observed in 20%. Fine-needle aspiration (FNA) suggested lymphoma in 78%. Histological confirmation was obtained by core-needle biopsy in 70%, incisional biopsy in 10%, and surgery in 15%. Nineteen patients (95%) had diffuse large B-cell lymphoma, and one had mucosa-associated lymphoid tissue (MALT) lymphoma. At presentation, 59% had localized disease, 12% regional, and 29% disseminated. Two patients died before treatment. Most received R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) or reduced-dose R-CHOP (R-miniCHOP); three also underwent radiotherapy. Complete remission was achieved in 61% of patients. Median follow-up was 2.5 years.

Conclusions: PTL should be suspected in patients with a rapidly enlarging thyroid mass. While FNA is often informative, biopsy is usually required for diagnosis. Most cases are diffuse large B-cell lymphoma, with chemotherapy as the mainstay of treatment. Larger studies are needed to refine diagnostic pathways and prognostic markers.

Introduction: Nesfatin-1 (NESF-1) is a neuropeptide occurring in the central nervous system and peripheral tissues. Strongly associated with anxiety, it regulates glucose levels and is a negative modulator of food intake. Intracerebroventricularly injected nesfatin-1 in experimental animals inhibits food intake, whereas administration of a NESF-1 neutralizing antibody stimulates their appetite. Glucagon-like peptide 1 (GLP-1), a gastrointestinal ormone released ca. 15-30 min. after a meal, demonstrates incretin properties. Peripheral administration of GLP-1 stimulates the secretion of gastric acid, slows down the emptying of the stomach, and reduces the feeling of hunger and the quantity of food ingested by the obese population.

Material and methods: A review of the medical database PubMed was carried out covering the years 1990-2024 in terms of blood concentrations of nesfatin-1 and GLP-1 in patients suffering from anorexia nervosa and simple obesity and the role of these hormones in the etiopathogenesis of the eating disorders referred to above.

Results: Based on the review of the available literature, it was noted that concentrations of NESF-1 in blood serum are reduced in the group of adult patients with anorexia nervosa (AN) and higher in the group of obese patients, in comparison to a control group of individuals with normal body weight. Findings of research on blood concentrations of GLP-1 in adult subjects with AN are divergent - they point to higher, reduced, or not significantly different GLP-1 levels as compared to the control group. According to the studies, in obese subjects basal GLP-1 levels in blood do not differ significantly from those of subjects with normal body weight, whereas after a meal or glucose administration they are significantly reduced compared to obese subjects.

Conclusions: Nesfatin-1 and GLP-1 are associated with eating disorders, although their role has not been fully clarified so far. Regulation of concentrations of these peptides is assumed to be important in adaptation processes of an organism to deficient and excessive body weight or to play a role in the etiopathogenesis of anorexia nervosa and obesity.

Introduction: Primary hyperparathyroidism is a set of symptoms caused by overproduction of parathormone (PTH), leading to impaired calcium and phosphorus metabolism. Proper diagnosis and detection of a parathyroid adenoma, including ectopic ones, is crucial to confirm the diagnosis and to tailor further treatment. In clinical practice, preoperative localization of parathyroid adenomas is a difficult task. Conventional imaging studies such as ultrasonography (US) and 99mTc-MIBI scintigraphy often cause unequivocal results; therefore, additional examinations are needed. The following paper discusses currently available diagnostic methods that could help in doubtful cases, and which should be considered during localization of parathyroid lesions.

Material and methods: When writing the following paper, we researched medical databases, such as PubMed and Google Scholar, for papers published in 2000-2024 with special attention paid to the latest articles published in the past 5 years. The presented data are gathered from 66 selected publications on primary hyperparathyroidism and contemporary methods of localization diagnostics by keywords: "primary hyperparathyroidism", "parathyroids", "parathormone", "MIBI", "scintigraphy", "parathyroids ultrasonography", "parathyroid adenoma", "parathyroid localization diagnostics", "imaging studies in hyperparathyroidism", "minimally invasive surgery in hyperparathyroidism", "18F-choline", "PET", and "PTH washout."

Results: Use of positron emission tomography with 18F-choline (18F-FCH PET/CT) or parathormone washout from ultrasound-guided fine-needle aspiration (FNA) increases the effectiveness of localization diagnostics. Due to the high sensitivity of those tests, contemporary reports emphasize their value more often than ever. These examinations have a great impact on the accurate identification of parathyroid lesions, and in some cases they allow minimally invasive surgery to be performed.

Conclusions: The following paper underlines a need for determination of a perfect tool for primary hyperparathyroidism localization diagnostics based on its sensitivity and availability; however, contemporary available tests and exams when combined may bring great results and allow a patient to be qualified for a minimally invasive surgical treatment.

Introduction: Studies show an association between polycystic ovary syndrome (PCOS) and an increased incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) in this patient group. Diagnostic tools that can screen relevant groups of PCOS' patients for liver disease are still being sought.

Material and methods: Our study included 242 patients with PCOS diagnosed on the basis of the Rotterdam criteria, which we divided according to phenotypes. Using the Fibrosis-4 (FIB-4) and BAAT (BMI, age, ALT, triglycerides) calculators, we conducted screening for liver disease in each group of patients. In addition, we compared the results of anthropometric measurements, androgen serum levels, and Homeostatic Model Assessment - Insulin Resistance (HOMA-IR) index in each group.

Results: The values of the FIB-4 and BAAT indices in this study are small regardless of phenotype. A notably significant difference in FIB-4 was found only between phenotypes A and B (p = 0.01). The median of the FIB-4 index among patients with phenotype B was Me:-0.51; interquartile range (IQR): 0.22. The median of FIB-4 index among patients with phenotype A was Me: -0.41; IQR: 0.18. The groups of PCOS patients divided by phenotypes based on the BAAT index are similar, a difference that was statistically insignificant (p = 0.3). The lowest levels of insulin were noted in phenotype C, and it was significantly different from levels of insulin in phenotype B. The multiple comparisons for levels of glucose and HOMA-IR were not significantly different.

Conclusions: The probability of liver fibrosis in the PCOS patients examined on the basis of both the FIB-4 and BAAT indices is low, which is probably due to the young age of the subjects. Higher FIB-4 index results were obtained in the group of patients with phenotype B compared to the group with phenotype A, and the group with phenotype B was similar to the groups with phenotype C and D. Moreover, based on our results, we demonstrated lower level of insulin in phenotype C compared to the group with phenotype B. The BAAT index result proved to be statistically insignificant in the studied patients, with a breakdown by PCOS phenotype.

Functional hypogonadism is a syndrome characterized by low testosterone levels and clinical features of hypogonadism without organic disease of the hypothalamus-pituitary-gonadal axis. It is most prevalent among middle-aged and older men as late-onset hypogonadism as well as in a wide range of conditions such as obesity, type 2 diabetes, opioid use, or exogenous steroid abuse. As a potentially reversible condition, lifestyle modifications are the basis of initial management of functional hypogonadism. However, if behavioral interventions cannot be expected to be successful in raising testosterone levels in a reasonable amount of time, then both testosterone and alternative treatments must be considered. In young men seeking fertility, testosterone is contraindicated; hence, selective estrogen receptor modulators and aromatase inhibitors might be offered; however, the available literature concerning their use in male functional hypogonadism is rather scarce. This review aims to update information about selective estrogen receptor modulators and aromatase inhibitors in the treatment of functional male hypogonadism.

Introduction: The objective was to investigate the association between physical activity variability (PAVar) and the risk of type 2 diabetes mellitus (T2DM) among middle-aged and older adults.

Material and methods: This longitudinal cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), following participants from 2011 to 2020. A total of 3970 individuals with sufficient physical activity (PA) data were categorized into quartiles based on the coefficient of variation (CV) for PAVar. The incidence of T2DM was assessed using Cox proportional hazards models adjusted for demographic, socioeconomic, and lifestyle factors. Mediation analysis was performed to evaluate whether sleep duration influenced the relationship between PAVar and T2DM risk. Sensitivity analyses excluded individuals with missing baseline data to ensure the reliability of the findings.

Results: Higher PAVar was associated with an elevated risk of T2DM. In fully adjusted models, participants in the highest CV quartile had a 70% greater risk of developing T2DM [hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.54-1.88] compared to those in the lowest quartile. Mediation analysis showed that sleep duration accounted for 18.5% of the total effect of PAVar on T2DM risk. Sensitivity analyses confirmed the robustness of these findings.

Conclusions: This study demonstrates the harmful effects of high PAVar on T2DM risk and underscores the need to promote consistent physical activity patterns and adequate sleep to prevent diabetes, particularly in aging populations.

Introduction: Obesity has emerged as a global health epidemic, which carries significant implications for both individual health and healthcare systems worldwide. Numerous reports have shown the health advantages associated with a 5-10% reduction of one's initial body weight, but it remains unclear whether the data from clinical trials translate to real-world clinical practice. In our retrospective analysis, we evaluated the effectiveness of a multifactorial obesity treatment, including pharmacotherapy, in Polish conditions. The objective was to assess the efficacy of this multimodal treatment in achieving a 5-10% weight reduction over 3-6 months.

Material and methods: The patient cohort included 1114 adults: 243 (22%) men and 871 (78%) women, aged 16-80 years, diagnosed with obesity and overweight in a team-based obesity treatment program with one-day-stay admissions. Each patient underwent a tailored multifactorial obesity treatment regimen, which incorporated dietary adjustments, physical activity, psychological support, and pharmacotherapy.

Results: Weight reduction was observed in 868 (78%) patients. Of these, 635 (57%) achieved a 5% weight reduction, and 379 (34%) achieved a 10% reduction. No significant gender differences were found in weight reduction. Unlike clinical trials, weight reduction was similar between those receiving only behavioral treatment and those also on medication. The profile of a good responder in real-world conditions included high adherence to recommendations and follow-up visits, and absence of type 2 diabetes.

Conclusions: Our study demonstrates that obesity can be effectively managed through individualized multimodal treatment. Nonetheless, this process demands sustained effort and necessitates individualized therapy overseen by a multidisciplinary therapeutic team.

Introduction: Adrenocortical carcinoma (ACC) is a rare malignant neoplasm. Hypercortisolism and inhibition of gonadotropin secretion usually result in menstrual disorders and secondary amenorrhea. The coincidence of ACC and pregnancy is therefore extremely rare. The signs of hypercortisolism are commonly seen in otherwise healthy pregnancies, which decreases the doctor's vigilance. We present the diagnostic challenges and current treatment recommendations according to European guidelines from the European Society of Endocrinology (ESE) and European Network for the Study of Adrenal Tumors (ENS@T) 2018 and Polish guidelines 2024.

Material and methods: We conducted an extensive search via MEDLINE using the phrases "Adrenocortical carcinoma", "ACC", and "Pregnancy" without temporal or language restrictions. Only cases with ACC diagnosed during pregnancy were taken into consideration. Ten papers were found, with 12 described cases. We analyzed the management and outcome both for the mother and the child. We also included a case of a woman treated in our department. A 29-year-old woman in the 20th/21st gestation week (GW) presented to us with Cushing's syndrome symptoms and androgenization. Laboratory tests showed low plasma adrenocorticotropic hormone (ACTH), high cortisol, testosterone, dehydroepiandrosterone sulfate (DHEA-SO4), androstenedione, 24-hour urinary free cortisol (UFC), and hypokalemia. In the abdominal magnetic resonance imaging (MRI) there was a mass in the left adrenal gland. An open surgery was performed in the 21st GW with no perioperative complications. The pathology report established the diagnosis of ACC. The tumor board along with the patient decided to defer the adjuvant therapy until the 32nd GW to increase the odds for the fetus to survive. In the 31st GW an urgent caesarian section was performed due to risk of fetal hypoxia. Computed tomography (CT) scan after the delivery showed local recurrence in the tumor bed. The patient was qualified to mitotane therapy and underwent tumor bed radiotherapy followed by chemotherapy, but the treatment did not stop the progression of the disease. She passed away 14 months after the diagnosis.

Conclusions: It is critical to remember about the possibility of ACC occurrence during pregnancy, as well as to know about the differences in hormonal tests in pregnant women such as higher free plasma cortisol, ACTH, UFC, and high rate of false-positive results of low-dose dexamethasone suppression test (LDDST) in comparison to non-pregnant women. Therapeutical options are scarce and pose an ethical dilemma.

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