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: 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.

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.

Not required for Clinical Vignette.

Not required for Clinical Vignette.

Not required for Clinical Vignette.

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.