Bogusław Okopień

Publications of Bogusław Okopień

• [Diagnosis and treatment of craniopharyngioma].

  Authors: Robert Krysiak, Witold Szkróbka, Bogusław Okopień

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 03/2012; 32(189):182-6.

  Craniopharyngioma is a benign, suprasellar brain tumour accounting for about 1 to 3% of all intracranial neoplasms. Because of the proximity of the tumour to the hypothalamus and pituitary gland itsCraniopharyngioma is a benign, suprasellar brain tumour accounting for about 1 to 3% of all intracranial neoplasms. Because of the proximity of the tumour to the hypothalamus and pituitary gland its complete resection is often impossible. It still remains one of the most difficult tumours to the effective treatment and is associated with frequent recurrence. Currently, surgical excision followed by external beam irradiation, in cases of residual tumour, is the main treatment option. In this paper, the authors review different aspects of diagnostic and management of the craniopharyngioma. Particular attention is paid to the results of the studies published in the recent years. The reader is also provided with some practical recommendations on dealing with patients suffering from this tumour.

• [Gynecomastia].

  Authors: Robert Krysiak, Bogusław Okopień

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 03/2012; 32(189):187-93.

  Gynecomastia, a benign enlargement of the male breast resulting from a proliferation of its glandular component, is a common condition, present in 30 to 50% of men. The disease, caused by hormonalGynecomastia, a benign enlargement of the male breast resulting from a proliferation of its glandular component, is a common condition, present in 30 to 50% of men. The disease, caused by hormonal imbalance at the breast tissue level, may occur both physiologically at some stages of life or be secondary to various disorders. On the basis of a thorough history, a detailed physical examination and an appropriate clinical evaluation, it must be determined whether this condition has a physiologic or pathologic cause. Although biochemical investigations or imaging procedures help in establishing an underlying cause, they are recommended to be performed only in selected patients. Treatment depends on the cause and may include observation, withdrawal of an offending drug, therapy of an underlying disease, pharmacotherapy and in some cases surgery or radiotherapy. In this review, the authors discuss the etiopathogenesis, diagnosis and treatment options in gynecomastia. Particular attention has been paid to the results of the studies published in the last years.

• [Multiple endocrine neoplasia type 1].

  Authors: Robert Krysiak, Bogusław Okopień

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 02/2012; 32(188):116-22.

  Multiple endocrine neoplasia (MEN) type 1 exhibits an autosomal dominant pattern of inheritance and results from mutation of the MEN-1 gene that is a tumor suppressor gene acting on theMultiple endocrine neoplasia (MEN) type 1 exhibits an autosomal dominant pattern of inheritance and results from mutation of the MEN-1 gene that is a tumor suppressor gene acting on the transcriptional level. The disease is characterized by a variety of neuroendocrine neoplasias and hormone excess syndromes. The major components of MEN-I are hyperparathyroidism due to multiple parathyroid adenomas, pancreatic or duodenal neuroendocrine tumors, and pituitary adenomas, in addition to some less common neoplastic manifestations. The development of the tumors often follows a substantially similar pattern: the initial lesion is a diffuse hyperplastic proliferation of the affected endocrine tissue with bilateral involvement of pair organs, followed by development of multiple micro- and, eventually, macronodular lesions. Its unpredictable course causes that there is controversy regarding treatment of the different manifestations and screening modalities of this disorder. This article reviews our current approach to the diagnosis, surveillance and management of these patients.

• [Current views on etiology, pathophysiology and clinical manifestations of acromegaly].

  Authors: Robert Krysiak, Bogusław Okopień, Bogdan Marek

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 02/2012; 32(188):123-8.

  Acromegaly is a relatively rare disease caused by excess secretion of growth hormone, usually from a pituitary somatotrope adenoma. Most of the tumors causing acromegaly are sporadic but in someAcromegaly is a relatively rare disease caused by excess secretion of growth hormone, usually from a pituitary somatotrope adenoma. Most of the tumors causing acromegaly are sporadic but in some cases the disease results from the presence of an inherited endocrine syndrome including type 1 multiple endocrine neoplasia, McCune-Albright syndrome and Carney complex. Because of the slow evolution of signs and symptoms, acromegaly can be a diagnostic challenge. The disease is characterised by significantly increased morbidity and mortality, both of which are secondary to the involvement of multiple organ systems. This prompts the need for the rapid and accurate recognition and management of this disorder. Acromegaly is diagnosed on the basis of clinical picture, hormonal assays and radiologic imaging of the pituitary gland. This article reviews the etiology, histopathological picture, clinical features and current diagnostic strategies in acromegaly and prognosis in this disorder.

• Short-term antihypertensive therapy lowers the C-reactive protein level.

  Authors: Andrzej Madej, Aleksandra Bołdys, Lukasz Bułdak, Krzysztof Labuzek, Marcin Basiak, Bogusław Okopień

  Postȩpy higieny i medycyny doświadczalnej (Online). 01/2012; 66:78-84.

  There is a growing body of data concerning significant interactions between markers of inflammation and cardiovascular diseases such as hypertension accompanied by elevated levels of plasmaThere is a growing body of data concerning significant interactions between markers of inflammation and cardiovascular diseases such as hypertension accompanied by elevated levels of plasma C-reactive protein (CRP). Therefore CRP is thought to be an independent risk factor of cardiovascular diseases. The aim of this study was to evaluate the effects of antihypertensive therapy (perindopril, bisoprolol and combined therapy) on plasma CRP concentration in 67 subjects with mild or moderate hypertension who have been treatment-naive and otherwise healthy. The results show a correlation between CRP level and blood pressure values. BP reduction was associated with a decrease in CRP concentration. The CRP-lowering effect of perindopril and bisoprolol was comparable and the degree of reduction might reflect their similar influence on blood pressure. Combined treatment influenced the CRP level to a greater extent than both monotherapies. Plasma CRP level was lowered by antihypertensive therapy independently of the drug applied. The CRP level did not normalize completely in moderate hypertensive patients.

• [Pathogenesis and clinical presentation of andropause].

  Authors: Robert Krysiak, Bogusław Okopień

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/2012; 32(187):70-3.

  In opposition to women, the age-related changes in reproductive hormones in men are subtle and occur gradually throughout many years of mature life. The decline in serum testosterone level mayIn opposition to women, the age-related changes in reproductive hormones in men are subtle and occur gradually throughout many years of mature life. The decline in serum testosterone level may present as a constellation of signs and symptoms of hypogonadism known as "andropause". They include: loss of energy, depressed mood, decreased libido, erectile dysfunction, decreased muscle mass and strength, increased fat mass, frailty, osteopenia, and osteoporosis. Diagnosis of andropause is based on clinical symptoms and laboratory determinations of serum testosterone levels. This review summarises the present state of knowledge on the pathogenesis, clinical presentation as well as diagnosis of andropause.

• [Treatment of patients with andropause].

  Authors: Robert Krysiak, Bogusław Okopień

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/2012; 32(187):74-8.

  The decline in serum testosterone level occur gradually throughout men's mature life and it may present as a constellation of signs and symptoms of hypogonadism known as "andropause". When diagnosed,The decline in serum testosterone level occur gradually throughout men's mature life and it may present as a constellation of signs and symptoms of hypogonadism known as "andropause". When diagnosed, the treatment should be introduced. The benefits of testosterone supplementation in this age group have yet to be equivocally established. Although testosterone therapy can induce adverse effects, these can be largely minimised by proper monitoring. This review summarises the present state of knowledge on the treatment of andropause.

• [Advances in the etiopathogenesis, diagnosis and treatment of paragangliomas].

  Authors: Robert Krysiak, Dorota Frysz-Naglak, Bogusław Okopień

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 11/2011; 31(185):302-8.

  Paragangliomas are rare, benign or less frequently malignant tumors developing from cells of the paraganglia, a diffuse neuroendocrine system dispersed from skull base to the pelvic floor. AlthoughParagangliomas are rare, benign or less frequently malignant tumors developing from cells of the paraganglia, a diffuse neuroendocrine system dispersed from skull base to the pelvic floor. Although paragangliomas may arise in any portion of this system, they most commonly occur below the diaphragm. Even 50% of the tumors may be hereditary and therefore genetic testing should be taken into consideration in all patients with paragangliomas. In many patients their presence leads to headaches, palpitations, sweating, or hypertension. However, subjects with nonfunctional tumors are either asymptomatic at presentation or experience only local symptoms caused by the mass effect. Functional paragangliomas can be almost always revealed by measurements of plasma concentrations of free metanephrines or 24-hour urinary outputs of fractionated metanephrines and catecholamines. There are also several morphological and functional imaging methods available that help localize neoplasm and assess its extent. In this paper, we discuss the published literature on the etiopathogenesis, diagnostic work up and the different treatment options for patients with paraganglioma. This review looks also at the recent advances in the physiology and molecular basis of these tumors.

• Ezetimibe--a new approach in hypercholesterolemia management.

  Authors: Dariusz Suchy, Krzysztof Łabuzek, Antoni Stadnicki, Bogusław Okopień

  Pharmacological reports : PR. 11/2011; 63(6):1335-48.

  Ezetimibe is the first agent used in hypercholesterolemia treatment known to lower intestinal cholesterol uptake that is able to inhibit NPC1L1 transport proteins in the brush boarder of enterocytesEzetimibe is the first agent used in hypercholesterolemia treatment known to lower intestinal cholesterol uptake that is able to inhibit NPC1L1 transport proteins in the brush boarder of enterocytes and macrophages. Furthermore, it demonstrates anti-inflammatory and immunomodulatory properties and influences the expression of certain antigens. The drug is rapidly absorbed from the gastrointestinal tract and is then glucuronidated to form the active metabolite. It also undergoes extensive enterohepatic circulation. Various genetic polymorphisms seem to influence the pharmacokinetics of ezetimibe with different effects. The drug also presents a complex impact on cytochrome P450 enzymes, as it is a metabolism-dependent inhibitor of CYP3A4. Ezetimibe does not demonstrate any clinically significant interactions with statins, fibrates, mipomersen sodium, levothyroxine or lopinavir. However, its effect in conjunction with cyclosporine is not neutral. The use of this cholesterol absorption inhibitor has been shown to be safe and effective among patients after cardiac, renal and liver transplants, as well as in HIV patients.

• Atorvastatin and fenofibric acid differentially affect the release of adipokines in the visceral and subcutaneous cultures of adipocytes that were obtained from patients with and without mixed dyslipidemia.

  Authors: Krzysztof Łabuzek, Łukasz Bułdak, Anna Duława-Bułdak, Anna Bielecka, Robert Krysiak, Andrzej Madej, Bogusław Okopień

  Pharmacological reports : PR. 09/2011; 63(5):1124-36.

  In this study, we compared the effects of atorvastatin and fenofibric acid, which were administered alone or in combination, on the secretory function of human adipocytes that were obtained from theIn this study, we compared the effects of atorvastatin and fenofibric acid, which were administered alone or in combination, on the secretory function of human adipocytes that were obtained from the visceral and subcutaneous adipose tissues of 19 mixed dyslipidemic patients and 19 subjects with a normal lipid profile. The adipocytes were incubated in vitro in the presence of atorvastatin and/or fenofibric acid. The secretory function of the cells was determined using ELISA assays. The visceral adipocytes released significantly more adiponectin and IL-6 and less PAI-1 than those that were obtained from subcutaneous tissue. The levels and patterns of adipokine release differed between the patients with or without lipid abnormalities and between the adipocytes that were obtained from visceral or subcutaneous adipose tissue. The culture that contained hypolipidemic drugs resulted in the significant changes of the release of adipokines. The effects of atorvastatin and fenofibric acid on the hormonal function of human adipocytes may be, in part, responsible for the clinical efficacy of these drugs in the prevention and treatment of dyslipidemia-related cardiovascular and metabolic disorders. The study supports the concept that the pleiotropic effects of fenofibrate and atorvastatin may be, in part, a result of their impact on the secretory function of adipocytes.

• Lymphocyte-suppressing action of angiotensin-converting enzyme inhibitors in coronary artery disease patients with normal blood pressure.

  Authors: Robert Krysiak, Bogusław Okopień

  Pharmacological reports : PR. 09/2011; 63(5):1151-61.

  The clinical effectiveness of angiotensin-converting enzyme (ACE) in the prevention and treatment of cardiovascular disorders partially results from its anti-inflammatory action. No previous studyThe clinical effectiveness of angiotensin-converting enzyme (ACE) in the prevention and treatment of cardiovascular disorders partially results from its anti-inflammatory action. No previous study has investigated the effect of any ACE inhibitor on lymphocyte cytokine release. In this study, we compared the effects of serum- and tissue-type angiotensin-converting enzyme inhibitors on systemic inflammation and lymphocyte secretory function in normotensive patients with stable coronary artery disease. The study included 134 patients with coronary artery disease who were randomized into one of three groups and treated with enalapril (20 mg/d, n = 47), perindopril (4 mg/d, n = 45) or placebo (n = 42), respectively. The control group included 40 age-, sex- and weight-matched healthy subjects. The plasma lipid profile, glucose metabolism markers, hsCRP and lymphocyte cytokine release were examined at the beginning of the study and after 30 and 90 days of treatment. Phytohemagglutinin-stimulated T cells released significantly more interleukin-2, interferon-γ and TNFα than the lymphocytes of control subjects. Neither enalapril nor perindopril treatment was associated with any significant changes in blood pressure. Perindopril treatment inhibited lymphocyte cytokine release and systemic inflammation, while the effect of enalapril was insignificant. Perindopril, and, to a lesser extent, enalapril, strongly reduced lymphocyte cytokine release in insulin-resistant but not insulin-sensitive subjects. Our results indicate that perindopril is superior to enalapril in producing lymphocyte-suppressing and systemic anti-inflammatory effects in normotensive coronary artery disease patients. These effects may contribute to a reduction in the vascular risk of this group of patients, particularly in those subjects who are resistant to insulin, when these patients are treated with tissue-type angiotensin-converting enzyme inhibitors.

• The effect of ezetimibe and simvastatin on hemostasis in patients with isolated hypercholesterolemia.

  Authors: Robert Krysiak, Witold Zmuda, Bogusław Okopień

  Fundamental & clinical pharmacology. 03/2011;

  The aim of this study was to assess the strength of hemostatic effects of ezetimibe, administered alone or in combination with simvastatin, in patients with isolated hypercholesterolemia. One hundredThe aim of this study was to assess the strength of hemostatic effects of ezetimibe, administered alone or in combination with simvastatin, in patients with isolated hypercholesterolemia. One hundred and four patients with isolated primary hypercholesterolemia were randomized to one of four treatment groups, simultaneously treated for 90 days with ezetimibe (10 mg daily), simvastatin (40 mg daily), ezetimibe (10 mg daily) plus simvastatin (40 mg daily), or placebo. Plasma lipids/lipoproteins and hemostatic cardiovascular risk factors were assessed on the day of randomization and after 30 and 90 days of therapy. Despite improving lipid/lipoprotein profile by both simvastatin and ezetimibe, only simvastatin reduced plasma levels/activity of fibrinogen, factor VII, factor X, von Willebrand factor, and plasminogen activator inhibitor-1. The strongest effects on plasma lipids/lipoproteins and the assessed hemostatic variables were observed when patients were treated with both simvastatin and ezetimibe. With the exception of oxidized low-density lipoproteins, the hemostatic effects of simvastatin or simvastatin plus ezetimibe did not correlate with the changes in plasma lipids/lipoproteins. Our study shows that simvastatin is a more effective agent than ezetimibe in affecting coagulation and fibrinolysis in individuals with isolated hypercholesterolemia. It also suggests that the combined administration of simvastatin and ezetimibe may bring more benefits to patients than monotherapy with only one of these agents.

• [Coexistence of resistance to thyroid hormone with pituitary incidentaloma].

  Authors: Robert Krysiak, Agnieszka Kedzia, Bogusław Okopień

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(4):274-8.

  Contrary to generalized resistance, pituitary resistance to thyroid hormones is characterized by features of hyperthyroidism. Its clinical manifestation resembles that of thyrotropin (TSH)-secretingContrary to generalized resistance, pituitary resistance to thyroid hormones is characterized by features of hyperthyroidism. Its clinical manifestation resembles that of thyrotropin (TSH)-secreting adenomas, tumors constituting about 1-2% of all pituitary lesions. Both patients with resistance to thyroid hormone and thyrotropin-secreting tumors have increased plasma thyroid hormone levels and raised or inappropriately normal thyrotropin levels. However, their treatment is different and therefore differentiation of these entities is very important. The significant progress made in recent years in the field of high-resolution imaging procedures led to a situation during which hormonally inactive adenomas not posing a risk to a patient's health, referred to as incidentalomas, are discovered in endocrine organs including the pituitary. In our paper, we report a case of a young man with predominant pituitary resistance to thyroid hormone. Because of coexisting pituitary incidentaloma the patient was initially misdiagnosed as having a TSH-secreting tumor. We describe in details diagnostic and treatment strategies applied in our patient. The described case of our patient illustrates the need for clinical awareness of the possible presence of resistance to thyroid hormones in subjects with central hyperthyroidism and focal lesions in the pituitary.

• [The effect of oxcarbamazepine on the clinical effectiveness of dopamine agonists in the treatment of prolactinoma].

  Authors: Robert Krysiak, Agnieszka Kedzia, Bogusław Okopień

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(4):279-82.

  The CYP450 enzyme family plays a very important role in the biotransformation of many drugs with a different chemical structure. Therefore, the inhibition or induction of CYP enzymes may beThe CYP450 enzyme family plays a very important role in the biotransformation of many drugs with a different chemical structure. Therefore, the inhibition or induction of CYP enzymes may be responsible for the development of numerous drug interactions. Moreover, a peculiarity of constitution causes that some persons in particular situations may respond differently to a drug or treatment than do most people. In this article, we show a case of a young woman diagnosed with prolactinoma who was initially successfully treated with bromocriptine. Two years later she developed epilepsy secondary to brain trauma and as a result, she started receiving oxcarbamazepine treatment. Unfortunately, the treatment led to a deterioration of prolactinoma control. To normalize plasma prolactin levels, bromocriptine dose had to be increased and then replaced, initially with cabergoline and later with quinagolide. Only the latter drug effectively reduced plasma prolactin levels and tumor size. This case shows for the first time the existence of a drug interaction between dopamine agonists and any anti-epileptic drug in patients with prolactinoma.

• [Vitamin K, bone metabolism and vascular calcification in chronic kidney disease].

  Authors: Agnieszka Zak-Gołab, Bogusław Okopień, Jerzy Chudek

  Przegla̧d lekarski. 01/2011; 68(9):629-32.

  Atherosclerosis is the main cause of morbidity and mortality in the general population, and premature death in patients with chronic kidney disease (CKD) especially dialysis ones. Besides the typicalAtherosclerosis is the main cause of morbidity and mortality in the general population, and premature death in patients with chronic kidney disease (CKD) especially dialysis ones. Besides the typical cardiovascular risk factors there is a considerable vascular calcification of intima media in these patients. Vitamin K - dependent proteins play an essential role in the pathogenesis of mineral and bone disorders related to CKD, including vascular calcification. Vitamin K is a family of vitamins, varying in the number of isoprenoid groups (saturated or unsaturated) connected into 2-methyl-1,4-naphthoquinone ring in C3 position. Vitamin K-dependent proteins require carboxylation (VKDPs) for biological activation. The coagulant factors are the most well-known VKDPs, but the role of the other proteins, like Matrix Gla Protein (MGP), Growth Arrest Specific Gene 6 (Gas-6) and osteocalcin has been recently discovered. MGP prevents vascular calcification and Gas-6 affects vascular smooth muscle cell apoptosis and movement. Carboxylation of osteocalcin promotes bone formation. Additionally vitamin K increases proliferation of osteoblasts and apoptosis of osteoclasts, influencing on bone remodeling. There is few studies indicating for decreased consumption of vitamin K in the general population. The restrictive diet recommended for dialysis patients additionally diminishes its daily supply, increasing the chance for vitamin K deficiency in this population. Clinical consequences of inhibition of epoxide reductase by generally used anticoagulants, that inhibiting vitamin K cycle and preventing gamma-carboxylation of Gla proteins, in the peripheral tissue is hardly known. This paper summaries the state of the art knowledge focused on the role of vitamin K in mineral and bone metabolism disorders in CKD patients.

• [Autoimmune polyendocrine syndrome type 3 in a patient after surgical treatment of Cushing syndrome].

  Authors: Robert Krysiak, Witold Szkróbka, Bogusław Okopień

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(3):193-7.

  In light of research carried out in recent years, it seems that autoimmune polyendocrine syndromes occur much more frequently than previously estimated. The underestimation of their real frequencyIn light of research carried out in recent years, it seems that autoimmune polyendocrine syndromes occur much more frequently than previously estimated. The underestimation of their real frequency probable results from physicians' inadequate knowledge of these clinical entities and sometimes their atypical clinical picture. On the basis of the clinical presentation, autoimmune polyendocrine syndromes may be divided into four different types. The most frequent of them, type 3, is composed of autoimmune thyroid disease associated with type 1 diabetes or other autoimmune conditions with the exception of Addison's disease and hypoparathyroidism. In this article, we report a case of a young woman, with a family history of autoimmune disorders, in whom type 3 autoimmune polyendocrine syndrome developed several months after adrenalectomy performed because of Cushing syndrome. We describe in details diagnostic and treatment strategies applied in our patient and their impact on the course and outcome of autoimmune polyendocrine syndrome. We conclude that immunosuppressive effects of glucocorticoid excess resulting from the presence of Cushing syndrome inhibited or reduced intensity of inflammatory processes responsible for the development of organ-specific autoimmune endocrine disorders. This case illustrates the need for clinical awareness of autoimmune polyendocrine syndromes in patients after surgically-induced normalization of adrenocortical hormone levels.

• [Primary aldosteronism in a patient after surgical treatment of primary hyperparathyroidism].

  Authors: Robert Krysiak, Iwona Kobielusz-Gembala, Bogusław Okopień

  Przegla̧d lekarski. 01/2011; 68(7):388-90.

  The presence of both parathyroid adenoma and primary aldosteronism in the same person has been reported in only few patients. Taking into account a relatively high prevalence of both primaryThe presence of both parathyroid adenoma and primary aldosteronism in the same person has been reported in only few patients. Taking into account a relatively high prevalence of both primary hyperparathyroidism and primary aldosteronism in the general population, these findings may be explained by a simple coincidence of both these disorders. In the present paper, we report a man with a family history of multiple endocrine neoplasia type 1 (MEN-1), who developed primary aldosteronism eight years after removal of parathyroid adenoma. We report in details diagnostic and treatment strategies applied in our patient and their impact on the course and outcome of both these disorders. In our opinion, the described case of our patient represents an atypical presentation of MEN-1 syndrome, a hereditary syndrome characterized by a variety of endocrine neoplasias and hormone excess syndromes, particularly tumors of the parathyroid glands, pancreatic islet cells, and pituitary gland. We conclude that each person with MEN-1 syndrome and the presence of adrenal lesions should be assessed for the presence of excess mineralocorticoid activity.

• [Beta-adrenolitics in therapy of cardiovascular diseases in patients with type 2 diabetes mellitus].

  Authors: Joanna Krupej, Leszek Kedzierski, Anna Gdula-Dymek, Robert Krysiak, Bogusław Okopień

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(2):132-41.

  The recent years have brought about a marked increase in the number of people suffering from carbohydrate metabolism disturbances. This is primarily due to adverse changes in lifestyle, whichThe recent years have brought about a marked increase in the number of people suffering from carbohydrate metabolism disturbances. This is primarily due to adverse changes in lifestyle, which consists of an improper diet, rich in simple carbohydrates and fats, and low physical activity. An increasing number of patients with diabetes resulted in the growth of a number of individuals suffering from diabetes-related complications, including cardiovascular diseases. Although, the first line treatment of cardiovascular disorders are beta-blockers, for many years their use in diabetic patients was questioned to the extent that diabetes was one of the major contraindication to these agents. These concerns stemmed primarily from the proven negative impact of first generation beta-blockers on carbohydrate metabolism. The aim of this study was to summarize the possibility of beta-blocker applications in type 2 diabetic patients suffering from cardiovascular disorders, which, in a non-diabetic population, are commonly treated with these agents, taking into account the diversity between various classes of beta-blockers. On the basis of published clinical trials and meta-analyses we discuss the impact of this group of agents on the development of new-onset diabetes, worsening of existing diabetes control, and the development and progression of diabetes-induced complications.

• [Atypical clinical presentation of autoimmune polyglandular syndrome type 4].

  Authors: Robert Krysiak, Iwona Kobielusz-Gembala, Bogusław Okopień

  Przegla̧d lekarski. 01/2011; 68(6):339-41.

  Autoimmune polyglandular syndromes (APS) are rarely diagnosed conditions characterised by the combination of two or more autoimmune endocrinopathies and nonendocrine autoimmunopathies. They compriseAutoimmune polyglandular syndromes (APS) are rarely diagnosed conditions characterised by the combination of two or more autoimmune endocrinopathies and nonendocrine autoimmunopathies. They comprise a wide spectrum of autoimmune disorders, differing in the immunologic features of their pathogenesis. Based on their clinical manifestation, APS are divided into four different types. Primary hypoparathyroidism is characteristic for APS type 1, the major disease components of which are adrenal insufficiency, hypoparathyroidism, and candidiasis. However, the literature is sparse regarding the presence of hypoparathyroidism in the remaining types of APS. In our article, we present a case of a young female with primary hypoparathyroidism and a family history of autoimmune disorders who after several years developed type 1 diabetes. She also had anti-transglutaminase and anti-parietal cell antibodies. This constellation of two endocrine disorders and non-endocrine abnormalities led to the diagnosis of APS type 4. We show in details diagnostic and treatment strategies undertaken in our patient and their impact on the course of APS.

• The dawn phenomenon and the Somogyi effect - two phenomena of morning hyperglycaemia.

  Authors: Malwina Rybicka, Robert Krysiak, Bogusław Okopień

  Endokrynologia Polska. 01/2011; 62(3):276-84.

  Morning hyperglycaemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycaemic control. The dawn phenomenon occurs when endogenous insulin secretionMorning hyperglycaemia in diabetic subjects may be caused by the dawn phenomenon, or the Somogyi effect, or poor glycaemic control. The dawn phenomenon occurs when endogenous insulin secretion decreases or when the effect of the exogenous insulin administered to the patient the day before disappears, together with a physiological increase in insulin-antagonistic hormones. The Somogyi effect is present in the case of excessive amounts of exogenous insulin. The dawn phenomenon is more common than the Somogyi effect. To diagnose these phenomena, it is useful to measure plasma glucose levels for several nights between 3 a.m. and 5 a.m. or use a continuous glucose monitoring system. Although their treatment differs, the best way of preventing both the dawn phenomenon and the Somogyi effect is an optimal diabetes control with insulin therapy.