Robert Krysiak

Publications of Robert Krysiak

• The role of adipokines in connective tissue diseases.

  Authors: Robert Krysiak, Gabriela Handzlik-Orlik, Boguslaw Okopien

  European journal of nutrition. 05/2012;

  OBJECTIVE: To discuss the relationship between adipokines and connective tissue diseases, by putting special emphasis on the potential role of leptin, adiponectin, resistin, and other adipose tissueOBJECTIVE: To discuss the relationship between adipokines and connective tissue diseases, by putting special emphasis on the potential role of leptin, adiponectin, resistin, and other adipose tissue products in the pathogenesis of rheumatoid arthritis and systemic lupus erythematosus and on possible application of adipokine-targeted therapy in the treatment of these disorders with emphasis on the recent findings. METHODS: PubMed literature search complemented by review of bibliographies listed in identified articles. RESULTS: Most of the data presented by different research groups showed changed levels of leptin, adiponectin, and resistin and occasionally also other adpokines in rheumatoid arthritis and systemic lupus erythematosus. The relationship between the remaining connective tissue diseases and adipokines is less documented. CONCLUSIONS: Plasma levels of adipokines might tell us too little about their role in connective tissue disorders, whereas adipokine effects on synovial tissues might differ from their known metabolic or cardiovascular effects, which implies that some re-appraisal of adipokines role may need to take place. It still remains obscure whether the observed disturbances in various adipokine systems in subjects with connective tissue diseases contribute to their development or only reflect the presence or activity of inflammatory process, which itself is induced by other pro-inflammatory factors.

• [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.

• [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.

• Coexistence of autoimmune polyglandular syndrome type 2 and diabetes insipidus in pregnancy.

  Authors: Robert Krysiak, Malgorzata Samborek

  The American journal of the medical sciences. 11/2011; 342(5):433-4.

  Autoimmune polyglandular syndromes are rarely diagnosed conditions characterized by the association of at least 2 organ-specific autoimmune disorders. Very few cases of these syndromes have beenAutoimmune polyglandular syndromes are rarely diagnosed conditions characterized by the association of at least 2 organ-specific autoimmune disorders. Very few cases of these syndromes have been described during pregnancy. The authors report a case of a patient diagnosed with autoimmune thyroiditis and a history of HELLP (hemolysis, elevated liver enzymes and low platelet) syndrome in a prior pregnancy. After increasing the levothyroxine dose, she developed Addisonian crisis. Normalization of adrenal cortex function resulted in the appearance of diabetes insipidus. This report shows that pregnancy may influence the course of preexisting endocrine disorders and lead to their unmasking. Although the risk of the development of autoimmune polyglandular syndromes during pregnancy is small, they may pose a serious health problem. The possible presence of these clinical entities should be considered in every woman with 1 or more endocrine disturbances.

• 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.

• Recurrent pancreatitis induced by hyperparathyroidism in pregnancy.

  Authors: Robert Krysiak, Mariusz Wilk, Bogusław Okopien

  Archives of gynecology and obstetrics. 09/2011; 284(3):531-4.

  As primary hyperparathyroidism affects mainly middle-aged and elderly women, it is an infrequent finding during gestation and breastfeeding. To date, less than 200 pregnant patients with primaryAs primary hyperparathyroidism affects mainly middle-aged and elderly women, it is an infrequent finding during gestation and breastfeeding. To date, less than 200 pregnant patients with primary hyperparathyroidism diagnosed during pregnancy have been described. Like in other disorders of the parathyroid gland, the recognition of primary hyperparathyroidism during pregnancy and lactation may be difficult, as clinical symptoms are not specific, while laboratory findings may be masked by some typical pregnancy-induced changes in calcium and phosphate homeostasis. If remains untreated, the disease may result in serious clinical implications for the mother and fetus. Most authors consider surgery within the second trimester of pregnancy as the treatment of choice in this group of patients. In our paper, we discuss the case of a 35-year-old female with a history of recurrent acute pancreatitis and recurrent abortions. As the patient declined surgery, conservative management with calcitonin was started and continued throughout the rest of pregnancy, and led to giving birth to the infant whose only health problem was transient hypocalcemia. The described case shows that conservative management, if started respectively early and conducted on the basis of a patient's condition, may effectively reduce increased perinatal and maternal morbidity and mortality in pregnant women declining surgery.

• 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 treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma.

  Authors: Robert Krysiak, Boguslaw Okopien

  Hypertension research : official journal of the Japanese Society of Hypertension. 08/2011; 35(1):123-5.

• Coexistence of primary aldosteronism and Hashimoto's thyroiditis.

  Authors: Robert Krysiak, Bogusław Okopien

  Rheumatology international. 07/2011;

  In light of research carried out in recent years, it seems that aldosterone may produce a complex proinflammatory effect. Theoretically, excessive aldosterone release may stimulate the developmentIn light of research carried out in recent years, it seems that aldosterone may produce a complex proinflammatory effect. Theoretically, excessive aldosterone release may stimulate the development and/or progression of autoimmune disorders. In this article, we report a case of a female in whom primary aldosteronism coexisted with Hashimoto's thyroiditis. Surgical removal of an aldosterone-producing tumor improved thyroid function and decreased thyroid autoimmunity. We describe in details diagnostic and treatment strategies applied in our patient and their impact on the course and outcome of thyroiditis. We also present monocyte and lymphocyte cytokine release in the index subjects before and after surgical treatment. We conclude that primary aldosteronism may exacerbate the clinical course of autoimmune thyroiditis and probably also of other autoimmune disorders.

• The effect of bezafibrate and omega-3 fatty acids on lymphocyte cytokine release and systemic inflammation in patients with isolated hypertriglyceridemia.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Boguslaw Okopien

  European journal of clinical pharmacology. 06/2011; 67(11):1109-17.

  The aim of this study was to compare the effects of fibrates and omega-3 fatty acids on lymphocyte secretory function and systemic inflammation in patients with isolated hypertriglyceridemia. TheThe aim of this study was to compare the effects of fibrates and omega-3 fatty acids on lymphocyte secretory function and systemic inflammation in patients with isolated hypertriglyceridemia. The study included 107 patients with isolated hypertriglyceridemia who received bezafibrate (200 mg twice daily), omega-3 fatty acids (1 g twice daily) or placebo for 12 weeks. The lipid profile, fasting and 2-h post-glucose load plasma glucose levels, homeostasis model assessment index (HOMA), plasma high-sensitivity C-reactive protein (hsCRP) levels and lymphocyte release of interleukin-2, interferon-γ and tumor necrosis factor-α were assessed at baseline, on the day of randomization, and after 4 and 12 weeks of treatment. Both bezafibrate and omega-3 fatty acids reduced plasma triglyceride levels. Bezafibrate additionally decreased total and low-density lipoprotein-cholesterol levels and the HOMA and insignificantly decreased post-glucose load plasma glucose, as well as increased high-density lipoprotein-cholesterol. Bezafibrate treatment was associated with a reduction in lymphocyte release of interleukin-2, interferon-γ and tumor necrosis factor-α, which was accompanied by a reduction in plasma hsCRP levels. Omega-3 fatty acid did not significantly reduce lymphocyte cytokine release and plasma hsCRP. The anti-inflammatory effects of both drugs did not correlate with their action on plasma lipids, but in the case of the former the effect was related to the improvement in insulin sensitivity. Our results indicate that bezafibrate is superior to omega-3 fatty acid in inhibiting systemic inflammation and lymphocyte secretory function.

• The effect of levothyroxine and selenomethionine on lymphocyte and monocyte cytokine release in women with Hashimoto's thyroiditis.

  Authors: Robert Krysiak, Boguslaw Okopien

  The Journal of clinical endocrinology and metabolism. 04/2011; 96(7):2206-15.

  No previous study determined monocyte- and lymphocyte-suppressing effects of levothyroxine and selenomethionine and assessed whether their coadministration is superior to treatment with only one ofNo previous study determined monocyte- and lymphocyte-suppressing effects of levothyroxine and selenomethionine and assessed whether their coadministration is superior to treatment with only one of these drugs. Our objective was to compare the effect of levothyroxine and selenomethionine on monocyte and lymphocyte cytokine release and systemic inflammation in patients with Hashimoto's thyroiditis. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: We conducted a randomized clinical trial involving a group of 170 ambulatory euthyroid women with recently diagnosed and previously untreated Hashimoto's thyroiditis and 41 matched healthy subjects. Participants were randomized in a double-blind fashion to receive a 6-month treatment with levothyroxine, selenomethionine, levothyroxine plus selenomethionine, or placebo. One hundred sixty-five patients completed the study. Monocyte and lymphocyte release of proinflammatory cytokines and plasma levels of C-reactive protein (CRP) were assessed. Compared with the control subjects, monocytes and lymphocytes of Hashimoto's thyroiditis patients released greater amounts of all cytokines studied. Levothyroxine reduced monocyte release of TNF-α, IL-1β, IL-6, and monocyte chemoattractant protein-1, whereas selenomethionine inhibited lymphocyte release of IL-2, interferon-γ, and TNF-α, which was accompanied by a reduction in plasma CRP levels. The decrease in cytokine release and in plasma CRP levels was strongest when both drugs were given together. Despite affecting different types of inflammatory cells, levothyroxine and selenomethionine exhibit a similar systemic antiinflammatory effect in euthyroid females with Hashimoto's thyroiditis. This action, which correlates with a reduction in thyroid peroxidase antibody titers, may be associated with clinical benefits in the prevention and management of Hashimoto's thyroiditis, particularly in subjects receiving both agents.

• Hypoparathyroidism in pregnancy.

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

  Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 04/2011; 27(8):529-32.

  Pregnancy and lactation are associated with remarkable changes in calcium homeostasis, resulting from pregnancy-induced alterations in the production, metabolism and excretion of calcium andPregnancy and lactation are associated with remarkable changes in calcium homeostasis, resulting from pregnancy-induced alterations in the production, metabolism and excretion of calcium and calcitropic hormones. Therefore, the clinical course of disorders affecting the parathyroid glands during pregnancy and lactation is often atypical. As the symptoms experienced by patients with parathyroid disorders are not specific, their diagnosis during gestation and breastfeeding may be sometimes very difficult. If left untreated, parathyroid disorders may pose a significant risk to the mother and fetus associated with increased perinatal and maternal morbidity and mortality. Hypoparathyroidism is a disorder rarely observed during pregnancy, resulting in most cases from surgical thyroidectomy. In our article, we present the case of a 32-year-old female with primary hypoparathyroidism diagnosed for the first time during pregnancy. We describe in details the treatment strategies undertaken in this patient and their impact on the outcome of pregnancy and lactation.

• 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.

• Autoimmune polyglandular syndrome type 2 induced by treatment with interferon alpha.

  Authors: Robert Krysiak, Aleksandra Boldys, Boguslaw Okopien

  The American journal of the medical sciences. 03/2011; 341(6):504-7.

  Interferon α therapy has been reported to result in a variety of autoimmune side effects and to increase the risk of thyroid dysfunction. Autoimmune polyglandular syndromes are rarely describedInterferon α therapy has been reported to result in a variety of autoimmune side effects and to increase the risk of thyroid dysfunction. Autoimmune polyglandular syndromes are rarely described conditions characterized by the combination of at least 2 autoimmune endocrinopathies and nonendocrine autoimmunopathies, differing in the immunologic features of their pathogenesis. In light of research carried out in recent years, it seems that autoimmune polyendocrine syndromes occur much more frequently than previously estimated. In this article, the authors describe autoimmune polyglandular syndrome type 2 composed of autoimmune thyroid disease, Addison's disease and premature ovarian failure in a 37-year old woman after treatment of hairy cell leukemia with interferon α. Because of the underlying disorder, interferon α treatment had to be continued, and therefore the patient was prescribed with levothyroxine, hydrocortisone, fludrocortisone and oral contraceptives. Termination of interferon α therapy was associated with a spontaneous normalization of thyroid and adrenal functions, and therefore levothyroxine, hydrocortisone and fludrocortisone treatment was withdrawn.

• The effect of ezetimibe and simvastatin on monocyte cytokine release in patients with isolated hypercholesterolemia.

  Authors: Robert Krysiak, Boguslaw Okopien

  Journal of cardiovascular pharmacology. 02/2011; 57(4):505-12.

  Apart from reducing plasma lipids, ezetimibe may produce non-lipid-related pleiotropic effects. The aim of this article was to compare the effect of ezetimibe and simvastatin on monocyte cytokineApart from reducing plasma lipids, ezetimibe may produce non-lipid-related pleiotropic effects. The aim of this article was to compare the effect of ezetimibe and simvastatin on monocyte cytokine release and systemic inflammation in isolated hypercholesterolemic patients. One hundred thirty-four subjects with isolated hypercholesterolemia were allocated to 1 of 4 treatment groups treated for 90 days with, respectively, ezetimibe, simvastatin, ezetimibe plus simvastatin, or placebo. Monocyte cytokine release was determined at baseline and after 30 and 90 days of treatment. Compared with placebo, all the remaining treatment options reduced-monocyte release of tumor necrosis factor-α, interleukin-1β, interleukin-6, and monocyte chemoattractant protein-1, which was accompanied by a reduction in plasma C-reactive protein levels. In subjects receiving both simvastatin and ezetimibe, posttreatment monocyte cytokine release and plasma C-reactive protein levels did not differ from those observed in 30 matched healthy subjects. Monocyte-suppressing and systemic-anti-inflammatory effects were more expressed in simvastatin- than in ezetimibe-treated patients and strongest when both the agents were administered together. The results obtained suggest that simvastatin may be a better treatment option than ezetimibe in isolated hypercholesterolemic patients and that hypercholesterolemic patients of high cardiovascular risk may benefit the most from combined treatment with simvastatin and ezetimibe.