Bogdan Marek

Publications of Bogdan Marek

• [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.

• The usefulness of determining the serum concentrations of vascular endothelial growth factor (VEGF) and its soluble receptor type 2 (sVEGF-2) in the differential diagnosis of adrenal incidentalomas.

  Authors: Wanda Foltyn, Janusz Strzelczyk, Bogdan Marek, Dariusz Kajdaniuk, Lucyna Siemińska, Violetta Rosiek, Beata Kos-Kudła

  Endokrynologia Polska. 01/2012; 63(1):22-8.

  Angiogenesis plays an important role in tumour growth, progression and invasiveness. Vascular endothelial growth factor (VEGF) is a recognised angiogenesis-stimulating factor. Soluble VEGF receptorsAngiogenesis plays an important role in tumour growth, progression and invasiveness. Vascular endothelial growth factor (VEGF) is a recognised angiogenesis-stimulating factor. Soluble VEGF receptors (sVEGFRs) have antiangiogenic properties. Recent studies have indicated that serum concentrations of these factors show a good correlation with the aggressiveness of these tumours in various organs. The aim of this study was to assess the usefulness of determining serum concentrations of VEGF and sVEGFR-2 in patients with adrenal incidentalomas. The study included 51 patients: 38 women aged 53.57 ± 10.12 years and 13 men aged 54.66 ± 12.73 years without a history of cancer but with non-functioning adrenal tumours incidentally detected on a CT scan. The analysis of the CT images included such morphological features of the tumour as: tumour size, tumour homogenicity, tumour density before and after administration of an intravenous contrast medium, and the value of percentage washout of the contrast medium from the tumour. Based on the above criteria, we identified a group of 40 patients with adrenal tumours who met the CT criteria for benign adenomas (Group 1) and 11 patients whose incidentally discovered tumours did not meet the radiological criteria for benign adenomas, thereby providing grounds for referring these patients for surgery (Group 2). The control group consisted of 20 healthy sex- and age-matched individuals. The mean serum concentrations of VEGF in the study and control groups were similar, although patients with adrenal tumours had significantly higher concentrations of sVEGFR-2 than healthy individuals. There were no significant differences in the mean concentrations of VEGF and sVEGFR-2 between the patients undergoing surgery (Group 2) and the patients not undergoing surgery (Group 1), or between the patients undergoing surgery (Group 2) and the control group. Postoperative histopathology of the resected adrenal tumours revealed benign adrenocortical adenoma in eight patients and the following in the remaining patients: adrenocortical carcinoma in one patient, phaeochromocytoma in one patient and ganglioneuroma in one patient. The adrenocortical carcinoma patient had the highest concentration of VEGF, while this patient's concentration of sVEGFR-2 was the lowest in the study group. In the patients diagnosed with ganglioneuroma and phaeochromocytoma, VEGF and sVEGFR-2 concentrations did not differ significantly from their mean concentrations in the study group. There were also no relationships between the serum concentrations of VEGF or sVEGFR-2 and the following parameters: tumour size, precontrast and postcontrast tumour densities or the value of percentage washout. Positive correlations were, however, identified between the concentration of VEGF and the concentrations of total cholesterol and LDL-cholesterol. Determining the serum concentrations of such angiogenesis markers as VEGF and sVEGFR-2 seems useful in the evaluation of the nature of incidentally detected adrenal masses (incidentalomas), especially in the preoperative differential diagnosis of adrenal masses that do not meet the CT criteria for benign tumours.

• Vascular endothelial growth factor (VEGF) - part 1: in physiology and pathophysiology.

  Authors: Dariusz Kajdaniuk, Bogdan Marek, Wanda Foltyn, Beata Kos-Kudła

  Endokrynologia Polska. 01/2011; 62(5):444-55.

  Angiogenesis is an important component of many physiological processes, such as the female sexual cycle, placenta formation, the processes of growth and differentiation of tissues, and reparativeAngiogenesis is an important component of many physiological processes, such as the female sexual cycle, placenta formation, the processes of growth and differentiation of tissues, and reparative processes including wound healing, fracture repair, and liver regeneration. The formation of new blood vessels during angiogenesis and vasculogenesis allows the growth and functioning of multicellular organisms. Pathological angiogenesis most commonly occurs in ischaemic, inflammatory and neoplastic diseases. Conditions in the pathogenesis of which angiogenesis plays an important role are sometimes labelled angiogenic diseases. To date, a number of pro-and anti-angiogenic factors have been defined. VEGF is the only specific mitogen for endothelial cells. It stimulates their growth and inhibits apoptosis, increases vascular permeability in many tissues, promotes vasculogenesis and angiogenesis. VEGF signalling activity in relation to the cell is dependent on having its specific membrane receptors (Flt-1, KDR, Flt-4). Angiogenesis plays a protective role in ischaemic heart disease and myocardial infarction. Angiogenesis extends life for patients after a stroke. Most of the facts about physiological angiogenesis are derived from studies into liver regeneration as a result of an acute injury or partial hepatectomy. Pathological hepatic angiogenesis occurs in the course of inflammation, fibrosis, hypoxia, and during tumourogenesis. There is interesting data relating to liver steatosis and obesity.

• [Dry eye syndrom--multispecialistic disease. Part two: diagnostic procedure and treatment].

  Authors: Mariusz Nowak, Bogdan Marek, Dariusz Kajdaniuk, Lucyna Siemińska, Beata Kos-Kudła, Katarzyna Nowak, Joanna Głogowska-Szelag

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(1):49-55.

  The authors present the review of the literature concerning on the diagnostic procedure and current treatment of the dry eye, including anti-inflammatory treatment. To diagnosis of the dry eyeThe authors present the review of the literature concerning on the diagnostic procedure and current treatment of the dry eye, including anti-inflammatory treatment. To diagnosis of the dry eye syndrome is based on the combination of clinical symptoms and clinical tests. These clinical tests evaluate tear clearance, tear stability, ocular surface integrity, tear osmolarity and conjunctival cytology. Measurement of tear osmolarity might provide a "gold standard" of diagnosis, but a practical tear osmolarity test is not yet widely available. Measurement of tear film instability by means of a TBUT test has good overall accuracy and may be more repeatable than many other diagnostic tests. The first step in managing the disease is to identify the underlying etiology and to try to eliminate it and/or treat it. Inflammation and the interruption of the inflammatory cascade seem to be the main focus in the treatment of dry eye, giving the anti-inflammatory therapy a new critical role.

• [Vascular endothelial growth factor (VEGF) in endocrinology and oncology].

  Authors: Dariusz Kajdaniuk, Bogdan Marek, Wanda Fołtyn, Beata Kos-Kudła

  Endokrynologia Polska. 01/2011; 62 Suppl 3:14-22.

  Endocrine glands are well vascularized and the structure of their vessels facilitates the exchange of various substances, including hormones. These glands are a frequent experimental model inEndocrine glands are well vascularized and the structure of their vessels facilitates the exchange of various substances, including hormones. These glands are a frequent experimental model in research on VEGF and angiogenesis. VEGF participates in the pathogenesis of diabetes. Diabetic nephropathy is in essence a microvascular disease that develops as a result of a confluence of hemodynamic and metabolic perturbations. Diabetic retinopathy is the most common microvascular complication of diabetes mellitus and is the leading cause of blindness. In diabetic retinopathy ischemic states and hence tissue hypoxia and angiogenesis takes place. Participation of angiogenesis and VEGF in pathogenesis of neoplastic disease is described in many papers. VEGF protein and mRNA were found in cancers of the thyroid, bronchus, lungs, esophagus, stomach, colon, liver, breast, ovary, uterus, kidney, urinary bladder, in malignant tumors of the brain, bone. In a series of reports connections between the degree of VEGF expression with tumor aggressiveness and prognosis in patients have been reported. Richly vascularized are GEP NET. In neuroendocrine tumors strong expression of VEGF, Flt-1 and KDR in relation to the unchanged surrounding tissues has been demonstrated. Depending on the disease entity or the degree of its severity attempts of application the angiogenic and antiangiogenic therapy are being made. Antiangiogenic therapy (usually regarded as a form of cancer therapy) is based on: inhibitory effects of proangiogenic ligands and their receptors; stimulation or delivery of angiogenesis inhibitors; direct destruction of neoplastic tumor vasculature.

• Vascular endothelial growth factor (VEGF) - part 2: in endocrinology and oncology.

  Authors: Dariusz Kajdaniuk, Bogdan Marek, Wanda Foltyn, Beata Kos-Kudła

  Endokrynologia Polska. 01/2011; 62(5):456-64.

  Endocrine glands are well vascularised and the structure of their vessels facilitates the exchange of various substances, including hormones. These glands are a frequent experimental model inEndocrine glands are well vascularised and the structure of their vessels facilitates the exchange of various substances, including hormones. These glands are a frequent experimental model in research on VEGF and angiogenesis. VEGF participates in the pathogenesis of diabetes. Diabetic nephropathy is in essence a microvascular disease that develops as a result of a confluence of haemodynamic and metabolic perturbations. Diabetic retinopathy is the commonest microvascular complication of diabetes mellitus and is the leading cause of blindness. In diabetic retinopathy, ischaemic states, and hence tissue hypoxia and angiogenesis, take place. The participation of angiogenesis and VEGF in the pathogenesis of neoplastic disease has been described in many papers. VEGF protein and mRNA have been found in cancers of the thyroid, bronchus, lungs, oesophagus, stomach, colon, liver, breast, ovary, uterus, kidney, and urinary bladder, and in malignant tumours of the brain and bone. There have been many reports of the connections between the degree of VEGF expression and tumour aggression and prognosis in patients. Richly vascularised are GEP NET. In neuroendocrine tumours, strong expression of VEGF, Flt-1 and KDR in relation to the unchanged surrounding tissues has been demonstrated. Depending on the disease entity or the degree of its severity, attempts to apply angiogenic and antiangiogenic therapy have being made. Antiangiogenic therapy (usually regarded as a form of cancer therapy) is based on: 1. inhibitory effects of proangiogenic ligands and their receptors; 2. stimulation or delivery of angiogenesis inhibitors; and 3. direct destruction of neoplastic tumour vasculature.

• Circadian concentrations of free testosterone, selected markers of bone metabolism, osteoprotegerin and its ligand sRANKL in obese postmenopausal women.

  Authors: Zofia Ostrowska, Beata Kos-Kudła, Bogdan Marek, Dariusz Kajdaniuk, Kinga Wołkowska-Pokrywa

  Postȩpy higieny i medycyny doświadczalnej (Online). 01/2011; 65:658-67.

  It has been suggested that increased testosterone secretion in postmenopausal obese women might have some protective effect on bone tissue; the association might be significantly influenced by theIt has been suggested that increased testosterone secretion in postmenopausal obese women might have some protective effect on bone tissue; the association might be significantly influenced by the RANKL/RANK/OPG system. The aim of the study was to determine whether postmenopausal obese women showed any relationship between the pattern of adipose tissue distribution, circadian free testosterone (FT) concentrations and bone metabolism (as assessed based on circadian osteocalcin [OC] and C-terminal telopeptide [CTx] levels), and to establish whether osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) might play a role in the relationship. FT, OC, CTx, OPG and soluble RANKL (sRANKL) levels were determined by ELISA in serum samples collected every three hours for 24 hours from 47 postmenopausal women (12 with gynoid obesity [GO], 17 with android obesity [AO], and 18 healthy individuals). Obese women demonstrated an adipose tissue distribution-dependent increase in mean circadian FT levels and a decrease in mean circadian OC, CTx, OPG and sRANKL compared to control participants. In GO subjects, these changes were accompanied by smaller FT amplitudes, suppression of the circadian rhythms of bone markers and OPG, and a shift of sRANKL rhythm acrophase, whereas AO subjects showed a decrease in bone marker amplitudes and suppression of OPG and sRANKL rhythms. In comparison with the controls, significant adipose tissue distribution-dependent changes were found in the correlations between FT and bone markers, FT and OPG, OC and CTx, OPG and sRANKL, CTx and OPG, and CTx and sRANKL. Compared to GO participants, those with AO had higher coefficients of correlations between mean circadian FT and OC as well as between OC and CTx, and lower in the case of FT and sRANKL as well as CTx and OPG and CTx and sRANKL. Postmenopausal obesity results in adipose tissue distribution-dependent alterations in circadian FT levels accompanied by suppression of bone metabolism and a decline in circadian variations of the osteokines under investigation, especially sRANKL. Increased FT secretion in postmenopausal women might exert a protective effect on bone tissue, most likely via a shift in the OPG/RANKL ratio that tilts the balance toward a functional excess of OPG.

• Plasma levels of NT-pro-brain natriuretic peptide in patients with overt and subclinical hyperthyroidism and hypothyroidism.

  Authors: Dorota Pakuła, Bogdan Marek, Dariusz Kajdaniuk, Robert Krysiak, Beata Kos-Kudła, Piotr Pakuła, Aleksander Gatnar, Halina Borgiel-Marek, Mariusz Nowak, Lucyna Siemińska, Joanna Głogowska-Szeląg, Zofia Ostrowska

  Endokrynologia Polska. 01/2011; 62(6):523-8.

  Several studies have assessed natriuretic peptides in patients with thyroid disorders, and these studies have provided contrasting results. This difference may be partially explained by the presenceSeveral studies have assessed natriuretic peptides in patients with thyroid disorders, and these studies have provided contrasting results. This difference may be partially explained by the presence of concomitant disorders of the cardiovascular system in participants. The study included 101 patients free of any cardiovascular disorder, who, on the basis of plasma levels of TSH and thyroid hormones, were divided into patients with overt hyperthyroidism, patients with subclinical hyperthyroidism, patients with overt hypothyroidism, patients with subclinical hypothyroidism, and control subjects with normal thyroid profile. Hyperthyroidism was induced either by nodular thyroid disease or by Graves' disease, while hypothyroidism was secondary to autoimmune thyroiditis or surgery. Compared to control subjects, hyperthyroid patients were characterised by higher plasma levels of NT-pro-BNP. This increase was particularly pronounced in cases of overt disease. On the other hand, neither clinical nor subclinical hypothyroidism was associated with any significant changes in this peptide. Plasma levels of NT-pro-BNP did not differ between patients with Graves' disease and toxic nodular goitre nor between patients with autoimmune hypothyroidism and hypothyroidism secondary to thyroidectomy. Only L-thyroxine substitutions, but not hyperthyroidism treatment, caused changes in plasma concentration of NT-pro-BNP. Hyperthyroidism and hypothyroidism induce changes of the plasma concentration of NT-pro-BNP. Although both exogenous L-thyroxine and antithyroid drugs restored thyroid function, only the former drug changed plasma NT-pro-BNP content. The thyrometabolic state of a patient should always be taken into consideration when NT-pro-BNP is assessed as a marker of cardiac dysfunction.

• [Dry eye syndrome--multispecialistic disease. Part one: Pathogenesis, signs, classification].

  Authors: Mariusz Nowak, Bogdan Marek, Dariusz Kajdaniuk, Lucyna Siemińska, Beata Kos-Kudła, Katarzyna Nowak, Joanna Głogowska-Szelag

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2010; 63(4):374-86.

  The authors presents the review of the literature concerning on the signs, classification, connections between the dry eye syndrome and other diseases and the risk factors of dry eye syndrome. It isThe authors presents the review of the literature concerning on the signs, classification, connections between the dry eye syndrome and other diseases and the risk factors of dry eye syndrome. It is a prevalent, multifactorial disease that is particularly frequent in elderly patients and women, especially in menopausal and postmenopausal period. Dry eye syndrome can be episodic with transient signs and symptoms or chronic with persistent signs and symptoms and is characterized by one or more of the following symptoms: burning, itching, foreign body sensation, soreness, dryness, photophobia, redness, and reduced visual acuity. The tear film instability of dry eye syndrome, which is accompanied by increased osmolarity of the tear film, causes inflammation and structural damage to the ocular surface. There are two major etiologic categories of dry eye syndrom: aqueous-deficient and evaporative. The most frequent classification of dry eye for practical clinical use is triple classification based on the ethiology, histopathological changes and severity of the disease.

• [Selected endocrine abnormalities in eating disorders].

  Authors: Robert Krysiak, Dariusz Kajdaniuk, Bogdan Marek, Bogusław Okopień

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2010; 63(2):61-74.

  Eating disorders belong to frequent health problems affecting people in developed countries. They are generally seen in young women and are particularly common in adolescence. Endocrine consequencesEating disorders belong to frequent health problems affecting people in developed countries. They are generally seen in young women and are particularly common in adolescence. Endocrine consequences of these disorders include: excessive activity of hypothalamic-pituitary-adrenal axis, hypogonadotropic hypogonadism, growth hormone resistance, low T3 syndrome, osteopenia, and abnormal activities of the hypothamus and adipose tissue. The endocrine changes associated with eating disorders have been studied in depth and as suggest the results of so far carried out studies, their aetiology is usually multifactoral. Most of these abnormalities are reversed, or at least alleviated, by weight gain. This review discusses the most important changes in the endocrine system related to eating disorders in the light of recent developments in this field. This article also tries to give insights into diagnosis and putative therapeutic strategies.

• Antioxidant potential, paraoxonase 1, ceruloplasmin activity and C-reactive protein concentration in diabetic retinopathy.

  Authors: Mariusz Nowak, Tomasz Wielkoszyński, Bogdan Marek, Beata Kos-Kudła, Elżbieta Swiętochowska, Lucyna Siemińska, Jacek Karpe, Dariusz Kajdaniuk, Joanna Głogowska-Szeląg, Katarzyna Nowak

  Clinical and experimental medicine. 12/2009;

  The aim of this study was to evaluate the ferric-reducing ability of serum (FRAS), paraoxonase 1 (PON1), ceruloplasmin serum oxidase activity and hsCRP level in patients with type1 diabetes mellitusThe aim of this study was to evaluate the ferric-reducing ability of serum (FRAS), paraoxonase 1 (PON1), ceruloplasmin serum oxidase activity and hsCRP level in patients with type1 diabetes mellitus without and with diabetic retinopathy. The study was performed in 76 patients with type 1 diabetes mellitus, 35 without diabetic retinopathy (group 1) and 41 with preproliferative and proliferative retinopathy (group 2). Control group consisted of 35 nondiabetic, age-, gender-, body mass-matched healthy volunteers who came to the outpatient clinic for a routine health check-up. We evaluated FRAS using the method described by Benzie and Strain; PON1 by kinetic spectrophotometric assay with paraoxon as substrate and ceruloplasmin using its oxidative activity with 3-phenylenodiamine as substrate. CRP was measured with a high sensitive enzyme immunoassay. PON1 activity was significantly decreased in patients with diabetic retinopathy (227.66 +/- 123.57 U/l) when compared with control (312.04 +/- 129.77 U/l). FRAS was significantly decreased in group 2 (439.33 +/- 79.87 mumol/l) when compared with group 1 (522.79 +/- 167.56 mumol/l) and control (529.80 +/- 81.99 mumol/l). Ceruloplasmin activity was significantly elevated in group 1 (58.36 +/- 22.56 U/g protein) when compared with control (45.22 +/- 14.96 U/g protein). We have found significant increase in hsCRP level in group 2 (3.71 +/- 2.47 mg/l) when compared with group 1 (1.75 +/- 1.01 mg/l) and control (0.57 +/- 0.46 mg/l). The PON1/CRP ratio in control group was significantly increased when compared with diabetic patients and was significantly decreased in group 2 compared with group 1. We have not found gender-dependent difference in studied parameters in both control and in study groups. We have found tendency to decrease the serum activity of FRAS and hsCRP in elder patients but the difference was significant only in group 2. FRAS and PON 1 activity is decreased in patients with type 1 diabetes mellitus with presence of diabetic retinopathy which confirms that oxidative stress could play a role in pathogenesis of diabetic retinopathy. Significantly elevated levels of hsCRP in diabetic patients with the presence of diabetic retinopathy compared with patients without diabetic retinopathy providing a link between inflammation and the development of microvascular complication of diabetes. Because of the significant difference in PON1/CRP ratio between patients without and with the presence of diabetic retinopathy, it seems that PON1:CRP ratio may be used as a biochemical marker for progression of retinopathy. The link between the antioxidant concentration, inflammation and the development of diabetes complications needs further longitudinal studies in order to confirm our findings.

• Atypical clinical manifestations of multiple endocrine neoplasia type 1 syndrome.

  Authors: Robert Krysiak, Dariusz Kajdaniuk, Bogdan Marek, Bogusław Okopień

  Polskie archiwum medycyny wewnȩtrznej. 04/2009; 119(3):175-9.

  Multiple endocrine neoplasia type 1 (MEN1) is a hereditary tumor syndrome characterized by a genetic predisposition to develop a variety of neuroendocrine tumors and hormone excess syndromes. TheMultiple endocrine neoplasia type 1 (MEN1) is a hereditary tumor syndrome characterized by a genetic predisposition to develop a variety of neuroendocrine tumors and hormone excess syndromes. The major components of MEN1 are hyperparathyroidism due to multiple parathyroid adenomas or hyperplasia, duodenopancreatic neuroendocrine tumors and pituitary adenomas, most often producing prolactin. Physicians' inadequate knowledge of this clinical entity and sometimes its atypical presentation result in a probable significant underdiagnosis of MEN1. This describes the case of a 65-year-old female in whom primary hyperparathyroidism, limited to only one parathyroid gland, was preceded by acromegaly that was diagnosed 23 years earlier. This case shows that MEN1 manifests itself even in older groups and hyperparathyroidism may not be the first symptom of this syndrome. Therefore, we believe that all subjects who, regardless of age, gender and initial manifestation present with whichever the major symptom should be followed up regularly for the early detection of MEN1.

• [Prolactinoma]

  Authors: Robert Krysiak, Bogusław Okopień, Bogdan Marek, Witold Szkróbka

  Przegla̧d lekarski. 02/2009; 66(4):198-205.

  Prolactin-secreting tumours (prolactinomas) are benign neoplasms constituting about 40 percent of all pituitary tumours. The incidence of these tumours varies with age and sex, occurring mostProlactin-secreting tumours (prolactinomas) are benign neoplasms constituting about 40 percent of all pituitary tumours. The incidence of these tumours varies with age and sex, occurring most frequently in females between 20 and 40-years-old. The clinical symptoms of prolactinomas are menstrual dysfunction and galactorrhea in women and loss of libido and potency in men. Differential diagnosis of the disease should include the intake of various drugs, hypothyroidism, renal failure, liver cirrhosis, compression of the pituitary stalk by other pathologies, idiopathic hyperprolactinemia and other types of pituitary adenomas. The aims of treatment are to restore or to achieve eugonadism through the normalisation of hyperprolactinemia and control of tumour mass. Because of the established effectiveness in the majority of cases and small number of acceptable adverse effects, dopamine agonists are considered the drugs of choice. Transsphenoidal surgery remains an option when medical therapy is neither effective nor well tolerated. The authors review the diagnosis and management of prolactinomas, including progress made in recent years.

• [Inhibitory effect of carbamazepine on hypotensive action of spironolactone in primary aldosteronism.]

  Authors: Robert Krysiak, Bogdan Marek, Bogusław Okopień

  Endokrynologia Polska. 02/2009; 60(1):52-55.

  Despite progress made in recent years, interactions between various drugs are far from being fully understood. Moreover, a peculiarity of constitution causes that some individuals in particularDespite progress made in recent years, interactions between various drugs are far from being fully understood. Moreover, a peculiarity of constitution causes that some individuals in particular situations respond differently to a drug or treatment than do most people. We report the case of a 68-year-old female with primary aldosteronism treated with spironolactone. The patient occasionally suffered from trigeminal neuralgia and was then prescribed with carbamazepine, which although alleviated pain worsened the control of blood pressure. To maintain blood pressure within normal limits the doses of spironolactone had to be increased. Replacement of carbamazepine with gabapentin prevented these drug-induced increases in blood pressure in our patient. This case shows for the first time the existence of a drug interaction between spironolactone and any anti-epileptic drug in primary aldosteronism.

• [Obesity and the relationship between somatotrophic axis and bone tissue.]

  Authors: Zofia Ostrowska, Andrzej Kobielski, Beata Kos-Kudła, Bogdan Marek, Dariusz Kajdaniuk

  Endokrynologia Polska. 01/2009; 60(4):302-309.

  In postmenopausal obese women often is observed increase bone mineral density in relation to slim women. Dominate the view that positive influence of adipose tissue on state of skeleton inIn postmenopausal obese women often is observed increase bone mineral density in relation to slim women. Dominate the view that positive influence of adipose tissue on state of skeleton in postmenopausal women can be consequence of the boost to load carrying bone, may also result from the role of adipose tissue as endocrine organ. Interaction existence between somatotrophic axis and bone tissue suggests that revealing itself changes of constituents concentration of this axis in obesity individuals may have significance in bone tissue remodeling modification after menopause. It has been demonstrated that GH and IGF-I secretion decrease with age and this changes are major in obesity persons, particularly in women, and they depend on BMI and the percentage of body fat content. GH as well as IGF-I may directly and indirectly modulate bone remodeling, stimulating both bone formation and bone resorption. In the light of latest data this last effect is realized through their influence on expression of OPG and/or RANKL, cytokines belonging to the family of tumor necrosis factor alpha, which provide important controlling process element of the numbers of activated osteoclasts through osteoblasts.

• [Adrenal disorders in pregnancy.]

  Authors: Bogdan Marek, Robert Krysiak, Bogusław Okopień

  Endokrynologia Polska. 01/2009; 60(4):331-342.

  Pregnancy dramatically affects the function of the adrenal glands and is associated with altered levels of adrenal hormones. Endocrine adaptation to pregnancy involves changes in the activities ofPregnancy dramatically affects the function of the adrenal glands and is associated with altered levels of adrenal hormones. Endocrine adaptation to pregnancy involves changes in the activities of the hypothalamic-pituitary-adrenal and renin-angiotensin-aldosterone axes. As a result, pregnancy may influence the course of pre-existing adrenal diseases or lead to their unmasking. Although disorders of the adrenal glands are rare during pregnancy, they may pose a serious health problem. The fact that some symptoms of adrenal disorders may be erroneously interpreted as symptoms of normal pregnancy together with overlapping their biochemical features make diagnosis of adrenal disorders in pregnancy difficult. Antenatal diagnosis and correct treatment of these disorders is necessary to prevent maternal and fetal morbidity and mortality. The aim of this paper is provide a scientific understanding of the normal function of adrenal glands in pregnancy and to discuss the pathophysiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy. We provide the reader with some practical recommendations concerning the approach to pregnant women with adrenal disturbances.

• Blood serum levels of vascular cell adhesion molecule (sVCAM-1), intercellular adhesion molecule (sICAM-1) and endothelial leucocyte adhesion molecule-1 (ELAM-1) in diabetic retinopathy.

  Authors: Mariusz Nowak, Tomasz Wielkoszyński, Bogdan Marek, Beata Kos-Kudła, Elzbieta Swietochowska, Lucyna Siemińska, Dariusz Kajdaniuk, Joanna Głogowska-Szelag, Katarzyna Nowak

  Clinical and experimental medicine. 10/2008; 8(3):159-64.

  BACKGROUND: Interaction between cells via intimate cell-cell contact is facilitated by a cell surface molecules, termed adhesion molecules. The aim of the study was to evaluate the blood serumBACKGROUND: Interaction between cells via intimate cell-cell contact is facilitated by a cell surface molecules, termed adhesion molecules. The aim of the study was to evaluate the blood serum concentration of soluble forms of vascular cell adhesion molecule (VCAM-1), intercellular adhesion molecule (ICAM-1) and endothelial leukocyte adhesion molecule-1 (ELAM-1) in patients with type 1 diabetes mellitus without and with diabetic retinopathy. MATERIALS AND METHODS: The study was performed in 75 patients with type 1 diabetes mellitus, 35 without retinopathy (group 1) and 40 with retinopathy (group 2). Soluble forms of VCAM-1, ICAM-1 and ELAM-1 were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: The serum concentration of sICAM-1 and sELAM-1 were significantly elevated and the concentration sVCAM-1 was elevated but not significantly in diabetic patients when compared with control subjects. There was a significant difference in VCAM-1 concentrations between the control group and group 2 (965.9 +/- 229.0 vs. 1283.7 +/- 387.6 ng/ml, p < 0.05) and between group 1 and group 2 (1115.0 +/- 285.5 vs. 1283.7 +/- 387.6 ng/ml, p < 0.05). There were significant differences in sICAM-1 concentrations between the control group and group 1 (p < 0.05) and between the control group and group 2 (p < 0.05). Where was no significant difference in sICAM-1 concentration between group 1 and 2 (405.2 +/- 135.9 vs. 443.1 +/- 112.7 ng/ml, p = 0.08). ELAM-1 concentration was significantly elevated in group 2 (120.5 +/- 49.3 ng/ml) when compared with the control group (51.7 +/- 18.1 ng/ml, p < 0.005) and with group 1 (81.2 +/- 27.7 ng/ml, p < 0.05). CONCLUSIONS: The correlations found between sVCAM-1, sICAM-1 and sELAM-1 and the presence of retinopathy suggest that cellular adhesion and neovascularization may be linked processes.

• Is there any relation between hyperinsulinemia, insulin resistance and colorectal lesions in patients with acromegaly?

  Authors: Wanda Foltyn, Beata Kos-Kudla, Janusz Strzelczyk, Violetta Matyja, Jacek Karpe, Adam Rudnik, Bogdan Marek, Dariusz Kajdaniuk, Aleksander Sieron, Wojciech Latos

  Neuro endocrinology letters. 03/2008; 29(1):107-12.

  INTRODUCTION: Pathogenesis of colonic lesions in patients with acromegaly remains still unclear. There are suggestions that apart from somatotropin axis hormones (GH and IGF-1), other agents alsoINTRODUCTION: Pathogenesis of colonic lesions in patients with acromegaly remains still unclear. There are suggestions that apart from somatotropin axis hormones (GH and IGF-1), other agents also take part in this process. Molecular and animal studies indicate a vital role of hyperinsulinemia in development of colorectal neoplasms. AIM OF THE STUDY: To evaluate a relation between insulin level, insulin resistance and its anthropometric markers and colorectal lesions in patients with acromegaly. MATERIAL AND METHODS: The study consisted of 40 patients with active, newly diagnosed acromegaly; 24 women and 16 men aged from 24 to 77 years (mean age 50.1, SD+/-12.1). The analysis included the results of somatotropin axis function (GH and IGF-1 level), carbohydrate metabolism assessment (fasting serum glucose and insulin levels, oral glucose tolerance test, HOMA-IR for insulin resistance), the results of anthropometric measurement (BMI, WHR) and colonoscopy. RESULTS: Colon pathologies (60 polyps and 2 flat lesions) were discovered in 19 (47.5%) patients with acromegaly, 8 of them had multiple polyps. Hyperplastic polyps were revealed in 11 (27.5%), while adenomas in 8 (20%) acromegalics. Patients with colorectal lesions were found to have higher WHR then subjects with normal colon (p=0.033). Positive correlation between the number of hyperplastic polyps in the patients with multiple changes in the colon and IGF-1 (p=0.025), insulin level (p=0.005) and HOMA-IR (p=0.001) was found. Multiple adenomas correlated positively with insulin level (p=0.007), HOMA-IR (p=0.006) and BMI (p=0.015). CONCLUSIONS: The study results show a relation between hyperinsulinemia, insulin resistance and colon pathologies in acromegaly. Fasting insulin level and HOMA-IR correlate positively with the number of hyperplastic polyps and adenomas in acromegalic patients with multiply colorectal lesions.

• [Subclinical hypothyroidism]

  Authors: Robert Krysiak, Bogdan Marek, Bogusław Okopień

  Wiadomości lekarskie (Warsaw, Poland : 1960). 02/2008; 61(4-6):139-45.

  Subclinical hypothyroidism, defined by elevated serum levels of thyroid stimulating hormone (TSH) with normal levels of free thyroid hormones, belongs to the most common disorders encountered in anSubclinical hypothyroidism, defined by elevated serum levels of thyroid stimulating hormone (TSH) with normal levels of free thyroid hormones, belongs to the most common disorders encountered in an endocrine office practice. It is assumed that elevated TSH levels in patients with subclinical hypothyroidism do not reflect pituitary compensation to maintain euthyroidism but probably represents a state of mild tissue hypothyroidism. Some patients with this condition experience subtle hypothyroid symptoms and have mild abnormalities of serum lipoproteins that may provoke atherosclerosis and cardiac dysfunction. Subclinical hypothyroidism is also associated with the risk of progression to overt hypothyroidism and with the risk of neuropsychiatric effects. For these reasons, subclinical hypothyroidism should be screened more carefully in the community. There is insufficient evidence that treatment ofsubclinical hypothyroidism is beneficial. Thyroxine therapy should be given if the serum TSH level is higher than 10 mIU/L but for lower TSH values, the decision for therapy should be individualized. This article reviews the epidemiology, etiopathogenesis, clinical presentation, diagnosis, and management of subclinical hypothyroidism. Based on the principles of evidence-based medicine, we provide some screening and treatment recommendations.

• [Medullary thyroid cancer - the present state of art.]

  Authors: Robert Krysiak, Bogdan Marek, Bogusław Okopień

  Endokrynologia Polska. 02/2008; 59(5):446-456.

  Medullary thyroid cancer is a neuroendocrine tumour originating from the parafollicular C cells of the thyroid gland that accounts for about 5-10% of all thyroid carcinomas. It may occur eitherMedullary thyroid cancer is a neuroendocrine tumour originating from the parafollicular C cells of the thyroid gland that accounts for about 5-10% of all thyroid carcinomas. It may occur either sporadically (75%) or in familial forms (25%) in familial medullary thyroid carcinoma and multiple endocrine neoplasia types 2A and 2B. Distinct clinical phenotypes in hereditary medullary thyroid cancer result from different missense germline mutations in the RET protooncogene. Medullary thyroid cancer produce calcitonin, measurement of which indicates the presence of tumour in at-risk individuals and the effectiveness of management in treated patients. Prognosis of patients with medullary thyroid cancer is variable, but the more constant factors that affect it are the stage of disease and the age of the patient. The goal of treatment of patients suffering from medullary thyroid cancer is to detect and surgically remove disease at its early stage. Total thyroidectomy with local nodal dissection leads to achievement of biochemical cure in more than 80% of cases. The tumour does not take up radioactive iodine, is relatively radioresistant, and there is no known effective systemic therapy for this cancer. The purpose of this article is to summarise the present state of knowledge on the etiology, clinical presentation, management, prognosis, and genetics of medullary thyroid cancer. (Pol J Endocrinol 2008; 59 (5): 446-455).