Vitamin D deficiency in obese patients with Type 2 diabetes

Introduction: Vitamin D deficiency is involved in the pathogenesis of insulin resistance, which is the main factor in the development of type 2 diabetes. In Poland, a high percentage of people with vitamin D deficiency is observed, as well as incidences of type 2 diabetes. In 2013, recommendations regarding vitamin D supplementation for Central Europe inhabitants were published, which recommend the use of vitamin D preparations for obese people with a dose of 600-4000 IU / per Day Purpose of the work: Evaluation of the prevalence of vitamin D deficiency in obese patients with chronically decompensated type 2 diabetes mellitus and appropriate supplementation in accordance with given recommendations. Material and metod: Evaluation of laboratory tests and applied pharmacotherapy in 40 patients with chronically decompensated type 2 diabetes, aged from 38 to 89 years old. Results: In the experimental group the average concentration of 25 (OH) D3 was 20.3 ng / ml ± 11.7. Supplementation of vitamin D preparations was used by 15% of patients. Only 22.5% of patients had correct concentrations of 25 (OH) D3, but only one person used vitamin D supplements in this group. Conclusions: One in five obese patients with type 2 diabetes have normal levels of vitamin D. Among obese diabetics nearly 90% of patients do not apply the recommendations for vitamin D supplementation. Knowledge about the benefits of vitamin D supplementation should be widely propagated among diabetologists and general practitioners

Subclinical hyperthyroidism in the course of autonomous nodules — clinical evaluation

Introduction: Subclinical hyperthyroidism (SCH), also known as mildly symptomatic hyperthyroidism, has recently been diagnosed more frequently. One of the main endogenous causes of this disorder is autonomously functioning thyroid nodule (AFTN). Despite the fact that it is usually asymptomatic, SCH entails repercussions on the cardiovascular system and bone, and it carries a risk of progression to overt hyperthyroidism with a typical clinical picture. Treatment is still controversial, and its benefits are widely debated in literature. Material and methods: From 459 patients authors selected a group of 49 patients (10.6% of all subjects with hyperthyroidism), 41 women (83.7%) with AFTN at the stage SCH treated in the Outpatient Endocrinological Clinic and the Department of Endocrinology of the Medical University of Lublin over a three-year period. The method applied in the study was a retrospective analysis of medical records with a particular account of medical history, physical examination, and additional tests obtained during the process of diagnostic and therapeutic procedures. Results: Forty-one patients (83.7%) suffered from typical symptoms of hyperthyroidism; only eight patients (16.3%) were asymptomatic. The most frequently reported symptoms were tachycardia in women (51.2%) and anxiety in men (50%). The type of thyrostatic drugs and the length of therapy did not affect the outcome of iodine-131 therapy. In the vast majority of the patients (87.8%) radioidodine therapy was effective; 30 patients (61.2%) reached euthyreosis and 13 patients (22.5%) developed hypothyroidism. Conclusions: Most patients with SCH in the course of AFTN suffered from typical symptoms of overt hyperthyroidism; only every sixth patient was asymptomatic. The volume of autonomous adenomas did not affect the result of 131I therapy; however, the impact of AFTN volume as well as the thyroid volume on RIT efficacy requires futher investigation. In the vast majority of patients 131I therapy was an effective method of treatment, and an earlier therapeutic effect was observed more often in the patients with focal lesions located in theright lobe.

Powikłania okołooperacyjne u pacjentek z cukrzycą poddanych zabiegom ginekologicznym

Objectives: The aim of the study was to estimate whether diabetes was an independent risk factor for perioperative complications in patients undergoing gynecologic surgery. Material and methods: The study population consisted of 182 women (diabetics and controls) who underwent elective gynecologic surgery. Each patient without diabetes from the control group and matched for age and body mass index diabetic patient were admitted with the same gynecologic diagnosis, underwent the same gynecologic procedure, were operated on in the same operating room and were hospitalized within the same time interval. The following parameters of the perioperative period were compared between every matched pair of patients (diabetic vs. non-diabetic patient): number and characteristics of intra- and postoperative complications, length of postoperative hospitalization, decrease in hemoglobin level, increase in body temperature, and postoperative use of antibiotics. Results: The study revealed no statistically significant differences between the diabetic patients and pair-matched controls in terms of the examined parameters of the perioperative period. Conclusions: Diabetes was not an independent risk factor for early postoperative complications after gynecologic procedures in the examined population. Good pre-operative glycemic control and strict cooperation of the diabetologist with the surgeon in the perioperative period resulted in reduction of the complication rate to the level typical for non-diabetic patients.  Cel pracy: Celem pracy było ustalenie, czy w badanej grupie pacjentek które zostały poddane zabiegom ginekologicznym, cukrzyca stanowiła niezależny czynnik ryzyka powikłań okołooperacyjnych. Materiał i metody: Badaniami objęto 182 kobiety (grupa badana i kontrolna łącznie) które zostały poddane zabiegom oraz operacjom ginekologicznym w trybie planowym. Każdej pacjentce z cukrzycą przyporządkowano pacjentkę bez cukrzycy: w podobnym wieku, o zbliżonej wartości wskaźnika masy ciała, z tym samym ginekologicznym rozpoznaniem zasadniczym, poddaną takiemu samemu zabiegowi operacyjnemu i na tej samej sali zabiegowej/operacyjnej, co pacjentka z grupy badanej oraz hospitalizowaną w tym samym okresie czasu. Następujące parametry okresu okołooperacyjnego zostały porównane między każdą pacjentką z cukrzycą i przyporządkowaną jej pacjentką bez cukrzycy: liczba i charakter powikłań, czas pooperacyjnej hospitalizacji, spadek stężenia hemoglobiny, wzrostu temperatury ciała, pozabiegowe zastosowanie antybiotyków. Wyniki: Nie wykazano istotnych statystycznie różnic między grupą cukrzycową a grupą kontrolną w zakresie analizowanych parametrów okresu okołooperacyjnego. Wnioski: Cukrzyca nie stanowiła niezależnego czynnika ryzyka wczesnych powikłań okołooperacyjnych po zabiegach ginekologicznych we wszystkich rodzajach zabiegów. Dobre przedoperacyjne wyrównanie cukrzycy, ocena pacjentek z cukrzycą przez lekarza diabetologa oraz ścisła współpraca okołooperacyjna między lekarzem ginekologiem a diabetologiem umożliwia ograniczenie liczby powikłań okołozabiegowych w grupie chorych z cukrzycą poddawanych zabiegom ginekologicznym do poziomu odpowiadającego pacjentkom bez cukrzycy.

Adiponectin as novel key player in tumors of adrenal glands – what do we know? A review

Introduction: Adrenal incidentalomas without clinically apparent hormonal activities have becoming a huge socio-economic problem due to recent advances in radiological techniques. Patients with incidentalomas are considered to be at high risk of developing metabolic disorders and cardiovascular diseases. That is why, the two-way relationship between adipose tissue activity and adrenal glands is in high interest and an object of extensively studies. Aim of the study: This article summarizes the current knowledge about adiponectin and its receptors in the tumorigenesis of adrenal neoplasia as well as their role in the developing obesity-related diseases. Description of knowledge: Adiponectin, an adipose tissue-derived pleiotropic hormone, with anti-inflammatory, anti-atherogenic, anti-diabetic, and insulin-sensitizing properties is engaged in developing diabetes mellitus type 2, hypertension or ischemic heart disease, but the latest researches also revealed its role in tumor cells proliferation and angiogenesis. The possible effects of adiponectin and its two receptors in both physiological processes and pathophysiology of adrenal glands is not fully understood. Recent studies suggested that adiponectin receptors expression is significantly higher in hormonally active adrenal tumors as compared to normal tissues of adrenal glands, which may prove the involving of adipose tissue and periadrenal fat depot in regulating the function of adrenal cortex or medulla. Conclusions: Adiponectin may be predictive factor of developing metabolic disorders in the group of patients with accidentally detected adrenal lesions. The discovering of its exact mechanism may result in modifying novel screening options as well as diagnostic process and treatment scheme. Therefore, further research is required to determine the effect of adiponectin and its role in the pathogenesis of obesity-related diseases in the course of adrenal tumors

Parathyroid cancer — difficult diagnosis — a case report

Parathyroid cancer is a rare disorder of unclear etiology that is difficult to diagnose and treat. It is most often diagnosed incidentally based on multi-organ non-specific symptoms of hypercalcemia as a consequence of parathyroid hormone oversecretion. We present a case of a male with primary hyperparathyroidism who was diagnosed with parathyroid cancer ectopically located in the mediastinum only after the third surgery. However, due to chronic hypercalcemia, problems with localization and a bad clinical condition, the patient was not able to undergo a radical resection and one year after the first pathological fracture died. Taking into consideration the whole clinical picture we want to emphasize the need to apply comprehensive differential diagnosis of hypercalcemia and localization diagnosis of parathyroid tissue with a use of MIBI scintigraphy accompanied by the computed tomography and magnetic resonance imaging, as the most specific diagnostic tools employed in this pathology.Parathyroid cancer is a rare disorder of unclear etiology that is difficult to diagnose and treat. It is most often diagnosed incidentally based on multi-organ non-specific symptoms of hypercalcemia as a consequence of parathyroid hormone oversecretion. We present a case of a male with primary hyperparathyroidism who was diagnosed with parathyroid cancer ectopically located in the mediastinum only after the third surgery. However, due to chronic hypercalcemia, problems with localization and a bad clinical condition, the patient was not able to undergo a radical resection and one year after the first pathological fracture died. Taking into consideration the whole clinical picture we want to emphasize the need to apply comprehensive differential diagnosis of hypercalcemia and localization diagnosis of parathyroid tissue with a use of MIBI scintigraphy accompanied by the computed tomography and magnetic resonance imaging, as the most specific diagnostic tools employed in this pathology

Ocena stężeń FGF-21 — nowej adipocytokiny w cukrzycy typu 2

Introduction: Fibroblast growth factor 21 FGF-21 is a newly discovered adipocytokine which may play a vital role in improvement of insulin sensitivity and pathogenesis of type 2 diabetes. The aim of the study was to assess FGF-21 concentrations in the serum of patients with type 2 diabetes, in comparison to a control group, and evaluate the possible relationships between the studied cytokine and selected clinical and biochemical parameters Material and methods: The study was conducted in 64 patients with type 2 diabetes, 28 women and 36 men aged 47-70 (median age 61.5), with a median duration of diabetes of 8.5 years. In fasting serum samples, concentrations of glucose, insulin, lipids profile parameters, creatinine, C-reactive protein (CRP), fibrinogen, HbA1c, adiponectin, and FGF-21 were determined. The control group comprised 20 healthy persons matched for age to the study group, with no disturbances in carbohydrate metabolism: 14 women and 8 men. Results: We found significant differences concerning the medians of body mass index (BMI) 32.4 kg/m2 v. 24.1 kg/m2, p < 0.001; waist circumference 114 cm v. 81 cm, p < 0.001; HDL cholesterol 42.5 mg/dl v. 62.5 mg/dl, p < 0.001; triglyceride (TG) 152 mg/dl v. 99 mg/dl, p < 0.01 in the studied group, in comparison with the control group, respectively. In patients with diabetes, median FGF-21 concentration was 239.9 pg/ml and was significantly greater in comparison to the control group: 112.6 pg/ml p < 0.01. Median adiponectin concentration in patients with type 2 diabetes was significantly lower in comparison to the control group, 7.5 ng/ml v. 9.95 ng/ml, p < 0.05. Significant correlations between FGF-21 concentrations and adiponectin (r = -0.24, p < 0.05), weight (r = 0.27, p < 0.05), glucose (r = 0.27, p < 0.05), HDL cholesterol (r = -0.26, p < 0.05), TG (r = 0.27, p < 005), and estimated glomerular filtration rate (eGFR) (r = -0.28, p < 0.05) were observed. No significant correlations between FGF-21 and parameters of metabolic control, markers of inflammatory status, and insulin resistance, or the presence of vascular complications of diabetes, were noticed. Conclusions: On the basis of the conducted studies it can be concluded that the greater FGF-21 concentration observed in the examined group of patients with type 2 diabetes may result from a compensatory reaction to metabolic disturbances or tissue resistance to this cytokine. The negative correlation between FGF-21 and eGFR suggests renal elimination of the examined compound. (Pol J Endocrinol 2010; 61 (1): 50-54)Wstęp: Czynnik wzrostu fibrolastów 21 (FGF-21, fibroblast growth factor 21) jest stosunkowo niedawno odkrytą adipokiną, mogącą odgrywać istotną rolę w poprawie insulinowrażliwości i patogenezie cukrzycy tytu 2. Celem pracy była ocena stężenia FGF-21 w surowicy krwi pacjentów cukrzycą typu 2 w porównaniu z grupą kontrolną, oraz znalezienie zależności pomiędzy tą cytokiną a innymi parametrami klinicznymi i biochemicznymi. Materiał i metody: Badania wykonano u 64 pacjentów z cukrzycą typu 2, w tym 28 kobiet i 36 mężczyzn w wieku 47-70 lat (średnia wieku 61,5), z medianą czasu trwania choroby 8,5 roku. W próbkach krwi pobranej na czczo wykonywano oznaczenia stężeń glukozy, insuliny, białka C-reaktywnego (CRP, C-reactive protein), fibrynogenu, lipidogramu, kreatyniny, HbA1c, adiponektyny i FGF-21. Grupę kontrolną stanowiło 20 osób (14 kobiet i 8 mężczyzn) z medianą wieku 58 lat, bez zaburzeń gospodarki węglowodanowej. Wyniki: W grupie badanej stwierdzono, w porównaniu z grupą kontrolną, istotne różnice w zakresie median wskaźnika masy ciała (BMI, body mass index) 32,4 kg/m2 v. 24,1 kg/m2, p < 0,001; obwodu talii 114 cm v. 81 cm, p < 0,001; cholesterolu frakcji HDL 42,5 mg/dl v. 62,5 mg/dl, p < 0,001; triglicerydów (TG, triglyceride) 152 mg/dl v. 99 mg/dl, p < 0,01. U pacjentów z cukrzycą mediana stężenia FGF-21 wynosiła 239,8 pg/ml i była istotnie wyższa w porównaniu z grupą kontrolną: 112,6 pg/ml, p < 0,001. Mediana stężenia adiponektyny u pacjentów z cukrzycą była istotnie niższa w porównaniu z grupą kontrolną, 7,5 ng/ml v. 9,95 ng/ml, p < 0,01. Zaobserwowano istotne zależności pomiędzy stężeniami FGF-21 a adiponektyną (r = -0,24, p < 0,05), masą ciała (r = 0,27, p < 0,05), glukozą (r = 0,27, p < 0,05), cholesterolem frakcji HDL (r = -0,26, p < 0,05), TG (r = 0,27, p < 005) oraz wielkością przesączania kłębuszkowego (eGFR, estimated glomerular filtration rate) (r = -0,28, p < 0,05). Nie znaleziono istotnych zależności pomiędzy stężeniem FGF-21 a parametrami wyrównania metabolicznego, wykładnikami stanu zapalnego i insulinooporności, jak również obecnością powikłań naczyniowych choroby. Wnioski: Na podstawie przeprowadzonych badań można przypuszczać, że obserwowane wyższe stężenia FGF-21 w badanej grupie pacjentów z cukrzycą typu 2, mogą wynikać z kompensacyjnej reakcji na zaburzenia metaboliczne bądź też są wynikiem tkankowej oporności na tę cytokinę. Ujemna korelacja stężeń FGF-21 z eGFR sugeruje eliminację drogą nerkową badanego związku. (Endokrynol Pol 2010; 61 (1): 50-54

Gestational diabetes mellitus — literature review on selected cytokines and hormones of confirmed or possible role in its pathogenesis

The incidence of gestational diabetes mellitus (GDM) increases globally, including Poland. Considering serious consequences of gestational diabetes for both mother and fetus, screening for this disorder is an obligatory element of managing pregnant woman. The pathogenesis of gestational diabetes is not yet thoroughly explained. However, it is insulin resistance and chronic subclinical inflammatory process which are considered to be major factors responsible for the development of GDM. These two states are triggered mainly by secretion of proinflammatory cytokines and by abnormal function of adipose tissue. The study reviews the literature on selected hormones and cytokines whose role in the GDM pathogenesis has been already confirmed as well as on those proteins whose role is either not yet fully understood or which may possibly participate in GDM development. Owing to the fact that underlying mechanisms of GDM are, in general, similar to the mechanisms responsible for metabolic disorders such as diabetes mellitus type 2 or obesity, in this review we focus first on the role these molecules play in pathogenesis of metabolic disorders and then present current state of knowledge on their action in gestational diabetes development. The review presents: TNF alpha, adipokines — adiponectin and leptin and relatively newly discovered proteins: fetuin A, periostin, angiopoietin-like protein 8 or high mobility group box

Copeptin as a novel biomarker of cardiometabolic syndrome

Arginine vasopressin (AVP), which is also called antidiuretic hormone (ADH), is a neurohormone synthetized from a pre-pro-hormone precursor in the supraoptic and paraventricular nuclei of the hypothalamus in response to increased plasma osmolality and decreased blood volume. AVP exerts several effects by binding to three different receptors: V1aR, V1bR, and V2R. In recent years, it has been suggested that increased plasma concentration of AVP may play a causal role in the development of type 2 diabetes, the metabolic syndrome, renal dysfunction and cardiovascular disease by influencing glucose homeostasis and lipid metabolism through several possible mechanisms involving V1aR and V1bR. V1aR located in the liver is involved in hepatic glycogenolysis and gluconeogenesis. V1bR, found in the pituitary gland and pancreas, mediates secretion of adrenocorticotrophic hormone (ACTH), insulin, and glucagon. However, AVP’s clinical use as a biomarker is limited due to its short half-life in plasma (16–20 minutes), small size, and poor stability, which make direct measurement difficult. Copeptin, the biologically inactive, stable, C-terminal part of pro-vasopressin, is co-secreted with AVP in equimolar amounts and thus is considered an adequate and clinically useful surrogate marker of AVP. The aim of this review is to assess the current state of knowledge about the potential role of copeptin as a novel biomarker of cardiometabolic syndrome on the basis of recent scientific literature published up to December 2020 and searches of the PubMed, Google Scholar, and Web of Science databases

Incretin hormones in the treatment of type 2 diabetes. Part I: Influence of insulinotropic gut-derived hormones (incretins) on glucose metabolism

Insulinotropic gut-derived hormones (incretins) play a significant role in the regulation of glucose homeostasis in healthy subjects and are responsible for 50-70% of insulin response to a meal. The main mediators of the incretin effect are glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1). However, in patients with type 2 diabetes the effect of incretins action is to a large extent impaired, which seems to explain disturbed secretional activity of &#946; cells in pancreatic islets. Detailed analysis of incretin defect proved that GIP secretion remains within physiological limits, whereas GLP-1 secretion is significantly decreased. Nevertheless, GLP-1 insulinotropic effect is preserved and GIP effect is significantly impaired. In consequence, substitutional GLP-1 administration aiming at the reduction of its deficiency, seems to be logical therapeutic management, because despite a physiologically retained quantity response from GIP, resistance to this peptide is frequently found. Therefore, particularly promising are the results of clinical studies with the use of GLP-1 analogues , GLP-1 receptors activation, as well as the inhibitors of dipeptidyl peptidase-IV (DPP IV), the enzyme responsible for incretin proteolysis, which restores the proper function of the intestinal-pancreatic axis in subjects with type 2 diabetes and creates new possibilities of a glycaemia reducing therapy and improvement in quality of life in this group of patients.Insulinotropowe hormony jelitowe (inkretyny) odgrywają ważną rolę w regulacji homeostazy glukozy u osób zdrowych i są odpowiedzialne za 50-70% odpowiedzi insulinowej na posiłek. Głównymi mediatorami efektu inkretynowego są polipeptyd insulinotropowy zależny od glukozy (GIP, glucose-dependent insulinotropic polypeptide) oraz glukagonopodobny peptyd-1 (GLP-1, dukagon-like peptide 1). Jednakże u pacjentów z cukrzycą typu 2 efekt działania inkretyn jest w znacznej mierze upośledzony, co wydaje się wyjaśniać zaburzoną czynność wydzielniczą komórek &#946; wysp trzustkowych. Szczegółowa analiza defektu inkretynowego udowodniła, że wydzielanie GIP pozostaje w granicach fizjologicznych, podczas gdy sekrecja GLP-1 jest istotnie zmniejszona. Jednocześnie jest zachowany insulinotropowy efekt działania GLP-1, natomiast efekt GIP ulega znacznemu upośledzeniu. Wobec tego, logicznym postępowaniem terapeutycznym wydaje się substytucyjne podawanie GLP-1 w celu zredukowania jego niedoboru, ponieważ pomimo fizjologicznie zachowanej, ilościowej odpowiedzi ze strony GIP, często stwierdza się oporność na ten peptyd. Dlatego niezwykle obiecujące są wyniki badań klinicznych z zastosowaniem analogów GLP-1, bądź aktywacji receptorów GLP-1, jak również inhibitorów dipeptylo-peptydazy IV (DPP IV), enzymu odpowiedzialnego za proteolizę inkretyn, co przywraca prawidłowe funkcjonowanie osi jelitowo-trzustkowej u osób z cukrzycą typu 2 i stwarza nowe możliwości terapii hipoglikemizującej i poprawy jakości życia w tej grupie chorych