The diagnostic and therapeutic difficulties in management with pheochromocytoma in pregnancy – a review

Introduction: Pheochromocytoma (PCC) is a very rare and life-threatening condition in pregnancy. According to different data, it occurs in about 0,00002%-0,007% of pregnant women. The early diagnosis and the proper clinical management play a crucial role in decreasing maternal and fetal mortality. Aim of the study: This article summarizes the current knowledge about the management with PCC in pregnancy and presents the possible maternal and fetal outcomes. Description of knowledge: The review revealed, that manifestations of catecholamine-secreting tumors are similar to the most common hypertension-associated problems occurring in pregnancy, such as pre-eclampsia. That is why, timely diagnosis is essential for the mothers and fetuses’ survivals. Despite the fact, that the fetus is protected from influence of maternal overproduction of catecholamines due to the presence of placental enzymes activity, there is an enormous risk of spontaneous abortion, fetal growth restriction, premature delivery, when the optimal therapy will not be applied on time. The diagnosis is based on laboratory tests – determination of plasma and urine concentration of catecholamines and imaging tests to localize the tumor, from which only MRI, in 1st and 3rd trimester, and ultrasound examination can be safely used in pregnancy. The guidelines suggest surgical tumor removal as the treatment of choice for women with PCC in pregnancy. The 2nd trimester seems to be the best period for the surgery, however it can be performed only after 10-14 days of effective therapy with alfa- and beta-blockers. The review of literature revealed that, surgical tumor removal carried out before the end of 24. hbd, is safe both for mother and her fetus life. Conclusions: PCC is a great challenge, because of the extremely rare occurrence in pregnant women and serious complications due to the secretion of catecholamines, which may result in catecholamin crisis, increasing the risk of mortality. Nevertheless, there is still no clear consensus on PCC treatment and further researches are needed to develop the optimal management in this clinical condition

Matrix metalloproteinases and their tissue inhibitors as novel markers in invasive pituitary adenomas – a review

Introduction: Pituitary adenomas are generally benign central nervous system neoplasms with still increasing prevalence, especially in younger people. According to the recent data, approximately 30-45% of them invade the local structures, which make their total resection impossible and result in high recurrence rate. Despite the huge advances in management with pituitary tumors, there are no universal biomarkers predicting their course. That is why, the two-way relationship between matrix metalloproteinases (MMPs) activities and the microenvironment of pituitary adenomas is an important object of extensive studies. Aim of the study: This article summarizes the current knowledge about selected MMPs and their tissue inhibitors (TIMPs) in tumorigenesis of pituitary adenomas as well as their role in local invasion in different hormonally active and inactive pituitary tumors. Description of knowledge: MMPs are a family of zinc-dependent proteolytic enzymes, which are engaged in various physiological and pathological conditions. So far, their role in different malignancies have been known for many years. Nevertheless, the possible effects of MMPs and TIMPs in pituitary adenomas are not fully understood. Recent studies suggested that MMPs’ expression is significantly higher in invasive pituitary tumors as compared to non-invasive pituitary adenomas, while the expression of TIMPs is decreased, which may prove their involving in tumorigenesis. Conclusions: MMPs may be predictive factors of the invasiveness and the higher recurrence rate in the group of patients with pituitary adenomas. Understanding the changes in the MMPs-TIMPs system and discovering of its exact mechanisms may result in applying novel screening options as well as modifying diagnostic process and treatment scheme. Therefore, further researches are required to determine the effects of MMPs and TIMPs and their role in the pathogenesis of invasive pituitary tumors

Hashimoto’s encephalopathy – an up-to-date overview

Introduction: Hashimoto’s encephalopathy (HE) is a rare, potentially life-threatening disease with a wide spectrum of clinical manifestations from slight symptoms to mainly neurological and psychiatric syndromes, which significantly debilitate the quality of life and make the diagnostic process complicated, especially in patients with no previous history of thyroid disorders. According to the recent data, it occurs in about 2.1 cases per 100 000 population with still increasing prevalence. Despite, over than fifty years have passed since the first case of HE was reported, its etiopathogenesis is not completely clarify and there is no universal diagnostic criteria. Aim of the study: This article summarizes the current knowledge about pathophysiology, clinical manifestations, difficulties in differential diagnosis and therapeutic dilemmas in patients with HE. Description of knowledge: HE is an autoimmune-mediated encephalopathy associated with Hashimoto’s disease and elevated titers of anti-thyroid antibodies, mainly anti-thyroid peroxidase antibody. The diagnostic process is usually multi-step due to various diseases mimicking HE, such as Creutzfeldt-Jacob disease, brain tumors, epilepsy, Alzheimer's disease, stroke, other forms of autoimmune encephalitis, schizophrenia, spontaneous cerebrospinal fluid leak or infectious encephalitis. The range of diagnostic procedures includes physical and mental examination, laboratory tests, brain imaging, EEG as well as cerebrospinal fluid analysis. However, the first line strategy based on steroids is effective, there are some cases in the literature that reveal this management as not fully sufficient, because only partial improvement was achieved or the steroid-dependence was observed. Among other therapeutic methods, plasmapheresis may be used additionally. Conclusions: HE requires interdisciplinary approach and it constitutes a great challenge for clinicians of various specialties, such as endocrinologists, neurologists, and psychiatrists. The prompt implementation of adequate therapy usually provides the full recovery of the patients without any early or late complications

The role of gut microbiota in patients with autoimmune thyroid diseases – current status and future perspectives

Introduction: Autoimmune diseases constitute a significant clinical problem, due to the increasing incidence, that is why the potential causes that determine their occurrence are sought. Intestinal microbiota greatly outnumber the all of human body’s cells. Its metabolic activity and disorders in the structure, resulting from, for example, antibiotic therapy, lead to homeostasis dysregulation, and in this way gain a new meaning in the etiology of autoimmune diseases. Aim of the study: This article summarizes the current knowledge about gut microbiota in patients with autoimmune thyroid diseases as well as discussed the alterations in the gut microbiota and their potential relationship with thyroid cancer. Description of knowledge: The analyzed scientific literature revealed a relationship between the occurrence of autoimmune diseases and intestinal flora disorders. It is believed that the microbiota that colonized the entire human body, due to diversity, co-formation of the intestinal barrier, its own metabolic activity and participation in many metabolic processes, plays an important role in regulating the immune system functioning. Many data indicate, that the changes in the composition of the intestinal flora in many autoimmune diseases can also be influenced by individual factors, environmental conditions, genetic predisposition, and diet. Conclusions: Gut microbiota is an important element of the immune system and due to the demonstrated changes in its composition in various disease processes and its significant effects on metabolism, the researchers are still underway to clarify all pathogenetic mechanisms of microbiota influencing human homeostasis. Therefore, further studies are required to determine the effect of microbiota and its role in the pathogenesis of autoimmune diseases

Multiple myeloma during pregnancy as a challenge in clinical practice – a review

Introduction: Multiple myeloma (MM) is a hematological malignancy characterized by an abnormal proliferation and accumulation of monoclonal plasma cells. MM typically affects the elderly people with the median age at the diagnosis between 65 to 74 years. Only in < 2% of cases it is observe

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

Adiponectin as novel biomarker of endothelial dysfunction in insulin resistance and obesity – a narrative review

Introduction: Obesity is a chronic fatal disease with still growing incidence among children, adolescents, and adults worldwide. The subclinical inflammatory process together with hipoadiponectinemia may lead to the development of various comorbidities, including cardiovascular complications. That is why, the relationship between adipose tissue activity, obesity, insulin resistance, and endothelial function is in high interest and an object of extensively studies.Aim of the study: This article summarizes the current knowledge on the anti-atherogenic effects of adiponectin and its properties to improve endothelial function in obesity-related insulin resistance.Description of knowledge: Adiponectin, an adipose tissue-derived pleiotropic hormone with anti-inflammatory, anti-atherogenic, anti-diabetic, and insulin-sensitizing actions, is not only engaged in modulation of type 2 diabetes mellitus, hypertension or coronary artery disease, but the latest researches highlight its role in improving vascular wall integrity. It affects complex signaling pathways in endothelial cells and influence inflammatory responses in the subendothelial space. Pre-clinical and clinical studies suggest that agents leading to increase in adiponectin levels, simultaneously contribute to decrease insulin resistance, and improve endothelial dysfunction.Conclusions: Adiponectin may be a predictive factor of endothelial dysfunctionality and vascular remodeling development in the group of patients with overweight, obesity, and insulin resistance. Discovering pharmacological agents and non-pharmacological interventions that increase the level of circulating adiponectin will become novel and innovative therapeutic strategy to ameliorate obesity-related comorbidities. Therefore, further studies are required to determine the exact role of adiponectin in the pathogenesis of metabolic diseases

Powikłania endokrynologiczne i metaboliczne terapii chorób rozrostowych układu krwiotwórczego

Despite the significant progress in the treatment of haematological malignancies and the improvement of treatment efficacy, it is still associated with numerous side effects. Among them, endocrinological and diabetic complications of immunotherapy are of particular importance, and they belong to the most frequently observed, mainly due to the interference of the treatment with functioning of the immune system. As a result, it can lead to the induction of autoimmune processes in many systems, including endocrine glands. The effectiveness of some therapies may also be determined by the occurrence of side effects in the form of autoimmune diseases. Increasing use of tyrosine kinase inhibitors, immune checkpoint inhibitors, as well as glucocorticosteroids exerting immunosuppressive effect, which are applied, leads to the development of various pathologies of the endocrine system. The most common complications developing on the background of autoimmune inflammation are disturbances in the function of thyroid gland, pituitary gland in its anterior lobe, and very rarely in the posterior lobe in the form of diabetes insipidus. The above-mentioned disorders may occur in patients of all ages, regardless of gender. Some dysfunctions are subclinical and are found incidentally during routine check-up, both in the course of the treatment process or after its completion. Taking into account the possibility of serious consequences of the therapy, it is now recommended to periodically control the patients.Mimo znacznego postępu, jaki dokonał się w terapii chorób rozrostowych układu krwiotwórczego, nadal z leczeniem wiążą się liczne działania niepożądane. Wśród nich istotne miejsce zajmują powikłania endokrynologiczne oraz diabetologiczne, które należą do jednych z częściej obserwowanych. Wynikają one przede wszystkim z ingerencji stosowanego leczenia w funkcjonowanie układu immunologicznego, w rezultacie czego może dochodzić do indukcji procesów o podłożu autoimmunologicznym w obrębie wielu układów, w tym gruczołów dokrewnych. Coraz powszechniejsze stosowanie inhibitorów kinaz tyrozynowych, inhibitorów punktów kontrolnych układu odpornościowego, jak również glikokortykosteroidów o działaniu immunosupresyjnym może prowadzić do rozwoju patologii układu wewnątrzwydzielniczego. Najczęstszymi powikłaniami rozwijającymi się na tle autoimmunizacyjnego zapalenia są zaburzenia funkcji tarczycy, przysadki w zakresie jej przedniego płata, a także niezwykle rzadko tylnego pod postacią moczówki prostej. Mogą one wystąpić u pacjentów we wszystkich grupach wiekowych, niezależnie od płci. Niektóre dysfunkcje mają przebieg subkliniczny i są stwierdzane przypadkowo, podczas rutynowych kontroli zarówno w trakcie leczenia, jak i po jego zakończeniu. Biorąc pod uwagę możliwość wystąpienia poważnych powikłań endokrynologicznych i diabetologicznych, obecnie zaleca się stałe monitorowanie chorych

Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Relation to Clinical Parameters and Smoking Status in Patients with Graves’ Orbitopathy—Novel Insight into Old Tests

Graves&rsquo; orbitopathy (GO) is an autoimmune disease with a chronic inflammatory background. Smoking behavior is the main environmental factor responsible for the transition of this major extra thyroidal manifestation of Graves&rsquo; disease (GD) from the subclinical to the overt form. Complete blood count-derived parameters are suggested to be novel inflammatory indices. The aim of this retrospective study was to investigate the association between neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte ratios (PLR) with selected clinical parameters and smoking status in 406 GD patients with (n = 168) and without GO (n = 238). The control group consisted of 100 healthy individuals. The activity of GO was graded according to Clinical Activity Score. Significantly higher white blood cells (WBC), neutrophil, and NLR (p &lt; 0.05) values were observed in GD patients with GO compared with those without GO. PLR values were significantly higher in GO patients than in the controls. WBC (6.81 &plusmn; 1.56 vs. 5.70 &plusmn; 1.23) and neutrophils (3.89 &plusmn; 1.06 vs. 3.15 &plusmn; 0.95) count was higher in active GO patients than in those with inactive GO. Positive correlation (p &lt; 0.05) between CAS score and WBC, neutrophil and monocyte count, and NLR was found. Smoking was associated with higher WBC (p = 0.040), neutrophil (p = 0.049), PLR (p = 0.032) values. Multivariate analysis revealed that WBC, NLR may be risk factors for GO development. WBC, neutrophil, NLR and PLR values seem to be useful tools in the assessment of inflammation in GD

Pierwotne chłoniaki nadnerczy jako interdyscyplinarny problem endokrynologiczny i hematologiczny — praktyczne wskazówki w zakresie diagnostyki i leczenia

Primary adrenal lymphomas (PAL) are rare neoplasms that should be considered in the differential diagnosis of adrenal insufficiency and incidentally detected focal lesions within the adrenal glands, especially those located bilaterally. PAL are tumors characterized by a rapid growth, an aggressive course and a poor prognosis. The disease usually develops in the elderly, most often in the 6.–7. decade of life, 2–7 times more often in men than in women. The etiopathogenesis of PAL is complex, multifactorial and still not fully understood.. The most commonly reported symptoms include fever of unknown origin, abdominal pain, fatigue, and weight loss. In the case of lesions localized on both sides, symptoms of adrenal insufficiency are relatively common. PAL may also be clinically silent and be detected as incidentalomas. The examination of choice in PAL diagnostics is computed tomography (CT) of the abdominal cavity aimed at the adrenal glands and combined with hormonal assessment. The gold standard in the diagnosis of PAL is percutaneous fine-needle aspiration biopsy under ultrasound or CT guidance, which allows for the final diagnosis. Histopathologically, the vast majority of cases are diffuse large B-cell lymphoma. It has been suggested to combine various methods of treatment, including immunochemotherapy/chemotherapy, surgery with subsequent immunochemotherapy/chemotherapy and/or radiotherapy. The purpose of the following systematic review was to perform an interdisciplinary analysis of the clinical picture, pathogenesis, diagnostic methods and current therapeutic strategies, taking into account the prognosis for individual PAL subtypes.Mimo że pierwotne chłoniaki nadnerczy (PAL) są zaliczane do rzadko spotykanych nowotworów, należy je uwzględnić w diagnostyce różnicowej niedoczynności kory nadnerczy oraz przypadkowo wykrytych zmian ogniskowych w obrębie gruczołów nadnerczowych, zwłaszcza zlokalizowanych obustronnie. Pierwotne chłoniaki nadnerczy cechuje szybki wzrost, agresywny przebieg i złe rokowanie. Najczęściej są rozpoznawane w 6.–7. dekadzie życia, 2–7 razy częściej w populacji mężczyzn niż kobiet. W obraz kliniczny wpisuje się: gorączka o nieznanej przyczynie, dolegliwości bólowe brzucha, ogólne osłabienie i utrata masy ciała, a w przypadku zmian zlokalizowanych obustronnie stosunkowo często obserwuje się objawy niedoczynności kory nadnerczy. Pierwotne chłoniaki nadnerczy mogą również przebiegać w sposób niemy klinicznie i być wykrywane jako incydentaloma. Badaniem z wyboru w diagnostyce PAL jest tomografia komputerowa (CT) jamy brzusznej celowana na nadnercza, połączona z oceną hormonalną. Złotym standardem w rozpoznawaniu PAL jest przezskórna biopsja aspiracyjna cienkoigłowa pod kontrolą ultrasonografii lub CT, która pozwala na postawienie ostatecznej diagnozy. Histopatologicznie zdecydowaną większość przypadków stanowi rozlany chłoniak z dużych limfocytów B. W leczeniu PAL zaleca się łączenie różnych rodzajów terapii, w tym immunochemioterapii/chemioterapii, leczenia chirurgicznego z następczą immunochemioterapią/chemioterapią i/lub radioterapią. W pracy dokonujemy interdyscyplinarnej analizy obrazu klinicznego, patogenezy, metod diagnostycznych oraz strategii terapeutycznych, z uwzględnieniem rokowania dla poszczególnych podtypów PAL