Popular co-occurrence of thyroid autoimmune disorders and specific gastrointestinal tract diseases

Introduction: Thyroid gland, despite of its small average size, is a crucial organ of human body. Hormones produced by the thyroid i.e. thyroxine (T4) and triiodothyronine (T3) are necessary for proper functioning the whole organism. Excess or deficiency of these hormones manifest as multiple symptoms of different organs or systems. In this review we focused on special complaints of gastrointestinal tract. Worth to notice is that some thyroid disorders are present in particular gastrointestinal disorders more frequently. Purpose: The aim of this review is to indicate co-occurrence disorders of the thyroid gland, especially autoimmune thyroiditis with disorders of some organs of gastrointestinal tract. State of knowledge: By this time we can enumerate series of thyroid diseases, i.e. hypothyroidism, hyperthyroidism, thyroid nodular goiter, neoplasms or multiple forms of thyroiditis. Generally chronic autoimmune thyroiditis is the most frequent disorders of the gland. That’s the reason why we focused on coexisting this state with gastritis, chronic inflammatory bowel diseases, steatosis of the liver or with neoplasms of gastrointestinal tract. We aim to prove the necessary of constitute diagnosis towards other autoimmune diseases, when the one has bed diagnosed. Thyroid disorders may result in abnormalities of functioning particular organs of the human body. This fact may have an impact on blood tests results – for example elevation of transaminases evaluating function of the liver is often noted in thyroid diseases, what should sensitize clinicians towards performing diagnostics of thyroid function during treatment of liver or intestines or stomach dysfunction. Summary: Diseases of the thyroid gland may coexist with particular diseases of gastrointestinal tract. They may alter the course of these disorders and constitute unfavorable factor of the treatment

Myasthenia gravis during treatment with anti-PD-1 - succesfull treatment using pirydostygminum – case report and literature review

Background: Against limited effectiveness of known oncological treatment such as chemio-and radiotherapy or surgery, new ways of treatment, such as for example immunotherapy has developed. Usage of immune checkpoint inhibitors (ICPIs), resulting in overactivation of immune system, may significantly raise efficacy of oncological treatment, but simultaneously predispose to occurrence various autoimmunological health complications. Adverse actions of the therapy may affect multiple organs and systems, with the presented example of immune-related neurological complication, myasthenia gravis. This relatively rare condition may be severe, life-threatening illness. Case report: We present a case of 66-year-old male patient diagnosted with a large tumor histopathologically assessed as squamous cell carcinoma. Due to ineffectiveness of implemented chemio- and radiotherapy, he was qualified for anti-PD1 immunotherapy with nivolumab. General treatment tolerance was very good with positive antineoplastic effect. Autoimmune hypothyroidism has emerged, therefore levothyroxine therapy has been implemented. After about a year of using immunotherapy, significant weakness and decrease in muscle strength has appeared, subsequently, immunotheraphy-related myasthenia gravis was raised. Improvement in the patient's condition was achieved after initiating pyridostigmine treatment. Cessation of antineoplastic treatment wasn’t necessary, what is unusual. Conclusions: Undeniably myastenia gravis may determine serious, life-threatening adverse effect of immunotherapy. Usually requires withdrawal of applied antioncological treatment, and should be treated with immunomodulators, immunosuppressants or intravenous immunoglobulins or plasmaphaeresis, however – as we present- in some cases may be properly cured only with pyridostygmine

Hyponatremia as drug-induced or secondary to endocrine disorder electrolyte abnormality

Introduction: Hyponatremia is one of the most commonly occuring electrolyte disorder. The main clinical symptoms of natrium imbalance are weakness, lost of appetite, headache, nausea with or without vomiting or altered mental status with somnolence or even seizures and death. Purpose: To present a list of drugs pretending to occurrence or natrium serum level reduction and known endocrine disorder causing hyponatremia. Summary: Hyponatremia is very common electrolyte disorder. Changes that may develop in human organism in the presence of this type of dyselectrolytemia, may be extremely dangerous for proper functioning and life of the entity. It’s well known, that hyponatremia may be caused by multiple factors, such as hormonal disturbances, taking special medicines or even excessive physical activity. It may also develop due to popular health conditions, for example congestive heart failure, liver cirrhosis, malignancies, neurological disorders or human-immunodeficiency virus infection1⁠. The huge amount of patients that are hospitalized in Chair and Department of Endocrinology in Lublin has prompted us to right analysis, due to available medical literature - the endocrine causes of hyponatremia. In second part of this review paper we aimed to enumerate drugs, that are able to result in developing hyponatremia

Transfusions of packed red blood cells in the pathology of newborn

Sick newborns are at present the largest group of patients receiving blood products. Therefore packed red blood cells transfusion is one of the most common procedures performed in Intensive Care Units. However, in order to avoid unnecessary risk, and thus reduce the rate of adverse invents after transfusion, which are particularly common in this group of patients, there is a need to develop proper standards of administration. The aim of this study is to review the current scientific literature on transfusion of packed blood cells in different medical situations in neonates

Male hypogonadism – brief review of symptoms, types and ways of treatment

Appropriate concentration of androgens is necessary for general men’s health, especially for development and maintain reproductive and sexual function, as well as metabolic balance. The state  of deficiency of testosterone or its inadequate action, as well as inability to produce good quality semen is called hypogonadism. Depending on the function of the testicles, production of androgens and sperm is also conditioned on hypothalamus-pituitary axis, metabolic status and age of the individual. Considering that, hypogonadism of primary, secondary, functional or late-onset origin may be recognised. As it concerns susceptible matter of sexual and reproductive health, it requires special interest of differently clinicians, i.e. endocrinologists, andrologists or urologists

Treatment of ophthalmopathy in the course of Graves’ disease

ABSTRACT: Introduction: Graves’ disease is an autoimmune disease in which the TSH receptor (TSHR) is an autoantigen. Its stimulation by antibodies inhibiting thyrotropin binding causes increased secretion of free thyroid hormones and consequently symptoms of thyrotoxicosis. Due to the presence of the same antigen also on orbital and skin fibroblasts, after activating the cell response mechanisms, non-thyroid symptoms of the disease appear, i.e. ophthalmopathy. In most patients, ophthalmopathy is mild and resolves spontaneously. However, in about 10% of patients the disease develops severe to moderate form and requires intensive therapy. Purpose: The aim of this paper is to present the treatment options for ophthalmopathy, which is the most common manifestation of non-thyroid symptoms of Graves’ disease, as well as to draw attention to the fact that treatment may be difficult and requires an interdisciplinary approach, and the treatment plan should be individually adapted to each patient. 1,2,3 State of knowledge: The first-line treatment according to the guidelines published in 2016 by the European Group on Graves Orbitopathy (EUGOGO) are high doses of glucocorticosteroids administered intravenously. The second-line treatment is repeated use of intravenous steroid cycle, oral therapy with glucocorticoids, then combined with orbital or cyclosporine radiation therapy, rituximab or expectant management approach. Rehabilitation treatment is necessary in most patients after the disease has been inactive and maintained for at least 6 months with vision impairment and/or reduced quality of life.1,2,3,7,9 Summary: Ophthalmopathy is the most common non-thyroid manifestation of Graves’ disease. This is a relatively rare disorder, but it has a significant negative impact on the quality of life of people affected by this disease. Therefore, it is very important, both among physicians and patients, to increase the awareness of this disease, apply effective preventive measures and inhibit its progress. Early diagnosis and appropriate treatment are of crucial importance

Causes of hypoglycemia

Introduction: Hypoglycemia is metabolic state of ogranism characterized by abnormally low blood glucose level. Due to International Hypoglycemia Study Group (2017) and following Polish Diabetes Association Guidelines is is recognized with serum glucose below 70mg/dl – with or without accompanying symptoms, such as tremor or altered mental status or even hypoglycemic coma. Symptoms mentioned above may have huge impact on personal or social functioning of the patient. Purpose: To present a list of known causes of hypoglycemic state. Summary: Hypoglycemia is quite unpleasant and dangerous metabolic state that may be caused by multiple etiological factors. The most common cause of this condition is useing too much insulin in treatment of diabetes mellitus. Other diabetic drugs, such us for example sulphonylureas may result in hypoglycemia. Chemicals containing sulfhydryl group in their structure may result in severe hypoglycemia in progress of Insulin Autoimmune Syndrome (IAS). Organic basis of hypoglycemia due to increased amount of producing insulin may be recognized, in progress of pancreatic secreting tumor, called insulinoma. From the other hand functional abnormality of carbohydrate metabolism may be found. It’s called functional hypoglycemia and may develop due to presence of hyperinsulism and insulin resistance secondary to incorrect lifestyle and diet. Partly organic and functional cause of hypogycemia may be recognized after bariatric surgery. Fairy seldom hypoglycemia with low blood insulin level may be found. The example of this state constitutes Dodge-Potter Syndrome, when tumor is able to produce insulin-growth factor 2 (IGF-2) stimulating insulin receptor, what results in serum glucose reduction. Hypoglycemia, as very adverse state for human organism, should be closely diagnose and efficiently treated

The role of selected mechanisms of innate immunity in the pathogenesis of diabetes

Understanding the important role of the non-specific immune response in protecting the body against the development of numerous diseases has become partially possible after the discovery of several classes of pattern recognition receptors (PRR), such as Toll-like or NOD-like receptors. A group of cytoplasmic proteins called the inflammasome, which detect PAMP and DAMP through the PRR receptors, is able to activate pro-inflammatory cytokines and trigger an acute inflammatory reaction both in the extracellular and intracellular space. Low-grade systemic and local inflammation contributes to the development and progression of various conditions, including autoimmune and metabolic diseases, such as diabetes, metabolic syndrome and atherosclerosis, which until recently were not even considered inflammatory diseases. This review will discuss the role of innate immunity in the development of type 1 and type 2 diabetes, focusing on the role of specific innate immunity receptors and insulin resistance involved in these diseases pathogenesis

Pancreatic neuroendocrine tumours in patients with von Hippel-Lindau disease

Von Hippel-Lindau disease is a highly penetrant autosomal genetic disorder caused by a germline mutation in the tumour suppressor gene, manifesting with the formation of various tumours, including neuroendocrine tumours of the pancreas. The incidence of the latter is not very high, varying from 5% to 18%. To compare, haemangioblastomas and clear cell renal carcinoma are present in 70% of von Hippel-Lindau patients and are considered the main prognostic factors, with renal cancer being the most common cause of death. However, pancreatic neuroendocrine tumours should not be neglected, considering their malignant potential (different to sporadic cases), natural history, and treatment protocol. This paper aims to review the literature on the epidemiology, natural history, treatment, and surveillance of individuals affected by pancreatic neuroendocrine tumours in von Hippel-Lindau disease

The impaired response of circulating asprosin concentrations to glucose levels fluctuation may be one of the causes of type 2 diabetes – a narrative review

It has been recently discovered that asprosin, an adopakine that is secreted by white adipose tissue, affects the release of glucose into the blood. When blood glucose levels rise, the production of asprosin is immediately suppressed. In healthy people, circulating asprosin shows daily fluctuations, and its concentration drops significantly with the beginning of eating. In patients with type 2 diabetes it was invastigated that both fasting and postprandial asprosin concentrations were significantly higher. Therefore, it is probable that elevated blood levels of asprosin and its impaired response to glucose levels fluctuation may be one of the causes of type 2 diabetes. It is considered, that administration of antibodies that block the action of asprosin may help diabetics reduce glucose levels. In addition, it can also contribute to the effective fight against obesity.</p