Objectives: Acromegaly is associated by various systemic complications, involving also the nervou... more Objectives: Acromegaly is associated by various systemic complications, involving also the nervous system. Other studies revealed peripheral but not central nervous system impairment with somatosensory evoked potentials examinations in acromegaly. Aim of the present study was to assess whether brainstem transmission in acromegaly is disturbed. Material and methods: The study was carried out in 37 patients. The control group consisted of 47 healthy persons. In all of the subjects, peripheral transmission, reflected by peak I latency, and brainstem transmission, tested by interpeak latency I-V (IPL I-V), were examined. Results: Peak I latency was delayed in 6 out of 37 patients (1 - bilaterally, 2 - right side, 3 - left side). The group-mean latency of peak I was 1.53 msec and 1.56 msec, for the right and left side, respectively. There were found no statistically significant differences between the right and left side, likewise in comparison with control group. In turn, as compared with the controls, IPL I-V was disturbed in 25 out of 37 patients: in most of the cases IPL I-V prolongation was observed (8 - bilateral prolongation, 11 - right side, 6 - left side). Moreover, the statistically significant difference between the brainstem sides (4.27 vs. 4.11 msec; p<0.05) was observed. Conclusion: In the examined patients with acromegaly, there was no peripheral disturbance in transmission, as examined by BAEPs registrations. Conversely, in nearly half of the patients with acromegaly, brainstem transmission was found to be delayed, and significant difference between responses from the both sides of the brainstem were noted.
Irisin (Ir), a recently identified adipo-myokine, cleaved and secreted from the protein FNDC5 in ... more Irisin (Ir), a recently identified adipo-myokine, cleaved and secreted from the protein FNDC5 in response to physical activity, has been postulated to induce the differentiation of a subset of white adipocytes into brown fat and to mediate the beneficial effects on metabolic homeostasis. Metabolic syndrome (MS), a cluster of factors leading to impaired energy homeostasis, affects a significant proportion of subjects suffering from polycystic ovary syndrome (PCOS). The aim of our study was to investigate the relationship between Ir plasma concentrations and metabolic disturbances. The study group consisted of 179 PCOS patients and a population of 122 healthy controls (both groups aged 25-35 years). A subset of 90 subjects with MS was isolated. A positive association between Ir plasma level and MS in the whole group and in controls was found. In subjects with high adipose body content (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;40%), Ir was higher than in lean persons (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30%). Our results showed a significant positive association between Ir concentration and android type of adipose tissue in the whole study group and in the control group. Understanding the role of Ir in increased energy expenditure may lead to the development of new therapeutics for obesity and obesity-related diseases.
Introduction: Pheochromocytoma is rare tumor with a highly variable clinical presentation. This r... more Introduction: Pheochromocytoma is rare tumor with a highly variable clinical presentation. This report provides clinical picture, efficiency of diagnostics and treatment of pheochromocytoma in 8-years in the endocrinological center in Wroclaw. Material and methods: The records of 37 patients with pheochromocytoma were identified, who were treated in 2000-2007 in the Department of Endocrinology, Diabetology and Isotope Treatment in Wroclaw. There were 23 women (age 23-75 year) and 14 men (age 17-74). We studied frequency of clinical signs, usefulness of diagnostic methods and efficacy of treatment. Results: The duration of the clinical history ranged from 2 months to 16 years. The most frequent symptoms were: hypertension paroxysmal and constant, palpitations, headache, sweating and anxiety. The most sensitive diagnostic method was increased concentration of urinary metanephrine in 24-hour urine. Computed tomography was the most widely used method for tumor localization. Adrenal pheochromocytoma was detecting by CT in all patients, predominated in right adrenal, in 1 case in urinary bladder. Surgery caused remission of hypertension in 59%, improvement in 26.8%, and no changes in 13.9% of patients. Malignancy was reported in 2 cases, 1 woman died after surgery. MEN 2A occur in 21.6%. Conclusions: The diagnosis of pheochromocytma is usually made after long duration of the disease. The study confirms that clinical presentation of pheochromocytoma is variable and nonspecific, this finding makes the diagnosis very difficult. The most typical symptom is paroxysmal hypertension, which is present only in 40%, other symptoms are nonspecific. The measurement of 24-hour urinary metanephrines was the best indicator. CT was almost always successful in localizing the tumor. Patients with pheochromocytoma should be consider for other endocrine diseases especially medullary carcinoma, primary hyperparathyroidism and other component of MEN 2A.
Objectives: Elevated cytokines levels were observed as a marker of increased bone resorption in c... more Objectives: Elevated cytokines levels were observed as a marker of increased bone resorption in certain diseases. The aim was to assess serum levels of selected cytokines in acromegaly, regarding to different disease's stages, gonadal function, gender and character of BMD change. Methods: The study was carried out in 62 patients with acromegaly (40 women, 22 men) aged 26-75 years in various stages of the disease. The controls were 30 healthy, age- and sex-matched subjects. Serum cytokines concentration was assessed using ELISA method. Results: We have shown higher (p=0.044) concentrations of TGF-beta in male patients with active acromegaly than in cured males. When the influence of all cytokines studied on BMD using multiple regression analysis was carried out, the borderline (p=0.099) statistical significance was achieved (regression coefficient B=0.68271) according to TGF-beta and trochanter major BMD. IL-6 and TNF-alpha were higher (p=0.062, and p=0.098, respectively) in these acromegalic patients, in which gain of trochanter major BMD occurred. IL-1beta levels were lower in patients with ultradistal radius and 1/3 distal radius BMD gain (p=0.007, and p=0.009, respectively). Lower TGF-beta levels (p=0.077) were shown in patients with 1/3 distal radius gain. IL-6 levels were higher in patients with total body BMD gain (p=0.059). Conclusions: The relations between TGF-beta and acromegaly activity in men, and trochanter major BMD in both sexes were documented. Concentrations of all cytokines studied correlated with the BMD changes in different bone sites. Noteworthy is homogeneity of the secretory character of cytokines studied according to BMD changes within particular skeleton sites.
Polish recommendations regarding management of patients suffering from neuroendocrine tumors of s... more Polish recommendations regarding management of patients suffering from neuroendocrine tumors of small intestine and appendix are presented. Small intestine, especially ileum represent most common origin of these tumors. Majority of them are well differentiated and grow slowly. Rarely, they are less differentiated with fast growth and poor prognosis. Symptoms are atypical, diagnosis could be often accidental. In 4-10% of patients typical symptoms of carcinoid syndrome are present. Chromogranin A is useful in the laboratory diagnostics, and urinary excretion of 5-hydroxyindoloacetic acid is helpuf for the diagnostics and monitoring of the disease. Histopathological diagnostics was extensively described. Ultrasound, colonoscopy, capsule endoscopy, baloon enteroscopy, computed tomography, magnetic resonance and somatostatin analogs scintigraphy could be used for the visualization. The treatment of choice in the neuroendocrine tumors of small intestine and appendix is radical or palliati...
The lancet. Diabetes & endocrinology, Jan 12, 2017
Cushing's disease is a rare debilitating endocrine disorder for which few prospective interve... more Cushing's disease is a rare debilitating endocrine disorder for which few prospective interventional studies have been done. We report results of the first phase 3 trial assessing long-acting intramuscular pasireotide in patients with Cushing's disease. In this phase 3 clinical trial we recruited patients aged 18 years or older with persistent, recurrent, or de-novo (non-surgical candidates) Cushing's disease who had a mean urinary free cortisol (mUFC) concentration (from three 24 h samples) of 1·5-5·0 times the upper limit of normal (ULN), a normal or greater than normal morning plasma adrenocorticotropic hormone concentration, and a pituitary source of Cushing's syndrome, from 57 sites across 19 countries. Exclusion criteria included previous pasireotide treatment, mitotane therapy within 6 months, and pituitary irradiation within 10 years. We randomly allocated patients 1:1 (block size of four) using an interactive-response-technology system to intramuscular pasir...
Objectives: Acromegaly is associated by various systemic complications, involving also the nervou... more Objectives: Acromegaly is associated by various systemic complications, involving also the nervous system. Other studies revealed peripheral but not central nervous system impairment with somatosensory evoked potentials examinations in acromegaly. Aim of the present study was to assess whether brainstem transmission in acromegaly is disturbed. Material and methods: The study was carried out in 37 patients. The control group consisted of 47 healthy persons. In all of the subjects, peripheral transmission, reflected by peak I latency, and brainstem transmission, tested by interpeak latency I-V (IPL I-V), were examined. Results: Peak I latency was delayed in 6 out of 37 patients (1 - bilaterally, 2 - right side, 3 - left side). The group-mean latency of peak I was 1.53 msec and 1.56 msec, for the right and left side, respectively. There were found no statistically significant differences between the right and left side, likewise in comparison with control group. In turn, as compared with the controls, IPL I-V was disturbed in 25 out of 37 patients: in most of the cases IPL I-V prolongation was observed (8 - bilateral prolongation, 11 - right side, 6 - left side). Moreover, the statistically significant difference between the brainstem sides (4.27 vs. 4.11 msec; p<0.05) was observed. Conclusion: In the examined patients with acromegaly, there was no peripheral disturbance in transmission, as examined by BAEPs registrations. Conversely, in nearly half of the patients with acromegaly, brainstem transmission was found to be delayed, and significant difference between responses from the both sides of the brainstem were noted.
Irisin (Ir), a recently identified adipo-myokine, cleaved and secreted from the protein FNDC5 in ... more Irisin (Ir), a recently identified adipo-myokine, cleaved and secreted from the protein FNDC5 in response to physical activity, has been postulated to induce the differentiation of a subset of white adipocytes into brown fat and to mediate the beneficial effects on metabolic homeostasis. Metabolic syndrome (MS), a cluster of factors leading to impaired energy homeostasis, affects a significant proportion of subjects suffering from polycystic ovary syndrome (PCOS). The aim of our study was to investigate the relationship between Ir plasma concentrations and metabolic disturbances. The study group consisted of 179 PCOS patients and a population of 122 healthy controls (both groups aged 25-35 years). A subset of 90 subjects with MS was isolated. A positive association between Ir plasma level and MS in the whole group and in controls was found. In subjects with high adipose body content (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;40%), Ir was higher than in lean persons (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30%). Our results showed a significant positive association between Ir concentration and android type of adipose tissue in the whole study group and in the control group. Understanding the role of Ir in increased energy expenditure may lead to the development of new therapeutics for obesity and obesity-related diseases.
Introduction: Pheochromocytoma is rare tumor with a highly variable clinical presentation. This r... more Introduction: Pheochromocytoma is rare tumor with a highly variable clinical presentation. This report provides clinical picture, efficiency of diagnostics and treatment of pheochromocytoma in 8-years in the endocrinological center in Wroclaw. Material and methods: The records of 37 patients with pheochromocytoma were identified, who were treated in 2000-2007 in the Department of Endocrinology, Diabetology and Isotope Treatment in Wroclaw. There were 23 women (age 23-75 year) and 14 men (age 17-74). We studied frequency of clinical signs, usefulness of diagnostic methods and efficacy of treatment. Results: The duration of the clinical history ranged from 2 months to 16 years. The most frequent symptoms were: hypertension paroxysmal and constant, palpitations, headache, sweating and anxiety. The most sensitive diagnostic method was increased concentration of urinary metanephrine in 24-hour urine. Computed tomography was the most widely used method for tumor localization. Adrenal pheochromocytoma was detecting by CT in all patients, predominated in right adrenal, in 1 case in urinary bladder. Surgery caused remission of hypertension in 59%, improvement in 26.8%, and no changes in 13.9% of patients. Malignancy was reported in 2 cases, 1 woman died after surgery. MEN 2A occur in 21.6%. Conclusions: The diagnosis of pheochromocytma is usually made after long duration of the disease. The study confirms that clinical presentation of pheochromocytoma is variable and nonspecific, this finding makes the diagnosis very difficult. The most typical symptom is paroxysmal hypertension, which is present only in 40%, other symptoms are nonspecific. The measurement of 24-hour urinary metanephrines was the best indicator. CT was almost always successful in localizing the tumor. Patients with pheochromocytoma should be consider for other endocrine diseases especially medullary carcinoma, primary hyperparathyroidism and other component of MEN 2A.
Objectives: Elevated cytokines levels were observed as a marker of increased bone resorption in c... more Objectives: Elevated cytokines levels were observed as a marker of increased bone resorption in certain diseases. The aim was to assess serum levels of selected cytokines in acromegaly, regarding to different disease's stages, gonadal function, gender and character of BMD change. Methods: The study was carried out in 62 patients with acromegaly (40 women, 22 men) aged 26-75 years in various stages of the disease. The controls were 30 healthy, age- and sex-matched subjects. Serum cytokines concentration was assessed using ELISA method. Results: We have shown higher (p=0.044) concentrations of TGF-beta in male patients with active acromegaly than in cured males. When the influence of all cytokines studied on BMD using multiple regression analysis was carried out, the borderline (p=0.099) statistical significance was achieved (regression coefficient B=0.68271) according to TGF-beta and trochanter major BMD. IL-6 and TNF-alpha were higher (p=0.062, and p=0.098, respectively) in these acromegalic patients, in which gain of trochanter major BMD occurred. IL-1beta levels were lower in patients with ultradistal radius and 1/3 distal radius BMD gain (p=0.007, and p=0.009, respectively). Lower TGF-beta levels (p=0.077) were shown in patients with 1/3 distal radius gain. IL-6 levels were higher in patients with total body BMD gain (p=0.059). Conclusions: The relations between TGF-beta and acromegaly activity in men, and trochanter major BMD in both sexes were documented. Concentrations of all cytokines studied correlated with the BMD changes in different bone sites. Noteworthy is homogeneity of the secretory character of cytokines studied according to BMD changes within particular skeleton sites.
Polish recommendations regarding management of patients suffering from neuroendocrine tumors of s... more Polish recommendations regarding management of patients suffering from neuroendocrine tumors of small intestine and appendix are presented. Small intestine, especially ileum represent most common origin of these tumors. Majority of them are well differentiated and grow slowly. Rarely, they are less differentiated with fast growth and poor prognosis. Symptoms are atypical, diagnosis could be often accidental. In 4-10% of patients typical symptoms of carcinoid syndrome are present. Chromogranin A is useful in the laboratory diagnostics, and urinary excretion of 5-hydroxyindoloacetic acid is helpuf for the diagnostics and monitoring of the disease. Histopathological diagnostics was extensively described. Ultrasound, colonoscopy, capsule endoscopy, baloon enteroscopy, computed tomography, magnetic resonance and somatostatin analogs scintigraphy could be used for the visualization. The treatment of choice in the neuroendocrine tumors of small intestine and appendix is radical or palliati...
The lancet. Diabetes & endocrinology, Jan 12, 2017
Cushing's disease is a rare debilitating endocrine disorder for which few prospective interve... more Cushing's disease is a rare debilitating endocrine disorder for which few prospective interventional studies have been done. We report results of the first phase 3 trial assessing long-acting intramuscular pasireotide in patients with Cushing's disease. In this phase 3 clinical trial we recruited patients aged 18 years or older with persistent, recurrent, or de-novo (non-surgical candidates) Cushing's disease who had a mean urinary free cortisol (mUFC) concentration (from three 24 h samples) of 1·5-5·0 times the upper limit of normal (ULN), a normal or greater than normal morning plasma adrenocorticotropic hormone concentration, and a pituitary source of Cushing's syndrome, from 57 sites across 19 countries. Exclusion criteria included previous pasireotide treatment, mitotane therapy within 6 months, and pituitary irradiation within 10 years. We randomly allocated patients 1:1 (block size of four) using an interactive-response-technology system to intramuscular pasir...
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Papers by Marek Bolanowski