[Insulin-like growth factor-1 (IGF-1) - structure and the role in the human body]. / Insulinopodobny czynnik wzrostu-1 (IGF-1) - budowa i rola w organizmie czlowieka.

In the recent years, managed to broadly explore the structure and role of insulin-like growth factors type 1 and 2 (IGF1 I 2). They belong to the structure of polypeptide hormones homologous to proinsulin. They are characterized by a wide range of activities. IGF-1 is a key mediator of most tissue effects of growth hormone (GH). In addition to effects on growth processes of the body, is also an important factor for cell homeostasis, is subject to both endocrine and tissue-specific auto- and paracrine regulation. In this paper, the current, general knowledge on the structure, function and mechanism of biological effects of IGF-1 in the human body was presented. Attention was also drawn to the directions of use of IGf-1 in the treatment of other diseases than the diseases of the hypothalamic-pituitary and growth disorders in children.

Gonadotroph adenoma causing ovarian hyperstimulation syndrome in a premenopausal woman.

INTRODUCTION: Gonadotroph adenomas occur commonly in middle-aged adults without any specific endocrinological symptoms. To date, only 30 cases of gonadotropinoma causing ovarian hyperstimulation syndrome in pre-menopausal women have been reported. CASE REPORT: A 37-year old woman with pituitary macroadenoma and hyperprolactinaemia was admitted to the Department of Endocrinology, Diabetology and Isotope Therapy. She presented with recurrent ovarian cysts, menstrual disturbances, headaches, visual impairment and galactorrhea. Her endocrine profile showed normal values of FSH, elevated concentrations of estradiol and suppressed LH levels. Transsphenoidal resection of the tumor tissue resulted in normalization of the hormone values and improvement in the clinical picture. CONCLUSIONS: Gonadotroph adenomas should be considered in the differential diagnosis in premenopausal women with OHSS.

Treatment with statins and testosterone levels in men.

INTRODUCTION: Statins belong to the most commonly used medicines worldwide. They affect cholesterol synthesis and thus they may suppress steroidogenesis. Our aim was to evaluate whether the use of statins is associated with the concentration of sex hormones.Material and methods/Results: In a population sample of men (n = 237) we found that subjects receiving statins had significantly lower concentrations of: total testosterone (14.9 vs. 16.35 nmol/L, p = 0.008 after correction for body mass), free testosterone (32 vs. 39 pmol/L, p = 0.004), calculated free testosterone (0.32 vs. 0.36 nmol/L, p < 0.001) and bioavailable testosterone (6.10 vs. 7.56 nmol/L, p < 0.001) than age-matched controls. CONCLUSIONS: We conclude that the use of statins may have an impact on the diagnosis of age-related testosterone deficiency in men.

[The androgen receptor gene polymorphism and clinical picture of androgen deficiency syndrome during aging male of men's population in Wroclaw]. / Polimorfizm genu receptora androgenowego a obraz kliniczny zespolu niedoboru androgenów w procesie starzenia sie populacji mezczyzn wroclawskich.

INTRODUCTION: One of the changes observed in the ageing process is the progressive reduction in androgen levels, which may be associated with the development of the clinical syndrome of androgen deficiency. The androgen receptor gene polymorphism may also contribute to the development of the above syndrome of clinical manifestations. To assess the relationship between CAG androgen receptor gene polymorphism and the development of manifestations of androgen deficiency syndrome in men aged 45 to 65. MATERIAL AND METHODS: A total of 268 men aged 45-65, randomly selected from the population of Wroclaw, Poland, were included in the study. The subjects completed the Heinemann questionnaire, followed by blood sampling for determination of the CAG androgen receptor gene polymorphism by polymerase chain reaction (PCR). The PCR reaction products for all the subjects were separated by capillary electrophoresis (ABI PRISM 310) and the number of CAG repeats was determined using the previously constructed standard curve: (CAG) n = 0.5*M[bp]-101. RESULTS: The minimum number of CAG repeats was 52 with the mean of 24. Based on the total score in the Heinemann questionnaire in all of the study subjects we found no or slight manifestations of androgen deficiency syndrome in 68 (25%) subjects, mild manifestations consistent with the andropause syndrome in 93 (35%) subjects, moderate manifestations in 88 (33%) subjects and severe manifestations in 19 (7%) subjects. The numbers of subjects with specific severities of androgen deficiency manifestations across the specific subscales were as follows: a) Psychological manifestations subscale: 111 subjects with no or very mild manifestations, 117 with mild manifestations, 33 with moderate manifestations and 7 with severe manifestations; b) Somatic manifestations subscale: 17 subjects with no or very mild manifestations, 72 with mild manifestations, 120 with moderate manifestations and as many as 59 with severe manifestations; c) Sexual dysfunction subscale: 26 subjects with no or very mild manifestations, 45 with mild manifestations, 80 with moderate manifestations and 117 with severe manifestations. In all the study men (n = 268) we found 76 with a low (< 21) and 119 with a high (> 23) number of CAG repeats. CONCLUSIONS: 1. In the entire study group (n = 268) we found a positive correlation between the number of CAG repeats and the severity of psychological manifestations. We also found that in men with a higher number of CAG repeats (> 23 repeats) the somatic and psychological manifestations associated with signs of androgen deficiency are more common during the ageing period and that these patients score higher on the overall Heinemann scale. 2. We found no correlation between the number of CAG repeats in men divided into 4 subgroups with respect to their scores (hence the severity) on the overall Heinemann scale and its three subscales (psychological, somatic and sexual dysfunction subscales) and their scores.

[Occurrence of androgen receptor gene CAG trinucleotide sequence polymorphism in the metropolitan population of Polish men]. / Wystepowanie polimorfizmu sekwencji trójnukleotydowej wielkomiejskiej polskich mezczyzn.

BACKGROUND: The activity of androgen receptor (AR) is modulated by a polymorphic region located within exon 1 its gene and characterizing a variable number of trinucleotide CAG repeats. The length of polymorphic region is inversely correlated with the transactivation function of AR gene. It was showed an ethnic differences existence in the length CAG repeats of AR gene. The aim of the study was determined of the number CAG repeats AR gene occurrence in the population Polish men. MATERIAL AND METHODS: In the population-based cross-sectional study participated a population-based sample randomly selected 466 men aged 25-65 years -- residents of Wroclaw, Poland. The CAG polymorphism was amplified by PCR method. RESULTS: The range of androgen receptor CAG repeats was from 1 to 57 with a mean 24 +/- 7,68. The most frequent repeat was 21. It was indicated in 34 (7,3%) of examined subjects. The number of triplets 20 329 (70,6%) men. There were no differences in the length of CAG repeats among the age groups. Both the distribution of small ( 20) number CAG repeats and age structure in men groups with the longer and shorter alleles were statistically all the same. CONCLUSIONS: The average number of AR gene CAG repeats and its range in the population Polish men were larger in comparison to the west European populations and more reminded the number repeats distribution meeting among Asians. This ethnic differences might explain the biological variabilities among different populations and another risk of hormone-dependent diseases occurrence.

[Pheochromocytoma in 8-year observation at a single endocrinological center in Wroclaw]. / Guz choromochlonny w 8-letniej obserwacji akademickiego osrodka endokynologicznego we Wroclawiu

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.

PPAR-gamma2 Pro12Ala polymorphism in the population of obese and non-obese men of the city of Wroclaw.

INTRODUCTION: The aim of this study was to examine the association of Pro12Ala PPARgamma2 polymorphism with anthropometric and biochemical parameters defining the risk for the development of metabolic syndrome in a healthy population of men. MATERIAL AND METHODS: The study group consisted of 176 healthy men, aged 25-65 years (average 54.16 years). Polymorphisms of the PPAR-g gene (Pro12Ala, Ala12Ala, Pro12Pro) were explored using the PCR-RFLP method. Plasma glucose, insulin, total cholesterol, LDL, HDL and TG were measured using commercially available kits. RESULTS: The genotypic distribution of the Pro12Ala polymorphism was as follows: Pro/Ala 69.8% (n = 123), Ala/Ala 28.4% (n = 50) and Pro/Pro 1.8% (n = 3). The Pro12Ala and Ala12Ala subjects did not differ in any of the measured variables. The non-obese (BMI < 30 kg/m(2), n = 117) and obese subpopulations (BMI > 30 kg/m(2), n = 56) did not significantly differ in the distribution of the genotypes. In the nonobese subpopulation, the homozygous Ala12 carriers (n = 38, 32.4%) had higher systolic blood pressure, plasma triglycerides, insulin levels and HOMA-IR. CONCLUSIONS: We conclude that despite the high frequency of the Ala allele at the PPAR-gamma2 gene in our population of Polish men, the Ala12 allele does not appear to improve insulin sensitivity or have an influence on the occurrence of obesity. It remains to be explained by larger studies if this polymorphism carries any risk of the development of metabolic abnormalities in non-obese men.

Relationship between vitamin D receptor BsmI and FokI polymorphisms and anthropometric and biochemical parameters describing metabolic syndrome.

INTRODUCTION: It was found that vitamin D may have a direct effect on adipocyte differentiation and metabolism and might be involved in the glucose regulation of insulin secretion, as suggested from the discovery of a nuclear localization of 1,25-(OH)(2)D(3) in pancreatic islets. In recent years, several polymorphisms in the VDR gene which are able to alter the activity of VDR protein have been described. The BsmI and FokI polymorphisms were described in relation to obesity and type 2 diabetes. The aim of the study was to find whether there are associations between BsmI and FokI polymorphisms and anthropometric (BMI, WHR, BP) and biochemical parameters describing metabolic syndrome. MATERIALS AND METHODS: Studied were 176 randomly selected men aged 25-65 years (mean: 51.99 years) with a mean BMI of 28.06 kg/m(2). Two polymorphisms of the VDR gene (FokI and BsmI) were explored using the PCR-RFLP method. Serum glucose, insulin, total cholesterol, LDL, HDL, and TG were measured using commercially available kits. RESULTS: It was found that BB carriers tend to have higher BMI (29.00 +/- 3.74 versus 26.81 +/- 3.76, p = 0.024) and waist circumference (101.79 +/- 10.59 versus 96.23 +/- 10.35, p = 0.014) compared with the bb genotypes. Similarly, FF and Ff carriers had higher fasting insulin levels than the ff genotypes (12.30 +/- 10.26 versus 9.76 +/- 5.88, p = 0.001 and 9.76 +/- 5.88 vs. 6.35 +/- 2.64, p = 0.008), and lover cHDL levels in comparison to ff genotypes (52.28 +/- 10.02 versus 60.63 +/- 16.58, p = 0.015 and 53.70 +/- 12.03 versus 60.63 +/- 16.58, p = 0.032. Besides these, no significant differences were found. CONCLUSIONS: The BsmI VDR polymorphism seems to influence BMI, while the FokI VDR polymorphism appears to affect insulin sensitivity and serum cHDL level.

[The CAG repeat polymorphism in androgen receptor gene repeat and frequency of chosen parameters of metabolic syndrome in 45-65 aged men in Wroclaw population]. / Polimorfizm CAG genu receptora androgenowego a wystepowanie wybranych parametrów zespolu metabolicznego u mezczyzn w wieku 45-65 lat w populacji wroclawskiej

INTRODUCTION: The activity of androgen receptor (AR) is modulated by a polymorphic CAG trinucleotide repeat in receptor gene. There are suggestion, that there are association between polymorphism androgen receptor gene and the occurrence typical features of metabolic syndrome in men. The metabolic syndrome is more frequent with aging. We knows, that polymorphism androgen receptor gene is associated with risk of prostate cancer and with occurrence Kennnedy's syndrome. However the association of this polymorphism for occurrence of hypertension, obesity and lipid and glucose concentration disturbance is not examined. MATERIAL AND METHODS: The original study population consisted 268 randomly selected wroclaw population men aged 45-65. The physician examination include mensuration of blood pressure and antropometrical analysis. The men were coming on an empty stomach between 8.00 and 10.00 am for blood taken. The blood were taken for biochemical measurements and for genetic analysis CAG repeat in androgen receptor gene. RESULTS: There is statistical significant differences between number of CAG repeat in men with normal and higher concentration of cholesterol LDL. There were no significant differences between number of CAG repeat in men in dependent of value of blood pressure and concentration of insulin, glucose, cholesterol HDL, total cholesterol and triglicerides. CONCLUSIONS: The investigation results are not unambiguous with regard to influence of polymorphism androgen receptor gene for occurrence of metabolic syndrome in men. We found only association between number of CAG repeat an androgen receptor gene and concentration of cholesterol LDL (which it is as we knows atherogenic factor).

[Receptor CD36 expression on peripheral blood monocytes in women with visceral obesity]. / Ekspresja receptora CD36 w monocytach krwi obwodowej u kobiet z otyloscia brzuszna.

INTRODUCTION: Receptor CD36 is involved in foam cells formation and in atherogenesis. Visceral obesity is important risk factor of accelerated atherosclerosis. There are no data about the role of CD36 in pathogenesis of atherosclerosis in women with visceral obesity. The aim of the study was to assess the impact of visceral obesity on CD36 expression on peripheral blood monocytes. MATERIAL AND METHODS: CD36 expression was evaluated (by flow cytometry) in study population consisted of 30 women aged 25-45 years (mean 34.03 +/- 11.14) with visceral obesity. Control group consisted of 15 nonobese women aged 25-45 years (mean 31.93 +/- 2.43). Physical examination was performed with body mass, BMI, waist and hip circumferences, waist to hip ratio evaluation. Oral glucose tolerance test was performed with estimation of glucose and insulin concentrations. RESULTS: Body mass, BMI, WHR, waist and hip circumferences were significantly higher in obese than in nonobese women. Glucose and insulin concentrations in 0', 30' 60' of OGTT as well as HOMA and FIRI values were significantly higher in obese than in nonobese women. Expression of CD36 on monocytes was significantly lower in obese women (mean 62.99 +/- 18.07) than in controls (mean 82.5 +/- 22.93). There were not significant correlations between CD36 expression and BMI, WHR and IR indexes. CONCLUSIONS: Expression of scavenger receptor CD36 on monocytes in obese women is significantly lower than in lean individuals. This observation needs further investigations.

[A case of hypophyseal and pineal germinoma]. / Przypadek rozrodczaka podwzgórza i szyszynki.

A case of 19-year-old male with idiopathic diabetes insipidus diagnosed 9 years ago. 1.5 years from the onset of the disease vision disturbances, neurologic deficiencies and symptoms of hypopituitarism showed up. MRI examination revealed an advanced hypophyseal and pineal gland tumor--germinoma. Total regression was achieved with radio- and chemotherapy. For 7 years from the end of treatment patient has not declared any complains except for vision disturbances and hypopituitarism has been substituted successfully. The case puts on the necessity of a strict endocrinologic and radiologic follow-up in patients with idiopathic diabetes insipidus due to the possibility of existing potentially curable disease ie. intracranial tumor.

Serum leptin concentrations in pre- and postmenopausal women on sex hormone therapy.

AIM: The aim of the present study was to investigate the influence of endogenous estradiol and estrogen and estrogen-progestin therapies on concentration in pre- and postmenopausal women. MATERIALS AND METHODS: The study groups consisted of 26 women with surgical menopause (mean+/-standard deviation (SD): age 51.8+/-2.6 years, body mass index (BMI) 26.45+/-4.56 kg/m(2)), 54 with natural menopause (mean+/-SD: age 50.5+/-3.0 years, BMI 25.75+/-4.09 kg/m(2)) and 40 premenopausal controls (mean+/-SD: age 48.3+/-2.3 years, BMI 26.23+/-4.12 kg/m(2)). The group with surgical menopause received estradiol transdermally (50 microg/day) and those with natural menopause received additionally medroxyprogesterone acetate (5 mg/day) for the last 12 days of the cycle. Before and after 4 months of therapy, body weight, waist and hip circumferences and blood pressure were measured, and BMI and waist-to-hip ratio (WHR) were calculated. Serum leptin, follicle-stimulating hormone (FSH), estradiol (E(2)), testosterone, prolactin and dehydroepiandrosterone sulfate (DHEAS) were measured prior to and after treatment. RESULTS: Leptin concentrations did not differ statistically among the groups. No correlations between leptin and E(2), FSH, prolactin, testosterone and DHEAS concentrations were found in any of the groups before and after treatment. Leptin level correlated positively with body mass, BMI and hip and waist circumferences in all groups. There were no correlations between leptin and WHR in the pre- and postmenopausal groups. In the premenopausal group and in some postmenopausal groups, serum leptin level correlated with blood pressure. CONCLUSIONS: Endogenous E(2) and androgens in premenopausal women and estrogen and estrogen-progestin therapies in postmenopausal subjects do not influence serum leptin concentrations. Leptin level is related to body mass and BMI, but not to sex hormone status. The distribution of adipose tissue and the type of obesity (android or gynoid) have no influence on serum leptin concentration. The correlation between serum leptin level and blood pressure requires further investigation.

[The influence of diabetes mellitus and insulin resistance on receptor CD36 expression. Part II. The role of receptor CD36 in the pathomechanism of diabetes complications]. / Wplyw cukrzycy i insulinoopornosci na ekspresje receptora CD36. Czesc II. Udzial receptora CD36 w patomechanizmie powiklan cukrzycy.

Glucose metabolism disorders are significant risk factors for accelerated atherosclerosis, but the exact pathogenesis of this impact and possible co-factors are not precisely known. On the other hand, only two thirds of all atherosclerosis cases are linked to so-called "classic" risk factors, and numerous studies are conducted to recognize those non-classic risk factors, among which homocysteine and adhesive molecules are the most often mentioned. Recently, the class B scavenger receptor CD36 has become an object of interest. Receptor CD36 is a membrane glycoprotein found on the surface of many cells, such as endothelial cells, cardiomyocytes, dendritic cells, platelets, monocytes, and macrophages. Ligands for receptor CD36 are oxidized LDL particles, long-chain fatty acids, collagens, thrombospondin I, apoptotic cells, and phospholipids. Receptor CD36 plays an important role in various processes, e.g. inner immune system response, apoptotic and necrotic cells removal, transport of fatty acids, and inhibition of neoplastic angiogenesis. Scavenging oxidized LDL particles is one of its most important functions. The most recent studies put forward the participation of receptor CD36 in atherogenesis. Additionally, increased CD36 expression has been described in diabetes mellitus and insulin resistance and in the pathogenesis of diabetic macro- and microangiopathy. Confounding data regarding human hereditary receptor CD36 deficiency as well as still unknown interactions between antidiabetic drugs and CD36 expression suggest the necessity for further studies on the participation of receptor CD36 in the atherogenesis linked with glucometabolic disorders and in the development of diabetes mellitus complications.

[Scavenger receptor CD36: its expression, regulation, and role in the pathogenesis of atherosclerosis. Part I]. / Receptor CD36--wystepowanie, regulacja ekspresji oraz rola w patogenezie miazdzycy. Czesc I.

Atherosclerosis is a progressive pathological process based on endothelial dysfunction and chronic inflammation. Monocytes, macrophages, and modified lipoproteins, especially oxidized LDLs (oxLDLs), play a fundamental role in the pathogenesis of atherosclerosis. Monocytes evolve into macrophages in the vascular wall and then accumulate oxLDLs, forming foam cells. OxLDLs are toxic and activate foam cells, stimulate the replication of macrophages and their migration into atherosclerotic plaque, and increase the expression of metaloproteinases. Macrophages bind oxLDLs through many types of receptors, among them scavenger receptors. One of these is CD36, a membrane glycoprotein expressed by endothelial cells, adipocytes, smooth and skeletal muscle cells, cardiomiocytes, platelets, monocytes, and macrophages. CD36 recognizes and binds many ligands, such as oxLDLs, long-chain fatty acids, collagen, thrombospondin 1, apoptotic cells, anionic phospholipids, and Plasmodium falciparum-infected erythrocytes. CD36 is involved in many processes, e.g. inner immune system responses, removal of apoptotic cells and Plasmodium falciparum-infected erythrocytes, and the transport of long-chain fatty acids, and it also mediates collagen and thrombospondin action. Recent reports indicate that CD36 may play a role in the development of atherosclerosis. An animal model revealed that lack of CD36 expression restrains atheroslerosis. Increased expression of CD36 was shown in atheroslerotic plaque and damaged vascular tissue. Contradictory data about the effects of antiatherosclerotic drugs on CD36 expression indicate the necessity for further investigation of the role of CD36 in the development of atherosclerosis.

Breast cancer and long-term hormonal treatment of male hypogonadism.

Breast cancer in men is rare and its etiology is multifactorial. Androgens may promote the development of breast carcinoma in men though data on the subject is scarce. We observed 45 men with hypergonadotropic hypogonadism (aged 18-57) who received 250 mg of testosterone esters (Omnadren 250, Jelfa, Poland) every 3-4 weeks for 5-26 years. Seventeen of them were treated for more than 10 years. During the observation period breast cancer was diagnosed in 2 subjects (11% of the followed men). In one case it occurred after 11 years and in the other after 15 years of the therapy. We point to a possible association between long-term androgen replacement and a risk of breast cancer in men.

[A case of primary hypoparathyroidism and hypothyroidism co-existing with chronic renal failure]. / Rzadki przypadek wspólistnienia pierwotnej niedoczynnosci przytarczyc i tarczycy z przewlekla niewydolnoscia nerek.

A case of 24-year old woman with chronic renal failure and primary hypoparathyroidism is presented. Primary hypothyroidism and bilateral hypoacousis were also found. Typically concomitant with chronic renal failure is development of secondary hyperparathyroidism and its co-morbidities, i.e. renal osteodystrophy that consists of osteomalacia, osteoporosis and pathological fractures. In case of some patients with very high concentration of parathormone (PTH) and with signs of renal osteodystrophy, which is the case of tertiary hyperparathyroidism, subtotal parathyroidectomy is the optimal treatment. Reduction of PTH concentration protects bones from further destruction and from accumulation of calcium phosphate in tissues. The accompanying primary parathyroid failure would probably protect from the further consequences of PTH over-production--renal osteodystrophy. The case is reported in view of a rare occurrence of such co-existence, lack of its description in Polish literature as well as diagnostic difficulties.

[Evaluation of the influence of sex hormones on homocysteine concentration in pre- and postmenopausal women]. / Ocena wplywu wybranych hormonów na stezenie homocysteiny u kobiet przed menopauza i po menopauzie.

The aim of study was to evaluate the influence of sex hormones: estradiol (E), follicle-stimulating hormone (FSH), progesterone (P), testosterone (T), dehydroepiandrosterone (DHEA-S) and cortisol (F) on the serum homocysteine concentration (HCY) in 40 premenopausal (group M) and 80 postmenopausal (group K) women. The influence of E2 therapy (ET) on the serum HCY level in the women with surgical menopause was also estimated. The plasma HCY concentration in the group M was significantly higher that in group K. After ET serum HCY level decreased significantly. No correlations were found between serum HCY and E2 concentrations in the all groups. No correlations were observed between HCY and FSH, P, T and F concentrations in pre-and postmenopausal groups. There was a significant negative correlation between serum HCY and DHEA-S concentration in group K. This result may indicate, that high level of DHEA decreases HCY concentration. There was no correlation in group M, where the mean concentration of DHEA was lower than in group K. The results of study indicate, that menopause increases and ET decreases plasma HCY concentration. DHEA-S may inhibit plasma HCY concentration in premenopausal women. More studies are needed to elucidate these hypotheses.

[The effect of estrogen deficiency, estrogen and estro-progestagene therapy on total plasma homocysteine and serum lipid peroxide levels in postmenopausal women]. / Wplyw niedoboru estrogenów, leczenia estrogenowego i estro-progestagienowego na stezenie homocysteiny i nadtlenków lipidów u kobiet po menopauzie.

OBJECTIVES: Elevated plasma homocysteine (Hcy) concentration is a risk factor for atherosclerosis and venous thrombosis. DESIGN: an observational study. MATERIALS AND METHODS: 120 healthy women were recruited and divided in two subgroups--postmenopausal women (M-80 women) and premenopausal women (40 women) with normal menstruation as control group. 26 women with surgical menopause were treated with percutaneous estrogen therapy and remaining 54 women were treated with estro-progestagen replacement therapy. Measurements of FSH and estradiol was made using radioimmunoassay. HCY was assessed using enzymatic conversion method. RESULTS: Concentrations of Hcy and lipid peroxides (LPO) in postmenopausal study group were higher than in the premenopausal. Treatment with estradiol (E2) alone or in combination with medroxyprogesterone acetate decreased LPO and Hcy concentrations to levels observed in premenopausal group. CONCLUSIONS: Our results suggest that estrogens have a profound influence on Hcy and LPO levels. Reduction in Hcy levels after treatment lowers the production of free radicals and thus contributes to lipid peroxidation decrease and LPO levels reduction after therapy. A practical conclusion may be proposed: in postmenopausal women with elevated Hcy levels who require hormonal replacement therapy, Hcy level control is indicated in order to administer such a therapy, which decreases Hcy concentrations.

[Amiodarone and the thyroid gland]. / Amiodaron a tarczyca.

Amiodarone is an iodine-rich drug. Its chronic administration may lead to disturbances in thyroid hormone metabolism and/or overt gland dysfunction. It causes an increased in serum fT4, rT3, and TSH concentrations and a decreased serum level of fT3 without thyroid dysfunction. Amiodarone may induce thyrotoxicosis (AIT--Amiodarone-induced thyrotoxicosis) or hypothyroidism (AIH--Amiodarone-induced hypothyroidism) in some persons. AIT occurs more frequently in areas with low iodine intake. The excess iodine contributes to excessive thyroid hormone synthesis-type I AIT or may lead to thyroiditis and a destructive process of thyroid follicular cells, resulting in excess thyroid hormone release-type II AIT. The mixed form of AIT also occurs. Type I AIT should be treated with antithyroid drugs alone or in association with potassium perchlorate, type II AIT benefits from treatment with glucocorticoids, whereas the mixed form of AIT is most effectively treated with a combination of thionamides, potassium perchlorate, and glucocorticoids. AIT often requires thyroidectomy after restoration of euthyroidism or radioiodine therapy, provided that 24-h thyroid radioactive iodine uptake values permit. AIH prevails in areas with high dietary iodine intake. It requires a discontinuation of amiodarone therapy and thyroid hormone (levothyroxine) replacement. It can remit spontaneously. Amiodarone and L-thyroxine therapy is also possible. Baseline thyroid function tests, thyroid antibodies, and imaging examinations such as thyroid ultrasound on initial evaluation and follow-ups every 6 months must be carefully monitored before starting amiodarone therapy.