[Advances in the diagnosis and treatment of Zollinger-Ellison syndrome]. / Postepy w diagnostyce i leczeniu zespolu Zollingera-Ellisona.

Zollinger-Ellison syndrome is a rare disorder caused by tumor secretion of gastrin, which results in gastric acid hypersecretion and secondarily in complicated peptic ulcer and diarrhea. ZES might be associated with multiple endocrine neoplasia type 1. The two main principal therapeutic strategies are to control both the gastric acid hypersecretion and the growth of the tumor. Surgery often fails to be curative and therefore many patients requires medical therapy, mainly treatment with proton pump inhibitors. The aim of this paper was to critically discuss contemporary diagnosis and treatment of this neoplasm on the basis of progress made in recent years.

[Rare pancreatic endocrine tumors]. / Rzadkie guzy endokrynne trzustki.

Functional pancreatic endocrine tumors other than gastrinoma and insulinoma are quite rare. Some of these tumors may be part of multiple endocrine neoplasia type one (MEN-1) syndrome or phakomatoses. Depending on their cell type, functional pancreatic endocrine tumors may cause distinct clinical endocrine syndromes, such as the 'glucagonoma syndrome', Verner-Morrison syndrome and the 'somatostatinoma syndrome'. The significant progress made in recent years, especially in the field of imaging procedures, has brought about great improvement in the identification and differentiation of these neoplasms. Currently, the only curative treatment for islet cell tumors is complete surgical resection. The medical treatment of endocrine pancreatic tumours consists of somatostatin analogues, chemotherapy, and interferon-alpha. The purpose of this manuscript is to provide an overview of the contemporary etiopathogenesis, diagnosis and treatment of rare pancreatic endocrine tumors.

[Thyroid disorders in pregnancy and after delivery]. / Choroby tarczycy w ciazy i po porodzie.

During pregnancy, normal thyroid activity undergoes significant changes. Endocrine adaptation to pregnancy involves changes in iodine metabolism, serum thyroxine binding globulin, chorionic gonadotropin, suppressed immune activity and the small enlargement of the thyroid gland, particularly in iodine-deficient areas. Consequently, pregnancy and the postpartum period often influence on the course of pre-existing thyroid diseases, which are encountered frequently in pregnant women and after delivery. In addition, some thyroid diseases occurring exclusively during these periods may develop. Most of the thyroid disorders in pregnancy and postpartum period are treatable but may affect mother and foetus adversely if they are not evaluated and managed appropriately. In this paper, the pathophysiology, clinical presentation, diagnosis and management of different thyroid diseases during pregnancy and postpartum period are reviewed. Particular attention is devoted to the results of recently published studies.

[Current concepts on diagnosis and treatment of carcinoid]. / Wspólczesne poglady na temat diagnostyki i leczenia rakowiaka.

Carcinoid tumours are relatively rare neuroendocrine neoplasms that often present as diagnostic dilemmas due to obscure or non-specific symptomatology. They can originate from any location in the body and on the basis of their localisation are traditionally described as originating from the foregut, midgut, and hindgut. Carcinoids occur most frequently in the gastrointestinal system, where they are most common in the small intestine, appendix, and rectum, and in the bronchi. Although, the majority are nonfunctional, some carcinoids can cause so called classical or atypical carcinoid syndrome and sometimes also paraneoplastic syndromes. Carcinoid tumours often present with metastatic disease. Recent years have brought new developments in the field of their diagnostic and treatment options. Despite the fact that many advances have been made in both the basic science and clinical areas, the optimal treatment of carcinoid tumours is still a matter of debate. In this article, the pathogenesis, clinical aspects, classification, diagnosis and treatment of carcinoids are reviewed including the latest advances in each area.

[Insulinoma]. / Wyspiak wydzielajacy insuline.

Insulinoma is considered the most common endocrine tumour of the pancreas with an annual prevalence of 4 cases per million people. Contrary to the other endocrine tumours of this organ, over 90% of the insulinomas are benign in nature. The clinical presentation of this neoplasm depends on excessive production of insulin and pro-insulin and is characterised by the symptoms of neuroglycopenia and catecholamine response. Effective management requires directed biochemical testing, careful choice of preoperative imaging tests, and complete pancreatic exploration by an experienced endocrine surgeon utilising intraoperative ultrasound. The only curative treatment for insulinoma is complete resection of the tumour. The aim of this paper is to critically discuss contemporary diagnosis and treatment of this neoplasm on the basis of progress made in recent years.

[Primary aldosteronism]. / Hiperaldosteronizm pierwotny.

In light of research carried during the past 15 years, it has become obvious that primary aldosteronism occurs much more frequently than previously estimated. This increase in its prevalence reflects a wider screening of patients for primary aldosteronism, especially with the use of the aldosterone to renin ratio. Currently many authors consider the disease as the most frequent recognisable and treatable cause of secondary hypertension. Although, primary aldosteronism is usually associated with hypertension and hypokalemia, many patients are either asymptomatic or manifest only slight symptoms. Early diagnosis and specific treatment reduce the morbidity and mortality related to this potentially life-threatening disorder. In this review, aetiology, symptoms, diagnosis and treatment of primary aldosteronism are reviewed with a special emphasis on the most recent literature.

[Hypophysitis]. / Zapalenie przysadki mózgowej.

Hypophysitis is a rare endocrine disorder with a female predilection affecting mainly young women during late pregnancy and in the postpartum period. The clinical, histopathological and morphological findings and the association of the disease with other autoimmune disorders allow most cases of hypophysitis to be included among the autoimmune diseases. This potentially life-threatening condition should be suspected especially in women of reproductive age who present with hypopituitarism or evidence of pituitary mass-induced headaches and visual symptoms. The natural history of hypophysitis is variable. At the present time, the treatment is only symptomatic but there is no absolute agreement among endocrinologists about the optimal management of this condition. In this review, aetiology, symptoms, clinical classification, diagnosis and treatment of hypophysitis are discussed with a special emphasis on the most recent literature.

Update on the management of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects 5% to 10% of women in reproductive age. It is the most simply defined as the association of hyperandrogenism (diagnosed clinically and/or biochemically) with chronic anovulation in the absence of specific ovarian, adrenal and pituitary gland diseases. Recent studies have revealed that PCOS is associated with hyperinsulinemia and insulin resistance. Both of them have been shown to play a substantial role in the increased risk of the cardiovascular events. The new data concerning the pathogenesis and management of PCOS have changed its treatment strategy. The management of PCOS is complex and includes lifestyle modification combined with dietary-induced weight loss, oral contraceptives, clomiphene citrate, gonadotropins, antiandrogens and insulin-sensitizing agents. Women with PCOS, diagnosed and managed properly, can benefit from the reduction or even reversal of the reproductive and metabolic morbidities and from the reduction of the risk factors for cardiovascular disorders. In this article, we describe all these treatment options. Although both standard and novel therapies are discussed, this review focuses on the progress made in the recent years.

[Postparum thyroiditis]. / Poporodowe zapalenie tarczycy.

Postpartum thyroiditis is one of the most common endocrinological disorders annually affecting millions of women world-wide. It is is defined as a syndrome of transient or permanent thyroid dysfunction occurring in the first year after delivery. A thyrotoxic phase of postpartum thyroiditis may be brief and unnoticed before a more long-lasting (permanent in up to 30%) hypothyroid phase occurs. The disease, found in approximately 5-10% of mothers in the general population, is an autoimmune disorder, and thyroid antibody-positive women in the first trimester have a 33% to 50% chance of developing thyroiditis in the postpartum period. Women suffering from other autoimmune conditions, or having a previous or family history of thyroid disease are at increased risk of its development. In this paper we present an overview of the pathogenesis, clinical aspects, diagnosis, and treatment options for postpartum thyroiditis with putting special emphasis on the results of recently published studies.

[Markers of inflammatory process in stable and unstable coronary artery disease]. / Wskazniki procesu zapalnego w stabilnej i niestabilnej chorobie wiencowej.

Clinical studies performed in last few years proved great role of inflammatory processes in development of atherosclerosis. Inflammatory markers indicating unstable atherosclerotic plaque were isolated. These biomarkers are used in diagnostics and identification of patients with unstable angina pectoris and miocardial infarct. Moreover usefulness of proinflammatory markers in indicating patients with high cardiovascular risk was confirmed. In result different markers of inflammation found their use in diagnostics of patients with stable and unstable coronary artery disease.

[Incidentaloma--one of the greatest challenges of modern endocrinology]. / Incidentaloma--jedno z najwiekszych wyzwan wspólczesnej endokrynologii.

Technological advance of the recent years has contributed to the development of the situation during which clinically inapparent masses are discovered in endocrine organs by high-resolution radiological imaging procedures that have been performed for other reasons. Most of these lesions, frequently referred to as incidentalomas, are clinically insignificant benign and hormonally inactive adenomas that neither pose a risk to a patient's health nor warrant the risks of further diagnosis and treatment. One of the greatest challenges of modern endocrinology is to distinguish the vast majority of clinically insignificant changes from other masses requiring further management such as hormone-secreting tumours and malignant lesions. Over the years a myriad of the diagnostic and therapeutic approaches has been recommended and presently there are still no uniform guidelines. The purpose of his article is to give an overview on the recent advances in diagnosis and management of pituitary and adrenal incidentalomas. We provide the reader with practical recommendations and underline areas in which further studies are required.

[Normoaldosterone spironolactone sensitive hypertension]. / Nadcisnienie normoaldosteronowe podatne na spironolakton.

We report the case of normoaldosterone spironolactone sensitive hypertension. Patients suffering from this recently identified form of arterial hypertension exhibit clinical symptoms resembling the symptoms of primary aldosteronism. The described disturbances may be misdiagnosed as essential hypertension because plasma aldosterone levels and aldosterone/renin ratio in patients are within the normal ranges. In the described state of the examined female, detection of the disease and implementation of spironolactone treatment not only normalised arterial blood pressure but also allowed to avoid unnecessary administration of many antihypertensive agents.

[Precocious puberty]. / Przedwczesne dojrzewanie plciowe.

Precocious puberty is usually defined as the appearance of secondary sexual development before the age of 8 years in girls and 9 years in boys. Precocious puberty is a heterogenous condition generally divided into central and peripheral forms driven respectively by hypothalamic-pituitary axis or by excessive production of sex steroids. Taking into account the risk associated with the underlying disorder as well as the impact of precocious puberty on stature growth and development of reproductive and mental functions, this condition has important consequences for affected children and their families. In this paper, the pathophysiology, clinical presentation, laboratory and radiological features, and treatment of the disorders leading to precocious puberty are reviewed. Particular attention is devoted to the results of the recently published studies.

[Thyroid hormone resistance syndrome]. / Zespól opornosci na hormony tarczycy.

Resistance to thyroid hormones (RTH) is an inherited syndrome characterised by reduced target tissue responsiveness to these hormones. In the recent years, it has become clear that RTH is probably much more common than is generally recognised, and is often misdiagnosed and inaccurately treated. Subjects suffering from RTH have raised serum thyroid hormone levels and raised or inappropriately normal thyrotropin levels. Two major forms of a clinical presentation of this disorder are asymptomatic or slightly symptomatic subjects with generalised resistance and patients with thyrotoxic features suggesting predominant pituitary resistance. Surprisingly, these various clinical situations are determined by the same genetic defect. In this paper, aetiology, symptoms, clinical classification, diagnosis and treatment of RTH are reviewed with putting special emphasis on the results of recently published studies.

[Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency]. / Wrodzony przerost nadnerczy na tle niedoboru 21-hydroksylazy steroidowej.

Congenital adrenal hyperplasia is a general term applied to a group of several inherited enzymatic defects of cortisol biosynthesis. The most frequent cause of this disease is by far 21-hydroxylase deficiency which is considered one of the commonest metabolic disorders. The degree to which the activity of this enzyme is diminished correlates with the severity of congenital adrenal hyperplasia and therefore the clinical presentation of 21-hydroxylase deficiency has a wide spectrum of clinical and laboratory abnomalities. The recent developments have improved prenatal diagnosis and treatment of affected females to minimise genital virilisation. Despite progress made in its recognition and treatment, diagnosis and management of 21-hydroxylase deficiency is still the subject of many debates and controversies. In this paper, aetiology, symptoms, diagnosis and treatment of 21-hydroxylase deficiency in various groups are reviewed with putting special emphasis on the results of recently published studies.

[Subclinical thyroid disorders]. / Subkliniczne schorzenia tarczycy.

The term subclinical thyroid disorders apply to patients who have an abnormal serum thyroid-stimulating hormone (TSH) concentration but thyroxine and triiodothyronine levels within their reference ranges. Subclinical hypothyroidism occurs in 4% to 10% of the general population, and is especially prevalent in elderly women. Depending on the study, subclinical hyperthyroidism has been found in 0.6-16 % of the population. Potential risks of subclinical hypothyroidism include progression to overt hypothyroidism, dyslipidemia, cardiovascular complications, and neurological and neuropsychiatric effects. In turn, subclinical hyperthyroidism represents a considerable risk factor for atrial fibrillation in the elderly and for postmenopausal osteoporosis. Treatment of subclinical thyroid disorders is controversial. In this paper, we discuss the prevalence, aetiology, clinical presentation, diagnosis, natural history, and potential pathophysiological consequences of subclinical hypothyroidism and subclinical hyperthyroidism. We also provide some screening and management recommendations.

[Hyperthyroidism in pregnancy]. / Nadczynnosc tarczycy w ciazy.

Thyroid disorders constitute one of the commonest endocrine problems found in pregnant women. They are usually treatable but may affect mother and foetus adversely if they are not evaluated relatively early and managed appropriately. The diagnosis of hyperthyroidism in pregnancy may be often challenging due to the fact that its symptoms mimic many of normal pregnancy complaints. Moreover, some forms of hyperthyroidism occur exclusively during this period. The goal of this article is to summarize the present state of knowledge on the etiology, clinical presentation, recognition and management of the various types of hyperthyroidism in pregnancy. On the basis of numerous studies, carried out mainly in the recent years, we provide some practical guidelines for clinical endocrinologists dealing with treatment of pregnant women.

[Verapamil-induced hyperprolactinemia--a case report]. / Hiperprolaktynemia spowodowana przez werapamil. Opis przypadku.

In many cases hyperprolactinemia can be caused by taking medications. Occasionally, verapamil-treated patients experience a slight asymptomatic increase in serum prolactin level. In this article we report the case of 42-year woman with manifest verapamil-induced hyperprolactinemia whose clinical symptoms suggested the occurrence of prolactinoma. A marked increase in prolactin levels and the preserved reactivity of this hormone in dynamic tests suggested that the patient exhibited "hypersensitivity" to verapamil. In the described state of the examined female detection of the disease, verapamil withdrawal and temporary bromocriptine administration have led to a full normalization of patient's clinical status.

[Anabolic therapy of osteoporosis]. / Anaboliczna terapia osteoporozy.

Osteoporosis is one of the most important problems in developed societies. Unfortunately, all drugs available nowadays on the market exhibit antiresorptive action bringing only moderate benefits to patients suffering from this disease. For the last few years, the number of studies on the suggested use of anabolic therapy in the treatment of osteoporosis has been growing up. In the present study we describe in details sodium fluoride, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins), growth hormone, insulin-like growth factor I, and parathormone and its analogues, describing their mechanism of action and adverse effects. We also show the results of experimental studies and clinical trials in which the mentioned drugs were used. On the basis of available results we are trying to establish the exact position of anabolic agents in pharmacotherapy of osteoporosis.