Endokrynologia 2 2013-2

 

List do czytelników/Letter to readers

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Dear Colleagues and Readers,

The long-awaited spring has finally arrived. Not so long ago, at the end of March, we participated in the spring edition of our Continuing Education Course which took place in Sopot, situated on the icebound Baltic Sea. Now that the seemingly endless winter is finally over, we all can take a more optimistic look at the world. Full of regained energy, we have prepared for you a selection of papers that we hope will meet the expectations held by our journal’s Readers.

The increasing life expectancy of societies, especially in the past decade, has made us realise that new reference ranges need to be established for parameters used in endocrinology and measured in elderly people. The results of the multicentre PolSenior Study presented as the first Original paper in this issue of the “Endokrynologia Polska” could therefore prove very useful to Central and Eastern European endocrinologists. In Poland, for instance, no reference values for sex hormones are available for ageing patients. The paper provides reference values for sex hormones by sex, age and cardiovascular risk factors. The study also suggests that the reference values presented in 5-year age ranges are more precise than those for the whole population over the age of 60 years, and that their clinical usefulness is increasing, given the number of cardiovascular risk factors and BMI.

The second original paper, by authors from Warsaw, reports on a study in which the investigators assessed body composition, parameters of lipid and carbohydrate metabolism and serum androgen levels in women with polycystic ovary syndrome (PCOS). Using DEXA visceral obesity was shown in all the obese women with PCOS. Indicators of obesity were shown to positively correlate with the investigated parameters of lipid and carbohydrate metabolism and with blood pressure values. The study also showed that free androgen index correlated with body mass and with BMI. The study confirms and provides more details on what clinicians have been aware of for years: the relationship between the components of the metabolic syndrome and the components of PCOS.

The authors from Ciechocinek and the neighbouring towns investigated the relationship between the selected polymorphisms of genes encoding the elements of the dopaminergic pathway and body mass index in overweight and obese women. Dopamine is a key compound in the regulation of satiety and food intake, and elevated dopamine levels in the dorsal part of the striatum are observed postprandially. The interpretation of the results of determination of gene polymorphisms is, as usually, very complex. A clear conclusion could, however, be drawn in this study that the impact of the polymorphisms in both genes could sum up and lead to deceased function of the dopaminergic reward system.

Due to the demographic and lifestyle changes in the developed countries osteoporosis has become a serious social problem and femoral neck fracture is now its most serious complication that is associated with a considerable mortality and permanent sequelae. Invaluable socioeconomic conclusions were drawn from the study. Femoral neck fracture, despite surgical management, continues to be associated with high mortality. High level of physical activity, particularly outdoor activity, independence and having a partner all beneficially affect the prognosis in patients who have suffered a femoral neck fracture. Femoral neck fracture negatively affected the patients’ financial situation. The speed of surgical intervention following a femoral neck fracture did not affect the survival.

Although the “explosion” of research studies into melatonin seems to be a thing of the past now, it does not mean, however, that stagnation in this area has set in. Authors from Łódź evaluated the effect of melatonin on the manifestations of irritable bowel syndrome in postmenopausal women. The study was prompted by the data demonstrating that melatonin exerts a relaxing influence on gastrointestinal smooth muscles and that its secretion decreases with age, particularly in postmenopausal women. The study showed that melatonin could be used in combination treatment of irritable bowel syndrome, particularly in irritable bowel syndrome with constipation.

In women with type 1 diabetes mellitus (T1DM), an increased prevalence of the clinical and biochemical manifestations of hyperandrogenism is seen. Authors from Katowice conducted a study to assess the hormonal profile and the prevalence of hyperandrogenism in pubescent girls with the same disease. This group of patients was compared with healthy individuals and with patients suffering from PCOS. The study showed menarche occurred later in girls with T1DM, that girls suffering from both T1DM and PCOS had lower HbA1c values than girls with T1DM but without PCOS and that girls with both T1DM and PCOS had lower values of free androgen index and gonadal volume than girls with PCOS but without T1DM. It follows, therefore, that the clinical manifestations of PCOS in pubescent girls suffering from T1DM are milder than those in non-diabetic pubescent girls suffering from PCOS, which may be associated with the protective role of SHBG and lower levels of free androgens.

Authors from Wrocław demonstrated that transplantation of autologous bone marrow mononuclear stem cells incubated with the VEGF gene improves the prognosis in critical leg ischaemia secondary to diabetes mellitus. The study also aimed to evaluate the safety of this treatment. A decrease in the severity of pain at rest was observed in all the patients and the angiograms revealed the formation of collateral blood vessels. Ischaemic ulcerations resolved completely in most of the patients and in isolated cases the investigators managed to reduce the extent of limb amputation.

The last of the original papers in the current issue of the Endokrynologia Polska reports on an experimental animal model study conducted by researchers from the Medical University of Łódź. The authors assessed the effect of galanin on the release of oxytocin (OT) in response to acute or chronic osmotic stimuli. The authors showed that galanin acted as a neuromodulator that stimulated the release of OT in response to chronic osmotic stimulation and that acute osmotic stimulation blocked the sensitivity of OT-ergic neurons to galanin.

In the Review paper entitled: “Pathomechanisms of the development of obesity in some endocrinopathies — an overview”, the authors from the Department of Endocrinology and Diabetes, Nicolaus Copernicus University in Toruń, presented a literature review and discussed the probable mechanisms underlying the development of obesity in thyroid diseases, polycystic ovary syndrome, hypercortisolaemia and hypopituitarism.

The Case reports section of the current issue of our journal features a case of a 30-year-old pregnant patient in whom fine needle aspiration biopsy of a thyroid tumour in the second trimester revealed Hürthle cell tumour and ultrasound and cytology suggested metastatic spread to the cervical lymph nodes. Surgical treatment performed before the 22nd week of gestation was successful and uneventful. The discussion addressed the issue of surgical management of differentiated thyroid carcinoma in pregnant women.

It is our great pleasure to recommend, in the Postgraduate education section, the paper entitled: “The management of Cushing’s disease — from investigation to treatment”, in which Agata Juszczak and Ashley Grossman from the University of Oxford discuss the current opinions on the diagnosis and treatment of this disease. The Reader will find multiple practical management tips related to this often problematic endocrine disorder. The authors conclude that patients with Cushing’s disease should undergo diagnostic evaluation and treatment at centres offering specialist endocrinology services and should be managed by an interdisciplinary team that includes neurosurgeons, radiologists and oncologist, which determines the therapeutic success.

Wish you all the best in the spring I encourage you to read this issue of our journal.

On behalf of the Editors

Beata Kos-Kudła

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