Purification of pituitary autoantigen by column liquid chromatography and chromatofocusing.

INTRODUCTION: Pituitary autoantibodies can be determined both in patients with pituitary disease as well as patients with autoimmune endocrine diseases. The purpose of the study was to isolate and purify pituitary autoantigen using sera of patients and the microsomal fraction of the pituitary. MATERIAL AND METHODS: To isolate a pituitary autoantigen, patient sera were used, which showed a strong immune response to pituitary antigens. Pituitary microsomal fractions were prepared from pituitary tissue homogenates. In the study, sera of patients with pituitary disease, Addison and Graves' disease were used. The initial stages were carried out by affinity chromatography on CN -Br sepharose column whereas purification was continued by column liquid chromatography on AcA54 Ultrogel. Chromatofocusing was performed by Polybuffer exchanger PBE 94. RESULTS: (125)I-labeled pituitary antigens after isolation appeared in column chromatography in three peaks. The first peak contained 50-70 kDa proteins, the second peak - 17 to 22 kDa proteins and the third peak contains (125)-iodides. Three fractions obtained from filtration on Ultrogel were separated in a polyacrylamide gel. In the first peak two bands 67 and 55 kDa appeared. The second peak contained low molecular weight substances, and the third peak contained (125)I. The first peak from Ultrogel was isolated by chromatofocusing - the first peak with pH 5.9 and the second one with pH 4.9. CONCLUSIONS: Isolation and purification of pituitary autoantigen with the use of column liquid chromatography and chromatofocusing resulted in obtainment of two antigenic proteins of specific gravity of 67 and 55 kDa.

Survivin--prognostic tumor biomarker in human neoplasms--review.

Accurate diagnosis and proper monitoring of cancer patients remain important obstacles for successful cancer treatment. The search for cancer biomarkers is carried out in order to quickly identify tumor cells and predict treatment response, ultimately leading to a favorable therapeutic outcome. One such prognostic marker seems to be survivin. Many studies have shown that survivin is strongly expressed in a vast majority of cancers. Its overexpression was demonstrated in breast and lung cancer prostate, gastric, colon, bladder and esophageal carcinomas, osteosarcomas, and lymphomas. In many of those tumors, high activity of the surviving gene was associated with a poor prognosis and worse survival rates. Moreover survivin expression was correlated with resistance to chemotherapy and radiotherapy-induced apoptosis. Since survivin may be identified as an independent prognostic factor and inhibitor of apoptosis, it may prove to be a useful therapeutic target in cancer therapy

Fatal course of cyclic Cushing's disease - lessons from a case.

We present a 56-year-old patient with cyclic Cushing's disease (CCD) observed for 28 months, who presented clinically and biochemically with alternating episodes of hyper-, normo- and hypocortisolemia. The course of the disease was fatal, the patient died due to severe hypokalemia.

Difficulties in diagnosis and treatment of acromegaly in a patient with a McCune-Albright syndrome. A case report and a review of literature.

We describe a female patient aged 43, who at the age of five was diagnosed with polyostotic fibrous dysplasia (FD). The patient was intermittently treated in our department since the age 33, for approximately 10 years, with intravenous bisphosphonates. At the age of 42 acromegaly was diagnosed incidentally, since clinical manifestations were poor, and, if present earlier, they had been related to FD. Only retrospectively, having biochemical confirmation of GH excess, we could relate them to acromegaly. Because of the involvement of the base of the skull there was no possibility of transphenoidal surgery. Long-acting somatostatin analogues were started, but no response was observed, with IGF-1 and GH being even higher during than before treatment. After the 37-year-history of FD, the occurrence of additional endocrine disorder enabled to make diagnosis of McCune-Albright syndrome (MAS) even in the absence of two out of three classical manifestations such as café-au-lait skin pigmentation and peripheral precocious puberty in the past medical history.

Emotions and features of temperament in patients with Addison's disease.

INTRODUCTION: Patients with Addison's disease experience many somatic and psychic changes, which decrease their quality of life. The aim of the study was to evaluate the "psychological equipment" of these patients to cope with stress connected with this chronic disease and the challenge of constant treatment. MATERIAL AND METHODS: Fifteen patients (13 female, 2 male) were included in the study. Standard psychological tests were used to assess anxiety, temperament, depression, and emotional intelligence. RESULTS: The results show that patients with Addison's disease have not only increased levels of anxiety and fear, and over-reaction to stimuli, but decreased performance efficiency and need for social contact as well. Such psychological characteristics may result in difficulties in doctor-patient communication, aggravation of patients' feelings, limitation of patients' involvement in therapy, and, finally, a decrease the effectiveness of therapy. CONCLUSIONS: The temperamental characteristics and personal traits of patients with Addison's disease seem not to be useful in stressful events, and psychological support can be helpful in the effective therapy of these patients. (Pol J Endocrinol 2010; 61 (1): 90-92).

Growth hormone-secreting macroadenoma of the pituitary gland successfully treated with the radiolabeled somatostatin analog (90)Y-DOTATATE: case report.

Pituitary tumors causing acromegaly are usually macroadenomas at the time of diagnosis, and they can grow aggressively, infiltrating surrounding tissues. Difficulty in achieving complete tumor removal at surgery can lead toward a strong tendency for recurrence, making it necessary to consider a means of treatment other than those currently used such as somatostatin analogs (SSAs), growth hormone (GH) receptor antagonist, surgical removal, and radiotherapy. The purpose of this paper is to describe a patient diagnosed with an aggressive, giant GH-secreting tumor refractory to medical therapy but ultimately treated with the radiolabeled somatostatin analog (90)Y-DOTATATE. A 26-year-old male with an invasive macroadenoma of the pituitary gland (5.6 × 2.5 × 3.6 cm) and biochemically confirmed acromegaly underwent 2 partial tumor resections: the first used the transsphenoidal approach and the second used the transcranial method. The patient received SSAs pre- and postoperatively. Because of the progression in pituitary tumor size, he underwent classic irradiation of the tumor (50 Gy). One and a half years later, the patient presented with clinically and biochemically active disease, and the tumor size was still 52 mm in diameter (height). Two neurosurgeons disqualified him from further surgical procedures. After confirming the presence of somatostatin receptors in the pituitary tumor by using (68)Ga-DOTATATE PET/CT, we treated the patient 4 times with an SSA bound with (90)Y-DOTATATE. After this treatment, the patient attained partial biochemical remission and a reduction in the tumor mass for the first time. Treatment with an SSA bound with (90)Y-DOTATATE may be a promising option for some aggressive GH-secreting pituitary adenomas when other methods have failed.

Pregnancy-associated osteoporosis manifesting for the first time during second pregnancy.

We present here a case of 26-year-old woman with pregnancy-associated severe osteoporosis which occurred for the first time at the end of the second pregnancy. We discuss changes in bone mass and metabolism taking place during normal pregnancy and other possible factors of osteoporosis during that period.

[Non-small cell lung cancer presenting under the mask of a primary adrenal cancer--case report]. / Niedrobnokomórkowy rak pluca przebiegajacy pod maska pierwotnego raka nadnercza--opis przypadku.

Adrenal carcinoma is a malignant disease that often results in distant metastases to different organs, including the lungs. While diagnosing patients with suspected adrenal carcinoma, metastases to the lungs should always be considered. The opposite clinical situation also should be considered, i.e. lung cancer metastases to the adrenal gland. Both conditions may have a very similar course and their differential diagnosis may be sometimes very difficult. However, proper diagnosis is of great importance because both diseases are treated by different means. We present a case of a 50-year-old female patient with a small primary focus of non-small cell lung carcinoma and its large metastasis to the left adrenal gland, accompanied by SIADH and paraneoplastic hypercalcemia. In the presented case adrenal carcinoma and its lung metastasis were primarily misdiagnosed which led to unnecessary laparotomy. The proper diagnosis was enabled by CT guided biopsy of the lung tumor.

[Influence of diet and physical activity on the course and therapy of osteoporosis]. / Wplyw diety i aktywnosci fizycznej na przebieg i leczenie osteoporozy.

UNLABELLED: Osteoporosis is a disease, the course of which is dependent among others on diet and physical activity. The aim of study was to find correlation between these factors and changes in bone density measured in lumbar spine. The project comprised 82 women with primary postmenopausal or senile osteoporosis treated with calcitonin, hormone replacement therapy and vitamin D. Bone density was measured by DEXA method before and after 12 month therapy. The patients were divided into four groups depending upon amount of ingested calcium and time of physical activity performed daily. RESULTS: Only in the group of women (n = 32) who were physically active and presented high dietary calcium intake (over 500 mg daily) statistically significant improvement in bone density was found: T-score increased by +0.23 (p = 0.010449). No statistically significant difference of bone density in other subgroups was found. CONCLUSIONS: Daily dietary calcium intake over 500 mg and physical activity performed for over 45 minutes every day provides higher bone density increase during pharmacotherapy of osteoporosis compared to pharmacotherapy alone or pharmacotherapy associated with only one of the above mentioned elements.

Pregnancy in a patient with adrenocortical carcinoma during treatment with Mitotane - a case report.

We present the case of a female patient with virilising adrenocortical carcinoma treated surgically who conceived during adjuvant treatment with mitotane. We discuss the frequently erroneous routine treatment with oral hormonal contraception without thorough differential diagnosis in female patients with oligo-/amenorrhea and subsequent delay in the proper diagnosis of adrenocortical carcinoma.

Delayed diagnosis of primary hyperparathyroidism in a patient with osteoclastoma.

Primary hyperparathyroidism (HPTo) nowadays is most often recognized incidentally in the asymptomatic period as a result of biochemical screening or evaluation of low bone mass. Classical manifestations of the disease are present in about 15-20% of patients. We present the case of a 28-year-old male patient who had been treated for two years for osteoclastoma of the proximal tibia, first by intralesional curettage with cement filling followed by bone grafting, and finally with a reconstructive arthroplasty of the knee joint. The patient had been consulted in different medical centers by at least 14 doctors representing 9 different specialties, but the correct diagnosis of HPTo had not been made, although classic manifestations of the disease had been present for 5-6 years. This suggests that a diagnosis of HPTo is difficult nowadays. Therefore, determination of serum calcium concentration and other markers of calcium and phosphate metabolism should be obligatory in patients with bone lesions.

[Primary hypoparathyroidism and hypergonadotropic hypogonadism in a male patient with common variable immunodeficiency. A case report]. / Pierwotna niedoczynnosc przytarczyc i hipogonadyzm hipergonadotropowy u mezczyzny z pospolitym zmiennym niedoborem odpornosci--opis przypadku.

We describe here a case of a 42-year-old male patient with severe hipogammaglobulinemia primary hypoparathyroidism and hypogonadism, various G1 disorders, malabsorption syndrome, anemia and recurrent severe sinopulmonary infections. We present also difficulties and limitations relating to diagnosis of common variable immunodeficiency and shortly present review of literature.