Assessment of real-world usage of lanreotide AUTOGEL 120 in Polish acromegalic patients - results from the prospective 12-month phase of Lanro-Study.

AIM OF THE STUDY: To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acromegaly care in Poland. MATERIAL AND METHODS: A multicentre, non-interventional, observational study on resource utilization in Polish acromegalic patients treated with ATG120 at 4 weeks or extended (> 4 weeks) dosing interval. The study recruited adult acromegalic patients treated medically for ≥ 1 year including at least 3 injections of ATG120. Data on dosing interval, aspects of administration, and resource utilization were collected prospectively during 12 months. Costs were calculated in PLN from the public health-care payer perspective for the year 2013. RESULTS: 139 patients were included in the analysis. Changes in dosing regimen were reported in 14 (9.4%) patients. Combined treatment was used in 11 (8%) patients. Seventy patients (50%) received ATG120 at an extended dosing interval; the mean number of days between injections was 35.56 (SD 8.4). ATG120 was predominantly administered in an out-patient setting (77%), by health-care professionals (94%). Mean time needed for preparation and administration was 4.33 and 1.58 min, respectively, mean product wastage - 0.13 mg. Patients were predominantly treated in an out-patient setting with 7.06 physician visits/patient/year. The most common control examinations were magnetic resonance imaging of brain and brain stem (1.36/patient/year), ultrasound of the neck (1.35/patient/year), GH (1.69/patient/year), glycaemia (1.12/patient/year), IGF-1 (0.84/patient/year), pituitary-thyroid axis hormone levels assessment (TSH-0.58/patient/year, T4-0.78/patient/year). There were 0.43 hospitalizations/patient/year. For direct medical costs estimated at PLN 50 692/patient/year the main item was the costs of ATG120 (PLN 4103.87/patient/month; 97%). The mean medical cost, excluding pharmacotherapy, was PLN 1445/patient/year (out-patient care - 49%, hospitalization - 23%, diagnostics/laboratory tests - 28%). CONCLUSIONS: These results represent the current use of ATG120 in the population of Polish acromegalic patients in a realistic clinical setting. Findings that 50% of patients could be treated with dose intervals of longer than 28 days support the potential of ATG120 to reduce the treatment burden.

[Mood of individuals with Graves-Basedow's disease and Hashimoto's disease]. / Nastrój osób z choroba Gravesa-Basedowa i choroba Hashimoto.

INTRODUCTION: Mood can be characterized as subjective, relatively long lasting emotional state. The impact of the mood on health can be considered in two aspects: mood as an intermediary factor/cause of disease or as its result. The aim of following paper was to define the mood of individuals with Graves-Basedow's disease Hashimoto's disease in comparison to each other and in comparison to healthy individuals. MATERIAL AND METHODS: The study group consisted of 70 individuals with Graves-Basedow's disease (56 women and 14 men) and the same amount of healthy ones. The study group of Hashimoto's disease consisted of 54 individuals (46 women and 8 men) and the same amount of healthy ones. The patients filled out three psychological methods: Profile of Mood States (POMS), University of Wales Institute of Science and Technology Mood Adjective Check List (UMACL), a personal survey and an analysis of the medical documentation. RESULTS: Results indicate difference between individuals with Graves-Basedow's disease and healthy ones taking under consideration mood: anger and tension, dejection, embarrassment and vigor. There is no difference between individuals with Hashimoto's disease and healthy ones considering mood. There are differences between Graves-Basedow's disease and Hashimoto's disease regarding tension - anger. No differences have been claimed concerning criterions of health such as: time of duration of disease, complications, coexisting other diseases. Nevertheless the level of hormones is connected with the mood. CONCLUSIONS: In case of Graves-Basedow's disease has been claimed stronger anger, sadness, embarrassment and less vigor. Individuals with Hashimoto's disease are regarded as similar to the healthy ones, without features of forced depression, irritability or embarrassment. To sum up the mood of individuals among testing group is a result of disease.

A difficult diagnosis: a case report of combined Riedel's disease and fibrosing Hashimoto's thyroiditis.

Riedel's disease (RD) is a rare form of chronic thyroiditis, predominantly characterised by fibrosis which may involve neighbouring tissues and organs. Hashimoto's disease (HD), on the other hand, is fairly common. Clinical differentiation between these diseases is often difficult, and the results of diagnostic imaging, laboratory tests and cytology studies are often similar. We report the case of a female patient with Riedel's thyroiditis displaying clinical, laboratory and radiological traits of both diseases. A 44 year-old Caucasian female was diagnosed with hypothyroidism. A fine-needle aspiration biopsy was performed; the findings were suggestive of an exacerbated chronic inflammatory process. However, a small lymphocyte-derived malignancy could not be ruled out with certainty, and so the patient was referred for elective thyroidectomy. The microscopic features of both specimens did not meet the criteria of Hashimoto's thyroiditis. The immunohistochemical studies revealed few scattered B lymphocytes (CD20 positive) and numerous scattered T lymphocytes (CD3 positive). Finally, Riedel's thyroiditis with an intense inflammatory infiltrate composed of lymphocytes was diagnosed. Reaching a diagnosis was particularly difficult in this patient, since Riedel's thyroiditis, the fibrosing form of Hashimoto's disease and malignant tumours of the thyroid can show similar traits upon physical and histopathological examination. As the clinical data was indicative of Hashimoto's thyroiditis and there were partial histological criteria of two forms of thyroiditis, namely Hashimoto's and Riedel's, the very rare diagnosis of a combined disease was made. Dense B and T lymphocytes and some plasma cell infiltrates, as well as the destruction of thyroid follicles by fibrosis extending into surrounding tissues, were supportive of the eventual diagnosis. Differentiating between the histopathological and clinical presentation of both diseases in one patient is difficult, primarily due to the partial overlapping of their histopathological traits. In order to avoid a diagnostic error, close cooperation between the endocrinologist and pathologist is mandatory. It is our opinion that in our patient the two diseases existed separately, and their coexistence was most likely coincidental.

The comparison of serum vascular endothelial growth factor levels between patients with metastatic and non-metastatic thyroid cancer, and patients with nontoxic multinodular goiter.

BACKGROUND: One of the important proangiogenic factors involved in the growth of normal and neoplastic tissues is vascular endothelial growth factor (VEGF). AIM: We hypothesized that serum VEGF concentration would differ between patients with metastatic and non-metastatic thyroid cancer, multinodular goiter, and healthy subjects. We also hypothesized that endogenous TSH stimulation would affect serum VEGF level. SUBJECTS AND METHODS: The study group consisted of 71 patients (62 females and 9 males), aged 44.9 +/- 12.3 years, with differentiated thyroid cancer (50 papillary, 17 follicular, and 4 oxyphilic), treated in our department during the years 2003-2006. All patients had undergone total or near-total thyroidectomy and radioactive iodine treatment, that had resulted in remission in 59 patients and persistent/recurrent disease in 12 patients. The study included two control groups: 30 patients with nontoxic multinodular goiter and 30 healthy subjects. RESULTS: Serum VEGF concentrations were significantly higher in patients with distant metastases than those in remission or healthy patients. (423.4 vs 217.6 vs 235.55 pg/ml respectively, P < 0.05). This was not observed in patients with locoregional metastases. During endogenous TSH stimulation, VEGF decreased significantly (215.3 vs 169.6 pg/ml, P < 0.05). Patients with multinodular goiter showed significantly lower VEGF concentrations than the remaining study groups. CONCLUSIONS: Serum VEGF concentration might be used as an additional marker of thyroid cancer with distant metastases, but its interpretation should be undertaken very cautiously. Endogenous TSH stimulation decreases VEGF levels in patients either with or without thyroid tissue, suggesting that its regulatory effects are through receptors located outside the thyrocytes.