Pituitary apoplexy as the first manifestation of non­functioning pituitary neuroendocrine tumour.

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Ectopic ACTH syndrome in the course of ACTH-secreting pancreatic neuroendocrine tumour in a patient with a pituitary lesion - diagnostic challenges and individual approach.

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Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment.

Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men's health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.

Cushing's Disease: Long-Term Effectiveness and Safety of Osilodrostat in a Polish Group of Patients with Persistent Hypercortisolemia in the Experience of a Single Center.

Osilodrostat is a potent oral steroidogenesis inhibitor that has emerged as the new medical agent for patients with Cushing's disease (CD) requiring long-term medical therapy for hypercortisolemia control. Its efficacy and safety have been assessed in clinical trials; however, real-world evidence is still scarce. This study aimed to investigate the long-term treatment (156 weeks) clinical and biochemical effect of osilodrostat in six patients with CD at a single center in Poland, initially participating in the LINC4 study. At week 36, all six patients met the key secondary endpoint of the LINC4 trial, achieving normalization of median urinary free cortisol. Osilodrostat treatment allowed for complete disease control in all patients and none of the patients was excluded due to the lack of treatment effectiveness in 156 weeks of follow-up. All patients demonstrated significant improvement from baseline on most metabolic and cardiovascular parameters, which was most evident at week 36 and sustained throughout the study period. This study supports and strengthens the role of osilodrostat as an effective long-term medical treatment in patients with CD. We also present three patient case histories in detail to highlight the clinical situations that endocrinologists might face during osilodrostat therapy.

Cushing's syndrome: a combined treatment with etomidate and osilodrostat in severe life-threatening hypercortisolemia.

Endogenous Cushing's syndrome (CS) is associated with increased morbidity and mortality. Early diagnosis and initiation of therapy are essential, but effective treatment remains a challenge. In a long-term follow-up, biochemical control of hypercortisolemia, especially when severe, is difficult to achieve. Life-threatening hypercortisolemia is difficult to control due to the limitations of pharmacotherapy, including its side effects, and may require etomidate infusion in the intensive care unit (ICU) to rapidly lower cortisol levels. The effectiveness of hypercortisolemia management can be increased by a dual blockade of cortisol production. We report the efficacy, safety, and tolerability of combined therapy with two steroidogenesis inhibitors, etomidate, and osilodrostat, in a 32-year-old woman diagnosed with severe ACTH-dependent hypercortisolemia, subsequently maintaining a stable level of cortisol with osilodrostat monotherapy. This approach enabled achievement of relatively rapid control of the hypercortisolemia while using an etomidate infusion and concomitant increasing doses of oral osilodrostat applying a "titrations strategy." Our experience shows that it is worth taking advantage of the synergistic anticortisolic action of etomidate with osilodrostat.

Nutrition and lifestyle in patients pharmacologically treated due to hypertension.

BACKGROUND: Proper nutrition and physical activity are together an important way of non-pharmacological treatment of arterial hypertension. The aim of the study was to answer the question whether patients with hypertension use non-pharmacological methods of hypertension treatment. METHODS: The study included a group of 280 patients aged 18-85, suffering from hypertension. In the study, 10 nutritional and non-nutritional factors affecting the treatment of hypertension were analyzed. Data regarding the diet were collected by a method of 24-h recall. Basic anthropometric measurements (body weight, body height, waist and hip circumference) were taken, as well as threefold measurement of blood pressure. The data were statistically analyzed. RESULTS: The average value of blood pressure was 131.2 ± 15.5/82.9 ± 10.5 mm Hg. Approximately 90% of the respondents had abnormal body weight, i.e. excessive weight or obesity. Abdominal obesity according to waist hip ratio assessment was diagnosed in 87% of women and 66% of men; according to the measurement of waist circumference, it was diagnosed in 140 (81%) women and 88 (81%) men. Among the ingredients with antihypertensive effect, the sodium intake was 4,417.8 ± 2,052.7 mg/d, which when converted to salt is on average 11 g/d, potassium: 3,808.5 ± 1,265.7 mg/d, calcium: 724.6 ± 413.7 mg/d, and magnesium: 383.9 ± 139.3 mg/d. One in 5 (18%) people declared smoking. Only 5% of subjects reported high level of physical activity. CONCLUSIONS: In persons with diagnosed hypertension, vast majority of patients did not implement non-pharmacological hypertension treatment.

Dietary and socio-economic factors in relation to Helicobacter pylori re-infection.

AIM: To examine if dietary and socio-economic factors contribute to Helicobacter pylori (H pylori) re-infection. METHODS: The population of patients consisted of subjects in whom H pylori infection had been successfully treated in the past. Patients were divided into two groups: I-examined group (111 persons with H pylori re-infection) and II-control group (175 persons who had not been re-infected). The respondents were interviewed retrospectively on their dietary habits and socio-economic factors. RESULTS: A statistically significant lower frequency of fermented dairy products (P < 0.0001), vegetables (P = 0.02), and fruit (P = 0.008) consumption was noted among patients with H pylori re-infection as compared to those who had not been re-infected. CONCLUSION: High dietary intake of probiotic bacteria, mainly Lactobacillus, and antioxidants, mainly vitamin C (contained in fruit and vegetables), might decrease the risk of H pylori re-infection.