Papers by Krzysztof Sworczak
Współczesna Onkologia, 2013
Ai im m o of f t th he e s st tu ud dy y: : To assess resource utilization and costs of treatment... more Ai im m o of f t th he e s st tu ud dy y: : To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acromegaly care in Poland. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : 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. R Re es su ul lt ts s: : 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 outpatient 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 outpatient 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/pa tient/ 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/pa tient/ 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%). C Co on nc cl lu us si io on ns s: : 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.
Genes
Type 1 hereditary hemochromatosis (HH) is an autosomal, recessive genetic entity with systemic ir... more Type 1 hereditary hemochromatosis (HH) is an autosomal, recessive genetic entity with systemic iron overload. Iron homeostasis disorders develop as a result of HFE gene mutations, which are associated with hepcidin arthropathy or osteoporosis and may cause permanent disability in HH patients despite a properly conducted treatment with phlebotomies. In this study, selected parameters of calcium and phosphate metabolism were analyzed in combination with the assessment of bone mineral density (BMD) disorders in patients from northern Poland with clinically overt HFE-HH. BMD was determined by a dual-energy X-ray absorptiometry (DXA) test with the use of the trabecular bone score (TBS) function. The study included 29 HH patients (mean age = 53.14 years) who were compared with 20 healthy volunteers. A significantly lower TBS parameter and serum 25-OH-D3 concentration, a higher concentration of intact parathormone and more a frequent occurrence of joint pain were found in HH patients compa...
Nadnercza s1 drugim (po tarczycy) gruczo3em wewnêtrznego wydzielania co do czêstoœci wystêpowania... more Nadnercza s1 drugim (po tarczycy) gruczo3em wewnêtrznego wydzielania co do czêstoœci wystêpowania nowotworów 3agodnych i z3oœliwych [1]. Guz rdzenia nadnercza (barwiak, pheochromocytoma) jest przedstawicielem guzów neuroendokrynnych i wywodzi siê z komórek chromoch3onnych, znajduj1cych siê w rdzeniu nadnerczy oraz z cia3ek przyzwojowych wspó3czulnego uk3adu nerwowego. Guzy chromoch3onne rozpoznaje siê stosunkowo rzadko i w ca3ej populacji ich czêstoœæ wystêpowania ocenia siê od 1 przypadku na 100 tys. do 1 na 500 tys./osób/rok [2, 3]. W 90 proc. guz chromoch3onny wykrywa siê w obrêbie nadnercza, czêœciej prawego. W 10 proc. przypadków wystêpuje obustronnie, z czego 50 proc. to postacie rodzinne [4]. W ok. 10 proc. przypadków mo¿e lokalizowaæ siê pozanadnerczowo i powstawaæ w ka¿dym miejscu, gdzie znajduj1 siê skupienia tkanki chromoch3onnej (np. w narz1dzie Zuckerkandla, wzd3u¿ przebiegu aorty brzusznej, we wnêce w1troby, w œcianie pêcherza moczowego i œródjajnikowo); poza jam1 brzu...
Genes, 2021
Type 1 hereditary hemochromatosis (HH) is an autosomal, recessive genetic entity with systemic ir... more Type 1 hereditary hemochromatosis (HH) is an autosomal, recessive genetic entity with systemic iron overload. Iron homeostasis disorders develop as a result of HFE gene mutations, which are associated with hepcidin arthropathy or osteoporosis and may cause permanent disability in HH patients despite a properly conducted treatment with phlebotomies. In this study, selected parameters of calcium and phosphate metabolism were analyzed in combination with the assessment of bone mineral density (BMD) disorders in patients from northern Poland with clinically overt HFE-HH. BMD was determined by a dual-energy X-ray absorptiometry (DXA) test with the use of the trabecular bone score (TBS) function. The study included 29 HH patients (mean age = 53.14 years) who were compared with 20 healthy volunteers. A significantly lower TBS parameter and serum 25-OH-D3 concentration, a higher concentration of intact parathormone and more a frequent occurrence of joint pain were found in HH patients compa...
Simultaneous Targeting PI3K_Akt_mTOR and MEK_RAF_ERK Pathways Results in a Synergistic Anti-Proliferative Effect in an Adrenocortical Carcinoma Model _ Therapies for Cancer
Endokrynologia Polska, 2011
Although vitamin deficiencies are uncommon in Poland or other developed countries, many patients ... more Although vitamin deficiencies are uncommon in Poland or other developed countries, many patients take vitamin supplements. Despite the widespread availability of vitamins and the universal belief that vitamins offer health benefits, few publications have addressed their role in the prevention and treatment of thyroid diseases. There is some evidence to suggest that the administration of vitamins with anti-oxidant properties in patients with hyperthyroidism can decrease the severity of clinical symptoms, and that vitamin D supplementation can have a beneficial effect on the bone system for these patients. It has also been suggested that patients with autoimmune thyroid diseases should be periodically screened for vitamin B12 deficiency. There has been no data to support vitamin supplementation in the primary or secondary prevention of thyroid malignancies.
INTRODUCTION Hyperhomocysteinaemia is an independent risk factor for premature atherosclerotic va... more INTRODUCTION Hyperhomocysteinaemia is an independent risk factor for premature atherosclerotic vascular disease and venous thrombosis. Hypothyroidism is associated with mild hyperhomocysteinaemia. The aim of the present study was to assess plasma total homocysteine (tHcy) and its determinants (folate, cobalamin) in hyperthyroid patients before and after treatment. MATERIAL AND METHODS Thirty hyperthyroid and thirty healthy premenopausal women were studied. The hyperthyroid patients were investigated in the untreated state and again after restoration of euthyroidism. The levels of homocysteine, folate, cobalamin, and thyroid stimulating hormone (TSH), free thyroxine (fT(4)), free triiodothyronine (fT(3)), and renal function were measured before and after treatment. RESULTS In hyperthyroidism, tHcy was lower than in the control group. The serum level of folate was higher and serum cobalamin was lower in the hyperthyroid state. Following antithyroid drug therapy, tHcy significantly inc...
Except from well-known the most frequent reasons of the hyperthyroidism such as the Graves-Basedo... more Except from well-known the most frequent reasons of the hyperthyroidism such as the Graves-Basedow disease, multinodular goitre and the autonomous adenoma we should also remember the other rarer illnesses leading to the excess of thyroid hormones in the serum. Authors presented the problem of atypical forms of thyrotoxicosis which run without the overproduction of thyroid hormones and are characterized by low 24 h 131 J uptake by the thyroid gland. So called masks of hyperthyroidism such as apathetic, neuromuscular, gastrointestinal and cardiovascular forms were also discussed in the article.
Correction: Autonomous Aldosterone Secretion as a Subclinical Form of Primary Aldosteronism: Pathogenesis and Clinical Significance
Experimental and Clinical Endocrinology & Diabetes
Old Problem, New Concerns: Hypercortisolemia in the Time of COVID-19
Frontiers in Endocrinology
The ongoing coronavirus disease 2019 (COVID-19) pandemic forced a change in the way we provide me... more The ongoing coronavirus disease 2019 (COVID-19) pandemic forced a change in the way we provide medical treatment. Endocrinology in the era of COVID-19 had to transform and reduce its vast potential to the absolute necessities. Medical professionals needed to update their clinical practice to provide their patients as much support and as little harm as possible in these increasingly difficult times. International expert statements were published to offer guidance regarding proper care. It was suggested to simplify the diagnostic scheme of hypercortisolemia and to modify the approach to treatment. Hypercortisolemic patients with COVID-19 and iatrogenic hypercortisolemia due to glucocorticoid use are important clinical scenarios – we aimed to provide a cohesive summary of issues to consider.
European Journal of Translational and Clinical Medicine
Hereditary hemochromatosis (HH) is a rare genetic disorder, developing secondary to the accumulat... more Hereditary hemochromatosis (HH) is a rare genetic disorder, developing secondary to the accumulation of iron in tissues, which may lead to multiple organ failure. If untreated, it may result in liver cirrhosis or cardiomyopathy. The damage to the pancreas and the anterior pituitary, on the other hand, leads to a decreased production and secretion of hormones that are essential to life. Common symptoms of HH, that are distressing for patients, include joint pain, particularly involving hands and wrists, as well as the chronic fatigue syndrome. Iron overload affects the skeletal system, leading to osteoporosis. The pathological accumulation of iron in the anterior pituitary impairs the gonadotropin synthesis, resulting in reduced serum levels of testosterone in men and estrogens in women. This, however, contributes to lower bone mass. In vivo tests have also revealed that abnormal iron accumulation is related to an increased activity and number of osteoclasts, as well as the influence on the differentiation and activity of osteoblast-lineage cells. Based on a systematic review of literature, hereditary hemochromatosis (HH) will be presented as a chronic disease, affecting most of the endocrine glands.
Renin-Angiotensin-Aldosterone System in the Pathogenesis of Pregnancy-Induced Hypertension
Experimental and Clinical Endocrinology & Diabetes
SummaryHypertension occurs in 7–10% of pregnant women. Despite the continuous development of medi... more SummaryHypertension occurs in 7–10% of pregnant women. Despite the continuous development of medicine, it is still an important risk factor for perinatal mortality of both mothers and fetuses. Pregnant women with hypertension are at greater risk of complications such as: placental abruption, cerebral and cardiac incidents, multiorgan failure, and disseminated intravascular coagulation. The aim of this review was to discuss multilevel disorders of the renin-angiotensin-aldosterone system in the etiopathogenesis of pregnancy-induced hypertension.
Endocrine Journal
Cushing Syndrome-(CS) and Subclinical Cushing Syndrome (SCS), it is of high interest the correlat... more Cushing Syndrome-(CS) and Subclinical Cushing Syndrome (SCS), it is of high interest the correlation between different adipokines and cytokines secreted by adipose tissue, with metabolic disorders and hormonal activity in this group. Even in nonfunctioning adrenal incidentalomas (NFAI) elevated risk for cardiovascular disease and metabolic syndrome was demonstrated. The aim of the study was to investigate plasma adiponectin, leptin, resistin, tumor necrosis factor α (TNFα), interleukin 6 (IL6) and monocyte chemoattractant protein 1 (MCP1) levels in patients with NFAIs and healthy subjects. The study included 18 NFAI patients and 18 healthy subjects. The groups were homogeneous in terms of age, sex and body mass index (BMI). Patients with NFAI showed significantly higher circulating levels of pro-inflammatory cytokines compared to healthy controls (MCP 1: p < 0.001; TNFα p = 0.021; IL6 p = 0.012). On the other hand, adiponectin concentration was significantly lower in the NFAI group (p = 0.034). The serum leptin and resistin concentrations did not differ significantly between the two groups. Acquired results were not dependent on glucocorticoid and catecholamine secretion in NFAI patients. Also, there were no clear correlations between BMI and cytokine levels. It is possible that increased risk for cardiovascular and metabolic diseases reported in NFAI patients is at least partially dependent on adipose tissue activity.
International journal of cancer, Jan 23, 2018
The first two genome wide association studies (GWAS) of papillary thyroid carcinoma (PTC) detecte... more The first two genome wide association studies (GWAS) of papillary thyroid carcinoma (PTC) detected five variants associated with PTC. Two of them (rs944289 and rs116909374) are located at 14q13 making that locus an important target of research into the genetic predisposition to PTC. We aimed at uncovering other variants at 14q13 associated with PTC independently from the GWAS variants. We performed next generation sequencing of the 14q13 region and analyzed the allele frequencies of single nucleotide polymorphisms (SNPs) in n=90 PTC cases vs. n=379 EUR controls from the 1000 Genome Project. The variants associated with PTC were validated in an Ohio cohort of n=1216 PTC cases and n=1416 controls. Next, we analyzed the association between SNPs and expression of nearby genes and clinical parameters. We showed that rs368187 was associated with PTC (OR=1.31, p=2.20x10 ). Rs1632250, Rs1863347 and rs1755787 showed association with classical PTC (cPTC) (n=891; OR=1.24, 2.22x10 , OR=1.31, p=...
Expression of adiponectin and leptin receptors in adrenal incidentaloma patients with subclinical hormone secretion
Cancer biomarkers : section A of Disease markers, Jan 10, 2018
The role of adopokines in adrenal tumors' hormonal activity remains unclear. Obesity may indu... more The role of adopokines in adrenal tumors' hormonal activity remains unclear. Obesity may induce arterial hypertension, disorders of carbohydrate metabolism, and is a risk factor of cardiovascular disease. In patients with subclinical hormone secretion by the adrenal cortex or medulla the risk of metabolic disease is increased. Authors of this retrospective study selected 78 patients with subclinical hormone secretion out of all adrenal incidentaloma patients hospitalized in the Department of Endocrinology and Internal Medicine between 1995 and 2014. The analyzed group comprised of 38 subclinical Cushing's syndrome (SCS), 40 incidentally discovered pheochromocytoma (PHEO) and 42 patients operated due to an adrenal tumor without pathological hormonal activity. Expression of adiponectin (AdipoR1, AdipoR2) and leptin (Ob-R) receptors in adrenal tumors was assessed in relation to body mass index (BMI) and hormonal activity. We found statistically significant negative correlations...
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Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2017
Frontiers in endocrinology, 2017
Sarcomas represent less than 1% of all malignant tumors found in the thyroid. Of these, primary e... more Sarcomas represent less than 1% of all malignant tumors found in the thyroid. Of these, primary extraosseoussarcoma has been reported only a few times in the past decade. We present the case of a 34-year-old male who had a fast-growing hard mass in the lower left neck. FNA was inconclusive. Core needle biopsy revealed the diagnosis of an Ewing sarcoma/primitive neuroectodermal tumor. Mutation of EWSR1 was confirmed using the FISH method. Following treatment by neoadjuvant chemotherapy, we observed clinical, radiological, and finally histopathological remission. This was followed by a left-sided isthmolobectomy with unilateral cervical lymph node dissection by lateral lymphadenectomy, which revealed no residual disease. Posttreatment radiotherapy was administered but discontinued upon the patient's request. After 18 months of observation, the patient had no recurrence or metastasis and required l-thyroxine supplementation. We discuss our case using a comparative literature review...
The Korean journal of internal medicine, Jan 19, 2017
Endocrine, 2017
The authors report a rare case of bilateral Tolosa-Hunt syndrome, which occurred in a 80-year-old... more The authors report a rare case of bilateral Tolosa-Hunt syndrome, which occurred in a 80-year-old female and remitted spontaneously. Inflammatory lesions were found not only in typical locations, i.e. superior orbital fissures and cavernous sinuses, but also in the pituitary; these imitated gland's macroadenoma in imaging studies.
Diagnostic and prognostic role of SF1, IGF2, Ki67, p53, adiponectin, and leptin receptors in human adrenal cortical tumors
Journal of surgical oncology, 2017
The authors have examined the immunohistochemical expression of several proteins and their relati... more The authors have examined the immunohistochemical expression of several proteins and their relationship with adrenal cortical carcinoma (ACC) diagnosis and progression. A total of 83 patients with benign and malignant adrenal cortex tumors operated on in a single center were included in the study. Expression of the following proteins was examined: steroidogenic factor 1 (SF1), insulin growth factor 2 (IGF2), Ki67, p53, as well as adiponectin (Adipo R1, Adipo R2), and leptin (Ob-R) receptors. Multivariate analysis revealed that the expression of SF1, IGF2, and Adipo R1 and R2 receptors was associated with ACC diagnosis. An acknowledged proliferation marker Ki67 was related with the size of ACC and was an independent ACC diagnosis marker. The authors also assessed the relationship between immunohistochemical parameters and overall survival (OS) and disease progression. Only high IGF2 expression was associated with longer OS (P = 0.025). The most significant one for the prognosis of AC...
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Papers by Krzysztof Sworczak