Piotr Kmieć

Vitamin D deficiency during winter months among an adult, predominantly urban, population in northern Poland

INTRODUCTION Vitamin D is vital in the regulation of the calcium-phosphate metabolism, has a direct impact on the musculoskeletal system, and also affects numerous other systems. Widespread vitamin D deficiency and its detrimental effect on health have been reported globally. Data concerning vitamin D status in Polish adult population is scarce. MATERIAL AND METHODS Ambulatory patients of an outpatient clinic in Gdańsk were included in the study. Serum concentrations of 25(OH) D, parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium and phosphorus were determined. In a questionnaire declared UVB exposure, dietary vitamin D and calcium intake, and health status of the subjects were assessed. Non- and parametric tests, logistic regression and population attributable risk were applied in data analysis. RESULTS 448 adults were examined from February to mid-April 2012, 305 women and 143 men, aged 19 to 86 (mean 46.3 ± 14.9 years). Mean 25-hydroxyvitamin D concentration was 14.3 ± 6.6 ng/mL. 84.4% of subjects were vitamin D deficient (25(OH)D < 20 ng/mL); 13.2% presented insufficient (20-30 ng/mL), and 2.5% (or 11 subjects) sufficient 25(OH)D concentrations. Significantly higher 25(OH)D concentrations were found in subjects who reported more UVB exposure, supplemented vitamin D orally and those who declared more physical activity. 21% of subjects had elevated serum PTH concentration (i.e. > 62 pg/mL); mean parathormone was 48.6 ± 25.2 pg/mL. A linear correlation was found between the logarithm of PTH and logarithm of 25(OH)D concentrations (r = -0.21, p < 0.001). CONCLUSIONS Results obtained here demonstrate the necessity of implementing a monitoring and prophylaxis programme of vitamin D deficiency in Poland.

Widespread vitamin D deficiency among adults from northern Poland (54°N) after months of low and high natural UVB radiation

INTRODUCTION Widespread vitamin D deficiency has been reported worldwide and evidence of its deleterious effects on health has been accumulating. There is insufficient data concerning vitamin D status among the Polish adult population. The aim of the study was to determine vitamin D status and factors influencing it - UVB exposure, supplementation, and diet - among adults in northern Poland following months of low and high natural UVB radiation. MATERIAL AND METHODS Adults were recruited in an outpatient clinic. All were examined twice in 2012: in winter (in February, March and the first half of April), and autumn (between 25 September and 8 November). Questionnaire examinations were performed, and serum concentrations of 25-hydroxy-vitamin D (25(OH)D), calcium, phosphorus, parathyroid hormone (PTH), and alkaline phosphatase (ALP) were determined. RESULTS 40 men and 69 women participated in the study (age 48.4 ± 15 years, body mass index (BMI) 25.9 ± 4.3 kg/m2, mean ± SD). Mean 25(OH)D serum level in winter was 13.3 ± 6.6 ng/mL, 81.1% of participants were vitamin D-deficient. Mean 25(OH)D concentration in autumn was 22.8 ± 7.9 ng/mL (42.2% of subjects were vitamin D-deficient). Median 25(OH)D and PTH concentrations between the two examination periods differed significantly (11.9 vs. 22.1 ng/mL, and 46.3 vs. 32.2 pg/mL, respectively). In autumn, negative correlations were found between: 25(OH)D and PTH serum levels, 25(OH)D and BMI values. When compared to respective counterparts, participants declaring vitamin D supplementation, and sunbed use had significantly higher median 25(OH)D concentrations. CONCLUSIONS UV exposure during the summer was insufficient to provide adequate vitamin D status for almost half of the participants by as soon as the early autumn. Our results suggest all-year-round vitamin D supplementation should be widely implemented.

Vitamin D deficiency in early autumn among predominantly non-elderly, urban adults in Northern Poland (54°N).

INTRODUCTION Data on vitamin D status among non-elderly adults from Central Europe are insufficient. Natural sunlight allows for cutaneous vitamin D synthesis only from April through August at latitudes over 54° in the northern hemisphere. In this study we aimed at determining vitamin D status among adults in the first weeks of autumn in northern Poland. MATERIAL AND METHODS A convenience sample of community-dwelling, predominantly urban and non-elderly adults was recruited in an outpatient clinic. Questionnaire and laboratory examinations were performed from September 26 through November 8. The latter comprised serum alkaline phosphatase activity (ALP), 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), calcium, and phosphorus concentrations. RESULTS 180 women and 124 men were enrolled into the study, aged 46+/-14.1 years (mean+/-standard deviation, SD). Mean 25-hydroxyvitamin D concentration of the studied sample was 21.1+/-9.3 ng/ml. More than 50% of studied subjects were vitamin D deficient (i.e. had 25(OH)D concentrations of less than 20 ng/ml), only 15.1% reached vitamin D concentrations of ≥30 ng/ml (sufficiency). Median 25(OH)D concentrations were higher in participants who declared longer sun exposure as well as those who supplemented vitamin D. A negative correlation was found between PTH and 25(OH)D concentrations: r=-0.23, p<0.001 (Spearman rank order test). DISCUSSION While there are a number of methodological limitations concerning the current study, the acquired results broaden the scarce amount of data on vitamin D status in Central Europe. Our data correspond well with those from previous studies. The presented study should be considered precursory to further research.

Liver metastasis of a neuroendocrine neoplasm of unknown primary origin in a female patient with a history of breast cancer

We report on and discuss a case of a female patient diagnosed with breast cancer in 1996, which was histopathologically assessed as an invasive ductal carcinoma. The patient was admitted to our Department in 2017 with a liver metastasis of a neuroendocrine tumour. On admission she had no symptoms of an endo-crinopathy and was in a good general condition. Due to unknown primary site of the metastasis and given the patient’s history of breast cancer, it was suspected that the breast cancer was in fact a neuroendocrine tumour. This hypothesis was confirmed by comparing histopathological specimens of the breast and liver tumours using advanced pathological methods.

Adipokine and cytokine levels in patients with adrenocortical cancer, subclinical Cushing's syndrome and healthy controls

Introduction: In recent years researchers have focused at hormonal activity in Cushings syndrome (CS) in connection with metabolic disorders and the role of adipokines and cytokines secreted by the adipose tissue. The aim of the study was to investigate levels of adipokines and cytokines in patients with: subclinical CS (SCS) – in relation to hormonal parameters of hypercortisolemia, and, adrenocortical cancer (ACC). Materials and methods: The study included 20 SCS as well as 7 ACC patients, and 18 healthy participants. Hormonal activity and serum concentrations of adiponectin, leptin, resistin, tumor necrosis factor alpha (TNF&agr;), interleukin 6 (IL6), and monocyte chemoattractant protein 1 (MCP1), were analyzed. Results: In SCS patients compared to healthy volunteers a trend toward higher concentrations of all pro‐inflammatory cytokines was noted, however, statistically significant differences were only found for TNF&agr; and IL6 (p=0.047 and p=0.028, respectively). Adiponectin concentrations were significantly lower in the SCS group (p=0.006). Serum adipokine and cytokine levels were independent of the presence of diabetes mellitus (DM) and hypertension (HT) in the SCS group. A significant correlation was found between subclinical glucocorticoid secretion and IL6 concentration (Pearsons r=0.517, p=0.02). Acquired results were independent of BMI. In ACC patients compared to controls higher IL6, TNF&agr; and MCP1 levels were recorded. Conclusion: It is possible that higher adipokine and pro‐inflammatory cytokine concentrations as well as lower anti‐inflammatory adiponectin concentrations comprise an additional risk factor of metabolic and cardiovascular diseases in SCS patients. It seems that at least among patients with SCS adipokine and cytokine secretion is independent of hormonal activity (except for IL6). HIGHLIGHTSAdipokine and cytokine secretion in SCS may increase cardiovascular risk.Adipokines and cytokines were not associated with secretion of glucocorticoids.The association of adipose tissue with ACC may be suggested.

Renin-Angiotensin-Aldosterone System in the Pathogenesis of Pregnancy-Induced Hypertension

Hypertension 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.