Dear Readers,

This issue of “Postępy Nauk Medycznych” being made available to you, dedicated to lecturers running postgraduate education in endocrinology within courses organized by the Department of Endocrinology of the Medical Centre of Postgraduate Education (CMKP), except for original papers, includes an extended part of review articles. Endocrinology is one of the most dynamically developing, as well as exceptionally interdisciplinary fields of medicine. Disturbance in the function of endocrine glands, connected with their hyperactivity or hypofunction, frequently leads not only to characteristic changes in appearance, but also to multi-organ complications. For this reason, endocrine and cardiovascular system disorders were selected as a leading subject of this issue. I hope that the interdisciplinary subject of this issue will be interesting for many physicians, also for those who are not endocrinologists.

In the department publishing original papers, a report of Wojciech Stefan Zgliczyński, M.Sc. from the School of Public Health of CMKP was published, which should be interesting for individuals, whom this issue was dedicated for – endocrinology teachers. Based on questionnaires filled out during courses for endocrinologists, the author tries to create a description of the profile of a physician specializing in this area. The information obtained regarding the professional and family situation, as well as opinions and values dominating in this group, which on one hand should contribute to adequate development of human resource management policy and education planning, while on the other hand it should contribute to becoming familiar with one’s own community.

The issue brought to you, begins with an etiology profile of one of the largest global collection of cases including adrenal incidentaloma and analysis of hypertension incidence in this group. In the material, which includes 2430 patients with incidentally detected adrenalomas, 90% were diagnosed as benign lesions, 7% – adrenocortical carcinoma, 0.5% with other malignant primary neoplasms of the adrenal glands, and 2.5% – metastases of neoplasms from other organs. Hypertension occurred in ca. 40%, but hypertension in only about 1/3 of them may be connected with lesions in the adrenal glands.

In the paper reporting studies on connections between abdominal and gynoid obesity as well as links between markers of metabolic disorders and androgen levels in serum of women with PCO, only a correlation between abdominal obesity and triglycerides level as well as between an insulin level and hypertension were demonstrated, but no relationship was established with concentration of androgens.

Publication evaluating clinical usability of libido disturbances in diagnosing late hypogonadism in male patients demonstrated that erection disorders are more specific symptoms of late hypogonadism in males than decreased libido, and it negatively correlates with total testosterone concentration.

Evaluation of vitamin D concentration in the group of 100 women with post-menopausal osteoporosis and diseases of the upper segment of the gastrointestinal tract who qualified for oral treatment with ibandronian revealed that vitamin D doses coming from combined preparations, which are used in Poland as a routine regimen, are not sufficient in terms of supplementation in the majority of cases. Vitamin D deficit may lead to a situation that even using modern, very effective antiresorptive drugs, will not be an efficient treatment preventing bone fractures.

The paper, which evaluates the efficacy of intravenous corticotherapy used in the form of weekly infusions in order to prevent exacerbation of orbitopathy in patients with Graves’ disease treated with radioactive iodine due to hyperthyroidism, revealed that this therapy is as effective as the previously commonly used oral therapy. However, there are some benefits coming from this intravenous method of treatment, which include a lower total dose of steroids and less frequent occurrence of adverse effects.

An interesting case report relates to a female patient with type 2 autoimmune polyglandular syndrome (APS 2), which includes diabetes mellitus, albinism and Graves’ disease. Within the course of Graves’ disease, severe orbitopathy occurred in this female patient, which required massive systemic intravenous corticotherapy. This treatment led to a significant increase in the demand for insulin. It seems that the experience of the authors obtained on the base of this difficult case may also be useful for other physicians.

The department publishing review articles also presents two publications related to typical endocrine diseases – acromegaly and Cushing’s syndrome, which lead to the occurrence of many complications in the cardiovascular system and significantly increased mortality. For this reason, each patient with diagnosed acromegaly and Cushing’s syndrome should be included in screening evaluations for the presence of complications in cardiovascular system, and in case they are present, the patient should undergo a suitable treatment. Curing or adequate control check-up of the course of acromegaly and Cushing’s syndrome result in improvement in the health condition, which contributes to prolonging the patients’ life.

The next two papers relate to thyrocardiac issues. One of the most common endocrine diseases, which is hypothyroidism, leads to heart failure, increase in peripheral resistance and hypertension, as well as to disturbances in cholesterol metabolism. It was emphasized in the paper that the consequences of hypothyreosis in the form of increased risk of ischemic disease and mortality due to cardiovascular causes may be reversible to a large extent as a result of substitutive treatment with L-thyroxin.

Adverse effects caused by amiodarone action, which are related to inducing disturbances in the thyroid function, become a large problem for cardiologists. Publication related to this matter provide us with much practical data in terms of diagnoses and treatment of these disturbances.

The problem of the influence of hyperaldosteronism on the cardiovascular system is also important for cardiologists. The authors of this paper emphasize that coronary disease, myocardial infarction, arrhythmias, paroxysmal atrial fibrillation and cerebral stroke, occur significantly more often in patients with primary hyperaldosteronism, comparing to the population with primary hypertension.

Suitable treatment of hyperaldosteronism should not only normalize blood pressure, but also inhibit adverse effect of aldosterone on the cardiovascular system.

In gynaecological practice, one of the most common endocrine diseases is polycystic ovarian syndrome (PCOS). In this article, which is mainly dedicated to gynaecologists, the authors emphasized that PCO syndrome frequently involves insulin resistance and hyperinsulinism, overweight or obesity, dyslipidemia and diabetes mellitus. Usually, it is accompanied by metabolic syndrome, which constitutes a risk factor for the development of diseases of the cardiovascular system. Treatment of patients with PCO syndrome depends on dominating symptoms, however, prophylaxis and prevention against metabolic complications should be considered at each stage of treatment.

At the end of the review articles, a very important interdisciplinary problem was presented, which relates to common vitamin D deficiency. There are more and more evidence confirming the key role of vitamin D deficiency as a risk factor for development of cardiometabolic diseases (including hypertension, type 2 diabetes mellitus and metabolic syndrome). Furthermore, vitamin D deficiency is connected with increase in the incidence of cardiovascular disorders and with elevated mortality.

I hope that the papers presented in this issue of “Postępy Nauk Medycznych” will be interesting not only for endocrinologists but also for physicians of other specialties, who come into contact with the interdisciplinary dimension of endocrinology in their clinical practice.