Papers by Marek Bolanowski
Endokrynologia, Otyłość i Zaburzenia Przemiany Materii, Apr 26, 2012
Endokrynologia Polska, 2016
Introduction: Klotho is a transmembrane protein that attenuates insulin/insulin-like growth facto... more Introduction: Klotho is a transmembrane protein that attenuates insulin/insulin-like growth factor-1 (IGF-1) signalling and appears to be involved in ageing. Recent data suggest that soluble a-Klotho (sKlotho) is also elevated in acromegaly. The aim of this study was to assess serum levels of sKlotho in patients in relation to the activity of the disease and to compare with the control group. Material and methods: We studied 55 patients with acromegaly and 29 healthy controls (CG). Patients were divided into three subgroups according to minimal GH (growth hormone) concentration during the oral glucose tolerance test (OGTT) and the IGF-1 concentration: a surgically cured acromegalic group (SCA), well-controlled acromegalic group (WCA), and active acromegaly group (AA). In all subjects, blood samples were taken to assess the concentration of sKlotho, GH, IGF-1, and biochemical markers. Results: Soluble a-Klotho was highest in the AA group and lowest in the SCA group. The differences in sKlotho levels were statistically significant when the AA group was compared to the SCA, WCA, and CG groups (p = 0.000, p = 0.002, p = 0.001, respectively). There were no significant differences in sKlotho levels among the SCA, WCA, and CG groups. sKlotho positively correlated with GH levels in the WCA and WCA + SCA groups (r = 0.666, p = 0.009; r = 0.366, p = 0.047, respectively) and with the IGF-1 level in the AA group (r = 0.589, p = 0.021). Conclusions: sKlotho is increased in active acromegaly and normalises after successful treatment. It could be a new biomarker of acromegaly activity.
Endokrynologia Polska, Feb 22, 2019
Acromegaly is a rare, chronic condition caused by growth hormone (GH) overproduction, usually due... more Acromegaly is a rare, chronic condition caused by growth hormone (GH) overproduction, usually due to a benign tumour of the pituitary gland. During the disease many complications occur, including cardiovascular disease and changes in the musculoskeletal, respiratory, and endocrine systems. Treatment includes surgery, medical therapy, and radiation. In this paper a literature review was conducted for information related to costs of management of acromegaly and its associated comorbidities using PubMed. The majority of total costs represent pharmacological treatment, especially the most common somatostatin analogues (SSA) therapy. The average reported annual cost of SSA therapy is EUR 12,000-40,000. Surgery reduces the cost of care via the possibility of avoiding lifelong pharmacological treatment. Radiotherapy is also suggested to lower the costs of therapy because about 60% of patients eventually will not require further pharmacological treatment; however, it is connected with negative outcomes like hypopituitarism, lower quality of life, and increased mortality. Cabergoline and pegvisomant are the lowest and highest priced treatments, respectively, but the overall impact on the cost of therapy is minor due to less frequent usage of these drugs. It is hard to fully estimate the impact of comorbidities of acromegaly on financial burden because patients are treated for them many years before the diagnosis of the underlying pathology. The treatment cost of comorbidities is higher in uncontrolled patients. Lifelong treatment of acromegaly and its comorbidities is very expensive. Early diagnosis and successful treatment reduce direct and indirect costs.
Endokrynologia Polska, Feb 22, 2019
Acromegaly is a rare disease caused by excessive production of growth hormone (GH), typically by ... more Acromegaly is a rare disease caused by excessive production of growth hormone (GH), typically by a pituitary tumour. The diagnosis is usually delayed, and patients frequently develop various complications that cause premature mortality. In patients with hypertension, heart failure, diabetes, and arthropathies that are not age-specific, attention should be paid to signs of acromegaly. Insulin-like growth factor 1 (IGF-1) assay should be used as a screening test whenever acromegaly is suspected. Further diagnostic investigations and treatment should be carried out at specialist centres. First-line treatment involves selective excision of pituitary adenoma using transsphenoidal access. Patients with chances of cure with surgical removal of the pituitary tumour should be referred to centres that have experience in this type of procedure, following pharmacological preparation. Other patients, as well as patients after failed neurosurgical treatment, should first receive chronic treatment with first-generation somatostatin analogues. For second-line treatment, pasireotide, pegvisomant, cabergoline, or combinations thereof should be considered. In every case, acromegaly sequelae require lifelong monitoring and active treatment. Current recommendations, being an updated version of the recommendations published in Endokrynologia Polska in 2014, which take into account the Polish situation, should prove useful in the management of patients with acromegaly.
Cushing's syndrome (also known as hypercortisolemia) is rare in pregnant women due to the menstru... more Cushing's syndrome (also known as hypercortisolemia) is rare in pregnant women due to the menstrual disturbances and infertility in women with hypercortisolism. A diagnosis of pathological hypercortisolism in pregnant women is often difficult as some symptoms of the disease may be associated with a complicated pregnancy. Hypercortisolemia leads to serious complications for mother and foetus, and is associated with premature labour and high foetal mortality. Hormonal and radiological diagnostics in pregnancy are limited. The results of hormonal measurements and dynamic tests are difficult to interpret due to the physiological changes in the hypothalamo-pituitaryadrenal axis connected with pregnancy. The optimal time and method of treatment should be chosen cautiously case by case because of the possibility of maternal and foetal complications. In this paper, we present a case of Cushing's syndrome secondary to adrenal adenoma in which the diagnosis was made in the 22 nd week of pregnancy. Due to the advanced gestational status and mild symptoms of hypercortisolism, only symptomatic treatment was introduced. The patient was under continuous obstetric and endocrinological care. At 35 weeks of gestation, the pregnancy was terminated by emergency caesarean section because of premature detachment of the placenta. A male infant weighing 2,450 g was delivered; neither adrenal insufficiency in the child nor hypercortisolemia complications in the mother were observed.
Frontiers in Endocrinology, Nov 2, 2022
Background: Patients with primary adrenal insufficiency need lifelong replacement therapy with gl... more Background: Patients with primary adrenal insufficiency need lifelong replacement therapy with glucocorticoids and mineralocorticoids, which may influence their bone quality. Aim: The aim of the study was to evaluate densitometry parameters, trabecular bone score and sclerostin concentrations in patients with primary adrenal insufficiency in comparison to control group. Materials and methods: We included 29 patients (62% females) with diagnose of autoimmune primary adrenal insufficiency (mean age 49.7 ± 11.7 years, mean duration of the disease 13.2± 13.6 years) and 33 healthy subjects (adjusted with age, sex and body mass index). Bone mineral density at the femoral neck, lumbar spine, total body and trabecular bone score were evaluated. Serum sclerostin concentrations were measured. Results: There were no significant differences in densitometry parameters (Tscore, Z-score, bone mineral density in all locations) as well as in trabecular bone score in patients with adrenal insufficiency in comparison to control group. Mean serum sclerostin concentration was significantly higher in patients with adrenal insufficiency than in control group (44.7 ± 23.5 vs 30.7 ± 10.4 pmol/l, p=0.006). There was a negative correlation between trabecular bone score and the duration of adrenal insufficiency and age, also a negative correlation between femoral neck and total densitometry parameters and 24-hour urine cortisol as a marker of hydrocortisone daily dose in patients with adrenal insufficiency.
Frontiers in Endocrinology, Apr 21, 2022
This study aimed to assess bone mineral density (BMD) and trabecular bone score (TBS) in 61 patie... more This study aimed to assess bone mineral density (BMD) and trabecular bone score (TBS) in 61 patients from the acromegaly group (AG) with regard to the activity of the disease in comparison to 42 patients-control group (CG). We also analyzed selected bone markers and their association with BMD and TBS. Materials and Methods: Lumbar spine and femoral neck BMD measurements were performed. TBS values were obtained. Serum concentrations of selected bone markers, including osteoprotegerin (OPG), were measured. Results: We revealed a difference in TBS values between the AG and CG as well as between the TCA (treatment-controlled acromegaly) vs. CG and TCA+CA (cured acromegaly) vs. CG. We did not observe any statistically significant difference in BMD. OPG had a lower concentration in the CG compared to the AG. TBS correlated negatively with OPG in the AG (r = −0.31, p = 0.01) and in the TCA+ CA group (r = −0.3, p = 0.01). Conclusions: The acromegalic patients have altered bone microstructure as indicated by the decreased TBS regardless of the activity of the disease and BMD. OPG could be a marker of the destruction of the bone microstructure, but further studies are needed.
Frontiers in Endocrinology, Sep 24, 2019
Introduction: The vitamin D receptor (VDR) gene is one of the most widely studied tumorigenesis-r... more Introduction: The vitamin D receptor (VDR) gene is one of the most widely studied tumorigenesis-related genes. The primary objective of this study was assessment of possible roles of VDR gene polymorphisms in acromegaly, with regard to the activity of the disease and compared them with a control group. Furthermore, we have assessed the associations between these polymorphisms with vitamin D status as well as with TBS (trabecular bone score) and risk for osteoporotic fracture in acromegaly patients. Materials and Methods: We studied 69 patients with acromegaly and 51 healthy controls (CG). Acromegaly patients were divided into three subgroups on the basis of disease activity (AA, active acromegaly; CD, controlled disease; CA, cured acromegaly). In all patients, blood samples were obtained to assess the hormonal and metabolic status as well as genetic analysis. VDR polymorphisms were determined by means of two methods, Polymerase Chain Reactions (PCR) and minisequencing (SNaPshot). Results: Genotype frequencies for VDR ApaI, TaqI, BsmI, and FokI polymorphisms did not deviate significantly from Hardy-Weinberg equilibrium (HWE) in the acromegaly group as well as in the control group. There was no statistically significant difference in distributions of these four VDR genotypes between acromegaly patients and the control group. This study revealed statistically significant negative correlation between risk of major osteoporotic fractures and genotypes tt (TaqI), aa (ApaI) and bb (BsmI) in acromegaly groups. Furthermore, the negative correlations were observed between TBS and risk for major osteoporotic fractures and hip fractures. Conclusions: Our study suggests that tt (TaqI), aa (ApaI) and bb (BsmI) of VDR gene may be associated with better bone quality and microarchitecture (higher TBS), which lead to a lower risk of osteoporotic fractures in acromegaly patients. TBS may be a useful tool for predicting risk of fractures in acromegaly patients.
Frontiers in Endocrinology, Jan 21, 2021
Introduction: The impairment in bone microarchitecture and reduced bone quality are relevant mech... more Introduction: The impairment in bone microarchitecture and reduced bone quality are relevant mechanisms underlying the increased fracture risk in Cushing's syndrome (CS). The trabecular bone score (TBS) is a relatively novel textural index of bone microarchitecture. Purpose: The objective of the study was to compare TBS, bone mineral density (BMD), and fracture risk in patients with endogenous CS to controls. We have investigated the association of TBS with anthropometric parameters and 25(OH) vitamin D concentrations. Materials and Methods: The study group comprised 19 consecutive patients with CS (14 women and 5 men; mean age 45.84 ± 13.15 years) and sex-, age-matched 36 controls (25 women and men; mean age 52.47 ± 8.98 years). Anthropometric parameters, biochemical and hormonal data were compared between groups. Lumbar spine (L1-L4) and femoral neck BMD (LS BMD, FN BMD) measurements were performed. TBS values were obtained from lumbar spine DXA images. Results: TBS was significantly lower in patients with CS compared to controls (p = 0.0002). The 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture were significantly higher in the CS group than in controls (p = 0.03, p < 0.0001, respectively). All subjects from the CS group with fractures had low TBS value (degraded microarchitecture). TBS correlated negatively with the duration of disease in patients with CS (r =-0.590 p = 0.008). Conclusions: The patients with active CS have altered bone microstructure as indicated by the decreased TBS and are at higher risk of hip and a major osteoporotic fractures. TBS seems to be a very important analytical tool facilitating fracture risk assessment in endogenous hypercortisolism.
Endokrynologia Polska, Oct 29, 2015
Introduction: Klotho is a transmembrane protein that attenuates insulin/insulin-like growth facto... more Introduction: Klotho is a transmembrane protein that attenuates insulin/insulin-like growth factor-1 (IGF-1) signalling and appears to be involved in ageing. Recent data suggest that soluble a-Klotho (sKlotho) is also elevated in acromegaly. The aim of this study was to assess serum levels of sKlotho in patients in relation to the activity of the disease and to compare with the control group. Material and methods: We studied 55 patients with acromegaly and 29 healthy controls (CG). Patients were divided into three subgroups according to minimal GH (growth hormone) concentration during the oral glucose tolerance test (OGTT) and the IGF-1 concentration: a surgically cured acromegalic group (SCA), well-controlled acromegalic group (WCA), and active acromegaly group (AA). In all subjects, blood samples were taken to assess the concentration of sKlotho, GH, IGF-1, and biochemical markers. Results: Soluble a-Klotho was highest in the AA group and lowest in the SCA group. The differences in sKlotho levels were statistically significant when the AA group was compared to the SCA, WCA, and CG groups (p = 0.000, p = 0.002, p = 0.001, respectively). There were no significant differences in sKlotho levels among the SCA, WCA, and CG groups. sKlotho positively correlated with GH levels in the WCA and WCA + SCA groups (r = 0.666, p = 0.009; r = 0.366, p = 0.047, respectively) and with the IGF-1 level in the AA group (r = 0.589, p = 0.021). Conclusions: sKlotho is increased in active acromegaly and normalises after successful treatment. It could be a new biomarker of acromegaly activity.
Frontiers in Endocrinology, Mar 16, 2021
Introduction: In acromegaly, chronic exposure to impaired GH and IGF-I levels leads to the develo... more Introduction: In acromegaly, chronic exposure to impaired GH and IGF-I levels leads to the development of typical acromegaly symptoms, and multiple systemic complications as cardiovascular, metabolic, respiratory, endocrine, and bone disorders. Acromegaly comorbidities contribute to decreased life quality and premature mortality. The aim of our study was to assess the frequency of acromegaly complications and to evaluate diagnostic methods performed toward recognition of them. Materials and Methods: It was a retrospective study and we analyzed data of 179 patients hospitalized in the Department of Endocrinology, Diabetes and Isotope Therapy in Wroclaw Medical University (Poland) in 1976 to 2018 to create a database for statistical analysis. Results: The study group comprised of 119 women (66%) and 60 men (34%). The median age of acromegaly diagnosis was 50.5 years old for women (age range 20-78) and 46 for men (range 24-76). Metabolic disorders (hyperlipidemia, diabetes, and prediabetes) were the most frequently diagnosed complications in our study, followed by cardiovascular diseases and endocrine disorders (goiter, pituitary insufficiency, osteoporosis). BP measurement, ECG, lipid profile, fasting glucose or OGTT were performed the most often, while colonoscopy and echocardiogram were the least frequent. Conclusions: In our population we observed female predominance. We revealed a decrease in the number of patients with active acromegaly and an increase in the number of well-controlled patients. More than 50% of patients demonstrated a coexistence of cardiac, metabolic and endocrine disturbances and only 5% of patients did not suffer from any disease from those main groups.
Thyrotropin-secreting adenomas (TSH-oma) are very rare pituitary tumours. They are macroadenomas ... more Thyrotropin-secreting adenomas (TSH-oma) are very rare pituitary tumours. They are macroadenomas usually presenting with signs and symptoms of hyperthyroidism, and mass effects. They can co-secrete other hormones such as growth hormone or prolactin. Different malignancies, including haematological ones, are reported in patients with pituitary diseases. Chronic lymphocytic leukemia (CLL) occurs mostly in older patients, more often in males. CLL is associated with increased risk of second malignancies such as other blood neoplasms, skin and solid tumours. We present a successful neurosurgical outcome in a patient with an interesting coincidence of atypical TSH-oma and asymptomatic CLL.
Introduction: It has been reported that orexins may play an important role in GH regulation. Orex... more Introduction: It has been reported that orexins may play an important role in GH regulation. Orexins participate in the regulation of pituitary hormones secretion, food intake regulation, and the sleep-wake cycle. It has been suggested that a defect of orexin A synthesis could be responsible for disturbances in GH synthesis in patients with acromegaly, and consequently aggravate metabolic disturbances caused by high levels of IGF1. The aim of this study: The aim of this study was to assess orexin A levels in relation to the activity of the disease and the influence on metabolic profile in patients with acromegaly. Material and methods: The subjects were 55 acromegalic patients divided into three main groups: a surgically cured acromegalic group (SCA); a well-controlled acromegalic group (WCA); an active acromegalic group (AA); and 29 healthy controls. In all subjects, blood samples were taken to assess the concentration of orexin A, lipids, glucose, insulin and hormones of the pituitary and peripheral glands. Results: The concentration of orexin A was highest in the control group (CG) and lowest in the WCA group. The differences of orexin A concentration were statistically significant when each group of acromegalics were compared to the CG. There were no significant differences in orexin A concentration among the studied groups of patients with acromegaly. The metabolic disturbances were more often observed in the groups of acromegaly patients. In the AA group, orexin A concentrations correlated negatively with plasma lipids. Conclusions: The concentration of orexin A is reduced in acromegaly compared to healthy subjects.
Endokrynologia, Otyłość i Zaburzenia Przemiany Materii, May 12, 2010
Witamina D reguluje homeostazę wapniowo-fosforanową organizmu, bierze udział w procesach prolifer... more Witamina D reguluje homeostazę wapniowo-fosforanową organizmu, bierze udział w procesach proliferacji, dojrzewania i różnicowania komórek. Jej stężenia w organizmie człowieka są zmienne, zależą przede wszystkim od efektywnej biosyntezy w naskórku, w mniejszym stopniu także od podaży egzogennej. Powstawanie witaminy D w organizmie jest proporcjonalne do stopnia ekspozycji na promieniowanie słoneczne, stąd w różnych szerokościach geograficznych i w różnych porach roku stężenia witaminy D będą się różnić. Sezonowość stężeń witaminy D w ludzkim ustroju implikuje okresowe występowanie zachorowań lub zaostrzeń pewnych grup schorzeń (np.: reumatoidalnego zapalenia stawów, stwardnienia rozsianego, cukrzycy typu 1, choroby Leśniowskiego-Crohna, astmy oskrzelowej, nowotworów sutka, prostaty, jelita grubego, pierwotnego nadciśnienia tętniczego, choroby wieńcowej i niewydolności serca).
Endokrynologia Polska, Jun 30, 2021
A 32-year-old woman was referred to the Department of Endocrinology, Diabetes and Isotope Therapy... more A 32-year-old woman was referred to the Department of Endocrinology, Diabetes and Isotope Therapy from a Gynaecology and Obstetrics Department to which she presented on the 4 th day of childbed with severe headache, hypertension, bilateral leg oedema, and lumbar pain. Chest radiograph showed moderate amounts of right pleural effusion and compression atelectasis. Abdominal sonography revealed a heterogeneous hypoechogenic mass in the area of the upper pole of the right kidney. This finding was confirmed by computed tomography, which showed a 6.2/7.4/6.0 cm sized mass arising from right adrenal gland with inferior vena cava extension to the level of the right atrium. On admission the patient demonstrated elevated blood pressure, headache, bilateral leg oedema, and severe abdominal and lumbar pain. No signs of hypercortisolaemia or hyperandrogenism were observed on physical examination. Laboratory results are presented in Table 1. Laboratory findings revealed leukocytosis, elevated levels of C-reactive protein, alanine aminotransferase, fibrinogen and D-dimer, and thrombocytopaenia. Urine test showed proteinuria and erythrocyturia in urine sediment. Hormonal study revealed an increased serum concentration of cortisol measured in the morning and at midnight, as well as decreased plasma renin activity during recumbency and after 120 minutes of upright posture. Supine aldosterone and aldosterone after 120 minutes of upright posture were elevated. Serum testosterone and DHEA-S levels were very high. On the basis of the imaging and laboratory findings, the diagnosis of hormonally active adrenocortical carcinoma (ACC) was established. Because of extension of the tumour to the level of the right atrium via the inferior vena cava, trans-thoracic echocardiography (TTE) was performed. In TTE a large
Endokrynologia Polska, Dec 30, 2020
Introduction: Radiofrequency echographic multi-spectrometry (REMS) is a recently introduced non-i... more Introduction: Radiofrequency echographic multi-spectrometry (REMS) is a recently introduced non-ionising technology employed in the evaluation of osteoporosis. The aim of our study was to compare bone mineral density (BMD) in acromegaly patients and healthy controls by performing novel REMS densitometry. The second objective was to analyse the correlation between results of REMS and classical dual-energy X-ray absorptiometry (DXA) in acromegaly patients. Material and methods: We enrolled 33 patients with acromegaly (AG) and 24 controls (CG). The acromegaly patients were divided into two subgroups: well-controlled acromegaly (WCA) and surgery-cured acromegaly (SCA). REMS was performed in all participants, while DXA was performed only in the acromegaly group. IGF-I and GH levels were measured in acromegaly patients. Results: Bone mineral density of the lumbar spine (LS) and the femoral neck (FN) obtained from REMS did not reveal significant differences between AG, CG, WCA, and SCA. Similarly, there were no significant differences in BMD measured by DXA at the LS and at the FN between WCA and SCA. Significant positive correlations between IGF-I concentrations and BMD obtained from both REMS and DXA were detected in the AG and WCA. In the AG and WCA, there were positive correlations between T-scores and LS BMD obtained from both methods. Conclusions: Radiofrequency echographic multi-spectrometry is a potential method in assessment of bone status in acromegaly. Further studies with participation of active disease patients are needed.
Introduction: The presence of subclinical Cushing's syndrome (SCS) and some features of the metab... more Introduction: The presence of subclinical Cushing's syndrome (SCS) and some features of the metabolic syndrome were evaluated in adrenal incidentaloma patients. Material and methods: 165 patients were studied. Plasma cortisol, ACTH, DHEA-S, 17-OH-P, aldosterone, renin activity and 24-h urinary methoxycatecholamines were measured. Fasting concentrations of glucose, insulin, triglycerides, T-chol., HDL-chol. and LDL-chol. were determined and the FIRI and QUICKI indices were calculated. Blood pressure, WHR and BMI were determined in all patients. Forty healthy volunteers were the controls. Results: 133 patients had unchanged endocrine function, 32 demonstrated hormonal disturbances without clinical symptoms (in 26 nonclinical hypercortisolism). The WHR and blood pressure in the SCS group were significantly higher than in the patients with nonfunctioning adenoma (NA). T-chol and LDL-chol were significantly higher, but HDL-chol was significantly lower, in the SCS than in the NA patients. Fasting insulin level was significantly higher in the SCS than in the NA patients and controls, while fasting glucose level was comparable. QUICKI was significantly lower in the SCS and NA patients than in the controls, while FIRI was significantly higher in the SCS group. Conclusions: In incidentaloma patients, hormonal function of the adrenal gland should be estimated because some of them present subclinical hyperfunction. These patients frequently display features of metabolic syndrome such as insulin resistance, hypertension, high triglycerides, T-chol and LDL-chol levels. Subtle autonomous cortisol secretion may be the cause of these features.
Introduction: Osteoporosis is one of the commonest metabolic diseases of bone. Its possible cause... more Introduction: Osteoporosis is one of the commonest metabolic diseases of bone. Its possible causes may include thyroid hormonal dysfunction. The objective of this study was to evaluate the effects of hyperthyroidism and hypothyroidism on osseous tissue metabolism in premenopausal women. Material and methods: 38 women with hyperthyroidism, 40 with hypothyroidism and 41 healthy women participated in this study. Initially after 6 and 12 months, each patient underwent selected hormonal, immunological and biochemical tests, measurement of concentrations of bone turnover markers and densitometry were also performed. Results: On initial evaluation, lower cortical bone density was found in patients with hyperthyroidism (femoral neck). After 12 months, an increase in BMD was seen, but it was still lower than in the control group. Statistically significantly higher concentrations of bone turnover markers, decreasing from the sixth month of treatment, were noted only in the group with hyperthyroidism. Statistically significant differences were not noted in the femoral neck nor in the lumbar spine BMD in patients with hypothyroidism. Conclusions: Hyperthyroidism poses a negative effect on bone metabolism. Hypothyroidism in premenopausal females does not have any influence on bone density.
We present revised diagnostic and therapeutic guidelines for the management of pancreatic neuroen... more We present revised diagnostic and therapeutic guidelines for the management of pancreatic neuroendocrine neoplasms (PNENs) proposed by the Polish Network of Neuroendocrine Tumours. These guidelines refer to biochemical (determination of specific and nonspecific neuroendocrine markers) and imaging diagnostics (EUS, CT, MR, and radioisotope examination with a 68 Ga or 99 Tc labelled somatostatin analogue). A histopathological diagnostic, which determines the further management of patients with PNENs, must be necessarily confirmed by immunohistochemical tests. PNENs therapy requires collaboration between a multidisciplinary team of specialists experienced in the management of these neoplasms. Surgery is the basic form of treatment. Medical therapy requires a multidirectional procedure, and therefore the rules of biotherapy, peptide receptor radionuclide therapy, chemotherapy and molecular targeted therapy are discussed.
Endokrynologia, Otyłość i Zaburzenia Przemiany Materii, Aug 7, 2012
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Papers by Marek Bolanowski