PTU - Polskie Towarzystwo Urologiczne
list of articles:

LOW T3 SYNDROME IN PATIENTS SUFFERING FROM RENAL CELL CLEAR CARCINOMA (RCC). THE DEPENDANCE ON ITS DIAMETER (T) AND GRADING (G)
Article published in Urologia Polska 2000/53/3.

authors

Zbigniew Tański
Zakład Biochemii Klinicznej Studium Nauk Podstawowych
Centrum Medycznego Kształcenia Podyplomowego w Warszawie
Kierownik: prof. dr hab. A. Macke-Nauman

keywords

kidney renal clear carcinoma (RCC) low T3 syndrome

summary

Objective. Low T3 syndrome is characterized by the decrease in tT3 level
and fT3 level, the normal level of tT4 and fT4 and TSH level situated within
the norm. The pathogenesis of low T3 syndrome has not been entriely
recognized yet.
Material and method. The course of low T3 syndrome in patients suffering
from RCC was examined before, during and after radical nephrectomy. It
was explained if the concentration of tT3 in blood depends on the grading
and the diameter of the tumour. The concentration of tT3 and tT4 in blood of
the renal artery and vein in the neoplastic kidney and peripheral vein was
determind. It was done depending on the diameter (T) and grading (G) of
the tumour. The research was applied to 54 patients (20 F, 34 M) at the age
from 27 to 72 suffering from RCC, who were treated at the Urological Word
of the United Provincial Hospital in Ostrołęka. The patients were divided
into groups depending on the diameter of the tumour T (Ta-T4), and grading
G (GrG3). Concentrations of TSH, tT4, fT4, tT3 and fT3 in the blood serum
were determined. The blood was collected from the renal artery and vein,
peripheral vein of the patients suffering from RCC on the day of their
admission to the Ward, 30 minutes before the operation, during the operation
as well as 30 minutes after it. It was also collected from the peripheral vein 1,
2, 5, 7, 30 and 60 days after the operation. Hormones were determined with
the help of Abbott IMX, MEIA system.
Results. The obtained results of the research point out that RCC leads to the
pathogenesis of low T3 syndrome. Low T3 syndrome depends on the diameter
of the tumour and its grading. No significant differences in arterio-venous
gradients of tT3 concentration (renal artery and vein) were found. tT3 in
renal artery was higher than in renal vein. The low T3 syndrome in RCC
depends on the decrease in the level of de novo generated tT3 in neoplastic
cells and restricting the conversion of tT4 to tT3 in alt cells of the body.

references

  1. [1] Berry, M. J., Kieffer, J. D., Harney, W. H., Larsen, P. R.: Selenocystein confers
  2. the biochemical propenties characteristic of the type I iodothyronine deiodinase.
  3. J. Biol. Chem. 1991, 226,14155-14158.
  4. [2] Chopra, I. J.: Clinical review 86: Euthyroid sick syndrome: is it a misnomer?
  5. J. Clin. Endocr. Metab. 1997, 82, 329-334.
  6. [3] Chopra, L. J., Hershman, J. M., Pardridge, W. M., Nicoloff, J. T.: Thyroid
  7. function in nonthyroidal illnesses. Ann. Intern. Med. 1983, 98, 946-957.
  8. [4] Docter, R., Krenning, E. P, de Jong, M., Hennemann, G.: The sick euthyroid
  9. syndrome: changes in thyroid hormone serum parameters and hormone metabolism.
  10. Clin. Endocr. 1993, 39, 499.
  11. [5] Epstein, F. H.: The molecular basis of thyroid hormone action. N. Eng. J. Med.
  12. 1994, 331, "847-853.
  13. [6] Foster, K., Prowse, A., van der Berg, A.: Somatic mutations of the von Hippel-
  14. Lindau disease tumor suppressor gene in nonfamilial clear cell renal carcinoma. Hum.
  15. Mol. Genet. 1995, 70, 530-534.
  16. [7] Hesh, R. D.: The ?low T3 syndrome" (R. D. Hesh Ed.). Acad. Press, London
  17. 1981.
  18. [8] Koehrie, J., Oertel, M., Hoang-Wu, C, Schnieders, F., Brabant, G.: Type I,
  19. 5' -Deiodinase a marker for differentiated thyroid carcinoma? Exp. Clin. Endocr.
  20. 1993, 101, 60-72.
  21. [9] Lin, K., Lin, Y., Parkison, C, Cheng, S.: Stimulation of proliferation by 3, 3\
  22. 5-triiodo-L~thyronine in poorly differetiated human hepatocarcinoma cells overex-
  23. pressing beta 1 thyroid hormone receptor. Cancer Lett. 1994, 85,189-194.
  24. [10] Nauman, A., Nauman, J.: Choroby tarczycy w: Choroby wewnętrzne (pod red.
  25. A. Wojtczaka). PZWL, Warszawa 1995, t. III, 27-58.
  26. [11] Nauman, A., Nauman, ]., Pietrzykowski, A., Łuczak, J., Tański, Z., Dut-
  27. kiewicz, S., Witeska, A.: Triiodothyronine receptor in human renal clear cell can-
  28. cer; overexpression ofTb^ isoform in tumor cells. J. Endocr. Invest. 1997,20,69-78.
  29. [12] Nauman, A., Nauman, J., Witeska, A., Dutkiewicz, S., Tański, Z.,
  30. Kałczak, S., Pietrzykowski, A.: Deiodinase type I in human kidney cancer-
  31. clarocellulare. J. Endocr. Invest. 1998, 36-45.
  32. [13] Nauman, A., Puzianowska-Kuźnicka, M., Tański, Z., Łuczak, J., Cheng,
  33. S. Y., Nauman, J.: Expression and function of thyroid hormone receptor (TR) in
  34. human clear cell kidney cancer.
  35. [14] Nauman, A.: Mechanizm działania hormonu tarczycy na poziomie molekularnym.
  36. Post. Nauk Med. 1990, 4, 233-239.
  37. [15] Nauman, A.: Monodejodynacja tyroksyny do trijodotyroniny - specyficzność
  38. tkankowa. Regulacyjny wpływ katecholamin. Endocr. Pol. 1990,41, supl.
  39. [16] Nauman, A.: Tarczyca i mechanizmy regulujące wydzielanie aktywnego hormonu
  40. - trijodotyroniny. Endokr. Pol., 1993, 44,109-116.
  41. [17] Nauman, J., Nauman, A., Pietrzykowski, A., Łazęcki, D., Dutkiewicz
  42. S., Tański Z., Witeska, A., Kauczak, M.: The low T3 syndrom in patients with
  43. kidney cancer - effect of cancer differentation. Endokr. Pol. 1996, 47, 365-374.
  44. [18] Nauman, J., Nauman, A., Witeska, A., Dutkiewicz, S.: 5*-deiodinase in
  45. human kidney cancer. J. Endocr. Invest. 1993,16, 76-107.
  46. [19] Nauman, J., Nauman, A.: Racjonalna diagnostyka zaburzeń czynności tarczycy.
  47. Abbott diagnostics - programy edukacyjne 1996,11-14.
  48. [20] Nicoloff, J. T., LoPresti, J. S.: Nonthyroidal illnesses. J. Endocr. Metab. 1994,
  49. 665-673.
  50. [21] Oppenheimer, J. H., Schwartz, H. L., Strait, K. A.: Thyroid hormone action
  51. 1994. Eur. J. Endocr. 1994,130,15-24.
  52. [22] Pietrzykowski, A.: Receptory jądrowe trijodotyroniny (T3R fij i kwasu retinowego
  53. (RAR (5) w gruczolaku nerki typu jasnokomórkowego u człowieka. Rozprawa dok-
  54. torska. CMKP, Warszawa 1997.
  55. [23] van der Hout, A. H., van der Berg, E., van der Vlies, P., Dijkhuizen, T.,
  56. Storkel, S., Oosterhuis, J. W., de Jong, B., Buys CH.C.M.: Lossofheterozy-
  57. gosity at the short arm ofchromosome 3 in renal-cell cancer correlates with the cyto-
  58. logical tumor type. Int. J. Cancer 1993, 53, 353-357.
  59. [24] van der Poił, T., Romijn, J. A., Wiersinga, W. M., Sauerwein, H. P: Tumor
  60. necrosis factor: A putatwe mediator of the sick euthyroid syndrome in man. J. Clin.
  61. Endocr. Metab. 1990, 71,1567-1571.
  62. [25] Wartofsky, L.: The low T3 or "sick euthyroid syndrome": Update 1994. Endocr.
  63. Soc. 1994, 3, 248-252.