In this article, we present a case of a 49-year-old woman presenting with a recurrent metastatic neuroendocrine tumor. Background: Insulinomas are neuroendocrine tumors derived from beta cells of the pancreas that secrete insulin. Usually, they are benign tumors; however, metastatic insulinomas are an extremely rare malignant form of these tumors, carrying a significantly worse prognosis. Case Presentation: A 49-year-old woman, a patient in the University Hospital in Wroclaw in the Department of Endocrinology, Diabetes and Isotope Therapy, first presented with abdominal pain in 2009, when ultrasound and further examination led to the diagnosis of a tumor in the pancreas (a solid pseudopapillary tumor of the pancreas—meta NET G2), and the patient underwent distal pancreatectomy with splenectomy. For ten years, she was under observation, and her symptoms, such as abdominal pain, nausea, weight loss, and general weakness, reappeared in 2019. Then, magnetic resonance imaging (MRI) showed a lesion in the liver, and further histopathology revealed neuroendocrine tumor (NET) metastasis to the liver. In 2022, the patient presented with loss of consciousness and convulsion, loss of weight, and hypoglycemia after meals. In April 2022, the daily glycemic profile was recorded and a 72 h fasting test was performed; however, their results excluded insulinoma. Positron emission tomography–computed tomography (PET-CT) with 18F-fluorodeoxyglucose (18F-FDG) and PET with gallium-68-DOTA-(Tyr3)-octreotate (68Ga-DOTA-TATE) showed a metastatic proliferative process in the liver. Persistent hypoglycemia led to another hospitalization in May 2022, and repeated tests allowed for the diagnosis of insulinoma. Treatment with somatostatin analogs and diazoxide was started. A CT scan in November 2022 and a PET scan in January 2023 showed new metastases to the liver, bones, and cervical lymph nodes, and it was decided to intensify the treatment. In May 2023, the patient was qualified for Lutathera treatment for insulinoma at the University Clinical Hospital in Poznań. In June 2023, another disturbing symptom was reported by the patient, a painful lump in the breast. During diagnostics, metastases with high proliferation markers were found in both breasts. Two months later, in August 2023, the patient received another dose of Lutathera. In October 2023, significant progression of liver lesions, metastases to bones of the spine, ribs, and pelvis, and periaortic and pelvic lymphadenopathy were found as well as elevated values of neuron-specific enolase and calcitonin. The patient was also referred to the Palliative Medicine Home Hospice. In consultation with the Lower Silesian Cancer Center, the decision was made to forgo further treatment with PRRT and initiate systemic chemotherapy. Despite the chosen treatment, the patient died on 27/DEC/2023. Conclusions: This case report can serve clinicians, as it presents a case of an extremely rare and insidious tumor, metastatic insulinoma.

Kardiochirugia i Torakochirurgia Polska 2022; 19 (1): 47-48

Introduction and purpose:Sleep deprivation (SD), paradoxically, has been shown to induce rapid antidepressant effects in patients with depressive disorders. This review explores the neurobiological underpinnings, clinical efficacy, and therapeutic strategies involving SD, aiming to clarify the mechanisms responsible for its mood-elevating effects and to assess its role in modern treatment of depression. Description of the state of knowledge:Clinical evidence consistently shows that a single night of total or partial SD can lead to a rapid reduction in depressive symptoms in approximately 40–60% of patients. However, these effects are short-lived, with relapse typically occurring after recovery sleep. Combination therapies, such as SD with phase advance and bright light exposure, have been developed to prolong therapeutic benefits. On the neurobiological level, SD appears to act through multiple pathways: resetting dysregulated circadian rhythms, enhancing monoaminergic neurotransmission (particularly serotonin and dopamine), upregulating brain-derived neurotrophic factor (BDNF), and inducing synaptic plasticity. Acute activation of the hypothalamic–pituitary–adrenal axis and transient increases in inflammatory markers have also been observed, suggesting a complex physiological adaptation that accompanies mood improvement. Additionally, glial mechanisms involving adenosine signaling may contribute to the antidepressant response. Summary:Sleep deprivation represents a unique, non-pharmacological intervention capable of rapidly alleviating depressive symptoms. Although transient on its own, its combination with chronotherapeutic or pharmacological strategies offers promising avenues for sustained therapeutic effect. Insights from SD research deepen our understanding of depression’s neurobiology and support the development of fast-acting antidepressant treatments that target circadian and neuroplastic mechanisms.

Introduction and purposeVitamin B12 deficiency remains an underdiagnosed condition with significant hematological, neurological, and psychiatric consequences. The aim of this review is to evaluate and compare the efficacy, indications, and clinical applicability of oral, sublingual, intramuscular, and subcutaneous vitamin B12 supplementation routes, and to provide evidence-based recommendations tailored to patient-specific conditions. Brief description of the state of knowledgeVitamin B12 is primarily absorbed in the distal ileum via an intrinsic factor-mediated mechanism. Deficiency is commonly caused by malabsorption syndromes, restrictive diets, medication use, and autoimmune disorders such as pernicious anemia. Intramuscular and subcutaneous administration bypass absorption defects and are considered the gold standard, especially in symptomatic patients. Oral and sublingual routes are increasingly used due to ease of use and cost-effectiveness. Sublingual supplementation, in particular, shows comparable biochemical efficacy to intramuscular injection and offers higher patient satisfaction. However, the variability in absorption and the use of surrogate biomarkers limit the consistency of clinical outcomes across studies. SummaryAll forms of vitamin B12 supplementation can be effective when used appropriately. Intramuscular administration remains superior in cases of severe deficiency and neurological involvement. Oral and sublingual supplementation are suitable for long-term maintenance and mild deficiencies, especially in patients with adherence capacity and no profound malabsorptive conditions. Clinical decision-making should be guided by etiology, severity, patient preference, and logistical feasibility.