[Evaluation of urinary metanephrines for the diagnosis of pheochromocytoma]

Evaluate the assay of urinary metanephrines in diagnosis of pheochromocytoma [PH] and determine diagnostic cut-off values.This is a retrospective study about 87 patients suspected of pheochromocytoma,whose of 24-h urinary fractionated metanephrine was measured. These cases were collected from Internal Medecine Departments [A and B] at Charles Nicolle's Hospital. Two groups of patients were studied: a pheochromocytoma group [n=33] with a histologically-proven pheochromocytoma and a control group of 54 patients. Receiver Operating Characteristic [ROC] curves were used to determine the best sensitivities and specificities. The analysis of biological parameters showed that means and standard deviation of urinary fractionated metanephrines in pheochromocytoma group were significantly higher than those of control group. Sensitivity and specificity of urinary normetanephrine test [95% and 98.1% respectively] were higher than those of urinary metanephrine and 3-methoxytyramine. A correlation between urinary normetanephrine and tumor size of pheochromocytoma was found. Urinary fractionated metanephrines is an efficient biochemical test for the diagnosis of pheochromocytoma

Prognostic value of pheochromocytoma of the adrenal gland scaled score [PASS score] tests to separate benign from malignant neoplasms

Differentiating malignant from benign pheochromocytoma has been challenging when based on histologic features. This is due to the definition of malignant pheochromocytoma which are defined by the presence of metastases. A PASS score was developed and according to many authors, a PASS score> =4 identified potentially malignant tumors. To assess the prognostic value of PASS score in differentiating benign pheochromocytomas from malignant ones. The records of 11 patients with tumors diagnosed as "pheochromocytoma" were identified from 1970 to 2010 in the files of the pathology, intern medicine and biochemistry departments of the Charles Nicolle hospital and Pasteur Institute. Receiver operating characteristics [ROC] curve analysis was performed to evaluate the diagnostic performance of PASS. The logistic model was developed using the 11 predictive variables. Its performance was evaluated by calculating the area under the ROC curve and comparing it with that of the PASS. In benign tumors, The PASS score was <4 in 3 cases and >/= 4 in 6 cases. In malignant tumors, the PASS score was >/= 4 in both cases. According to the ROC curve analysis, a PASS equal or superior to 4 identifies malignant pheochromocytoma with a sensitivity of 50% and a specificity of 45%. I think that PASS score, despite its low sensitivity, may help to reserve the more aggressive treatment and narrow follow up for potentially malignant tumors. Widespread of this called score with complete clinical data will help to validate these findings and to add other prognostic factors of value that could be a part of this scaled score such as immunohistochemical findings

[Lack of association between renin-angiotensin system [RAS] polymorphisms and hypertension in Tunisian type 2 diabetics]

The genes encoding renin-angiotensin system [RAS] components are potent candidate genes in both hypertension and diabetes namely ACE encoding the angiotensin converting enzyme and AGT encoding angiotensinogen. It has been suggested that the insertion/deletion [I/D] polymorphism in intron 16 of ACE gene is associated with ACE levels, and M235T gene polymorphism is associated with plasma AGT levels. We examined in this report the association between ACE I/D and AGT M235T polymorphisms with hypertension status in Tunisian type 2 diabetic subjects. Thirty nine hypertensive and 22 normotensive type 2 diabetic Tunisian patients were recruited for this study. The I/D polymorphism of ACE gene was analysed with nested PCR in order to avoid mistyping heterozygous individuals and the M235T polymorphism of AGT gene was analysed using PCR and allele specific restriction. The distribution of DD, ID and II genotypes did not significantly differ between type 2 diabetic patients with or without hypertension [DD: 49%; ID: 41%; II: 10% vs DD: 36%; ID: 55%; II: 9%, respectively] [lasmbda[2]= .06, p=0.5 8]. There was also no significant statistical difference between these two groups for the M235T polymorphism [TT: 20%; MT: 54%; MM: 26% vs TT: 27%; MT: 41%; MM: 32%, respectively] lambda[2]=0.95, p=0.62] RAS polymorphisms do not seem to play a role in the development of hypertension in the studied Tunisian type 2 diabetic subjects

[Soluble transferrin receptor in the biologial diagnosis of iron deficiency. about 24 cases]

In inflammatory diseases, classical parameters of iron status [serum iron, serum ferritin. total iron-binding capacity of transferrin and transferrin saturation] are not very reliable. The purpose of this study is to investigate soluble transferrin receptor, its index and classical parameters of iron status [serum iron serum ferritin, total iron-binding capacity of transferrin and transferrin saturation] during iron-deficiency anemia and combined iron deficiency and inflammatory anemia. Out study concerned 24 patients: 18 patients with iron-deficiency anemia and 6 patients with combined iron-deficiency and inflammatory anemia, 55 healthy subjects were included as controls. Both groups underwent classical parameters of iron status [serum iron, serum ferritin, total iron-binding capacity of transferrin and transferrin saturation] and measurement of soluble transferrin receptor with its index. In iron-deficiency anemia, total iron-binding capacity of transferrin, soluble transferrin receptor and its index were enhanced, whereas serum iron, ferritinemia and transferrin saturation were low compared so controls. Compared to patients with iron-deficiency anemia, those with combined iron-deficiency and inflammatory anemia showed higher levels of serum iron and ferritinemia. In contrast, soluble transferrin receptor and its index did not vary significantly between both groups. Our findings show the interest of soluble transferrin receptor and its index in the detection of iron deficiency during anemia of inflammatory states

[Lipoprotein [A] as a risk factor for coronary artery disease]

Lp[a] may represent a link between the fields of atherosclerosis and thrombosis. Elevated Lp[a] levels > 300 mg/l have been associated with the presence of atherosclerotic disease. This prospective study initiated in 1995 and, until June 1999 enrolled 218 subjects divided in two groups: Gl: subjects with / without angiographically proven coronary artery disease[CAD], n = 124 and Gll: controls, n-94 The objective of this study was to assess the influence of high Lp[a] serum levels on the CAD. Secondary end point was to demonstrate a correlation between the level sevum Lp[a] and the severity of angiographic coronary findings, we found that the cases had significantly [p = 0.004] higher Lp[a] levels than the controls and that correlation existel between the value of Lp[a] serum levels and severity of angiographic findings. However, we do recommend Lp[a] screening for patients with curly CA 1:] or a family history of CAD