Correlation analysis between short-term insulin-like growth factor-I and glucose intolerance status after transsphenoidal adenomectomy in acromegalic patients: a large retrospective study from a single center in China

ABSTRACT Objectives: Our study aimed to investigate the associations of glucose tolerance status with insulin-like growth factor-I (IGF-I) and other clinical laboratory parameters of acromegalic patients before and after the patients underwent transsphenoidal adenomectomy (TSA) by conducting a single-center, retrospective study. Subjects and methods: A total of 218 patients with acromegaly who had undergone TSA as the first treatment were retrospectively analyzed. Serum IGF-I, growth hormone (GH) and glucose levels were measured before and after surgery. Results: The follow-up levels for random GH, GH nadir, and the percentage of the upper limit of normal IGF-I (%ULN IGF-I) were decreased significantly. The percentages of normal (39.0%), early carbohydrate metabolism disorders (33.0%) and diabetes mellitus (28.0%) changed to 70.2%, 16.5% and 13.3%, respectively, after TSA. %ULN IGF-I at baseline was higher in the diabetes mellitus (DM) group than in the normal glucose tolerance group and impaired glucose tolerance (IGT) /impaired fasting glucose (IFG) groups before TSA, and the DM group exhibited a greater reduction in %ULN IGF-I value after surgery. The follow-up %ULN IGF-I value after surgery was significantly lower in the improved group, and Pearson's correlation analysis revealed that the reductions in %ULN IGF-I corresponded with the reductions in glucose level. Conclusion: This study examined the largest reported sample with complete preoperative and follow-up data. The results suggest that the age- and sex-adjusted IGF-I level, which reflects altered glucose metabolism, and the change of it are associated with improved glucose tolerance in acromegalic patients both before and after TSA.

Long-term follow-up of patients with elevated IGF-1 and nadir GH > 0 4 µg/L but < 1 µg/L

ABSTRACT Objective To report the results of initial investigation and after 5 years of patients with a suspicious clinical scenario for acromegaly, elevated IGF-1, and nadir GH during an oral glucose tolerance test (OGTT) > 0.4 µg/L but < 1 µg/L. Subjects and methods Seventeen patients who had elevated IGF-1 (outside puberty and pregnancy) in two measurements and GH between 0.4 and 1 µg/L during OGTT were selected. Results During initial assessment, only one patient had microadenoma on magnetic resonance imaging (MRI) of the pituitary. In this patient, IGF-1 returned to normal spontaneously after 5 years. In the remaining 16 patients, spontaneous normalization of IGF-1 was observed in four and IGF-1 continued to be elevated in 12 after 5 years. None of the latter patients developed a phenotype of acromegaly, changes in physiognomy or increase in IGF-1 and no tumor was detected by imaging methods. Two patients had nadir GH < 0.4 µg/L, while the nadir GH remained between 0.4 and 1 µg/L in 10 patients. Conclusion In patients (notably young adult or adult women) without a typical phenotype in whom IGF-1 is measured due to a suspicious clinical scenario and is found to be slightly elevated, even if confirmed and in the absence of other causes, a nadir GH cut-off value of 0.4 µg/L instead of 1 µg/L in the OGTT might be inadequate for the diagnosis.

Evaluation of preoperative ultrasonographic and biochemical features of patients with aggressive parathyroid disease: is there a reliable predictive marker?

ABSTRACT Objective Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don’t fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up. Subjects and methods Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters. Results Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease. Conclusion Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery.

Prolactinomas: evolution after menopause

ABSTRACT Objetive The aim was to assess the evolution of tumor size and prolactin (PRL) levels in patients with micro and macroprolactinomas diagnosed and treated with dopamine agonists during fertile age, and the effects of suspension of drugs after menopause. Retrospective study, 29 patients with prolactinomas, 22 microadenomas and 7 macroadenomas, diagnosed during their fertile age were studied in their menopause; treatment was stopped in this period. Age at menopause was 49 ± 3.6 years. The average time of treatment was 135 ± 79 months. The time of follow-up after treatment suspension was 4 to 192 months. Results Pre-treatment PRL levels in micro and macroadenomas were 119 ± 57 ng/mL and 258 ± 225 ng/mL, respectively. During menopause after treatment suspension, and at the latest follow-up: in microadenomas PRL levels were 23 ± 13 ng/mL and 16 ± 5.7 ng/mL, respectively; in macroadenomas, PRL levels were 20 ± 6.6 ng/mL 5t5and 25 ± 18 ng/mL, respectively. In menopause after treatment suspension, the microadenomas had disappeared in 9/22 and had decreased in 13/22. In the group of patients whose tumor had decreased, in the latest follow-up, tumors disappeared in 7/13 and remained unchanged in 6/13. In macroadenomas, after treatment suspension 3/7 had disappeared, 3/7 decreased and 1/7 remained unchanged. In the latest control in the 3 patients whose tumor decreased, disappeared in 1/3, decreased in 1/3 and there was no change in the remaining. Conclusions Normal PRL levels and sustained reduction or disappearance of adenomas were achieved in most of patients, probably due to the decrease of estrogen levels. Dopamine agonists might be stopped after menopause in patients with prolactinomas.

Serological under expression of microRNA-21, microRNA-34a and microRNA-126 in colorectal cancer

PURPOSE: This paper describes the ability of miRNA value predict oncological outcomes in CRC patients and correlates to clinical and pathologic variables. METHODS: We prospectively analyzed the serological expression of microRNA-21, microRNA-34a, and microRNA-126 in 37 stage II - IV CRC patients and correlate to seven fit counterparts. Serological microRNAs were extracted using the miRNeasy Mini Kit(r) (Qiagen, Hilden, Germany). Quantification of microRNAs was performed using TaqMan Master Mix(r) reagent (Applied Biosystems, USA). RESULTS: We obtained serological underexpression microRNA-21, microRNA-34a, and microRNA-126 in CRC group. However, miRNAs serological values do not impact prognosis. Furthermore, miRNAs was not influenced by CEA values, TNM staging, and histological subtype. CONCLUSION: Despite lower expression of miR-21, miR-34a and miR-126 in the CRC group, no association with poor prognosis was found.

Criterios para la indicación selectiva de glucocorticoides en pacientes con tumores hipofisiarios sometidos a cirugía transesfenoidal / Selective use of glucocorticoids during the perioperative period of transsphenoidal surgery for pituitary tumors

Background: There is consensus in promoting the selective use of glucocorticoids (GC) in the peri-operative period of transsphenoidal surgery (TE) for pituitary adenomas (PA). Aim: To evaluate the safety of a selective glucocorticoid administration protocol and the usefulness of immediate postoperative cortisol levels as a predictor of final eucortisolism. Patients and Methods: Clinical and biochemical data from 40 patients aged 27 to 78 years (65% males) were prospectively collected. Exclusion criteria were previous use of GC, apoplexy and Cushing disease. Patients with pre-operative short synthetic ACTH test (SST) > 18 µg/dl or basal cortisol > 15 µg/dl did not receive GC. A morning serum cortisol (SC) threshold of 10 µg/dl in postoperative days one to three was used to decide a discharge without GC. Hypotension, dizziness or nausea, requirement of increased dose of corticosteroids, hospitalizations and emergency service visits were investigated, as well as surgical and endocrinological complications. Corticotropic status was evaluated three months after surgery. Results: Macroadenomas were present in 87% of patients. Median hospital stay was 4 days and follow up lasted 9 months. No differences were found in gender, age or tumor size between patients who received or not GC (35 and 65% respectively). Eighty five percent of patients were discharged without GC and all of them had normal corticotropic function three months after surgery. A SC ≥ 15 µg/dl had 100% specificity to predict eucortisolism. Conclusions: Selective glucocorticoid administration is safe. A normal corticotropic function before surgery and in the immediate postoperative period are useful to identify patients who do not need GC.

Hiperparatiroidismo primario con normocalcemia, una asociación de diagnóstico complejo: a propósito de un caso clínico / Normocalcemic hyperparathyroidism: report of one case

We report a 59 years old female with a history of nephrolithiasis and progressive worsening of her bone mineral density. High serum PTH levels were detected, with normal serum calcium. Causes of secondary hyperparathyroidism were discarded. The patient was followed during six years, period in which she maintained elevated serum PTH and normal serum calcium. During the second year of follow up, hydrochlorothiazide was indicated. Serum calcium raised progressively and after six years, it became abnormally high. The patient was subjected to a total left lobe and subtotal right lobe thyroidectomy. The surgeon found a 1.6 mm diameter left parathyroid nodule. After surgery the patient is asymptomatic and is receiving levothyroxine supplementation.

Serum concentrations of fatty acids and colorectal adenoma risk: a case-control study in Japan.

BACKGROUND: Epidemiologic studies of n-3 fatty acids (FAs) and risk of colorectal cancer have generated inconsistent results, and relations with precursor colorectal adenomas (CRA) have not been evaluated in detail. We here focused on possible associations of serum FAs with CRA in the Japanese population. METHODS: We conducted a case-control study of 203 asymptomatic CRA cases (148 men, 55 women) and 179 healthy controls (67 men, 112 women) during 1997-2003 in Nagoya, Japan. Baseline information was obtained using a lifestyle questionnaire and serum FA levels were measured by gas chromatography. RESULTS: A non-significant inverse association with CRA was observed for eicosapentaenoic acid (EPA) among women. Moreover, the concentrations of docosahexaenoeic acid (DHA), a major component of n-3 highly-unsaturated FAs (HUFAs), were significantly lower in cases in both sexes. In addition, serum concentrations of total FAs, saturated FAs (SFAs) and mono-unsaturated FAs (MUFAs) had strong positive links with CRA risk. In contrast, arachidonic acid (AA) and DHA were inversely related, with 66% and 59% risk reduction, respectively. Ratios of SFAs/n-3 PUFAs and SFAs/n-3 HUFAs exhibited significant positive relations with CRA risk but there was no clear link with n-6 PUFAs/n-3 PUFAs. CONCLUSIONS: Our findings suggest a promoting influence of SFAs and MUFAs along with a protective effect of DHA on CRA risk. However, further research is needed to investigate the observed discrepancy with the generally accepted roles of the AA cascade in carcinogenesis.

C-Reactive Protein Level and Colorectal Adenoma / 대한소화기학회지

BACKGROUND/AIMS: Recent studies implicated inflammation playing an important role in the occurrence and advancement of colorectal cancer. Colorectal adenoma as the representative precursor lesion of colorectal cancer has meaningful association with inflammation. Accordingly, the purpose of this study was to evaluate the association between serum C-reactive protein (CRP) levels and the risk of colorectal adenoma METHODS: This study was undertaken on 5,487 subjects (3,478 men and 2,009 women) who underwent colonoscopy at the Health Promotion Center in Kangbuk Samsung Hospital and Samsung Medical Center. The subjects were allocated into 3,505 normal control subjects and 1,982 patients with colorectal adenoma. The mean level of CRP was compared between the two groups, and the correlations with other variables were analyzed by multiple regression analysis. Also, the risk of colorectal adenoma according to CRP level and difference of CRP level according to the characteristics of adenomas were analyzed. RESULTS: There was no significant difference in serum CRP level between normal and colorectal adenoma group. After adjusting for the clinically significant variables of colorectal adenoma, multiple logistic regression analysis of the risk of colorectal adenoma according to the CRP level (3) and the CRP level according to characteristics of adenomas showed no significant difference. CONCLUSIONS: An inflammatory marker, CRP is not a risk factor for colorectal adenoma development.

The role of bilateral inferior petrosal sinus sampling in the diagnosis of Cushing's syndrome

Adrenocorticotropin hormone (ACTH)-dependent Cushing's syndrome is most often due to a pituitary corticotroph adenoma, with ectopic ACTH-secreting tumors representing approximately 15 percent of cases. Biochemical and radiological techniques have been established to help distinguish between these two entities, and thus aid in the localization of the neoplastic lesion for surgical resection. The test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (BIPSS). BIPSS is an interventional radiology procedure in which ACTH levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood levels before and after corticotropin hormone (CRH) stimulation. A gradient between these two locations indicates pituitary Cushing's, whereas the absence of a gradient suggests ectopic Cushing's. Accurate BIPSS results require hypercortisolemia to suppress normal corticotroph ACTH production and hypercortisolemia at the time of the BIPSS to assure excessive ACTH secretion. In some cases, intrapituitary gradients from side-to-side can be helpful to localize small corticotroph adenomas within the sella. BIPSS has rare complications and is considered safe when performed at centers with experience in this specialized technique.

A síndrome de Cushing (SC) ACTH-dependente é mais freqüentemente devida a um adenoma corticotrófico da hipófise, com os tumores ectópicos secretores de ACTH representando aproximadamente 15 por cento dos casos. Técnicas bioquímicas e radiológicas foram estabelecidas para permitir a distinção entre essas duas entidades e, assim, auxiliar na localização da lesão neoplásica para ressecção cirúrgica. O teste que oferece a mais alta sensibilidade e especificidade é a coleta bilateral de amostras de sangue do seio petroso inferior (BIPSS). BIPSS é um procedimento de intervenção radiológica no qual os níveis de ACTH obtidos da drenagem venosa bem próxima da hipófise são comparados com os níveis sanguíneos periféricos antes e após estímulo com corticorrelina (CRH). Um gradiente entre essas duas localizações indica SC hipofisário, enquanto a ausência de gradiente sugere SC ectópica. Resultados acurados na BIPSS requerem a presença de hipercortisolemia e que ela suprima normalmente a produção de ACTH pelo corticotrofos por ocasião da BIPSS para garantir a secreção excessiva de ACTH. Em alguns casos, os gradientes intra-hipofisários de um lado para outro podem ser úteis na localização de pequenos adenomas corticotróficos no interior da sela. A BIPSS raramente apresenta complicações, sendo considerada segura quando realizada em centros com experiência nessa técnica especializada.

El cateterismo bilateral y simult neo de los senos petrosos inferiores en el diagnóstico diferencial del síndrome de Cushing / Bilateral inferior petrosal sinus sampling in the differential diagnosis of ACTH-dependent Cushing's syndrome

Background: The features of pituitary ACTH-dependent Cushing syndrome are often indistinguishable from those of occult ectopic ACTH-dependent Cushing syndrome (CS). Aim: To assess the diagnostic accuracy of bilateral inferior petrosal sinus sampling (BIPSS) in the differential diagnosis of ACTH-dependent Cushing's syndrome as compared with ACTH levels and the overnight high dose dexamethasone suppression test (HDDST). Material and methods: Retrospective review of medical records of 23 patients (aged 19 to 63 years, 16 women) with surgically proven CS, 20 pituitarymicroadenomas (CD) and 3 with occult ectopic ACTH secretion (EAS). Results: No tumor was identifiable by imaging techniques. Mean plasma ACTH values were higher in patients with EAS than in CD (103± 110.2 and 73.1±41.98 pg/mL respectively, p=NS). Three patients with EAS and 3 patients with CD did not suppress cortisol with the HDDST. The sensitivity of the test was 86 percent and the specificity 100 percent. To improve the diagnostic outcome of BIPSS, an stimulation with Desmopressin (9 fig i.v) was performed in 9 patients. The threshold for a pituitary source, was defined as an inferior petrosal sinus to peripheral ACTH basal and post Desmopression ratio >2. BIPSS was successfully carried out in 22 patients and no complications occurred. In 6 patients BIPSS failed to meet the threshold criteria. In 3 patients, bronchial carcinoid tumors which proved to synthesize ACTH, were removed. The diagnostic sensitivity of BIPSS greatly improved from 86 percent to 100 percent after Desmopressin stimulation. BIPSS accurately predicted the ¡ateralization of the microadenoma in 8 of 12 patients (66 percent). Conclusions: The combination of Desmopressin stimulation with BIPSS was useful for the differential diagnosis of ACTH-dependent Cushing's Syndrome. However, the preoperative location of pituitary microadenomas was poorly predicted by BIPSS.

Resultados do tratamento cirúrgico na acromegalia com um único neurocirurgião e meta-análise cumulativa / Outcome of surgical treatment for acromegaly performed by a single neurosurgeon and cumulative meta-analysis / Outcome of surgical treatment for acromegaly performed by a single neurosurgeon and cumulative meta-analysis

Avaliamos retrospectivamente os resultados da cirurgia transesfenoidal num grupo de acromegálicos operados por um único neurocirurgião, comparando-os com uma meta-análise cumulativa de 10 séries (1.632 pacientes) publicadas entre 1992-2005. Estudamos 28 pacientes (17M/11F; 44,1 ± 12,7 anos; 27 com macroadenomas, sendo 86 por cento invasivos), acompanhados por 21,4 ± 17,6 meses após a cirurgia; eles foram classificados de acordo com a atividade da acromegalia em: 1) doença controlada (DC): GH basal ou médio < 2,5 ng/ml ou GH nadir no TTOG < 1ng/ml e IGF-1 normal; 2) não controlada (DNC): GH basal ou médio > 2,5 ng/ml ou nadir no TTOG > 1 ng/ml e IGF-1 elevado; 3) inadequadamente controlada (DIC): GH normal e IGF-1 elevado ou GH elevado e IGF-1 normal. Após a cirurgia, os níveis de GH reduziram de 61,7 ± 101,1 ng/ml para 7,2 ± 13,7 ng/ml (p< 0,001), e os de IGF-1 de 673,1 ± 257,7 ng/ml para 471,2 ± 285 ng/ml (p= 0,01). A taxa de remissão bioquímica foi de 57 por cento [10 pacientes (35,5 por cento) com DC e 6 (21,5 por cento) com DIC], similar àquela obtida na meta-análise de cirurgias de macroadenomas. Sete dos 28 pacientes foram submetidos à re-intervenção (4 operados em outro hospital e 3 pelo nosso neurocirurgião), sendo 5 (71,5 por cento) classificados como DC no pós-operatório. Invasão de seio cavernoso foi mais prevalente nos DNC e DIC, e desvio de haste hipofisária no grupo DNC. A taxa de remissão foi maior nas séries em que apenas um único cirurgião realizou os procedimentos (66 por cento vs. 49 por cento; p< 0,05). Em conclusão, esses dados comprovam que a experiência do neurocirurgião pode aumentar significativamente as taxas de remissão do tratamento cirúrgico da acromegalia, especialmente em tumores maiores e mais invasivos, e que a re-intervenção realizada por cirurgião experiente deve ser considerada nos algoritmos de abordagem terapêutica desta doença.

The aim of this retrospective study was to evaluate the results of transsphenoidal surgery in a group of patients with acromegaly who were operated by the same neurosurgeon. Our results were compared to those from a cumulative meta-analysis of 10 series (1,632 patients) published between 1992­2005. We followed 28 patients (17M/11F; 44.1 ± 12.7 yr; 27 with macroadenomas; 86 percent being invasive) during 21.4 ± 17.6 months after treatment. Patients were classified according to disease activity as follows: 1) controlled (CD): basal or mean GH < 2.5 ng/ml or nadir GH (OGTT) < 1 ng/ml and normal IGF-1; 2) uncontrolled (UCD): basal or mean GH > 2.5 ng/ml or nadir GH > 1 ng/ml and elevated IGF-1; 3) inadequately controlled (ICD): normal GH and elevated IGF-1 or elevated GH and normal IGF-1. After surgery, GH levels decreased from 61.7 ± 101.1 ng/ml to 7.2 ± 13.7 ng/ml (p< 0.001) and mean IGF-1 from 673.1 ± 257.7 ng/ml to 471.2 ± 285 ng/ml (p= 0.01). Biochemical remission rate was 57 percent [10 (35.5 percent) patients with CD and 6 (21.5 percent) with ICD], similar to the mean remission rate observed in the meta-analysis of surgical outcome of macroadenomas. Seven of 28 patients were submitted to surgical re-intervention (4 had been previously operated elsewhere and 3 by our neurosurgeon), with CD observed in 5 (71.5 percent) on follow-up. Cavernous sinuses invasion was more prevalent in UCD and ICD, whereas infundibular stalk deviation occurred only in patients with UCD. Remission rate was significantly higher in series where all surgical procedures were performed by the same surgeon (66 percent vs. 49 percent; p< 0.05). Thus, the surgeon's experience significantly improves the surgical outcome in acromegaly, especially in patients harboring large and invasive tumors, and re-intervention performed by an experienced surgeon should be considered in the algorithms for clinical management of this disease.

Association of serum lipids and apolipoprotein E gene polymorphism with the risk of colorectal adenomas

To investigate the relationship of serum lipids and apolipoprotein [apoE] gene polymorphism to colorectal adenomas. This study took place in the Department of Gastroenterology, Renmin Hospital of Wuhan University, PR China from June 2003 to March 2005. Ninety-eight patients with colorectal adenomas and 40 healthy subjects were enrolled, and their serum levels of triglyceride [TG], total cholesterol [TC], high density lipoprotein cholesterol [HDL-C], and low density lipoprotein cholesterol [LDL-C] were determined. The apoE gene polymorphism was identified by polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP]. Serum TC levels of colorectal adenomas group [5.32 +/- 0.85 mmol/L], distal colorectal adenomas group [5.58 +/- 0.63 mmol/L], and villous adenoma group [5.49 +/- 0.69 mmol/L] were higher than the control group [4.28 +/- 0.62 mmol/L, p=0.016], proximal colorectal adenomas group [4.82 +/- 0.58 mmol/L, p=0.038] and non-villous adenoma group [4.76 +/- 0.58 mmol/L, p=0.03]. Serum HDL-C levels of colorectal adenomas group [1.39 +/- 0.25 mmol/L] were lower than the control group [1.51 +/- 0.29 mmol/L] [p=0.035]. Serum lipids levels of each genotype in colorectal adenomas group were not statistically significant. Apolipoprotein E3/E4 genotypic frequency in colorectal adenomas group [7.1%] was lower than the control group [17.5%] [p=0.012]. The findings suggest that altered lipid metabolism may be differentially associated with colorectal adenomas and the persons with apoE E3/E4 genotype have lower risk suffering from colorectal adenomas than those with other genotypes

The syndromes of low-renin hypertension: "separating the wheat from the chaff"

Hiperaldosteronismo primário (HAP) é caracterizado por hipertensão com renina baixa, com ou sem hipocalemia, compreendendo o adenoma produtor de aldosterona (APA) e a hiperplasia adrenal bilateral ou HA idiopático (HAI). Em séries recentes usando a relação aldosterona (aldo, ng/dL):renina (ng/mLúh) (RAR) para rastreamento, a prevalência de HAP atinge 8-20% dos hipertensos; a predominância atual do HAI (>80%) sobre APA sugere a inclusão de hipertensos essenciais com renina baixa (HERB), nos quais aldo pode ser suprimida por expansão de volume. Avaliamos as características do teste RAR, obtido retrospectivamente de 127 pacientes com HAP (81 APA; 46 HAI) e 55 com hipertensão essencial (30 HERB; 25 com renina normal, HERN) estudados de 1975 a 1990. Usando a combinação de cutoffs de 27 para RAR e de 12ng/dL para aldo, obtivemos sensibilidade (S) de 89,8% e especificidade (E) de 98,2% na separação entre HAP e HE: todos os APA e 72% dos HAI (mas apenas um [3%] HERB) tinham valores acima destes limites. Dentre os 46 HAI, 10 (21,7%) tinham RAR <27 e destes, 4 tinham aldo <12ng/dL, virtualmente indistingüíveis dos HERB. Valores mais elevados de cutoff (RAR >100; aldo >20) permitem 84% de S e 82,6% de E na separação entre APA e HAI. Como HAI e HERB ("o joio") devem ser estágios do espectro de uma mesma doença, parece irrelevante a separação dessas entidades. Entretanto, identificação precisa do APA ("o trigo") é fundamental, por ser a única forma de HAP curável cirurgicamente. Assim, enquanto a suspeita de um APA precisa ser criteriosamente investigada e tratada cirurgicamente, pacientes com doença não tumoral (HAI e HERB) podem ser tratados com antagonistas do receptor de aldo, que também previnem os efeitos inflamatórios envolvidos no processo de fibrose e remodelação anormal do miocárdio.

Alterations in serum cholesterol levels in Benign colorectal tumours

Colorectal adenoma is the benign precursor of colorectal carcinoma. This study was designed to assess the relation between serum cholesterol levels and colorectal adenoma. Subjects were selected from males who underwent colonoscopy for various reasons. Among selected subjects, twenty were histologically confirmed cases of colorectal adenoma [constituting the patient group] and sixteen age- and body mass index [BMI]-matched were free from colorectal adenoma [constituting the control group]. Before any medical and surgical treatment, fasting blood samples were taken for the estimation of lipid fractions of various serum lipoproteins. Patients showed raised levels of serum cholesterol [P<0.05] and low density lipoprotein cholesterol [LDLc] [P<0.01], as compared to those in the control subjects. High-density lipoprotein cholesterol [HDLc] and triglycerides did not show statistically significant difference between patients and controls. The findings of the present study suggest that the patients with colorectal adenoma may have higher levels of total cholesterol and LDLc

Para Bombay phenotype--a case report.

Bombay phenotype is peculiar in that red cells are not agglutinated by antisera A, B or H; while serum contains anti A, B and H. Existence of modifying genes at independent loci with variable expression of ABO genes is postulated. We report here a case of partial suppression where antigens could be detected by elution tests and unlike classical Bombay type, normal amount of appropriate blood group substances were present in saliva. This case of para Bombay phenotype was detected as a result of discrepancy in cell and serum group ng. This highlights the importance of both forward and reverse grouping in ABO testing.

Incidence of Nelson's syndrome and residual adrenocortical function in patients of Cushing's disease after bilateral adrenalectomy.

Eighteen patients of Cushing's Disease, who had undergone bilateral "total" adrenalectomy 2 to 10 years back, were evaluated for residual adrenocortical function and for any evidence of Nelson's Syndrome. Surprisingly, all patients were discovered to have measurable plasma cortisol, albeit in the subnormal range. The standard criteria for accepting "completeness of adrenalectomy" were fulfilled in 16 patients. It was possible to wean one patient off replacement therapy. Thus, the dose of replacement steroids needs to be regulated according to the blood steroid levels in order to avoid unnecessary hypercortisolism. Radiological evidence of pituitary tumor diagnosed Nelson's Syndrome in 2 patients. Nelson's Syndrome was further suspected in 8 others who showed pigmentation. One of these had an enlarged sella and an erosion of the dorsum sellae, but had a normal CT scan. Another patient had evidence of incidental pituitary pathology (incidentaloma) which resolved spontaneously. Contrast enhanced CT scans of the sella are necessary for early detection of Nelson's Syndrome.

Significado de la concentración elevada de gastrina en pacientes con adenoma hipofisario / The significance of a high concentration of gastrin in patients with hipophyseal adenoma

Desde hace algún tiempo se ha venido tratando de modificar el concepto tradicional que define a una hormona: -un mensajero químico que producido por cierto tipo de células, navega por la circulación sanguínea hasta alcanzar a otra célula específica y distante, en donde ejerce su acción biológica-. En los últimos años se ha acumulado una enorme información que sustenta el concepto que la hormona es producida de manera ubicua y que no necesariamente tiene antes que "viajar" para ser reconocida por una gran variedad de células y que éstas son aparentemente inespecíficas. Es una ironía que la idea atrevida que formuló Starling a principio del siglo, resucite vigorosamente varia décadas después: Si, como estoy inclinado a creer, el crecimiento y actividad de todos los órganos del cuerpo están regulados por mecanismos químicos similares a los que he descrito; un mayor conocimiento de las hormonas y de su manera de acción, puede aclarar la forma como está controlado el cuerpo, el cual es la meta de la ciencia médica". De esta manera se conforma una imagen más cercana a la realidad fisiológica. Parece ser que el efecto de la hormona depende esencialmente de su estructura molecular, la cual se puede químicamente "metamorfiar", así como de su capacidad celular, expresada a través de sus receptores, para modular a ese mensajero. En 1954 Medawar bosquejó la teoría: "la evolución de la endocrinología no es una evolución de las hormonas, sino una evolución del uso para el cual se secreta la hormona: una evolución no de la estructura química, sino de la actividad biológica, de las reacciones y de la respuesta tisular". Otra contribución científica seminal consistió en la integración de los grandes sistemas que son responsables de conservar el equilibrio de medio interno, así los sistemas nervioso y endocrino actúan de manera concertada para mantener armónicamente todas las funciones vitales...