Impairment in flow-mediated vasodilatation of the brachial artery in acromegaly

The aim of this study was to assess flow-mediated dilatation [FMD] of the brachial artery in patients with acromegaly. We prospectively evaluated 25 patients with acromegaly [14 females, 11 males; aged 42 +/- 12 years; growth hormone [GH] levels 34 +/- 14 ng/ml] and 27 control subjects [15 females, 12 males; aged 45 - 8 years; GH levels 3 +/- 1.5 ng/ml]. The patients and controls were matched for age, gender, body mass index, cigarette smoking, blood pressure, lipid levels, diabetes mellitus, hypertension, and its duration. Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in the 2 groups. The endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery. The FMD was lower in patients with acromegaly [9.97 +/- 3.5%] than in controls [16.1 +/- 3.4%], and the difference was statistically significant [p = 0.0001]. Endothelial dysfunction may develop in the preclinical phase of atherosclerosis in patients with acromegaly. Endothelium-dependent FMD may be impaired in acromegalic patients, and measurement of endothelial function may identify high-risk individuals earlier

Dopamine-secreting adrenal ganglioneuroma presenting with paroxysmal hypertension attacks

Adrenal ganglioneuromas are rare tumors originating from the neural crest tissue of the sympathetic nervous system. The clinical presentation for most patients is asymptomatic, and most of these tumors are hormone silent. We report a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient. A 46-year-old woman was admitted to our hospital with a 2-month history of right flank pain, and a 2-year history of paroxysmal hypertensive attacks associated with headaches, palpitations, nervousness, and sweating. Abdominal CT and MRI revealed a solid round tumor approximately 4 cm in diameter on the upper pole of the right kidney. Urinary levels of dopamine and homovanillic acid were slightly elevated, although urinary levels of metanephrine and normetanephrine were suppressed. The urinary levels of epinephrine, norepinephrine, and vanillylmandelic acid were within normal limits. Right adrenalectomy was performed for treatment purposes. Histological diagnosis of the tumor was a ganglioneuroma originating from the adrenal medulla. In conclusion, this is a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient

Carotid body tumors and adrenal pheocchromocytomas in siblings of a turkish family

This is a report of 2 hypertensive siblings with a history of carotid body tumors and subsequent benign adrenal pheochromocytomas [pheos] in a family where the mother had died of possible adrenal carcinoma. The first case was a 35-year-old woman with paroxysmal hypertensive attacks and a right adrenal mass. She had earlier undergone surgery to remove bilateral carotid body tumors. Investigation revealed excessive excretion of catecholamines and their metabolites in the urine. Abdominal MRI and 131I-MIBG scintigraphy revealed a right adrenal tumor. Right adrenalectomy was performed. The second case, the 45-year-old brother of the first case, was found to have a left adrenal mass on abdominal MRI. Catecholamines and their metabolites in the urine were found to be increased. He had also had surgery to remove bilateral carotid body tumors of the neck. Left adrenalectomy was performed. Both siblings showed no evidence of other familial syndromes, such as multiple neoplasia type 2, von Hippel-Lindau disease or neurofibromatosis type 1. Although the combination of familial carotid body tumors and pheo is rare, a patient who remains hypertensive after removal of a carotid body tumor deserves a careful evaluation to exclude pheo. Such tumors may be extra-adrenal or multifocal

Coagulation and fibrinolysis parameters in type 2 diabetic patients with and without diabetic vascular complications

To investigate the markers of endogenous coagulation/fibrinolysis and vascular endothelial cell function, and to assess the relationships between hemostatic parameters and diabetic vascular complications in type 2 diabetic patients. Materials and Coagulation and fibrinolysis parameters were measured in 92 type 2 diabetic patients [43 male, 49 female, mean age 50.1 ' 13.4 years] with [n = 44] and without [n = 48] vascular diabetic complications, and in 40 nondiabetic healthy subjects [20 male, 20 female, mean age 49.8 ' 15.1 years]. Common lipid parameters were also measured. The plasma levels of fibrinogen, antithrombin III [AT III], plasminogen activator inhibitor-1 [PAI-1], von Willebrand factor [vWF] activity and prothrombin time were found to be significantly increased in the type 2 diabetic patients compared with the healthy subjects. Glycosylated hemoglobin lc was inversely correlated with plasma protein S and activated prothrombin time. Protein C and S activities were positively correlated with plasma vWF activity, and were negatively correlated with plasma t-PA levels. vWF activity was negatively correlated with plasma t-PA levels. AT III levels were positively correlated with plasma total cholesterol levels, plasma low density lipoprotein cholesterol levels, plasma triglycerides and D-dimer levels. Plasma PAI-1 levels and factor V activity in diabetic patients with microvascular complications were significantly higher than those of the diabetic patients without microvascular complications. The plasma PAI-1 and platelet count were increased in patients with diabetic retinopathy compared with the diabetic patients without retinopathy. Plasma PAI-1 levels and factor VII activity were significantly higher in the diabetic patients with nephropathy than in diabetic patients without nephropathy. Plasma concentrations of fibrinogen and PAI-1 were significantly higher in the diabetic patients with neuropathy than the diabetic patients without neuropathy. The data demonstrated that patients with type 2 diabetes mellitus had a hypercoagulable state and hypofibrinolysis, thereby indicating that activation of coagulation with a reduced fibrinolytic activity may contribute to the increased risk of vascular disease in type 2 diabetic patients

Leukocytoclastic vasculitis: a rare manifestation of propylthiouracil hypersensitivity

We report a case of leukocytoclastic vasculitis as a manifestation of propylthiouracil hypersensitivity. A 66-year-old woman with a history of a toxic adenoma was referred for evaluation of a purpuric rash on the legs and buttocks bilaterally. She was biochemically hyperthyroid. Biopsy of the skin lesions revealed leukocytoclastic vasculitis. Propylthiouracil therapy was discontinued, and methimazole started. The purpuric rash resolved and surgical treatment for toxic adenoma resulted in euthyroid state. This report indicated that leukocytoclastic vasculitis should be considered in the differential diagnosis of patients with a vasculitic rash. The discontinuation of the propylthiouracil was associated with disappearance of the lesions