[Prolactin--a marker of the activity of connective tissue systemic disease?]. / Prolaktin--marker aktivity systémových ochorení spojiva?

The ethiopathogenesis of auto-immune diseases has not yet been fully explored. Auto-immune diseases develop in individuals with a genetic pre-disposition. Among the endogenous factors, also sexual hormones play a role, especially prolactin. The objective of the study was to use basal exam and TRH test to determine stimulated prolactin values in patients with a systemic connective tissue disease: systemic lupus erythematosus (SLE), systemic sclerosis, Sjögren's syndrome, dermatomyositis. PATIENT GROUP AND METHODS: The authors examined 43 patients with systemic connective tissue diseases: 20 patients with SLE, 7 patients with Sjögren's syndrome, 7 patients with systemic sclerosis and 9 patients with dermatomyositis. The mean age of the patients was 39.87 years. The control group consisted of 30 volunteers with a mean age of 35.17 years. OUTCOME: Prolactin level in the patients with systemic connective tissue diseases was 14.629 ng/ml, which is more than in the control group. A statistically significant increase in prolactin level was recorded 20 minutes after i.v. stimulation as compared with the control group (30.982 ng/ml). This statistically significant difference was still present 60 minutes after the TRH administration, with 16.43 ng/ml in the control group, and 36.890 ng/ml in the systemic connective tissue disorder patient group. The differences between prolactin levels for the different systemic connective tissue diseases were not statistically significant. A positive correlation in the patient group was found between the stimulated prolactin values and the FW value. On the whole, however, there was no clear correlation found between laboratory activity and prolactin levels. CONCLUSION: The authors found out that post-stimulation prolactin levels were statistically significantly higher in patients with systemic connective tissue disease as compared with the control group. Correlation analyses did not show a clear link between inflammatory activity and prolactin levels, and therefore the authors assume that medium increased values of prolactin are rather a risk factor for the disease than an inflammation marker in patients with a systemic connective tissue disease.

[Dynamic changes in the QT interval during the head-up tilt test in patients with vasovagal syncope]. / Dynamické zmeny QT intervalu pocas head-up tilt testu u pacientov s vazovagálnou synkopou.

Dynamic changes of the QT and QTc interval as well as QT dispersion and QTc dispersion during the head-up tilt test were investigated in 15 patients (8 men, mean age 32 years) with vasovagal syncope (VVS) and a positive head-up tilt test and in a control group of 15 patients with syncope in the case-history and a negative head-up tilt test (9 men, mean age 33 years). The value at rest of the QT interval did not differ in patients with VVS and controls. In controls at the beginning of HUT shortening of QT occurred (0.447 sec. vs. 0.419 sec. p = 0.0002), subsequently the QT did not change significantly. In patients with VVS during the beginning of the test only an insignificant shortening of QT occurred, while during the development of the syncope QT was prolonged (0.394 sec. vs. 0.420 sec. p < 0.0001). QT corrected for the pulse rate (QTc) did not change significantly during HUT. QTc dispersion was in patients with VVS significantly lower 3 minutes before the development of the syncope (0.067 sec. vs. 0.085 sec. p = 0.03), which may indicate the decline of the sympathetic and increase of the parasympathetic tonus which subsequently leads to the development of vasovagal syncope. QTc dispersion before the test was higher in patients with VVS as compared with controls (0.087 sec. vs. 0.063 sec., p = 0.03), which suggests an increase in the baseline sympathetic tonus in patients with VVS.

[Prolactin levels before and after stimulation with thyroliberin in primary hypothyroidism]. / Koncentrácie PRL pred a po stimulácii tyreoliberínom u primárnych hypotyreóz.

The authors examined the concentration of thyrotropic hormone (TSH) and prolactin (PRL) before and after stimulation with synthetic thyroliberine (0.2 mg TRH i.v.) in a group of 72 women with primary hypothyroidism (mean age 45 years, range 17-69 years) and 12 controls (mean age 35 years, range 17-49 years). According to the total thyroxin concentrations (TT4) and TSH they divided the group into three smaller subgroups: developed primary hypothyroidism (n = 8, mean age 50 years, TT4 < 65 nmol/l, basal TSH concentration > 15.0 mIU/l nmol/l), subclinical hypothyroidism, severe grade (n = 23, mean age 36 years, TT4 > 65 nmol/l, basal TSH concentration < 4.5 mIU/l), subclinical hypothyroidism mild degree (n = 39, mean age 42 years, TT4 > 65 nmol/l, basal TSH concentration < 4.5 mIU/l, TSH after TRH stimulation > 25 mIU/l). Mean basal PRL concentrations were in all three patient groups significantly higher than in the control group (P < 0.01) but mutually they did not differ significantly. Poststimulation PRL concentrations were also significantly higher than in controls however the values in developed hypothyroidism were significantly higher than in subclinical patients. No correlation was found between TSH and PRL concentrations.

[Effect of passive leg lifting on sodium excretion in patients with liver cirrhosis]. / Vplyv pasivneho zdvihnutia dolnych koncatin na exkreciu sodika u chorych s cirhozou pecene.

18 healthy subjects and 15 patients with liver cirrhosis were examined using a 2-hour method of passive leg rising (PLR). Renal and hormonal responses to PLR were investigated. There was a significant increase in diuresis (p < 0.01) and sodium excretion (p < 0.01) simultaneously with a decrease in plasma renin activity (p < 0.01) and plasma aldosterone (p < 0.01) in the group of healthy subjects. Similarly, in the group of patients with liver cirrhosis a significant increase in diuresis (p < 0.01), natriuresis (p < 0.05) together with a decrease in plasma renin activity (p < 0.05) and aldosterone (p < 0.01) were detected. 3 of 15 patients were nonrespondents. We conclude that PLR leads to central volume expansion which causes suppression of sodium retaining factors, and the increase in diuresis and natriuresis not only in healthy objects but also in cirrhotics. This simple method may be used as the first therapeutic regimen in patients with cirrhosis and edemas. (Tab. 2, Fig. 3, Ref. 13.)

[Adrenal incidentalomas]. / Adrenálne incidentalómy.

The extensive use and progress in the improvement of imaging techniques brings about the growing incidence of incidentalomas, i.e. adrenal lesions accidentally revealed during the imaging of the abdominal cavity which was originally focused on the visualisation of organs other than adrenal glands. Despite the fact than the majority of incidentalomas (55-91%) represent benign adrenocortical adenomas, it is necessary to focus the diagnostic approach on the exclusion of malignity and hormonal activity. However, no common consent has been yet achieved in the management of incidentalomas. The authors review the literature data on the prevalence, diagnosis (namely hormonal assessments as well as imaging methods) and the current suggestion of the necessity of further investigation and treatment of adrenal incidentalomas. (Tab. 1, Fig. 5, Ref. 64.)

Humoral mechanisms in the pathogenesis of postprandial hypotension in patients with essential hypertension.

OBJECTIVE: To examine the role of catecholamines and insulin in the development of postprandial hypotension (PPH) in hypertensive patients. PATIENTS: Forty patients with essential hypertension (25 men, 15 women, mean age 68 +/- 2 years). METHOD: Blood pressure and heart rate were recorded in all subjects immediately after a 1903 kJ test meal and at 15-minute intervals for up to 1 hour after the meal. At these time points, circulating levels of norepinephrine, epinephrine, dopamine and C-peptide were measured. RESULTS: Twenty-three patients (58%) had PPH. By 15 minutes norepinephrine had significantly increased in PPH-negative subjects while it rose more slowly in PPH-positive patients and peaked by 45 minutes after the meal. Norepinephrine levels in 15 minutes were lower in PPH-positive than in PPH-negative ones (159.8 +/- 9.7 vs. 212.3 +/- 21.1 pg/ml, p = 0.01). Epinephrine levels rose only in PPH-negative subjects and did not differ significantly at the different time points. However, the area under curve analysis showed significantly lower epinephrine values in PPH-positive subjects (2903 + 247 pg.min.ml-1 vs. 3710 + 284 pg.min.ml-1, p = 0.03). Dopamine increased in both groups, although it was lower in subjects with PPH during the entire study (15 minutes: 68.6 +/- 3.7 vs. 93.7 +/- 11.7 pg/ml, p = 0.02; 30 minutes: 68.8 +/- 3.7 vs. 86.1 +/- 7.7 pg/ml, p = 0.03; 45 minutes: 60.5 +/- 4.2 vs. 79.7 +/- 5.2 pg/ml, p = 0.006). The postprandial C-peptide response did not differ between patients with PPH and those without PPH. CONCLUSIONS: In patients with essential hypertension, a marked decline in postprandial systolic blood pressure is associated with lower postprandial levels of norepinephrine, epinephrine and dopamine as compared to subjects without postprandial hypotension. This indicates that impaired sympatho-adrenal activation after ingestion of a meal may contribute to the development of PPH. Insulin appears not to be involved in the pathogenesis of postprandial hypotension.

[Mitral stenosis evaluated with three-dimensional echocardiography]. / Mitrálna stenóza hodnotená trojrozmernou echokardiografiou.

The authors evaluated the possibilities of three-dimensional echocardiography in the assessment of the severity of mitral valve stenosis. In 45 patients, the Doppler pressure half-time method was compared with two three-dimensional echocardiographic methods in the measurement of mitral valve orifice: anyplane echocardiography and surface rendering. There was significant relation between them: r = 0.74 and r = 0.70, both p < 0.0001. In addition, mitral valve stenosis was also quantified by two new indices, such as the doming volume of the mitral apparatus and mitral valve volume. Subgroup analysis revealed relation between atrial fibrillation and decreasing doming volume as well as significantly higher mitral valve volume in patients with critical stenosis. Associated valve abnormalities did not influence the mitral orifice measurement neither by Doppler method nor three-dimensional echocardiography. In conclusion, three-dimensional echocardiography allows reliable assessment of mitral stenosis and moreover provides new quantitative indices, which can be clinically important in the assessment of three-dimensional geometry of the mitral apparatus.

Prolactin and interleukin 2 concentrations before and after i.v. TRH application in primary hypothyroidism and in controls.

The authors evaluated serum level of prolactin (PRL) and interleukin 2 (IL-2) before and after i.v. application of tyreoliberin (TRH) 0.2 mg in 10 women as controls and 10 women with primary hypothyreoidism. In controls, there was a significant increase of IL-2 20 min following application of TRH (IL-2 0 min: 17.95 +/- 11.69, IL-2 in 20 min: 33.36 +/- 17.73 fmol/l), in patients with hypothyreoidism the serum level of IL-2 decreased (IL-2 0 min: 31.32 +/- 19.0, IL-2 in 20 min: 19.11 +/- 17.8 fmol/l). The basal concentration of IL-2 in patients with hypothyreoidism was significantly higher as in controls (p < 0.01). The presented finding indicated relation between the neuroendocrine and immune system but its value is not yet apparent. (Tab. 4, Fig. 1, Ref. 7.)

[Hormonal and morphologic characteristics of adrenal incidentalomas]. / Hormonálna a morfologická charakteristika adrenálnych incidentalómov.

The authors analyse hormonal and morphological characteristics of adrenal incidentalomas, i.e. pathological adrenal masses accidentally found on CT scan performed due to extraadrenal causes of other causes of adrenal pathology. The group of patients was consisted by 42 patients at the age 24-79 years (27 females and 15 males). The most frequent clinical symptoms included arterial hypertension, diabetes mellitus and obesity. CT examinations revealed 36 cases of unilateral lesions (in 21 cases the lesions were localised on the right and in 15 cases on the left) and 6 bilateral lesions. The size of adrenal masses ranged from 7 mm to 12 cm. The CT examination helped in characterising myelolipomas in 3 cases, cysts in two cases, and pre-assuming malignity in 6 cases. Hormonal analyses have revealed primary aldosteronism in 2 cases, subclinical hypercortisolism in 1, steroid enzymopathy in 2 and secondary hyperaldosteronism in 2 patients. No patient had catecholamine overproduction. 19 patients were indicated for adrenalectomy with the following histological findings.: adenoma (n = 5), cyst (n = 2), myelolipoma (n = 3), carcinoma (n = 3), feochromocytoma, ganglioneuroma, metastases, lymphoma, sarcoidosis and pseudodrenal structure--Gravitz tumor (n = 1, respectively). The size of all neoplasms exceeded 3 cm, therefore the authors recommend adrenalectomy in incidentalomas with hormonal activity exceeding 3 cm in size. (Tab. 2, Fig. 1, Ref. 17.)

Midodrine hydrochloride in the treatment of vasovagal syncope.

Therapy of vasovagal syncope is still a subject of debate. Various pharmacotherapies were proposed. However, they are often not tolerated or ineffective. The purpose of this prospective, nonrandomized study was to evaluate the usefulness of alpha-agonist midodrine hydrochloride in the treatment of vasovagal syncope. Forty-one patients (mean age 34 years, 18 men) with history of recurrent syncope and positivity of head-up tilt testing were included (28 patients with type 1, 10 patients with type 2, 3 patients with type 3 according to VASIS classification). In all patients oral therapy with midodrine was started. Initial dose was 2.5 mg two times daily. When necessary, the dose was increased to 5 mg two times daily. Efficacy of treatment was assessed by repeated head-up tilt testing after 1-2 weeks of therapy and by long-term follow-up. After midodrine hydrochloride treatment, 39 of 41 patients (95%) had no inducible presyncope or syncope on repeated tilt table testing. Effective dose was 2.5 mg two times daily in 25 patients and 5 mg two times daily in 16 patients. During a mean follow-up period 19+/-9 months, 38 of 39 patients (97%) with negative repeated tilt table test remained free of syncope recurrence.

A study of the renal sodium excretion during the normal menstrual cycle using method of passive leg rising.

12 healthy women (age 18-38 years) were examined using the 2-hour's method of passive leg rising (PLR) in follicular (FP) and luteal (LP) phases of normal ovulatory cycle. Renal and hormonal response to PLR was investigated. There was a significant increase of diuresis (from 53 +/- 9 ml/h to 298 +/- 27 ml/h in FP, from 69 +/- 12 to 324 +/- 28 ml/h in LP) and natriuresis (from 4.5 +/- 0.9 to 9.8 +/- 1 mmol/h in FP, from 5.7 +/- 0.3 to 12.1 +/- 1.1 mmol/h in LP), simultaneously with a decrease of plasma renin activity (PRA) and plasma aldosterone (PA) in both FP and LP. Baseline PRA was mildly and PA was significantly higher in LP compared to FP. Urinary osmolarity, heart rate and systolic blood pressure dropped significantly. Renal and hormonal response to PLR were identical in the two phases of the menstrual cycle. Authors conclude that 1/PLR causes significant diuresis and natriuresis due to central volume expansion and may be used as a simple stimulating test of renal sodium excretion, 2/renal sodium retention does not occur in the LP of normal ovulatory cycle.

Occurrence and relevance of postprandial hypotension in patients with essential hypertension.

The aim of this study was to determine the occurrence of postprandial hypotension (PPH) in patients with arterial hypertension, identify its risk factors and evaluate the importance of postprandial blood pressure reduction in relation to the management of hypertension. Forty-nine patients (23 male; 26 female; mean age 65.6 +/- 12 years) with diagnosed hypertension underwent measurement of blood pressure and pulse rate before intake of a standardised breakfast (1821 kJ) and at 15-minute intervals until 1 hour thereafter. The orthostatic test for detection of orthostatic hypotension was performed before the ingestion of food. PPH was detected in 22 patients (45%) with arterial hypertension. Patients treated with diuretics had significantly greater postprandial reductions in blood pressure compared to those who received no diuretic treatment. Levels of premeal systolic blood pressure, age, orthostatic hypotension, history of syncope cardiovascular disease or stroke were not associated with a more severe decline in postprandial blood pressure. Maximal reductions in blood pressure were recorded approximately 33 +/- 15 minutes after ingestion of food. Therefore, recent intake of food should be taken into account in the evaluation of hypertension and the effect of antihypertensive drugs when blood pressure is measured within one hour after a meal.

[Conn's syndrome and severe arrhythmias]. / Connov syndróm a závazné arytmie.

In the submitted case-history the authors describe Conn's syndrome. A solitary cortical adenoma was involved manifested at first by so-called "lone" atrial fibrillation (idiopathic without organic causes). The trigger factor of the life threatening ventricular tachycardia were variable values of serum potassium and treatment of atrial fibrillation by anti-arrhythmic drugs.

[The renin-angiotensin-aldosterone system and serum lipoproteins in patients with essential hypertension]. / Systém renín-angiotenzín-aldosterón a sérové lipoproteíny u chorých s esenciálnou hypertenziou.

The authors investigated the relationship between the activity of the renin-angiotensin-aldosterone system and serum lipid levels in patients with essential hypertension (EH). They examined 72 patients with EH stage I and II WHO classification (group A, n = 72, age bracket 16-70 years). They investigated the plasma renin activity (PRA), plasma aldosterone (PA) and total cholesterol (TCH), HDL, LDL cholesterol and triglycerides (TG). They divided the group into three sub-groups according to the PRA into low (L), normal (N) and high renin groups (H) In the whole group they did not find significant differences in the lipid levels in relation to PRA. They selected from the group patients older than 40 years (group B) and in those they recorded significantly higher TCH levels in group H as compared with normal (N) (p < 0.05) and L (p < 0.05) and significantly higher LDL levels in group H as compared with L (p < 0.01). They found a significant direct relationship between PRA and TCH (p < 0.05) and between PRA and LDL (p < 0.01), a liminal relationship between PA and TCH (p = 0.05). They did not find a significant relationship between the RAAS activity and HDL or TG. The authors conclude that patients with EH above 40 years and high PRA a markedly greater hyperlipoproteinaemia as compared with the low- or normal-renin group. This may partly explain the higher incidence of cardiovascular complications in high-renin EH reported by some authors.

[Basal autonomic tone in patients with vasovagal syncope]. / Bazálny autonómny tonus u pacientov s vazovagálnou synkopou.

Autonomic nervous mechanisms play an important part in the pathogenesis of vasovagal syncope. The objective of the submitted work was investigation of the autonomic tone in patients with vasovagal syncope. The authors examined a group of 39 patients with vasovagal syncope (patients with a positive head-up tilt test (HUT) from a group of patients with syncopes of unknown origin--12 men, 27 women, mean age 34 years), a control group of 21 patients with negative HUT from the group of patients with syncope of unknown etiology (11 men, 10 women, mean age 32 years) and a control group of 14 healthy subjects without history of syncope (14 men, mean age 26 years). The autonomic tone was evaluated on the basis of statistical and spectral analysis of heart rate variability. The basal autonomic tone in patients with vasovagal syncope does not differ from that in normal subjects. The increased vagal tonus probably is not a predisposing moment for the development of vasovagal syncope. Assessment of the basal autonomic tone does not make prediction of the results of the head-up tilt test possible.

[Catecholamine plasma levels during the tilt-table test in patients with vasovagal syncope]. / Plazmatické hladiny katecholamínov pocas testu na naklonenej rovine u pacientov s vazovagálnou synkopou.

BACKGROUND: The head-up tilt test (HUT) makes it possible to diagnose vasovagal syncope. The objective of the trial was to follow up changes of catecholamine plasma levels during HUT and test their importance in the pathogenesis of vasovagal syncope. METHODS AND RESULTS: In 25 patients with syncope of obscure etiology during HUT the noradrenalin, adrenalin and dopamine levels were followed up. In 125 patients (8 men and 7 women, mean age 34.3 years) HUT was positive. The control group was formed by 10 patients with negative HUT (4 men, 6 women, mean age 41.1 years). The catecholamine levels were assessed by the method of high resolution liquid chromatography during minutes 0, 5 and after completion of the test (i.e. during development of the syncope or the 45th minute). On comparison by the t-test no statistically significant difference between the group with vasovagal syncope and the control group was found. Noradrenalin 0 min: 186.4 +/- 61.6 pg/ml vs. 190.5 +/- 67.4 pg/ml (n.s.), 5th min. 506.3 +/- 178.9 pg/ml vs. 566.8 +/- 195.6 pg/ml (n.s.), end of test 457.3 +/- 154.1 pg/ml vs. 352.3 +/- 169.9 pg/ml (n.s.). Adrenalin 0 min. 54.0 +/- 12.6 pg/ml vs. 54.9 +/- 13.6 pg/ml (n.s.), 5th min. 114.3 +/- 35.6 pg/ml vs. 128.1 +/- 41.0 pg/ml n.s., end of test 98.2 +/- 40.6 vs. 783 +/- 31.2 pg/ml (n.s.). Dopamine 0 min. 113.9 +/- 36.5 pg/ml vs. 158.4 +/- 67.2 pg/ml (n.s.), 5th min. 318.1 +/- 72.7 vs. 328.5 +/- 119.7 pg/ml (n.s.), end of test 279.4 +/- 93.8 pg/ml vs. 231.7 +/- 98.5 pg/ml (n.s.). CONCLUSIONS: Catecholamine plasma levels in patients with vasovagal syncope did not differ from the control group. The importance of catecholamines in the pathogenesis of vasovagal syncope thus cannot be confirmed.

[Incidence of primary hyperaldosteronism in hospitalized patients with hypertension]. / Výskyt primárneho hyperaldosteronizmu u hospitalizovaných hypertonikov.

AIMS: To detect the incidence of primary hyperaldosteronism (PH) in hospitalized hypertensive patients. METHODS: Authors assessed plasma renin activity (PRA) and plasma aldosterone (PA) in 100 patients with arterial hypertension hospitalized at the II. department of Internal medicine in Kosice because of resistance to ambulatory treatment, eventually with the aim of differential diagnosis of arterial hypertension. RESULTS: From 100 hypertensive patients 90 (90%) have had essential hypertension (EH), 8 (8%) PH, 2 (2%) renovascular hypertension and 1 patient (1%) pheochromocytoma. Aldosterone-renin ratio was in PH patients 10-fold higher comparing with EH patients. From the 8 patients with PH 4 have had adenoma and in 3 patients hyperplasia was diagnosed with the use of CT or histology, 1 case was idiopathic hyperaldosteronism without CT hyperplasia evidence. In all PH patients the level of kalemia was less than 4 mmol/l, i.e. kalemia 4.0 mmol/l has 100% sensitivity for PH detection. CONCLUSION: Introduction of PRA and PA examinations in the diagnostic process of arterial hypertension led to more frequent diagnosis of PH, which may probably represent the most frequent form of endocrine hypertension. Although ARR is a reliable test for PH screening, routine ARR examinations in ambulatory practice are technically complicated and connected with high costs. Increasing the threshold level of kalemia for PH detection led to higher sensitivity and that is why the authors consider ARR examination rational in every patient with kalemia level less than 4 mmol/l. (Tab. 4, Ref. 18.)

[The Groningen Activity Restriction Scale (GARS) in the evaluation of severity of rheumatoid arthritis]. / Groningenská mierka obmedzenia cinností (GARS) pri posúdení závaznosti reumatoidnej artritídy.

BACKGROUND: The functional ability of the patient in chronic diseases reflects the severity of the pathological process and the success of treatment. OBJECTIVE: Evaluation of the functional ability of patients with RA and assessment of the influence of the pathological process on the performance of simple everyday tasks. METHODS: Physical capacity and functional ability were examined using the Groningen activity restriction scale (GARS) and Health Assessment Quesionnaire (HAQ). RESULTS: The authors examined 160 patients with RA (135 women and 25 men), mean age 48.3 +/- 12.13 years and a duration of the disease of 21.32 +/- 15.61 months. The mean value of the functional ability according to GARS was 32.67 +/- 11.61. Women had a poorer score (33.36 +/- 11.91) than men (28.96 +/- 9.44), the difference was however not statistically significant. The mean value of functional ability according to HAQ/FDI of the patients was 1.079 +/- 0.65. Women had a poorer score (1.156 +/- 0.625) than men (0.722 +/- 0.936), the difference being significant (P < 0.01). The authors found a significant correlation (P < 0.001) between HAQ and GARS as well as a significant relationship with parameters assessing the inflammatory activity. In GARS a relationship with the duration of the disease was found (P < 0.05), but not with HAQ. There was no significant relationship between GARS or HAQ with the patients age. In investigations of the restriction of functional ability during common everyday activities it was revealed that the greatest problem of patients is care of feet and nails, climbing stairs and personal hygiene. As to household activities the highest score was recorded for "strenuous house work" (scrubbing floors, cleaning windows and vacuum cleaning), shopping ironing and bedmaking. CONCLUSION: GARS is a reliable practical and simple scale of functional ability of patients with RA which can be used for the accurate description of the severity and for evaluation of the degree of functional ability.

[Changes in thrombocyte aggregation in primary hypothyroidism]. / Zmeny agregability trombocytov pri primárnej hypotyreóze.

The authors examined the thrombocyte aggregation in 10 controls and 17 patients with the diagnosis of primary hypothyroidism before and after 2 months substitution treatment with levothyroxine. They recorded a significantly reduced intensity of the aggregation response in untreated patients as compared with controls after adrenaline (p < 0.01), ADP (p < 0.01) but not after ristocetin. Impaired thrombocyte aggregation was observed in 11 of 17 patients, i.e. in 65%. After treatment the thrombocytopathy improved in 7 of 11 patients (63%), in four it persisted. Except one female patient the thrombocytopathy improved in all patients with manifest hypothyroidism. In patients with the latent form of hypothyroidism probably an independent coincidence of elevated TSH levels and impaired thrombocyte function was involved. The authors did not detect any cases of acquired von Willebrand's disease. In the conclusion the authors mention that impaired thrombocyte aggregation is a frequent phenomenon after thyroxine treatment. It may be of clinical significance when combined with other changes of haemostasis or in conjunction with the use of some drugs.

Aldosterone-producing adenoma associated with foci of myelolipoma.

The simultaneous occurrence of adrenal myelolipoma and endocrine disorders is rare. Myelolipomas have occasionally been found in patients with Cushing's syndrome, pheochromocytoma and hyperthyroidism. A recently published study described one well-documented case of adrenal adenoma and myelolipoma in a patient with Conn's syndrome. In this report the patient had a one-year history of treated hyperthyroidism and diagnosed aldosterone-producing adenoma. A disseminated adrenal myelolipoma was found within the adrenocortical adenoma. To our knowledge this histological finding has not been previously reported in association with both Conn's syndrome and hyperthyroidism.