Epinephrine producing pheochromocytoma. Is the secretory pattern decisive for the clinical manifestation?

Adrenal incidentalomas are becoming a major clinical problem, due to increasingly frequent radiological examinations. We present two cases of patients referred to our department with a finding of an unsuspected adrenal mass. Both of them were normotensive and without symptomatology typical for pheochromocytoma. In one patient we found 20-times higher levels of epinephrine and 3-times higher levels of dopamine in 24-h urine, in the second patient there were 8-times higher levels of epinephrine alone. Norepinephrine in urine, as well as values of all adrenal cortical hormones were normal. The diagnosis of pheochromocytoma was confirmed in both cases by a 123I-metaiodobenzylguanidine (MIBG) scintigraphy. The patients underwent adrenalectomy, which was performed without complications. We conclude that levels of single catecholamines excreted are decisive for the clinical presentation of pheochromocytoma. Epinephrine producing pheochromocytoma is more often oligo- or asymptomatic. We stress the importance of a complete hormonal screening in every case of adrenal incidentaloma, with measuring levels of catecholamines and/or metanephrines.

Effect of vitamin E supplementation on microalbuminuria, lipid peroxidation and blood prostaglandins in diabetic patients.

BACKGROUND: Oxidative stress is an important pathogenic factor in the development of diabetic vascular complications. AIMS: To study the effect of vitamin E supplementation on microalbuminuria, plasma levels of malondialdehyde (MLD) and metabolites of prostaglandins TXA2 (TXB2) and PGI2 (6-keto-PGF1alpha) and to evaluate the relation between plasma MLD and thromboxane B2 (TXB2) in diabetic patients. PATIENTS AND METHODS: Diabetic microalbuminuric patients were supplemented with vitamin E 1200 IU daily (EVIT, Rodisma, Germany) and measurements of microalbuminuria, MLD, TXB2 and 6-ketoPGF1alpha were repeated after 4 months of treatment. RESULTS: Vitamin E supplementation lowered microalbuminuria (93.8 +/- 45.6 vs 67.95 +/- 28.4 microg/min, p < 0.05), MLD (0.55 +/- 0.26 vs 0.32 +/- 0.16 micromol/l, p < 0.001) and also TXB2 level (115.14 +/- 22.7 vs 15.32 +/- 14.7 ng/l, p < 0.001) in diabetic microalbuminuric patients. The changes of 6-keto-PGF1alpha after treatment were not significant. CONCLUSIONS: Our results did not show any significant relationship between levels of MLD and TXB2. Vitamin E supplementation significantly lowered microalbuminuria, MLD and TXB2. (Tab. 2, Fig. 2, Ref. 35).

[Effect of vitamin E therapy on progression of diabetic nephropathy]. / Vplyv liecby vitamínom E na progresiu diabetickej nefropatie.

Pathogenesis of diabetic nephropathy, which belongs to most serious microangiopathic complications of diabetes, is still not completely clear. Thromboxan A2 and increased oxidation stress are new factors apparently associated with pathogenesis of diabetic nephropathy. It was the aim of the contribution to verify the participation of thromboxan A2 and oxidation stress in the pathogenesis of diabetic nephropathy, as well as to follow the effects of treatment with vitamin E on its progression. In 19 diabetic subjects with microalbuminemia (MA) (age 55.2 +/- 7.6 years), 10 diabetic subjects with normoalbuminemia (NA) (age 54.4 +/- 6.1 years) and in 10 healthy subjects (age 53.6 +/- 9.4) the authors examined the level of malondialdehyde (MLDA) in serum, metabolites of thromboxan A2 (thromboxan B2-TXB2) and prostacyclin PGI2 (6-keto-PGF1 alpha) in urine by means of an RIA method (Isotop, Hungary). The diabetic patients with microalbuminemia were subsequently administered natural vitamin E (EVIT, Rodisna, FRG) at the daily dose of 1200 IU for the period of four months. After two and four months, respectively, MA, MLDA, TXB2 and 6-keto-PGF1 alpha) were examined. The age of the subjects in the two groups was not significantly different. In diabetic subjects with MA, the authors observed significantly higher MLDA levels in serum than in the control individuals (0.55 +/- 0.26 vs. 0.22 +/- 0.02 mumol/l, P < 0.001) and a significant difference occurred also in TBX2 in urine (134.7 +/- 113.8 vs. 27.7 +/- 10.1 ng/12 h, P < 0.001). Increased levels of TXB2 in urine were already present in diabetic subjects with NA as compared with healthy individuals (69.1 +/- 38.8 vs. 27.7 +/- 10.1 ng/12 h, P < 0.05). The treatment with vitamin E caused a significant decrease of MA (93.8 +/- 45.6 vs. 67.95 +/- 28.4 micrograms/min, P < 0.05), MLDA in serum (0.55 +/- 0.26 vs. 0.32 +/- 0.16 mumol/l, P < 0.001). On the basis of our results it is possible to suppose the role of oxidation stress and increased level of thromboxan A2 in the pathogenesis of diabetic nephropathy. The authors also confirmed that the treatment with vitamin E favorably decreases microalbuminemia, while the nephroprotective effect is apparently mediated not only by the antioxidant action, but also the decrease of thromboxan A2 production.

[Optimism or pessimism in the treatment of cerebral infarct]. / Optimizmus ci pesimizmus v liecbe mozgového infarktu.

The aim of the study was to analyse the effects of drug and rehabilitation treatment of cerebral stroke. Material consists of 2,500 patients with focal brain ischemia. About three-fourths (68.7%) of patients with cerebral stroke improved receiving complex drug treatment, rehabilitation and psychological care. 54.9% of the whole group of patients had a neurological deficit score below 150, i.e. more than one half of the whole group (n = 2,500) left the hospital practically in good health capable of carrying on in their original occupation. Only 11.9% of patients died, but 48.9%, i.e. practically one half of them showed an extracerebral cause of death. The results of treatment are dependent on age. In the higher age group, the number of deteriorated cases as well as the number of death increases. The results of treatment are dependent on an early initiation of treatment after the onset of brain ischemia. In the 2nd time-period, the results of treatment are better in comparison to the 1st period due to new strategies of treatment, i.e. due to drugs that improve heart failure, rheological properties of the blood and brain metabolism and due to intensive rehabilitation care. The results have shown the improvement not only in movement possibilities of the patients, but also the improvement in majority of the psychological parameters (IQ, emotionality, sociability scale etc.).

[Vascular headache. Changes in visual evoked potentials]. / Vaskulárna cefalea. Zmeny zrakových evokovaných potenciálov.

The authors examined visual evoked potentials using the method of the visual full field stimulation hemi-field, using a check-board patterned structural stimulus in 69 patients with the diagnosis of vascular headache. The peak latencies of the waves did not differ significantly in the group of patients with vascular cephalea, as compared with the control group; this applies to both ways of stimulation. The es amplitudes of waves (P1 = P100 and N2) were significantly higher in the group with vascular cephalea after stimulation by the visual field. Of half the visual field stimulation did not reveal statistically significant differences in the latencies waves. The results may indicate an increased electrophysiological activity of the visual system in the interparoxysmal period in patients with vascular cephalea.