Primary aldosteronism in pregnancy: diagnostic and therapeutic challenges.

Not required for Clinical Vignette.

HE4 levels in uncomplicated pregnancies: are there any differences?

OBJECTIVE: The aim of our study was to evaluate HE4 serum concentrations throughout uncomplicated pregnancies in the absence of adnexal masses. METHODS: In a retrospectively designed, monocentric study (Department of Gynecology and Obstetrics, General Hospital Celje, Celje, Slovenia, EU), 229 women with uncomplicated pregnancies were included. HE4 levels were obtained and analyzed with regard to gestational age of pregnancy. RESULTS: While having all HE4 levels within reference range, differences in mean concentrations between study groups were found be statistically significant (Group I, n = 22, <20 weeks of pregnancy, mean = 42.2 pmol/L; Group II, n = 40, pregnancies between 20-34 weeks of pregnancy, mean = 43.6 pmol/L; Group III, n = 167, ≥34 weeks of pregnancy, mean = 57.5 pmol/L, p < .001). CONCLUSION: Our findings confirmed that HE4 levels in uncomplicated pregnancies are within reference range provided by manufacturer, however its serum concentration rises significantly in third trimester. The HE4 cutoff value (<140 pmol/L) used for nonpregnant women can be helpful in the evaluation of adnexal masses in pregnancy.

Subspecialty training in Europe: a report by the European Network of Young Gynaecological Oncologists.

BACKGROUND: ESGO (European Society of Gynaecological Oncology) and partners are continually improving the developmental opportunities for gynaecological oncology fellows. The objectives of this survey were to evaluate the progress in the infrastructure of the training systems in Europe over the past decade. We also evaluated training and assessment techniques, the perceived relevance of ENYGO (European Network of Young Gynaecological Oncologists) initiatives, and unmet needs of trainees. METHODOLOGY: National representatives of ENYGO from 39 countries were contacted with an electronic survey. A graduation in well/moderately/loosely-structured training systems was performed. Descriptive statistical analysis and frequency tables, as well as two-sided Fisher's exact test, were used. RESULTS: National representatives from 33 countries answered our survey questionnaire, yielding a response rate of 85%. A national fellowship is offered in 22 countries (66.7%). A logbook to document progress during training is mandatory in 24 (72.7%) countries. A logbook of experience is only utilized in a minority of nations (18%) for assessment purposes. In 42.4% of countries, objective assessments are recognized. Trainees in most countries (22 (66.7%)) requested additional training in advanced laparoscopic surgery. 13 (39.4%) countries have a loosely-structured training system, 11 (33.3%) a moderately-structured training system, and 9 (27.3%) a well-structured training system. CONCLUSION: Since the last publication in 2011, ENYGO was able to implement new activities, workshops, and online education to support training of gynaecological oncology fellows, which were all rated by the respondents as highly useful. This survey also reveals the limitations in establishing more accredited centers, centralized cancer care, and the lack of laparoscopic training.

Pregnancy in a Unicornuate Uterus with Non-Communicating Rudimentary Horn: Diagnostic and Therapeutic Challenges.

Unicornuate uterus with non-communicating rudimentary horn is a type of congenital uterine abnormality that occurs as a consequence of the arrested development of one of the two Müllerian ducts. Patients with unicornuate uterus have increased incidence of obstetric and gynaecological complications. We present a report of a clinical case of a 28-years-old female, who was referred to the hospital for evaluation of her infertility. The patient reported primary infertility and inability to conceive after 3-year period of regular unprotected intercourse. Transvaginal ultrasound, along with the preoperative evaluation were completed; however, no anomalies or irregularities were reported. Combined diagnostic simultaneous laparoscopy and hysteroscopy were performed to establish the diagnosis of unicornuate uterus with non-communicating rudimentary horn. The patient conceived spontaneously after diagnostic laparoscopy and hysteroscopy. During and after pregnancy, our patient and her child experienced numerous complications (cervical incompetence, acute chorioamnionitis, acute fetal distress, pneumonia, septic shock) and procedures (cervical cerclage, urgent cesarean section, intensive care unit treatment) without significant fetal or maternal compromise.

Comparison of HE4 and CA125 levels in women with benign gynecologic disorders : Does age or menopausal status matter?

OBJECTIVE: The aim of this study was to measure serum concentrations of human epididymis protein 4 (HE4) in premenopausal and postmenopausal women with benign adnexal tumors and compare HE4 levels with those of cancer antigen 125 (CA125) measured in the same samples. METHODS: In a retrospectively designed, monocentric study (Department of Gynecology & Obstetrics, General Hospital, Celje, Slovenia, EU), 147 women diagnosed with various benign adnexal tumors were included. Preoperative HE4 and CA125 levels were obtained and analyzed with regard to histopathological classification, menopausal status, and age distribution. RESULTS: A marked difference was observed in patients with endometriomas in which mean CA125 was elevated above the reference range in the premenopausal (mean 90.1 U/ml) and postmenopausal groups (mean 48.5 U/ml), while HE4 levels were within the reference range, irrespective of age or menopausal status. Inflammatory adnexal tumors were associated with elevated levels of CA125 (mean 142.2 U/ml, premenopausal and mean 62.4 U/ml, postmenopausal patients); HE4 levels were not elevated regardless of age or menopausal status. CONCLUSION: HE4 is elevated less frequently than CA125 in benign adnexal tumors, regardless of age or menopausal status.

PARASITIC MYOMA AS AN ADNEXAL MASS: UNEXPECTED FINDING AFTER VAGINAL HYSTERECTOMY.

A rare case of parasitic myoma mimicking an adnexal mass in a previously hysterectomized, postmenopausal woman is presented. Two years after vaginal hysterectomy (due to myomas), an asymptomatic right adnexal tumor was noted during regular annual follow up. Ultrasound demonstrated a large 4-5 cm solid mass in the right adnexa, while ovarian cancer biomarkers (CA 125 and HE4) were negative. Intraoperatively, another 3 cm large solid tumor located above the vaginal cuff was discovered. Both pelvic tumors were excised by laparoscopic surgery. The masses were confirmed by histopathology to be leiomyomas.

Statistical regression model of standard and new laboratory markers and its usefulness in prediction of preeclampsia.

OBJECTIVE: This study was undertaken to investigate the usefulness of angiogenic markers and standard laboratory parameters measurement after 20th week of pregnancy for the individual prediction of preeclampsia (PE). METHODS: A prospective designed study included 34 patients with PE and a control group of 35 uncomplicated pregnancies. Patients were recruited from 20th until 41st week of pregnancy at the Department of Obstetrics and Gynecology, General Hospital Celje, Slovenia. PlGF (placental growth factor), sFlt-1 (soluble fms-like tyrosine kinase 1), erythrocytes, leukocytes, platelets, hemoglobin, hematocrit, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, alkaline phosphatase, total bilirubin, urea, creatinine, urate, body mass index, body surface area, parity, and age were evaluated to predict the occurrence of PE based on multivariate logistic regression model. RESULTS: When parameters such as PlGF, sFlt-1, and urates were included into logistic regression model, we correctly classified 85% patients. With additional two models which also contained anthropometric parameters, we correctly classified 88% and 91% patients, respectively. CONCLUSION: Our results demonstrated that angiogenic markers and urates individually and particularly when used as laboratory test panel have significant prognostic value in the prediction of PE.

Optimal laboratory panel for predicting preeclampsia.

OBJECTIVE: This study was undertaken to investigate the usefulness of standard biochemical and hematological parameters measurement at third trimester of pregnancy for the individual prediction of preeclampsia. METHODS: A retrospective designed study included 113 patients with preeclampsia and a control group of 95 normal, uncomplicated pregnancies. Patients were recruited in the third trimester of pregnancy at the Department of Gynecology and Obstetrics, General Hospital Celje, Slovenia, EU. Erythrocytes, leukocytes, thrombocytes, hemoglobin, hematocrit, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, total bilirubin, urea, creatinine, uric acid, body mass index, parity, and age were evaluated to predict the occurrence of preeclampsia based on multivariate logistic regression model. RESULTS: When parameters such as uric acid and urea were included into logistic regression model, we correctly classified 79.6% patients. With additional four parameters (thrombocytes, hematocrit, aspartate aminotransferase and leukocytes) we correctly classified 83.8% patients with preeclampsia. CONCLUSION: Our findings confirmed that several standard biochemical and hematological parameters, when used as laboratory test panel have significant prognostic value in the prediction of preeclampsia.