Primary aldosteronism in pregnancy: diagnostic and therapeutic challenges.

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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.

Randomised trial of HPV self-sampling among non-attenders in the Slovenian cervical screening programme ZORA: comparing three different screening approaches.

Background To overcome obstacles within the Slovenian organised cervical cancer screening programme, a randomised pilot study of human papillomavirus (HPV) self-sampling among non-attenders was performed, aiming to assess three different screening approaches. Participants and methods Non-attenders aged 30-64 years from two Slovenian regions were randomised to two HPV self-sampling groups-the opt-in (I1, n = 14.400) and the opt-out (I2, n = 9.556), with a control group (P, n = 2.600). Self-collected samples were analysed using the Hybrid Capture 2 assay. HPV-positive women were invited to a colposcopy. The overall and type-specific intention-to-screen response rates and histological outcomes with a positive predictive value (PPV) according to the women's age, the screening approach, the level of protection resulting from previous screening history, and the region of residence were assessed. Results Of the 26.556 women enrolled, 8.972 (33.8%) responded with self-sample for HPV testing and/or traditional cytology within one year of enrolment. Response rates were 37.7%, 34.0% and 18.4% (p < 0.050) for opt-out, opt-in and control groups. Cervical intraepithelial neoplasia (CIN)2+ was diagnosed in 3.9/1.000, 3.4/1.000, and 3.1/1.000 women (p > 0.050), respectively. PPV of the HPV self-sampling was 12.0% and 9.6% for CIN2+ and CIN3+. The highest PPV was obtained in non-attenders in screening programme for more than 10-years and concordant results of HPV testing with 40.8% for CIN2+ and 38.8% for CIN3+. Conclusions The results of our study show that a high response to HPV self-sampling can be achieved also in an opt-in approach, if women are encouraged to choose between self-sampling at home and screening with gynaecologist. In addition, clinically important risk difference for a high-grade cervical lesion exists in the case of a positive result of HPV testing on self-collected samples, depending on the length of the interval since last screening. Stratified management of these women should be strongly considered. Women who were not screened with cytology for at least 10 years should be referred to immediate colposcopy for histology verification instead to delayed re-testing.

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.