Circulating vascular endothelial growth factor and active renin concentrations and prostaglandin E2 urinary excretion in patients with adrenal tumours.

OBJECTIVES: The aim of the present study was to determine vascular endothelial growth factor (VEGF), prostaglandin E(2) (PGE(2)) and active renin levels in patients with hormonally active adrenal tumours. DESIGN: The study was comprised of 16 patients with primary aldosteronism, 13 patients with active Cushing's syndrome due to adrenal adenomas, 8 patients with adrenal carcinomas, 19 patients with phaeochromocytoma and 19 healthy volunteers. METHODS: Active renin in plasma was determined by a two-site immunoradiometric assay. VEGF in sera samples and PGE(2) in 24-h urine were measured by ELISA. RESULTS: VEGF was significantly elevated in all the four groups of patients as compared with the controls. VEGF levels in patients with Cushing's syndrome were higher than those in patients with primary aldosteronism. Patients with adrenal carcinomas had the highest VEGF levels and the differences reached significance as compared with patients with primary aldosteronism and phaeochromocytoma. PGE(2) levels were not significantly different among groups. Active renin was significantly the lowest in patients with primary aldosteronism and significantly the highest in patients with phaeochromocytoma compared with the controls. Active renin in patients with primary aldosteronism was significantly lower than in those with Cushing's syndrome, phaeochromocytoma and adrenal carcinoma. CONCLUSIONS: Our data indicated that the mean level of VEGF in patients with all investigated adrenal tumours was significantly higher than in healthy controls. The cortisol-producing tumours appear to have increased angiogenic potential. Angiogenesis is probably associated not only with malignancy but also with functional activity of the adrenal tumors.

Role of 24-hour monitoring in assessing blood pressure changes in polycystic ovary syndrome.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is associated with higher risk of developing cardiovascular diseases including higher incidence of hypertension later in life. Absence of circadian blood pressure fluctuations is considered as a marker of pre-hypertensive state and correlates highly with target organ damage in hypertension. AIM: Characterization of the circadian blood pressure rhythms as well as comparison of the results from the clinical measurements and Holter-monitored blood pressure data in women with PCOS. MATERIALS AND METHODS: The study comprised 35 women (mean age 22.6 +/- 5.9 years, mean BMI 31.4 +/- 7.1 kg/m2) with proven diagnosis. 24-hour ambulatory Holter-monitoring using Oscar device (Sun Tech Medical Instruments, USA) was performed in parallel with clinical measurements of blood pressure. RESULTS: There were 25.7% of the subjects diagnosed with hypertension according to the criteria of ambulatory monitoring observing discrepancy with the criteria for normal clinically measured blood pressure in 7 cases (20%). The "white coat" effect was observed in 11.4%. Physiological nocturnal drop in the systolic pressure was not observed in 51.4% of the patients and in the diastolic pressure - in 22.9% of the cases. CONCLUSIONS: The results confirm the advantages and the importance of the 24-hour monitoring as a diagnostic and predictive method for assessment of blood pressure alterations even in the absence of overt hypertension. PCOS is characterized by higher incidence of unstable blood pressure that is an additional risk factor for further development of cardiovascular diseases in this relatively young age group.