Calcium-dependent low renin syndrome in a diabetic patient with prostaglandin deficiency.
Bonnet F. Vincent M. Thivolet C.
Service d'Endocrinologie, Hopital Edouard Herriot, Lyon, France.
Calcium and prostaglandin are supposed to play a critical role in the renin-angiotensin aldosterone system. Calcium has been described as an inhibitory second messenger for renin exocytosis whereas vasodilatory prostaglandins, such as PGE2, are known to stimulate the production of renin. These factors are probably interrelated since calcium also enhances urinary prostaglandin release. We report the case of a 52 year-old diabetic patient treated with insulin injections with intestinal malabsorption leading to chronic hyperkalemia and hypocalcemia in whom a low renin syndrome and low levels of urinary prostaglandins were observed. The correction of the hypocalcemia was able to improve plasma renin as well as urinary prostaglandin levels. This observation suggests a prominent role played by calcium on the in vivo regulation of renin and prostaglandin release. These results illustrate the closed loop between plasma calcium level, urinary prostaglandins production and renin release.
Adrenal cystic lesions: report of 12 surgically treated cases and review of the literature.
Bellantone R. Ferrante A. Raffaelli M. Boscherini M. Lombardi CP. Crucitti F.
Istituto di Clinica Chirurgica, Facolta di Medicina dell'Universita Cattolica del S. Cuore, Roma, Italy.
Adrenal cysts are rare (0,064%-0,18% in autopsy series) and less than 500 cases have been reported in the western literature. Incidental diagnosis of adrenal cysts, however, is reported with increasing rates. We observed 12 patients with adrenal cyst. Each of them had a careful laboratory and instrumental evaluation; all the patients were operated. In our series about 67% of the patients were symptomatic (6 patients with abdominal pain, 1 with palpable mass, 1 with hemorrhagic shock). No biochemical alteration was observed. Conversely we observed an unusual subclinically hyperfunctioning cystic adenoma, potentially progressive to a clinically recognizable endocrine syndrome. US, CT and MRI had a sensitivity of 66,7%, 80% and 100% respectively. Adrenalectomy was performed in all patients. The pathological findings were: 1 epithelial cyst (cystic adenoma), 2 endothelial cysts (vascular cystic ectasia with adenomatous adrenocortical hyperplasia and 1 vascular cyst) and 9 pseudocysts. On the basis of these results, we conclude that a careful hormonal, morpho-functional and instrumental evaluation is indicated in all adrenal cysts, even if the available diagnostic procedures, even when combined, cannot always define their nature. Surgical excision, when possible by laparoscopic approach, is indicated in presence of symptoms, endocrine abnormalities (even when subclinic), complications, suspicion of malignancy and/or large size (>5 cm). Adrenal gland must be excised en bloc, also because of the possible presence of other adrenal lesions.
Low IGF-I levels are often uncoupled with elevated GH levels in catabolic conditions.
Gianotti L. Broglio F. Aimaretti G. Arvat E. Colombo S. Di Summa M. Gallioli G. Pittoni G. Sardo E. Stella M. Zanello M. Miola C. Ghigo E.
Dipartimento di Medicina Interna, Universita di Torino, Italy.
Increased GH together with decreased IGF-I levels pointing to peripheral GH insensitivity in critically ill patients have been reported by some but not by other authors. To clarify whether elevated GH levels are coupled with low IGF-I levels in all catabolic conditions, basal GH and IGF-I levels were evaluated in patients with sepsis (SEP, no.=13; age [mean+/-SE]=59.2+/-1.2 yr), trauma (TRA, no.=16; age=42.3+/-3.4 yr), major burn (BUR, no.=26; age=52.8+/-4.2 yr) and post-surgical patients (SUR, no.=11; age=55.0+/-4.7 yr) 72 hours after ICU admission or after cardiac surgery. GH and IGF-I levels were also evaluated in normal subjects (NS, no.=75; age=44.0+/-1.5 yr), in adult hypopituitaric patients with severe GH deficiency (GHD, no.=54; age=44.8+/-2.3 yr), in patients with liver cirrhosis (LC, no.=12; age=50.4+/-2.8 yr) and in patients with anorexia nervosa (AN, no.=19; age=18.7+/-0.8 yr). Basal IGF-I and GH levels in GHD were lower than in NS (68.6+/-6.4 vs 200.9+/-8.7 microg/l and 0.3+/-0.1 vs 1.4+/-0.2 microg/l; p