The levels of adhesion molecules in essential thrombocythemia

AIM

It is known that thrombocytosis is closely related to vascular complications and particularly thrombosis in essential thrombocytemia (ET) cases. The aim of this study is to investigate a possible correlation between adhesion molecules and vascular attacks as well as the relation of these molecules to the platelet count.

METHODS

The study group consisted of 30 ET patients and 30 healthy controls subjects. Serum intracellular adhesion molecule-1 (ICAM-1), serum vascular adhesion molecule-1 (VCAM-1) and serum E-selectin levels were determined by ELISA method according to manufacturer's instructions.

RESULTS

There were no significant differences between two groups with respect to levels of sICAM-1 and sE-selectin (P>0.05). The VCAM-1 levels and platelets were significantly higher in patients with ET compared to controls (P=0.000). Spearman's correlation analysis revealed that sVCAM-1 levels were correlated with platelet counts (r=0.574, P<0.001) CONCLUSION: High VCAM-1 level in ET and its correlation with the platelet count suggest that these may be a factor in vascular complications and thrombocytosis.

Is there any relationship between imatinib mesylate medication and hypothalamic-pituitary-adrenal axis dysfunction?

BACKGROUND

Imatinib mesylate [tyrosine kinase (TK) inhibitor] is a novel medication in the treatment of chronic myelogenous leukaemia (CML). TK is also essential in hypothalamo-pituitary-adrenal (HPA) axis.

PURPOSE

The aim of this study was to evaluate HPA axis in patients treated with imatinib. Twenty-five patients were included in this study.

METHODS

Glucagon stimulation test (GST) and low-dose (1 microg) adrenocorticotropin test (LDSST) were used to assess the HPA gland axis.

RESULTS

Seventeen (68%) subjects had impaired peak response when a cortisol cut-off value is accepted as 500 nmol/L. Twelve (48%) out of 17 subjects also failed to show a response to LDSST. Therefore, 12 patients (48%) were defined as HPA deficient. Only two of these 25 patients had morning serum cortisol < 200 nmol/l (7.22 microg/dl), and failed the GST and/or LDSST, indicating that the majority had partial glucocorticoid deficiency. If the cut-off presume for LDSST is from 500 to 600 nmol/l, 16 patients (64%) would have failed both the GST and LDSST.

CONCLUSION

Our results indicate an increased prevalence of subclinical glucocorticoid deficiency in patients receiving imatinib mesylate for CML. Therefore under stressed conditions, such as intercurrent illness state, overt and untreated partial glucocorticoid deficiency in CML patients become life threatening.

Impaired hypothalamo-pituitary-adrenal axis in patients with ankylosing spondylitis

BACKGROUND

To investigate the hypothalamic-pituitary- adrenal (HPA) axis in patients with ankylosing spondylitis (AS) and healthy controls.

METHODS

Forty-nine AS patients and 20 healthy controls were included. Lowdose ACTH test (LDST) was used to assess the HPA axis. Basal cortisol, stimulated peak cortisol levels, and acutephase reactants [C-reactive protein (CRP), erythrocyte sedimentation rate, and fibrinogen] were studied. Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Metrology Index were also evaluated.

RESULTS

Patient and control groups were not different regarding age, sex, body mass index and waist circumference (WC). Basal cortisol levels did not show a significant difference between groups. However, cortisol increment after low-dose ACTH was significantly impaired in AS subjects with respect to controls (20.0+/-4.4 vs 24+/-2.2 microg/dl, p<0.001). Eleven AS patients had impaired cortisol peak after LDST when a cortisol cut-off is accepted as 500 nmol/l (18 microg/dl) and none of the controls exhibited a peak cortisol responses to LDST<500 nmol/l. Comparison of AS subjects who were receiving anti-tumor necrosis factor (TNF) (no.=23), and conventional therapy (no.=26) yielded similar basal and peak cortisol concentrations. Peak cortisol concentrations were associated with basal cortisol, impaired cortisol response, CRP, and fibrinogen. Impaired cortisol response (subjects with peak cortisol levels <18 microg/dl) was significantly correlated with basal and peak cortisol concentrations and BASDAI.

CONCLUSION

Our results indicate an increased prevalence of subclinical glucocorticoid deficiency in AS patients. Anti-TNF treatment seems not to have effect on HPA axis.

Does imatinib mesylate therapy cause growth hormone deficiency?

OBJECTIVE

The purpose of this study was to determine whether or not imatinib mesylate therapy induces growth hormone deficiency (GHD).

SUBJECTS AND METHODS

Seventeen patients with chronic myloid leukemia (CML) were enrolled in the study. The glucagon stimulation test (GST), and standard deviation scores (SDSs) of insulin-like growth fac- tor 1 (IGF-I) and insulin-like growth factor binding protein (IGFBP-3) were used to determine GHD. The L-dopa test was performed on those with IGF-I SDSs above the -1.8 cut-off level.

RESULTS

Of the 17 patients in the study, 12 (70%) had severe GHD (serum GH level <3 microg/l after GST). IGF-I SDSs and IGFBP-3 SDSs were below -1.8 in 12 patients (70%) and below -0.9 in 10 subjects (58%). Four of the 5 remaining subjects with IGF-I SDS >-1.8 showed insufficient GH response to L-dopa stimulation. Nine subjects (52%) had both severe GHD based on GST response and IGF-I SDS below -1.8. If an IGF-I SDS cut-off value l<-3 were used,5 out of 17 subjects (30%) would be classified as GH deficient. These same patients also showed severe GHD based on GST response.

CONCLUSIONS

The data showed that a large number of patients on imatinib mesylate therapy had GH deficiency. A study involving a larger number of patients with a matched control group is needed to confirm the present observations.

Endobronchial low-grade MALT lymphoma causing unilateral hypertranslucency

Mucosa-associated lymphoid tissue-derived lymphoma (MALT lymphoma) arises not only from the stomach but also from various non-gastrointestinal sites. A thirty two year old woman, suffering from breathlessness for one year, had been treated for bronchial asthma. A chest radiograph showed a mediastinum and heart transposition to the right side and emphysema of the left lung. In the thorax spiral tomography, a mass narrowing left main bronchi, five centimeters in length from the carina, was seen. A fiberoptic bronchoscopy revealed millimetric polypoid lesions those nearly totally obstructed the left main bronchi. The bronchoscopic biopsy showed a diagnosis of MALT lymphoma. She was seen for check-ups following chemotherapy but no further treatment has been carried out.