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Tracheal complications should be suspected in mechanically ventilated COVID-19 survivors with respiratory symptoms. Treatment requires a multimodal approach of interventional bronchoscopy and surgery with tight follow-up due to a high rate of restenosis.

Introduction: Emerging evidence suggests that the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome plays an important role in the pathogenesis of COPD. Moreover, it may be involved in ongoing chronic inflammation that is present in patients with end-stage COPD who are candidates for lung transplantation (LT). Aims and objectives: The aim of this study was to determine the gene expression of NLRP3, caspase-1 (CASP1) and interleukin-1β (IL1B) in 5 patients with COPD before LT and 1 year after LT. Methods: Gene expression was examined by qPCR in the peripheral blood samples using the commercial TaqMan gene expression assays (Applied Biosystems, Foster City, CA, USA). The calculation of the relative mRNA expression was performed by the 2−∆∆Ct method. Spirometry parameters were determined before and after LT while symptoms burden, history of exacerbations and health status were assessed by mMRC, CAT and SGRQ-C scores. Results were statistically significant if P 0.05. Results: Gene expressions of NLRP3, CASP1 and IL1B were significantly downregulated in patients one year after LT (P = 0.009, P = 0.014, P = 0.005, respectively). On the other hand, spirometry values were significantly increased at 1-year post- transplantation period with FEV1 (L) increasing from 0.59 to 3.22 (P = 0.001) and FVC (L) from 1.81 to 3.57 (P = 0.010). In addition, significant improvements in mMRC, CAT and SGRQ-C scores were observed after LT (P = 0.041, P = 0.035 and P = 0.015, respectively). Conclusions: NLRP3, CASP1 and IL1B expression were decreased in lung transplant recipients with COPD one year after LT, suggesting a significant involvement of NLRP3 inflammasome in severe COPD.

Introduction: Heat shock protein 70 (Hsp70) can be found in the extracellular compartment and it is considered that extracellular Hsp70 (eHsp70) contributes to inflammation in chronic obstructive pulmonary disease (COPD). eHsp70 mainly acts pro- inflammatory and activates immune responses by engaging Toll-like receptors (TLRs) 2 and 4. Moreover, it may be involved in ongoing chronic inflammation that is present in patients with end- stage COPD who are candidates for lung transplantation (LT). Aims and objectives: The aim of the study was to compare eHsp70 concentration and TLR2 and TLR4 gene expression in 5 COPD patients before LT and one year after LT. Methods: Spirometry was performed before and after LT. Dyspnoea grade was assessed by modified Medical Research Council (mMRC), symptoms burden and history of exacerbations by COPD Assessment Test (CAT score), and health status by St. Georges Respiratory Questionnaire (SGRQ-C) score for COPD patients. Concentration of eHsp70 was measured by enzyme-linked immunosorbent assay (ELISA) (Enzo Life Science, Farmingdale, NY, USA), while TLR2 and TLR4 expression was examined by quantitative polymerase chain reaction (qPCR) in the peripheral blood samples using the TaqMan gene expression assays (Applied Biosystems, Foster City, CA, USA). The calculation of the relative gene expression was performed by the 2−∆∆Ct method. Results were statistically significant if P

Lung transplantation is a therapeutic option for the treatment of advanced lung disease. The risk of pulmonary infections is increased in lung transplant recipients. We report a case of a pulmonary coinfection with Mycobacterium tuberculosis and Nocardia species in a lung transplant recipient., Transplantacija pluća jedna je od terapijskih opcija kod liječenja uznapredovale plućne bolesti. Primatelji presađenih pluća imaju povećani rizik za nastanak plućnih infekcija. U radu prikazujemo slučaj koinfekcije pluća kod bolesnika s transplantiranim plućima, čiji su uzročnici Mycobacterium tuberculosis i Nocardia species.

Background: To determine the effect of lockdown measures on lung transplant patients during the COVID-19 pandemic. Subjects and methods: We collected data from Croatian lung transplant patients before and after the lockdown and analyzed changes in weight, BMI, lung function and blood lipid status. Results: An average increase of 3.74 kg (+4.92%) body weight during the 4 month lockdown period was observed. Lung function values and blood lipid status remained stable. Conclusion: Such weight gain could have detrimental effects on the morbidity and mortality of lung transplant patients. Further follow up is needed to determine the long term impacts of this observation.

Objectives: At our Cystic Fibrosis Centre (CF Centre) for children and adults it is the policy to see patients at least quarterly/year and have at least 4 respiratory samples cultured. We analysed the adherence to this regime in pandemic and regular circumstances.Methods: We compared the number of check-up visits, hospitalisations and respiratory samples taken in the pre-pandemic 2019 and the pandemic year 2020. Descriptive statistics and t-test (paired two sample for means) were used. Results: The sample consists of 93 patients (40 males, 52 adults), age range 2–36 yrs, median age in 2020: 19, 5 yrs. Our goal of at least 4 visits/yr was not achieved for 29/93 patients in 2019. vs. 43/93 in the pandemic year. Although some patients visited the CF Centre more frequently in the pandemic year (15/93), most of them came less often. From a total of 93 patients seen in 2019, 12 did not have a check-up in 2020. Altogether, during the COVID-19 pandemic 2020. year we noticed a convincing, statistically significant trend in declining routine check-ups, as well as hospital admissions among cystic fibrosis patients in relation to prepandemic 2019 year (M = 5, 20 ± 3, 19 vs. M = 3, 87 ± 2, 88 ; t = 4, 77, p < 0.001). This phenomenon, of course, entails a reduced, also statistically significant, number of respiratory cultures performed in pandemic 2020 year (M = 4, 88 ± 4, 22 vs. M = 3, 34 ± 3, 20 ; t = 5, 29, p < 0.001). Conclusion: We definitely observed a negative trend in follow-ups of CF patients in the pandemic year. In our case it could also be partially caused by two serious earthquakes in the Zagreb area. Avoiding hospital arrivals and dropping out of usual follow-up practice due to fear of COVID-19 contagion may be responsible for more frequent CF exacerbations and poorer outcome for our patients in the future. Whether the observed lower compliance rate during the pandemic 2020 year result in more significant threat to our patients than COVID-19 itself remains to be seen

Neinvazivna mehanička ventilacija (NIV) je ventilacija pozitivnim tlakom primijenjena preko neinvazivnih sučelja. Smatra se standardnim načinom zbrinjavanja bolesnika hospitaliziranih zbog globalne respiracijske insufi cijencije u sklopu akutnog pogoršanja kronične opstruktivne plućne bolesti (KOPB). NIV poboljšava izmjenu plinova, smanjuje dišni rad i posljedično omogućava oporavak dišne muskulature. Dokazano je da NIV može reducirati potrebu za intubacijom, morbiditet i mortalitet pacijenata s teškim pogoršanjem KOPB-a. NIV skraćuje vrijeme liječenja u jedinicama intenzivne skrbi i ukupno trajanje bolničkog liječenja. Može se koristiti u svrhu olakšavanja odvajanja bolesnika od invazivne mehaničke ventilacije i prevenciji razvoja respiracijske insufi cijencije nakon ekstubacije. U bolesnika s teškom respiracijskom acidozom i poremećajem svijesti postoji visok rizik neuspjeha liječenja NIV-om. U tih bolesnika liječenje NIV-om treba provoditi uz intenzivni nadzor i u uvjetima koji omogućavaju brzu endotrahejsku intubaciju u slučaju potrebe. Kontroverzni su podatci o koristi dugotrajne primjene NIV-a u stabilnom KOPB-u. U odnosu na standardno liječenje, primjena NIV-a visokog intenziteta poboljšava ishode ovih bolesnika. NIV visokog intenziteta poboljšava izmjenu dišnih plinova, plućnu funkciju, kvalitetu života vezanu uz zdravlje, podnošenje fi zičkog napora i preživljenje. Dodatak NIV-a u stabilnoj fazi bolesti programu respiratorne rehabilitacije poboljšava rezultate respiratorne rehabilitacije. S obzirom da NIV pruža niz koristi bolesnicima s KOPB-om svaki bi liječnik koji je uključen u liječenje ovih bolesnika trebao vladati ovom tehnikom., Noninvasive ventilation (NIV) refers to positive pressure ventilation that is delivered through a noninvasive interface. It is considered as a standard treatment for patients admitted to hospital with hypercapnic respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease (COPD). NIV improves gas exchange and reduces respiratory muscle work, consequently allowing respiratory muscle recovery. The available evidence establishes that NIV might reduce intubation, morbidity and mortality rates in patients with severe COPD exacerbations. NIV shortens intensive care unit and total hospital lengths of stay. It can be used to facilitate the process of weaning from mechanical ventilation and prevent development of post-extubation respiratory failure. Patients with severe respiratory acidosis or with altered levels of consciousness due to carbon dioxide retention are at a high risk of NIV failure. In these patients, a NIV trial should be attempted in closely monitored clinical conditions where prompt endotracheal intubation may be performed. The benefi ts of long-term NIV management of stable COPD are still controversial. However, implementation of high-intensity NIV has been shown to improve outcomes in this patient group. High-intensity NIV improves gas exchange, lung function, health-related quality of life, exercise tolerance and survival compared to standard care alone. In stable severe COPD, the addition of NIV to a pulmonary rehabilitation program improves outcomes as compared to pulmonary rehabilitation alone. Since NIV provides signifi cant benefi ts in COPD, every physician who is involved in the treatment of these patients should be familiar with this technique.

Lung transplantation has become a life-saving procedure for the patients with a variety of end- stage pulmonary diseases. The most common indications for lung transplantation are: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1 antitrypsin deficiency related emphysema, and primary pulmonary hypertension. Patients whose life expectancy is predicted at less than 50% over the next 24-36 months despite optimal and maximal medical management and/or if they have class III and IV symptoms according to the New York Heart Association (NYHA) association should be referred for a transplant assessment. There are several types of lung transplantation procedures: single- lung, double-lung, lobar lung, and heart-lung transplantation. Lung transplant recipients are at increased risk for different types of complications. Infectious complications are common due to a high level of immunosuppression, continuous contact of the transplanted organ with the environment along with the loss of defence mechanisms, including the mucociliary clearance, cough reflex and lymphatic drainage. Primary graft dysfunction may occur within the first 24 hours after the transplantation. It can result from allograft injury during transplant process (explantation and preservation of donor organ, cold ischemic storage) or from ischemia- reperfusion injury of the allograft after implantation. Despite improved immunosuppressive regimes, acute rejection affects more than 30% of lung transplant recipients within the first year after transplant. We distinguish acute cellular, humoral and hyperacute rejection. After the first transplantation year, chronic rejection is the primary cause of mortality in lung transplant recipients, accounting for approximately 40% of deaths. There are two types of chronic lung rejection phenotypes: bronchiolitis obliterans syndrome and restrictive allograft syndrome. The key to successful treatment of post-transplant complications is prompt patient evaluation which often includes invasive diagnostic testing to assure appropriate therapeutic approach. Croatian transplantation programme exists since 2011. Lung transplantation has performed in 67 patients, lung and heart transplantation in two patients, and lung re-transplantation in one patient.

O izazovima liječenja NTM.

UVODDosadašnja ispitivanja odnosa indeksa tjelesne mase (engl. = body mass index, BMI), masnog tkiva i koštane mase dala su kontradiktorne rezultate. Njihov odnos u endokrinim bolestima do sada nije detaljnije ispitivan. Novija istraživanja na velikom broju ispitanika pokazala su da debljina ne štiti od prijeloma, kao što se ranije vjerovalo. Povezana je s većim rizikom prijeloma kostiju potkoljenice. U postmenopauzalnih žena s osteoporozom je povećan rizik prijeloma kosti, a posebno kostiju gležnja i potkoljenice, odnosno humerusa i lakta. Debljina je povezana i s povećanim rizikom ponavljanih prijeloma podlaktice u dječaka. Iako većina studija pokazuje pozitivnu povezanost BMI i mineralne gustoće kosti (engl.= bone mineral density, BMD), ispitivanje odnosa sastava tijela, te rizika prijeloma pokazalo je da su mišićna masa i masna masa, te distribucija masti čimbenici koji neovisno o BMI utječu na BMD i rizik prijeloma. Masno tkivo, mišići i kosti su međusobno povezani. Masno tkivo djeluje na kosti humoralnim i biomehaničkim mehanizmom, ali i indirektno preko utjecaja na mišiće koji uglavnom biomehanički djeluju na kosti. Djelovanje visceralnog i potkožnog masnog tkiva na kosti se razlikuje. Zato različiti tipovi debljine mogu za posljedicu imati različit utjecaj na BMD i rizik prijeloma.Različite endokrine bolesti povezane su s povećanim rizikom osteoporoze i prijeloma kosti. Patofiziološki mehanizmi su složeni. Oni uključuju endokrine mehanizme, ali je moguć i indirektni učinak preko utjecaja endokrinih poremećaja na sastav tijela (masno tkivo i mišiće) i preko njega na kosti. Do sada ovaj mehanizam nije detaljnije ispitivan. CILJ ISPITIVANJAIspitati jesu li BMI i distribucija masti povezani s mršavom masom, BMD-om i BMC-om (engl.=bone mineral content) u bolesnika s akromegalijom, Cushingovim sindromom i hipertireozom. ISPITANICIU ispitivanju je sudjelovalo 74 ispitanika sa: - akromegalijom 20 - Cushingovim sindromom 14 - hipertireozom 40 METODE Mjerili smo TT (kg), TV (m) i izračunali BMI (kg/m2). Denzitometrijski smo mjerili masnu (g) i mršavu masu (g): ukupnu, na trupu i ekstremitetima. Izračunali smo omjere masne mase: trup/ukupna masa, noge/ukupna masa, ruke+noge/trup, kao mjeru distribucije masti. Za procjenu koštane mase mjerili smo BMD (g/cm2) i BMC (g/cm): L1-L4 regije, vrata bedrene kosti i radiusa. REZULTATI Prosječna dob ispitanika bila je 50 godina. Ustanovljena je pozitivna korelacija BMI i BMD-a L1-L4, vrata bedrene kosti, radiusa i ukupnog BMD-a (Pearson Correlation Sig. 2-tailed, p

UVOD Masno tkivo je vrlo aktivna endokrina žlijezda koja izlučuje veliki broj adipokina koji imaju endokrino, parakrino i autokrino djelovanje. Prije nekoliko godina je ustanovljeno da kemoatraktant chemerin predstavlja adipokin kojeg izlučuje visceralno masno tkivo. Njegova koncentracija u krvi u pozitivnoj je korelaciji s količinom masnog tkiva i povišena je u debljini. On sudjeluje u diferencijaciji adipocita autokrino-parakrinim djelovanjem. Koncentracija chemerina je povišena u upanim tkivima i u krvi u nekim upalnim bolestima i metaboličkom sindromu, mada još nije sasvim sigurno djeluje li on pro- ili anti-inflamatorno. Debljina je povezana s kroničnim sistemskim upalnim stanjem, a chemerin bi mogao predstavljati vezu između debljine i upalnog stanja, mada to još nije potvrđeno. S druge strane, u kroničnim upalnim bolestima dolazi do ubrzane koštane pregradnje i pojačanog gubitka kosti, odnosno osteoporoze. U taj proces mogu biti uključeni neki citokini, pa potencijalno i kemoatraktanti. Zato bi bilo korisno ispitati utječe li kemoatraktrant chemerin, čija koncentracija u debljini je povišena, na koštanu masu u debljini. Do sada nije ispitivan utjecaj chemerina na koštanu masu. CILJ ISPITIVANJAJe li u debljini koncentracija adipokina chemerina u plazmi povezana s BMD-om i BMC-om. ISPITANICE I METODE U ispitivanje je uključeno 46 ispitanica s BMI >30 kg/m2 Koncentraciju chemerina u plazmi mjerili smo ELISA metodom. Limit detekcije assaya bio je 0.13 g/l. Korišten je kit firme BioVendor - Laboratorni medicina a.s., Modrice, Czech Republic.Metodom denzitometrije pomoću x-zraka s dvije jačine (engl. dual x-ray densitometry = DEXA) mjerili smo ukupnu i regionalu (ruke, noge i trup) mršavu i masnu masu (g). Istom metodom mjerili smo mineralnu gustoću kosti (engl. bone mineral density = BMD, g/cm2) i mineralni sadržaj kosti (engl. bone mineral content = BMC, g/cm). REZULTATI  Prosječna dob ispitanica bila je 50 godina, a BMI: 38, 52 kg/m2.  Rezultati su pokazali značajnu pozitivnu povezanost koncentracije chemerina u plazmi i BMD-a rebara (Pearson Correlation, P=0, 05).  Nije ustanovljena povezanost koncentracije chemerina s BMI, ukupnom mršavom i masnom masom i njihovom distribucijom, niti s ukupnim ili regionalnim BMD-om i BMC-om (P>0, 05). RASPRAVAUstanovili smo pozitivnu povezanost koncentracije chemerina i BMD-a rebara, dok nismo ustanovili povezanost s BMD-om drugih dijelova skeleta, niti s BMC-om. Nismo ustanovili povezanost koncentracije chemerina s ukupnom masnom masom, denzitometrijski procijenjenom distribucijom masne mase, niti s mršavom masom. Dosadašnji radovi su pokazali postojanje povezanosti koncentracije chemerina u krvi i BMI, masne mase i visceralne masne mase. Naši rezultati se mogu objasniti na tri načina: a) koncentracija chemerina u krvi nije povezana s masnom masom niti distribucijom masti, b) na rezultate je utjecao mali broj ispitanika (45), c) denzitometrija nije dobra metoda za procjenu distribucije masti. U prethodnom ispitivanju odnosa sastava tijela i koštane mase u akromegaliji, Cushingovom sindromu i hipertireozi ustanovili smo pozitivnu povezanost omjera masna masa na trupu/ukupna masna masa s BMD-om rebara (P

Malo je spoznaja o promjenama strukture tijela koje se događaju u hipertireozi i u remisiji bolesti i njihovom utjecaju na parametre metabolizma masti, uglikohidrata i kosti. U cilju boljeg upoznavanja utjecaja remisije hipertireoze na strukturu tijela proveli smo ispitivanje u bolesnica s dugotrajnom nereguliranom hipertireozom u kojih je provedena terapija radioaktivnim jodom. U 56 ispitanica prosječne dobi 59.21 (30-79) godina, prije započinjanja radiojodne terapije mjerili smo denzitometrijski BMD u L1-L4, vratu bedrene kosti i podlaktičnim kostima, ukupnu masnu masu, distribuciju masti i mršavu masu, te laboratorijske parametre pregradnje kosti, metabolizma masti i glukoze. Nakon godinu dana ponovili smo iste pretrage. Istraživanje su završile 24 ispitanice. Rezultati su pokazali porast TT za 2.05 kg (p=0.012) i BMI za 0.92 kg/m2(p=0.006). Pri tome je porasla je glikemija za 0.22 mmol/l (p=0.046). Registrirano je smanjenje koncentracije AF u plazmi, vjerovatno povezano s porastom koncentracije 25(OH)D3 (p=0.002). Iznenađujuće je smanjenje BMD-a ruku (p=0.011), dok se BMD i BMC drugih dijelova skeleta nisu značajno mijenjali nakon godinu dana. Potrebno je nastaviti istraživanje kroz duži vremenski period i na većem broju ispitanika da bi se razjasnilo kako remisija hipertireoze utječe na strukturu tijela, distribuciju masti, koštanu masu.

Incidentalomi nadbubre`ne `lijezde jesu tumori otkriveni tijekom dijagnosti~ke evaluacije nekoga drugog klini~kog stanja. Tehnolo{; ; ki napredak radiolo{; ; kih ure|aja i njihova sve ve}; ; a upotreba u svakodnevnoj klini~koj praksi doveli su do ~e{; ; }; ; eg otkrivanja ovih tumora ~ine}; ; i njihovu dijagnostiku i lije~enje jednim od najva`nijih izazova moderne endokrinologije. Radi racionalnog pristupa ovim bolesnicima radna skupina koju su ~inili vode}; ; i hrvatski stru~njaci iz podru~ja bolesti nadbubre`ne `lijezde, na temelju relevantne znanstvene literature i postoje}; ; ih smjernica europskih i svjetskih dru{; ; tava, donijela je preporuke za dijagnostiku i lije~enje incidentaloma nadbubre`ne `lijezde.

46-godišnja bolesnica je hospitalizirana sa slikom floridne hipertireoze (T3 6, 2 nmol/l T4 240 nmol/L TSH manji od 0, 05 mU/L), hipertenzijom (izmjeren RR 200/120 mmHg), tahikardijom (EKG sinus 129/min) i općim lošim stanjem. UZV-om vrata pokazala se difuzno promijenjena uvećana struma sa pozitivnim nalazom antitijela, klinički izraženom oftalmopatijom. Bolesnica navodi da je u zadnjih 3-4 mjeseca počela gubiti na težini, primijetila je tremor ruku i povremeno lupanje srca. Međutim, nekoliko dana prije prijema u bolnicu primijetila je povremeno kočenje donjih ekstremiteta, naočito nakon sna. Pri prijemu iz laboratorijskih nalaza dominira niska vrijednost kalija od 2, 4 mmol/L. Uz uvedenu nadoknadu kalija iv. (kalijev klorid), neselektivnog beta blokatora, peroralnog tireostatika te ostalu standardnu suprotivnu terapiju dolazi do povlačenja neuromuskularnih tegoba. Učinjen EMNG nakon provedene terapije nije pokazao osobitosti, a po smirivanju hipertireoze nije bila potrebna antihieprtenzivna terapija. Radi se o tireotoksičnoj periodičkoj paralizi, bolesti nepoznatog uzroka koja je karakterizirana progresivnom slabosti mišića praćene hipokalijemijom u hipertireozi. Mogući uzrok je unutarstanični pomak kalija nastao povećanom osjetljivošću Na+/K+–ATP-aze stanične membrane koja je inače stimulirana inzulinom i beta adrenegičkom stimulacijom. U stanjima viška hormona štitnjače povećana je osjetljivost na adrenergički stimulus čime se objašnjava hipokalijemija. Bolest se najčešće javlja u mladih muškaraca orijentalnog porijekla. Ovo je drugi dosada opisani slučaju tireotoksične periodične paralize u Hrvatskoj, prvi puta dijagnosticirane u 24-godišnjeg muškarca (J. Morović-Vergles i sur: Tireotoksična periodična paraliza: prikaz slučaja. Acta clin Croat 2002). U našem slučaju rijetka bolesti javila se u etničkom okruženju kod kojeg se njena pojava ne očekuje, ali i u spolu koji nije tipičan za navedenu bolest

Prikaz bolesnice s inzulinomom

U literaturi nedostaju podaci o utjecaju mršavljenja na promjene strukture tijela. Ove promjene bi mogle imati utjecaja na parametre metaboličkog sindroma i koštane mase. U Centru za debljinu KBC Zagreb ispitivan je utjecaj mršavljenja na strukturu tijela u 17 ispitanica tijekom 8 mjeseci. Prosječna dob ispitanica bila je 50.18 godina (21-74). Sve su dobile iste preporuke o promjeni načina života, uravnoteženoj niskokalorijskoj prehrani sa smanjenjem unosa od 500 kcal/dan i redovitim šetnjama 1 sat. Bolesnicama je na prvom i kontrolnom pregledu denzitometrijski mjerena ukupna masna masa, distribucija masti, mršava masa i mineralna gustoća kosti. Osim toga laboratorijski su mjereni metabolički parametri koštane pregradnje i metabolizma masti i ugljikohidrata. Tijekom prosječno 8 mjeseci zabilježeno je statistički značajno smanjenje tjelesne težine (p=0.017) i BMI (p=0.026). Pri tome je došlo i do promjena u strukturi tijela. Ustanovljeno je i statistički značajno smanjenje masne mase u rukama (lijevo, p=0.0022, desno p=0.017), nogama (lijevo p=0.003, desno, p=0.039) i trupu (p=0.007), i ukupne masne mase (p:0.009). Mršava masa se nije značajnije mijenjala. BMD se smanjio u L1-L4 regiji (p=0.012) i vratu bedrene kosti (p=0.028). Rezultati pokazuju da mršavljenje uzrokuje promjene strukture tijela i smanjenje koštane mase. Potrebna su daljnja ispitivanja u cilju iznalaženja specifičnijih metoda liječenja debljine u bolesnika s različitim tipovima debljine.

The majority of adrenal incidentalomas (AI), adrenal masses discovered incidentally during diagnostic investigation of non-adrenal disorders, are benign and non-functional. Interestingly, no studies with ambulatory blood pressure monitoring (ABPM) in patients with AI have been published so far. In this case-control study, we analyzed ABPM data of 57 patients with AI (12 men, 45 women) and 103 patients with essential hypertension (EH) (60 men, 63 women). ABPM was performed using a SpaceLabs 90207 device. Classification and interpretation of ABPM data were done according to the ESH/ECS guidelines. Average daytime values were higher in the EH than in the AI group (136 ± 9/87 ± 10 vs. 133 ± 21/80 ± 15), as well as blood pressure load (BPL) for systolic and diastolic BP (46.5 ± 30.6 vs. 37.9 ± 30.2 ; 41.6 ± 32.0 vs. 26.4 ± 31.4 mmHg, respectively). On the contrary, average nighttime values were higher in the AI than in the EH group (125 ± 21/73 ± 14 vs. 119 ± 13/71 ± 11). There were no differences in nighttime BPL between EH and AI. In the AI group, BPL was higher during nighttime than during daytime for both systolic and diastolic BP (47.0 ± 32.3 vs. 37.9 ± 30.2 ; 29.6 ± 31.0 vs. 26.4 ± 31.4, respectively). No differences in BP variability were observed between EH study suggest that further investigations are needed before any final conclusion could be made.

The majority of adrenal incidentalomas (AI), adrenal masses discovered incidentally during diagnostic investigation of non-adrenal disorders, are benign and non-functional. However, not so many studies on clinical characteristics of patients with AI have been published so far, and our aim was to analyze data in our group of patients. In this case-control study, we analyzed the clinical characteristics of 57 patients with AI (12 males, 45 females) and compared to data of 103 patients with essential hypertension (EH) (60 males, 63 females) referred to our hospital. All patients underwent clinical examination, blood pressure (BP) measurements, and hormonal testing. Imaging techniques were performed as well. Patients were not taking antihypertensive drugs during the examination.

Increased arterial stiffness has been shown to predict cardiovascular mortality. Recently, ambulatory arterial stiffness index was proposed as a new method.