[Extremely elevated erythrosedimentation in an adult population in the City of Buenos Aires]

BACKGROUND

An extremely elevated erythrosedimentation rate (ESR), defined as equal or higher than 100 mm/h, has been linked to serious underlying conditions, such as infections, connective tissue and oncologic disease.

AIM

To analyze a group of patients in order to determine the underlying diagnosis and the characteristics associated with extremely elevated ESR in our environment.

METHODS

Cross-sectional study of adult patients, who presented with at least one ESR equal or higher than 100 mm/h at Hospital Italiano, in Buenos Aires (Buenos Aires, Argentina) between January 2002 and August 2014.

RESULTS

During the previously stated period of time, we analyzed the results of 879 patients. All patients were over 18 years of age. The median for the ESR results was 111 mm/h (interquartile range 105-120). The most prevalent etiology of an elevated ESR was infectious (41.64%), followed by malignancies (21.62%) and autoimmune / inflammatory diseases (12.97%). The most frequent individual diagnosis found was pneumonia (11.49%), followed by undetermined causes (5.92%).

CONCLUSION

When comparing inpatient versus outpatient populations, the most frequent cause was infectious in the former group, while malignancies were the most frequent diagnosis in the latter.

Recent advances in the understanding of the pathophysiology and treatment of hyperprolactinemia

Hyperprolactinemia is frequently diagnosed in patients with infertility and menstrual cycle irregularities. Control of prolactin secretion is complex and involves inhibition by dopamine and possibly endothelins, as well as stimulation by serotoninergic and opioidergic pathways, gonadotropin-releasing hormone, and possibly galanin. Some patients with hyperprolactinemia have underlying functional disorders, but by using magnetic resonance imaging, a microprolactinoma can be found in most. Prolactin circulates in a low-bioactivity glycosylated and a nonglycosylated form, and an antibody-bound form is found in a few hyperprolactinemic patients who are relatively asymptomatic. The majority of patients, particularly those with macroprolactinomas, will benefit from treatment with bromocriptine. Available alternatives for intolerant patients include vaginal administration of bromocriptine and pergolide mesylate. Other compounds, monthly injectable and slow-release forms of bromocriptine, quinagolide and carbegoline, are not yet available in the United States. Withdrawal of treatment during pregnancy is still recommended, with a low risk of tumor enlargement, and the need for life-long treatment is now being reconsidered.