Vitamin D receptor gene polymorphism and cardiovascular risk variables in elderly Polish subjects.

The aim of this work was to evaluate whether the FokI and BsmI polymorphisms of the VDR gene are associated with anthropometric and biochemical features of cardiovascular disease (CVD) in a Caucasian population aged over 65, participants of the Polish PolSenior study. We performed the study on randomly selected subjects: 427 women and 454 men aged over 65. Measurements of anthropometric parameters were carried out and biochemical parameters were estimated using commercial kits. VDR polymorphisms (rs10735810, rs1544410) were genotyped by PCR and FRLP. The prevalence of BsmI genotypes was 50% Bb, 23% bb, 27% BB in women and 48% Bb, 20% bb, 32% BB in men. The prevalence of FokI was 48% Ff, 22% ff, 30% FF in women and 50% Ff, 18% ff, 32% FF in men. The women bearing the rare allele b differ in homeostatic model assessment (HOMA) (p < 0.049) from women bearing common allele B, and the men differ in insulin level (p < 0.047) and HOMA (p < 0.017). There were no significant differences in anthropometric or biochemical parameters between genotypes in FokI in female and male groups. The common allele B is connected with biochemical risk factors of CVD in older Caucasian men and women.

[Iodine supply and thyroid function in the group of healthy pregnant women living in Warsaw]. / Zaopatrzenie wjod oraz czynnosc tarczycy w grupie zdrowych kobiet ciezarnych zamieszkujacych Warszawe.

UNLABELLED: Iodine deficiency and thyroid gland disorders are especially harmful for pregnant women and normal fetal development. After initiation in 1997 of obligatory iodine prophylaxis, Poland has been found since 2003 a country with sufficient delivery of this microelement. However, in the population of pregnant women, slight deficiency of this element still exists. Insufficient iodine supply results in abnormalities of thyroid hormones'biosynthesis. Simultaneously, adaptive changes, occurring in pregnancy, make the proper interpretation of hormone's assays difficult. Lack of normative data for the thyroid hormones concentration in the each pregnancy trimester for Polish population cause additional difficulties in the interpretation of these results. The aim of the study was prospective observation of iodine intake and thyroid function in healthy pregnant women supplemented with 150 pg of iodine daily MATERIALS AND METHODS: 62 healthy pregnant women living in Warsaw in the early weeks of pregnancy, confirmed by ultrasonographic examination, were included to this study. Pregnancies were singleton resulting in birth of healthy neonates. Urinary iodine concentrations (UIC), serum TSH, fT4, fT3, antyTPO, thyroid volume and morphology by the ultrasonography examination were assessed in consecutive trimesters of pregnancy. TSH level was measured in the each newborn. RESULTS: Low urinary iodine concentrations (UIC)-median 96 microg/l was found at the beginning of pregnancy Only in 14% of pregnant women UIC exceeded 150 microg/l. In spite of intended supplementation of at least 150 microg of extra iodine per day, medians of UIC in the next trimesters were 122 microg/l and 129 microg/l, respectively. TSH levels kept reference values for the 1st trimester of pregnancy in 86% of participants and in the next trimesters in 85% and 95%, respectively. Levels of fT4 were within reference range for the women in the 1st trimester. In 2nd trimester 12% and in 3rd trimester 33% of pregnant women had fT4 level below the reference value. Concentrations of fT3 were within reference values during whole pregnancy. Median thyroid volume was respectively 11.12 ml; 13.0 ml and 15.75 ml (range: 6.8-26.8 ml) in subsequent trimesters.Median neonatal' TSH level on the 3rd day of life, as a screening of thyroid insufficiency, was 1.34 mlU/l (range: 0.01-6.6 mlU/l) and in 4.41 % of newborns TSH concentrations were higher than 5 mlU/I. CONCLUSION: Despite the sufficient supply of iodine in the whole population, iodine consumption among the pregnant women is still not satisfactory. The increase of TSH values above the upper reference level for pregnant women in 15% of patients may be related to iodine deficiency. It is important to educate pregnancy planning women about this problem. Our observations confirm the importance of the recommendations that during the pregnancy every woman should receive supplementation of iodine at the minimal amount of 150 microg daily.

Insulinoma in a patient with MEN 1 syndrome--9-year follow-up: case report.

INTRODUCTION: Multiple endocrine neoplasia type 1 (MEN 1) is a rare autosomal dominant inherited endocrine disease characterized by pancreatic, parathyroid, and anterior pituitary tumours. Hypercalcaemia due to parathyroid tumours is usually the first manifestation of MEN 1. Pancreatic islet tumours occur less frequently, among them gastrinomas and insulinomas are the most prevalent. Prolactinomas are a relatively common pituitary presentation of the syndrome. The gene causing MEN 1 is localized in chromosome 11q13 and encodes a protein named menin, which interacts with various proteins involved in transcriptional regulation, cell division, and DNA repair. Various mutations in the menin gene have been described, but so far no strong correlation between genotype and phenotype has been found. CASE REPORT: We report a case of a 31-year-old man, a lawyer, who was diagnosed with MEN 1 syndrome in 1999 at the age of 21 when he was operated because of prolactinoma and hyperparathyroidism. In 2000 insulinoma was suspected and eventually multifocal lesions in the pancreas were revealed. However, the patient did not agree to be operated on. Since then he has been followed up and has been treated with diazoxid. We observed gradual progression of the disease, but the patient remains in relatively good condition. CONCLUSIONS: Careful screening for MEN 1 is important in young patients with pituitary tumours. Regular follow up is crucial even after surgical treatment. The presented patient developed gradual enlargement of insulinomas and reoccurrence of hyperparathyroidism as well.

Congenital adrenal hyperplasia due to 21-hydroxylase deficiency - management in adults.

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is one of the most common autosomal recessive hereditary diseases. The impairment of cortisol synthesis leads to excessive stimulation of the adrenal glands by adrenocorticotropic hormone (ACTH), adrenal hyperplasia, and excessive androgen synthesis. The syndrome is characterised by a considerable correlation between the genotype and the phenotype with the type of CYP21A2 gene mutation affecting the severity of 21-hydroxylase deficiency. The clinical manifestations of CAH in adults result from adrenocortical and adrenomedullary insufficiency, hyperandrogenism, and the adverse effects of glucocorticosteroids used for the treatment of the condition. Non-classic CAH may sometimes be asymptomatic. In patients with classic CAH obesity, hyperinsulinaemia, insulin resistance, and hyperleptinaemia are more often seen than in the general population. These abnormalities promote the development of metabolic syndrome and its sequelae, including endothelial dysfunction, and cardiovascular disease. Long-term glucocorticosteroid treatment is also a known risk factor for osteoporosis. Patients with CAH require constant monitoring of biochemical parameters (17a-hydroxyprogesterone [17-OHP] and androstenedione), clinical parameters (body mass, waist circumference, blood pressure, glucose, and lipids), and bone mineral density by densitometry. The principal goal of treatment in adults with CAH is to improve quality of life, ensure that they remain fertile, reduce the manifestations of hyperandrogenisation in females, and minimise the adverse effects of glucocorticosteroid treatment. Patients with classic CAH require treatment with glucocorticosteroids and, in cases of salt wasting, also with a mineralocorticosteroid. Radical measures, such as bilateral adrenalectomy, are very rarely needed. Asymptomatic patients with non-classic CAH require monitoring: treatment is not always necessary. Medical care for patients with CAH should be provided by reference centres, as the management of such patients requires collaboration between an endocrinologist, diabetologist, gynaecologist, andrologist, urologist, and psychologist.

Polymorphism of the oestrogen receptor beta gene (ESR2) is associated with susceptibility to Graves' disease.

OBJECTIVE: To investigate whether a polymorphism in the ESR2 gene (rs4986938, previously associated with endometriosis, ovulatory dysfunction and premature onset of coronary heart disease) increases the risk of Graves' disease (GD). SUBJECTS AND DESIGN: A cohort of 375 GD patients (300 females and 75 males) and 1001 individuals representative of the background population of Poland (502 males and 499 females) were genotyped for rs4986938 using allele-specific polymerase chain reaction (PCR). RESULTS: We found an increased frequency of the ESR2 A allele among the patients vs. controls (38.0%vs. 32.7%, OR = 1.26, P = 0.009) that was caused by a co-dominant (OR = 1.25, P = 0.01, P(for model fit) = 0.127) or a recessive (OR = 1.67, P = 0.003, P(for model fit) = 0.554) effect. The association was found in both sexes (OR = 1.21, P = 0.046 and OR = 1.53, P = 0.029, respectively, for co-dominant and recessive models in females, and OR = 1.44, P = 0.034 and OR = 2.29, P = 0.01, respectively, for the two models in males) and was more pronounced among the DRB1*03-negative (OR = 1.63, P = 0.0002) than DRB1*03-positive patients (OR = 1.04, P = 0.822). No other statistically significant associations between the ESR2 genotype and GD subsets were found (age of onset, smoking, clinically evident ophthalmopathy, family history of GD, and PTPN22 and CTLA4 (CT60) genotypes were analysed). CONCLUSIONS: In a Polish population the ESR2 A allele is associated with GD with a strength comparable to polymorphisms of PTPN22 and CTLA4 CT60 loci (OR approximately 1.7). The association with ESR2 is found in both sexes and may be particularly strong among the DRB1*03-negative individuals.

Consensus statement of the Polish Society for Endocrinology: presurgical somatostatin analogs therapy in acromegaly.

Consensus statement of the Polish Society for Endocrinology, regarding presurgical somatostatin analogs in acromegaly has been presented. It is suggested to administer depot somatostatin analog (Octreotide LAR at the dose 20 mg and then 30 mg or equivalent doses of Lanreotide Autogel 90/120 mg every 4 weeks) in order to normalize or suppress to a maximal extent GH and IGF-1 concentrations. The period of therapy in case of microadenoma would be at least 3 months (targets: biochemical improvement, reduced risk of disease's complications, perioperative risk reduction, inhibition of tumor growth). The period of therapy in case of macroadenoma would be at least 6 months, until maximal possible reduction of GH and IGF-1 concentrations (targets: tumor shrinkage, biochemical improvement, reduced risk of disease's complications, perioperative risk reduction). Using an uniform approach in a group, as numerous as possible, of treated patients would allow objective evaluation of long-term efficacy of the treatment.

First isolation of Clostridium difficile PCR-ribotype 027/toxinotype III in Poland.

Of 175 Clostridium difficile strains isolated from patient hospitalized in one academic hospital in Warsaw between 2005-2006, one isolate belonged to PCR-ribotype 027/toxinotype III. This isolate had tcdA, tcdB, binary toxin genes (cdtA and cdtB), a 18-bp deletion and a 1 bp deletion at 117 position in the tcdC gene. Antimicrobial susceptibility tests revealed high level resistance to erythromycin, moxifloxacin and gatifloxacin. This is a first report of the 027 strain of C. difficile in Poland.

Human breast cancer tissue expresses high level of type 1 5'-deiodinase.

Type 1 5'-deiodinase is one of two isoenzymes that participate in conversion of prohormone thyroxine into triiodothyronine (T3). A decrease in type 1 5'-deiodinase expression was observed in renal clear cell carcinoma, thyroid cancer, and lung cancer. The aim of this study was to evaluate type 1 5'-deiodinase activity and mRNA level in breast cancer tissue and non-cancerous surrounding breast tissue. Material was collected from 36 patients undergoing radical mastectomy or local tumor resection. In all non-cancerous breast tissues, type 1 50-deiodinase activity was found to be at a very low or immeasurable level, and type 1 5'-deiodinase mRNA was detected only in 2 out of the 36 samples. By contrast, 20 out of the 36 breast cancer tissues, mainly grades G1 and G2, expressed abundant type 1 5'-deiodinase activity and/or a high mRNA level. Our data demonstrated the presence of type 1 5'-deiodinase in well-differentiated breast cancer tissue. High enzymatic activity of type 1 50-deiodinase can potentially lead to an increase in the production of T3, which may affect target gene transcription, including genes responsible for energy expenditure, growth, differentiation, and proliferation.

[Consensus of the Polish Society of Endocrinology. Presurgical somatostatin analogs therapy in acromegaly]. / Konsensus Polskiego Towarzystwa Endokrynologicznego. Przygotowanie analogami somatostatyny do leczenia operacyjnego akromegalii.

Consensus statement of the Polish Society of Endocrinology, regarding presurgical somatostatin analogs in acromegaly has been presented. It is suggested to administer depot somatostatin analog (Octreotide LAR at the dose 20 mg and then 30 mg or equivalent doses of Lanreotide Autogel 90/120 mg every 4 weeks) in order to normalize or suppress to a maximal extent GH and IGF-1 concentrations. The period of therapy in case of microadenoma would be at least 3 months (targets: biochemical improvement, reduced risk of disease's complications, perioperative risk reduction, inhibition of tumor growth). The period of therapy in case of macroadenoma would be at least 6 months, until maximal possible reduction of GH and IGF-1 concentrations (targets: tumor shrinkage, biochemical improvement, reduced risk of disease's complications, perioperative risk reduction). Using an uniform approach in a group, as numerous as possible, of treated patients would allow objective evaluation of long-term efficacy of the treatment.

Reference Values for TSH and Free Thyroid Hormones in Healthy Pregnant Women in Poland: A Prospective, Multicenter Study.

OBJECTIVES: The diagnosis and treatment of thyroid diseases in pregnant women remains a challenge. Various medical associations recommend establishing the reference intervals for thyroid hormones by a local laboratory. Considering differences within geophysical, socioeconomic conditions, and iodine prophylaxis in various populations, it is advisable to assess reference intervals for thyroid hormones specific to a region of residence. The objective was to assess trimester-specific reference intervals for TSH, fT3, and fT4 for pregnant women in the Polish population. METHODS AND RESULTS: We conducted a prospective study in 4 centers representing different regions of Poland (Krakow, Warsaw, Poznan, and Bialystok). Our study included consecutive, healthy pregnant women (172 patients), with an age range of 27-47 years. All women had a negative history for thyroid diseases, normal thyroid peroxidase antibody levels, and proper iodine prophylaxis. All newborns had TSH levels in the appropriate reference range. Serum TSH, fT3, fT4, and thyroid-peroxidase antibodies were measured in each trimester. The reference intervals were calculated using the percentile method, as recommended by the International Federation of Clinical Chemistry. The reference values calculated were 0.009-3.177, 0.05-3.442, and 0.11-3.53 mIU/L for TSH; 3.63-6.55, 3.29-5.45, and 3.1-5.37 pmol/L for fT3; and 11.99-21.89, 10.46-16.67, and 8.96-17.23 pmol/L for fT4 in consecutive trimesters of pregnancy. Reference intervals for pregnant women when compared to the general population showed a lower concentration of TSH in every trimester of pregnancy and lower fT4 in the 2nd and 3rd trimesters. CONCLUSIONS: Using appropriate trimester-specific reference intervals may improve care of pregnant women by preventing misdiagnosis and inadequate treatment.

Interaction of HLA-DRB1 alleles with CTLA-4 in the predisposition to Graves' disease: the impact of DRB1*07.

OBJECTIVE: To study interactions between the two most widely confirmed Graves' disease (GD) loci: HLA-DRB1 and CTLA-4. HLA-DRB1*03 (risk allele) and DRB1*07 (protective allele) were analyzed in this aspect, the linked TNF G(-308)A polymorphism was also considered. DESIGN: A case-control study of 429 patients with GD compared to 308 healthy subjects. The impact of genes and their interactions were analyzed by stepwise logistic regression. RESULTS: The independent effects of DRB1*03 and DRB1*07 were confirmed in our study both by stratification studies and logistic regression. CTLA-4 did not appear to be associated with GD when the interactions with other genes were considered. By logistic regression we observed a significant interaction between DRB1*07 and CTLA-4 and revealed that CTLA-4 49G attenuated the DRB1*07-related protection, the effect noticed also in three-way stratification studies. We confirmed that the TNF G(-308)A polymorphism is only a marker of the DRB1 status. CONCLUSION: Our results stress the importance of complex gene interactions in the multigene predisposition to GD. The interactions between two predisposing loci, DRB1 and CTLA-4, are exerted rather by DRB1*07 than DRB1*03 allele: CTLA-4 acts via switching off the protective DRB1*07 influence, whereas the effect of DRB1*03 is independent.

[Triiodothyronine receptors (TR) are present in breast cancer tissues]. / Receptory dla trójjodotyroniny (TR) sa obecne w tkankach raka sutka na poziomie bialka.

INTRODUCTION: Possible relationships between breast cancer and thyroid hormones have been suggested for many years. The aim of this study was qualitative examination of triiodothyronine receptors (TR) in breast cancer tissues and in non cancerous breast tissue taken from the opposite side to the localization of the tumor. MATERIAL AND METHODS: The material consisted of 15 breast cancer tissues of grades G1 to G3 and the same number of control tissues obtained during radical mastectomy or local tumor resection. Tissues were homogenized. Protein fraction was isolated. Protein for TR was assessed in Western Blot reaction. RESULTS: Protein fraction for TR was present in all cancer tissues and 6 healthy controls. CONCLUSIONS: Obtained data may suggest so far unknown role of thyroid hormones and their nuclear receptors in the generation and development of breast cancer.

[Adrenal tuberculosis as a cause of primary adrenal insufficiency--case report]. / Gruzlica nadnerczy przyczyna niedoczynnosci kory nadnerczy--opis przypadku.

Adrenal tuberculosis is relatively infrequent cause of primary adrenocortical insufficiency in developed countries. Adrenal involvement is most often the result of hematogenous spread of the pulmonary tuberculosis. Isolated adrenal tuberculosis, especially with enlargement of adrenal glands can cause diagnostic problems and requires differentiation from primary or secondary neoplastic disease. In this paper we present a case of 61-year-old man with several months history of adrenocortical insufficiency without signs of pulmonary tuberculosis. Computed tomography scan revealed asymmetrical mass-like enlargement in adrenal glands. Despite of consecutive investigations, the diagnosis remained uncertain. Because of the possibility of neoplastic process of unknown origin, the patient was qualified for surgical exploration during which both enlarged glands were removed. The diagnosis of tuberculosis was made on microscopic examination.

[Production and preliminary characteristics of polyclonal antibodies specific to SSTR2A and SSTR5 receptors in the pituitary gland]. / Otrzymywanie oraz wstepna charakterystyka poliklonalnych przeciwcial swoistych dla receptorów SSTR2A i SSTR5 przysadki.

The increasing interest in somatostatin receptors (SSTR) is mainly due to their involvement in the regulation of hormone secretion and the role in somatostatin analogue treatment of patients with pituitary adenomas. The efficiency of this treatment is highly dependent on receptor expression in tissue which on the protein level requires specific anti-receptor antibodies for testing. In this paper we introduced the principles for the production of several polyclonal antibodies specific for C-terminal intracellular part or N-terminal extracellular part of SSTR2A and SSTR5 receptors. The antibodies were highly specific for peptides used for immunization of animals, had low cross-reaction activities for other SSTR2A and SSTR5 peptides and reacted with receptors on immunoblots and in immunohistochemistry. The final verification of the antibodies' specificity would allow us to perform the research concerning the structure and posttranslational modifications of SSTR and avoid dependency of commercial sources.

Association between vitamin D concentration and levels of sex hormones in an elderly Polish population with different genotypes of VDR polymorphisms (rs10735810, rs1544410, rs7975232, rs731236).

BACKGROUND: Vitamin D co-regulates the synthesis of sex hormones in part by interaction with its nuclear receptor. The aim of this study was to determine whether there is an association of vitamin D concentration vs the level of sex hormones in elderly Polish individuals with different genotypes of the vitamin D receptor (VDR) gene. MATERIALS AND METHODS: Rs10735810, rs1544410, rs7975232, and rs731236 polymorphisms of VDR, the serum sex hormone level, free estrogen index (FEI) and free androgen index (FAI) as well as vitamin D, were evaluated in 766 persons (362 women and 404 men) selected from 5695 Polish population, aged 65-90years from the PolSenior survey. RESULTS: We observed that women with GG (rs731236), TT (rs7975232), BB (rs1544410) and FF (rs10735810) genotypes were characterized by a significant correlation between vitamin D vs testosterone concentration and FAI value. We found a significant correlation between testosterone level and FAI vs vitamin D concentration in men with heterozygote AG in the rs731236 polymorphism and in the GG (rs7975232), the BB (rs1544410), and the Ff (rs10735810) genotypes. CONCLUSION: In elderly selected Polish population with different genotypes of VDR polymorphisms, a statistically significant relationship between vitamin D concentration vs testosterone level was observed.

[Late onset of medullary thyroid carcinoma with bilateral adrenal pheochromocytomas in the case of patient with MEN 2]. / Pózne ujawnienie sie raka rdzeniastego tarczycy u chorej z obustronnymi guzami chromochlonnymi nadnerczy w przebiegu zespolu wielonarzadowej gruczolakowatosci wewnatrzwydzielniczej.

A 22-year-old woman complained of paroxysmal face flushing, palpitation and hypertension. CT scan revealed 55 mm mass in the right adrenal gland. Hormonal examination showed highly elevated urinary catecholamines and their metabolites excretion. Histological examination of the removed right adrenal gland confirmed the diagnosis of pheochromocytoma. 4 years later we observed the recurrence of similar symptoms. After the hormonal examination and CT imaging left adrenalectomy was performed, because of the presence of 33 mm diameter tumor in the left adrenal gland. Young age of our patient and occurence of bilateral pheochromocytomas suggested multiple endocrine neoplasia type 2. DNA sequence analysis of peripheral white blood cells revealed that codon 609 in exon 10 of the RET gene was mutated from TGC to CGC. During the further follow up of this patient we found 5 mm mass in the left lobe of the thyroid. Result of cytological examination of this focal mass and elevated calcitonin level in the pentagastrin test suggested the diagnosis of medullary thyroid cancer which was later confirmed after total thyeoidectomy based on results of histopathology of tumor. No metastatic changes was found. DNA analysis of the somatic mutation of the RET protooncogene was useful for the early detection of medullary thyroid cancer in the case of the 30-year-old patient with MEN 2A.

[Iodine supply in school children three years after introduction of obligatory salt iodization]. / Podaz jodu u dzieci szkolnych w trzy lata po wprowadzeniu obowiazkowego jodowania soli spozywczej.

Three years after introduction of obligatory salt iodization in Poland we evaluated iodine supply in children from Mazovia region. Urinary iodine concentration (UIC) was estimated in morning samples from 779 schoolchildren aged 6-14 years. Previous investigation 7 years ago revealed mild or moderate iodine deficiency in this area. UIC was lower than 100 micrograms/l in 80% of samples and mean UIC was 56.9 +/- 42.3 micrograms/l. According to WHO and ICCIDD recommendations median value of UIC at least 100 micrograms/l in the representative sample of population indicates satisfactory iodine supply. Recent data revealed that UIC was much higher than in the first phase of study, 7 years ago--mean 115.5 +/- 76.6 micrograms/l and median 100.69 micrograms/l. UIC lower than 100 micrograms/l occurred in 48% of samples, more frequently in rural regions. Iodine supply in the region was diversified--we revealed rural cohort where mean and median values of UIC (corresponding 78.96 +/- 47 micrograms/l and 67.8 micrograms/l) were unexpectedly low. Our results confirm the improvement of iodine supply in Poland after 1997. Nevertheless, taking under consideration that daily iodine supply in children and adolescents should reach 120-150 micrograms, the situation is not fully satisfactory--almost in half of schoolchildren iodine consumption hardly reaches recommended value for the whole population. We stress the necessity of continuous monitoring of the adequacy of iodine supplementation and its results.

[Diagnostic difficulties in Grave's orbitopathy--case report]. / Trudnosci diagnostyczne w orbitopatii tarczycowej--opis przypadku.

Graves' orbitopathy is caused by intraorbital inflammatory reaction due to autoimmune thyroid disease. In most cases the diagnosis is based on the coexistence of typical eye signs and hyperthyroidism symptoms. In presented case, the absence of thyroid dysfunction implicated performance of differential diagnosis. Among many available diagnostic tools nuclear magnetic resonance seems to be the most accurate in confirmation of diagnosis of Graves' orbitopathy.

[Dramatic symptoms of pheochromocytoma in old woman during antiarrhythmic therapy with sotalol: case report]. / Dramatyczne ujawnienie sie guza chromochlonnego u chorej w wieku podeszlym po zastosowaniu sotalolu--opis przypadku.

We present the case of 81-years old woman with diabetes mellitus and moderate hypertension who reported multiple syncope's. Cerebral and metabolic causes of syncope's were excluded and the patient was diagnosed to have sick sinus syndrome. After implantation of the cardiac pacemaker the treatment with sotalol was started. After introducing the antiarrhythmic drug the frequency of syncopes increased dramatically and blood pressure rose unusually (up to 250/140 mm Hg). Subsequently phaeochromocytoma was suspected. Laboratory data as well as computed tomography confirmed the diagnosis of left adrenal tumour. After successful surgery the blood pressure normalized and the patient recovered uneventfully. The reported cases describes the difficulties in diagnosing phaeochromocytoma in elderly people with multiple different accompanying diseases.