INSTITUT ZA TRAVNJAŠTVO I KRMNO BILJE

Context: Tumors producing insulin-like growth factor 2 (IGF-2oma) are a major cause of spontaneous hypoglycemia. The treatment mainstay is surgical resection. Many case reports note resolution of hypoglycemia after IGF-2oma resection; however, outcomes are variable according to tumor type. We report a case of resolving hypoglycemia, observed on continuous glucose monitoring (CGM), after resection of an IGF-2-producing solitary fibrous tumor, of pleura and review the current literature. Case Report: A 69-year-old woman presented with impaired consciousness because of hypoglycemia. An IGF-2oma was diagnosed as the cause for hypoglycemia because of decreased serum insulin and IGF-1, presence of a pleural tumor, and a high-molecular-weight form of serum IGF-2 detected by western immunoblot. Surgical resection was performed; pathological examination demonstrated a solitary fibrous tumor with low-grade malignancy. CGM showed reversal of hypoglycemia after tumor resection. Approximately 2 years after resection, the patient has no signs of tumor recurrence or hypoglycemia. Conclusions: An IGF-2-producing solitary fibrous tumor of pleura in this case caused hypoglycemia. From a search of the literature of 2004–2014, 32 cases of IGF-2oma with hypoglycemia that underwent radical surgery were identified; in 19 (59%) patients, hypoglycemia was reversed and there was no subsequent recurrence. The remaining 13 (41%) experienced tumor recurrence or metastasis and recurrence of hypoglycemia average 43 months after initial tumor resection. The tumor of the present case was a low-grade malignancy. Regular follow-up with biomarker-monitoring of glucose metabolism and assessment of hypoglycemic symptomatology, in conjunction with imaging tests, is important for detecting possible tumor recurrence and metastasis.PostprintPeer reviewe

Can we predict age at natural menopause using ovarian reserve tests or motherʼs age at menopause? A systematic literature review

OBJECTIVE:: This review aimed to appraise data on prediction of age at natural menopause (ANM) based on antimüllerian hormone (AMH), antral follicle count (AFC), and motherʼs ANM to evaluate clinical usefulness and to identify directions for further research. METHODS:: We conducted three systematic reviews of the literature to identify studies of menopause prediction based on AMH, AFC, or motherʼs ANM, corrected for baseline age. RESULTS:: Six studies selected in the search for AMH all consistently demonstrated AMH as being capable of predicting ANM (hazard ratio, 5.6-9.2). The sole study reporting on motherʼs ANM indicated that AMH was capable of predicting ANM (hazard ratio, 9.1-9.3). Two studies provided analyses of AFC and yielded conflicting results, making this marker less strong. CONCLUSIONS:: AMH is currently the most promising marker for ANM prediction. The predictive capacity of motherʼs ANM demonstrated in a single study makes this marker a promising contributor to AMH for menopause prediction. Models, however, do not predict the extremes of menopause age very well and have wide prediction interval. These markers clearly need improvement before they can be used for individual prediction of menopause in the clinical setting. Moreover, potential limitations for such use include variations in AMH assays used and a lack of correction for factors or diseases affecting AMH levels or ANM. Future studies should include women of a broad age range (irrespective of cycle regularity) and should base predictions on repeated AMH measurements. Furthermore, currently unknown candidate predictors need to be identified

Fluctuations in anti-Müllerian hormone levels throughout the menstrual cycle parallel fluctuations in the antral follicle count : A cohort study

Introduction In this prospective cohort study we aimed to investigate the hypothesis that fluctuations in anti-Müllerian hormone levels stem from fluctuations in the number of antral follicles. Material and methods Repeated measurements of anti-Müllerian hormone and antral follicles (follicles 2–8 mm) were performed in 44 women with a regular cycle, during one menstrual cycle. If our hypothesis that anti-Müllerian hormone fluctuations stem from fluctuations in the antral follicles is correct, a fluctuation in the antral follicles would result in an equal and parallel shift in anti-Müllerian hormone. Hence, the difference between antral follicles and anti-Müllerian hormone would remain constant over time. A mixed model analysis, assessing the stability between anti-Müllerian hormone and antral follicles, was performed using the difference between logantral follicles and loganti-Müllerian hormone. Cohen's D was calculated for the largest of fixed effects in order to assess stability in relative distance between antral follicles and anti-Müllerian hormone. To assess if fluctuation in anti-Müllerian hormone or antral follicles originated from between-subject fluctuation, or from within subject fluctuation, the intra-class correlation coefficient was calculated. Results Mixed model analysis and Cohen's D (0.12) confirmed the stability of the difference between logantral follicles and loganti-Müllerian hormone and so confirmed our hypothesis. The good intra-class correlation coefficient (0.73) indicated a small contribution of within-subject variation to anti-Müllerian hormone fluctuations. Conclusions Fluctuations in anti-Müllerian hormone levels parallel fluctuations in antral follicles, suggesting that anti-Müllerian hormone levels are closely linked to variation in the antral follicles. This knowledge adds to the basic understanding of the origin of anti-Müllerian hormone and could aid in interpretation of individual anti-Müllerian hormone levels

Does AMH relate to timing of menopause? results of an individual patient data meta-analysis

Context: Anti-Mü llerian hormone (AMH)-based age at menopause predictions remain cumbersome due to predictive inaccuracy. Objective: To perform an individual patient data meta-Analysis, regarding AMH-based menopause prediction. Design: A systematic literature search was performed using PubMed, Embase, and Cochrane databases. Prospective cohort studies regarding menopause prediction using serum AMH levels were selected by consensus discussion. Individual cases were included if experiencing a regular cycle at baseline. Exclusion criteria were hormone use and gynecological surgery. Results: This meta-Analysis included 2596women, and 1077 experiencedmenopause. A multivariable Cox regression analysis assessed time to menopause using age and AMH. AMH predicted time to menopause; however, added value on top of age was poor [age alone: C-statistic, 84%; age + AMH: hazard ratio (HR), 0.66; 95% CI, 0.61 to 0.71; C-statistic, 86%). Moreover, the capacity of AMH to predict early (#45 years) and late menopause (55 years) was assessed. An added effect of AMH was demonstrated for early menopause (age alone: C-statistic 52%; age + AMH: HR, 0.33; 95%, CI 0.24 to 0.45; C-statistic, 80%). A Weibull regression model calculating individual age at menopause revealed that predictive inaccuracy remained present and increased with decreasing age atmenopause. Lastly, a check of nonproportionality of the predictive effect ofAMHdemonstrated a reduced predictive effect with increasing age. onclusion: AMH was a significant predictor of time to menopause and especially of time to early menopause. However, individual predictions of age at menopause demonstrated a limited precision, particularly when concerning early age atmenopause, making clinical application troublesome