The management of immune thrombocytopenia (ITP) and the prediction of patient response to therapy still represent a significant and constant challenge in hematology. ITP is a heterogeneous disease with an unpredictable evolution. Although the pathogenesis of ITP is currently better known and its etiology has been extensively studied, up to 75% of adult patients with ITP may develop chronicity, which represents a significant burden on patients’ quality of life. A major risk of ITP is bleeding, but knowledge on the exact relationship between the degree of thrombocytopenia and bleeding symptoms, especially at a lower platelet count, is lacking. The actual management of ITP is based on immune suppression (corticosteroids and intravenous immunoglobulins), or the use of thrombopoietin receptor agonists (TPO-RAs), rituximab, or spleen tyrosine kinase (Syk) inhibitors. A better understanding of the underlying pathology has facilitated the development of a number of new targeted therapies (Bruton’s tyrosine kinase inhibitors, neonatal Fc receptors, strategies targeting B and plasma cells, strategies targeting T cells, complement inhibitors, and newer TPO-RAs for improving megakaryopoiesis), which seem to be highly effective and well tolerated and result in a significant improvement in patients’ quality of life. The disadvantage is that there is a lack of knowledge of the predictive factors of response to treatments, which would help in the development of an optimized treatment algorithm for selected patients.

Factor XI is a zymogen with an important role in the coagulation cascade. It is activated by FXII, thrombin and or it can be autoactivated. It has a prothrombotic effect after being activated by thrombin, but also through its antifibrinolytic action, stabilizing the formed clot. Hereditary deficiency of FXI causes haemophilia C - a disease manifested by an usually provoked, small to moderate mucosal bleeding. People with severe FXI deficiency have a low risk of thrombotic events. Conversely, increased FXI values have been found to be associated with increased risk of venous thromboembolism and ischemic stroke. Lowering serum FXI levels has become a treatment target for the prevention of thrombotic events. New pharmacological agents - FXI inhibitors - have been investigated in phase II clinical trials, with promising results in terms of efficacy and safety in the prevention of thrombotic events. FXI inhibitors are emerging as new anticoagulant agents with broad indication prospects beyond direct oral anticoagulants and vitamin K antagonists.

Objectives To assess the frequency of multiple thrombophilia-associated mutations and polymorphisms in a selected population of high-risk pregnancies. Methods Thrombophilia screening was performed for 1,500 pregnant women with prior pregnancy complications or thrombotic events. Nine thrombophilia-associated mutations or polymorphisms were screened: factor V Leiden, factor V H1299R, prothrombin G20210A, MTHFR C677T, MTHFR A1298C, factor XIII V34L, PAI-1 4G/5G polymorphisms, EPCR G4600A, EPCR C4678G. Results Out of the 1,500 patients, 1,291 fulfilled the criteria for data interpretation. All patients had low-risk thrombophilia-associated genetic variants. Only 1.24 % of cases presented high-risk abnormalities (homozygous factor V Leiden/prothrombin G20210A, or both mutations in heterozygous form). Heterozygous factor V Leiden occurred in 10.38 % of cases, while only 5.81 % carried heterozygous prothrombin G20210A mutation. The frequency of prothrombin G20210A mutation was higher (10.37 %) in the subgroup associating factor V Leiden, than in the subgroup lacking it (5.36 %). Low-risk genetic variants occurred with a higher frequency: 23.78 % factor V H1299R, 57.32 % MTHFR C677T, 55.54 % MTHFR A1298C, 44.07 % factor XIII V34L, 73.20 % PAI-1 4G/5G polymorphisms, 69.64 % EPCR G4600A, and 69.63 % EPCR C4678G. Conclusions All patients had at least one prothrombotic genetic mutation or variant. Our data highlight the need for thrombophilia screening, including low-risk genetic variants, in a high-risk population of pregnant women with a history of pregnancy complications or thrombotic events.

Taurine is a semi-essential, the most abundant free amino acid in the human body, with a six times higher concentration in platelets than any other amino acid. It is highly beneficial for the organism, has many therapeutic actions, and is currently approved for heart failure treatment in Japan. Taurine has been repeatedly reported to elicit an inhibitory action on platelet activation and aggregation, sustained by in vivo, ex vivo, and in vitro animal and human studies. Taurine showed effectiveness in several pathologies involving thrombotic diathesis, such as diabetes, traumatic brain injury, acute ischemic stroke, and others. As human prospective studies on thrombosis outcome are very difficult to carry out, there is an obvious need to validate existing findings, and bring new compelling data about the mechanisms underlying taurine and derivatives antiplatelet action and their antithrombotic potential. Chloramine derivatives of taurine proved a higher stability and pronounced selectivity for platelet receptors, raising the assumption that they could represent future potential antithrombotic agents. Considering that taurine and its analogues display permissible side effects, along with the need of finding new, alternative antithrombotic drugs with minimal side effects and long-term action, the potential clinical relevance of this fascinating nutrient and its derivatives requires further consideration.

Anemia is a common clinical problem in daily clinical prac­tice. Anemia could be the only expression of a sub­cli­ni­cal celiac disease. Iron deficiency is the most important back­ground of this anemia. Sometimes, iron deficiency ane­mia with no identifiable cause can be the only sign of an undiagnosed celiac disease. The pathogenic me­ch­a­nism of anemia in gluten-sensitive enteropathy deserves consideration for a proper and faster diagnosis, especially in cases with atypical presentation – iron de­fi­ciency anemia.

Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptidases play an important role in adipogenesis and angiogenesis by modifying tissues and degrading the extracellular matrix (ECM). Matrix glycoproteins, gelatin, collagens, proteoglycans and elastin are all found in the ECM. Current meta-analysis confirmed the lower levels of IL-6 and CRP was found following bariatric surgery. Several studies have shown correlations between E-selectin levels, BMI, and MMP-9 levels. There was also a strong link between the metalloproteinases MMP-2 and MMP-9. MMP-2 and adiponectin levels are related. MMP-9 levels, on the other hand, were modestly linked with E-selectin and HDL cholesterol levels, as previously stated. Also current observations imply that alterations in the ECM caused by MMP-mediated degradation may be crucial for the differentiation of adipocytes. The most crucial component of this is that MMPs are involved in the remodeling of tissue after gastric bypass surgery, as revealed by these markers (especially MMP-2 and MMP-9). Thus, it is tempting to assume that adipocyte derived MMPs may constitute a novel pharmaceutical target for limiting adipose tissue development through the reduction of adipocyte differentiation and angiogenesis. MMP-2 exhibits far more accurate oscillations than MMP-9 during pre- and post-surgical weight fluctuations, and hence may be used as a predictor for gastric bypass success. The purpose of this paper is to conduct a comprehensive review of the literature with an emphasis on the critical functions that MMPs have in the pathophysiology of obesity and the related diseases.

Chronic nandrolone decanoate exposure is associated with a modified redox status in the favor of oxidants. Paraoxonase and myeloperoxidase activities are considered sensitive biomarkers of oxidative stress and inflammation, being also predictors for coronary artery disease. The aim of our study was to investigate the impact of chronic nandrolone administration on paraoxonase and myeloperoxidase activities in Wistar rats. 16 Wistar rats were divided into two groups (n=8 for each of them): nandrolone decanoate (A) treated group and control group (C). After 12 weeks of nandrolone decanoate administration we analyzed several plasma oxidative stress parameters: TROLOX Equivalent Antioxidant Activity, paraoxonase and myeloperoxidase activities, total thiols, and advanced oxidation protein products. Our results showed a significant decreased total antioxidant activity in nandrolone treated group compared with controls, while paraoxonase activity and total thiols levels were significantly increased. Myeloperoxidase activity and advanced oxidation protein products were not significantly different between the two studied groups. In conclusion decreased plasma total antioxidant activity suggested increased oxidative stress induced by chronic high doses of nandrolone. Despite oxidative stress presence high doses of nandrolone induced also increased plasma paraoxonase activity.

Anabolic androgenic steroids (AAS), simply called “androgens”, represent the most widespread drugs used to enhance performance and appearance in a sporting environment. High-dosage and/or long-term AAS administration has been associated frequently with significant alterations in the cardiovascular system, some of these with severe endpoints. The induction of a prothrombotic state is probably the most life-threatening consequence, suggested by numerous case reports in AAS-abusing athletes, and by a considerable number of human and animal studies assessing the influence of exogenous androgens on hemostasis. Despite over fifty years of research, data regarding the thrombogenic potential of exogenous androgens are still scarce. The main reason is the limited possibility of conducting human prospective studies. However, human observational studies conducted in athletes or patients, in vitro human studies, and animal experiments have pointed out that androgens in supraphysiological doses induce enhanced platelet activity and thrombopoiesis, leading to increased platelet aggregation. If this tendency overlaps previously existing coagulation and/or fibrinolysis dysfunctions, it may lead to a thrombotic diathesis, which could explain the multitude of thromboembolic events reported in the AAS-abusing population. The influence of androgen excess on the platelet activity and fluid–coagulant balance remains a subject of debate, urging for supplementary studies in order to clarify the effects on hemostasis, and to provide new compelling evidence for their claimed thrombogenic potential.

Objective: Obesity is an exceedingly current pathology with many clinical, molecular, and psychological implications. The number of obese people has doubled in the past ten years, and we can observe an early onset of obesity. Bariatric surgery is an effective treatment for severe obesity and type 2 diabetes mellitus (T2DM); Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most prevalent types of this procedure . Nevertheless, no single mechanism has emerged that thoroughly explains the metabolic benefit and subsequent long-term effects after surgery. Webster's new collegiate dictionary defines the noun model as: 'a descriptive or analogy used to help visualize something that cannot be directly observed.' Sustained by this definition, the animal models in nutritional research are fundamental to improve human conditions. Due to the recent boost in experimental surgery, our aim in this study is to set the main technical characteristics of the gastric bypass operation and specific animal care in the metabolic surgery field we have been undertaking in our center. Materials and methods: We chose Wistar rats fed with a high caloric diet (HCD) 82g / 100 g fat, 53/100 g saturated fat, 64/100 g carbohydrates. After 7-15 weeks of this diet, depending on the protocol understudy, a consistent three-fold greater weight gain is achieved than the usual range of the free eating chow. After approximately three months on an HCD, the obese rats manifest biochemical features of the metabolic syndrome. Results: The weight loss for group B (By-pass) was 125 ± 16.16 g, and for group BS (By-pass + Sulodexid), it was 133.10 ± 14.38 g. Although the weight loss was higher in group BS, it is not statistically significantly higher than in group B (p = 0.345), despite administering a pharmacologically active substance in group BS. Although small (approximately 40-50 g), the difference between the control group and groups B and BS is statistically significant with p = 0.016 and 0.026 and Pearson index of 0.674 and 0.628, respectively. Statistical significance also kept the difference between group C and group S (p = 0.028, Pearson Coefficient = 0.621). Conclusions: First of all, Metabolic surgery is the most effective weight-loss method and improvement or even remission of some diseases associated with obesity. Like today's high-calorie diet, the diet administered, mostly of adolescents, generates both obesity and its associated diseases: diabetes, hypertriglyceridemia, hypercholesterolism, thus increasing mortality and overall morbidity. Second, metabolic surgery radically improves the parameters targeting obesity (weight,% EBWL) and its associated conditions: diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, strongly associated with decreasing life expectancy of the general population. Parameters targeted by gastric bypass: glycemia, TGL, CHO, hepatic steatosis, testicular atrophy registering significant improvements.

Melatonin is an indoleamine produced by the pineal gland and secreted in a circadian manner. In the past few decades, research into melatonin has increased. Melatonin has many important roles in human physiology: regulator of circadian rhythms, sleep inducer, antioxidant, and anticarcinogenic. The pineal gland develops completely after birth, so both the embryo and fetus are dependent on the maternal melatonin provided trans placentally. Melatonin receptors are widespread in the embryo and fetus since early stages. There is solid evidence that melatonin is neuroprotective and has a positive effect on the outcome of compromised pregnancies. Also, chrono disruption leads to reproductive dysfunction. Thus the influence of melatonin on the developing human fetus may not be limited to entertaining circadian rhythmicity, but further studies are needed.

Matrix metalloproteinases (MMPs) are enzymes involved in the modulation of extracellular matrix (ECM) and adipocytes and preadipocyte differentiation. The pathophysiology of obesity has characterized by many cellular and molecular processes such as inflammatory processes, macrophage infiltration of adipose tissue, and remodeling of ECM via MMP. The purpose of the study was to determine if we can consider MMPs as a marker of effectiveness in bariatric surgery and if sulodexide administration pre- and postoperative has a benefit in terms of tissue remodeling of weight loss. An experimental study has performed using 40 obese Wistar rats (10 rats in the control group and 30 obese rats in study groups). Those in the study group were divided into three groups and underwent gastric bypass (B group), sulodexide administration (S group), gastric bypass, and sulodexide administration (BS group). Sulodexide was administered because of its antithrombotic effect in the procoagulant status of obese subjects. The pre- and postoperative weight, glucose level, cholesterol, triglycerides, MMP-2, and MMP-9 were analyzed. We compared the results to see if bariatric surgery modifies the MMPs status and if there is a correlation between the weight loss and the other parameters and also if sulodexide has any contribution to the results. The MMP-2 and MMP-9 activities were detectable, but MMP-2 was significantly higher than MMP-9. MMP-2 correlates with body weight parameters before surgery and after surgery, after significant bodyweight reduction as a result of bariatric surgery (r = 0.478,p = 0.017). There is a strong correlation between the weight loss, glucose level, and cholesterol and the values of MMP-2 (r = 0.92,p = 0.022, respectively,r = 0.759,p = 0.033). MMP-9 is correlated with weight loss and triglycerides level. But it was not as sensitive as MMP-2. Sulodexide administration in group S had a positive influence on the MMP-2 and MMP-9 compared with the values of groups B and C but without statistical significance. MMP-2 and MMP-9 are the two most important ECM enzymes involved in adipose tissue remodeling after bariatric surgery. The correlations between cholesterol, triglycerides, glucose, weight loss, excess weight, and body mass index (BMI) parameters and MMPs level demonstrate the direct relationship of these enzymes in obesity. Although we believe that more in-depth studies are required, MMPs may be considered a marker of the effectiveness of bariatric surgery.

Capsaicin is a widespread spice known for its analgesic qualities. Although a comprehensive body of evidence suggests pleiotropic benefits of capsaicin, including anti-inflammatory, antioxidant, anti-proliferative, metabolic, or cardioprotective effects, it is frequently avoided due to reported digestive side-effects. As the gut bacterial profile is strongly linked to diet and capsaicin displays modulatory effects on gut microbiota, a new hypothesis has recently emerged about its possible applicability against widespread pathologies, such as metabolic and inflammatory diseases. The present review explores the capsaicin–microbiota crosstalk and capsaicin effect on dysbiosis, and illustrates the intimate mechanisms that underlie its action in preventing the onset or development of pathologies like obesity, diabetes, or inflammatory bowel diseases. A possible antimicrobial property of capsaicin, mediated by the beneficial alteration of microbiota, is also discussed. However, as data are coming mostly from experimental models, caution is needed in translating these findings to humans.

Purpose – Combined airway burns with cutaneous burns is a further negative prognostic factor in burn patients. In this study we tried to identify the most relevant negative prognostic factors at admission in a relatively homogeneous population. Methods – In this study, ten young patients who suffered from skin and airway burns following a fire in a club, admitted to our ICU department, were included. At the intake, ABSI and APACHE II scores were calculated, and a series of biomarkers were also collected. The correlation and associations between gravity scores and biomarkers was then calculated using the Spearman correlation and Chi square tests. Results – Based on data analysis, we found very high values of ABSI 8.9 ± 1.4 and APACHE II 25.4 ± 2.79 scores, procalcitonin (46.16 ± 68.18 ng/ml), white blood cells (41.26 ± 15.66 × 103/mm3), hematocrit (51.6 ± 7.31 %), and low corrected albumin values (22.08 ± 4.66 g/l). The statistical analysis revealed a good correlation between gravity scores and values of PCT and low albumin levels (p< 0.05). The mortality was also associated with the need for vasopressor support from the beginning (p < 0.05). Conclusions – Adverse prognostic factors that we have identified in this group of young patients with skin burns and airway include: increased values of the severity scores and PCT, low values of corrected albumin and vasopressor support necessary at admission.

Background and Objectives: Anabolic androgenic steroids (AAS), used as a therapy in various diseases and abused in sports, are atherogenic in supraphysiological administration, altering the plasma lipid profile. Taurine, a conditionally-essential amino acid often used in dietary supplements, was acknowledged to delay the onset and progression of atherogenesis, and to mitigate hyperlipidemia. The aim of the present study was to verify if taurine could prevent the alterations induced by concomitant chronic administration of high doses of AAS nandrolone decanoate (DECA) in rats. Materials and Methods: Thirty-two male Wistar rats, assigned to 4 equal groups, were treated for 12 weeks either with DECA (A group), taurine (T group), both DECA and taurine (AT group) or vehicle (C group). Plasma triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hepatic triglycerides (TGh) and liver non-esterified fatty acids (NEFA) were then determined. Results: DECA elevated TG level in A group vs. control (p = 0.01), an increase prevented by taurine association in AT group (p = 0.04). DECA decreased HDL-C in A group vs. control (p = 0.02), while taurine tended to increase it in AT group. DECA decreased TGh (p = 0.02) in A group vs. control. Taurine decreased TGh in T (p = 0.004) and AT (p < 0.001) groups vs. control and tended to lower NEFA (p = 0.08) in AT group vs. A group. Neither DECA, nor taurine influenced TC and LDL-C levels. Conclusions: Taurine partially prevented the occurrence of DECA negative effects on lipid profile, suggesting a therapeutic potential in several conditions associated with chronic high levels of plasma androgens, such as endocrine disorders or AAS-abuse.

Obesity involves the growth of adipose tissue cells (adipocytes and preadipocytes), as well as microvascular endothelial cells. Matrix metalloproteinases (MMPs) are relevant ezymes for the modulation of extracellular matrix (ECM) and adipocyte and preadipocytes differentiation. They are elevated in obese patients, generating abnormal ECM metabolism.[1]. This article proposes a thorough study of literature with focus on the important roles of matrix metalloproteinases in the pathophysiology of obesity. The article represents a narrative review based on an English-language PubMed research of the medical literature regardind important aspects of the proposed aim. MMP-2 activity was signiucantly higher than MMP-9, both activities were detectable. MMP-9 was strongly correlated with body weight parameters before surgery, as well as after significant body weight reduction as a result of bariatric surgery. Concerning MMP-2 and MMP-9 they are also involved in the turnover of basement membranes both those of adipose tissue and endothelial. MMP-9 levels were moderately correlated with HDL cholesterol levels. Taken together, the present data suggest that changes in ECM through MMP-mediated degradation might play a critical role in the adipocyte differentiation process. These findings are detected both in clinical trials and in laboratory animal experiments. It is then tempting to speculate that the adipocyte-derived MMPs might represent a new pharmacological target for the inhibition of adipose tissue growth by inhibiting adipose differentiation as well as angiogenic process.

BACKGROUND AND AIMS:The purpose of this study is to assess the frontal and parietal ECoG spectrum (gamma range) changes during isoflurane and combined xenon-isoflurane anaesthesia in rats.METHODS:Experiments were carried out on four adult male Sprague-Dawley rats (250-300 g). The anaesthesia was induced with isoflurane and maintained with isoflurane and a xenon-isoflurane mixture. The rats were maintained at two different anaesthetic depths: light (isoflurane anaesthesia) and deep (isoflurane and xenon-isoflurane anaesthesia). The frontal and the parietal cortical activity was assessed by computing the median frequency, spectral edge frequency and functional connectivity between these two areas during light and deep anaesthesia.RESULTS:We noticed a decrease in cortical connectivity under deep isoflurane anaesthesia and an increase in connectivity under deep xenon-isoflurane anaesthesia. Moreover, during xenon-isoflurane anaesthesia, a trend of regularity of electro-cortical activity was present compared with isoflurane anaesthesia.CONCLUSIONS:Xenon-isoflurane deep anaesthesia demonstrated a series of specific ECoG features regarding frontoparietal functional connectivity (gamma range connectivity increase) and regularity of the electrocortical activity compared with isoflurane anaesthesia.

Obesity is a current pathology with many clinical, molecular, and psychological implications. The number of obese people has doubled in the past 10 years and we can observe an early onset of obesity. We have used a modified BAROS and SF36TM questionnaire to conduct a descriptive study on 34 obese patients undergoing surgery for obesity—laparoscopic sleeve gastrectomy (LSG). The inclusion criteria were the embodiment of surgery for obesity: BMI (body mass index) >40 kg/m2 or BMI > 35 kg/m2 and associated comorbidities. The postoperative BMI was 25.7670 ± 3.74759 kg/m2 (mean ± SD). The average number of lost kilograms was 38.74 ± 12.526 (mean ± SD), and the average percentage of excess body weight loss (% EBWL) was 85.9952 ± 22.69028% (mean ± SD). Patients lost an average of 36.88–38.56 kg at 6–12 months after surgery, and they reach a % EBWL of 94.69 ± 30.02% and a normal BMI of 23.96 kg/m2 at 18 months postoperatively. All patients significantly reduced the amount of food eaten after surgery. More than 2 years after the surgery, patients increased their food intake by about 30%, but maintained their weight loss and a normal BMI. Related to quality of life, 77.78% of patients declared a vast improvement, 11% a good quality of life, and only 3.7% said that the quality of life is worse than before the surgery. Also, a relationship between quality of life and the improvement of sexual life, or with the increased frequency of physical exercise has been observed. Improving quality of life is directly related with the weight loss, with %EBWL, and with the postoperative BMI. Bariatric surgery should be understood in all the positive changes that it generates in everyday life.

Capsaicin induces a localized inflammatory process known as neurogenic inflammation upon its topical administration on the skin, due to the release of various neuropeptides from the cutaneous sensory nerve endings. In this study, we investigated real-time skin blood flow changes that occur in neurogenic inflammation induced by topical capsaicin by means of in vivo reflectance confocal microscopy. 27 healthy subjects (15 women and 12 men, mean age ± Standard Deviation: 22.62±4.47) were administered topical capsaicin solution (Capsaicin group) or immersion oil (Control group) on the dorsal side of their non-dominant hand. At different time intervals during administration (0, 10, 25, and 40 minutes), cutaneous blood flow was evaluated using reflectance confocal microscopy and compared between the two groups. Blood flow values were higher during topical capsaicin, with significant increase after 25 (P=0.0160, Dunn's multiple comparisons test) and 40 minutes (P=0.0132, Dunn's multiple comparisons test) after its administration when compared with the initial 0 min value. Furthermore, the differences in the blood flow changes between the two groups were significant at 25 min (P=0.0182, Dunn's multiple comparisons test) and 40 min (P=0.0296, Dunn's multiple comparisons test) after capsaicin administration. Reflectance confocal microscopy allows in vivo, real-time evaluation of cutaneous blood flow changes within the capsaicin-induced inflammation, and this method might serve as a research model to test neurovascular reactivity.

Supraphysiological administration of anabolic androgenic steroids has been linked to increased blood pressure. The widely distributed amino acid taurine seems to be an effective depressor agent in drug-induced hypertension. The purpose of this study was to assess the impact of chronic high dose administration of nandrolone decanoate (DECA) and taurine on blood pressure in rats and to verify the potentially involved mechanisms. The study was conducted in 4 groups of 8 adult male Wistar rats, aged 14 weeks, treated for 12 weeks with: DECA (A group); vehicle (C group); taurine (T group), or with both drugs (AT group). Systolic blood pressure (SBP) was measured at the beginning of the study (SBP1), 2 (SBP2) and 3 months (SBP3) later. Plasma angiotensin-converting enzyme (ACE) activity and plasma end products of nitric oxide metabolism (NOx) were also determined. SBP3 and SBP2 were significantly increased compared to SBP1 only in the A group (P<0.002 for both). SBP2, SBP3 and ACE activity showed a statistically significant increase in the A vs C (P<0.005), andvs AT groups (P<0.05), while NOx was significantly decreased in the A and AT groups vs controls (P=0.01). ACE activity was strongly correlated with SBP3 in the A group (r=0.71, P=0.04). These findings suggest that oral supplementation of taurine may prevent the increase in SBP induced by DECA, an effect potentially mediated by angiotensin-converting enzyme.

INTRODUCTION:Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, which can derive from either parasympathetic or sympathetic paraganglia and are closely related to pheochromocytomas.CASE REPORT:We present the case of a young male patient of 37 years old, who was admitted for hypertensive crisis and palpitations. His medical history included medically controlled type 2 diabetes mellitus, (diagnosed 10 months ago), Hepatitis A. Hormonal evaluation revealed elevated urinary metanephrines and normetanephrines, with mainly increased normetanephrines (2330 ug/24 h). Plasmatic metanephrins were in normal range, but levels of plasmatic normetanephrins were elevated (952 pg/ml). The assessment of pituitary and aldosterone-renin axis values were within normal limits. Abdominal computed tomography showed left adrenal nodular lesion on the external arm, bilobulated, size 32/33 mm with maximum axial and cranio-caudal diameter of approx. 45 cm, suggestive of a benign lesion, keeping the cleavage plane to vecinatate structures. Left adrenalectomy was performed by laparoscopic approach. We mention that immediately after induction of anesthesia were recorded blood pressures of 298/143 mmHg. Histopathologic and immunohistochemical examination diagnose paraganglioma, without invasion of adjacent tissues. The patient evolution was favorable, with the remission of the symptoms and normalization of hormonal markers. It is imperative to note the remission of diabetes in the postoperative period.DISCUSSION:This is the case of a young patient with functional retroperitoneal paraganglioma, who presented with symptoms of pheochromocytoma. Compared to pheochromocytomas, paragangliomas are rarely symptomatic and functional. Association with diabetes is even more rare. Specialized investigations allowed the proper diagnosis and the therapeutic approach above was the result of a multidisciplinary cooperation.