Long-term clinical and radiological outcomes of endoscopic ultrasound-guided radiofrequency ablation of benign insulinomas.

OBJECTIVE: In recent years, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative nonsurgical treatment for pancreatic neuroendocrine tumours. The aim of our study was to assess the long-term follow-up of patients treated with EUS-RFA for a sporadic insulinoma in our centre in terms of efficacy, safety and risk of recurrence. DESIGN, PATIENTS AND MEASUREMENTS: We retrospectively analysed the data of 11 patients with an insulinoma treated by EUS-RFA in our tertiary centre between June 2018 and April 2022. Clinical and biological, as well as imaging, follow-up was planned at 3, 6, 12 months and then annually. RESULTS: In our series, there were nine women and two men with a median age of 65 years. All tumours were sporadic, with a mean size of 11 mm. The procedure allowed an immediate and complete symptomatic and biological remission in all patients without notable complications. Complete radiological resolution of the tumour after ablation was observed in seven patients, and persistence of an asymptomatic tumour residue was observed in four patients. During the mean follow-up period of 26 months, two patients presented a significant but asymptomatic increase of the tumour residue; a second EUS-RFA session was performed in one patient and the other patient is being closely monitored. CONCLUSIONS: EUS-RFA treatment of benign insulinomas provides a long-term complete clinical resolution of hypoglycaemia. A long-term follow-up is essential if residual tumour persists after initial EUS-RFA treatment.

First trimester isolated maternal hypothyroxinaemia: adverse maternal metabolic profile and impact on the obstetrical outcome.

BACKGROUND: Isolated maternal hypothyroxinaemia (IH) is defined as low maternal FT4 (<5th percentile) and normal thyroid-stimulating hormone. There is concern on its potential negative effects on the mother and offspring. OBJECTIVE: We aimed to evaluate the prevalence of IH and to assess the consequences of hypothyroxinaemia on the maternal and foetal outcomes. SUBJECTS AND METHODS: From a total of 1300 consecutive pregnant women recruited during the prenatal screen (mean gestational age, 11·8 weeks), thyroid function parameters were assessed in 879 women. After exclusion of women with T4 supplements, with twin pregnancies and with diabetes, data from 783 women were included. Maternal and neonatal outcomes in 55 selected women with IH and negative thyroid auto-antibodies without thyroid disorders or pregnancy achieved through assisted reproductive techniques were compared with a selected euthyroid control group (N = 165). RESULTS: Among the 783 non diabetic singleton pregnant women, 68 women (8·7%) were identified with IH. When compared to the selected euthyroid controls, selected women with hypothyroxinaemia had significantly increased body mass index (BMI) in preconception (P = 0·003), in the first trimester (P = 0·004) and at the time of delivery (P = 0·001). At term, foetal breech presentation and caesarean section rate were significantly higher (P = 0·006 and P = 0·026, respectively) than in the euthyroid controls. A significant increase in macrosomia was also noted (P = 0·026). CONCLUSION: The prevalence of hypothyroxinaemia in early pregnancy was of 8·7%. IH is associated with an increased maternal BMI and is related with a risk of breech presentation, a significant increase in macrosomia and caesarean sections. Screening should consider overweight as risk factor for hypothyroxinaemia.

Etomidate infusion at low doses is an effective and safe treatment for severe Cushing's syndrome outside intensive care.

INTRODUCTION: Intravenous etomidate infusion is effective to rapidly lower cortisol levels in severe Cushing's syndrome (CS) in the intensive care unit (ICU). Recently, etomidate treatment has also been proposed at lower doses in non-ICU wards, but it is not yet clear how this approach compares to ICU treatment. METHODS: We compared data from patients with severe CS treated with high starting doses of etomidate (median: 0.30 mg/kg BW/day) in ICU or with lower starting doses (median: 0.025 mg/kg BW/day) in non-ICU medical wards. RESULTS: Fourteen patients were included, among which ten were treated with low starting doses (LD) and four with high starting doses etomidate (HD). All patients had severe and complicated CS related to adrenal carcinoma (n = 8) or ectopic ACTH secretion (n = 6). Etomidate was effective in reducing cortisol levels below 500 nmol/L in a median of 1 day in the HD group compared to 3 days in the LD group (P = 0.013). However, all patients of the HD group had etomidate-induced cortisol insufficiency and needed frequent monitoring, while no patient from the LD group required hydrocortisone supplementation. No patient in either group died from complications of CS or etomidate treatment, but final outcome was poor as six patients in the LD group and all four patients in the HD group died from their cancer during follow-up. CONCLUSION: Our study suggests that, for patients with severe CS who do not require intensive organ-supporting therapy, the use of very low doses of etomidate in medical wards should be considered.